bluuebunny/crossref_metadata_2025 huggingface dataset:
Positioning Historical Trauma Theory within Aotearoa new Zealand
Authors: Pihama Leonie , Reynolds Paul , Smith Cherryl , Reid John , Smith Linda Tuhiwai , Nana Rihi Te
Published: February 2017

This article explores the relevance of historical trauma theory for Māori research. In exploring the impact of historical trauma upon Māori it has become clear that the terminology associated with historical trauma theory is considered controversial in Aotearoa New Zealand. As such, this article provides an overview of key definitions relevant to historical trauma and explores these in relation to recent reporting related to the use of the terms “holocaust” and “genocide” in the context of colonization in Aotearoa New Zealand. It is argued that in order to engage fully with the impacts of colonization on Māori wellbeing we must articulate fully the impact of historical trauma events and the contribution of those events to the negative health disparities experienced by many of our whānau (extended family), hapū (sub-tribes) and iwi (tribes).
Seeking Reform of Indigenous Education in Canada: Democratic progress or democratic colonialism?
Authors: Wotherspoon Terry
Published: February 2017

After several decades of calls for action, overall levels of educational participation and attainment among indigenous people remain much lower than those for Canadians as a whole. Beginning with an overview of recent educational trends, this paper seeks to understand why educational visions expressed by indigenous people several decades ago remain unfulfilled. Focusing on recent federal government legislation for First Nations education, the analysis highlights how government policies and public discourses frequently exclude and undermine indigenous people and their rights despite constitutional recognition of indigenous status within a liberal democratic context. These processes of “democratic colonization”, as the emergence of alternative movements such as Idle No More has made evident, reveal the continuing impact of colonization on indigenous people and their lands and communities, reinforced through many of the kinds of government policies, practices and public opinions around which the movement initially coalesced. This paper explores the various factors that facilitate and impede educational reform within this social context.
Lessons for Collaboration Involving Traditional Knowledge and Environmental Governance in Ontario, Canada
Authors: Mcgregor Deborah
Published: February 2017

Efforts to incorporate Aboriginal traditional knowledge (TK) into environmental governance regimes in Ontario continue to evolve in urgency, scope and complexity. Both Indigenous and non-Indigenous parties have an interest in seeing such undertakings succeed, and yet errors in implementation continue to derail initiatives on a far too frequent basis. A brief look at the impetus behind current initiatives is provided, followed by highlights of some of the reasons why Aboriginal groups remain cautious in their interactions with outside agencies wishing to utilize and potentially exploit their knowledge. As well, reasons are offered as to why Indigenous peoples continue to see the sharing of TK as necessary in the move towards achieving global sustainability. Finally, lessons from two Ontario examples of attempts at government–First Nation collaboration are presented. Key among these is the finding that early, ongoing and mutually beneficial relationship-building between involved parties is essential to project success.
In Conversation with Uncle Lewis: Bushfires, weather-makers, collective management
Authors: O'brien Lewis , Watson Irene
Published: February 2017

Indigenous knowledge in relation to bushfires has been largely overlooked in Australia. In this paper Uncle Lewis O'Brien, Kaurna elder and Chief Investigator of the Australian Research Council (ARC) project Indigenous Knowledge: Water Sustainability and Wild Fire Mitigation, is “yarning” or in conversation with Irene Watson. The ARC project is working towards positioning an Indigenous philosophical standpoint that will bring a greater focus to Indigenous understandings of our natural world and the relationship between humans and the natural world, particularly in an era of climate change. In this conversation Uncle Lewis O'Brien points to the limitations of Western understandings of environmental management—and in particular the prevention of bushfires—from an Indigenous knowledges standpoint. It is a conversation about the philosophical positions Indigenous peoples have also deployed in our struggle to outlive colonialism, while also remaining open to sharing Indigenous knowledges that have been shared amongst First Nations for thousands of years.
Perceptions of Landscape and the Interplay between Rainfall and Vegetation
Authors: Boland John
Published: February 2017

People's views of landscape can have significant impact on their land use choices. This in turn can have climate implications. In the literature, there is significant attention paid to the effect of climate on landscape, but as well, there are more examples than one might expect of the effects of landscape change on climate. I present evidence of this from Western Australia and Africa, and some conjectured negative and positive effects in two locations in South Australia. I argue that the land use change affecting the landscape and thus affecting the climate emanates from one's view of landscape. There are also some personal reflections of perceptions of landscape from someone who started life in a climate and landscape far removed from the South Australian environment within which he has chosen to live.
Older Men Gardening on the Marae: Everyday practices for being Māori
Authors: King Pita , Hodgetts Darrin , Rua Mohi , Whetu Tiniwai Te
Published: February 2017

Like indigenous peoples globally, Māori are over-represented among the homeless population due to processes of colonialism, disruptions and continued socio-economic marginalization. This article explores how, through gardening and other everyday practices, a group of older Māori men who are homeless find respite, reconnection, a sense of belonging, and remember Māori ways of being. We consider how the regular participation of these men also contributes to the reconciliation of the marae (communal complex used for everyday Māori life) space that has been reclaimed by Ngāti Whātua (local Auckland tribe) after a lengthy hiatus. Our analysis foregrounds the importance of core values of manaakitanga (care for others), whanaungatanga (relationships based on shared experience or kinship) and wairuatanga (spirituality) for responses to Māori homelessness.
The Experiences of Indigenous Health Workers Enrolled in a Bachelor of Nursing at a Regional Australian University
Authors: Stuart Lynne , Gorman Don
Published: February 2017

In Australia, the Indigenous health workforce is in urgent need of Indigenous health professionals with credible qualifications in higher education that they can draw upon when attempting to influence government policies and health strategies. One way that this can be addressed is by Indigenous health workers gaining a Bachelor of Nursing degree. This paper reports on a study that focused on the experiences of Indigenous health workers, and how they have met and overcome significant and specific challenges in higher education to become registered nurses. The active involvement of five Indigenous health worker participants is described and their experiences discussed in relation to cross-cultural awareness; financial, cultural, academic, family and peer support; stress factors; staying motivated; and the many and varied issues that impact on confidence levels. The paper provides a number of recommendations for improving the student support mechanisms for Indigenous health workers to overcome barriers to successfully participating in, and graduating from, higher education degree courses.
E-Whanaungatanga: The role of social media in Māori political empowerment
Authors: Waitoa Joanne , Scheyvens Regina , Warren Te Rina
Published: February 2017

Lower voter turnout and lack of political empowerment sees Māori engaging less than Pākehā (European New Zealanders) with the political system to the detriment of Māori development. This paper explores the potential of social media to enhance Māori development via political engagement. Mana Party Facebook pages are used as a case study to investigate if social media can encourage Māori political awareness and participation. Results found that social media has both positive and negative implications for political engagement and indigenous development. While social media aligns with tikanga Māori (values/customs) through tino rangatiratanga (self-determination) and whanaungatanga (relationships/networks), other aspects such as cultural misappropriation conflict with Māori values. The paper explores tensions in the use of social media for political engagement among indigenous peoples and offers a framework promoting e-whanaungatanga to illustrate how they might use social media in a way that emphasizes the positive and mitigates the negative aspects of the platform.
Using Twitter in an Indigenous Language: An analysis of te reo Māori tweets
Authors: Keegan Te Taka , Mato Paora , Ruru Stacey
Published: February 2017

Language revitalization theory suggests that one way to improve the health of a language is to increase the number of domains where the language is used. Social network platforms provide a variety of domains where indigenous-language communities are able to communicate in their own languages. Although the capability exists, is social networking being used by indigenous-language communities? This paper reports on one particular social networking platform, Twitter, by using two separate methodologies. First, Twitter statistics collated from the Indigenous Tweets website are analysed. The data show that languages such as Basque, Haitian Creole, Welsh, Irish Gaelic, Frisian and Kapampangan do have a presence in the “Twittersphere”. Further analysis for te reo Māori (the Māori language) shows that tweets in te reo Māori are rising and peak when certain events occur. The second methodology involved gathering empirical data by tweeting in te reo Māori. This served two purposes: it allowed an ancillary check on the validity of the Indigenous Tweets data and it allowed the opportunity to determine if the number of indigenous-language tweets could be influenced by the actions of one tweeter.
It's in Our Blood: Indigenous women's knowledge as a critical path to women's well-being
Authors: Gaudet Janice Cindy , Caron-Bourbonnais Diane
Published: February 2017

The research reported in this article sought to shed light on the North, Central and South American indigenous moon time teachings related to the menstrual cycle of women. The historical institutionalization, medicalization and colonization of indigenous women's practices have devalued and almost destroyed this knowledge. This study explored the question of whether or not lost indigenous knowledge of women's power can be reclaimed for women's health and well-being. A qualitative participatory research methodology was adopted, based on an indigenous paradigm and scholarly rigour and including protocols acceptable to an Ojibwe grandmother, Isabelle Meawasige, who shared her knowledge and experience. The experiential knowledge gained and the meanings expressed by female participants in a circle sharing facilitated by the principal author are presented and discussed. The results of this research reveal optimistic possibilities to co-create health and well-being for the participants, grounded in what is both visible and invisible within indigenous women's culture.
Examining the Relationship between Attachment Styles and Resilience Levels among Aboriginal Adolescents in Canada
Authors: Sam Johanna , Ghosh Hasu , Richardson Chris G.
Published: February 2017

The history of colonization in Canada has a traumatic intergenerational impact on young Aboriginal people's health, which is evidenced by the wide health disparities (Adelson, 2005; Health Council of Canada, 2012). However, extant research shows that, through resilience, many Aboriginal adolescents overcome adverse situations and develop into healthy adults (Andersson & Ledogar, 2008). Knowledge of the ways and extent to which Aboriginal youth seek support to cope with stressful events may be improved by examining the distribution of attachment styles and their relationship with resilience. The data (n = 136) used for this study were obtained from the British Columbia Adolescent Substance Use Survey. Findings indicate resiliency was significantly associated with attachment style (p < .01). The study findings provide support for tailoring resilience mental health promotion and intervention resources according to attachment style to foster long-term engagement in programming that helps Aboriginal youth live a healthy and holistically balanced life.
Negotiating Indigenous Modernity: Kungun Ngarrindjeri Yunnan—Listen to Ngarrindjeri speak
Authors: Rigney Daryle , Bignall Simone , Hemming Steve
Published: February 2017

The objective of this article is to compare Indigenous and Western modernities by examining how contemporary Indigenous polities are finding inventive ways to assert their sovereignty. Our discussion presents an innovation in Indigenous governance introduced recently by the Ngarrindjeri people in Southern Australia. We explain the conditions in which Ngarrindjeri initiated their process of political reformation; we link our analysis to critiques of Western modernism and imperialism; and we then outline some key political technologies created by the Ngarrindjeri Nation to enable its successful influence in matters affecting their Country and community. We find that these resources remain firmly grounded in Ngarrindjeri ways of knowing, being and doing, yet they are expressed in a contemporary hybrid form that is accessible to non-Indigenous negotiation partners. As a consequence, they have established a modern Indigenous framework for intercultural negotiation of interests previously controlled by the South Australian state and other non-Indigenous organizations.
Indigenous Social Media Practices in Southwestern Amazonia
Authors: Virtanen Pirjo Kristiina
Published: February 2017

This article discusses how the use of social media fosters, motivates, and regulates social relations among the Arawakan-and Panoan-speaking indigenous groups in the state of Acre and the southern part of the state of Amazonas, Brazil, where even the smallest towns have recently received high-speed internet connections. The research this article is based on analyzed what motivates indigenous social media users in Amazonian Brazil. I have gathered ethnographic data over a number of fieldwork trips since 2003 and followed indigenous Facebook users since 2009. The article shows how social networking sites have become a powerful tool for (re)producing relationships and social economies. It looks at what social networking sites offer for indigenous people and how they impact and alter their social relationships. The findings suggest that social networking sites are generating new reflections on Amazonian indigenous traditions and knowledge, and changing the way indigenous Amazonians relate to the outside world.
Strengthening Our Voices: Urban-dwelling Aboriginal people and research protocols
Authors: Lawless Jo-Anne
Published: February 2017

The study of Indigenous peoples and their cultures has in the past raised serious ethical questions within the academic sphere as well as in the Aboriginal community. This paper examines culturally appropriate and sensitive research ethics within urban Aboriginal communities in Canada, through the lens of the research guideline of Ownership, Control, Access and Possession, and the more recent Utility, Self-Voicing, Access and Inter-relationality framework created by the Ontario Federation of Indigenous Friendship Centres. Ethically sound research by and for Aboriginal peoples continues to advance, and this paper's findings underscore the ability of urban Indigenous communities to create, gather and interpret their own data using frameworks that recognize their skill and autonomy.
Shared Decision Making with Aboriginal Women Facing Health Decisions: A qualitative study identifying needs, supports, and barriers
Authors: Jull Janet , Giles Audrey , Boyer Yvonne , Lodge Minwaashin , Stacey Dawn
Published: February 2017

Shared decision making (SDM) may narrow health equity gaps by engaging clients with their health care providers in decision making; little is known about SDM interventions with Aboriginal people. This study describes the health decision-making experiences of Aboriginal women by identifying decision needs, supports, and barriers. An interpretive descriptive qualitative study was conducted from January to June 2013 with an advisory group using a mutually developed ethical framework, participatory research principles, and postcolonial theory. Aboriginal women at Minwaashin Lodge were interviewed in semi-structured interviews and transcripts were coded using thematic analysis. Participants were 13 women between 20 and 70 years of age, and of Inuit, Métis, or First Nations descent. SDM needs and supports are represented by themes focused on relational features of SDM, and presented in a Medicine Wheel framework. Findings indicate that to be relevant for Aboriginal women, SDM tools and approaches may need to be adapted, and participatory approaches must be used.
Machining analysis of unidirectional and bi-directional flax-epoxy composite laminates
Authors: Delahaigue J , Chatelain J-F , Lebrun G
Published: February 2017

Natural fibers, and more particularly, flax fibers, have a considerable potential as replacements for synthetic fibers. These fibers are of significant economic and environmental interest because they are natural products, are biodegradable, and unlike synthetic fibers, are entirely recyclable. They are also less expensive than synthetic fibers, less abrasive for machining, and their specific properties (strength-to-weight ratio) are comparable to those of glass fibers. Consequently, they thus provide economic and environmental benefits for companies. Unfortunately, machining knowledge with respect to this kind of material is low, and research in this domain has barely begun. The objective of this study is to describe the machinability of unidirectional and bidirectional flax/epoxy composites and to analyze the influence of cutting parameters and fiber orientation on cutting forces and surface finish. Milling tests were performed on unidirectional composite laminates with two different tools. The results show that the surface finish and cutting forces depend largely on the feed rate, and to a lesser extent, on the cutting speed. The PCD cutting tool, with a zero helix angle, showed the best performances as compared to the CVD cutting tool, which had a different geometry. The former provided a better surface finish, a lower delamination factor, and lower cutting forces. The material was found to be easy to machine and low abrasive, since no tool wear was observed following the cutting tests. Finally, it was found that an intermediate feed rate value and a high cutting speed were the best of all parameters tested for achieving a low cutting force level, low surface roughness, and high throughput.
Association of seven renin angiotensin system gene polymorphisms with restenosis in patients following coronary stenting
Authors: Zhu Min , Yang Minjun , Lin Jiangbo , Zhu Huanhuan , Lu Yifei , Wang Bing , Xue Yinshen , Fang Congfeng , Tang Lijiang , Xu Baohui , Jiang Jianjun , Chen Xiaofeng
Published: February 2017

Background and objective:

Percutaneous coronary intervention, despite being effective for coronary revascularization, causes in-stent restenosis due to neointimal hyperplasia in a large number of patients. The renin-angiotensin system is involved in neointimal hyperplasia. This study sought to evaluate seven gene polymorphisms of key renin-angiotensin system components, including angiotensinogen, angiotensin-converting enzyme and angiotensin II type 1a receptors, and their associations with in-stent restenosis in patients with coronary artery disease following coronary stenting.

Methods and results:

Three hundred and fifty-two patients undergoing coronary drug-eluting stent implantation were recruited. Seventy-five patients (21.3%) were diagnosed as restenosis by angiography. Genotyping for angiotensin-converting enzyme insertion/deletion demonstrated a significant association of angiotensin-converting enzyme DD genotype with the occurrence of restenosis. Direct DNA sequencing revealed no association of angiotensinogen (M235T, G217A, G152A, G-6A, and A-20C) or angiotensin II type I receptor A1166C polymorphisms with in-stent restenosis. However, angiotensin II type 1a A1166C polymorphism was significantly associated with increased susceptibility to restenosis in a subgroup of patients aged more than 60 years.

Conclusion:

Thus, our study suggests that genetic polymorphisms of angiotensin-converting enzyme insertion/deletion are associated with in-stent restenosis in coronary artery disease patients following coronary stenting.
The Three Waves of Anti-Austerity Protest in Greece, 2010–2015
Authors: Karyotis Georgios , Rüdig Wolfgang
Published: February 2017

The apparent ubiquity of protest in recent years and the rise of Occupy movements across the world have fuelled claims that a new style of mobilisation is emerging which is markedly different from previous social movements. Analysing a series of original survey data, this article engages with this debate by providing a panoramic account of how the anti-austerity movement evolved in Greece, comparing the drivers of protest in three distinct protest waves. Contrary to expectations, the rise of the Greek version of the Indignados during 2011 did not decisively transform the anti-austerity movement that emerged in 2010, which mainly displayed characteristics typically associated with ‘old’ social movements. However, elements of the ‘new social movements’ approach featured more prominently in the third wave of protest, beginning in mid-2012 and culminating in January 2015 with victory for SYRIZA, the party which channelled the anti-austerity movement into the political scene. The model developed to study protest in non-electoral arenas also performs well to explain the success of SYRIZA in the electoral arena, highlighting the reciprocal but understudied relationship between mobilisation and electoral politics.
Needs of a Silent Minority: Mexican Transgender Asylum Seekers
Authors: Gowin Mary , Taylor E. Laurette , Dunnington Jamie , Alshuwaiyer Ghadah , Cheney Marshall K.
Published: February 2017

Mexican male to female transgender asylum seekers in the United States suffer from serious health issues that can be attributed to stressors related to their transgender, ethnic minority, and socioeconomic status. This study explored these stressors, the resulting health issues, and the needs of this particularly vulnerable population. Asylum seekers’ (n = 45) sworn declarations and psychological evaluations were examined by a multidisciplinary research team using a systematic document review process. The review identified stressors that occurred both in Mexico and the United States: verbal, physical, and sexual assaults; unstable environments; fear for safety/security; hiding undocumented status; and economic insecurity. The health issues that resulted in part from these stressors include posttraumatic stress disorder, depression, anxiety, sleep issues, isolation, avoidance, drug/alcohol use, and suicidal tendencies. Despite suffering from multiple health issues, asylum seekers rarely sought health or social services. Health promotion practitioners can play an important role in serving this silent minority by (1) expanding community-based research focused on the intersection of transgender, ethnic minority, and socioeconomic status; (2) using trusted community members to connect this population to necessary resources; (3) providing communication training/resource development for health care providers; and (4) creating a network of service organizations that understand the needs of transgender asylum seekers.
A computational study on gas–liquid flow in a lime slurry pond equipped with a rotary jet mixing system
Authors: Qu Yanpeng , Zhou Cheng , Zhong Yunpan , Chen Songying , Wang Ruiyan
Published: February 2017

The flue-gas desulfurization model was studied through computational fluid dynamics software. The oxidation air was asymmetrically pumped into the slurry pond. A rotary jet mixing system was established at the bottom center of the pond to agitate the lime slurry. The Navier–Stokes equation as the control equation, the standard k–ε turbulence model, sliding grids structure, and three-dimensional Eulerian multiphase flow of lime slurry were used for the numerical simulation. The independence of the meshes and the time step was verified. The distribution of the concentration of oxidation air and influents on the velocity of flow was analyzed with five angular velocities (0.01, 0.10, 0.20, 0.50, and 1 rad/s) for the rotary jet mixing. The simulation results showed that the angular velocity has a great influence on the velocity of the slurry and the distribution of the oxidation air.
Multi-stage nozzle-shape optimization for pulsed hydrogen–air detonation combustor
Authors: Ornano Francesco , Braun James , Saracoglu Bayindir Huseyin , Paniagua Guillermo
Published: February 2017

Thermal engines based on pressure gain combustion offer new opportunities to generate thrust with enhanced efficiency and relatively simple machinery. The sudden expansion of detonation products from a single-opening tube yields thrust, although this is suboptimal. In this article, we present the complete design optimization strategy for nozzles exposed to detonation pulses, combining unsteady Reynolds-averaged Navier–Stokes solvers with the accurate modeling of the combustion process. The parameterized shape of the nozzle is optimized using a differential evolution algorithm to maximize the force at the nozzle exhaust. The design of experiments begins with a first optimization considering steady-flow conditions, subsequently followed by a refined optimization for transient supersonic flow pulse. Finally, the optimized nozzle performance is assessed in three dimensions with unsteady Reynolds-averaged Navier–Stokes capturing the deflagration-to-detonation transition of a stoichiometric, premixed hydrogen–air mixture. The optimized nozzle can deliver 80% more thrust than a standard detonation tube and about 2% more than the optimized results assuming steady-flow operation. This study proposes a new multi-fidelity approach to optimize the design of nozzles exposed to transient operation, instead of the traditional methods proposed for steady-flow operation.
A new model for reliability design and reliability sensitivity analysis of a hydraulic piston pump
Authors: Zhang Tianxiao , Zhang Yimin
Published: February 2017

Research on the reliability of a hydraulic piston pump is still uncertain. In this article, the matrix random moment method for reliability design was deduced according to vector algebra theory, the reliability design model of friction pairs (the specific work of friction pairs was set as the state function) was established, and a new reliability analysis method was provided for hydraulic equipment. In addition, the variable relational expression of digital characteristics of state function of slipper and swash-plate friction pairs and digital characteristics of random variable was modified into a matrix relational expression to simplify the calculation procedures, and reliability sensitivity information of the slipper and swash-plate friction pairs was obtained based on simulation and contrasted the results with the results from the Monte Carlo method to provide the influence rule and relation curve of the change of design parameters on reliability of slipper and swash-plate friction pairs. The calculation of reliability design and reliability sensitivity analysis of the slipper and swash-plate friction pairs was solved according to computer programmes, thereby providing the theoretical basis for reliability design and reliability sensitivity analysis for slipper and swash-plate friction pairs of hydraulic piston pump.
A systems approach to risk analysis of maritime operations
Authors: Rokseth Børge , Utne Ingrid Bouwer , Vinnem Jan Erik
Published: February 2017

Technological innovations and new areas of application introduce new challenges related to safety and control of risk in the maritime industry. Dynamically positioned systems are increasingly used, contributing to a higher level of autonomy and complexity aboard maritime vessels. Currently, risk assessment and verification of dynamically positioned systems are focused on technical reliability, and the main effort is centered on design and demonstration of redundancy in order to protect against component failures. In this article, we argue that factors, such as software-requirement errors, human errors, including unsafe or too late decision-making, and inadequate coordination between decision makers, also should be considered in the risk assessments. Hence, we investigate the feasibility of using a systems approach to analyzing risk in dynamically positioned systems and present an adapted version of the system-theoretic process analysis. A case study where the system-theoretic process analysis is applied to a dynamically positioned system is conducted to assess whether this method significantly expands the current view on safety of dynamically positioned systems. The results indicate that the reliability-centered approaches, such as the failure mode and effect analysis, sea trials, and hardware-in-the-loop testing, are insufficient and that their view on safety is too narrow. This article shows that safety constraints can be violated in a number of manners other than component failures for dynamically positioned systems, and hence, system-theoretic process analysis complements the currently applied methods.
Dynamic assessment of the wrist after total wrist arthroplasty
Authors: Singh H.P. , Bhattacharjee D. , Dias J.J. , Trail I.
Published: February 2017

Our aim was to assess the outcome in patients with total wrist arthroplasty performed for end stage wrist osteoarthritis. We analysed the ranges of motion of operated and un-operated wrists using a flexible electrogoniometer during the Sollerman hand function test. We assessed grip strength with a digital dynamometer and completed patient reported outcome scores more than one year post-operatively. We reviewed 12 patients with a mean age of 64 (range 48–82) years. The flexion-extension arc was 72% and radioulnar deviation arc was 53% of the un-operated side but the total range of motion (area of circumduction) was 43% of the un-operated side and only 20% of the circumduction in age and gender-matched normal volunteers. Peak grip strength was 68% of the un-operated side. The patients reported good outcome with mean Michigan Hand Questionnaire (MHQ) scores of 56 (range 25–84) and mean Patient Evaluation Measure (PEM) scores of 39 (range 20–68). Patients completed the activities of Sollerman hand function test in twice the time (6 min) as required for a normal volunteer (2.8 min). The circumduction ellipses were narrow and central with limited radio-ulnar deviation and small mean areas of motion during activities of daily living.
Comparison of Postoperative Outcomes in Elderly Patients With a Do-Not-Resuscitate Order Undergoing Elective and Nonelective Hip Surgery
Authors: Beverly Anair , Brovman Ethan Y. , Urman Richard D.
Published: February 2017

Purpose:

Emergency hip surgery generally has worse outcomes than elective hip surgery, even when adjusted for patient and surgical factors. Do-not-resuscitate (DNR) status patients are typically at higher perioperative risk and undergo a narrow range of surgical procedures. We aimed to compare the outcomes after hip surgery of differing degrees of urgency in this cohort.

Materials and Methods:

Using National Surgical Quality Improvement Program (NSQIP) data, we conducted univariate and multivariate analyses comparing outcomes of DNR status patients after emergency and nonemergency hip surgery (2007-2013). We conducted a subanalysis of mortality in elective versus nonelective cases (elective variable introduced from 2011).

Results:

Of 668 hip surgery cases in DNR status patients, 210 (31.4%) were emergency and 458 (68.8%) were nonemergency. There were no significant associations between emergency and nonemergency surgery regarding patient demographics, comorbidities, functional capacity, anesthesia type, or operative duration. There was no significant difference in the 30-day postoperative mortality between emergency (21.4%) and nonemergency (16.4%) or between elective (19.6%) and nonelective (18.3%) hip fracture surgeries performed in patients with preexisting DNR status. Morbidity patterns in emergency vs nonemergency cases demonstrated no significant differences, with the commonest 3 complications being transfusion (21.0% and 21.4%, respectively), urinary tract infection (9.5% and 7.9%, respectively), and pneumonia (both at 5.2%). The 30-day home discharge rates were low at 4.7% and 5.6%, respectively. Multivariate analysis demonstrated no significant associations between emergency and nonemergency surgery for mortality, discharge destination, length of stay or complications, except perioperative myocardial infarction (3.7% vs 1.3%, P < .04).

Conclusion:

For patients with DNR status, both emergent and non-emergent hip surgery carries high mortality, greatly exceeding rates predicted for that patient by American College of Surgeons NSQIP risk calculators. Morbidity rates and patterns for patients with DNR status are also similar in emergency and nonemergency groups. These data may be useful in discussing risk and obtaining adequately informed consent in DNR patients undergoing hip surgery.
The Benefits of Streamlined Hip Fracture Management in a Regional Hospital
Authors: Mow T. C. , Lukeis Jen , Sutherland A. G.
Published: February 2017

Introduction:

Hip fracture is an increasingly common injury in the growing elderly population. The morbidity and mortality associated with this injury can be reduced by minimizing delays to surgical treatment. We describe the impact of a regional hospital service redesign project that utilized the principles of smart simplicity, a management strategy that lays emphasis on collaboration to achieve desired goals.

Methods:

Prior to the redesign, patients with hip fractures were taking an average of 72 hours for surgical treatment. A hip fracture working group was created to examine closely the process of hip fracture care, and a single key performance indicator (KPI) of “surgery within 48 hours” was adopted. This allowed identification of processes that could be clarified and streamlined, with the agreement of relevant stakeholders, in the creation of a new hip fracture pathway.

Results:

In the first 3 months of the pathway’s implementation, 16 of 18 patients had surgery within 48 hours of presentation. In a 6-month follow-up audit after 2 years of implementation, 36 of 39 patients were treated within 48 hours. This was significantly different to the time to surgery seen in the 12 months prior to the redesign ( P < .001, Student t test). The mean time to surgery was reduced from 72 hours to 36 hours, a saving in an annual acute bed stay cost of A$152 000.

Discussion:

Decreased time to the operating room, the cost savings inherent to this, can be achieved with the introduction of the best standard of care. A redesign that mandates collaboration in achieving a single KPI has allowed a significant culture shift in the treatment of hip fractures in our institution in the months following its institution.

Conclusion:

Collaborative, multidisciplinary collaboration has facilitated a higher standard of care and demonstrated significant cost benefit.
Enteral Administration of Twice-Daily Dolutegravir and Rilpivirine as a Part of a Triple-Therapy Regimen in a Critically Ill Patient with HIV
Authors: Turley Sarah Lynn , Fulco Patricia Pecora
Published: February 2017

The administration of antiretroviral therapy (ART) in intubated critically ill patients may be challenging. Limited pharmacokinetic data exist characterizing the effects of crushed ART with subsequent enteral administration on antiretroviral drug concentrations or the clinical impact on HIV virologic suppression. We report a case of a 27-year-old HIV-positive male with presumed multidrug-resistant HIV and a diagnosis of lymphoma who required enteral ART administration after intensive care unit admission. Crushed twice-daily dolutegravir (separated from enteral nutrition by 2 hours) and rilpivirine (concurrently with a bolus feed) were administered via an orogastric tube. Therapeutic drug monitoring for both dolutegravir and rilpivirine demonstrated antiretroviral absorption via the enteral route (both values slightly below the therapeutic laboratory reference range) with continued virologic suppression.
A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States
Authors: Goswami Neela D. , Colasanti Jonathan , Khoubian Jonathan J. , Huang Yijian , Armstrong Wendy S. , del Rio Carlos
Published: February 2017

Prompt antiretroviral therapy (ART) initiation after AIDS diagnosis, in the absence of certain opportunistic infections such as tuberculosis and cryptococcal meningitis, delays disease progression and death, but system barriers to inpatient ART initiation at large hospitals in the era of modern ART have been less studied. We reviewed hospitalizations for persons newly diagnosed with AIDS at Grady Memorial Hospital in Atlanta, Georgia in 2011 and 2012. Individual- and system-level variables were collected. Logistic regression models were used to estimate the odds ratios (ORs) for ART initiation prior to discharge. With Georgia Department of Health surveillance data, we estimated time to first clinic visit, ART initiation, and viral suppression. In the study population (n = 81), ART was initiated prior to discharge in 10 (12%) patients. Shorter hospital stay was significantly associated with lack of ART initiation at the time of HIV diagnosis (8 versus 24 days, OR: 1.14, 95% confidence interval: 1.04-1.25). Reducing barriers to ART initiation for newly diagnosed HIV-positive patients with short hospital stays may improve time to viral suppression.
Visceral Hyperalgesia
Authors: Asaro Joseph , Robinson Christine A. , Levy Philip T.
Published: February 2017

Visceral hyperalgesia refers to increased pain sensation in response to gastrointestinal sensory stimulus. In neonates with neurological impairments, gabapentin has been successfully used as a treatment for visceral hyperalgesia in neonates. The authors describe a preterm infant with myelomeningocele and persistent neuropathic pain that manifested as irritability, hypertonicity, poor weight gain, and feeding intolerance. After exclusion of other etiologies, the diagnosis of visceral hyperalgesia was suspected and the infant was treated with gabapentin. Following appropriate titration to effect and close monitoring of side effects of gabapentin, he subsequently demonstrated improved tone, decreased irritability with feedings, and appropriate weight gain. In addition, the authors provide a review of the available literature of gabapentin use in neonates and offer suggestions on when to consider starting gabapentin in a neonate with neurological impairment and chronic unexplained gastrointestinal manifestations.
Mathematics Curriculum Effects on Student Achievement in California
Authors: Koedel Cory , Li Diyi , Polikoff Morgan S. , Hardaway Tenice , Wrabel Stephani L.
Published: February 2017

We estimate relative achievement effects of the four most commonly adopted elementary mathematics textbooks in the fall of 2008 and fall of 2009 in California. Our findings indicate that one book, Houghton Mifflin’s California Math, is more effective than the other three, raising student achievement by 0.05 to 0.08 student-level standard deviations of the Grade 3 state standardized math test. We also estimate positive effects of California Math relative to the other textbooks in higher elementary grades. The differential effect of California Math is educationally meaningful, particularly given that it is a schoolwide effect and can be had at what is effectively zero marginal cost.
Environmentally benign Fe(III)–montmorillonite for rapid adsorption of methylene blue dye in aqueous medium under ambient conditions
Authors: Vinuth M. , Naik H. S. Bhojya , Mahadevaswamy M. M. , Prabhakara M. C.
Published: February 2017

Herein we have explored the highly efficient and environmentally benign clay mineral, Fe(III)–montmorillonite [Fe(III)–Mt], for adsorption of methylene blue (MB) dye from aqueous solution under ambient conditions. The Fe(III)–Mt was interacted with MB dye solution at different pH, temperature and solid-to-liquid ratio. The concentration of MB dye removal was estimated from its optical density at λmax = 665 nm using UV–Vis spectrophotometer. The MB dye removal was rapid at basic pH and increases with temperature up to 40 °C. A complete reduction (100%) was occurred in about 7 min at pH 7 and 10 while at pH 3 in about 10 min. The time taken for complete reduction at 0, 30 and 40 °C are 10, 7 and 5 min respectively. The removal followed by adsorption of dye molecules on the spent clay mineral was evident from FESEM/EDX analysis. More importantly, Fe(III)–Mt could be separated and retrieved easily after the reaction by centrifugation from the degraded MB dye solution. The experimental results of MB dye removal from Fe(III)–Mt follows the pseudo first order kinetics. This study reveals that Fe(III)–Mt has the potential to be used as reductant/adsorbant to remove cationic pollutants effectively and rapidly from drinking water and large scale of industrial wastewater.
Optimization of monochlorotriazine β-cyclodextrin grafting on cotton and assessment of release behavior of essential oils from functionalized fabric
Authors: Khanna Shelly , Chakraborty J. N.
Published: February 2017

Monochlorotriazinyl β-cyclodextrin (MCT β-CD) was employed for the inclusion complexation with oils of cedarwood, clove, eucalyptus and peppermint to assess their release behavior from functionalized cotton. The process of MCT β-CD grafting was optimized using response surface methodology with three independent factors including MCT β-CD concentration, pH and curing temperature and effect of their second order interactions on dependent variables as % nitrogen content, % graft yield, tensile strength and wash durability was examined. The interaction of MCT β-CD concentration and pH had the decisive effect on the investigated dependent variables. FTIR and % retained nitrogen confirmed the substantial retention of modified host on functionalized cotton after five vigorous wash cycles.1HNMR characterized the full entrapment of oils within MCT β-CD cavity on cotton. All the oils were substantially retained in the inclusion complexes with the MCT β-CD before and after wash than when present uncomplexed on the treated cotton. Peppermint was the slowest to fade off and cedarwood was rapid in sublimation from the cyclodextrin moieties.
The Deaf Mentoring Survey: A Community Cultural Wealth Framework for Measuring Mentoring Effectiveness with Underrepresented Students
Authors: Braun Derek C. , Gormally Cara , Clark M. Diane
Published: February 2017

Disabled individuals, women, and individuals from cultural/ethnic minorities continue to be underrepresented in science, technology, engineering, and mathematics (STEM). Research has shown that mentoring improves retention for underrepresented individuals. However, existing mentoring surveys were developed to assess the majority population, not underrepresented individuals. We describe the development of a next-generation mentoring survey built upon capital theory and critical race theory. It emphasizes community cultural wealth, thought to be instrumental to the success of individuals from minority communities. Our survey targets relationships between deaf mentees and their research mentors and includes Deaf community cultural wealth. From our results, we identified four segregating factors: Being a Scientist, which incorporated the traditional capitals; Deaf Community Capital; Asking for Accommodations; and Communication Access. Being a Scientist scores did not vary among the mentor and mentee variables that we tested. However, Deaf Community Capital, Asking for Accommodations, and Communication Access were highest when a deaf mentee was paired with a mentor who was either deaf or familiar with the Deaf community, indicating that cultural competency training should improve these aspects of mentoring for deaf mentees. This theoretical framework and survey will be useful for assessing mentoring relationships with deaf students and could be adapted for other underrepresented groups.
Efficacy of a Meiosis Learning Module Developed for the Virtual Cell Animation Collection
Authors: Goff Eric E. , Reindl Katie M. , Johnson Christina , McClean Phillip , Offerdahl Erika G. , Schroeder Noah L. , White Alan R.
Published: February 2017

Recent reports calling for change in undergraduate biology education have resulted in the redesign of many introductory biology courses. Reports on one common change to course structure, the active-learning environment, have placed an emphasis on student preparation, noting that the positive outcomes of active learning in the classroom depend greatly on how well the student prepares before class. As a possible preparatory resource, we test the efficacy of a learning module developed for the Virtual Cell Animation Collection. This module presents the concepts of meiosis in an interactive, dynamic environment that has previously been shown to facilitate learning in introductory biology students. Participants (n = 534) were enrolled in an introductory biology course and were presented the concepts of meiosis in one of two treatments: the interactive-learning module or a traditional lecture session. Analysis of student achievement shows that students who viewed the learning module as their only means of conceptual presentation scored significantly higher (d = 0.40, p < 0.001) than students who only attended a traditional lecture on the topic. Our results show the animation-based learning module effectively conveyed meiosis conceptual understanding, which suggests that it may facilitate student learning outside the classroom. Moreover, these results have implications for instructors seeking to expand their arsenal of tools for “flipping” undergraduate biology courses.
Endothelial cell activation in central nervous system inflammation
Authors: Wu Fengjiao , Liu Lixin , Zhou Hong
Published: February 2017

Leukocyte migration across the endothelial barrier plays an essential role in CNS inflammation. The migration process requires complex endothelial adhesion molecules concentrated at the junctions of endothelial cells. Recent findings suggest that cerebral endothelial cells play an active role in the pathogenesis of CNS inflammatory diseases. This review describes our current understanding of the effects of various inflammatory mediators of leukocyte migration on cerebral endothelial cells, the mechanisms underlying the leukocyte-endothelial cell interactions, and the crosstalk between endothelial cells and glial cells or platelets. These emerging mechanisms may provide new therapeutic strategies for a variety of CNS inflammatory diseases.