bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined analysis of job and task benzene air exposures among workers at four US refinery operations
Authors: Burns Amanda , Shin Jennifer (Mi) , Unice Ken M , Gaffney Shannon H , Kreider Marisa L , Gelatt Richard H , Panko Julie M
Published: February 2016

Workplace air samples analyzed for benzene at four US refineries from 1976 to 2007 were pooled into a single dataset to characterize similarities and differences between job titles, tasks and refineries, and to provide a robust dataset for exposure reconstruction. Approximately 12,000 non-task (>180 min) personal samples associated with 50 job titles and 4000 task (<180 min) samples characterizing 24 tasks were evaluated. Personal air sample data from four individual refineries were pooled based on a number of factors including (1) the consistent sampling approach used by refinery industrial hygienists over time, (2) the use of similar exposure controls, (3) the comparability of benzene content of process streams and end products, (4) the ability to assign uniform job titles and task codes across all four refineries, and (5) our analysis of variance (ANOVA) of the distribution of benzene air concentrations for select jobs/tasks across all four refineries. The jobs and tasks most frequently sampled included those with highest potential contact with refinery product streams containing benzene, which reflected the targeted sampling approach utilized by the facility industrial hygienists. Task and non-task data were analyzed to identify and account for significant differences within job-area, task-job, and task-area categories. This analysis demonstrated that in general, areas with benzene containing process streams were associated with greater benzene air concentrations compared to areas with process streams containing little to no benzene. For several job titles and tasks analyzed, there was a statistically significant decrease in benzene air concentration after 1990. This study provides a job and task-focused analysis of occupational exposure to benzene during refinery operations, and it should be useful for reconstructing refinery workers’ exposures to benzene over the past 30 years.
Examination of the Brief Fear of Negative Evaluation Scale–Version 2 and the Brief Fear of Negative Evaluation Scale–Straightforward Items Factor Structure in a Sample of U.S. College Students
Authors: Liu Liu , Lowe Patricia A.
Published: February 2016

The current study examined the factor structure of the Brief Fear of Negative Evaluation–Straightforward Items (BFNE-S) and the Brief Fear of Negative Evaluation–Version 2 (BFNE-II) among 151 college students from the United States. Results indicated that the BFNE-S and the BFNE-II scores demonstrated excellent internal consistency reliability. Single-group confirmatory factor analyses found that compared with the BFNE-II, the BFNE-S demonstrated a superior fit for the unitary theoretical model. Together, these findings suggest that the BFNE-S appears to be a better measure for assessing fear of negative evaluation in U.S. college students.
The synergism between melamine and expandable graphite on improving the flame retardancy of polyamide 11
Authors: Jin Xiaodong , Chen Chen , Sun Jun , Zhang Xing , Gu Xiaoyu , Zhang Sheng
Published: February 2016

Expandable graphite (EG) has attracted more and more attention in fire science society due to its excellent char-forming ability, however, it cannot meet commercial flame-retardant requirements because of the low intensity of the char. This work reported our very recent efforts on improving the char quality of EG by introducing melamine (MEL) in order to enhance the fire resistance and thermal stability of polyamide 11 (PA 11) composite. The flammability characterized by limiting oxygen index, UL-94 vertical burning, and cone calorimeter (cone) tests shows that the presence of both EG and MEL can significantly improve the flame retardancy and thermal stability of PA 11 composites. The scanning electron microscopic analysis shows that EG and MEL are beneficial to form compact char layers that can isolate the matrix from heat and oxygen. It is proposed that the formation of hydrogen bonds between MEL and PA 11 are crucial for improving the flame retardancy of the composites.
Organizational culture, quality improvement tools and methodologies, and business performance of a supply chain
Authors: Tomic Branislav , Spasojević Brkić Vesna , Karapetrovic Stanislav , Pokrajac Slobodan , Milanović Dragan D , Babić Bojan , Djurdjevic Tijana
Published: February 2016

Unlike previous studies that have revealed a link between quality improvement programs and organizational culture typologies in individual companies, this study describes organizational culture dimensions that affect the use of quality improvement tools and methodologies and how both affect supply chain company performance. Structural equation modeling methods are applied to a sample of 200 organizations in the supply chain of a Canadian multinational company. The results show that employee promotion and investment constitutes the most influential cultural dimension. Organizational objectives and an employee reward system individually affect Kaizen. When the level of formalization in an organization is high, Kaizen and total quality management tools are used more intensively. When the level of formalization is low, lean manufacturing and internal audits are used more intensively. Superior communication in an organization causes plan–do–check–act approaches, lean manufacturing methods, corrective actions and internal audits to be used less intensively. Generally speaking, most quality improvement tools and methodologies positively influence business performance. These results suggest that organizations can improve business performance levels by selecting appropriate quality improvement programs depending on existing organizational culture dimensions and may thereby develop an organizational culture that enables successful quality improvements in a supply chain context.
Influence of contact loss underneath concrete underlayer on dynamic performance of prefabricated concrete slab track
Authors: Juanjuan Ren , Rongshan Yang , Ping Wang , Feng Dai , Xiaobo Yan
Published: February 2016

Contact loss between the concrete underlayer and the subgrade caused by the differential settlement or stiffness of subgrade structure is a common distress, which deteriorates the mechanical properties of the track structure and adversely affects the safety and comfort for the operation on high-speed railway. The objective of this paper is to study the damage mechanism of prefabricated slab track subjected to such contact loss and to propose a critical value for the size of contact loss that would not jeopardize the safety of rail traffic and riding comfort of passengers. Thus, a vibration calculation model for the vertically coupled vehicle-J-slab track-subgrade system is established using finite element method, both of the short-wave irregularity and the German long-wave irregularity were taken into account to calculate the dynamic response of vehicle, track structure and subgrade with different contact loss areas and speeds scenarios. Based on the numerical simulation results, a critical value of contact loss area is proposed. When the actual contact loss area is smaller than the critical value, the welded joint irregularity is the dominant factor in the vehicle dynamic response; however, when the actual contact loss area is larger than the critical value, the track irregularity induced by contact loss under the concrete underlayer becomes the dominant factor. It is suggested that the contact loss area should be controlled under the critical value in order to ease or mitigate the dynamic response of the vehicle and track structure. The numerical simulation indicates the critical contact loss area is about 10 m2 for the short-wave irregularity case and 14 m2 for the long-wave irregularity case, thus it is suggested that the contact loss area underneath the concrete underlayer should not exceed 10 m2, which is consistent with the Swedish standard and the German standard on weak areas of subgrade compaction.
Urban crises and the new urban agenda
Authors: Earle Lucy
Published: February 2016

This paper highlights how the global policy framework for crisis response needs to change to remain effective in an urbanizing world, where disaster risk is increasing and most refugees and half of all internally displaced people are in urban areas. This includes a need to understand how affected populations are inserted within complex urban contexts – and the current and potential roles of city and municipal governments. This implies a focus on bolstering or repairing existing systems – markets, infrastructure and provision of utilities – so that affected populations are quickly able to meet their needs in ways that are familiar to them. Assisting affected populations through existing city systems also helps ensure that emergency interventions contribute to longer-term urban development goals. Camps can create dependency where populations are discouraged from working. They are expensive, generate stigma, and can be the site of violence and exploitation. The humanitarian imperative to save lives and preserve dignity can be aligned with an approach that helps towns and cities get back on track, and even flourish, after a crisis. It is to be hoped that Habitat III’s “new urban agenda” reflects this.
Subchronic toxicology of tetrabromobisphenol A in rats
Authors: Osimitz Thomas G , Droege Wiebke , Hayes A Wallace
Published: February 2016

Tetrabromobisphenol A (TBBPA) is used to protect a wide range of electrical and electronic equipment, consumer electronics and office and communication equipment from catching fire. TBBPA reacts covalently with other monomers becoming an integral part of the cross-linked molecular structure. This study was conducted to evaluate the subchronic toxicity of TBBPA administered by gavage daily for 13 weeks at 0, 100, 300, and 1000 mg/kg/day in male and female CD® rats. A 6-week post-treatment control and 1000 mg/kg/day recovery groups were included. TBBPA exerted no marked effect on the rate of mortality, clinical signs, body or organ weights, feed consumption, histopathology, urinalysis, ophthalmology, and neurological outcomes in a functional observation battery, motor activity, serum thyroid stimulating hormone, serum triiodothyronine, or other serum chemistries. Although differences were observed for bilirubin and alkaline phosphatase, the observed alterations were within the normal range and thus were neither biologically or toxicologically meaningful. The single thyroid-related parameter affected by TBBPA was a reduction in serum thyroxine levels, but the decrease was not of sufficient magnitude to induce other more sensitive indicators of thyroid perturbation. The No Observed Adverse Effect Level was at least 1000 mg/kg/day, the highest dose tested. Based on an upper bound aggregate exposure for adults estimated by the European Union, the margin of exposure is approximately 5000, suggesting that, for the endpoints examined in this study, exposure to TBBPA presents a reasonable certainty of no harm.
The Social Functions of Group Rituals
Authors: Watson-Jones Rachel E. , Legare Cristine H.
Published: February 2016

Convergent developments across social scientific disciplines provide evidence that ritual is a psychologically prepared, culturally inherited, behavioral trademark of our species. We draw on evidence from the anthropological and evolutionary-science literatures to offer a psychological account of the social functions of ritual for group behavior. Solving the adaptive problems associated with group living requires psychological mechanisms for identifying group members, ensuring their commitment to the group, facilitating cooperation with coalitions, and maintaining group cohesion. The intersection of these lines of inquiry yields new avenues for theory and research on the evolution and ontogeny of social group cognition.
The Impact of an In-Service Workshop on Cooperating Teachers’ Perceptions of Culturally Responsive Teaching
Authors: McKoy Constance L. , MacLeod Rebecca B. , Walter Jennifer S. , Nolker D. Brett
Published: February 2016

Culturally responsive teaching values students’ identities, backgrounds, and cultural references as key tools for building meaningful learning environments. It has been adopted by many educators globally, but has not been incorporated consistently by music educators. Few researchers in music education have investigated the impact of culturally responsive teaching and misconceptions exist about what it means to teach music in a culturally responsive manner. The purpose of this research was to investigate the impact of an in-service program on cooperating teachers’ perceptions of culturally responsive teaching. At the conclusion of the workshop, participants rated familiarity and importance of culturally responsive teaching higher than they did prior to the workshop. Sixteen of the 18 participants indicated that the workshop had changed their understanding of culturally responsive teaching.
Examining Pedagogical Content Knowledge of an Expert Band Director Teaching Lips Slurs
Authors: Millican J. Si
Published: February 2016

The purpose of this case study was to describe how one band director used pedagogical content knowledge while working with beginning-band students to help them develop the skill of playing brass lip slurs. Data were generated from (1) video recordings of each class over two different weeks during the school year, (2) “think aloud” interviews in which the teacher described what educational actions and decisions the teacher was making, and (3) detailed observation notes. I used cognitive task analysis to develop a concept map illustrating components of pedagogical content knowledge the teacher used during instruction. The teacher combined content knowledge, knowledge of students, and curriculum knowledge providing examples of how pedagogical content knowledge manifests itself in teaching beginning band. Examining the teacher’s pedagogical content knowledge revealed core teaching practices that may be useful for music teacher educators to understand and develop.
Anticoagulation in Patients With Cirrhosis
Authors: Ha Nghi B. , Regal Randolph E.
Published: February 2016

Objective: To review current literature for anticoagulation in patients with cirrhosis and provide a summary of the effects of cirrhosis on the coagulation cascade, therapeutic monitoring through interpretation of antifactor Xa (anti-Xa), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) as well as current prophylaxis and treatment recommendations in cirrhotic patients. Methods: A systematic electronic literature search was conducted in PubMed using the key terms anticoagulation, warfarin, low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), target-specific oral anticoagulants, deep-vein thrombosis (DVT), pulmonary embolism (PE), portal vein thrombosis (PVT), venous thromboembolism, anti-Xa, activated partial thromboplastin time, anticoagulation therapeutic monitoring, coagulopathy, coagulation cascade, chronic liver disease, cirrhosis, and decompensated liver disease. Study Selection: Studies written in the English language from January 2000 to December 2015 were considered for this review article. All search results were reviewed, and the relevance of each article was determined by authors independently. Conclusions: Patients with cirrhosis are at higher risk for both bleeding and thrombosis-related complications. Cirrhosis affects production of both procoagulant and anticoagulant factors, thus resulting in increased INR and aPTT levels and decreased anti-Xa levels. LMWH is the treatment of choice for the prevention and treatment of DVT/PE/PVT in patients with cirrhosis, and monitoring with anti-Xa levels for dose adjustment is not recommended. UFH is an alternative in cirrhotic patients for shorter-term use and in cases of severe renal dysfunction and/or hemodynamic instability. Cirrhotic patients on anticoagulation therapy should be monitored closely for signs and symptoms of bleeding and thrombosis.
Sustainable Flows
Authors: Danière Amrita , Drummond Lisa , NaRanong Anchana , Tran Van Anh Thi
Published: February 2016

There is widespread recognition that cities in the Global South need to transition toward sustainable water practices. This is particularly true of places experiencing growth and impacts from climate change concomitantly, as are Bangkok and Hanoi. We evaluate case studies in each of these two Southeast Asian cities to explore possible sustainable water management practices that their urban communities, and others experiencing similar issues, could adopt in the near term. Our analysis of these case studies supports four key conclusions: Simple expansion of rigid infrastructure does not necessarily meet local needs for water, communities can themselves provide insights and creative models, governments at any scale can be flexible and such flexibility can achieve appropriate solutions, and small-scale experimentation can and does work and can be successfully scaled up with government encouragement and support.
The Two Sides of the Paris Climate Agreement
Authors: Clémençon Raymond
Published: February 2016

The December 2015 Paris Climate Agreement is better than no agreement. This is perhaps the best that can be said about it. The scientific evidence on global warming is alarming, and the likelihood depressingly small that the world can stay below a 2°C—even less a 1.5°C warming—over pre-industrial times. The Paris Agreement does not provide a blueprint for achieving these stabilization objectives. But it is ultimately the hope, however small, that a fundamental and rapid energy transition is achievable that must inform social and political behavior and activism in the coming years. In this sense, the Paris outcome is an aspirational global accord that will trigger and legitimize more climate action around the world. The question is whether this will happen quickly enough and at a sufficient scale to avoid disastrous warming of the planet. What is certain is that it will not occur without determined and far-reaching government intervention in energy markets in the next few years, particularly in the largest polluting countries.
Detection of damage through coupled axial–flexural wave interactions in a sagged rod using the spectral finite element method
Authors: Jothi Saravanan T , Gopalakrishnan N , Prasad Rao N
Published: February 2016

This paper presents the results of a computational and experimental validation exercise performed towards damage identification of a sagged rod with known damage by using the coupled axial–flexural wave interaction mechanics. Towards simulating the damage scenario in a sagged conductor made of steel wire rope, a prismatic steel rod is taken up for study. An initial axial wave, tangential to the curve of the arc, manifests as both axial and flexural waves as it propagates alongside the length of the rod. This interaction effect between axial and flexure wave propagation is studied in this paper. Impedance mismatch is made in the rod by changing its cross-sectional area along its length. Numerical simulations are implemented using the spectral finite element method with a combined axial and flexure effect. The concept of obtaining the exact spectral element dynamic stiffness matrix for a wave propagation analysis sagged rod is discussed. Computation is implemented in the Fourier domain using Fast Fourier Transform (FFT). In the time domain, post processing of the response is done, which is applicable in structural diagnostics in addition to the wave propagation problem. The predominant single-frequency-based amplitude-modulated, narrow-banded, burst wave propagation is found to be better matched if the elemental rod theory is replaced with a modified rod theory called the Love theory. The differences in the propagating waves allow identification of the damage location in a very clear-cut way. The methodology of the moving correlation coefficient is also successfully employed to detect the damage precisely. This fact is very encouraging for future work on structural health monitoring.
Linking data on work, health and lifestyle to explain socio-occupational inequality in Danish register-based incidence of diabetes
Authors: Poulsen Kjeld , Andersen Lars Louis
Published: February 2016

Aims: This study aimed to combine three consecutive cohorts representative of the general working population to estimate the lifestyle, work and health of the entire Danish working population and to explore the influence of these factors on socio-occupational inequality in relation to incident diabetes over ten years. Methods: This study linked the National Danish Diabetes Register with (a) three questionnaire rounds (1995, 2000, 2005) on work, health and lifestyle from the Danish Work Environment Cohort Study (DWECS) among 6823 representative Danish workers aged 30–59 years and (b) the different socio-occupational groups of the entire Danish population aged 30–59 years ( n=1,833,756). The relative risk (RR) was calculated using a Poisson regression. Results: In DWECS, none of the investigated job factors was associated with incident diabetes. Lifestyle factors in terms of smoking (RR = 1.35; 95% confidence interval (CI) 1.07–1.70), high body mass index (overweight RR = 2.81; 95% CI 2.11–3.74 and obesity RR = 7.49; 95% CI 5.46–10.28) were risk factors for incident diabetes. When adjusted for health and lifestyle, there was no difference in diabetes risk among socio-occupational groups in DWECS. In the entire working population, there was a negative socio-occupational gradient for the risk of diabetes. Compared with professionals, workers in elementary occupations had the highest ten-year risk (RR = 2.06; 95% CI 2.01–2.12). Conclusions: We found a significant negative socio-occupational gradient in the risk of incident diabetes. However, lifestyle rather than work environment appears to be the most important factor and adjusting for this almost eliminated the socio-occupational inequality for the development of diabetes.
Prevalence of Helicobacter pylori infection among preschool children in Latvia: no significant decrease in prevalence during a ten year period
Authors: Daugule Ilva , Karklina Daiga , Rudzite Dace , Remberga Silvija , Rumba-Rozenfelde Ingrida
Published: February 2016

Aims: Published data show a trend of decreasing prevalence of Helicobacter pylori in Eastern European countries due to socioeconomic changes. The aim of this study was to determine the prevalence of H. pylori infection among children in Latvia and to compare these results with previous studies in the same population. The risk factors associated with infection were also analysed. Methods: Preschool children in kindergartens and primary health care centres were investigated using a stool antigen test. Their parents were asked to fill out a questionnaire about possible risk factors. Statistical analysis included Pearson’s χ2 test and linear regression analysis. Results: The prevalence of H. pylori infection determined by the monoclonal stool antigen test in children aged 1–6 years (median 5 years) was 15.5% (15/101) (95% confidence interval 8.67–23.48%). In the regression analysis, H. pylori positivity was significantly negatively associated with the consumption of imported fruit at least once per week ( p=0.02). Conclusions: The prevalence of H. pylori in the studied population has not decreased significantly during the last decade and is still associated with socioeconomic factors. The role of some dietary factors (e.g. the consumption of fruit) in the spread of infection should be studied further.
An innovative capstone health care informatics clinical residency: Interprofessional team collaboration
Authors: Custis Laura M , Hawkins Shelley Y , Thomason Tanna R
Published: February 2016

Integrated information systems and wireless technology have been increasingly incorporated into health care organizations with the premise that information technology will promote safe, high-quality, cost-effective patient care. With the advancement of technology, the level of expertise necessary to assume health care information technology roles has escalated. The purpose of this article is to describe a clinical residency project whereby students in a graduate degree health care informatics program successfully fulfilled program competencies through a faculty-lead research project focused on the use of home telehealth with a group of heart failure patients. Through the use of Donabedian’s framework of structure, process, and outcomes, the health care informatics students completed essential learning activities deemed essential for transition into the role of an informatics specialist. Health care informatics educational leaders are encouraged to adapt this template of applied learning into their practices.
Transient thermoelastic investigation of FGM composite plate with varying grading parameter
Authors: Sharma Rajesh , Jadon Vijay Kumar , Singh Balkar , Sharma Neeraj
Published: February 2016

Functionally graded materials (FGM) are newly developed materials described by variation in the characteristics gradually over volume. These materials find applications in very high temperature environments namely aerospace industry, nuclear reactors, gas turbines, and electronics cooling. These materials are used in high temperature environments with dynamic load conditions, so their transient thermoelastic analysis under these conditions is necessary. In this paper, transient thermoelastic investigation of FGM is carried out using finite element method (FEM). The effect of temperature dependence is considered in the thermophysical properties of a FGM plate in the direction of its thickness. FEM is applied to solve the thermo mechanical equations and Newmark direct integration scheme is used for obtaining the solution for transient loading. This method improves the accuracy for three dimensional cases and produces solutions directly in time domain. A comparative study is made with some existing methods, and it is found that temperature and thermal stresses remain within safe limits at higher temperatures while preserving the deformation in the structure. The results show that the grading parameter has a dominating effect on transient thermoelastic behavior on FGM plate.
Cognitive, linguistic and print-related predictors of preschool children’s word spelling and name writing
Authors: Milburn Trelani F , Hipfner-Boucher Kathleen , Weitzman Elaine , Greenberg Janice , Pelletier Janette , Girolametto Luigi
Published: February 2016

Preschool children begin to represent spoken language in print long before receiving formal instruction in spelling and writing. The current study sought to identify the component skills that contribute to preschool children’s ability to begin to spell words and write their name. Ninety-five preschool children (mean age = 57 months) completed a battery of cognitive, linguistic, as well as print-related measures, including spelling/writing tasks (i.e. letters, words and name). All writing samples were scored using scoring matrices and inter-rater reliability was 90% and above. Hierarchical linear regression was conducted for word spelling, indicating that after controlling for age and IQ, the model of best fit included expressive vocabulary, working memory, blending, letter naming and letter writing ability. Logistic regression was conducted for name writing, indicating that the model that included age, expressive vocabulary, letter naming and letter writing identified preschool children who wrote their name conventionally and those who could not. Letter writing explained unique variance in both word spelling and name writing, and phonological awareness explained unique variance in word spelling only. These findings suggest that different processes underlie word spelling and name writing, supporting the consideration of a dual-route model of children’s early spelling and writing ability.
Outcomes of Endovascular Therapy With the Controlled Antegrade Retrograde Subintimal Tracking (CART) or Reverse CART Technique for Long Infrainguinal Occlusions
Authors: Chou Hsin-Hua , Huang Hsuan-Li , Hsieh Chien-An , Jang Shih-Jung , Cheng Shih-Tsung , Tsai Sou-Chan , Wu Tien-Yu , Ko Yu-Lin
Published: February 2016

Purpose: To compare the safety, efficacy, and clinical outcomes associated with the controlled antegrade retrograde subintimal tracking (CART) or reverse CART (r-CART) technique to the conventional retrograde approach in the treatment of patients with long infrainguinal occlusions. Methods: From May 2008 to April 2014, 121 patients failed antegrade recanalization and underwent a retrograde approach to recanalize long infrainguinal occlusions. Patients who underwent successful endovascular therapy (EVT) by the conventional retrograde approach (CRA group) were compared to patients who had successful EVT using the CART/r-CART technique (CART group) after failure of a bidirectional approach. The efficacy, safety, vessel patency, and other clinical outcomes were compared between the groups. Results: Fifty-eight patients (mean age 71.6±12.2 years; 32 men) underwent successful EVT (47.9%, 58/121) using the conventional retrograde approach (CRA group), while 44 patients (mean age 70.8±11.1 years; 31 men) among the 50 patients who underwent the CART/r-CART technique were successfully treated (88.0%, 44/50). Both groups had similar average occlusion lengths and gained 100% immediate hemodynamic success after EVT. There was no significant difference between the groups regarding procedure-related complications. During follow-up, 28 patients died (p=0.380), but there were no differences in the rates of major (p=0.279) or minor amputation (p=0.417) between the groups. There was no difference in the 2-year primary patency (31% vs 24%, p=0.686), assisted primary patency (66% vs 76%, p=0.251), target vessel revascularization (65% vs 54%, p=0.845), or sustained clinical success (52% vs 46%, p=0.995) rates between the CRA and CART groups, respectively. Conclusion: Based on acceptable safety, efficacy, and follow-up results in this study, the CART/r-CART technique can salvage patients with long peripheral occlusions after failure of the conventional antegrade or retrograde approach.
Recurrent Admissions for Respiratory Distress Caused by Large Renal AVF
Authors: Keller Weston William , Miserlis Dimitrios , Suh Melissa , Dale Matthew , Sayyed Samer , Baxter B. Timothy
Published: February 2016

Renal arteriovenous fistulas (AVFs) are an uncommon complication of nephrectomy. In this report, we present the case of a 66-year-old female presenting with progressive dyspnea on exertion and exercise intolerance. She was diagnosed and treated for adult onset reactive airway disease. The patient underwent nephrectomy at age 18 secondary to recurrent pyelonephritis from vesicoureteral reflux. She underwent a surveillance computed tomography (CT) scan to evaluate a small ascending aneurysm that was initially detected on cardiac echocardiogram. A large left renal AVF was detected incidentally on the CT scan. The fistula was successfully treated by ligation of the renal artery with resolution of pulmonary symptoms.
Second Chances Academy
Authors: Horsford Sonya Douglass , Powell Keyona L.
Published: February 2016

This case considers the leadership challenge facing district officials in a mid-sized urban–suburban school district receiving negative media coverage for the overrepresentation of poor, Black, and Latino males in its alternative high school, Second Chances Academy. Many of its students also qualify for special education and English learner services. Local civil rights leaders have expressed moral outrage over the school’s abysmal graduation rate, describing it as a “pit stop” along the school-to-prison pipeline. Now that the third principal in 2 years has resigned, the district superintendent must not only manage public criticism and find the right person to lead Second Chances Academy but also confront the socially unjust practices embedded in his district’s alternative education program.
The Yearbook Photo and Graduation Speech
Authors: Fleig Jeffrey
Published: February 2016

Only 48.6% of University Council For Educational Administration (UCEA) institutions which focus on social justice in principal preparation programs address sexual orientation, this case describes how the completion of an equity audit for an educational leadership course compelled Principal Olson to reflect on his identity as a social justice leader. The racial identity development of Principal Olson led him to understand his own Whiteness and privilege and how his actions not only marginalized students of color but also students who are lesbian, gay, bisexual, transgender, or questioning (LGBTQ). The day before graduation, Principal Olson listened as the class president rehearsed her speech where she told the audience she is transgender. This is not a debate of whether the speech should be given, but the issue is how Principal Olson will respond when questioned.
The “Affirmative Action Hire”
Authors: Marshall Joanne M. , Marsh Tyson E. J.
Published: February 2016

This case tells the story of a new principal who wants to lead inclusively by including people of all religious and non-religious beliefs. When she questions some of the existing practices in her school, she faces resistance from school members and from the community, who question her identity, her intentions, and her authority. The case is intended for use in leadership courses and highlights some dilemmas of inclusive leadership around religion, as well as those found in the intersectionality of religion, race, and gender.
Prostate Cancer Education in African American Barbershops
Authors: Luque John S. , Ross Levi , Gwede Clement K.
Published: February 2016

There have been very few studies to rigorously evaluate the potential of African American barbers to educate men about prostate cancer in the barbershop setting. This research brief presents baseline data from a cross-sectional survey identifying differences in decisional conflict and stage of decision making by screening status from an efficacy trial to educate African American men about informed decision making for prostate cancer screening. Those men who had already received the prostate-specific antigen (PSA) test were more advanced in their stage of decision making and had less decisional conflict about the PSA test than those men who had never received a PSA test. Educational interventions to increase informed decision making with prostate cancer screening must consider previous PSA test history as a mediating variable affecting decision self-efficacy.
Subclavian steal: Endovascular treatment of total occlusions of the subclavian artery using a retrograde transradial subintimal approach
Authors: Satti Sudhakar R , Golwala Sohil N , Vance Ansar Z , Tuerff Sonya N
Published: February 2016

Introduction

In symptomatic subclavian steal syndrome, endovascular treatment is the first line of therapy prior to extra-anatomic surgical bypass procedures. Subintimal recanalization has been well described in the literature for the coronary arteries, and more recently, in the lower extremities. By modifying this approach, we present a unique retrograde technique using a heavy tip microwire to perform controlled subintimal dissection.

Methods

We present two cases of symptomatic subclavian steal related to chronic total occlusion of the left subclavian artery and right innominate artery, respectively. Standard crossing techniques were unsuccessful. Commonly at this point, the procedures would be aborted and open surgical intervention would have to be pursued. In our cases, retrograde access was easily achieved via an ipsilateral retrograde radial artery, using controlled subintimal dissection and a heavy-tipped wire.

Results

We were able to easily achieve recanalization in both attempted cases of chronic total occlusion of the subclavian and innominate artery, using a retrograde radial subintimal approach. Subsequent stent-supported angioplasty resulted in complete revascularization. No major complications were encountered during the procedures; however, one patient did develop thromboembolic stroke secondary to platelet aggregation to the stent graft, 9 days post-procedure.

Conclusions

Endovascular treatment is considered the first-line intervention in medically refractory patients with symptomatic subclavian steal syndrome. In the setting of chronic total occlusions, a retrograde radial subintimal approach using a heavy tip wire for controlled subintimal dissection is a novel technique that may be considered when standard approaches and wires have failed.
Therapeutic internal carotid or vertebral artery occlusion using the WEB device
Authors: van Rooij Willem Jan , Sluzewski Menno , Bechan Ratna , Peluso Jo PP
Published: February 2016

The WEB device was used to occlude the internal carotid artery or vertebral artery as treatment for large aneurysms. The WEB could be placed accurately at the desired position inside the vessel. Two WEBs were sufficient to occlude the parent artery.
Tachycardia burden in stroke unit is associated with functional outcome after ischemic stroke
Authors: Jeong Han-Gil , Ko Sang-Bae , Kim Chi Kyung , Kim Yerim , Jung Seunguk , Kim Tae Jung , Yoon Byung-Woo
Published: February 2016

Background

Stroke unit care is associated with decrease in mortality and improvement in neurological outcome in patients with acute stroke. Heart rate is a commonly monitored variable in the stroke unit. However, little is known about tachycardia burden in the stroke unit and its association with outcome.

Aims

To investigate the effects of tachycardia burden in the stroke unit on functional outcome in patients with acute ischemic stroke.

Methods

We collected data from 246 patients with acute ischemic stroke admitted to our stroke unit between July 2013 and June 2014. Tachycardia burden was defined as duration of heart rate over 95 per minute divided by the total monitoring time, using the heart rate data sampled every 1 min. We divided the study population into quartiles of tachycardia burden and analyzed their association with poor three-month functional outcome (modified Rankin Scale score of ≥3).

Results

Among included patients (age, 67.4  ±  12.8; male, 53.7%), tachycardia burden was 0.7% (median, interquartile range [0.1–5.7%]). The patients with higher tachycardia burdens were older, more likely to have higher stroke severity, cardioembolic etiology, atrial fibrillation, fever, pneumonia, higher initial glucose level, and higher white blood cell count. As compared with the lowest quartile (<0.1%), the highest quartile of tachycardia burden (≥6.0%) was significantly associated with poor outcome (adjusted odds ratio, 5.10; 95% confidence interval, 1.38–18.90; p = 0.01) after adjustment for covariates.

Conclusions

Patients with increased tachycardia burden during stroke unit stay have poor functional outcome. Countermeasures against worsening factors might be utilized for patients with increased tachycardia burden.
Vorapaxar monotherapy for secondary stroke prevention: A call for randomized trial
Authors: Serebruany Victor L , Kim Moo H , Hanley Daniel F
Published: February 2016

Background and Purpose

Vorapaxar, a novel platelet thrombin protease-activated receptor 1 blocker, is currently approved for post-myocardial infarction and peripheral artery disease indications on top of clopidogrel or/and aspirin. We sought to summarize the conflicting stroke data after vorapaxar for justifying a secondary stroke prevention trial.

Methods

Analyses of the stroke data after vorapaxar yielded from thrombin-receptor antagonist vorapaxar in acute coronary syndromes (TRACER) and TRA2P clinical trials, and affiliated Food and Drug Administration (FDA) reviews.

Results

The stroke data are mixed, with catastrophic 2.5 excess of intracranial bleeding risks (HR = 2.52; 95% CI = 1.46–4.36, p < 0.0001); trend to worsened second stroke rates (13.0% vs. 11.7%; HR = 1.03; 95% CI = 0.85–1.25, p = NS), but a hint towards less primary ischemic strokes in vorapaxar indicated population (HR = 0.57; 95% CI = 0.43 to 0.75; p < 0.001). These conflicting data are not solely attributed to vorapaxar, but rather reflect unreasonably aggressive triple antiplatelet strategies utilized frequently in TRA2P and dominant in TRACER. Overall, the FDA-confirmed evidence advocates future vorapaxar secondary stroke prevention trial due to being first-in-class agent, unique pharmakynetics, and exhibiting very mild “comfort zone” antiplatelet profile. The three arm trial testing head-to-head monotherapy with vorapaxar (Zontivity®), versus clopidogrel (Plavix®), and versus extended-released dipyridamole with very low dose aspirin (Aggrenox®) is warranted.

Conclusions

Vorapaxar may be superior to currently recommended antiplatelet strategies and should be tested as a monotherapy in a randomized outcome-driven secondary stroke prevention trial.
Modeling flexible two-dimensional warranty contracts for used products considering reliability improvement actions
Authors: Su Chun , Wang Xiaolin
Published: February 2016

In this article, a new pre-sale reliability improvement model is proposed for repairable used products sold with a two-dimensional free repair warranty policy. Using bivariate failure modeling framework, this model can describe the effect of reliability improvement action on the past age and past usage of a used product separately. Under the two-dimensional free repair warranty policy, product failures within the warranty coverage are rectified minimally by the dealer at no cost to new buyers. The optimal reliability improvement policy is determined to minimize the total expected servicing cost per unit sale from the dealer’s perspective. Moreover, a four-step approach is developed to design flexible warranty contracts with optimized reliability improvement policies for used products. Numerical example and sensitivity analysis are provided to demonstrate the effectiveness of the proposed model and approach.
Shared care of the expectant mother
Authors: Blackman Jenny
Published: February 2016

Although the natural process of pregnancy and childbirth do not change, the specialty of obstetrics (‘to stand by’ in Latin) is forever changing. There is no time to ‘stand by’ with ever busier maternity units and pressures on appointments, beds and resources. As techniques, pathways, tests and guidelines become more advanced and detailed we must not lose sight of basic skills, thorough clinical assessment, and the need for more joined-up thinking between obstetrics as a specialty and general practice. This article does not focus on intrapartum care or on the high-risk pregnancy issues managed within maternity units, rather it considers some of the areas where shared care of the expectant mother between obstetricians, midwives and those working within general practice matter most. It also highlights some of the common issues that arise during pregnancy and present to a primary care setting.
Case-Based Reasoning for Insulin Bolus Advice
Authors: Pesl Peter , Herrero Pau , Reddy Monika , Oliver Nick , Johnston Desmond G. , Toumazou Christofer , Georgiou Pantelis
Published: February 2016

Background:

Insulin bolus calculators assist people with Type 1 diabetes (T1D) to calculate the amount of insulin required for meals to achieve optimal glucose levels but lack adaptability and personalization. We have proposed enhancing bolus calculators by the means of case-based reasoning (CBR), an established problem-solving methodology, by individualizing and optimizing insulin therapy for various meal situations. CBR learns from experiences of past similar meals, which are described in cases through a set of parameters (eg, time of meal, alcohol, exercise). This work discusses the selection, representation and effect of case parameters used for a CBR-based Advanced Bolus Calculator for Diabetes (ABC4D).

Methods:

We analyzed the usage and effect of selected parameters during a pilot study (n = 10), where participants used ABC4D for 6 weeks. Retrospectively, we evaluated the effect of glucose rate of change before the meal on the glycemic excursion. Feedback from study participants about the choice of parameters was obtained through a nonvalidated questionnaire.

Results:

Exercise and alcohol were the most frequently used parameters, which was congruent with the feedback from study participants, who found these parameters most useful. Furthermore, cases including either exercise or alcohol as parameter showed a trend in reduction of insulin at the end of the study. A significant difference ( P < .01) was found in glycemic outcomes for meals where glucose rate of change was rising compared to stable rate of change.

Conclusions:

Results from the 6-week study indicate the potential benefit of including parameters exercise, alcohol and glucose-rate of change for insulin dosing decision support.
Medication therapy management by pharmacists in a kidney transplant ambulatory clinic
Authors: Lee Puay Hoon , Fan Petrina Yuen Wai , Kee Terence Yi Shern
Published: February 2016

Introduction:

Pharmacists play an essential role as part of the multidisciplinary transplant team in providing comprehensive pharmaceutical care for kidney transplant recipients.

Methods:

A prospective, observational, single-centre study evaluated the clinical pharmacy service in a kidney transplant ambulatory clinic. At each visit, pharmacists reviewed and optimised the medication regimens of transplant recipients, which include the medication therapy management of immunosuppression, infective and non-infective complications commonly seen post-transplantation. Pharmacists also performed medication reconciliation and provided medication education during each visit. Any drug-related problems or discrepancies identified were communicated to the physicians in the clinic.

Results:

Between September 2013 and March 2015, a total of 3581 cases were reviewed. Pharmacists identified 663 drug-related problems involving 319 recipients. Most of the pharmacists’ clinical recommendations (93%) were accepted by physicians. The common drug-related problems identified were ‘inappropriate dosage regimen’ (38%), ‘omission of drug therapy’ (28%) and ‘monitoring parameters recommendation’ (9%). Common drug classes involved were immunosuppressive agents (25%), anti-infectives (14%) and anti-hypertensive agents (12%). During medication reconciliation, pharmacists identified 180 medication discrepancies. Common medication discrepancies identified include ‘incorrect dose’ (68%), ‘incorrect duration’ (17%) and ‘incorrect drug’ (13%). All drug-related problems and medication discrepancies were resolved or addressed at the same clinic visit.

Conclusions:

Pharmacists play a pivotal role in the provision of medication therapy management to ensure safe and effective use of medications in kidney transplant recipients with complex medication regimens. This was achieved through identification and resolution of drug-related problems from medication review and medication discrepancies from medication reconciliation.