bluuebunny/crossref_metadata_2025 huggingface dataset:
Probing the Logic of Forgiveness, Human and Divine
Authors: Mihut Cristian
Published: July 2014

Danaher suggests that doxological justice, grounded in an acute receptivity of the generosity of God, can decenter our current notions of justice. Instead I focus on what might be called doxological forgiveness, that is, grace-responsive forgiveness. The first section argues that a conception of forgiveness which I dub repentance-responsive is compatible with and even requires holding punitive attitudes. The second section sketches the alternative account of grace-responsive forgiveness. Those who embody this virtue have epistemic and theological warrant to entirely disavow punitive emotions. The third section argues that God embodies a grace-responsive forgiveness that undermines retributivism and eclipses repentance-responsive forgiveness.
Change from Within? A Response to Ruth Armstrong’s Article
Authors: Bennett Jamie
Published: July 2014

In her fascinating paper, Ruth Armstrong offers an appreciative account of the potential for trust and change in post-prison supervision and support. This transformative potential is seen not only in prisoners, or ex-prisoners, but also within the criminal justice system and those working within the system. In this response I focus on the issue of staff and occupational cultures, drawing upon both my own experience as a prison manager and my research into the working lives of prison managers.1
Can Persistent Offenders Acquire Virtue?
Authors: Bottoms Anthony , Shapland Joanna
Published: July 2014

Most offenders, even persistent offenders, eventually desist from crime, and the fastest period of deceleration in the frequency of offending is in the early twenties. This article summarises results from a longitudinal study of desistance from or persistence in crime in this age range, illustrated by three case histories. A key finding is that, because of their deep prior engagement in crime, would-be desisters from repeat offending need to make many adjustments to their patterns of daily life. The authors explain why virtue ethics has been found to be a valuable resource in theorising these results.
Response to the Work of Professor Steiker
Authors: Mathewes Charles
Published: July 2014

This brief response to Carol Steiker’s essay asks questions about the kind of contribution Christian theologians and ethicists can make to large pluralistic debates about criminal justice, and highlights several insights that it discerns in Steiker’s argument—insights that, it argues, require a theological register and idiom to be identified, and articulated, in their proper fullness.
Replacing target setting by value models in the ‘house of quality’ for value-based requirements specifications
Authors: Zhang Xinwei , Eres Hakki , Baron Claude , Auriol Guillaume , Kossmann Mario
Published: July 2014

Setting targets for engineering characteristics is common practice in the ‘house of quality’ for establishing requirements specifications. However, if deployed arbitrarily, this practice is prone to errors and can often yield irrational results. Three potential methodological problems have been identified, regarding the setting of independent targets for each engineering characteristic, setting fixed targets and cascading down targets from the system level to the component level have been identified. In this article, targets are categorised as constraints and goals because of their different implications for value trade-offs. Then, a ‘multi-attribute utility theory’ based approach is proposed, in which a system value model is developed in order to replace the setting of targets for system engineering characteristics and component value models are further derived to replace the setting of targets for component engineering characteristics. These value models enhance the traditional approach to requirements specification so that value-based requirements specifications can be developed. A case study is deployed to demonstrate the applicability of the approach in the civilian aerospace context for the development of requirements for commercial aircraft. The benefits of the proposed approach are twofold: (1) value becomes an explicit construct and (2) value can be rationally modelled and simulated in the ‘house of quality’ in order to establish value-based requirements specifications. Furthermore, identified methodological problems in terms of setting engineering characteristic targets at any level are mitigated.
Restructuring UK local government employment relations: pay determination and employee participation in tough times
Authors: Bach Stephen , Stroleny Alexandra
Published: July 2014

The Conservative-led coalition government has been committed to shrinking the state and this has had a major impact on local government. This article examines the consequences of austerity measures for staff participation and pay determination in UK local government. Local government has been particularly hard hit by austerity measures and this has encouraged employers to change terms and conditions, review forms of staff participation and cut jobs. The implications for the institutional resilience of systems of employment regulation and employee involvement in the sector are considered.
Local government austerity policies in the Netherlands: the effectiveness of social dialogue in preserving public service employment
Authors: Weske Ulrike , Leisink Peter , Knies Eva
Published: July 2014

The financial and economic crisis has led to fiscal austerity measures and reform policies in the Netherlands that have had a direct impact on municipalities. Decreased municipal budgets have forced municipalities to cut public services and lower the employment conditions of municipal employees. It may be expected that in countries like the Netherlands, with stronger social dialogue institutions, decision-making will provide more room for effective employee participation. This study investigates whether and how social dialogue has influenced austerity policies in Dutch municipalities. The results indicate that collective bargaining at sectoral level resulted in moderate increases in nominal wages as well as support for workers who were made redundant. At the workplace level, the effectiveness of social dialogue through works councils has varied depending on the history of relationships between employers and employee representatives and their strategic approach in dealing with austerity.
The #YoSoy132 movement and the struggle for media democratization in Mexico
Authors: García Rodrigo Gómez , Treré Emiliano
Published: July 2014

In this article, we analyze through a political economy of communication lens the historical and political contexts in which the #YoSoy132 movement emerged, the concentration of Mexican media system and the possibilities offered by social media to young people, situating the issue of media democratization at the centre of the #YoSoy132 struggle. Drawing on two group and four individual interviews, we also focus on the dimension of students’ communication practices in order to provide a more nuanced evaluation of the role played by digital media inside the movement. By blending a political economy analysis with an exploration of media practices, we offer an in-depth understanding of how communication technologies were used and appropriated in order to democratize mainstream media, foster pluralism and trigger important processes related to political culture within the Mexican context. We conclude by assessing the achievements as well as the challenges of #YoSoy132.
The Biopolitics of Transnational Adoption in South Korea
Authors: Kim Hosu
Published: July 2014

This article examines several key aspects of maternity homes for ‘unwed mothers’ in order to understand the overwhelming phenomenon of single mothers giving up their babies for adoption in South Korea and its naturalization as a common practice. Drawing upon Foucault’s concept of biopolitics, this article recasts maternity homes as an institution of biopolitical welfare and highlights two features of social governance that the maternity home extends over the population of single mothers and their children. First, I argue that this unique, non-governmental social service agency functions as a hub of biopolitical technologies, where multiple social, legal, economic, and political forces work in concert to curb single motherhood through the promotion of adoption via (1) containment, (2) classification, and (3) circulation. Second, attending to the intricate dynamics of maternity home practices, this article observes the ways in which a single mother relinquishes her motherhood via adoption and, in so doing, becomes a birthmother, a self-regulating and self-governable subject.
Intense Embodiment
Authors: Allen-Collinson Jacquelyn , Owton Helen
Published: July 2014

In recent years, calls have been made to address the relative dearth of qualitative sociological investigation into the sensory dimensions of embodiment, including within physical cultures. This article contributes to a small, innovative and developing literature utilizing sociological phenomenology to examine sensuous embodiment. Drawing upon data from three research projects, here we explore some of the ‘sensuousities’ of ‘intense embodiment’ experiences as a distance-running-woman and a boxing-woman, respectively. Our analysis addresses the relatively unexplored haptic senses, particularly the ‘touch’ of heat. Heat has been argued to constitute a specific sensory mode, a trans-boundary sense. Our findings suggest that ‘lived’ heat, in our own physical-cultural experiences, has highly proprioceptive elements and is experienced as both a form of touch and as a distinct perceptual mode, dependent upon context. Our analysis coheres around two key themes that emerged as salient: (1) warming up, and (2) thermoregulation, which in lived experience were encountered as strongly interwoven.
Disability and Deleuze
Authors: Stephens Lindsay , Ruddick Susan , McKeever Patricia
Published: July 2014

Building on Deleuze’s theories of the becoming of bodies, and notions of the geographic maturity of the disabled body we formulate an emplaced model of disability wherein bodies, social expectations and built form intersect in embodied experiences in specific environments to increase or decrease the capacity of disabled children to act in those environments. We join a growing effort to generate a more comprehensive model of disability, which moves beyond a binary between the individual and the social. Drawing on in-depth case studies conducted with 13 physically disabled children, we consider the intersections between their primary environments (homes, schools and neighbourhoods) and the multiple subjectivities they embody. Ultimately we make a case about the importance of responsive, situated models of subjectivity for the development of adaptations, and that physical and social adaptations must respond to these children’s complex and varied needs and desires.
“It makes me feel like myself”: Person-centered versus traditional visual arts activities for people with dementia
Authors: Sauer Philip E , Fopma-Loy Joan , Kinney Jennifer M , Lokon Elizabeth
Published: July 2014

During a 15-month period between February 2010 and April 2011, video data on ( n = 38) people with dementia were collected during a person-centered and intergenerational arts activity program called Opening Minds through Art (OMA) at three different long-term care facilities in Ohio. A subsample of the OMA participants ( n = 10) were also video recorded during traditional visual arts activities (e.g. coloring books, scrapbooking). A modified version of the Greater Cincinnati Chapter Well-Being Observation Tool© was used to code the intensity and frequency of observed domains of well-being (i.e. social interest, engagement, and pleasure) and ill-being (i.e. disengagement, negative affect, sadness, and confusion). Descriptive results indicate a high percentage of moderate or high intensities of well-being during OMA sessions with little to no ill-being. Paired-sample t-tests comparing OMA vs. traditional visual arts activities showed significantly higher intensity scores for OMA in the domain of engagement and pleasure, as well as significantly lower intensity scores for disengagement. The findings of this exploratory study contribute to the overall discussion about the impact of person-centered, creative-expressive arts activities on people with dementia.
Minor Amputation and Palliative Wound Care as a Strategy to Avoid Major Amputation in Patients With Foot Infections and Severe Peripheral Arterial Disease
Authors: Barshes Neal R. , Gold Benjamin , Garcia Aimee , Bechara Carlos F. , Pisimisis George , Kougias Panos
Published: July 2014

Foot infections occurring in patients with severe peripheral arterial disease (PAD) who are not considered candidates for revascularization and limb salvage efforts are generally treated with major amputations. Herein we describe our early experiences in managing foot infections with minor amputations and palliative wound care as a strategy to avoid the functional disability often associated with major amputations. Patients with severe PAD that underwent minor amputations and subsequent palliative wound care for moderate/severe infections were paired with age-matched controls with PAD that underwent primary major amputations for foot infections. Eleven patients who underwent minor amputations and palliative wound care of 13 limbs were compared to an age-matched cohort of 12 patients undergoing 13 major amputations.The median age was 80 years in both groups. Survival at 1 and 2 years did not differ significantly between groups. All patients who were ambulatory and/or independently living remained so following palliative management; in contrast, major amputation changed ambulatory status in 75% of patients and independent living status in 50%. Palliative management did not result in ascending/systemic sepsis or progressive necrosis. The need for reoperations was uncommon in both groups. In summary, minor amputations and operative drainage with subsequent palliative wound care appears to be a safe management option in patients with severe PAD and moderate or severe foot infections that are not candidates for revascularization. Palliative management may result in less functional impairment than major amputation.
Minimally Invasive Vacuum-Assisted Closure Therapy With Instillation (Mini-VAC-Instill) for Pleural Empyema
Authors: Hofmann Hans-Stefan , Neu Reiner , Potzger Tobias , Schemm Rudolf , Grosser Christian , Szöke Tamas , Sziklavari Zsolt
Published: July 2014

Enthusiasm for minimally invasive thoracic surgery is increasing. Thoracoscopy plays a significant therapeutic role in the fibrinopurulent stage (stage II) of empyema, in which loculated fluid cannot often be adequately drained by chest tube alone. For some debilitated and septic patients, further procedures such as open-window thoracostomy (OWT) with daily wound care or vacuum-assisted closure (VAC) therapy are necessary. In the present article, we propose a new option of minimally invasive VAC therapy including a topical solution of the empyema without open-window thoracostomy (Mini-VAC-instill). Three patients who underwent surgery using this technique are also presented. The discussion is focused on the advantages and disadvantages of the approach.
Conceptualizing Longitudinal Mixed Methods Designs
Authors: Plano Clark Vicki L. , Anderson Nancy , Wertz Jessica A. , Zhou Yuchun , Schumacher Karen , Miaskowski Christine
Published: July 2014

Longitudinal research is well suited for investigating phenomena that change over time. With the growing acceptance of mixed methods, researchers are combining qualitative and quantitative approaches within longitudinal research. However, little attention has been paid to how researchers integrate longitudinal mixed methods databases. The purpose of this methodological review was to describe how researchers combine mixed methods and longitudinal approaches in practice and delineate dimensions and issues inherent within these complex designs. We examined published empirical studies from the health sciences that self-identified as longitudinal and mixed methods. Our results identify major dimensions, variations, and issues for designing longitudinal mixed methods research and suggest recommendations for researchers interested in using this complex approach.
Mortality and Financial Burden of Periprosthetic Fractures of the Femur
Authors: Shields Edward , Behrend Caleb , Bair Jeff , Cram Peter , Kates Stephen
Published: July 2014

Objective:

This study examines patient factors to identify risks of 12-month mortality following periprosthetic femur fractures. Hospital charges were analyzed to quantify the financial burden for treatment modalities.

Methods:

Data were retrospectively analyzed from a prospective database at a university hospital setting. One-hundred and thirteen patients with a periprosthetic fracture of the proximal or distal femur were identified. Risk factors for 12-month mortality were analyzed, and financial data were compared between the various treatment modalities.

Results:

In all, 14% of patients died (16 of 113) within 3 months and the 1-year mortality was 17.7% (20 of 113). Patients who died within 1 year had higher hospital charges (US$33 880 ± 25 051 vs US$22 886 ± 16 841; P = .01) and were older (87.6 ± 8.5 vs 81.5 ± 8.6; P = .004). Logistic regression analysis revealed age was the only significant predictor of 1-year mortality ( P = .029, odds ratio 1.1). Analysis of financial data revealed 4 distinct groups ( P < .05 between groups). Distal femoral revision arthroplasty (RA-DF) generated the highest hospital charges of US$91 035 ± 25 579 (n = 3). The second most highly charged group included proximal femoral fractures treated with revision arthroplasty (US$34 078 ± 17 832; n = 20) and hemi/total hip arthroplasty (THA; US$41 556 ± 23 651; n = 8). The third most charged group underwent open reduction internal fixation of the proximal (US$18 706 ± 6829; n = 35) and distal (US$22 381 ± 10 835; n = 35) femur. Nonoperative treatment generated the lowest charges (US$6426 ± 2899; n = 11). On average, the hospital lost money treating patients with RA-DF (US$−19 080 ± 2022 per patient) and hemi/THA (US$−6594 ± 9305 per patient), while all other treatment groups were profitable.

Conclusion:

One-year mortality after periprosthetic femur fractures was 17.7%, is mostly influenced by age, and 80% of deaths occur within 3 months. Patients treated with primary/revision arthroplasty generate more hospital charges than internal fixation. The average patient treated with revision arthroplasty of the distal femur or hemi/THA for a periprosthetic femur fractures resulted in net financial losses for the hospital.
Experiences of Japanese University Students’ Willingness to Speak English in Class
Authors: Osterman Grant L.
Published: July 2014

English as a foreign language (EFL) in Japan is becoming a mandatory subject in all compulsory educational systems. Currently, the average Japanese student will study EFL for at least 8 years. Yet despite this period of time, Japanese continually score low on international English tests. Using a qualitative descriptive multiple case study method, the willingness to communicate (WTC) in a Japanese university setting was researched. Twelve student participants, ranging in age from 18 to 20, were interviewed in one Japanese university classroom. Data were gathered by classroom observations and post-class interviews. Data were analyzed by using qualitative software to aggregate the data into five themes. The results revealed that although the prior experiences with learning English has been mostly positive, students believe that the grammar-based learning has not been helpful in developing oral communication competency and what would help is an earlier start to oral English communication. Other findings revealed that the classroom environment has a severe impact on students’ WTC and the interaction with other students in the class. Recommendations for future research include gathering more case studies to compare and test students who have had an opportunity to start English learning earlier and the benefits of grammar-based learning.
Ethical Guardrails When Children Participate in Research
Authors: Harcourt Deborah , Quennerstedt Ann
Published: July 2014

This article investigates interpretations of sound research ethics in social science research involving children as framed through regulation. Coinciding with an emergent significance being given to research that involves children, debate has developed regarding whether particular ethical considerations are warranted in this type of research. We overlay the examination of regulation documents in Sweden and Australia with an interpretative lens drawn from these regulations that has the potential to position children as competent social actors in the research process. We then argue that there is possibility for ethical procedures to be viewed not only as risk management but also as beneficial research practice to stimulate continuing debate about how to work ethically in social science research when children are participants.
Going Live
Authors: Meadors Margaret , Benda Natalie , Hettinger A. Zachary , Ratwani Raj M.
Published: July 2014

This study evaluated the immediate effects of implementing an electronic health record (EHR) system on physician workflow in the emergency department. Two sets of observations were conducted in one emergency department. The first set of observations, the baseline period, was completed in the 22 days prior to the implementation of a new EHR. The second set of observations, the go-live period, was completed during the seven-day period immediately after the EHR go-live date. A comparison across four task-based categories revealed that during the go-live period there was a decrease in the proportion of time physicians spent in patient rooms and engaged with paper-based tasks, and an increase in the proportion of time physicians spent at computer stations and working with other people. In addition, physicians engaged in more information seeking behaviors during the go-live period than during the baseline period. The impact of these shifts in tasks and behaviors is discussed with a focus on the importance of fully understanding the EHR go-live process.
Robot-Assisted Surgery and the Nature of Remote Work
Authors: Balkin E. Asher , Kumar Salil , Manko Volodymyr , Jahn Michelle A. , So Joey , Antonik Christopher
Published: July 2014

The result of a multi-year, multi-lab, interdisciplinary research project examining the impact of the introduction of robot-assisted surgical (RAS) technology into modern operating rooms, this presentation explores intra-corporeal RAS as a highly specialized, but not entirely unique working technique. Hundreds of hours of direct in-room observation, interviews with RAS surgeons at all levels of expertise from almost total novices to world-renowned experts have allowed the authors to recognize specific commonalities, particularly those dealing with changes in operator perspective, altered team roles, and coordination processes. In particular analogs between RAS, areal refueling, tower-crane construction work, and robotic arm control in space are presented. Most fundamentally, these four work situations are united by thee factors: the inability of the primary control operator to directly see the worksite, the need for high-precision coordination with colleagues, and the loss of situational awareness created by working in such environments. While RAS is relatively new, refueling teams, construction crews, and astronauts have been working under such conditions for much longer. As a result, this paper offers a series of best practice suggestions derived from other fields’ experiences similar working conditions.
Approaching Proactivity armed with Evidence from Reactivity
Authors: Alexander Michael , Bagian Tandi , Williams Linda C.
Published: July 2014

In a large healthcare organization, individual medical facilities have the opportunity to learn from each other, correcting process vulnerabilities proactively without actually experiencing the error. The work represented here is an effort to capitalize on the size of the VA healthcare system to inform proactive process improvement efforts at VA facilities with reactive event report data from the entire VA system. We seek to do this by mapping event reports to the steps of a process, and examining the parts of sub-processes prone to failure in order to understand how and why it failed. This allows an individual medical facility to learn from previous process failures and make corrections.
Efficacy of a System for Tracking and Managing Osteoarthritis Pain for Both Healthcare Providers and Older Adults
Authors: Barg-Walkow Laura H. , McBride Sara E. , Morgan Michael J. , Mitzner Tracy L. , Clarke Ellen E. , Bauer David T. , Knott Camilla C , Rogers Wendy A.
Published: July 2014

Osteoarthritis is a leading cause of chronic pain, affecting approximately one-third of older adults in the United States and imposing a financial burden on the healthcare system. Pain management for osteoarthritis is complex; there is a need for a technology to support people with osteoarthritis to capture, integrate, and display information on pain and mediating factors critical for pain management. We developed a system that can support self-management of osteoarthritis pain, including identification of factors influencing pain. The efficacy of this system was tested with seven older adults— who reported experiencing osteoarthritis pain for at least three years—and three healthcare providers—who reported experience assisting older adults in managing osteoarthritis pain within the past year. For both groups, our system improved their ability to answer comprehension questions about osteoarthritis pain. Overall, this system for tracking and managing pain supported users’ understanding of osteoarthritis pain and its mediators, which could ultimately lead to improved management of osteoarthritis pain.
Cognitive Aids
Authors: Fletcher Keaton A. , Bedwell Wendy L.
Published: July 2014

The high task and emotional demands of healthcare drain individual cognitive, affective, and physical resources. When these resources are depleted, practitioners are no longer able to vigilantly prevent system-based errors from occurring. Cognitive aids have frequently been suggested—and implemented—as a method to reduce the cognitive load associated with medical practice. Although cognitive aids can offer true benefits, haphazard implementation and overuse has led to “checklist fatigue.” To avoid this misuse and to maximize the benefits of these beneficial tools, we suggest that cognitive aids should be clear, easy to use, adaptable to the context, properly trained prior to implementation, pilot tested, and based on a needs-analysis. Furthermore, it appears that best practices for one type of cognitive aid in one context cannot necessarily be generalized to another. Therefore, this qualitative synthesis of the literature aims to provide three contextual factors to consider when addressing an issue with a cognitive aid. Designers and administrators need to consider the skill type that will be addressed, the physical, social, and organizational environment in which the aid will be utilized, as well as the experience level of the targeted users.
Handoff Communication and Electronic Health Records
Authors: Apker Julie , Beach Christopher , O’Leary Kevin , Ptacek Jennifer , Cheung Dickson , Wears Robert
Published: July 2014

When transferring patient care responsibilities across the healthcare continuum, clinicians strive to communicate safely and effectively, but communication failures exist that threaten patient safety. Although researchers are making great strides in understanding and solving intraservice handoff problems, inter-service transition communication remains underexplored. Further, electronic health records (EHRs) figure prominently in healthcare delivery, but less is known about how EHRs contribute to inter-service handoffs.

This descriptive, qualitative study uses Sensemaking Theory to explore EHR-facilitated, inter-service handoffs occurring between emergency medicine and internal/hospitalist medicine physicians. The researchers conducted six focus groups with 16 attending physicians and medical residents at a major Midwestern academic hospital. Findings suggest clinicians hold varied expectations for information content and relational communication/style. Their expectations contribute to making sense of uncertain handoff situations and communication best practices. Participants generally perceive EHRs as tools that, when used appropriately, can enhance handoffs and patient care continuity. Ideas for practical applications are offered based on study results.
Human Factoring Healthcare
Authors: Miller Kristen , Bagian Tandi , Williams Linda
Published: July 2014

Even in a just culture, preventable or avoidable adverse events can often be attributed to a failure to follow recognized, evidence-based best practices or guidelines at the individual and/or system level. Investigations of adverse events have heightened the awareness of the need to redesign systems and processes to prevent human error. Despite the existence of considerable information about how to improve care through the application of human factors, healthcare professionals are not provided a means to ensure sufficient education in healthcare human factors and the impact on patient safety. Additionally, even when existing knowledge is taught, providers are challenged to translate and apply knowledge to affect safe patient care. The Department of Veterans Affairs (VA) National Center for Patient Safety (NCPS) Healthcare Human Factors Modules were designed to address these challenges by combining dissemination of existing knowledge and recent research into accessible, hands-on activities that drive home human factors and patient safety competencies. These modules represent an innovative and engaging way to allow providers and administrators alike the ability to advance the shift to systems thinking through high-impact education.
Towards an Ontology for Interdisciplinary Handoff Communication in Intensive Care
Authors: Abraham Joanna , Kannampallil Thomas G. , Patel Vimla L.
Published: July 2014

Handoffs are considered a vulnerable point in the clinical workflow. A recent report by The Joint Commission (TJC) found that nearly 80% of communication errors occur during care transitions. While there has been significant research on handoff tools and their use, it can be argued that there is variability among the handoff tools used in current practice. We conducted a multi-year, longitudinal evaluation on the nature of content and structure of handoffs among residents and nurses in a medical intensive care unit (MICU). In this paper, we report on our top-level findings regarding the use of a body-systems based formatted tool that supported standardized, interactive and effective communication for both medical and nursing practice. We discuss the theoretical and practical implications of our results for the design and development of future handoff tools.
Task Excursion Analysis
Authors: Fuller Helen J. A. , Bagian Tandi M.
Published: July 2014

This paper introduces Task Excursion Analysis (TEA), a new approach for assessing medical device usability that is under development at the Veterans Health Administration’s National Center for Patient Safety. This approach will aid in identifying vulnerabilities that exist in the design of a device and, eventually, it will allow purchasers and users to select a device that will minimize the potential harm to patients.
Retained Guidewires
Authors: Dushane Theodore E. , Paull Douglas E.
Published: July 2014

Inserting a central venous catheter is a commonly performed invasive procedure. While much attention has been paid to the risk of blood borne infections as a consequence of using catheters, little notice has been made of another risk: during the placement of these catheters, the guidewire used can be left behind in the patient. The purpose of this study is to explore this complication using data collected by the Veterans Health Administration (VHA) at its 151 hospitals and clinics.
Usability Testing of Medical Devices Used by Teams
Authors: Stephens Robert , Mulcare Maureen
Published: July 2014

The current approach to validating the safety and effectiveness of most medical devices involves conducting usability testing with a single participant.However, this approach might not be appropriate for medical devices used by a team of individuals because it does not enable researchers to evaluate the impact of teamwork (e.g., collaboration, coordination, cross-checking) on the team’s use of the device. In this manuscript, we present four alternative approaches to conducting usability testing of medical devices used by teams, some involving a team of participants and some involving confederates who represent absent team members. We present important considerations for each approach and tradeoffs among approaches. Finally, we conclude by recommending an approach that best balances these tradeoffs.
Praseodymium oxide modified hybrid silane coatings for anti-corrosion applications
Authors: Jothi K. J. , Palanivelu K.
Published: July 2014

The simple, cost effective, highly efficient and self-protective siloxane coating was prepared by dispersing the praseodymium oxide in a hybrid sol–gel network. The embedded nanoparticles were varied from 0·25 to 1 wt-%, and an optimum percentage was carried for further studies. The corrosion resistance of the siloxane coatings was studied by salt spray technique and electrochemical impedance spectroscopy. Surface morphology was studied to explain the arrangement of nanoparticles on the surface of the coatings. The resulted SiO2@Pr6O11 core–shell was characterised by transmission electron microscopy. The above results revealed that the nanoparticles enriched silane could provide surpassing corrosion protection coatings compared to the unmodified silane films. This work presents an efficient anti-corrosive coating for the industrially significant stainless steel 304 (SS 304). This study had led to a better understanding factor influencing the anticorrosion performance and properties of anticorrosive coatings with embedded nanoparticles.
Factors that predict thrombosis in relatives of patients with venous thromboembolism
Authors: Couturaud Francis , Leroyer Christophe , Tromeur Cecile , Julian Jim A. , Kahn Susan R. , Ginsberg Jeffrey S. , Wells Philip S. , Douketis James D. , Mottier Dominique , Kearon Clive
Published: July 2014

Key Points

Unprovoked venous thromboembolism (VTE) and VTE at young age are independent predictors of VTE in patient relatives. Factor V Leiden or the prothrombin 20210A gene variant in patients with VTE was not an independent predictor of VTE in patient relatives.
Endothelial cell protein C receptor: a multiliganded and multifunctional receptor
Authors: Mohan Rao L. Vijaya , Esmon Charles T. , Pendurthi Usha R.
Published: July 2014

Endothelial cell protein C receptor (EPCR) was first identified and isolated as a cellular receptor for protein C on endothelial cells. EPCR plays a crucial role in the protein C anticoagulant pathway by promoting protein C activation. In the last decade, EPCR has received wide attention after it was discovered to play a key role in mediating activated protein C (APC)-induced cytoprotective effects, including antiapoptotic, anti-inflammatory, and barrier stabilization. APC elicits cytoprotective signaling through activation of protease activated receptor-1 (PAR1). Understanding how EPCR-APC induces cytoprotective effects through activation of PAR1, whose activation by thrombin is known to induce a proinflammatory response, has become a major research focus in the field. Recent studies also discovered additional ligands for EPCR, which include factor VIIa, Plasmodium falciparum erythrocyte membrane protein, and a specific variant of the T-cell receptor. These observations open unsuspected new roles for EPCR in hemostasis, malaria pathogenesis, innate immunity, and cancer. Future research on these new discoveries will undoubtedly expand our understanding of the role of EPCR in normal physiology and disease, as well as provide novel insights into mechanisms for EPCR multifunctionality. Comprehensive understanding of EPCR may lead to development of novel therapeutic modalities in treating hemophilia, inflammation, cerebral malaria, and cancer.
Positive solutions for P-Laplace problems with nonlinear time-fractional differential equation
Authors: Qiu Meilan , Mei Liquan , Yang Ganshan , Yuan George Xianzhi
Published: July 2014

In this paper, we study the existence and multiplicity of positive solutions for semi-linear elliptic equations with a sign-changing weight function in weighted Sobolev spaces. By investigating the compact embedding theorem and based on the extraction of the Palais-Smale sequence in the Nehari manifold which is a subset of the weighted Sobolev spaces, we derive the existence of the multiple positive solutions of the equations by using the variational method. In the last part of this paper, by applying the Arzela-Ascoli fixed point theorem, some existence results of the corresponding time-fractional equations for semi-linear elliptic equations are obtained.

MSC:35Q30, 76D05, 76D10.
Coincidence and common fixed point theorems for Suzuki type hybrid contractions and applications
Authors: Singh Shyam Lal , Kamal Raj , De la Sen Manuel
Published: July 2014

Coincidence and common fixed point theorems for a class of Suzuki hybrid contractions involving two pairs of single-valued and multivalued maps in a metric space are obtained. In addition, the existence of a common solution for a certain class of functional equations arising in a dynamic programming is also discussed.

MSC:47H10, 54H25.
Common fixed point theorem for two pairs of non-self-mappings satisfying generalized Ćirić type contraction condition in cone metric spaces
Authors: Huang Xianjiu , Luo Jing , Zhu Chuanxi , Wen Xi
Published: July 2014

In this paper, we prove a common fixed point theorem for two pairs of non-self-mappings satisfying the generalized contraction condition of Ćirić type in cone metric spaces. Our result generalizes and extends some recent results related to non-self-mappings in the setting of cone metric spaces.

MSC:47H10, 54H25.
A global overview on the diet of the dice snake (Natrix tessellata) from a geographical perspective: foraging in atypical habitats and feeding spectrum widening helps colonisation and survival under suboptimal conditions for a piscivorous snake
Authors: Weiperth András , Gaebele Tibor , Potyó Imre , Puky Miklós
Published: July 2014

Background

The dice snake (Natrix tessellataLaurenti, 1768) is generally considered to be a fully or partially piscivorous freshwater snake species. The aim of the study was to make the first global overview on the taxonomy and geographical distribution of the species based on own observations, available databases and the special literature.

Results

Besides freshwaters,N. tessellataturned out to hunt also in marine and terrestrial habitats predating on at least 29 and 15 species, respectively. On the basis of our data and the literature altogether, 113 prey taxa, mostly fish, were listed but 20% of them were invertebrates, amphibians, reptiles and mammals. The importance of non-fish species in the diet was especially pronounced in deserts, high mountains and in dry Mediterranean areas. In spite of the wide feeding spectrum, only fish and amphibians were found to be predominant food items over the whole species' range. Fish dominated the catch of the dice snake in most quantitative studies, except one survey in Turkey, where the ratio of non-fish prey items was over 50%.

Conclusions

The global analysis of the diet of the dice snake revealed a feeding spectrum characteristically changing over the broad distribution area including non-fish prey as well as taxa from marine and terrestrial habitats. The analysis of the feeding spectrum separated four large geographical units with further distinctions in Central and Eastern Europe. Such diversity helps explain why this species was able to colonise a large and diverse Eurasian range.
Phase III Randomized Trial of Induction Chemotherapy in Patients With N2 or N3 Locally Advanced Head and Neck Cancer
Authors: Cohen Ezra E.W. , Karrison Theodore G. , Kocherginsky Masha , Mueller Jeffrey , Egan Robyn , Huang Chao H. , Brockstein Bruce E. , Agulnik Mark B. , Mittal Bharat B. , Yunus Furhan , Samant Sandeep , Raez Luis E. , Mehra Ranee , Kumar Priya , Ondrey Frank , Marchand Patrice , Braegas Bettina , Seiwert Tanguy Y. , Villaflor Victoria M. , Haraf Daniel J. , Vokes Everett E.
Published: July 2014

Purpose

Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease.

Patients and Methods

Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m2on day 1, cisplatin 75 mg/m2on day 1, and fluorouracil 750 mg/m2on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS).

Results

A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival.

Conclusion

IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN.
Effect of Routine Assessment of Specific Psychosocial Problems on Personalized Communication, Counselors' Awareness, and Distress Levels in Cancer Genetic Counseling Practice: A Randomized Controlled Trial
Authors: Eijzenga Willem , Aaronson Neil K. , Hahn Daniela E.E. , Sidharta Grace N. , van der Kolk Lizet E. , Velthuizen Mary E. , Ausems Margreet G.E.M. , Bleiker Eveline M.A.
Published: July 2014

Purpose

This study evaluated the efficacy of a cancer genetics–specific questionnaire in facilitating communication about, awareness of, and management of psychosocial problems, as well as in lowering distress levels.

Methods

Individuals referred to genetic counseling for cancer at two family cancer clinics in the Netherlands were randomly assigned to an intervention or a control group. All participants completed the psychosocial questionnaire before counseling. In the intervention group, the counselors received the results of this questionnaire before the counseling session. All sessions were audiotaped for content analysis. Primary outcomes were the frequency with which psychosocial problems were discussed, the genetic counselors' awareness of these problems, and their management. Secondary outcomes included cancer worries and psychological distress, duration and dynamics of the counseling, and satisfaction.

Results

The frequency with which psychosocial problems were discussed with 246 participating counselees was significantly higher in the intervention group (n = 127) than in the control group (n = 119; P = .004), as was the counselors' awareness of psychosocial problems regarding hereditary predisposition (P < .001), living with cancer (P = .01), and general emotions (P < .001). Counselors initiated more discussion of psychosocial problems in the intervention group (P < .001), without affecting the length of the counseling session. No significant differences were found on management (P = .19). The intervention group reported significantly lower levels of cancer worries (P = .005) and distress (P = .02) after counseling.

Conclusion

The routine assessment of psychosocial problems by questionnaire facilitates genetic counselors' recognition and discussion of their clients' psychosocial problems and reduces clients' distress levels.
Placenta Passage of the Thyroid Hormone Analog DITPA to Male Wild-Type and Mct8-Deficient Mice
Authors: Ferrara Alfonso Massimiliano , Liao Xiao-Hui , Gil-Ibáñez Pilar , Bernal Juan , Weiss Roy E. , Dumitrescu Alexandra M. , Refetoff Samuel
Published: July 2014

Monocarboxylate transporter 8 (MCT8) deficiency causes severe X-linked intellectual and neuropsychological impairment associated with abnormal thyroid function tests (TFTs) producing thyroid hormone (TH) deprivation in brain and excess in peripheral tissues. The TH analog diiodothyropropionic acid (DITPA) corrected the TFTs abnormalities and hypermetabolism of MCT8-deficient children but did not improve the neurological phenotype. The latter result was attributed to the late initiation of treatment. Therefore, we gave DITPA to pregnant mice carrying Mct8-deficient embryos to determine whether DITPA, when given prenatally, crosses the placenta and affects the serum TFTs and cerebral cortex of embryos. After depletion of the endogenous TH, Mct8-heterozygous pregnant dams carrying both wild-type (Wt) and Mct8-deficient (Mct8KO) male embryos were given DITPA. Effects were compared with those treated with levothyroxine (L-T4). With DITPA treatment, serum DITPA concentration was not different in the two genotypes, which produced equal effect on serum TSH levels in both groups of pups. In contrast, with L-T4 treatment, TSH did not normalize in Mct8KO pups whereas it did in the Wt littermates and dams despite higher concentration of serum T4. Finally, both treatments similarly modulated the expression of the TH-dependent genes Shh, Klf9, and Aldh1a3 in brain. Thus, the ability of DITPA to cross the placenta, its thyromimetic action on the expression of TH-dependent genes in brain, and its better accessibility to the pituitary than L-T4, as assessed by serum TSH, make DITPA a candidate for the prenatal treatment of MCT8 deficiency.