bluuebunny/crossref_metadata_2025 huggingface dataset:
The ritualization of heritage destruction under the Islamic State
Authors: Shahab Sofya , Isakhan Benjamin
Published: March 2018

This article develops the conceptual framework of the ritualization of heritage destruction to analyse and interpret the targeting of pre-monotheistic heritage sites and artefacts by the Islamic State. It draws upon anthropological studies of initiation rituals in violent male cults alongside literature on heritage destruction to conduct a systematic analysis of key Islamic State propaganda outlets. The analysis reveals that the heritage destruction wrought by the Islamic State functions as part of a broader process of ritualization that is instrumental in forming bonds between members and ensuring their allegiance. Such rituals serve multiple purposes: they physically and ideologically separate new recruits from existing social norms and laws; they breed a deference to leadership and create a unified identity towards the potentiality of violence; and they situate heritage destruction itself within a complex symbolic kaleidoscope of prescribed actions and specific attire, invoking connections to an imagined past and repeating the actions of their forbearers. The article concludes by noting that such analysis of the ritualization of heritage destruction is not only vital to understanding how groups such as the Islamic State successfully transform ordinary young men into a violent jihadist communitas, but also in further understanding, and responding to, such attacks on heritage sites.
Just wealth transfer taxation
Authors: Cappelen Cornelius , Pedersen Jørgen
Published: March 2018

This article examines John Stuart Mill’s influential proposal of how to tax wealth transfers. According to Mill, every person should be free to bequeath but not to receive bequest. Mill proposed an upper limit on how much each person could receive from wealth transfers. We discuss three objections against this proposal. The nonseparability objection holds that it is not possible to separate the freedom to give from the freedom to receive. The objection from private property holds that private property includes an unlimited right to dispose of one’s assets and that this right is violated under Mill’s scheme. The objection from incentives holds that Mill’s scheme would have negative effects on people’s willingness to work and save. We argue that these objections can be met and that taxing bequeathed wealth according to Mill’s scheme is more just and more efficient compared to systems that rely less on wealth transfer taxation.
A consumer-based brand performance model for assessing brand success
Authors: Molinillo Sebastian , Ekinci Yuksel , Japutra Arnold
Published: March 2018

The aim of this study is to introduce a Consumer-Based Brand Performance Model (CBBPM) to measure brand success. The CBBPM consists of four critical constructs—brand equity, brand trust, brand satisfaction, and brand loyalty—and is applied across different product categories and brands. In total, 881 consumers participated in the survey, and a structural equation modeling approach was employed to test the research hypotheses. The findings of the study suggest that the CBBPM is valid and reliable. Brand equity is positively associated with brand satisfaction, brand trust, and brand loyalty. The positive effects of brand trust and brand satisfaction on brand loyalty are supported. The study suggests that the CBBPM should be used as a strategic brand management tool to track brand performance and to compare them with competing brands.
A Bayesian approach for the segmentation of series with a functional effect
Authors: Baragatti Meili , Bertin Karine , Lebarbier Emilie , Meza Cristian
Published: March 2018

Abstract:

In some application fields, series are affected by two different types of effects: abrupt changes (or change-points) and functional effects. We propose here a Bayesian approach that allows us to estimate these two parts. Here, the underlying piecewise-constant part (associated to the abrupt changes) is expressed as the product of a lower triangular matrix by a sparse vector and the functional part as a linear combination of functions from a large dictionary where we want to select the relevant ones. This problem can thus lead to a global sparse estimation and a stochastic search variable selection approach is used to this end. The performance of our proposed method is assessed using simulation experiments. Applications to three real datasets from geodesy, agronomy and economy fields are also presented.
How are people with dementia involved in care-planning and decision-making? An Irish social work perspective
Authors: Donnelly Sarah , Begley Emer , O’Brien Marita
Published: March 2018

In recent years, there have been national and international policy advances around capacity and decision-making and an apparent burgeoning rights-based approach to the issue, all of which have the potential to impact on the experience for people with dementia in Ireland. There is little evidence however on whether these policies and principles are being translated into practice and whether traditional paternalistic approaches to decision-making are being challenged. To gain insight into current practice, research was undertaken with social workers working with older people in Ireland; reporting on the involvement of people living with dementia in care-planning processes. Data collection included a mixed method approach; an on-line survey of social workers from across the country who reported on their open caseload during the month of June 2015 (N = 38 social workers reporting on the experiences of 788 older people, of which 39% of older people had a formal diagnosis of dementia). In addition, semi-structured telephone interviews were conducted with social workers working in the nine Community Health Organisation areas (N = 21). Findings show that people with dementia were high users of social work services, accounting for 44.5% of the client group. Social workers reported that there were no standardised approaches to how Health and Social Care Professionals involved people with dementia in care planning and decision-making. Overall, people with dementia were more likely to be excluded from decision-making processes due to (i) assumptions that they lacked capacity, (ii) family members preferences that the person was not involved, (iii) communication difficulties, (iv) time constraints, (v) little or no opportunity given or (vi) the person delegated decision-making to others. Good practices were identified through multidisciplinary team approaches and formal care planning meetings. This research highlights variability in how people with dementia participate in decision-making around their care. It sheds light on existing barriers which challenge the full implementation of the Irish Assisted Decision-Making legislation; highlighting the need for appropriate guidance and education for Health and Social Care Professionals. The findings also show that family dynamics and existing relationships can play a role in how people with dementia participate and are involved. To ensure consistent opportunities for participation, effective practices and approaches to supporting the participation of people living with dementia in care planning needs to be developed and rolled out in all care settings through increased training and adoption of standardised approaches.
Queer pedagogy: Approaches to inclusive teaching
Authors: Nemi Neto João
Published: March 2018

While it is common knowledge that language shapes how we think about gender and sexual identity there is no standard educational practice to create awareness about the place of sexual and gender diversity in the context of language learning. This article draws on queer pedagogy and queer theory to devise teaching practices that acknowledge queer visibility in the classroom. The goal of this article is to examine strategies to enhance inclusion, recognition and visibility of sexual and transgender minorities in the classroom. I propose that language instruction is in need of a queer pedagogy that challenges both the heteronormative assumptions of most language textbooks, and classroom practices that erase Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA) visibility. I argue that language instructors need to be inventive and critical, willing to address in class what most language manuals omit. This way, I hope to contribute to the development of tools and strategies that guarantee a safe, affirmative space for sexual and transgender minorities in our classrooms.
The influence of fiber content and length on mechanical and water absorption properties of Calotropis Gigantea fiber reinforced epoxy composites
Authors: Velusamy K , Navaneethakrishnan P , Rajeshkumar G , Sathishkumar TP
Published: March 2018

This work deals with the investigation of mechanical properties and water absorption behavior of Calotropis Gigantea fiber reinforced epoxy composites prepared by using compression molding technique. The experiments were carried out by varying fiber length (10, 20, and 30 mm) and volume fraction (0, 5, 10, 15, 20, 25, and 30%). In addition to this, the water absorption behavior was analyzed at different climatic temperatures of 10℃, 40℃, and 70℃. The composites reinforced with 25% in volume of Calotropis Gigantea fiber showed better tensile, flexural, and impact properties. The hardness value and water absorption rate are higher for composites reinforced with 30% in volume of 30-mm Calotropis Gigantea fibers. Moreover, by increasing the bath temperature, the water absorption rate associated to this class of composite increases.
Assessing the comfort of functional fabrics for smart clothing using subjective evaluation
Authors: Tadesse Melkie Getnet , Harpa R , Chen Y , Wang L , Nierstrasz V , Loghin C
Published: March 2018

Sensory investigations of the functional textiles could be an alternative for the quality inspection and control of the products. The purpose of this research is to use subjective evaluation technique for assessing the tactile comfort of some functional textile fabrics based on AATCC Evaluation procedure 5-2011. Blind subjective evaluations and visual subjective evaluations were performed for sensory investigation. Ten fabric-skin-contact and comfort-related sensory properties were used to evaluate the handle of the functional textile fabrics. The reliability of the sensorial data obtained by subjective tests was evaluated using statistical data analysis techniques. A minimum and maximum consensus distances recorded were 0.58 and 1.61, respectively, using a descriptive sensory panel analysis and proves the consistency and similar sensorial perception between panelists. The Pearson correlation coefficient between panelists was up to 96% and hence a strong agreement between the panelist’s judgment. The results allowed to consider the subjective evaluation using a panel of experts could be validated in the case of functional fabrics. For functional textiles, additional visual subjective evaluation should be considered to have a similar human perception in addition to blind subjective evaluation.
Screening in the Upper Elementary Grades: Identifying Fourth-Grade Students At-Risk for Failing the State Reading Assessment
Authors: Kent Shawn C. , Wanzek Jeanne , Yun Joonmo
Published: March 2018

This study examined the predictive validity and classification accuracy of individual- and group-administered screening measures relative to student performance on a year-end state reading assessment in two states. A sample of 321 students was assessed in the areas of word-level and text fluency, as well as reading comprehension in the fall of fourth grade. For individual measures, a group-administered reading comprehension test exhibited the highest classification accuracy (74%–80%) for both outcomes though no screener demonstrated optimal sensitivity and specificity levels. Using a multivariate approach, logistic regression results revealed minimal to no increase in classification accuracy over the single comprehension measure. Receiver operating characteristic (ROC) curve analyses determined local cut scores to maintain sensitivity constant at .90, which resulted in a large number of false positives. The implications and limitations of these findings for screening at the upper elementary level are discussed.
Scoring Mental Health Quality of Life With the SF-36 in Patients With and Without Diabetes Foot Complications
Authors: Ahn Junho , Del Core Michael A. , Wukich Dane K. , Liu George T. , Lalli Trapper , VanPelt Michael D. , La Fontaine Javier , Lavery Lawrence A. , Raspovic Katherine M.
Published: March 2018

The aim of this study was to examine if using orthogonal and oblique factor analysis detect changes in health-related quality of life differently in diabetic patients on the Short Form-36 (SF-36) survey. A total of 155 patients had diabetic foot complications (DFC), and 145 patients had no DFCs. The SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were calculated using scoring coefficients determined by orthogonal and oblique rotation principle component analyses of the subscales. The DFC group had lower orthogonal ( P < .00001) and oblique PCS scores ( P < .00001). However, despite lower Mental Health subscale scores in the patients with DFCs, orthogonal MCS scores ( P = .156) did not differ. In contrast, the oblique MCS scores reflected the difference in the Mental Health subscale ( P = .0005). Orthogonal and oblique PCS scores did not differ significantly. However, orthogonal MCS scores were significantly higher than oblique MCS scores in those with DFCs ( P = .0004) and without DFCs ( P = .005). The shorter, 12-item SF-12 survey demonstrated similar results. Poorer physical function leads to higher orthogonal MCS scores than if determined by oblique scoring coefficients since Physical Function, Bodily Pain, and General Health are weighted more negatively in orthogonal coefficients when calculating the MCS score. Oblique scoring coefficients may address this issue, but further study is necessary to confirm whether oblique MCS scores accurately represent the mental health of patients with diabetic foot disease.
Evidence for Differential Effects of 2 Forms of Exercise on Prefrontal Plasticity During Walking in Parkinson’s Disease
Authors: Maidan Inbal , Nieuwhof Freek , Bernad-Elazari Hagar , Bloem Bastiaan R. , Giladi Nir , Hausdorff Jeffrey M. , Claassen Jurgen A. H. R. , Mirelman Anat
Published: March 2018

Background. In a randomized control trial conducted in patients with Parkinson’s disease, a treadmill training program combined with virtual reality that targeted motor and cognitive aspects of safe ambulation led to fewer falls, compared with treadmill training alone. Objective. To investigate if the 2 types of training differentially affected prefrontal activation and if this might explain differences in fall rates after the intervention. Methods. Sixty-four patients with Parkinson’s disease were randomized into the treadmill training arm (n = 34, mean age 73.1 ± 1.1 years, 64% men, disease duration 9.7 ± 1.0 years) or treadmill training with virtual reality arm (n = 30, mean age 70.1 ± 1.3 years, 71% men, disease duration 8.9 ± 1.1 years). Prefrontal activation during usual, dual-task, and obstacle negotiation walking was assessed before and after 6 weeks of training, using a functional near-infrared spectroscopy system. Results. Treadmill training with and without virtual reality reduced prefrontal activation during walking ( P < .001), with specific interactions related to training arm ( P = .01), lateralization ( P = .05), and walking condition ( P = .001). For example, among the subjects who trained with treadmill training alone, prefrontal activation during dual-task walking and obstacle negotiation increased after training, while in the combined training arm, activation decreased. Conclusions. Prefrontal activation during usual and during more challenging walking conditions can be altered in response to 2 different types of training. The addition of a cognitive training component to a treadmill exercise program apparently modifies the effects of the training on the magnitude and lateralization of prefrontal activation and on falls, extending the understanding of the plasticity of the brain in PD.
Toward a patient-specific tissue engineered vascular graft
Authors: Best Cameron , Strouse Robert , Hor Kan , Pepper Victoria , Tipton Amy , Kelly John , Shinoka Toshiharu , Breuer Christopher
Published: March 2018

Integrating three-dimensional printing with the creation of tissue-engineered vascular grafts could provide a readily available, patient-specific, autologous tissue source that could significantly improve outcomes in newborns with congenital heart disease. Here, we present the recent case of a candidate for our tissue-engineered vascular graft clinical trial deemed ineligible due to complex anatomical requirements and consider the application of three-dimensional printing technologies for a patient-specific graft. We 3D-printed a closed-disposable seeding device and validated that it performed equivalently to the traditional open seeding technique using ovine bone marrow–derived mononuclear cells. Next, our candidate’s preoperative imaging was reviewed to propose a patient-specific graft. A seeding apparatus was then designed to accommodate the custom graft and 3D-printed on a commodity fused deposition modeler. This exploratory feasibility study represents an important proof of concept advancing progress toward a rationally designed patient-specific tissue-engineered vascular graft for clinical application.
Predicting rehospitalization in patients treated with antipsychotics: a prospective observational study
Authors: Abdullah-Koolmees Heshu , Gardarsdottir Helga , Minnema Lotte A. , Elmi Kamjar , Stoker Lennart J. , Vuyk Judith , Goedhard Laurette E. , Egberts Toine C. G. , Heerdink Eibert R.
Published: March 2018

Background:

Prediction of rehospitalization in patients treated with antipsychotics is important for identifying patients in need of additional support to prevent hospitalization. Our aim was to identify factors that predict rehospitalization in patients treated with antipsychotics at discharge from a psychiatric hospital.

Methods:

Adult patients suffering from schizophrenia, psychotic or bipolar I disorders who had been hospitalized in a psychiatric hospital for ⩾7 days and were treated with oral antipsychotics at discharge were included. The main outcome was rehospitalization within 6 months after discharge. A prediction model for rehospitalization was constructed including: patient/disease and medication characteristics, patients’ beliefs about medicines, and healthcare-professional-rated assessment for all patients. The patients were stratified by diagnosis (schizophrenia and nonschizophrenia). Area under the receiver operating characteristic curve (AUCROC) was also assessed.

Results:

A total of 87 patients were included and 33.3% of them were rehospitalized within 6 months after discharge. The variables that predicted rehospitalization were duration of hospitalization, patients’ attitude towards medicine use, and healthcare-professional-rated assessment with an AUCROC of 0.82. Rehospitalization for patients with schizophrenia could be predicted (AUCROC = 0.71) by the Global Assessment of Functioning score, age, and harm score. Rehospitalization was predicted (AUCROC = 0.73) for nonschizophrenia patients with, for example rehospitalization predicted by the nurse.

Conclusions:

Rehospitalization was predicted by a combination of variables from the patient/disease and medication characteristics, patients’ attitude towards medicine use, and healthcare-professional-rated assessment. These variables can be assessed relatively easily at discharge to predict rehospitalization within 6 months.
Surgical Correction of Supravalvar Aortic Stenosis: 52 Years’ Experience
Authors: Roemers Rosa , Kluin Jolanda , de Heer Frederiek , Arrigoni Sara , Bökenkamp Regina , van Melle Joost , Ebels Tjark , Hazekamp Mark
Published: March 2018

Objectives:

Supravalvar aortic stenosis (SVAS) is a rare congenital anomaly. The “single-patch technique,” “‘two sinus augmentation with an inverted Y-patch” (both nonsymmetrical corrections), “three-patch technique,” and the “slide aortoplasty” (both symmetrical corrections) are the techniques implemented by the majority of surgeons for the correction of SVAS. In the few studies that compared these techniques, no technique was shown to be superior over another. The aim of the present study is to review the 52-year experience with the surgical correction of SVAS in two of four congenital cardiothoracic surgical centers in the Netherlands.

Methods:

We retrospectively reviewed all patient files of those who underwent an operation to correct their SVAS, between 1962 and 2014 in our centers. Patients were divided according to their operating technique. These groups were compared using the end points freedom from reoperation and mortality.

Results:

A total of 49 patients were included, 23 (46.9%) patients in the nonsymmetrical group and 26 (53.1%) patients in the symmetrical group. Survival after 20 years in the nonsymmetrical group was 80% (standard error [SE]: 0.091) and in the symmetrical group was 85% (SE: 0.085; P = .163). Freedom from reoperation after 20 years in the nonsymmetrical group was 88% (SE: 0.079) and in the symmetrical group was 71% (SE: 0.107; P = 0.313).

Conclusion:

In this patient group, there is no significant difference in survival and freedom from reoperation between the different surgical techniques for SVAS repair. Compared to the survival in the general population, the survival of SVAS patients is remarkably low. Apparently, SVAS is not a benign disease and probably patients should be followed more closely for the rest of their lives.
Early Outcomes of Hypoplastic Left Heart Syndrome Infants: Meta-Analysis of Studies Comparing the Hybrid and Norwood Procedures
Authors: Cao Jacob Y. , Lee Seung Yeon , Phan Kevin , Ayer Julian , Celermajer David S. , Winlaw David S.
Published: March 2018

The hybrid strategy is an alternative to the traditional Norwood procedure for initial palliation of infants with hypoplastic left heart syndrome (HLHS) who are deemed to be at high surgical risk. Numerous single-center studies have compared the two procedures, showing similar early outcomes, although the cohort sizes are likely insufficiently powered to detect significant differences. The current meta-analysis aims to explore the early morbidity and mortality associated with the hybrid compared to the Norwood procedure. MEDLINE, Cochrane Libraries, and Embase were systematically searched, and 14 studies were included for statistical synthesis, comprising 263 hybrid and 426 Norwood patients. Early mortality was significantly higher in the hybrid patients (relative risk [RR] = 1.54, P < .05, 95% confidence interval [CI]: 1.02-2.34), whereas interstage mortality was comparable between the two groups (RR = 0.88, P > .05, 95% CI: 0.46-1.70). Six-month (RR = 0.89, P < .05, 95% CI: 0.80-1.00) and one-year (RR = 0.88, P < .05, 95% CI: 0.78-1.00) transplant-free survival was also inferior among the hybrid patients. Furthermore, the hybrid patients required more reinterventions following initial surgical palliation (RR = 1.48, P < .05, 95% CI: 1.09-2.01), although the two groups had comparable length of hospital and intensive care unit stay postoperatively. In conclusion, our results suggest that the hybrid procedure is associated with worse early survival compared to the traditional Norwood when used for initial palliation of infants with HLHS. However, due to the hybrid being used preferentially for high-risk patients, definitive conclusions regarding the efficacy of the procedure cannot be drawn.
Brom Aortoplasty for Supravalvular Aortic Stenosis
Authors: Mongé Michael C. , Eltayeb Osama M. , Costello John M. , Johnson Joyce T. , Popescu Andrada R. , Rigsby Cynthia K. , Backer Carl L.
Published: March 2018

Background:

Controversy remains regarding the optimal surgical approach for children with supravalvular aortic stenosis (SVAS).

Methods:

Since 1997 we have used Brom three-patch aortoplasty for patients with SVAS. We prefer computed tomography (CT) imaging for preoperative evaluation rather than cardiac catheterization as it avoids the well-known morbidity of general anesthesia. The purpose of this study was to present our intermediate-term results of this strategy.

Results:

Twenty consecutive patients with SVAS were treated with Brom aortoplasty. Mean age was 3.7 ± 5.9 years (median, 1.5 years). Twelve patients had Williams syndrome. Ten patients had preoperative advanced medical imaging (seven CT, three magnetic resonance imaging) and did not have cardiac catheterization. Mean times for cardiopulmonary bypass and cross-clamp were 172 ± 29 minutes and 110 ± 21 minutes, respectively. Ten patients had simultaneous pulmonary artery stenosis patching. Median length of stay was seven days. There was no operative or late mortality. Mean follow-up was 6 ± 5 years. There were no reoperations on the aortic root. Fifteen patients had mild or less aortic insufficiency (AI) and two had moderate AI. One patient who had infant balloon dilation of the aortic valve and postoperative subacute bacterial endocarditis had moderate-to-severe AI and aortic stenosis (AS). One patient had moderate residual SVAS; all others had no AS. No patients had late coronary insufficiency.

Conclusion:

Brom aortoplasty promotes restoration of normal aortic root geometry and relief of coronary ostial stenosis, which is important in preventing myocardial ischemia. Computed tomography imaging is our preferred diagnostic modality. Intermediate-term outcomes are excellent with no recurrent SVAS, coronary events, or reoperations on the aortic valve.
“It’s a Man Who Runs the Show”: How Women Middle-Managers Experience Their Professional Position, Opportunities, and Barriers
Authors: Einarsdottir Unnur D. , Christiansen Thora H. , Kristjansdottir Erla S.
Published: March 2018

The ratio of women in top-management positions is improving very slowly, even in countries scoring high on gender equality like Iceland. Despite over three decades of research having documented the barriers faced by women seeking top-management positions, understanding is still lacking as to why women are not overcoming these barriers at a greater rate. This study presents the lived experiences of women in middle-management positions in some of the largest organizations in Iceland, aiming to understand how the women experience the barriers and opportunities they face. It is important to give voice to these women as they are the ones who could be in line for top-management positions. Interviews with 11 women were analyzed and interpreted according to phenomenological methodology, revealing four themes. Findings show that the women experience top management as a network that is closed to them. Top-management jobs appear tailored for men and would require the women to take on unbearable responsibilities. They experience their hard work and diligence as unappreciated. Finally, they compare and contrast themselves with the stereotype of the male executive and blame themselves for not fitting the role. Thus, they feel pressured to adapt to the masculine gender role if they are to stand a chance of a top-management position. Not fitting this role further undermines their self-confidence and ambition, rendering them less likely to seek advancement.
Continuing Professional Development Strategies: A Model for the Iranian EFL Teachers’ Success
Authors: Tabatabaee-Yazdi Mona , Motallebzadeh Khalil , Ashraf Hamid , Baghaei Purya
Published: March 2018

Throughout the past decade, evaluating teachers’ success has become a crucial issue due to the increased motivation on teacher accountability. In view of that the purpose of the present study is to determine EFL (English as a foreign language) teachers’ success in the Iranian institutional context based on students’ perspectives. More specifically, the present study surveyed any significant correlation between teachers’ practices of continuing professional development (CPD) strategies and teachers’ success. For this purpose, a CPD model was suggested and verified using partial least squares structural equation modeling (PLS-SEM), to examine CPD factors contributing to EFL teachers’ success. A total of 316 English-major institutional teachers in Iran completed the CPD questionnaire. Besides, about 30% of their students, 828 students, are asked to fill in teachers’ success questionnaire, which intended to check students’ opinions on how successful they measured their teachers in teaching. Findings specified that practice of CPD strategies had a strong direct predicting power on EFL teachers’ success. It was illustrated that “updating” construct strongly affects both “collaborating” and “reflecting.” Moreover, “reflecting” moderately influence “collaborating” and “collaborating” intensely affects “decision making.” The results, specifically, highlight the fact that one to be a successful teacher in the field of EFL should be a good decision maker in the field too.
Yoga for Young Adults With Noncurative Cancer: A Brief Report
Authors: Woodside Hillary , Culos-Reed S Nicole , Grégoire Marie-Claude , Rutledge Robert , Keats Melanie R
Published: March 2018

Background

The practice of yoga has been shown to improve disease- and treatment-related side effects in the noncurative cancer patient.

Objective

This user experience study aimed to examine the feasibility and usefulness of a DVD-based yoga program for young adult cancer patients with a noncurative diagnosis.

Methods

Participants were asked to partake in a 7-week DVD-based yoga program and complete measures of program use and usefulness.

Results

Nine patients expressed study interest and 5 consented to participate. Four completed the full study protocol. Participants reported being satisfied with the program and described that it provided an opportunity for self-care. Improvements in functional, physical, and spiritual well-being and overall quality of life were found. Barriers included competing time demands and feeling unwell. No adverse events were reported.

Conclusion

The program was viewed as an accessible and useful activity option; however, a desire for greater social support from relatable others was highlighted.
Renal Artery Rupture in Association With Fibromuscular Dysplasia
Authors: Akel Tamer , Elsayegh Suzanne
Published: March 2018

Fibromuscular dysplasia is a noninflammatory arteriopathy of unknown etiology that affects medium-sized arteries. Although patients affected with it are often asymptomatic, some might have recurrent catastrophic events that depend mainly on the arterial bed involved. The most worrisome vascular complications of the disease are aneurysmal rupture and arterial dissection. Herein, we report a case of a 49-year-old woman who presented with sudden-onset abdominal pain without any inciting factors. She was found to have active blood extravasation from a capsular branch of the renal artery that happened spontaneously. Angiography revealed fibromuscular dysplasia in the renal arteries without any obvious aneurysms. To our knowledge, this is the first case in the literature describing such an event. In this article, we also review the possible underlying pathology behind such an event.
Kratom, an Emerging Drug of Abuse, Raises Prolactin and Causes Secondary Hypogonadism: Case Report
Authors: LaBryer Lauren , Sharma Rohan , Chaudhari Kaustubh Suresh , Talsania Mitali , Scofield Robert Hal
Published: March 2018

Background. Kratom is a drug derived from the leaves of the tree Mitragyna speciose, which is native to southern Thailand. The route of administration is oral. Kratom has become increasingly available in the United States. The active ingredients in the drug bind the opioid mu-receptor; therefore, kratom has similar physiological effects as mu-opioids. Elevated prolactin is a common medical condition frequently caused by a variety drugs, including opioids. Case Report. A 42-year-old man presented with poor energy and low libido. He had mildly elevated serum prolactin with hypogonadotropic hypogonadism as evidenced by low serum testosterone with luteinizing hormone and follicle-stimulating hormone in the normal range. At his initial visit, he reported no use of any recreational or therapeutic drug. Two months later when seen in follow-up, both the testosterone and prolactin levels had returned to normal. At that visit he reported frequent use of kratom, which he had discontinued a few days after the first visit. Discussion. Kratom is now widely available in health food stores and online and is considered an emerging drug of abuse. At present kratom is legal in the United States, but recently the Drug Enforcement Administration served noticed of its intention of making kratom a Schedule I drug. A number of adverse events or side effects have been reported, but this is the first report of hyperprolactinemia as the result of ingestion of kratom.
Ending Cervical Cancer Screening in Low-Risk Women After Age 65
Authors: Boone Emily , Karp Michael , Lewis LaVonna
Published: March 2018

Background:

Current evidence-based cervical cancer testing guidelines recommend that screening of low-risk women ceases after age 65. Despite this, research suggests that continued testing by primary care providers remains common and represents unnecessary patient discomfort, cost, and consumption of valuable primary care resources.

Objective:

To understand why primary care providers might knowingly ignore consensus evidence-based screening guidelines for cervical cancer in low-risk women of this age-group and to identify barriers to adherence with best practice recommendations.

Methods:

A survey tool to identify barriers to adherence with current guidelines for cervical cancer screening in low-risk women older than age 65 was mailed to 4929 randomly selected primary care providers throughout California. Providers were asked to indicate the predominant reason(s) they might knowingly continue cervical cancer screening in women older than 65 years, despite evidence-based recommendations to the contrary.

Results:

Qualified surveys were received from 1259 (25.5%) of those surveyed, representing primary care providers of all types, practicing in areas of vastly different demographics. Despite published reassurance to the contrary, many providers retain fear that discontinuation of testing in low-risk women after age 65 may result in missed invasive cervical cancer. Even among health-care providers who agree that cessation of screening is safe, other circumstances prompt their recommendation to continue cervical screening.

Conclusion:

Although the data from this study suggest areas of policy intervention to lessen unnecessary cervical cancer screening, the broader implication is that advancement of evidence-based medicine will be of little value in improving the quality and cost of health care if barriers to guideline adherence are poorly understood and addressed.
Falls-Related EvEnts in the first year after StrokE in Ireland: Results of the multi-centre prospective FREESE cohort study
Authors: Walsh Mary E , Galvin Rose , Williams David JP , Harbison Joseph A , Murphy Sean , Collins Ronan , McCabe Dominick JH , Crowe Morgan , Horgan N Frances
Published: March 2018

Introduction

Falls are common post-stroke adverse events. This study aimed to describe the first-year falls incidence, circumstances and consequences among persons discharged home after stroke in Ireland, and to examine the association between potential risk factors and recurrent falls.

Patients and methods

Patients with acute stroke and planned home-discharge were recruited consecutively from five hospitals. Variables recorded pre-discharge included: age, stroke severity, co-morbidities, fall history, prescribed medications, hemi-neglect, cognition and functional independence (Barthel index). Falls were recorded with monthly diaries, and 6 and 12-month interviews. The association of pre-discharge factors with recurrent falls (>1 fall) was examined using univariable logistic regression.

Results

A total of 128 participants (mean age = 68.6, SD = 13.3) were recruited; 110 completed the 12-month follow-up. The first-year falls incidence was 44.5% (95% CI = 35.1–53.6) with 25.6% falling repeatedly (95% CI = 18.5–34.4). Fallers experienced 1–18 falls (median = 2) and five reported fractures; 47% of fallers experienced at least one fall outdoors. Only 10% of recurrent fallers had bone health medication prescribed at discharge. Lower Barthel index scores (<75/100, RR = 4.38, 1.64–11.72) and psychotropic medication prescription (RR = 2.10, 1.13–3.91) were associated with recurrent falls.

Discussion

This study presents prospectively collected information about falls circumstances. It was not powered for multivariable analysis of risk factors.

Conclusion

One-quarter of stroke survivors discharged to the community fall repeatedly and mostly indoors in the first year. Specific attention may be required for individuals with poor functional independence or those on psychotropic medication. Future falls-management research in this population should explore falls in younger individuals, outdoor as well as indoor falls and post-stroke bone health status.
In-hospital dynamics of glucose, blood pressure and temperature predict outcome in patients with acute ischaemic stroke
Authors: Skafida Anastasia , Mitrakou Asimina , Georgiopoulos Georgios , Alevizaki Maria , Spengos Konstantinos , Takis Konstantinos , Ntaios George , Thomadakis Christos , Vemmos Konstantinos
Published: March 2018

Introduction

We aimed to assess alterations in glucose, blood pressure and temperature in acute ischaemic stroke and investigate their association with early all-cause mortality and functional outcome.

Patients and methods

We studied all consecutive acute ischaemic stroke patients admitted in 2001–2010 to the Acute Stroke Unit, at Alexandra University Hospital, in Athens. Serial measurements were performed in the first seven days post-stroke and different parameters have been estimated: mean daily values, variability, subject-specific baseline levels and rate of change in serial measurements. Cox-proportional-hazards-model analysis and logistic-regression analysis were applied to investigate the association between these parameters and all-cause mortality and functional outcome after adjustment for known confounders of stroke outcome.

Results

In 1271 patients (mean age 72.3 ± 11.2 years), after adjusting for confounders, baseline glucose levels (HR: 1.005, 95%CI: 1.001–1.01; p = 0.017), variability of systolic BP (SBP) as estimated by standard deviation (HR: 1.028, 95%CI: 1.01–1.048; p = 0.005), the baseline temperature (HR: 2.758, 95%CI: 2.067–3.68; p < 0.001) and the rate of temperature change (HR: 1.841, 95%CI: 1.616–2.908; p < 0.001) were independently associated with all-cause mortality within three months. Poor functional outcome was associated with subject-specific baseline values of temperature (OR: 1.743; 95%CI: 1.076–2.825; p = 0.024), the rate of SBP (OR: 1.159; 95% CI: 1.047–1.280; p = 0.004) and temperature change (OR: 1.402; 95% CI: 1.061–1.853; p = 0.018).

Discussion

The main strength of our study is that we analysed simultaneously three parameters and we used four different variables for each parameter of interest.

Conclusion

Baseline glucose levels, variability of SBP and baseline temperature and its rate of change are independent predictors of all-cause mortality. Baseline values of temperature and the rate of changes in SBP and temperature are independent predictors of poor functional outcome.
Human CTL-based functional analysis shows the reliability of a munc13-4 protein expression assay for FHL3 diagnosis
Authors: Shibata Hirofumi , Yasumi Takahiro , Shimodera Saeko , Hiejima Eitaro , Izawa Kazushi , Kawai Tomoki , Shirakawa Ryutaro , Wada Taizo , Nishikomori Ryuta , Horiuchi Hisanori , Ohara Osamu , Ishii Eiichi , Heike Toshio
Published: March 2018

Key Points

A novel human CTL-based platform for comprehensive functional analysis of UNC13D variants is introduced. Pathogenicity of a reported UNC13D variant was determined by measuring expression of the translated munc13-4 protein.
Choice of provider for out-patient treatment is not working
Authors: Veale David
Published: March 2018

In 2012, the coalition government introduced the legal right for National Health Service (NHS) patients in England to choose their mental healthcare provider for out-patient treatment. This was a significant step towards parity of care between mental and physical ill health, and NHS Improvement and NHS England have provided sensible guidance on its implementation. However, several factors prevent the system from working as it was intended: lack of awareness of the principle of patient choice for out-patient treatment; complacency from some trusts and commissioners; mental health trusts operating outside the e-referrals system; misuse of care pathways; lack of direct access by many general practitioners for out-of-area referrals; and delays in authorisation for funding. I describe how I have come to this conclusion and suggest some solutions.

Declaration of interest

The author is employed by a trust that potentially benefits from ‘patient choice’.
Diet regulates membrane extension and survival of niche escort cells for germline homeostasis via insulin signaling
Authors: Su Yu-Han , Rastegri Elham , Kao Shih-Han , Lai Chun-Min , Lin Kun-Yang , Liao Hung-Yu , Wang Mu-Hsiang , Hsu Hwei-Jan
Published: March 2018

Diet is an important regulator of stem cell homeostasis; however, the underlying mechanisms of this regulation are not fully known. Here, we report that insulin signaling mediates dietary maintenance of Drosophila ovarian germline stem cells (GSCs) by promoting the extension of niche escort cell (EC) membranes to wrap around GSCs. This wrapping may facilitate the delivery of bone morphogenetic protein stemness factors from ECs in the niche to GSCs. In addition to the effects on GSCs, insulin signaling-mediated regulation of EC number and protrusions controls the division and growth of GSC progeny. The effects of insulin signaling on EC membrane extension are, at least in part, driven by enhanced translation of Failed axon connections (Fax) via Ribosomal protein S6 kinase. Fax is a membrane protein that may participate in Abelson tyrosine kinase-regulated cytoskeletal dynamics and is known to be involved in axon bundle formation. Therefore, we conclude that dietary cues stimulate insulin signaling in the niche to regulate EC cellular structure, probably via Fax-dependent cytoskeleton remodeling. This mechanism enhances intercellular contact and facilitates homeostatic interactions between somatic and germline cells in response to diet.
Aplip1, the Drosophila homolog of JIP1, regulates myonuclear positioning and muscle stability
Authors: Auld Alexander L. , Roberts Sacha A. , Murphy Ciaran B. , Camuglia Jaclyn M. , Folker Eric S.
Published: March 2018

During muscle development, myonuclei undergo a complex set of movements that result in evenly spaced nuclei throughout the muscle cell. In Drosophila, two separate pools of Kinesin and Dynein work in synchrony to drive this process. However, how these two pools are specified is not known. Here, we investigate the role of Aplip1 (the Drosophila homolog of JIP1, JIP1 is also known as MAPK8IP1), a known regulator of both Kinesin and Dynein, in myonuclear positioning. Aplip1 localizes to the myotendinous junction and has genetically separable roles in myonuclear positioning and muscle stability. In Aplip1 mutant embryos, there was an increase in the percentage of embryos that had both missing and collapsed muscles. Via a separate mechanism, we demonstrate that Aplip1 regulates both the final position of and the dynamic movements of myonuclei. Aplip1 genetically interacts with both Raps (also known as Pins) and Kinesin to position myonuclei. Furthermore, Dynein and Kinesin localization are disrupted in Aplip1 mutants suggesting that Aplip1-dependent nuclear positioning requires Dynein and Kinesin. Taken together, these data are consistent with Aplip1 having a function in the regulation of Dynein- and Kinesin-mediated pulling of nuclei from the muscle end.

This article has an associated First Person interview with the first author of the paper.
Substitution with Satiation: A New Class of Utility Functions and a Complementary Pivot Algorithm
Authors: Garg Jugal , Mehta Ruta , Vazirani Vijay V.
Published: March 2018

We introduce new classes of utility functions and production sets, called Leontief-free, which are applicable when goods are substitutes and utilities/production are subadditive (to model inter-good satiation). When goods are complements, the well studied Leontief utility functions do an adequate job; however, to the best of our knowledge, a similar concept for the case of goods that are substitutes was not known.

For markets with these utility functions and production sets, we obtain the following results: Rational-valued equilibria, despite the fact that these utility functions and production sets are nonseparable. We prove that the problem of computing an equilibrium is PPAD-complete, where PPAD stands for Polynomial Parity Arguments on Directed Graphs. We obtain complementary pivot algorithms based on a suitable adaptation of Lemke’s classic algorithm. Our algorithms run in strongly polynomial time if the number of goods is a constant, despite the fact that the set of solutions is disconnected. Experimental verification confirms that our algorithms are practical.
Step aboard me scurvy hearties!
Authors: Francis-Pester Dawn
Published: March 2018

Children have always loved the daring and strength of pirates. This article features a number of ways to harness their enthusiasm with a range of crafts and activities.
X is for spooky X-Ray specs…
Authors: Hammond Paula , Lillie Stephen
Published: March 2018

This month, we continue our series that takes the form of an extended alphabetical adventure around the body, helping children to get to know themselves a little better.
The base for processing
Authors: Martland Rebecca
Published: March 2018

The second instalment in our look at the forthcoming General Data Protection Regulations that come into force in May, looks at the lawful basis for collecting personal information.
A form of evaluation
Authors: Webb Penny
Published: March 2018

Ofsted has announced that its inspectors will no longer look at the online self-evaluation forms childminders have become used to submitting. So what next for providing evidence?
Science: Reflecting, evaluating
Authors: Sargent Marianne
Published: March 2018

This is the eighth in a series of extracts from the book, Developing Early Science Skills Outdoors, which explores ideas for providing children with opportunities to learn outside.