bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiopatia e gravidez
Authors: Testa Carolina Burgarelli , Borges Vera Therezinha Medeiros , Bortolotto Maria Rita De Figueiredo Lemos
Published: June 2018

A assistência às pacientes cardiopatas passou por enormes avanços nas últimas décadas. Apesar da queda morbidade, a gravidez nesse grupo representa importante causa de mortalidade materna e de pior prognóstico fetal, mesmo em países desenvolvidos. O acompanhamento obstétrico dessas pacientes precisa ser individualizado conforme a estratificação de risco materno. Há poucos ensaios clínicos randomizados, sendo que a maior parte das condutas é baseada em estudos retrospectivos.Neste artigo realizamos uma revisão de literatura para embasar as melhores práticas na assistência multidisciplinar durante o ciclo gravídico puerperal das pacientes portadoras de cardiopatia.
Cuidados paliativos em medicina fetal
Authors: Bolibio Renata , Jesus Roberta Carolina De Almeida , Oliveira Fernanda Figueiredo de , Gibelli Maria Augusta Bento Cicaroni , Benute Glaucia Rosana Guerra , Gomes Ana Lucia , Nascimento Nathalia Bertolassi Oliveira do , Barbosa Tercilia Virginia Aparecida , Zugaib Marcelo , Francisco Rossana Pulcineli Vieira , Bernardes Lisandra Stein
Published: June 2018

Malformações fetais acometem cerca de 3% das gestações, e a possibilidade desse diagnóstico é uma das principais preocupações vivenciadas pelos pais e familiares. Quando é diagnosticado uma malformação que implique em possível mortalidade da criança, é necessário o planejamento do seguimento da gestação, o que abrange diversos aspectos que incluem avaliação minuciosa do prognóstico, organização do cuidado após o parto, e seguimento da família de forma abrangente e integrada. Recentemente os conceitos de cuidados paliativos foram introduzidos na perinatologia com essa finalidade, e o presente artigo tem como objetivo discutir o modelo de cuidado paliativo aplicado no atendimento a gestantes e familiares de fetos com malformação.
Formação Moral e Ética nos Cursos de Graduação
Authors: Rodrigues Caio César Coelho , Camargo Ricardo Leite
Published: June 2018

Baseado nos conceitos de La Taille (2006) em que a ética contempla a moral, mas também envolve o projeto de vida e a trajetória profissional, o presente estudo buscou analisar as reflexões sobre o sucesso profissional dentro de um curso de graduação em Administração. Investigando o projeto de vida, as concepções da universidade sobre o sucesso profissional e seus desdobramentos, descobriu-se que os alunos podem ou não incluir a preocupação com o outro na sua visão de sucesso profissional, mas eles entendem a necessidade de um esforço tanto da instituição como do corpo discente para realizar essa discussão no âmbito universitário.
Temporal Trends in the Outcomes of Dialysis Patients Admitted With Acute Ischemic Stroke
Authors: Alqahtani Fahad , Berzingi Chalak O. , Aljohani Sami , Al Hajji Mohamed , Diab Anas , Alvi Muhammad , Boobes Khaled , Alkhouli Mohamad
Published: June 2018

Background

There is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke (
AIS
) in patients on maintenance dialysis.

Methods and Results

We used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of
AIS
in dialysis patients. A total of 930 010 patients were admitted with
AIS
between 2003 and 2014, of whom 13 642 (1.5%) were on dialysis. Overall, the incidence of
AIS
among dialysis patients decreased significantly (
P
trend
<0.001), while it remained stable in non‐dialysis patients (
P
trend
=0.78). Compared with non‐dialysis patients, those on dialysis were younger (67±13 years versus 71±15 years,
P
<0.001), and had higher prevalence of major comorbidities. Black patients constituted 35.2% of dialysis patients admitted with
AIS
compared with 16.7% of patients in the non‐dialysis group (
P
<0.001). After propensity score matching, in‐hospital mortality was higher in the dialysis group (7.6% versus 5.2%,
P
<0.001), but this mortality gap narrowed overtime (
P
trend
<0.001). Hemorrhagic conversion and gastrointestinal bleeding rates were similar, but blood transfusion was more common in the dialysis group. Rates of severe disability surrogates (tracheostomy, gastrostomy, mechanical ventilation and non‐home discharge) were also similar in both groups. However, dialysis patients had longer hospitalizations, and accrued a 25% higher total cost of acute care.

Conclusions

Dialysis patients have 8‐folds higher incidence of
AIS
compared withnon‐dialysis patients. They also have higher risk‐adjusted in‐hospital mortality, sepsis and blood transfusion, longer hospitalizations, and higher cost. There is a need to identify preventative strategies to reduce the risk of
AIS
in the dialysis population.
The Inefficacy of Strong Ties Networks in Migration Employment Outcomes
Authors: Absuelo Ruby , Hancock Peter
Published: June 2018

We examined Philippine graduates’ use of social networks to obtain initial employment in the United States labour market. Our research focused on employment opportunities and found that Philippine graduates’ usage of Strong Ties networks contributed to underemployment. Reliance on Strong Ties networking decreased respondents’ broader range of US employment opportunities and further impeded their prospects of upward employment mobility. While the Philippine graduates’ Strong Ties networking provided assistance and most specifically acted as intermediaries for gaining their initial employment, this type of networking had a significant impact resulting in poor labour market outcomes and rather imperfect long-term employment opportunities. Moreover, we found that, in conjunction with the use of Strong Ties, key variables, such as low-demand degree fields, lower educational attainment, lesser proficiency in English and green card status, were also strongly associated with poor employment outcomes.
Taxonomy and phylogeny of Nitella (Charophyceae, Characeae) from Brazil with emphasis on the midwest and southeast regions
Authors: BORGES FABIO RENATO , NECCHI JR ORLANDO
Published: June 2018

The genus Nitella is the most species-rich within the Charales. Brazilian studies on the genus are relatively scarce and consist of floristic surveys, lacking modern and more precise information. This investigation applied scanning electron microscopy to analyze the oospore wall and molecular data associated with traditional morphological characters to analyze forty-two populations of Nitella from the midwest and southeast regions of Brazil. Forty-two new sequences of rbcL, twelve of ITS1 and twenty-three of ITS2 were generated for the five species recognized in this study: Nitella acuminata A. Braun ex Wallman, Nitella axillaris A. Braun, Nitella elegans B. P. Pal, Nitella flagellifera J. Groves & G. O. Allen and Nitella microcarpa A. Braun.. Phylogenetic analyses of sequences of these three markers were congruent in that they grouped our species with others from different countries to form five clades. Our results on ultrastrucure of the oospore wall were consistent with previous studies for the same species from other regions of the world. The data reinforced the conclusion that the use of ornamentation of oospore wall may be extremely useful for the construction of a natural system for Characeae at section level. Molecular evidence, reinforced by morphological data, for the Brazilian material analyzed suggests that Nitella subglomerata A. Braun and Nitella gollmeriana A. Braun could be synonymys of Nitella acuminata; and Nitella axilliformis K. Imahori appears to be the same as Nitella axillaris. However, no formal proposition was made considering that type specimens were not analyzed and these observations were based on a relatively small number of samples strictly from Brazil. We showed that even among geographically distant populations, such as from other continents, of some Nitella species, the degree of identity among DNA sequences was high.
Elevational size variation and two new species of torrent frogs from Peninsular Malaysia (Anura: Ranidae: Amolops Cope)
Authors: ONN CHAN KIN , ABRAHAM ROBIN KURIAN , GRISMER JESSE L. , GRISMER L. LEE
Published: June 2018

Previously, only one species of torrent frog (Amolops larutensis) was thought to occur throughout Peninsular Malaysia. However, genomic work has demonstrated that populations from eastern Peninsular Malaysia form two separate lineages that are genetically distinct from A. larutensis that is now restricted to the western half of Peninsular Malaysia. This study demonstrates that all three lineages can be morphologically distinguished from each other, thereby providing additional support for the recognition of the eastern lineages as two distinct species. These lineages are described herein as Amolops gerutu sp. nov. from the eastern states of Kelantan, Terengganu, and Pahang, and A. australis sp. nov. from the southern-most state of Johor. In general, these two new species form a clade that is sister to A. larutensis and can be readily distinguished from it by having: (1) considerably denser and more pronounced dorsal tubercles, and (2) the posterodorsal surface of thighs having dense, dark stippling as opposed to broad vermiculations. Although differences in other morphometric characters were detected, their utility as diagnostic characters should be applied with caution due to the large intraspecific variation that overlaps among different species in many of the characters we measured. As such, we advocate for the use of tuberculation and pattern of the posterodorsal portion of the thighs as primary diagnostic characters. These characters can readily distinguish A. larutensis from the two new species. To differentiate A. australis sp. nov. from A. gerutu sp. nov. and A. larutensis, body size can be a good diagnostic character as A. australis sp. nov. is significantly smaller in both males (mean = 31.04 ± 1.59 mm) and females (mean = 46.48 ± 3.2 mm). Additionally, we show a strong positive correlation between body size and elevation, with populations from montane forests (>900 m asl) being considerably larger than populations at lower elevations.
Immigrants’ Economic Assimilation: Evidence from Longitudinal Earnings Records
Authors: Villarreal Andrés , Tamborini Christopher R.
Published: June 2018

We examine immigrants’ earnings trajectories and measure the extent and speed with which they are able to reduce the earnings gap with natives, using a dataset that links respondents of the Survey of Income and Program Participation (SIPP) to their longitudinal earnings obtained from individual tax records. Our analysis addresses key debates regarding ethnoracial and cohort differences in immigrants’ earnings trajectories. First, we find a racially differentiated pattern of earnings assimilation: black and Hispanic immigrants are less able to catch up with native whites’ earnings compared to white and Asian immigrants, but they are almost able to reach earnings parity with natives of their same race and ethnicity. Second, we find no evidence of a declining “quality” of immigrant cohorts even after controlling for their ethnoracial composition and human capital. Immigrants arriving since 1994 actually experience similar or slightly higher earnings growth compared to immigrants from earlier eras. We identify a pattern of accelerated assimilation in which more educated immigrants experience much of their earnings growth during the first years after arriving.
CAD/CAM Ceramic Restorative Materials for Natural Teeth
Authors: Spitznagel F.A. , Boldt J. , Gierthmuehlen P.C.
Published: June 2018

Advances in computer-aided design (CAD) / computer-aided manufacturing (CAM) technologies and their ease of application enabled the development of novel treatment concepts for modern prosthodontics. This recent paradigm shift in fixed prosthodontics from traditional to minimally invasive treatment approaches is evidenced by the clinical long-term success of bonded CAD/CAM glass-ceramic restorations. Today, defect-oriented restorations, such as inlays, onlays, and posterior crowns, are predominately fabricated from glass-ceramics in monolithic application. The variety of CAD/CAM ceramic restorative systems is constantly evolving to meet the increased demands for highly aesthetic, biocompatible, and long-lasting restorations. Recently introduced polymer-infiltrated ceramic network CAD/CAM blocks add innovative treatment options in CAD/CAM chairside 1-visit restorations. The material-specific high-edge stability enables the CAD/CAM machinability of thin restoration margins. Full-contour zirconia restorations are constantly gaining market share at the expense of bilayered systems. Advancements in material science and bonding protocols foster the development of novel material combinations or fabrication techniques of proven high-strength zirconia ceramics. CAD/CAM applications offer a standardized manufacturing process resulting in a reliable, predictable, and economic workflow for individual and complex teeth-supported restorations. More evidence from long-term clinical studies is needed to verify the clinical performance of monolithic polymer-infiltrated ceramic network and zirconia teeth-supported minimally invasive and extensive restorations.
A License to Be Crazy
Authors: Putnam Louisa
Published: June 2018

The author’s multivoiced perspectives as mother, holistic practitioner, therapist, and social justice activist will address and question some of her and others’ assumptions, beliefs, mistakes, and social constructions around madness. Rather than coming to a conclusive “answer” to the question “What is psychosis if it is not what the bio medical model of psychiatry says it is,” the author cautiously offers her gleanings and queries. These few bare questionable and questioning bones rattle to tell more of their story.
Extractive Capital, Imperialism, and the Colombian State
Authors: Sankey Kyla
Published: June 2018

Since the turn of the century, Colombia has become increasingly dependent on mining exports to drive economic growth. While the surge in mining investments in Colombia and the problems associated with this form of economic development have received much attention from scholars and policy analysts, the common explanation is that the state has been undermined or eroded by emergent global forces. However, nation-states should be seen not as victims but as authors and enforcers of new processes of capital accumulation. The Colombian state has acted as the principal guarantor of the political and territorial conditions necessary for this form of extractive capitalism by reconstituting property and contract laws, signing free-trade agreements, reconfiguring the internal state apparatus. and expanding military forces.

Desde el principio del siglo, Colombia se ha vuelto cada vez más dependiente de las exportaciones mineras para impulsar el crecimiento económico. Si bien el aumento de las inversiones mineras en Colombia y los problemas asociados con esta forma de desarrollo económico han recibido mucha atención por parte de académicos y analistas de políticas, la explicación común es que el estado ha sido socavado o erosionado por las fuerzas globales emergentes. Sin embargo, los Estados-nación deberían ser vistos no como víctimas sino como autores y ejecutores de nuevos procesos de acumulación de capital. El estado colombiano ha actuado como el principal garante de las condiciones políticas y territoriales necesarias para esta forma de capitalismo extractivo mediante la reconstitución de las leyes de propiedad y contratos, la firma de acuerdos de libre comercio, la reconfiguración del aparato estatal interno, y la expansión de fuerzas militares.
Mass Migration from Rural India: A Restudy of Kunkeri Village in Konkan, Maharashtra, 1961–1987–2017
Authors: Vartak Kalyani , Tumbe Chinmay , Bhide Amita
Published: June 2018

This article examines a particular village—Kunkeri—in Konkan, Maharashtra, characterized by persistent mass outmigration for over five decades, by combining a field study in 2017 with detailed ethnographic and statistical baseline data collected by the Census of India in 1961 and 1987. It documents the increase in outmigration rates, catch-up in outmigration intensities by the lowest castes to those of the upper castes, diversification of household migration strategies and outmigrants’ occupations, the lessening of single-male migration strategies, the presence of a diasporic association and the growing significance of commuting and migration for education. Yet, despite mass outmigration and a general rise in the standard of living across castes, we observe strong continuity in the distribution of castes and land ownership structures within Kunkeri. These findings point to both the transformative and status-quo preserving features of persistent mass migration from rural India.

JEL: O15, J61, N35
New channels, new ways of becoming informed? Examining the acquisition of public affairs knowledge by young people in China
Authors: Di Cui , Fang Wu
Published: June 2018

People always rely on a specific media environment to acquire knowledge about public affairs. This pilot study investigates gain of public affairs knowledge as an effect of media use and interpersonal discussion in China. Based on a contextual understanding of China’s press system, this study explores the mainstream and alternative forms of public affairs knowledge and the ways they are linked with use of new media (i.e., web news and social media) and traditional media (i.e., newspaper and television). An analysis of survey data first shows that television news and web news have direct positive effects on mainstream knowledge, and only web news directly contributes to alternative knowledge. Second, news from newspapers, television, the web and social media have indirect effects on both mainstream and alternative forms of public affairs knowledge through elaboration and interpersonal discussion. Third, elaboration is only associated with alternative knowledge, whereas interpersonal discussion is associated with both mainstream and alternative knowledge. Theoretical and practical implications of the findings are discussed.
Process Dissociation Procedure Improves Assessment of Motor Imagery Ability Using Implicit Sequence Learning
Authors: Solomon Jack P. , Kraeutner Sarah N. , Boe Shaun G.
Published: June 2018

For motor imagery (MI) to be effective for motor learning and rehabilitation, one must be able to perform it. The covert nature of MI makes it difficult to objectively assess MI ability. Assessment of MI ability is particularly pertinent in clinical populations, where brain damage can preclude the ability to perform it. To aid assessment of MI ability, we developed MiScreen, a mobile application that uses MI-based training through which individuals implicitly learn. The logic behind MiScreen is that if an individual can learn via MI, they must be able to perform it. Here we apply process dissociation procedure (PDP) to the data resulting from the MI-based training underlying MiScreen to address the limitations of MiScreen that reduce its applicability. Our results show that the use of PDP increases the number of users for which MiScreen would be applicable, demonstrating added value. Incongruence between PDP and current analysis procedures highlights the need for future work to identify the optimal analysis that best represents MI-based learning, and thus MI ability.
Intra-Abdominal Hypertension is a Risk Factor for Increased VAP Incidence: A Prospective Cohort Study in the ICU of a Tertiary Hospital
Authors: Papakrivou Eleni , Makris Demosthenes , Manoulakas Efstratios , Karvouniaris Marios , Zakynthinos Epaminondas
Published: June 2018

Background:

Ventilator-associated pneumonia (VAP) might be increased in cases with intra-abdominal hypertension (IAH). However, despite animal experimentation and physiological studies on humans in favor of this hypothesis, there is no definitive clinical data that IAH is associated with VAP. We therefore aimed to study whether IAH is a risk factor for increased incidence of VAP in critical care patients. This 1-center prospective observational cohort study was conducted in the intensive care unit of the University Hospital of Larissa, Greece, during 2013 to 2015. Consecutive patients were recruited if they presented risk factors for IAH at admission and were evaluated systematically for IAH and VAP for a 28-day period.

Results:

Forty-five (36.6%) of 123 patients presented IAH and 45 (36.6%) presented VAP; 24 patients presented VAP following IAH. Cox regression analysis showed that VAP was independently associated with IAH (1.06 [1.01-1.11]; P = .053), while there was an indication for an independent association between VAP and abdominal surgery (1.62 [0.87-3.03]; P = .11] and chronic obstructive pulmonary disease (1.79 [0.96-3.37]; P = .06).

Conclusions:

Intra-abdominal hypertension is an independent risk factor for increased VAP incidence in critically ill patients who present risk factors for IAH at admission to the ICU.
On thermomechanical behaviors of the functional graded shape memory alloy composite for jet engine chevron
Authors: Liu Bingfei , Wang Qingfei , Hu Shilong , Zhang Wei , Du Chunzhi
Published: June 2018

This study presents a theoretical work for a novel adaptive jet engine chevron concept based upon embedding the functionally graded shape memory alloy actuators in a composite laminate, termed a functionally graded shape memory alloy actuator composite. The constitutive models of the functionally graded shape memory alloy actuator composites including the monolayer shape memory alloy composites and multilayer shape memory alloy composites with different volume fractions of the shape memory alloy were first given. An example using such models was discussed on a published finite element work on a shape memory alloy hybrid composite jet engine chevron concept to prove the validity of the theoretical work. The thermomechanical behaviors of the functionally graded shape memory alloy actuator composite with different volume fractions of the shape memory alloy subjected to the thermal loading were then discussed using the obtained constitutive model. The tip deflections of the jet engine chevron with different embedding patterns of the shape memory alloy were finally obtained.
Visual Inquiry: Exploring Embodied Organizational Practices by Collaborative Film-Elicitation
Authors: Skjælaaen Gudrun R. , Bygdås Arne Lindseth , Hagen Aina Landsverk
Published: June 2018

Analysis of visual data is underdeveloped in visual research, and this article gives a methodological contribution on how to perform collaborative video research on organizational practices, combining ethnographic methods and intervention through film-elicitation. We provide guidance for how to (a) collect ethnographic data with (and without) camera, (b) make preparations for film-elicitation, and (c) facilitate collaborative sensemaking with participants. Building on an enactive approach, we argue that film-elicitation based on a preliminary visual analysis and categorization conducted by researchers reenacts the immediacy and vitality of lived experience. This is done through enabling organizational members to create communicative constructs of the culturally embedded, inarticulate, and embodied aspects of social conduct. As such, we argue that video research is a powerful means for process-oriented theories concerned with capturing the multiplicity of organizational practices.
Encountering #Feminism on Twitter: Reflections on a Research Collaboration between Social Scientists and Computer Scientists
Authors: Kirkwood Steve , Cree Viviene , Winterstein Daniel , Nuttgens Alex , Sneddon Jenni
Published: June 2018

The growth of social media presents an unparalleled opportunity for the study of social change. However, the speed and scale of this growth presents challenges for social scientists, particularly those whose methodologies tend to rely on the qualitative analysis of data that are gathered firsthand. Alongside the growth of social media, companies have emerged which have developed tools for interrogating ‘big data’, although often unconnected from social scientists. It is self-evident that collaboration between social scientists and social media analysis companies offers the potential for developing methods for analysing social change on large scales, bringing together their respective expertise in technological innovations and knowledge of social science. What is less well known is how such a partnership might work in practice. This article presents an example of such a collaboration, highlighting the opportunities and challenges that arose in the context of an exploration of feminism on Twitter. As will be shown, machine-learning technologies allow the analysis of data on a scale that would be impossible for human analysts, yet such approaches also heighten challenges regarding the study of social change and communication.
Is Muscle MELD a More Promising Predictor for Mortality After Living Donor Liver Transplantation?
Authors: Badawy Amr , Kaido Toshimi , Hamaguchi Yuhei , Anazawa Takayuki , Yagi Shintaro , Fukumitsu Ken , Kamo Naoko , Okajima Hideaki , Uemoto Shinji
Published: June 2018

Background:

To improve the outcome of living donor liver transplantation (LDLT), a scoring system that could predict accurately the patient and graft survival posttransplant is necessary. The aim of this study is to evaluate our previously proposed Muscle-model for end-stage liver disease (M-MELD) score and to compare it with the other available scores to find the best system that correlates with postoperative outcome after liver transplant.

Methods:

We retrospectively reviewed the data of 199 patients who underwent LDLT from January 2010 to July 2016 and calculated the preoperative MELD, MELD Na, the product of donor age and MELD (D-MELD), M-MELD, integrated MELD, and the balance of risk (BAR) score in all patients. The area under the receiver operating characteristics curves (AUCs) of each score was computed and compared at 3-, 6-months, and 1-year after LDLT.

Results:

The M-MELD, D-MELD, and integrated MELD had a good discriminative performance in predicting 3-month mortality after LDLT with AUCs > 0.7, while the M-MELD was the only score that showed a good discriminative performance in predicting 6-month and 1-year mortality after LDLT with AUCs > 0.7.

Conclusion:

Muscle-MELD score is a simple and useful predictor of patient survival after LDLT which showed a better predictive performance than other available scores.
Advancing Health Equity With Lifestyle Medicine
Authors: Rooke Jennifer
Published: June 2018

The Optimal Health and Wellness Clinic of Morehouse Healthcare seeks to advance health equity by providing lifestyle medicine services to its predominantly African American patient population. Health equity means eliminating health disparities by providing services that meet the needs of the population served. African Americans have a higher burden of cardiovascular disease and diabetes than other American ethnic groups. Recent evidence indicates that eating a plant-based diet may eliminate disparities in cardiovascular disease and diabetes. The clinic provides lifestyle intervention services such as stress and sleep management, but the focus is on helping patients to adopt and maintain a plant-based diet. A range of encounter options that include shared medical appointments and cooking classes are offered. The clinic is an example of a lifestyle medicine specialty practice within the multispecialty practice arm of a medical school. The shared mission to promote health equity provides substantial resources to the clinic and allows for collaborative efforts to improve the health of the community.
Meta-Awareness of Dysregulated Emotional Attention
Authors: Ruimi Liad , Hadash Yuval , Zvielli Ariel , Amir Iftach , Goldstein Pavel , Bernstein Amit
Published: June 2018

We explore the human capacity for and the function(s) of meta-awareness for biased attentional processing of emotional information (MAB) subserving mental (ill) health. We do so by integrating probe-caught sampling methods, signal detection theory, and multilevel modeling of cognitive-experimental laboratory data among daily smokers ( N = 75) known to exhibit biased attentional processing of reward-related (drug) cues in addiction. We found (a) evidence of the capacity for and individual differences in MAB; (b) that momentary MAB was most likely observed in the event of the most extreme micro-expressions of biased attentional processing; and (c) that momentary micro-expressions of biased attention without MAB were more likely followed by attentional dysregulation, whereas momentary micro-expressions of biased attention with MAB were more likely followed by more balanced attentional expression or greater attentional control. We discuss the implications for basic and clinical science of meta-awareness.
Factors Associated With Physical Performance Measures in a Multiethnic Cohort of Older Adults
Authors: Granic Antoneta , Mossop Helen , Engstrom Gabriella , Davies Karen , Dodds Richard , Galvin James , Ouslander Joseph G. , Tappen Ruth , Sayer Avan A.
Published: June 2018

Objective: To explore the association between ethnicity, sociodemographic, health, and lifestyle factors, and physical performance (PP) in ethnically diverse community-dwelling older adults from one geographic area. Method: We used multivariable linear regression to identify factors associated with upper (grip strength [GS], arm curls [AC]) and lower (chair stands [CS]) body strength and mobility (gait speed [GSp]) in 577 older adults (mean age 74 ± 8; 104 African American, 142 Afro-Caribbean, 123 Hispanic, and 208 European American) from South Florida. Results: Worse mental health was negatively associated with CS in African Americans and AC in Hispanics. Older age and higher body mass index (BMI) was associated with slower GSp in all except in Hispanics. Higher physical activity was associated with higher upper body strength in Hispanics and better mobility in African Americans and Afro-Caribbeans, but not in European Americans. Conclusion: Studies with large multiethnic cohorts are needed to further our understanding of ethnic differences in PP, which will help in tailoring interventions and recognizing unmet needs for health and social services.
Risk factors for poor outcome in community-onset Clostridium difficile infection
Authors: Lee Eunyoung , Song Kyoung-Ho , Bae Ji Yun , Yoon Doran , Hwang Joo-Hee , Choe Pyoeng Gyun , Park Wan Beom , Bang Ji Hwan , Kim Eu Suk , Park Sang Won , Kim Nam Joong , Oh Myoung-don , Kim Hong Bin
Published: June 2018

Background

A substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI.

Methods

We performed a retrospective review of all inpatients with CDI, in a 1300-bed tertiary-care hospital in Korea, from 2008 through 2015. CO-CDI was defined as CDI occurring within 48 h of admission. Poor outcome was defined as follows: 1) all-cause 30-day mortality, 2) in-hospital mortality, or 3) surgery due to CDI.

Results

Of a total 1256 CDIs occurring over 8 years, 152 (12.1%) cases were classified as CO-CDI and 23 (15.1%) had a poor outcome, including 22 (14.5%) cases of mortality and 2 (1.3%) cases of surgery. Patients with a poor outcome had a higher mean age than those without a poor outcome (75.8 vs. 69.6 years, p = 0.03). The proportion of men and prior proton pump inhibitor (PPI) use were significantly higher in the poor outcome group (65.2% vs. 41.9%, p = 0.04; 39.1% vs. 17.6%, p = 0.02, respectively). Multivariate binary logistic model showed that PPI use and anemia (hemoglobin < 10 g/dL) at presentation were significantly associated with a poor outcome (adjusted odds ratio [aOR], 3.76; 95% confidence interval [95CI], 1.26–11.21, aOR, 4.67; 95CI, 1.52–14.34, respectively).

Conclusions

Clinicians should not only be aware of the possibility of CDI in the community setting but also pay more attention to PPI-using elderly patients with anemia in consideration of a poor outcome.
Have 100 years of talking therapies taught psychiatrists how to communicate?
Authors: Wilson Jon
Published: June 2018

Formal communication skills training is the norm at UK medical schools, and evidence is mounting that it is effective in a number of domains, including patient satisfaction and shared decision-making, leading to improved treatment adherence. However, applying these models in mental health settings is challenging, despite the fact that positive therapeutic relationships and an ability to actively manage consultations are the cornerstone of psychiatric practice. Communication skills training is still too often regarded as better suited to physical health consultations than more complex psychiatric interviews. Here, it is considered why this might be, with reference to the one eligible randomised controlled trial identified in this systematic literature review.

DECLARATION OF INTEREST

J.W. has previously worked with Professor Papageorgiou at the University of East Anglia and has authored chapters in books that she has co-edited.
Does evidence support the high expectations placed in precision medicine? A bibliographic review
Authors: Cortés Jordi , González José Antonio , Medina María Nuncia , Vogler Markus , Vilaró Marta , Elmore Matt , Senn Stephen John , Campbell Michael , Cobo Erik
Published: June 2018

Background: Precision medicine is the Holy Grail of interventions that are tailored to a patient’s individual characteristics. However, conventional clinical trials are designed to find differences with the implicit assumption that the effect is the same in all patients within the eligibility criteria. If this were the case, then there would be no grounds for treating different patients differently. One consequence of the assumption is that the variance in the outcome variable would be the same in treated and control arms. We reviewed the literature to see if this were the case and so to see how often precision medicine would not be useful.

Methods: We reviewed parallel trials with quantitative outcomes published in 2004, 2007, 2010 and 2013. We collected baseline and final standard deviations of the main outcome. We assessed homoscedasticity by comparing the variance of the primary endpoint between arms through the outcome variance ratio (treated to control group).

Results: The review provided 208 articles with enough information to conduct the analysis. One out of seven studies (n = 30, 14.4%) had statistically different variances between groups, leading a non-constant-effect. The adjusted point estimate of the mean outcome variance ratio (treated to control group) is 0.89 (95% CI 0.81 to 0.97).

Conclusions: We found that the outcome variance was more often smaller in the intervention group, suggesting that treated patients may end up pertaining more often to reference or “normality” values and thus would not require further precision medicine. However, this result may also be compatible with a reduced effect in some patients, which would require studying whether the effect merits enduring the side effects as well as the economic costs. We have shown that the comparison of variances is a useful but not definitive tool to asses if the design assumption of a constant effect holds.
shinySISPA: A web tool for defining sample groups using gene sets from multiple-omics data
Authors: Dwivedi Bhakti , Kowalski Jeanne
Published: June 2018

As opposed to genome-wide testing of several hundreds of thousands of genes on very few samples, gene panels target as few as tens of genes and enable the simultaneous testing of many samples.  For example, some cancer gene panels test for 50 genes that can affect tumor growth and potentially identify treatment options directed against the genetic mutation.  The increasing popularity of gene panel testing has spurred the technological development of panels that test for diverse data types such as expression and mutation.   Once samples are tested, there is the desire to examine clinical associations based on the panel and for this purpose, one would like to identify, among the samples tested, which show support for a molecular profile (e.g., presence of mutation with increased expression) versus those samples that do not among the genes tested.  With user-specified molecular profile of interest, and gene panel data matrices (e.g., gene expression, variants, etc.) that define the profile, shinySISPA (Sample Integrated Set Profile Analysis) is a web-based shiny tool to define two sample groups with and without profile support based on our previously published method from which clinical associations may be readily examined. The shinySISPA can be accessed from http://shinygispa.winship.emory.edu/shinySISPA/.
Predicting ionizing radiation exposure using biochemically-inspired genomic machine learning
Authors: Zhao Jonathan Z.L. , Mucaki Eliseos J. , Rogan Peter K.
Published: June 2018

Background: Gene signatures derived from transcriptomic data using machine learning methods have shown promise for biodosimetry testing. These signatures may not be sufficiently robust for large scale testing, as their performance has not been adequately validated on external, independent datasets. The present study develops human and murine signatures with biochemically-inspired machine learning that are strictly validated using k-fold and traditional approaches.

Methods: Gene Expression Omnibus (GEO) datasets of exposed human and murine lymphocytes were preprocessed via nearest neighbor imputation and expression of genes implicated in the literature to be responsive to radiation exposure (n=998) were then ranked by Minimum Redundancy Maximum Relevance (mRMR). Optimal signatures were derived by backward, complete, and forward sequential feature selection using Support Vector Machines (SVM), and validated using k-fold or traditional validation on independent datasets.

Results: The best human signatures we derived exhibit k-fold validation accuracies of up to 98% (DDB2,  PRKDC, TPP2, PTPRE, and GADD45A) when validated over 209 samples and traditional validation accuracies of up to 92% (DDB2,  CD8A,  TALDO1,  PCNA,  EIF4G2,  LCN2,  CDKN1A,  PRKCH,  ENO1,  and PPM1D) when validated over 85 samples. Some human signatures are specific enough to differentiate between chemotherapy and radiotherapy. Certain multi-class murine signatures have sufficient granularity in dose estimation to inform eligibility for cytokine therapy (assuming these signatures could be translated to humans). We compiled a list of the most frequently appearing genes in the top 20 human and mouse signatures. More frequently appearing genes among an ensemble of signatures may indicate greater impact of these genes on the performance of individual signatures. Several genes in the signatures we derived are present in previously proposed signatures.

Conclusions: Gene signatures for ionizing radiation exposure derived by machine learning have low error rates in externally validated, independent datasets, and exhibit high specificity and granularity for dose estimation.
Institutions and Entrepreneurial Activity: The Interactive Influence of Misaligned Formal and Informal Institutions
Authors: Eesley Charles E. , Eberhart Robert N. , Skousen Bradley R. , Cheng Joseph L. C.
Published: June 2018

We contribute to the institutions and entrepreneurship literature by examining the interactive influence of formal and informal institutions on new business creation, survival, and growth. Prior literature demonstrates how formal and informal institutions shape the level of entrepreneurship. This paper extends this to examine the cases when formal and informal institutions conflict with one another to cast an analytic eye on why countries differ in the type of entrepreneurial activity in terms of entry, survival, and growth. We argue that national and regional differences can be better explained by the interactive influence of formal and informal institutions. Moreover, we argue that informal institutions dominate formal institutions due to the former’s characteristics of deep embeddedness and resistance to change over time. These ideas are presented and summarized into a typology of institutional effects on entrepreneurship activity depending on the combination of formal and informal institutions. The paper concludes with implications for future theory and research on the joint influence of different institutional effects and particularly on the intersection between institutions and entrepreneurship.
Die Sakralisierung des Individuums
Authors: Moebius Stephan
Published: June 2018

Der Beitrag analysiert die Heldenverehrung und Heroisierung im Anschluss an religionssoziologische Konzepte der Durkheim-Schule und Hans Joas als eine Sakralisierung bestimmter Individuen. Fasst man die Heldenverehrung im Anschluss an die durkheimiens und Joas als Sakralisierungsprozess, so kommen dadurch auch die affektiv-emotionalen, psychischen, religiösen und ambivalenten Dimensionen der Sozialfigur des Helden besser zum Vorschein, als nähme man allein den Zuschreibungscharakter des Heldentums in den Blick. Im Anschluss an die Bestimmung des Sakralisierungsprozesses untersucht der Beitrag ferner die Konstitutierung des Helden aus praxeologisch-poststrukturalistischer Sicht, um sowohl die Effekte männlicher Herrschaft als auch die Mechanismen der symbolischen Macht bei der Sakralisierung von Individuen zu Helden herauszuarbeiten.
Phantomschmerzen
Authors: Hainz Martin A.
Published: June 2018

Martin A. Hainz widmet sich in seinem Beitrag der Frage, wie Konzepte des Ichs jenen des Gespensts entsprechen, unter Einbeziehung von Texten u.a. William Shakespeares, Heinrich Heines und Bram Stokers sowie vor allem Jacques Derridas. Es geht um Anrufungen und Abweichungen im Herzen dessen, was eine Identität sei.
Phantome zwischen uns. Einem ominösen Phänomen namens "Illegale" auf der visuellen Spur
Authors: Oberprantacher Andreas
Published: June 2018

Dieser Beitrag begibt sich auf die Spur von Menschen, von denen kaum gesagt werden kann, dass es sie gibt, wiewohl sie so gut wie ständig medial gehetzt werden: »Illegale«. Als ominöses Phänomen an der Grenze von »Flucht« und »Migration« sind Menschen, die als »Illegale« diskrediert und diffamiert werden, effektiv eine unheimliche Gestalt, welche nicht zuletzt die Gegenwart Europas heimsucht. In Erinnerung an Derridas Hauntologie wird die Frage erörtert, was es bedeuten könnte, sich diesem Phantom zu stellen.
DAVID GEGEN GOLIATH. EIN HALBGARER MUSIKER ÜBER SEIN SCHAFFEN IN AUSEINANDERSETZUNG MIT DER GESELLSCHAFT ALS GANZE
Authors: Heidenreich Kris
Published: June 2018

Der Singer/Songwriter Kris Heidenreich widmet sich in seinem Beitrag der Fragestellung, inwiefern seine Kompositionen als eine Auseinandersetzung mit der Gesellschaft als Ganzes zu verstehen sind. Hierbei führt er zuerst aus, in welchem Kontext seine Musik heranreift und welche Voraussetzungen gegeben sein müssen, damit ein Song entsteht mit einem »Grund, der das Vielerlei sammelt und zu einem Ganzen bündelt«. Schließlich widmet er sich der Frage, inwieweit ein zutiefst persönlicher künstlerischer Ausdruck eine authentische Kritik an der Gesellschaft beinhalten kann, ohne dass er an »der rationalen Kälte, die gerade Musik- und Kunstschaffenden so fremd ist«, leidet. Der Autor liefert einen einzigartigen Einblick in die Praxis eines heranreifenden Musikers aus erster Hand.
Subjectivity and Synchrony in Artistic Research
Authors: Schindler Johanna
Published: June 2018

Artistic research has become an established mode of inquiry and knowledge production in many fields. Johanna Schindler examines the collaborative practices of two artistic research projects in the fields of digital musical instrument design and responsive environments. How are individual research modes organized? Which forms of knowledge are at stake? And what sort of influence do institutional settings, spatial arrangements, and boundary objects have on the emerging research dynamics? Schindler's ethnographic study explores these questions and suggests concrete measurements that can be utilized to adapt the research environments, funding structures, and evaluation criteria of artistic research projects to the specific needs of this emerging field.
No dejen nunca de caminar mirando al horizonte
Authors: Magro Carlos , Adrià Ferran
Published: June 2018

El proyecto “Escuelas Creativas” surge de la convicción de que cada realidad escolar es distinta. La clave ha sido entender que todas las escuelas tienen la capacidad interna de mejora y que cada comunidad educativa debe buscar sus propias soluciones y fomentar y gestionar el cambio.
“Primera alianza”: de la seguridad en las relaciones al aprendizaje
Authors: Pitillas Salvá Carlos , Halty Barrutieta Amaia , Berástegui Pedro-Viejo Ana
Published: June 2018

El proyecto “Primera Alianza”, desarrollado en el Instituto Universitario de la Familia (Universidad Pontificia Comillas de Madrid), se centra en la promoción de vínculos seguros entre adultos (padres y profesores) y niños, como estrategia para promover un desarrollo integral en estos. En este artículo explicamos por qué (y cómo) la seguridad en los vínculos influye directamente sobre la capacidad de crecer y aprender, y por qué esta seguridad debería ocupar el centro de nuestras reflexiones acerca de la educación.
Proyectos con voz de infancia
Authors: Aguilar Liébana Blanca Alicia
Published: June 2018

Debido a la progresiva incorporación del ABP en los centros educativos, se hace necesario reflexionar sobre sus aspectos más relevantes, aquellos que ponen en valor la voz de la infancia: el lugar que ocupan las ideas del alumnado en la práctica de los proyectos, cómo los docentes favorecen esta puesta en valor y la necesidad de una documentación continuada, reflexiva y participada que democratice la escuela como lugar de discusión de los saberes de la comunidad.
Modelo de gestão de riscos em lavanderias de beneficiamento no arranjo produtivo local (APL) têxtil e de confecções de Pernambuco, Brasi
Authors: Lorena Emmanuelle M. G. , Lorena Cynthia M. G. , Medeiros Raimundo M. , El-Deir Soraya G. , Holanda Romildo M. , Araújo Vinícius D.
Published: June 2018

Os riscos ambientais inerentes ao processo de lavagem e beneficiamento têxtil são considerados um fator negativo ao Arranjo Produtivo Local do Agreste pernambucano. A produção gera contaminação nos corpos hídricos, no solo e no ar; além de desequilíbrio no ecossistema, por desmatamento da flora nativa; como também da feição social, por exposição dos trabalhadores a danos potenciais à saúde. O objetivo desse estudo consiste em estabelecer modelo de gestão de riscos em lavanderias de beneficiamento no APL têxtil e de confecções do Agreste de Pernambuco, baseado na ISO 31.000:2009, ocorrendo nos mês de novembro e dezembro de 2016, numa unidade fabril na cidade de Caruaru. O modelo foi estabelecido com o emprego de ferramentas como, relatório fotográfico, entrevista semi-estruturada, brainstorming, mapeamento de processo e priorização de ações por meio da matriz GUT e concepção de mapa de riscos em layout. Como resultado, foi possível estabelecer um modelo aplicado à indústria têxtil no segmento de lavagem de jeans com aderência as características locais. Para a validação do modelo, o mesmo foi aplicado à lavandeira em estudo, obtendo assim, dados quanto à identificação dos riscos demonstrando que os processos com maiores concentrações são o de lavagem e de geração de vapor (45,3%), sendo os riscos ecológicos como maior representatividade (51%). Conclui-se que o modelo estabelecido, mesmo que preliminarmente, foi avaliado como satisfatório, visto o cumprimento das etapas pré-estabelecidas. Porém, a gestão dos riscos não deve ser executada uma única vez, sendo necessário acompanhamento.