bluuebunny/crossref_metadata_2025 huggingface dataset:
Permanent Pacemaker Implantation After Transcatheter Aortic Valve Implantation
Authors: Urena Marina , Webb John G. , Tamburino Corrado , Muñoz-García Antonio J. , Cheema Asim , Dager Antonio E. , Serra Vicenç , Amat-Santos Ignacio J. , Barbanti Marco , Immè Sebastiano , Briales Juan H. Alonso , Benitez Luis Miguel , Al Lawati Hatim , Cucalon Angela Maria , García del Blanco Bruno , López Javier , Dumont Eric , DeLarochellière Robert , Ribeiro Henrique B. , Nombela-Franco Luis , Philippon François , Rodés-Cabau Josep
Published: December 2013

Background—

Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients.

Methods and Results—

A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74–1.30;
P
=0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56–1.17;
P
=0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77–1.30;
P
=0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11–0.85;
P
=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time (
P
=0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6- to 12-month follow-up (estimated coefficient, −2.26; 95% confidence interval, −4.07 to −0.44;
P
=0.013;
R
2
=0.121).

Conclusions—

The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.
Neurofibromin-Deficient Myeloid Cells Are Critical Mediators of Aneurysm Formation In Vivo
Authors: Li Fang , Downing Brandon D. , Smiley Lucy C. , Mund Julie A. , DiStasi Matthew R. , Bessler Waylan K. , Sarchet Kara N. , Hinds Daniel M. , Kamendulis Lisa M. , Hingtgen Cynthia M. , Case Jamie , Clapp D. Wade , Conway Simon J. , Stansfield Brian K. , Ingram David A.
Published: December 2013

Background—

Neurofibromatosis type 1 (NF1) is a genetic disorder resulting from mutations in the
NF1
tumor suppressor gene. Neurofibromin, the protein product of
NF1
, functions as a negative regulator of Ras activity in circulating hematopoietic and vascular wall cells, which are critical for maintaining vessel wall homeostasis. NF1 patients have evidence of chronic inflammation resulting in the development of premature cardiovascular disease, including arterial aneurysms, which may manifest as sudden death. However, the molecular pathogenesis of NF1 aneurysm formation is unknown.

Method and Results—

With the use of an angiotensin II–induced aneurysm model, we demonstrate that heterozygous inactivation of
Nf1
(
Nf1

+/–

) enhanced aneurysm formation with myeloid cell infiltration and increased oxidative stress in the vessel wall. Using lineage-restricted transgenic mice, we show that loss of a single
Nf1
allele in myeloid cells is sufficient to recapitulate the
Nf1

+/–

aneurysm phenotype in vivo. Finally, oral administration of simvastatin or the antioxidant apocynin reduced aneurysm formation in
Nf1

+/–

mice.

Conclusion—

These data provide genetic and pharmacological evidence that
Nf1

+/–

myeloid cells are the cellular triggers for aneurysm formation in a novel model of NF1 vasculopathy and provide a potential therapeutic target.
Extensive Leukoaraiosis Is Associated With High Early Risk of Recurrence After Ischemic Stroke
Authors: Kim Gyeong-Moon , Park Kwang-Yeol , Avery Ross , Helenius Johanna , Rost Natalia , Rosand Jonathan , Rosen Bruce , Ay Hakan
Published: December 2013

Background and Purpose—

The integrity of white matter tracts connecting different parts of the brain is important for rapid compensation for the lost function from ischemic stroke. Impaired white matter reserve capacity secondary to leukoaraiosis may facilitate detection of new symptomatic ischemic events that would otherwise remain inconspicuous after an initial ischemic stroke. We sought to identify whether the extent of leukoaraiosis was a predictor of risk of early stroke recurrence.

Methods—

We used Cox regression analysis in consecutive patients with ischemic stroke to determine the relationship between leukoaraiosis burden and symptomatic stroke recurrence within 90 days. We graded total leukoaraiosis, periventricular leukoaraiosis, and subcortical leukoaraiosis using the Fazekas scale as mild (<2) and extensive (≥2) on fluid-attenuated inversion recovery images obtained within 72 hours of stroke onset in the hemisphere contralateral to acute stroke.

Results

—There were 106 recurrent events in 2378 patients. The cumulative incidence of recurrence was 5.9% at 90 days. Kaplan–Meier estimate of recurrence-free survival rate was lower in patients with extensive leukoaraiosis (
P
=0.04) and extensive periventricular leukoaraiosis (
P
=0.02) but not in extensive subcortical leukoaraiosis (
P
=0.09). Multivariable Cox regression analysis revealed a hazard ratio of 1.50 (95% confidence interval, 1.00–2.25) for extensive leukoaraiosis, 1.67 (95% confidence interval, 1.11–2.51) for extensive periventricular leukoaraiosis, and 1.42 (95% confidence interval, 0.94–2.12) for extensive subcortical leukoaraiosis.

Conclusions—

The extent of leukoaraiosis independently predicts 90-day recurrent stroke risk after ischemic stroke. This suggests that leukoaraiosis may be used for risk stratification in ischemic stroke.
Roles of Hypertension in the Rupture of Intracranial Aneurysms
Authors: Tada Yoshiteru , Wada Kosuke , Shimada Kenji , Makino Hiroshi , Liang Elena I. , Murakami Shoko , Kudo Mari , Kitazato Keiko T. , Nagahiro Shinji , Hashimoto Tomoki
Published: December 2013

Background and Purpose—

Systemic hypertension has long been considered a risk factor of aneurysmal rupture. However, a causal link between systemic hypertension and the development of aneurysmal rupture has not been established. In this study, using a mouse model of intracranial aneurysm rupture, we examined the roles of systemic hypertension in the development of aneurysmal rupture.

Methods—

Aneurysms were induced by a combination of deoxycorticosterone acetate (DOCA)-salt and a single injection of elastase into the cerebrospinal fluid in mice. Antihypertensive treatment was started 6 days after aneurysm induction. Aneurysmal rupture was detected by neurological symptoms and confirmed by the presence of intracranial aneurysm with subarachnoid hemorrhage. Hydralazine (direct vasodilator) or discontinuation of DOCA-salt treatment was used to assess the roles of systemic hypertension. Captopril (angiotensin-converting enzyme inhibitor) or losartan (angiotensin II type 1 receptor antagonist) was used to assess the roles of the local renin–angiotensin system in the vascular wall.

Results—

Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose-dependent relationship between reduction of blood pressure and prevention of aneurysmal rupture. Captopril and losartan were able to reduce rupture rate without affecting systemic hypertension induced by DOCA-salt treatment.

Conclusions—

Normalization of blood pressure after aneurysm formation prevented aneurysmal rupture in mice. In addition, we found that the inhibition of the local renin–angiotensin system independent from the reduction of blood pressure can prevent aneurysmal rupture.
Iodinated Contrast Does Not Alter Clotting Dynamics in Acute Ischemic Stroke as Measured by Thromboelastography
Authors: McDonald Mark M. , Archeval-Lao Joancy M. , Cai Chunyan , Peng Hui , Sangha Navdeep , Parker Stephanie A. , Wetzel Jeremy , Riney Stephen A. , Cherches Matt F. , Guthrie Greer J. , Roper Tiffany C. , Kawano-Castillo Jorge F. , Pandurengan Renga , Rahbar Mohammad H. , Grotta James C.
Published: December 2013

Background and Purpose—

Iodinated contrast agents used for computed tomography angiography (CTA) may alter fibrin fiber characteristics and decrease fibrinolysis by tissue plasminogen activator (tPA). Thromboelastography (TEG) measures the dynamics of coagulation and correlates with thrombolysis in acute ischemic stroke patients. We hypothesized that receiving CTA before tPA will not impair thrombolysis as measured by TEG.

Methods—

Acute ischemic stroke patients receiving 0.9 mg/kg tPA <4.5 hours of symptom onset were prospectively enrolled. For CTA, 350 mg/dL of iohexol or 320 mg/dL of iodixanol at a dose of 2.2 mL/kg was administered. TEG was measured before tPA and 10 minutes after tPA bolus. CTA timing was left to the discretion of the treating physician.

Results—

Of 136 acute ischemic stroke patients who received tPA, 47 had CTA before tPA bolus, and 42 had either CTA after tPA and post–tPA TEG draw or no CTA (noncontrast group). Median change in clot lysis (LY30) after tPA was 95.3% in the contrast group versus 95.0% in the noncontrast group (
P
=0.74). Thus, tPA-induced thrombolysis did not differ between contrast and noncontrast groups. Additionally, there was no effect of contrast on any pre–tPA TEG value.

Conclusions—

Our data do not support an effect of iodinated contrast agents on clot formation or tPA activity.
The Effect of Observation Length and Presentation Order on the Reliability and Validity of an Observational Measure of Teaching Quality
Authors: Mashburn Andrew J. , Meyer J. Patrick , Allen Joseph P. , Pianta Robert C.
Published: December 2013

Observational methods are increasingly being used in classrooms to evaluate the quality of teaching. Operational procedures for observing teachers are somewhat arbitrary in existing measures and vary across different instruments. To study the effect of different observation procedures on score reliability and validity, we conducted an experimental study that manipulated the length of observation and order of presentation of 40-minute videotaped lessons from secondary grade classrooms. Results indicate that two 20-minute observation segments presented in random order produce the most desirable effect on score reliability and validity. This suggests that 20-minute occasions may be sufficient time for a rater to observe true characteristics of teaching quality assessed by the measure used in the study, and randomizing the order in which segments were rated may reduce construct irrelevant variance arising from carry over effects and rater drift.
Are We There Yet? The State of Public Human Resource Management Research
Authors: Jordan Todd , Battaglio R. Paul
Published: December 2013

Beginning in 1996, the state of Georgia embarked on a bold experiment in public management reform, embracing employment at-will (EAW) for public employees. Public human resource management (PHRM) research since the Georgia reforms has called for a greater appreciation for the link between personnel reforms and performance. This research examines whether the appeal for more exacting research has been taken up. The analysis provides an overview of research on public personnel reform, focusing on five themes identified by the literature: decentralization, performance-based pay, declassification, deregulation, and privatization. Reviewing 238 articles in 13 journals since 1996, the present effort finds a lack of empirical evidence linking personnel reforms with results. The authors conclude with several perspectives for future assessments of PHRM reform and lessons for practice.
Engaging the Neighborhood
Authors: Mooney-Melvin Patricia
Published: December 2013

The East Rogers Park Neighborhood History Project, a community-based initiative, represented an effort to build upon community engagement with its history and to sensitize students to the fact that the locality was not just there for their consumption and use but rather represented an opportunity for engaged learning that diminished barriers between the community and the students. It encouraged local residents to think more broadly about their world and to appreciate its ties to the larger metropolitan community. It introduced students to reflective practice, a centerpiece of public history training. And, it provided an opportunity to nurture an appreciation for stewardship among the students, as they not only drew from but gave back to the community. As a collaborative project, it highlights some of the opportunities and challenges that attend the more recent enthusiasm for engaged learning and civic engagement. While this project did not involve all elements of the community, the pedagogical approach utilized in this initiative and the issues relating to community-based projects raised by it can inform current discussions about engaged learning and scholarship.
The Racial Politics of Place
Authors: Carroll Fred
Published: December 2013

White civic leaders worked with the Federal Housing Administration and Resettlement Administration on the Virginia Peninsula in the mid-1930s to build two suburban subdivisions for poor and working-class African Americans. In an era of “managed” race relations, the developments reinforced paternalistic white rule by extending urban practices of segregation into racially undefined suburban areas. The homes provided opportunity, not equality. However, the houses also challenged spatial boundaries concerning race and class and fractured public conceptions of monolithic racial unity along class lines. The developments were among the first in the nation to use federal tax dollars to support black families’ aspirations for homeownership and middle-class living standards. Their occupancy, expense, and location angered working-class whites who lived nearby. The ensuing conflicts revealed the near impossibility of reconciling cautious federal experiments in racial betterment with expanding black demands for empowerment and white concerns that black gains occurred at their personal expense.
The I’s, We’s, and She/He’s of Breakups
Authors: Blackburn Kate , Brody Nicholas , LeFebvre Leah
Published: December 2013

People adjusting from couplehood to singlehood often engage in account creation in order to privately make sense of their relationship life and death, as well as publicly explain the changes to their social network. This study analyzes language style differences in retrospective private and public accounts of relationship breakups. We examined language use as it relates to the creation of accounts, breakup initiator status, and relationship dissolution adjustment. We found that (a) public and private breakup accounts contain different types and percentages of first-person and third-person pronouns, (b) pronoun use differs based on the breakup initiator, and (c) use of first-person singular and plural pronouns predicts post-breakup adjustment. Findings suggest that language style differences in private and public accounts from the same person may illustrate variations in how individuals adjust to stressful experiences.
Managing the Complications of Mild Therapeutic Hypothermia in the Cardiac Arrest Patient
Authors: Noyes Adam M. , Lundbye Justin B.
Published: December 2013

Mild therapeutic hypothermia (MTH) is used to lower the core body temperature of cardiac arrest (CA) patients to 32°C from 34°C to provide improved survival and neurologic outcomes after resuscitation from in-hospital or out-of-hospital CA. Despite the improved benefits of MTH, there are potentially unforeseen complications associated during management. Although the adverse effects are transient, the clinician should be aware of the associated complications when managing the patient receiving MTH. We aim to provide the medical community comprehensive information related to the potential complications of survivors of CA receiving MTH, as it is imperative for the clinician to understand the physiologic changes that take place in the patient receiving MTH and how to prepare for them and manage them if they do occur. We hope to provide information of how to manage these potential complications through both a review of the current literature and a reflection of our own experience.
Connective Tissue Disease-Associated Interstitial Lung Disease
Authors: Solomon Joshua J. , Fischer Aryeh
Published: December 2013

The connective tissue diseases (CTDs) are a group of systemic disorders characterized by autoimmunity and autoimmune-mediated organ damage. The lung is a frequent target and all components of the respiratory system are at risk. Interstitial lung disease (ILD) represents a broad group of diffuse parenchymal lung injury patterns characterized by varying degrees of inflammation and fibrosis, is a common manifestation of CTD particularly common in systemic sclerosis, polymyositis/dermatomyositis, and rheumatoid arthritis, and is a leading cause of significant morbidity and mortality. The lung injury patterns of CTD-associated ILD (CTD-ILD) mirror those of idiopathic interstitial pneumonia and may arise at any time during the course of the CTD or may be the first manifestation of CTD. Patients with CTD that present with respiratory failure often present significant diagnostic dilemmas. Thorough and comprehensive assessments to exclude respiratory *infection, acute interstitial pneumonia, medication toxicity, pulmonary embolism, cardiac dysfunction, and diffuse alveolar hemorrhage are the fundamental components for the evaluation of such patients. Furthermore, patients with CTD are also at risk of acute exacerbations of underlying ILD. Acute exacerbations are manifested by subacute respiratory deterioration with worsening hypoxemia in the setting of new radiographic abnormalities. The prognosis of patients with CTD having respiratory failure is often quite poor, highlighting the need for prompt and thorough clinical assessments to determine the underlying etiology and implementation of appropriate therapeutic strategies.
Successful Use of Extracorporeal Membrane Oxygenation in an Adult Patient With Toxic Shock-Induced Heart Failure
Authors: Gabel Eilon , Gudzenko Vadim , Cruz Daniel , Ardehali Abbas , Fink Mitchell P.
Published: December 2013

Cardiomyopathy secondary to toxic shock syndrome (TSS) is an uncommon but potentially life-threatening problem. We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotropes. Venoarterial extracorporeal membrane oxygenation (VA ECMO) was instituted as a bridge to recovery. After administration of antibiotics and intravenous immunoglobulin, the patient’s condition improved and he was successfully weaned off ECMO after 6 days. The patient recovered from multiorgan failure, and left ventricular ejection fraction improved from <10% pre-ECMO to 65% 8 months after discharge. This case supports the view that VA ECMO can be used successfully to support vital organ perfusion in patients with profound but reversible cardiomyopathy attributed to TSS.
Exploring Women’s Empowerment Through “Credit-Plus” Microfinance in India
Authors: Krenz Kristin , Gilbert Dorie J. , Mandayam Gokul
Published: December 2013

Transnational feminist discourse has critiqued the pursuit of women’s empowerment through international development programs. Empowerment, when reduced to the provision of financial resources and services, is unlikely to lead to wider changes in gender inequality unless programs strategically combine credit with other vital services. We interviewed women participating in a multifaceted empowerment program in Mumbai, India, to explore the potential of the “Credit-Plus” model to facilitate pathways of individual and collective empowerment. Emergent themes of empowerment were enhanced socioemotional well-being, increased economic assets, and improved household gender equity. Interview responses demonstrate changes in individual, household, and collective agency dynamics.
Modeling and analysis of a novel conical magnetic bearing for vernier-gimballing magnetically suspended flywheel
Authors: Fang Jiancheng , Wang Chune , Tang Jiqiang
Published: December 2013

The vernier-gimballing magnetically suspended flywheel can generate control moment in radial directions by tilting the spinning rotor to rotate around the radial axes. In order to reduce the extra tilting torque caused by the uniform distribution of flux density and the magnetic coupling among different channels, a novel 3 degrees of freedom conical permanent-magnet-biased magnetic bearing is proposed in the paper. The axial and radial stators are both designed with the normal directions of the midst faces directing to the centroid of the rotor, so as to decrease the extra torque by shortening the length of torque arm. A novel structure of radial X and Y stator poles separated by nonmagnetic material is proposed, and the upper and lower conical stators are designed to be mirror structures with each other, so that the magnetic coupling can be reduced. The mathematical model of the proposed permanent-magnet-biased magnetic bearing is constructed by methods of equivalent magnetic circuit and finite element. Calculations and simulations are carried out on the suspension force, extra tilting torque, and force coupling. The results show that with the conical structure, the extra tilting torque can be decreased from 10.83 Nm to 0.11 Nm when the rotor tilts around X axis for 1°. The magnetic forces among X, Y, and Z directions are almost decoupled even when the rotor shifts in some direction. All the results prove that the novel permanent-magnet-biased magnetic bearing is suitable for application in vernier-gimballing magnetically suspended flywheel.
Shape-design optimization of hull structures considering thermal deformation
Authors: Choi Myung-Jin , Kim Min-Geun , Cho Seonho
Published: December 2013

We developed a shape-design optimization method for the thermo-elastoplasticity problems that are applicable to the welding or thermal deformation of hull structures. The point is to determine the shape-design parameters such that the deformed shape after welding fits very well to a desired design. The geometric parameters of curved surfaces are selected as the design parameters. The shell finite elements, forward finite difference sensitivity, modified method of feasible direction algorithm and a programming language ANSYS Parametric Design Language in the established code ANSYS are employed in the shape optimization. The objective function is the weighted summation of differences between the deformed and the target geometries. The proposed method is effective even though new design variables are added to the design space during the optimization process since the multiple steps of design optimization are used during the whole optimization process. To obtain the better optimal design, the weights are determined for the next design optimization, based on the previous optimal results. Numerical examples demonstrate that the localized severe deviations from the target design are effectively prevented in the optimal design.
The full costs of generating electricity
Authors: Grimston M
Published: December 2013

The recent debate about costs of low-carbon electricity has tended to be based on a rather crude ‘cost of a generating unit divided by number of units produced’ approach. Advocates of renewables in particular talk about ‘grid parity’ when discussing the costs of generation. However, the potentially vast costs associated with managing the inherent intermittency of some renewables, notably wind and solar, are not at present fully reflected either in the stated costs of these energy sources nor in the quoted ‘subsidies’ they are receiving. It is becoming increasingly clear that the full costs – both economic and environmental – of all sources of electricity, most notably variable sources such as renewables like wind and solar, should include not only the direct costs referred to above but also indirect costs caused by, for example, the intermittency of the output. These costs are potentially very large and include the need for grid strengthening (grid-level system costs); the effect on the economics of other generators, leading to higher prices (or threats to security of supply, in itself a huge potential cost to consumers); and the greenhouse gas emissions caused by the need to vary the output of dispatchable fossil-fuelled power plants, thereby reducing their thermal efficiency. A rational approach to allocating financial resources to deliver maximum supply security and emission reduction would involve ascribing all costs and environmental effects, direct and indirect, to the source which has ultimately given rise to them. Instead of discussing ‘grid parity’, the relevant measure should be ‘system level parity’, including all of these costs which, however they are allocated, will have to be met by consumers and/or taxpayers. This would lead to a very different discussion re the way of achieving economic, security of supply and environmental goals – for example, reappraising the extent to which, in practice, variable renewables can be described as ‘low carbon’.
Subjective Experience and Sociability in a Collaborative Serious Game
Authors: Oksanen Kimmo
Published: December 2013

The meaning of social dimension of gaming for enjoyable and engaging game experiences is supported by an increasing amount of research. Nonetheless, this issue has rarely been studied in the context of serious games. This study attempts to narrow the knowledge gap in the understanding of collaborative serious game experiences and the relationship between the social dimension of gaming and core game experiences. The aim of this study is to empirically investigate what kinds of game experiences are generated when playing collaborative serious game and how the sense of social presence and the sociability of the environment are connected to the core game experience. Findings reinforce the idea that social presence is an essential part of game experience in multiplayer games. Results also showed that the sociability of the game and a sense of social presence are strongly connected to the various dimensions of the core game experience, including engagement, in the forms of flow and immersion. Thus, results indicate that the sociability of the game and sense of social presence seem to be potential factors in the emergence of positive and engaging game experiences, at least in the context of collaborative games.
Social Network Games
Authors: Paavilainen Janne , Hamari Juho , Stenros Jaakko , Kinnunen Jani
Published: December 2013

This article presents the results of an interview study on how people perceive and play social network games on Facebook. During recent years, social games have become the biggest genre of games if measured by the number of registered users. These games are designed to cater for large audiences in their design principles and values, a free-to-play revenue model and social network integration that make them easily approachable and playable with friends. Although these games have made the headlines and have been seen to revolutionize the game industry, we still lack an understanding of how people perceive and play them. For this article, we interviewed 18 Finnish Facebook users from a larger questionnaire respondent pool of 134 people. This study focuses on a user-centric approach, highlighting the emergent experiences and the meaning-making of social games players. Our findings reveal that social games are usually regarded as single player games with a social twist, and as suffering partly from their design characteristics, while still providing a wide spectrum of playful experiences for different needs. The free-to-play revenue model provides an easy access to social games, but people disagreed with paying for additional content for several reasons.
Are Geriatric Medicine Fellows Prepared for the Important Skills of Hospice and Palliative Care?
Authors: Cao Qing , Lee Tae J. , Hayes Stella M. , Nye Ann M. , Hamrick Irene , Patil Shivajirao , Steinweg Kenneth K.
Published: December 2013

Many geriatricians care for terminally ill and dying patients, but it is unclear whether the current geriatric medicine fellows receive sufficient training in hospice and palliative care (H&PC). A national cross-sectional survey was conducted between March and June 2011 to determine fellows’ experience and perceived competency with H&PC. Fellows (143 of 298, 48%) and program directors (PDs; 69 of 150, 46%) answered the surveys on paper or online. Three-fourths of the fellows planned to practice H&PC; however, only 35% fellows versus 42% PDs believed that fellows were well prepared in this area. Factors associated with fellows’ self-reported better preparation included completion of an H&PC rotation, experiences with an inpatient hospice facility, inpatient palliative care consulting service, and the presence of a formal H&PC curriculum.
Comparison of the Short-Term Results of the First and Last 50 Scandinavian Total Ankle Replacements
Authors: Schimmel Janneke J. P. , Walschot Luc H. B. , Louwerens Jan Willem K.
Published: December 2013

Background:

Total ankle replacement (TAR) is presently considered to be an acceptable alternative to ankle fusion for patients with debilitating conditions of the ankle. The placing of a total ankle prosthesis is a technically demanding procedure. We hypothesized that the challenging conditions could cause a longer learning curve (>30 cases), and therefore the short-term results of the first and the last 50 cases in a consecutive series of 134 cases were compared.

Methods:

The first and last consecutive 50 cases by a single surgeon in a series of 134 Scandinavian Total Ankle Replacements (STAR; Waldemar Link, Hamburg, Germany), inserted between May 1999 and May 2008, were evaluated. Operation characteristics, clinical outcome (Foot Function Index [FFI], Kofoed score), complications, and the component alignment on X-rays were assessed. The outcome measures for both groups were compared using independent Student t tests, chi-square tests, and nonparametric alternatives ( P < .05).

Results:

Surgery time decreased from a median of 125 (83-160) to 100 (65-170) minutes ( P < .001), and fewer perioperative complications were observed (12 vs 4, P = .04). The sagittal alignment of the tibial component was closer to normal in the last series ( P < .001). The clinical outcome did not differ between the 2 series (median FFI: 32 [0-74] vs 25 [0-75], Kofoed score: median 71 [21-96] vs 80.5 [23-100]). The major underlying pathology did change from rheumatoid arthritis (60%) to osteoarthritis (44%; P = .002). No differences in type and number of complications were reported.

Conclusion:

The surgery time did decrease, there were fewer perioperative fractures, and the tibial component orientation improved, suggesting the presence of a learning curve. Operative experience and a shift in major underlying pathology did not influence clinical outcome. In view of this learning curve we suggest more restrictive patient selection for at least the first 50 TARs.

Level of Evidence:

Level III, comparative series.
Local Government Fragmentation and the Local Public Sector
Authors: Goodman Christopher B.
Published: December 2013

This study analyzes the influence of fragmentation and concentration variables on per capita direct expenditures for all counties in the United States from 1982 to 2002. Building on recent research, fragmentation and concentration variables are developed to incorporate the horizontal as well as the vertical dimensions. This analysis explicitly takes into account the potential simultaneity between individual preferences for the spatial arrangement of local governments and the size of the local public sector using the element of time. The findings suggest that increased levels of fragmentation lead to an enlargement of the local public sector; however, the results are more complex than expected. Similarly, the concentration of service delivery responsibilities into counties and single purpose districts tends to increase the size of the local public sector.
Non-work at work: Resistance or what?
Authors: Paulsen Roland
Published: December 2013

Based on 43 interviews conducted with employees who spend around half of their working-hours on non-work related activities such as ‘cyberloafing’, a typology of empty labour is suggested according to sense of work obligation and potential output in order to set the phenomenon of workplace time-appropriation into a theoretical context in which wasteful aspects of organization and management are taken into account. Soldiering, which emanates from a weak sense of work obligation in the individual, may entail aspects of resistance, but there are also less voluntary forms of empty labour deriving from a lack of relevant work tasks. All types of empty labour are, however, bound up with the simulation of productivity. Therefore, they ironically serve to maintain the capitalist firm’s reputation for efficiency.
Mental health screening and early intervention: Clinical research study for under 5-year-old Children in Care in an inner London borough
Authors: Hardy Carol , Hackett Elizabeth , Murphy Elizabeth , Cooper Beatrice , Ford Tamsin , Conroy Susan
Published: December 2013

Typically the social-emotional development or mental health of under 5-year-old Children in Care (CiC) is not routinely assessed and there are few published data in the UK on the prevalence of difficulties for these children. Our hypothesis was that there could be a significant level of unidentified and unmet need within this group. A screening procedure was developed and piloted in a 12-month study assessing both child factors and the developing relationships between children and their caregivers. Previous screening studies have shown that recommendations for interventions are not reliably expedited. An intervention component was incorporated to address this and minimise delay in the children and their carers receiving support. Close inter-agency collaboration was integral to the establishment, implementation and high level of participation in the study. The screening proved acceptable to the majority of birth parents and caregivers, with 94% uptake of participants. In the year prior to screening only 10% of under-fives coming into care were identified as having difficulties in contrast to 67% of children in the screening cohort. The brief interventions offered were taken up in three-quarters of cases, leading to increased referrals on and access to mental health services for these children.
Psychometric analysis of the Short-Form Chinese Health and Safety Executive’s Management Standards Indicator Tool among nurses in Taiwan
Authors: Kao Chia-Chan , Wang Ruey-Hsia , Ying Jeremy C , Lin Yu-Hua , Chang Feng-Yi , Chen Kuei-Ying
Published: December 2013

The purpose of the study was to develop a Short-Form Chinese version of the Health and Safety Executive’s Management Standards Indicator Tool that can be used to measure work-related stress among nurses in Taiwan. Three subscales (supportive climate, role perception, and workload) were developed from an exploratory factor analysis. The three-factor confirmatory factor analysis indicated that the model fit the data well. The evidence based on convergent validity was supported by a significant correlation between the Short-Form Chinese version of the Health and Safety Executive’s Management Standards Indicator Tool and the job satisfaction subscale of the Chinese Patient Safety Attitude Questionnaire. Cronbach’s α values demonstrated internal item consistency for the Short-Form Chinese version of the Health and Safety Executive’s Management Standards Indicator Tool.
Exploring the relationship between student approaches to learning and reading achievement at the school level
Authors: Musu-Gillette Lauren E , Barofsky Meryl Y , List Alexandra
Published: December 2013

Using the Early Childhood Longitudinal Study, Kindergarten Cohort of 1998 (ECLS-K, 98), a nationally representative sample of kindergarteners in the United States, we investigated the relationship between approaches to learning and spring reading achievement with particular emphasis on classroom and school-level differences. We employed hierarchical linear modelling to investigate classroom- and school-level influences on children’s spring reading achievement and their teacher-rated approaches to learning. Results indicate that classroom-level variables are particularly important predictors of spring reading in kindergarten and also relate to the strength of the relationship between teacher-rated approaches to learning and spring reading achievement. Specifically, in classrooms with a high frequency of reading activities, there is a stronger relationship between teachers’ ratings of approaches to learning and spring reading achievement than in classrooms with a low frequency of reading activities. Also, the relation between teachers’ ratings of approaches to learning and achievement appears to be stronger in schools with high enrolment, as compared to schools with low enrolment. Findings suggest that the frequency of reading activities in the classroom is not only important for students’ reading achievement, but that these activities are also related to the important relationship between approaches to learning and reading achievement.
Increasingly mobile: How new technologies can enhance qualitative research
Authors: Moylan Carrie Ann , Derr Amelia Seraphia , Lindhorst Taryn
Published: December 2013

Advances in technology, such as the growth of smart phones, tablet computing, and improved access to the internet have resulted in many new tools and applications designed to increase efficiency and improve workflow. Some of these tools will assist scholars using qualitative methods with their research processes. We describe emerging technologies for use in data collection, analysis, and dissemination that each offer enhancements to existing research processes. Suggestions for keeping pace with the ever-evolving technological landscape are also offered.
Mistrust and refugee women who are lone parents in resettlement contexts
Authors: Lenette Caroline
Published: December 2013

The theme of mistrust in resettlement contexts is largely overlooked in refugee discourses. Through a qualitative inquiry of post-migration experiences of four women raising children alone in Brisbane, Australia, this paper outlines how the presence of mistrust could at times create difficult resettlement circumstances for these women, who then needed to negotiate additional obstacles in everyday life. The definition of social mistrust used here is a form of deliberate and ongoing suspicion about lone refugee women’s choices and lifestyles from other community members. Importantly, the women achieved a sense of well-being despite experiencing mistrust, both in inter-group and intra-group contexts, indicating that they conceptualised access to and benefits from social networks with different emphases on trust. Sociocultural narratives of mistrust, particularly gender-specific perspectives can enrich refugee discourses and challenge established notions of trust inherent to understandings of social networks in resettlement. The findings discussed in this paper contribute to debunking the ‘myth’ of homogeneity in relation to refugee groups and demonstrate the diversity of experiences among sub-groups of refugee women. The theme of mistrust, particularly among women, is an oft-neglected aspect and requires further attention.
Understanding the Sociocultural Context of Coping for African American Family Members of Homicide Victims
Authors: Sharpe Tanya L.
Published: December 2013

The disproportionate representation of African American survivors of homicide victims places them at greater risk for compromised mental health. However, an examination of factors that influence how this population copes with this traumatic event is absent from the literature. This article elucidates the importance of sociocultural factors that influence coping resources and strategies for African Americans surviving the homicide of a loved one. A socioculturally responsive model of coping is presented that can be utilized in furthering the development of research and practice that is culturally responsive to the needs of African American survivors of homicide victims.
New Balance
Authors: Richardson Laurel
Published: December 2013

In this ethnography, I report a shopping experience in Florence, Italy, and use it as an exemplar of cultural syncretism. Although I use poetic devices (such as alliteration, repetition, and assonance) to usher the reader into the experience, the experience happened as I have written it.
Cognitive Dysfunction and Age-Related Macular Degeneration
Authors: Rozzini Luca , Riva Maddalena , Ghilardi Nausica , Facchinetti Paola , Forbice Eliana , Semeraro Francesco , Padovani Alessandro
Published: December 2013

Several previous studies showed that age-related macular degeneration (AMD) and Alzheimer’s disease (AD) share common risk factors and histopathology changes, and there is epidemiological evidence linking AMD to cognitive impairment. We tested this theory in 51 patients with late-stage AMD and 24 controls by analyzing their neuropsychological profiles. In this study, data showed that patients affected by late-stage AMD have a worse global cognitive function than those of the controls and, in particular, show worse performances in memory tasks. Moreover, patients affected by the dry form of AMD are significantly impaired in executive functions in addition to memory. Data support the hypothesis of a possible association between AMD and cognitive impairment. In particular, patients affected by the dry form of AMD may be at greater risk of developing subsequent dementia.
Neuropsychological Factors Related to College Ice Hockey Concussions
Authors: Pedersen Heather A. , Ferraro F. Richard , Himle Michael , Schultz Caitlin , Poolman Mark
Published: December 2013

We analyzed data from 74 male collegiate hockey players. Each athlete’s season began with a baseline administration of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neuropsychology test battery. Fourteen athletes sustained a sport-related head injury and were readministered the test to assess the impact of the injury. A significant decrease in performance (compared to baseline) on immediate and delayed word recall and designs followed the first concussion. Following a second sport-related concussion, the 4 affected athletes showed significant decrease in visual motor speed. Performance improved on 2 response speed measures ( Ps < .01). More errors occurred during a visual processing/discrimination task and immediate recall of designs declined ( Ps < .05). We discuss the results in light of recent work related to the impact of early-life concussions and head injury on late-life consequences, such as chronic traumatic encephalopathy, and more immediate issues such as return-to-play decisions for athletes.
Apolipoprotein E Alleles in Cuban Patients With Mild Cognitive Impairment
Authors: Suárez Viana Manrique , Fernández Yuriem , López Elena del Carmen Ruiz , Clarke David Higginson , Bobes Maria Antonieta , Riverón Ana Maria , López-Cánovas Lilia
Published: December 2013

Background:

Apolipoprotein E (ApoE) ∊4 genotype is the most clearly documented risk factor for Alzheimer’s disease (AD). Epidemiological studies demonstrate an accelerated rate of progression to dementia and AD in patients with mild cognitive impairment (MCI). We assessed the ApoE allele and genotypes frequencies in Cuban patients with MCI.

Methods:

We performed ApoE genotyping of 74 Cuban patients more than 65 years old. Cognitive assessments included the Mini-Mental State Examination (MMSE) and a cognitive battery for evaluating memory, attention, perception, and executive function.

Results:

Cognitive impairments were characterized by amnesia and executive deficits in patients with MCI. The Apo ∊4 allele frequency was 0.196 in patients with MCI, 10-fold higher than that in the controls. Patients carrying the ∊4 allele exhibited poorer performance in MMSE and tests assessing executive function and short-term memory than noncarriers.

Conclusions:

The patients exhibited amnestic MCI multiple domains. Cognitive performance was worse in patients who carried the ApoE ∊4 allele.
Mild Cognitive Impairment
Authors: Ghosh Sayantani , Libon David , Lippa Carol
Published: December 2013

Mild cognitive impairment (MCI) is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types—amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of MCI is mostly clinical and is aided by various scales and neuropsychological testing. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Although there is no evidence supporting any pharmacological intervention, cognitive rehabilitation, memory training, and caregiver support play a strong role in limiting and sometimes reversing the ongoing cognitive decline. As the spectrum of MCI is heterogeneous, making the right diagnosis can be a challenging; hence, we need a systematic yet cost-effective algorithm for the timely management of MCI.
Social Representation of Dementia and Its Influence on the Search for Early Care by Family Member Caregivers
Authors: Juárez-Cedillo Teresa , Jarillo-Soto Edgar C. , Rosas-Carrasco Oscar
Published: December 2013

Introduction:

Social representations (SRs) contain 3 dimensions: information, attitude, and field. These affect the recognition of the first symptoms of dementia by the patient’s caregiver. This study focused on the period from the first signs of cognitive difficulties to the diagnosis of dementia.

Methods:

Eight caregivers of elderly patients with dementia were interviewed to construct their SRs regarding dementia and how this influences seeking medical treatment during the first stages of the disease. Social representations were analyzed through a structural focus, based on the content analysis.

Results:

Decision making is related to knowledge about dementia, attitude (emotions and sensitivity), and the concept of the caregiver about the relative with dementia. The results confirm the importance of the symbolic dimension of personal experience in managing care and seeking medical treatment.

Conclusion:

The presence of dementia in the family creates interpersonal dilemmas that caregivers experience. The solutions are framed in the sociocultural context.