bluuebunny/crossref_metadata_2025 huggingface dataset:
Where policy and practice collide: Comparing United States, South African and European Union approaches to protecting children online
Authors: Bulger Monica , Burton Patrick , O’Neill Brian , Staksrud Elisabeth
Published: January 2017

That children have a right to protection when they go online is an internationally well-established principle, upheld in laws that seek to safeguard children from online abuse and exploitation. However, children’s own transgressive behaviour can test the boundaries of this protection regime, creating new dilemmas for lawmakers the world over. This article examines the policy response from both the Global North and South to young people’s online behaviour that may challenge adult conceptions of what is acceptable, within existing legal and policy frameworks. It asks whether the ‘childhood innocence’ implied in much protection discourse is a helpful basis for promoting children’s rights in the digital age. Based on a comparative analysis of the emerging policy trends in Europe, South Africa and the United States, the article assesses the implications for policymakers and child welfare specialists as they attempt to redraw the balance between children’s online safety while supporting their agency as digital citizens.
From universal towards child-specific protection of the right to privacy online: Dilemmas in the EU General Data Protection Regulation
Authors: Macenaite Milda
Published: January 2017

The new European Union (EU) General Data Protection Regulation aims to adapt children’s right to privacy to the ‘digital age’. It explicitly recognizes that children deserve specific protection of their personal data, and introduces additional rights and safeguards for children. This article explores the dilemmas that the introduction of the child-tailored online privacy protection regime creates – the ‘empowerment versus protection’ and the ‘individualized versus average child’ dilemmas. It concludes that by favouring protection over the empowerment of children, the Regulation risks limiting children in their online opportunities, and by relying on the average child criteria, it fails to consider the evolving capacities and best interests of the child.
Literacy and training in digital research: Researchers’ views in five social science and humanities disciplines
Authors: Tsatsou Panayiota
Published: January 2017

This article examines the views of researchers in five social science and humanities disciplines on their digital literacy and the training they need or have undertaken. Theoretically, this article draws upon two competing conceptualisations of digital literacy: digital literacy as ‘user skills’ and digital literacy as ‘user–technology interactivity’. Empirically, it suggests that social science and humanities researchers’ understandings and evaluations of their digital literacy unfold at two levels – the factual and the perceptual – and involve not only (technical) skills but also user experiences, emotions and complex processes of learning, practising and self-development when interacting with technology. Furthermore, researchers challenge the value of generic institutional training for literacy enhancement and envision the development of informal communities of experience exchange and knowledge-sharing across the research community. These findings lead to recommendations on training provision and support the conceptualisation of digital literacy as a process where user interactivity with technology results in certain experiences, reflections and lessons, rather than merely reflecting users’ technical skills.
Current Environmental Enforcement Issues: Some International Developments and Their Implications for the UK
Authors: Hagger Lynn
Published: January 2017

This article will examine enforcement possibilities available in the UK and the domestic implications of some international developments. This will involve an evaluation of the regulatory system in relation to environmental protection, followed by an overview of alternative methods of enforcement which include opportunities for the individual and/or non-governmental organisation (NGO) to use EC law, judicial review and the common law as well as the prospects provided by expanded statutory civil liability and any developments that take place in relation to human rights. While the locus of the human rights discourse seems to have moved from a substantive to a procedural perspective, this article will argue that, given the shortcomings of current (and proposed) methods of enforcement, there should be a realignment of the debate. It is advanced that such a right would underpin environmental protection to the extent that it would need to be considered within all aspects of enforcement and be in a position to override other rights.
Escaping India’s culture of education: Migration desires among aspiring middle-class young men
Authors: Sancho David
Published: January 2017

Research on Indian overseas students in Australia has shown that there is an intricate connection between class and migration processes. Yet most of this work has focused on the experiences of students already abroad. Research on the formulation of migration-decisions and class dynamics from the sending side has been slow to emerge. This paper fills this gap and locates the analysis of migration desires within the literature on the Indian middle classes. I demonstrate how a middle-class culture of education that articulates hegemonic experiences, aspirations, and trajectories drives many aspiring middle-class young men to consider migrating as an alternative path to social mobility. Migration emerges as a temporary strategy geared towards accruing economic and cultural capital necessary for the fulfilment of class-based personal ambitions and wider social responsibilities at home. Migration is shown to stretch the boundaries of processes of class formation that now straddles multiple sites, resources, and aspirations.
Videogame consumption: The apophatic dimension
Authors: Brock Tom
Published: January 2017

This article applies psychological-sociological accounts of the ‘apophatic’, a form of negative thinking, to examples of gaming practices to conceptualise a new theory of videogame consumption. It challenges the prevailing notion that the games consumer is always a ‘cataphatic’ thinker – that is, an activistic, rational-pleasure seeker – and looks to the ‘sorrows’ of gaming to find evidence of its more undesirable nature. The term ‘apophatic’ is characterised as an attempt to de-value the rational value purportedly placed on gaming practices. ‘Griefing’ other players is a good example of this apophatic ethic, where players derive value from the subversion of serious play through the disruption and destruction of other players’ game worlds. The struggle with ‘failure’ is another. As such, the article concludes with a reflection on the almost unsayable nature of videogame consumption, and suggests that consumer value may be derived from its more negative, spiritual-like aspects.
Social bases of material consumption: The relationship between social groups and possession of household appliances in Denmark
Authors: Jacobsen Mette Hove
Published: January 2017

In this article, possession of household appliances in Denmark is used to address the role of social groups in reproducing social norms of material consumption practices. This has been down-played in studies engaging with the ‘practice turn’, especially within the sociology of sustainable consumption. Using latent class analysis, four distinct latent subgroups with similar patterns of material consumption are identified and analysed. On the basis of the possession of appliances, these groups are characterised and labelled unlimited, outdated, limited and updated. After assigning the households to the latent group to which they have the highest probability of belonging, the social character of these groups is examined using logit models, thus making explanations of differences in material consumption practices possible. As identified in other domains of consumption, this study found that patterns of material consumption are socially structured. Researchers within the sociology of sustainable consumption have been particularly interested in studying the role of material arrangements and infrastructures in reproducing shared understandings and common procedures. This article argues that, in order to fully understand the dynamic mechanisms of consumption patterns and the possibilities for sustainable development, the field should equally engage with shared understandings generated and reproduced by social groups.
What stories to tell? A trilogy of methods used for knowledge exchange in a community-based participatory research project
Authors: Fraser Sarah L
Published: January 2017

Researchers in the field of Aboriginal health generally have a keen interest in ‘participating in change’ to address the ongoing injustices experienced by Aboriginal peoples. Perhaps the most promoted methods for this purpose are those described as Indigenous methods and action research. Criteria of authenticity are generally used to assess the quality of research. In this essay, we reflect on how certain basic principles of action research, more notably ontological authenticity and educative authenticity can penetrate the process of knowledge exchange, creating spaces of ontological contamination and transformation. We reflect on the context of sharing ‘difficult knowledge’, knowledge that is encountered and shared in a post-colonial context of unequal power dynamics. We describe a trilogy of methods used for such knowledge exchange activities with three distinct audiences, and distinct goals. A commonality amongst the three described methods is the ‘unfinished’ and unorganised nature of what is transmitted, requiring the receptor to actively participate in the differentiation and reorganisation of information in a way that makes sense to him/her.
The reproduction of rural spaces through education: Abstraction of the rural and the creation of new differential spaces
Authors: Cervone Jason A
Published: January 2017

This paper examines the situating of rural communities in the United States within the neoliberal global context. It will focus on Henri Lefebvre's concept of abstract space, as well as additional theories on the ways space is produced and understood. The paper will use these theories to create an understanding of the ways rural communities are shaped and the role education plays in reproducing neoliberal ideology specifically through rural school consolidation. Abstracted rural space and schools are leading rural youth to internalize neoliberal ideology wherein they see themselves as economic actors rather than active engaged members of their community, and the best way to be successful is to gain the mobility to move to an urban center. Under this line of thought, rural exists only to serve capital as a site of resource extraction and low wage labor. The paper will conclude with a discussion on the way rural education can provide rural youth with the knowledge in which to produce rural spaces that represent what a modern rural community should be, focusing on improving the quality of life for residents, rather than what neoliberal capitalism needs it to be through the creation of common schools. This type of education can lead to the development of a right to the rural, a play off of Lefebvre's right to the city, wherein rural youth can critically examine their place and the place of rural communities in the world.
Limitations of Percutaneous Transluminal Angioplasty and Stenting for the Treatment of Disease of the Superficial Femoral and Popliteal Arteries
Authors: Laird John R.
Published: January 2017

The long-term primary patency rates for percutaneous transluminal angioplasty (PTA) and stenting in treatment of disease of the superficial femoral and popliteal arteries have been disappointing. Three-year primary patency rates of ∼50% have been reported for PTA and first-generation stents. Early results with newer nitinol stents appear promising; however, long-term data are lacking. One- and 2-year primary patency rates of 76% to 97% and 60% to 84%, respectively, have been reported with nitinol stents. An emerging concern with nitinol stents is the frequency of stent fracture (≥25%) after interventions for long-segment disease. A recent study has shown that stent fractures are associated with in-stent restenosis and with significantly lower primary patency at 1 year.

The therapeutic success of PTA and stenting correlates with the complexity of the underlying disease. The best results are achieved when treating focal stenoses in patients with good distal runoff. Because endovascular interventions are preferred by patients, can be repeated, and preserve the option of bypass surgery, PTA and stenting are increasingly employed for diffuse and complex SFA disease. Clarifying the role of PTA and stenting in the treatment of complex SFA disease will require future studies that stratify results by both lesion anatomy and treatment indication.
Where Are You? Location Tracking and the Promise of Child Safety
Authors: Hasinoff Amy Adele
Published: January 2017

Life360 is a surveillance app marketed to families that tracks and shares users’ location information in the name of child safety. Using this app as a case study, I examine how one Silicon Valley company promotes the idea that digital data are inherently objective and meaningful, specifically in the way they frame location information as necessary and sufficient for protecting children from harm. Apps like Life360 sell users a service that collects, repackages, and commodifies their personal information. These functions help fulfill the promise that Silicon Valley innovations developed for consumers can help solve social problems—in this case, that an app can help make children safer in public spaces. By closely analyzing the app itself and the texts produced by the company, this article finds that such technological solutions to risk both create and relieve a new anxiety about the need to know exactly where one’s family members are at all times.
TV Series Production and the Urban Restructuring of Istanbul
Authors: Celik Rappas Ipek A. , Kayhan Sezen
Published: January 2017

This article explores the entangled relationship between Turkish TV series and the city of Istanbul examining both the series’ representation of the city and the effects of flourishing series’ production on the city. We argue that TV series production and representation changes and is changed by the urban restructuring of globalizing Istanbul since the late 1980s. Analyzing internationally popular series such as Noor, Valley of the Wolves, and 1001 Nights and building on television, urban and cultural studies, this article explores the ways that Istanbul’s neoliberal renovation process appears in and is shaped by TV series. The three segments of the article probe how series reflect and push forth the gentrification of historical neighborhoods, their increasing use of abandoned post-industrial areas as shooting locations, and their promotion of spaces associated with creative industries and luxury lifestyles. We show that both images and image making are connected to city making.
Understanding the Adoption of Voter Identification Laws in the American States
Authors: Biggers Daniel R. , Hanmer Michael J.
Published: January 2017

Recently, many states have reversed the decades-long trend of facilitating ballot access by enacting a wave of laws requesting or requiring identification from registrants before they vote. Identification laws, however, are not an entirely new phenomenon. We offer new theoretical insights regarding how changes in political power influence the adoption of identification laws. In the most extensive analysis to date, we use event history analysis to examine why states adopted a range of identification laws over the past several decades. We consistently find that the propensity to adopt is greatest when control of the governor’s office and legislature switches to Republicans (relationships not previously identified), and that this likelihood increases further as the size of Black and Latino populations in the state expands. We also find that federal legislation in the form of the Help America Vote Act seems to enhance the effects of switches in partisan control.
Impaired redox environment modulates cardiogenic and ion-channel gene expression in cardiac-resident and non-resident mesenchymal stem cells
Authors: Subramani Baskar , Subbannagounder Sellamuthu , Ramanathanpullai Chithra , Palanivel Sekar , Ramasamy Rajesh
Published: January 2017

Redox homeostasis plays a crucial role in the regulation of self-renewal and differentiation of stem cells. However, the behavioral actions of mesenchymal stem cells in redox imbalance state remain elusive. In the present study, the effect of redox imbalance that was induced by either hydrogen peroxide (H2O2) or ascorbic acid on human cardiac-resident (hC-MSCs) and non-resident (umbilical cord) mesenchymal stem cells (hUC-MSCs) was evaluated. Both cells were sensitive and responsive when exposed to either H2O2 or ascorbic acid at a concentration of 400 µmol/L. Ascorbic acid pre-treated cells remarkably ameliorated the reactive oxygen species level when treated with H2O2. The endogenous antioxidative enzyme gene (Sod1, Sod2, TRXR1 and Gpx1) expressions were escalated in both MSCs in response to reactive oxygen species elevation. In contrast, ascorbic acid pre-treated hUC-MSCs attenuated considerable anti-oxidative gene (TRXR1 and Gpx1) expressions, but not the hC-MSCs. Similarly, the cardiogenic gene (Nkx 2.5, Gata4, Mlc2a and β-MHC) and ion-channel gene ( IKDR, IKCa, Ito and INa.TTX) expressions were significantly increased in both MSCs on the oxidative state. On the contrary, reduced environment could not alter the ion-channel gene expression and negatively regulated the cardiogenic gene expressions except for troponin-1 in both cells. In conclusion, redox imbalance potently alters the cardiac-resident and non-resident MSCs stemness, cardiogenic, and ion-channel gene expressions. In comparison with cardiac-resident MSC, non-resident umbilical cord-MSC has great potential to tolerate the redox imbalance and positively respond to cardiac regeneration.

Impact statement

Human mesenchymal stem cells (h-MSCs) are highly promising candidates for tissue repair in cardiovascular diseases. However, the retention of cells in the infarcted area has been a major challenge due to its poor viability and/or low survival rate after transplantation. The regenerative potential of mesenchymal stem cells (MSCs) repudiate and enter into premature senescence via oxidative stress. Thus, various strategies have been attempted to improve the MSC survival in ‘toxic’ conditions. Similarly, we investigated the response of cardiac resident MSC (hC-MSCs) and non-resident MSCs against the oxidative stress induced by H2O2. Supplementation of ascorbic acid (AA) into MSCs culture profoundly rescued the stem cells from oxidative stress induced by H2O2. Our data showed that the pre-treatment of AA is able to inhibit the cell death and thus preserving the viability and differentiation potential of MSCs.
Evaluation of cementitious repair mortars modified with polymers
Authors: Weng Tsai-Lung
Published: January 2017

The aim of this study was to evaluate the effects of added polymers on the properties of repair mortars. Two types of polymers, ethylene vinyl acetate and polyvinyl acetate–vinyl carboxylate, were used as a replacement for 3%, 5%, and 8% of the cement (by weight). All tests were conducted using two water–cement ratios of 0.5 and 0.6. The effectiveness of the repair materials was evaluated according to setting time, drying shrinkage, thermal expansion, compressive strength, and bond strength. Specimens containing polyvinyl acetate–vinyl carboxylate at a water–cement ratio of 0.5 presented the highest compressive and bond strength. Specimens containing ethylene vinyl acetate presented strength characteristics exceeding those of the control at 28 days. The drying shrinkage of polyvinyl acetate–vinyl carboxylate specimens was similar to that of the control. At a water–cement ratio of 0.5, the thermal expansion of polyvinyl acetate–vinyl carboxylate specimens was lower than that of ethylene vinyl acetate specimens; however, at a water–cement ratio of 0.6, the thermal expansion was independent of the type of polymer.
On solving fractional mobile/immobile equation
Authors: Pourbashash Hossein , Baleanu Dumitru , Al Qurashi Maysaa Mohamed
Published: January 2017

In this article, a numerical efficient method for fractional mobile/immobile equation is developed. The presented numerical technique is based on the compact finite difference method. The spatial and temporal derivatives are approximated based on two difference schemes of orders [Formula: see text] and [Formula: see text], respectively. The proposed method is unconditionally stable and the convergence is analyzed within Fourier analysis. Furthermore, the solvability of the compact finite difference approach is proved. The obtained results show the ability of the compact finite difference.
Synchronization approach for chaotic time-varying delay system based on Wirtinger inequality
Authors: Zhao Zhanshan , He Meili , Zhang Jing , Xu Guowei
Published: January 2017

A novel control approach based on Wirtinger inequality is designed for nonlinear chaos synchronization time delay system. In order to reduce the conservatism for the stability criterion, a Lyapunov–Krasovskii functional with triple-integral term is constructed. The improved Wirtinger inequality is used to reduce the conservative which is caused by Jensen inequality, and a stability criterion is proposed by reciprocally convex method. Furthermore, a state feedback controller is designed to synchronize the master-slave systems based on the proposed criteria through cone complementary linearization approach. Finally, a simulation for Lorenz chaos time delay system is given to prove the validity based on the proposed synchronization control approach.
Biochemical profiling of tuberculosis patients co-infected with hepatitis C virus
Authors: Akram Yusra , Mahmood Zahed , Riaz Muhammad , Javed Irum , Shahid Muhammad , Batool Tahira , Shah Syed Muhammad Ali , Munir Naveed , Tahir Imtiaz Mahmood
Published: January 2017

The present research work was planned to investigate the biochemical parameters in tuberculosis (TB) patients in comparison with healthy individual and TB patients co-infected with hepatitis C virus (HCV). For the study, we determined liver enzymes, serum proteins, hemoglobin photometrically, and erythrocyte sedimentation rate (ESR) by the Westergren method. The results showed a significant ( P <0.05) increase in the level of alanine aminotransferase in the Test group (TB + HCV patients) and the TB control group when compared with the healthy control group. A non-significant ( P >0.05) increase in the level of aspartate aminotransferase was observed in the Test group while a non-significantly ( P >0.05) reduced level was observed in the TB control group when compared with healthy controls. Alkaline phosphatase was increased significantly ( P <0.05) in the Test group but non-significantly ( P >0.05) in the TB control group compared to healthy control group. Significant ( P <0.05) variation in the concentration of serum proteins among different groups in the studied population was also observed. Significant ( P <0.05) variation in hemoglobin concentration was observed only on comparing the Test group with healthy individuals ( P = 0.013). No significant ( P >0.05) variation in serum calcium level was observed among study groups. ESR was found to be lower in the healthy control group while significantly ( P <0.05) increased in the Test and TB control groups. The HCV co-infected patients were investigated through HCV screening by the immunochromatographic method. We concluded that variation in biochemical and hematological parameters observed in the studied population help us to diagnose HCV co-infected TB patients.
Efficacy of otilonium bromide in irritable bowel syndrome: a pooled analysis
Authors: Clavé Pere , Tack Jan
Published: January 2017

Background:

Otilonium bromide (OB) is a spasmolytic agent acting as an L-type calcium channel antagonist in intestinal and colonic smooth muscle cells (SMCs). We analyzed three independent clinical trials with homogeneous design on patients with irritable bowel syndrome (IBS). After 2 weeks receiving placebo, patients were randomized to receive OB (3 × 40 mg daily) or placebo for 15 weeks. We aimed to perform a pooled analysis of the data from these homogeneous clinical trials to evaluate the efficacy of OB treatment on symptoms and global response of patients.

Methods:

A total of 883 patients with IBS (69.8% women, mean age 46.2 years, 43.8% mixed type) were included, 442 treated with OB and 441 with placebo. The efficacy results from the three studies at weeks 5, 10 and 15 were pooled in an intention-to-treat (ITT) strategy, analyzed with a logistic regression model and described by forest plots.

Results:

Despite a placebo effect in all efficacy variables, a significant therapeutic effect of OB was observed at weeks 10 and 15 with reference to: (a) intensity and frequency of abdominal pain; (b) rate of responders as evaluated by patients (71.8% at week 10 and 77.2% at week 15); (c) severity of bloating; (d) rate of responders as evaluated by physicians (55% at week 10 and 63.9% at week 15). No significant OB effect was observed in stool frequency and consistency.

Conclusions:

OB is more effective than placebo in IBS treatment. Therapeutic benefits are significant after 10 weeks and are maximal after 15 weeks of treatment.
Self-assessment of independence in older people: First results from an open-access website for senior citizens and caregivers in France
Authors: Koskas Pierre , Wolfowicz B
Published: January 2017

Background:

E-health initiatives on the Internet can be used to provide support to people with chronic diseases and to their caregivers. In 2014/2015, we created a free website called jesuisautonome.fr where older people, or their carers on their behalf, can assess their independence in daily living by filling out a simple questionnaire.

Objectives:

To evaluate the interest of the public in websites of this kind, by analysing home care plans obtained via the self-assessment questionnaire. We also describe patterns of use and visitor behaviour.

Method:

Over a period of 6 months, we analysed data from the website in terms of the basic characteristics of the user; the number of questionnaires completed; the main types of needs in terms of home support; and data from Google Analytics about the number of visitors, user behaviour and behaviour flow.

Results:

During the 6-month study period, 439 visitors to the site either viewed, part-completed or fully completed the questionnaire. A total of 190 users completed the questionnaire. Seventy-one per cent of the completed questionnaires were from family caregivers, and 29% were from senior citizens. The mean age of those receiving care was 78 ± 10.46 years. Their main needs were for domiciliary care (29.3%). Data from Google Analytics showed about 420 visits per month. Approximately 7.5% completed a questionnaire, approximately 5.3% downloaded a home care plan and there was a bounce rate of about 62%.

Conclusion:

First results from this website tend to endorse its use as a means of making practical solutions available to caregivers and older people.
Variability in Foot and Ankle Case Volume in Orthopaedic Residency Training
Authors: DeFroda Steven F. , Gil Joseph A. , Blankenhorn Brad D. , Daniels Alan H.
Published: January 2017

Surgical case volume during orthopaedic surgical residency is a concern among trainees and program directors alike. With an ongoing trend toward further subspecialization and the rapid development of new techniques and devices, the breadth of procedures that residents are exposed to continues to increase. Accreditation Council for Graduate Medical Education surgical case logs from 2009 to 2013 for graduating orthopaedic surgery residents were examined to assess the national averages of orthopaedic procedures logged by graduating orthopaedic surgery residents in the leg/ankle and foot/toes categories. This investigation revealed that there was an 8% increase in the total number of leg/ankle cases and 12% increase in foot/toes cases performed by graduating orthopaedic surgery residents, which has not significantly increased from 2009 to 2013. Across years examined in this study, significant variability existed between the 10th and 90th percentiles for total foot and ankle resident case exposure (P < .05), particularly within ankle arthroscopy, where there was a 15-fold difference in the number of arthroscopy cases performed by residents in the 90th percentile compared with the 10th percentile. The overall volume of foot and ankle cases performed by graduating orthopaedic surgery residents has increased despite not being statistically significantly from 2009 to 2013.

Levels of Evidence: Level III: Cohort study
Differences between children and young people: A multiple case study from Denmark
Authors: Johansen Martin Blok
Published: January 2017

The words ‘children’ (Danish: ’børn’) and ‘young people’ (Danish: ’unge’) are so often combined that they almost have the character of idiomatic expressions. But what differences in the use of the words can be found? This article seeks to study the prevalent, dominant discourses about children and young people. In particular, it endeavours to answer the following question: What is thematized, and how are the thematizations created and maintained? The study is theoretically inspired by Foucault’s discourse analysis. The methodological approach is that of a multiple case study. Thus, it provides examples of how children are typically referred to in positive terms such as innocent, imaginative, cheerful, spontaneous, creative and competent (a surplus discourse), while young people are typically referred to in negative terms such as irresponsible, rootless, violent, dysfunctional, hedonistic and unaccountable (a deficit discourse).
Book Review: Tukumbi Lumumba-Kasongo (Ed.) (2016), Land Rreforms and Natural Resource Conflicts in Africa: New Development Paradigms in the Era of Global Liberalization
Authors: Chambati Walter
Published: January 2017

Tukumbi Lumumba-Kasongo (Ed.) (2016), Land Rreforms and Natural Resource Conflicts in Africa: New Development Paradigms in the Era of Global Liberalization, London: Routledge, Hardback, ISBN 978-138-88882-1, pp. 232, £90.00.
Behavioral Assessment of Listening Effort Using a Dual-Task Paradigm
Authors: Gagné Jean-Pierre , Besser Jana , Lemke Ulrike
Published: January 2017

Published investigations ( n = 29) in which a dual-task experimental paradigm was employed to measure listening effort during speech understanding in younger and older adults were reviewed. A summary of the main findings reported in the articles is provided with respect to the participants’ age-group and hearing status. Effects of different signal characteristics, such as the test modality, on dual-task outcomes are evaluated, and associations with cognitive abilities and self-report measures of listening effort are described. Then, several procedural issues associated with the use of dual-task experiment paradigms are discussed. Finally, some issues that warrant future research are addressed. The review revealed large variability in the dual-task experimental paradigms that have been used to measure the listening effort expended during speech understanding. The differences in experimental procedures used across studies make it difficult to draw firm conclusions concerning the optimal choice of dual-task paradigm or the sensitivity of specific paradigms to different types of experimental manipulations. In general, the analysis confirmed that dual-task paradigms have been used successfully to measure differences in effort under different experimental conditions, in both younger and older adults. Several research questions that warrant further investigation in order to better understand and characterize the intricacies of dual-task paradigms were identified.
Rehabilitation of Discharged Patients With Chronic Obstructive Pulmonary Disease—Are New Strategies Needed?
Authors: Morsø Lars , Jensen Morten Sall , von Plessen Christian , Qvist Peter
Published: January 2017

Background:

Rehabilitation after hospital stay implies several benefits for patients with chronic obstructive pulmonary disease (COPD); still few patients are referred and participate in rehabilitation programs. We conducted a case study to investigate the effects of interventions targeting the referral, uptake, and completion for a program of early rehabilitation in the primary health-care sector.

Methods:

We undertook targeted initiatives to make patients participate in an individualized rehabilitation program with gradual increased intensity. After discharge, primary care COPD nurses and physiotherapists guided patients through progressing exercises in small groups online. Patients proceeded to class-based exercises, patient education and/or leisure activities, or continued telerehabilitation. We evaluated the effects of the intervention by assessing referral rates, completion, and readmission.

Results:

Sixteen (23% of discharged patients) patients were referred to rehabilitation. In comparison, only 1 (0.8%) in 131 patients from Vejle hospital was referred to Vejle hospital. Twelve patients completed rehabilitation, all having severe COPD. All started the program within 2 weeks and proceeded to the online-guided exercises within 4 weeks. Study data showed that after 30 days, 1 (6.3%) of the 16 patients in the rehabilitation program had been readmitted compared to 8 (14.8%) of 55 patients who were not referred. After 90 days, 2 (12.5%) and 11 (20.0%) patients were readmitted, respectively. The readmission rate showed a nonsignificant decline in patients participating in rehabilitation.

Conclusion:

This case study showed that the referral rate of patients with COPD to early municipal rehabilitation is extremely low without a targeted effort and still insufficient in spite of a focused intervention. We showed that completion of a municipal rehabilitation program shortly after discharge is possible even for patients with severe COPD. The findings from our pilot study can guide further investigations into the effect of implementation strategies for handovers between health-care sectors to secure early-onset rehabilitation of patients with COPD.
Associations Between Relative Value Units and Patient-Reported Back Pain and Disability
Authors: Gold Laura S. , Bryan Matthew , Comstock Bryan A. , Bresnahan Brian W. , Deyo Richard A. , Nedeljkovic Srdjan S. , Nerenz David R. , Heagerty Patrick , Jarvik Jeffrey G.
Published: January 2017

Objective: To describe associations between health care utilization measures and patient-reported outcomes (PROs). Method: Primary data were collected from patients ≥65 years with low back pain visits from 2011 to 2013. Six PROs of pain and functionality were collected 12 and 24 months after the index visits and total and spine-specific relative value units (RVUs) from electronic health records were tabulated over 1 year. We calculated correlation coefficients between RVUs and 12- and 24-month PROs and conducted linear regressions with each 12- and 24-month PRO as the outcome variables and RVUs as predictors of interest. Results: We observed very weak correlations between worse PROs at 12 and 24 months and greater 12-month utilization. In regression analyses, we observed slight associations between greater utilization and worse 12- and 24-month PROs. Discussion: We found that 12-month health care utilization is not strongly associated with PROs at 12 or 24 months.
Key paediatric messages from the 2016 European Respiratory Society International Congress
Authors: Grigg Jonathan , Balfour-Lynn Ian M. , Everard Mark , Hall Graham , Karadag Bülent , Priftis Kostas , Roehr Charles Christoph , Rottier Bart L. , Midulla Fabio
Published: January 2017

In this article, the Group Chairs of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting abstracts presented at the 2016 ERS International Congress, which was held in London.
Enhanced suppression of polyclonal CD8+25+ regulatory T cells via exosomal arming of antigen-specific peptide/MHC complexes
Authors: Mu Chuanyong , Zhang Xueshu , Wang Lu , Xu Aizhang , Ahmed Khawaja Ashfaque , Pang Xueqin , Chibbar Rajni , Freywald Andrew , Huang Jianan , Zhu Yehan , Xiang Jim
Published: January 2017

Compared with CD4+25+ regulatory T cells (Tregs), the mechanisms for natural, polyclonal CD8+25+ Treg immune suppression have been significantly less studied. We previously showed that polyclonal T cells can acquire antigen-specific targeting activity through arming with exosomal peptide-MHC (pMHC). In this study, we assessed the suppressive effect of CD8+25+ Tregs or CD8+25+ Tregs armed with ovalbumin (OVA)-specific exosomes on other immune cells and OVA-specific dendritic cell (DCOVA)-stimulated antitumor immunity. We demonstrate that CD8+25+ Tregs inhibit T cell proliferation in vitro in a cell contact-dependent fashion but independent of the expression of immunosuppressive IL-10, TGF-β, and CTLA-4. CD8+25+ Tregs anergize naïve T cells upon stimulation by up-regulating T cell anergy-associated Egr2 and down-regulating IL-2 production. Tregs also anergize DCs by preventing DC maturation through the down-regulation of Iab, CD80, CD86, and inflammatory cytokines, leading to defects in T cell stimulation. Moreover, CD8+25+ Tregs inhibit CTLs through inducing CTL death via perforin-mediated apoptosis and through reducing effector CTL cytotoxic activity via down-regulating CTL perforin-production and degranulation. In addition, we show that CD8+25+ Tregs suppress DCOVA-stimulated CTL responses in priming and effector phases and inhibit immunity against OVA-expressing CCLOVA lung cancer. Remarkably, polyclonal CD8+25+ Tregs armed with OVA-specific exosomal pMHC class-II (pMHC-II), or pMHC class-I (pMHC-I) complexes exert their enhanced inhibition of CTL responses in the priming and the effector phases, respectively. Taken together, our investigation reveals that assigning antigen specificity to nonspecific polyclonal CD8+25+ Tregs for enhanced immune suppression can be achieved through exosomal pMHC arming. This principle may have a great effect on Treg-mediated immunotherapy of autoimmune diseases.
Transcutaneous Carbon Dioxide Measurements in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Prospective Observational Study
Authors: Bauchat Jeanette R. , McCarthy Robert , Fitzgerald Paul , Kolb Stephen , Wong Cynthia A.
Published: January 2017

BACKGROUND:

Neuraxial morphine is the most commonly used analgesic technique after cesarean delivery. The incidence of respiratory depression is reported to be very low (0%–1.2%) in this patient population as measured by pulse oximetry and respiratory rates. However, hypercapnia may be a more sensitive measure of respiratory depression. In the current study, the incidence of hypercapnia events (transcutaneous CO2 [TcCO2] >50 mm Hg) for ≥2-minute duration was evaluated using the Topological Oscillation Search with Kinematical Analysis monitor in women who received intrathecal morphine for postcesarean delivery analgesia.

METHODS:

Healthy women (>37 weeks of gestation) scheduled for a cesarean delivery with spinal anesthesia with intrathecal morphine were recruited. Baseline STOP-BANG sleep apnea questionnaire and TcCO2 readings were obtained. Spinal anesthesia was initiated with 12 mg hyperbaric bupivacaine, 15 µg fentanyl, and 150 µg morphine. The Topological Oscillation Search with Kinematical Analysis monitor was reapplied in the postanesthesia care unit and TcCO2 measurements obtained for up to 24 hours. Supplemental opioid administration and adverse respiratory events were recorded. The primary outcome was the incidence of hypercapnia events, defined as a TcCO2 reading >50 mm Hg for ≥2 minutes in the first 24 hours after delivery.

RESULTS:

Of the 120 women who were recruited, 108 completed the study. Thirty-five women (32%; 99.15% confidence interval, 21%–45%) reached the primary outcome of a sustained hypercapnia event. The median time (interquartile range [IQR]) from intrathecal morphine administration to the hypercapnia event was 300 (124–691) minutes. The median (IQR) number of events was 3 (1–6) and longest duration of an event was 25.6 (8.4–98.7) minutes. Baseline median (IQR) TcCO2 measurements were 35 (30–0) mm Hg and postoperatively, median (IQR) TcCO2 measurements were 40 (36–43) mm Hg, a difference of 5 mm Hg (99.15% confidence interval of the difference 2–8 mm Hg, P < .001). The incidence of hypercapnia events was 5.4% in women with a baseline TcCO2 value ≤31 mm Hg, 22.5% with a baseline TcCO2 between 32 and 38 mm Hg, and 77.4% with a baseline TcCO2 >38 mm Hg (P < .001).

CONCLUSIONS:

Hypercapnia events (>50 mm Hg for ≥2-minute duration) occurred frequently in women receiving 150 μg intrathecal morphine for postcesarean analgesia. Higher baseline TcCO2 readings were observed in women who had hypercapnia events.
Assessing the Agreement Between Radiologic and Clinical Measurements of Lumbar and Cervical Epidural Depths in Patients Undergoing Prone Interlaminar Epidural Steroid Injection
Authors: Jones James Harvey , Singh Naileshni , Nidecker Anna , Li Chin-Shang , Fishman Scott
Published: January 2017

BACKGROUND:

Fluoroscopy-guided epidural steroid injection (ESI) commonly is performed to treat radicular pain yet can lead to adverse events if the needle is not advanced with precision. Accurate preoperative assessment of the distance from the skin to the epidural space holds the potential for reducing the risks of adverse effects from ESI. It was hypothesized that the distance from the skin to the epidural space as measured on preoperative magnetic resonance imaging (MRI) would agree with the distance traveled by a Tuohy needle to reach the epidural space during midline, interlaminar ESI. This study compared the final needle depth measurement at the point of loss of resistance (LOR) from cervical or lumbar ESI to the distance from the skin to the anterior and posterior borders of the epidural space on the associated cervical and lumbar preoperative MRI.

METHODS:

This retrospective chart review analyzed the procedure notes, MRI, and demographic data of patients who received a prone, interlaminar ESI at an outpatient chronic pain clinic between June 1, 2013, and June 1, 2015. The following data were collected: body mass index (BMI), age, sex, intervertebral level of the ESI, and LOR depth. We then measured the distance from the skin surface to the anterior border of the ligamentum flavum (ligamentum flavum depth [LFD]) and dura (dura depth [DD]) on MRI. A total of 335 patients were categorized into the following patient subgroups: age ≥65 years, age <65 years, BMI ≥30 kg/m2 (obese), BMI <30 kg/m2 (nonobese), male, and female. Secondary analyses were then performed to compare the agreement between LOR depth and DD with that between LOR depth and LFD within each patient subgroup. Intraclass correlation coefficient (ICC) and Bland-Altman plot were used to assess the agreement between DD or LFD and LOR depth.

RESULTS:

Data from 335 ESIs were analyzed, including 147 cervical ESIs and 188 lumbar ESIs. Estimated ICC values for the agreement between LOR depth and LFD for all lumbar and cervical measurements were 0.88 (95% confidence interval [CI], 0.85–0.91) and 0.72 (95% CI, 0.64–0.79), respectively. Estimated ICC values for the agreement between LOR depth and DD for all lumbar and cervical measurements were 0.86 (95% CI, 0.82–0.89) and 0.69 (95% CI, 0.60–0.77), respectively.

CONCLUSIONS:

This study assessed the agreement between MRI-derived measurements of epidural depth and those determined clinically. MRI-derived measurements from the skin to the anterior border of the ligamentum flavum, which represents the most posterior aspect of the epidural space, revealed stronger agreement with LOR depths than did measurements to the dura or the most anterior aspect of the epidural space. These results require further analysis and refinement before supporting clinical application.
Orthogonal Views of Coronary Vessels: A Method for Imaging the Delivery of Blood Cardioplegia Using Transesophageal Echocardiography
Authors: Maracaja Neto Luiz F. , Modak Raj , Schonberger Robert B.
Published: January 2017

Coronary blood flow can be disrupted during cardiac interventions such as mitral valve surgeries, left atrial appendage ligation, transcatheter aortic valve implantation, and aortic procedures involving reimplantation of coronary buttons. Although difficult to accomplish, coronary imaging using transesophageal echocardiography can be performed by the use of orthogonal imaging with the ability for real-time tilt for angle adjustment. The technique described herein allows imaging of the right coronary artery, left main coronary artery bifurcation, left anterior descending, and circumflex coronary arteries. The imaging is facilitated by acquisition during the delivery of blood cardioplegia. Coronary sinus and great cardiac vein imaging also can be obtained during the delivery of retrograde cardioplegia. Although further studies are needed, this imaging technique may prove useful in procedures where coronary flow disruption is suspected or as an additional parameter to confirm delivery of cardioplegia.
Leopold Bloom’s Dark Riddle: Joyce, Levinas, and the Storytelling Self
Authors: Winterhalter Teresa
Published: January 2017

This article argues that although James Joyce’s Ulysses faces us with an overarching verbal complexity, we need not allow the insights into Leopold Bloom’s voicing grounded in Bakhtinian analysis to delimit the endpoint in exploring Joyce’s narrative technique. Stressing that Bloom is at once a creature of multiple linguistic contingencies and a lone storyteller who longs to compose a coherent story of himself to make sense of his life, my argument traces Bloom’s internal ordeal through what Emmanuel Levinas might call his “narrative intentionality.” By following Levinasian “dark riddles” that compose Bloom’s discursive negotiations, it concludes that Joyce demonstrates the vital role self-narrativizing plays in countering existential isolation, and that his narrative technique is in important ways aligned with Levinas’s conception of an ethics of love.
Efficient CRISPR/Cas9-assisted gene targeting enables rapid and precise genetic manipulation of mammalian neural stem cells
Authors: Bressan Raul Bardini , Dewari Pooran Singh , Kalantzaki Maria , Gangoso Ester , Matjusaitis Mantas , Garcia-Diaz Claudia , Blin Carla , Grant Vivien , Bulstrode Harry , Gogolok Sabine , Skarnes William C. , Pollard Steven M.
Published: January 2017

Mammalian neural stem cell (NSC) lines provide a tractable model for discovery across stem cell and developmental biology, regenerative medicine and neuroscience. They can be derived from foetal or adult germinal tissues and continuously propagated in vitro as adherent monolayers. NSCs are clonally expandable, genetically stable, and easily transfectable – experimental attributes compatible with targeted genetic manipulations. However, gene targeting, which is crucial for functional studies of embryonic stem cells, has not been exploited to date in NSC lines. Here, we deploy CRISPR/Cas9 technology to demonstrate a variety of sophisticated genetic modifications via gene targeting in both mouse and human NSC lines, including: (1) efficient targeted transgene insertion at safe harbour loci (Rosa26 and AAVS1); (2) biallelic knockout of neurodevelopmental transcription factor genes; (3) simple knock-in of epitope tags and fluorescent reporters (e.g. Sox2-V5 and Sox2-mCherry); and (4) engineering of glioma mutations (TP53 deletion; H3F3A point mutations). These resources and optimised methods enable facile and scalable genome editing in mammalian NSCs, providing significant new opportunities for functional genetic analysis.