bluuebunny/crossref_metadata_2025 huggingface dataset:
Gendered transitions from education to work: The mysterious relationship between the fields of education and work
Authors: Wyn Johanna , Cuervo Hernán , Crofts Jessica , Woodman Dan
Published: April 2017

This article addresses the paradox that, despite achieving educational participation exceeding their male peers, young women see fewer returns for this investment in the labour market. We argue that this paradox is obscured by youth transitions frameworks that assume a close, linear relationship between education and work. We draw on Bourdieu’s concept of field to highlight the distinctive logics (particularly the ‘time economy’) that shape different engagements by young people in education and work. This approach reveals the enduring power of the time structure of paid work in Australia to dominate key dimensions of life, including caring work, placing many women in a situation where they feel they must ‘choose’ career or parenthood. Our analysis of the intersections and disjunctions of these different fields highlights the challenges for young women’s transitions from education to work, and highlights the need for a relational framework to critically analyse the relationship between these fields.
The datafication of data journalism scholarship: Focal points, methods, and research propositions for the investigation of data-intensive newswork
Authors: Ausserhofer Julian , Gutounig Robert , Oppermann Michael , Matiasek Sarah , Goldgruber Eva
Published: April 2017

This article explores the existing research literature on data journalism. Over the past years, this emerging journalistic practice has attracted significant attention from researchers in different fields and produced an increasing number of publications across a variety of channels. To better understand its current state, we surveyed the published academic literature between 1996 and 2015 and selected a corpus of 40 scholarly works that studied data journalism and related practices empirically. Analyzing this corpus with both quantitative and qualitative techniques allowed us to clarify the development of the literature, influential publications, and possible gaps in the research caused by the recurring use of particular theoretical frameworks and research designs. This article closes with proposals for future research in the field of data-intensive newswork.
Community engagement with a postcolonial, African-based relational paradigm
Authors: Chilisa Bagele , Major Thenjiwe Emily , Khudu-Petersen Kelne
Published: April 2017

The article engages with debates on democratizing and decolonizing research to promote multi-epistemological research partnerships that revolutionize the research methods landscape, bringing new paradigms onto the map to advance new research methods that engage and transform communities. The argument in the article is that people of all worlds irrespective of geographic location, colour, race, ability, gender or socio-economic status should have equal rights in the research scholarship and research process to name their world views, apply them to define themselves and be heard. An African-based relational paradigm that informs a postcolonial research methodological framework within which indigenous and non–indigenous researchers can fit their research is presented. The article further illustrates how an African relational ontological assumption can inform a complimentary technique of gathering biographical data on the participants and how African relational epistemologies can inform partnership of knowledge systems. The use of proverbs and songs as indigenous literature and community voices that researchers can use to deconstruct stereotypes and deficit theorizing and community-constructed ideologies of dominance is illustrated.
Evaluating Community–Academic Partnerships of the South Carolina Healthy Brain Research Network
Authors: Soltani Suzan Neda , Kannaley Kristie , Tang Weizhou , Gibson Andrea , Olscamp Kate , Friedman Daniela B. , Khan Samira , Houston Julie , Wilcox Sara , Levkoff Sue E. , Hunter Rebecca H.
Published: April 2017

Community–academic partnerships have a long history of support from public health researchers and practitioners as an effective way to advance research and solutions to issues that are of concern to communities and their citizens. Data on the development and evaluation of partnerships focused on healthy aging and cognitive health were limited. The purpose of this article is to examine how community partners view the benefits and barriers of a community–academic partner group established to support activities of the South Carolina Healthy Brain Research Network (SC-HBRN). The SC-HBRN is part of the national Healthy Brain Research Network, a thematic research network funded by the Centers for Disease Control and Prevention (CDC). It is focused on improving the scientific and research translation agenda on cognitive health and healthy aging. Semistructured interviews, conducted at end of Year 2 of the 5-year partnership, were used to collect data from partners of the SC-HBRN. Reported benefits of the partnership were information sharing and networking, reaching a broader audience, and humanizing research. When asked to describe what they perceived as barriers to the collaborative, partners described some lack of clarity regarding goals of the network and opportunities to contribute to the partnership. Study results can guide and strengthen other public health-focused partnerships.
New design method for horizontal alignment of complex mountain highways based on “trajectory–speed” collaborative decision
Authors: Xu Jin , Lin Wei , Shao Yiming
Published: April 2017

The safety evaluation of geometry features design based on actual driving behavior has always been a basic concept of highway design. However, current design methods, including both the design speed method and operating speed method, are still far away from real-world driving conditions. In this work, we propose a new alignment design method which can take into account typical handing patterns (driving styles) of human drivers and can pay special attention to dangerous driving behaviors. The core of the proposed method is forecasting the trajectories of typical direction control patterns within roadway width, which can be used by drivers. Then, forecast the driving speed of typical speed control patterns on the basis of the curvature of the preview trajectory just determined. Mathematical programming method was used in this study, whereby the objective functions and constraints were developed to model the typical driving patterns. This article provided five direction control patterns and four speed control patterns to designers so that they could select an appropriate pattern to predict the trajectory and speed for the designed road. Finally, the trajectory and speed are used to control the geometric features of the road. Geometric features can determine the driveway shape, such as curve radius, deflection angle, spiral length, tangent length, roadway/lane/shoulder width, and any or all of these can be adjusted by the designer. Meanwhile, as more than one driving pattern is optional and vehicle performance, driving stability, and ride comfort restrictions are introduced to trajectory/speed decision-making, the new method more closely approximates to real-world driving than conventional methods. The application example shows that the proposed method is especially suitable for the horizontal alignment design of low/medium design speed highways that traverse rugged terrain.
The Brightest and the Best: Factors Influencing the Retention or Withdrawal of Completing Teachers
Authors: Diamond C.T. Patrick , Borthwick Jill
Published: April 2017

Allegations that the most able simply intend to leave teaching were challenged by qualitative and quantitative data collected from 147 prospective teachers completing their credentialling diploma. A conceptual framework combining personal construct and social learning theories modelled the influences of personal, academic and social factors on intended persistence. A single line version of the repertory grid elicited reasons for intended persistence or withdrawal which were coded into 11 categories supported by the literature. A multiple classification analysis showed that those who were confident of promotion and who were committed to and satisfied by teaching intended persisting. While the findings were less clear for psychological constructs and for academic and social integration, some of the best prospective teachers intended staying for at least five years. The course itself was well received.
How Home-School Relations Policies Can Increase Educational Inequality: A Three-year Follow-up
Authors: Toomey Derek
Published: April 2017

This paper reports research which investigated the possibility that the normal operation of home-school relations policies may increase educational inequality. In most schools, the site for home-school relations work is the school. Parents are invited to attend the school for various purposes (e.g. information evenings) for guidance as to how to assist their child's learning or to assist in classrooms. The parents who respond to these invitations are likely to be those who are more confident in dealing with the school and who offer more support to their children's learning at home. As a result of their visits, they may gain information and skills which benefit their own children's schooling through the help which they give at home. There is the possibility that there may be teacher expectation effects advantageous to the children of the high-contact parents. The research investigated these possibilities by examining the operation of home-reading programs in the preparatory (Prep) level classrooms of five disadvantaged primary schools in Melbourne in 1984. Parents were interviewed and teachers made systematic assessments of the children's reading competence and ratings of the supportiveness of the home environment for school learning of each child. Initial analysis of the data suggested that the above possibilities may be true. The level of contact of the parents with the school was predictive of the children's reading competences, after taking into account the support given by the families for the children's reading development. The three-year follow-up showed that advantages in reading achievement remained for the children of the high contact parents, controlling for their Prep level competences and home background support for school achievement.
Differential Participation in Whole-Class Activities
Authors: Tobin Kenneth , Malone John
Published: April 2017

Target students are defined as those who dominate interactions with the teacher, usually in whole-class interactions by asking and responding to questions. In this study of five Year 8 mathematics classes, approximately five target students were evident in three of five participant classes. The majority of the target students were high ability males. Target student involvement was facilitated by the behaviours of teachers and students and management problems which prevailed in each of the three classes. The two other classes provided a marked contrast to those which contained target students. In one class, the teacher systematically involved a larger number of students in whole-class interactions and, in the other, there were few whole-class interactions. The disproportionate involvement of target students is regarded as problematic because of the relatively high proportion of time allocated to whole-class activities.
Differentiation of T-helper cells in distinct phases of atopic dermatitis involves Th1/Th2 and Th17/Treg
Authors: Su Chuanli , Yang Tao , Wu Zhihong , Zhong Jiang , Huang Yunshu , Huang Tao , Zheng Enjin
Published: April 2017

The aim of this article is to study T-helper (Th) cell differentiation in the progression of acute, subacute, and chronic atopic dermatitis. Skin biopsies from 48 patients with acute, subacute, and chronic atopic dermatitis were studied using immunohistochemistry with antibodies to TARC/CCL17, CTACK/CCL27, and RANTES/CCL5. Peripheral blood mononuclear cells were studied in 17 patients using flow cytometry to measure the content of Th1/Th2 cells and Th17/Treg cells. Levels of interferon (IFN)-γ, interleukin (IL)-4, IL-17A, and transforming growth factor (TGF)-β1 were evaluated with enzyme-linked immunosorbent assay (ELISA). Distinctive expressions of T-cell-specific chemokines TARC/CCL17, CTACK/CCL27, and RANTES/CCL5 were observed at different stages of atopic dermatitis, which were consistent with the differentiation of the Th cell subsets, Th2/Th1, and Th17/Treg. Th2 and Th17 were acute-phase subsets, while Th1 and Treg were chronic-phase subsets. At an early stage of atopic dermatitis, Th17 and Th2 cells were found in peripheral blood mononuclear cells, followed by Th1 cells, Treg cells, and eosinophils; in late-stage or subacute and chronic atopic dermatitis, Th17 and Th2 cell numbers decreased. The levels of the IFN-γ and TGF-β1 increased during the progression of atopic dermatitis from acute to chronic forms. The levels of IL-17A and IL-4 decreased during the progression of atopic dermatitis from acute to chronic forms. The differentiation of Th subsets at distinct phases in atopic dermatitis may form the basis for further studies on the classification or control of this increasingly common clinical condition.
Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke)
Authors: Steen Carlsson Katarina , Andsberg Gunnar , Petersson Jesper , Norrving Bo
Published: April 2017

Background

Randomised controlled trials have demonstrated substantial clinical benefit for thrombectomy in patients with acute ischaemic stroke and proximal anterior circulation arterial occlusion.

Aim

We investigated the long-term cost-effectiveness of thrombectomy after thrombolysis versus thrombolysis alone using real-world outcome data on need for health care, home help and nursing home care.

Methods

We used real-life resource use and survival data from the Swedish Stroke Register and pooled outcomes from five randomised controlled trials published in 2015 in a newly constructed Markov cost-effectiveness model with a societal perspective. Data were stratified by age (18–64; 65–74; 75–84 years) and modified Rankin scale at three months for patients with an index ischaemic stroke in 2014 fulfilling inclusion criteria NIHSS ≥ 8 before treatment and treated with thrombolysis ( n = 710). Univariate sensitivity analyses explored robustness of results. A life-time perspective and 3% discount rate were applied.

Results

Thrombectomy increases the health care cost per patient (+GBP 9000) mainly because of intervention costs, but the reduced burden on the social services (home help services −GBP 13,000; nursing home care −GBP 26,000) implies overall cost savings. The average patient gain was 1.0 quality-adjusted life year (QALY) with higher gains for younger age groups. Thrombectomy was a dominant strategy in the base case and all sensitivity analyses where social services were considered.

Conclusion

Thrombectomy has a small effect on hospital costs except for the direct intervention cost. However, thrombectomy is highly likely to lead to substantial cost savings in the social service sector, up to four times the increase in health-care costs.
Sudanese Students’ Perceptions of Their Class Activities: Psychometric Properties and Measurement Invariance of My Class Activities–Arabic Language Version
Authors: Pereira Nielsen , Bakhiet Salaheldin Farah , Gentry Marcia , Balhmar Tahani Abdulrahman , Hakami Sultan Mohammed
Published: April 2017

This study examined the psychometric properties and measurement invariance of the Arabic version of My Class Activities (MCA), an instrument designed to measure students’ perceptions of interest, challenge, choice, and enjoyment in classrooms. Scores of 3,516 Sudanese students in Grades 2 to 8 were used. Confirmatory factor analysis (CFA) was used to evaluate the factor structure of MCA. Multigroup CFA was used to examine measurement invariance across students in gifted and regular schools (nongifted). Four items were deleted to improve model fit and internal consistency. Results indicated noninvariant indicator intercepts across gifted and nongifted students, suggesting that MCA-Arabic can be used with elementary and middle school students; however, it should not be used to compare gifted and nongifted students.
A Replication of the Internal Validity Structure of Three Major Teaching Rating Scales
Authors: Peters Scott J. , Pereira Nielsen
Published: April 2017

Even as the importance of replication research has become more widely understood, the field of gifted education is almost completely devoid of replication studies. An area in which replication is a particular problem is in student identification research, since instrument validity is a necessary prerequisite for any sound psychometric decision. To begin to address this issue, our study sought to replicate the internal validity structure of three teacher rating instruments. The goal was to determine whether data gathered using these instruments fit their published internal validity structures. Results indicated all three instruments failed to meet traditional fit criteria, but to varying degrees, and that further replication or instrument revision are needed before these instruments can be used with confidence.
Treatment of Barrow type ‘B’ carotid cavernous fistulas with flow diverter stent (Pipeline)
Authors: Castaño Carlos , Remollo Sebastián , García-Sort Rosa , Domínguez Carlos , Terceño Mikel
Published: April 2017

Background

Carotid cavernous fistulas (CCFs) Barrow type ‘B’ are dural shunts between the meningeal branches of the internal carotid artery and the cavernous sinus. The symptoms include vision deterioration, ophthalmoplegia with diplopia, exophthalmos, conjunctival injection, chemosis, ocular bruit, seizures, or neurological deficit. Endovascular treatment remains the gold standard for treatment through the transvenous or transarterial routes. The transvenous approaches have been proved to be the first option. Endovascular access through the superior ophthalmic vein (SOV) or inferior petrosal sinus have been widely used. The problem arises when there is no vascular access. For these cases, different approaches have been described, such as: direct access to the SOV; combining direct access to the SOV along with blind probing of the proximal occluded SOV; and a direct puncture of the cavernous sinus. But these techniques are very aggressive and can cause serious complications. As a result of the above, we describe a new alternative technique, which is effective and less invasive for the treatment of these special cases.

Case reports

We report two cases of Barrow type ‘B’ CCFs that did not have vascular access (neither arterial nor venous) to embolise fistulas with coils or glue, and which were successfully resolved with a flow diverter (Pipeline) stent in the internal carotid artery. To our knowledge, this treatment has not previously been described for this pathology.

Conclusions

The placement of a flow diverter stent in the internal carotid artery is an effective alternative technique in those cases of Barrow type ‘B’ CCFs that have no vascular access (neither venous nor arterial).
Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department
Authors: Gabrielian Sonya , Chen Jennifer C. , Minhaj Beena P. , Manchanda Rishi , Altman Lisa , Koosis Ella , Gelberg Lillian
Published: April 2017

Objectives: Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population’s acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians’ attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit. Methods: To study feasibility, we captured (from May to September 2012) the number of patients screened for homelessness, positive screens, unique patients seen, and primary care visits. We focused on acceptability to ED clinicians (physicians, nurses, social workers); we sent a 32-item survey to ED clinicians (n = 57) who worked during clinic hours. Questions derived from an instrument measuring clinician attitudes toward homeless persons; acceptability of homelessness screening and the clinic itself were also explored. Results: Over the 5 months of interest, 281 patients were screened; 172 (61.2%) screened positive for homelessness; 112 (65.1%) of these positive screens were seen over 215 visits. Acceptability data were obtained from 56% (n = 32) of surveyed clinicians. Attitudes toward homeless patients were similar to prior studies of primary care physicians. Most (54.6%) clinicians agreed with the homelessness screening procedures. Nearly all (90.3%) clinicians supported expansion of the homeless-tailored clinic; a minority (42.0%) agreed that ED colocation worked well. Conclusion: Our data suggest the feasibility of recruiting patients to a homeless-tailored primary care clinic colocated with the ED; however, the clinic’s acceptability was mixed. Future quality improvement work should focus on tailoring the clinic to increase its acceptability among ED clinicians, while assessing its impact on health, housing, and costs.
Does obesity influence early outcome of fixed-bearing unicompartmental knee arthroplasty?
Authors: Woo Yew Lok , Chen Yong Qiang Jerry , Lai Mun Chun , Tay Kheng Jin Darren , Chia Shi-Lu , Lo Ngai Nung , Yeo Seng Jin
Published: April 2017

Obesity is a known major contributing risk factor for knee osteoarthritis (OA). It is also believed that obese unicompartmental knee arthroplasty (UKA) patients tend to have poorer outcome and possible early failure. The purpose of this study is to investigate the early outcome of obese UKA patients in a single institution. Patients who underwent fixed bearing medial UKA in between year 2005 and 2010 were included in this study. They were divided into four groups based on Body Mass Index (BMI): 25 kg/m2 (Control); 25–29.9 kg/m2 (Overweight); 30–34.9 kg/m2 (Obese); >35 kg/m2 (Severely Obese). Functional outcome was assessed using Knee Society Score (KSS), Oxford Knee Score (OKS) and Short-form 36 (SF-36). One-way ANOVA with Bonferroni post-hoc test was used to compare the four groups for quantitative variables. There were 673 patients in this study, no significant difference between the four BMI groups for gender and side of operated knee ( p > 0.05). The functional outcome of all four groups at 2 years were comparable (all p > 0.05). At a mean follow up of 5.4 (range 2.5, 8.5) years, 9 revision surgeries (1.3%) were identified. The mean duration from initial surgery to revision surgery was 49 months (Range 6, 90). Patients’ pre-operative BMI did not influence the early outcome of UKA patients. However, patients with higher BMI had relatively lower functional score prior to the surgery and tended to be younger. This did not translate to early failure and the functional improvement was similar among all four groups.
Return to Play After Revision Anterior Cruciate Ligament Reconstruction in National Football League Players
Authors: Okoroha Kelechi R. , Kadri Omar , Keller Robert A. , Marshall Nathan , Cizmic Zlatan , Moutzouros Vasilios
Published: April 2017

Background:

National Football League (NFL) players who undergo anterior cruciate ligament (ACL) reconstruction have been shown to have a lower return to play (RTP) than previously expected. However, RTP in the NFL after revision ACL reconstruction (RACLR) is not well defined.

Purpose/Hypothesis:

The purpose of this study is to determine the RTP of NFL players after RACLR and evaluate factors that predict RTP. Our hypothesis was that more experienced and established players would be more likely to RTP after RACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 24 NFL players who underwent RACLR between 2007 and 2014 were reviewed and evaluated. Return to NFL play, time to return, seasons and games played prior to and after revision surgery, draft status, and demographic data were collected. Overall RTP was determined, and players who did RTP were compared with those unable to RTP. Data were also compared with control players matched for age, position, size, and experience.

Results:

After RACLR, 79% (19/24) of NFL players returned to NFL regular-season play at an average of 12.6 months. All players who were drafted in the first 4 rounds, played in at least 55 games, or played 4 seasons of NFL play prior to injury were able to RTP. Players drafted in the first 4 rounds of the NFL draft were more likely to RTP than those who were not (odds ratio, 0.1; 95% CI, 0.01-1.00; P = .05). Those who returned to NFL play played in significantly less games and seasons after their injury than before ( P = .01 and P = .01, respectively). However, these values did not differ when compared with matched controls ( P = .67 and P = .33).

Conclusion:

NFL players who RTP after RACLR do so at a similar rate but prolonged time period compared with after primary ACL reconstruction. Athletes who were drafted in earlier rounds were more likely to RTP than those who were not. Additionally, player experience prior to injury is an important factor when predicting RTP after RACLR.
Proliferative Vitreoretinopathy (PVR) Update: Current Surgical Techniques and Emerging Medical Management
Authors: Kuriakose Robin K. , Xu Kunyong , Chin Eric K. , Almeida David R. P.
Published: April 2017

Purpose:

To provide an update on current surgical techniques and emerging medical management in proliferative vitreoretinopathy (PVR).

Methods:

A literature search was conducted on studies in the past decade with the inclusion of historical, landmark studies.

Results:

Proliferative vitreoretinopathy remains the primary obstacle to successful retinal detachment (RD) surgery, despite increasing knowledge on its pathophysiology and efforts to reduce its occurrence. A number of recent visualization and surgical advancements, including smaller gauge vitrectomies, have shown promising results. Likely, effective PVR prevention and treatment may rest on a multimodal approach, with particular attention toward adjunct pharmacological use. There is a growing body of literature on effective anti-inflammatory, antineoplastic/proliferative, antigrowth factor, and antioxidant adjunct therapy. Nonetheless, a number of preoperative and perioperative risk factors must be assessed before considering any surgical or medical management. Newer preoperative risk factor findings, such as smoking, highlight the need for a broad consideration during patient counseling.

Discussion:

Most studies in this field are retrospective in design, and the number of randomized control trials is limited, owing to the uncommon nature and complicated clinical profiles of patients with PVR RDs. Prospective studies should consider including combination drug formulations as a part of its intervention. Surgical techniques that may mitigate the inflammatory response by reducing ocular trauma should also continue to be investigated.
How I treat central venous access device–related upper extremity deep vein thrombosis
Authors: Rajasekhar Anita , Streiff Michael B.
Published: April 2017

Central venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.
Lung function and disease severity in cystic fibrosis patients heterozygous forp.Arg117His
Authors: Shteinberg Michal , Downey Damian G. , Beattie Diane , McCaughan John , Reid Alastair , Stein Nili , Elborn J. Stuart
Published: April 2017

Expression ofp.Arg117Hiscystic fibrosis (CF) transmembrane conductance regulator is influenced by a polythymidine (poly-T) tract and a thymidine–guanine (TG) repeat on intron 9, which vary in length and affect exon 10 skipping.

We compared clinical characteristics and the rate of progression of lung disease of CF patients carrying thep.Arg117Hismutation with different intron 9 varying sequences (poly-T) and mutation classesin trans.

Data were collected from patients in Northern Ireland, UK, including diagnostic features, sweat chloride, nutritional status, sputum microbiology, CF-related complications and lung function. Poly-T and TG repeats were determined by PCR. Forced expiratory volume in 1 s (FEV1) decline was determined from linear regression of FEV1measurements of patients over time.

We identified 62 patients withp.Arg117His, 55 with a class I/II mutationin transand six withp.Arg117His/p.Gly551Asp. 42 patients had 5T and 13 had 7T. All patients had 12 TG repeats. Patients withp.Arg117His-5T had greater lung function decline, sweat chloride concentrations, pancreatic insufficiency and prevalence ofPseudomonas aeruginosainfection compared with patients withp.Arg117His-7T.

Lung function decline and disease severity inp.Arg117Hisis determined by the poly-T tract length and identity of the mutationin trans.Patients withp.Arg117His-5T and a second class I/II mutation have a severity similar top.Phe508delhomozygous patients, although lung function decline is delayed to an older age. There may be linkage disequilibrium betweenp.Arg117Hisand 12 TG repeats.
An observational study of 110 elderly lithium-treated patients followed up for 6 years with particular reference to renal function
Authors: Bocchetta Alberto , Cabras Francesca , Pinna Martina , Poddighe Antonio , Sardu Claudia , Ardau Raffaella , Chillotti Caterina , Del Zompo Maria
Published: April 2017

Background

Recent observational studies have focused on lithium treatment in the elderly, with particular reference to safety in terms of thyroid and renal functions. The purpose of this study was to compare the clinical characteristics of patients starting lithium treatment before (N = 79) or after (N = 31) the age of 65 years. Patients were followed up for 6 years with focus on renal function and prescription of levothyroxine and methimazole.

Results

At baseline, median lithium serum concentration was 0.55 mmol/l. The estimated glomerular filtration rate was lower than 60 ml/min/1.73 m2 in 43 (39%) patients. In a multiple regression analysis controlling for age and gender, we found a significant effect of duration of lithium treatment on estimated glomerular filtration rate (−0.85 ml/min/1.73 m2 per year of prior exposure). The annual decline during follow-up was 2.3 ml/min/1.73 m2. Two patients were prescribed levothyroxine, and two were prescribed methimazole for the first time during follow-up.

Conclusions

Median lithium serum concentration in this cohort of elderly patients with mainly bipolar disorders was lower than the therapeutic range indicated for younger adults. The decline in glomerular filtration rate may be accelerated by long-term lithium use. Thyroid and renal functions continue to require close monitoring throughout the course of lithium treatment.

Trial registration NP/2013/3836. Registered 24 June 2013
Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study
Authors: Lalmand Manon , Wilwerth Madeleine , Fils Jean-François , Van der Linden Philippe
Published: April 2017

BACKGROUND:

After cesarean delivery, postoperative pain management allows early rehabilitation and helps prevent postpartum depression and chronic pain. Our present prospective, randomized controlled, double-blind study assessed the duration and effect of intrathecal analgesia and continuous ropivacaine wound infiltration versus a control group after cesarean delivery. The primary outcome was analgesia duration, defined as time to first morphine request. Secondary outcomes were cumulative postoperative morphine consumption, number of patients who did not require IV morphine, incidence of adverse effects, and time to first ambulation.

METHODS:

A total of 192 full-term parturients undergoing elective cesarean delivery were randomly allocated into 3 groups (control, morphine, and catheter). All patients received spinal anesthesia with 10 mg bupivacaine 0.5% hyperbaric bupivacaine (2 mL) + 5 μg of sufentanil (1 mL) and a multiholed catheter inserted into the wound. In the control group, NaCl 0.9% was administered intrathecally (0.1 mL) and through the catheter. The morphine group received 100 μg morphine (0.1 mL) intrathecally and NaCl 0.9% infused through the wound catheter. The catheter group received 0.1 mL NaCl 0.9% intrathecally and ropivacaine 0.2% infused in the catheter. Each patient received a 15-mL bolus of the dedicated solution through the catheter, which was connected to an elastomeric pump infusor delivering the same solution at a rate of 10 mL/h for 30 hours. All patients also received multimodal analgesia including acetaminophen and diclofenac. Analgesia duration was defined as the time from spinal injection (T0) to first IV morphine requirement (T1) administered via a patient-controlled IV analgesia pump. Statistical data analyses included use of the Kruskal-Wallis rank-sum test followed by the post hoc Tukey test and χ2 test.

RESULTS:

The duration of postoperative analgesia was increased with intrathecal morphine (380 minutes; 215–1527) and ropivacaine wound infusion (351 minutes; 227–594) compared with the control (247 minutes; 182–338) with effect sizes of 0.171 (0.043–0.293) for morphine versus control and 0.164 (0.052–0.271) for catheter versus control. There was no difference between the morphine group and catheter group (effect size, 0.007; −0.118 to 0.132). Cumulative postoperative morphine consumption was also significantly lower in the morphine group and catheter group compared with the control group. The incidence of adverse effects did not differ between groups.

CONCLUSIONS:

After elective cesarean delivery, 100 μg intrathecal morphine and ropivacaine wound infusion both increased the duration and effect of postcesarean analgesia without increased incidence of side effects.
Physician-Directed Versus Computerized Closed-Loop Control of Blood Pressure Using Phenylephrine in a Swine Model
Authors: Marques Nicole Ribeiro , Whitehead William E. , Kallu Upendar R. , Kinsky Michael P. , Funston Joe S. , Wassar Taoufik , Khan Muzna N. , Milosch Mindy , Jupiter Daniel , Grigoriadis Karolos , Kramer George C.
Published: April 2017

BACKGROUND:

Vasopressors provide a rapid and effective approach to correct hypotension in the perioperative setting. Our group developed a closed-loop control (CLC) system that titrates phenylephrine (PHP) based on the mean arterial pressure (MAP) during general anesthesia. As a means of evaluating system competence, we compared the performance of the automated CLC with physicians. We hypothesized that our CLC algorithm more effectively maintains blood pressure at a specified target with less blood pressure variability and reduces the dose of PHP required.

METHODS:

In a crossover study design, 6 swine under general anesthesia were subjected to a normovolemic hypotensive challenge induced by sodium nitroprusside. The physicians (MD) manually changed the PHP infusion rate, and the CLC system performed this task autonomously, adjusted every 3 seconds to achieve a predetermined MAP.

RESULTS:

The CLC maintained MAP within 5 mm Hg of the target for (mean ± standard deviation) 93.5% ± 3.9% of the time versus 72.4% ± 26.8% for the MD treatment (P = .054). The mean (standard deviation) percentage of time that the CLC and MD interventions were above target range was 2.1% ± 3.3% and 25.8% ± 27.4% (P = .06), respectively. Control statistics, performance error, median performance error, and median absolute performance error were not different between CLC and MD interventions. PHP infusion rate adjustments by the physician were performed 12 to 80 times in individual studies over a 60-minute period. The total dose of PHP used was not different between the 2 interventions.

CONCLUSIONS:

The CLC system performed as well as an anesthesiologist totally focused on MAP control by infusing PHP. Computerized CLC infusion of PHP provided tight blood pressure control under conditions of experimental vasodilation.
Closed-Loop Feedback Computer-Controlled Phenylephrine for Maintenance of Blood Pressure During Spinal Anesthesia for Cesarean Delivery: A Randomized Trial Comparing Automated Boluses Versus Infusion
Authors: Ngan Kee Warwick D. , Tam Yuk-Ho , Khaw Kim S. , Ng Floria F. , Lee Shara W. Y.
Published: April 2017

BACKGROUND:

We previously described the use of closed-loop feedback computer-controlled infusion of phenylephrine for maintaining blood pressure (BP) during spinal anesthesia for cesarean delivery. In this study, we report a modified system in which phenylephrine is delivered by intermittent boluses rather than infusion. We hypothesized that the use of computer-controlled boluses would result in more precise control of BP compared with infusions.

METHODS:

Two hundred fourteen healthy patients having spinal anesthesia for elective cesarean delivery were randomized to have their systolic BP maintained by phenylephrine administered by computer-controlled continuous infusion or computer-controlled intermittent boluses. From induction of anesthesia until the time of uterine incision, a noninvasive BP monitor was set to cycle at 1-minute intervals. In the infusion group, the infusion rate was automatically adjusted after each BP measurement using a previously described algorithm. In the bolus group, the algorithm was modified so that the mass of drug that would have been delivered over 1 minute was instead injected as a rapid intravenous bolus after each BP measurement. The precision of BP control was assessed using performance error calculations and compared between groups, with the primary outcome defined as median absolute performance error, and the latter being a measure of inaccuracy showing an average of the magnitudes of the differences of measured BP values above or below the target values.

RESULTS:

The precision of BP control was greater, as shown by smaller values for median absolute performance error, in the bolus group (median 4.38 [quartiles 3.22, 6.25] %) versus the infusion group (5.39 [4.12, 7.04] %, P = .008). In the bolus group, phenylephrine consumption was smaller; this was associated with smaller values for median performance error compared with the continuous infusion group (P < .001), which indicates that values for systolic BP, averaged over time, were slightly lower in the bolus group. There were no differences in cardiac output, nausea or vomiting, or neonatal outcome between groups.

CONCLUSIONS:

We confirmed the hypothesis that BP control was more precise when computer-controlled phenylephrine was delivered using intermittent boluses rather than continuous infusion. However, the difference between groups was small and was not associated with any difference in clinical outcomes. In the infusion group, greater doses of phenylephrine were delivered, which was related to the time taken for the noninvasive BP monitor to complete measurements. The use of intermittent boluses may be a useful alternative in the design of closed-loop vasopressor systems.
Electric Nerve Stimulation Does Not Correctly Predict Needle-Nerve Distance and Potential Local Anesthetic Spread for Interscalene Brachial Plexus Blockade
Authors: Fielmuth Stefan , Szalata Marek , Sievert Heidi , Beier David , Rehberg Sebastian , Hahnenkamp Klaus , Mauermann Knut , Meissner Konrad
Published: April 2017

This study evaluated electric nerve stimulation as a nerve location tool. After eliciting motor response in 43 patients undergoing shoulder surgery, the needle tip’s position, distance from the closest nerve, and spread of saline were evaluated using ultrasound imaging. The needle’s tip resided 1 to 4 mm from the closest nerve in 21, in direct contact with it in 7, and 6 to 18 mm away in 15 patients. In 21 patients, subsequent saline dissection did not reach the brachial plexus. Thus, the success rate of electric nerve stimulation for correct needle-nerve distance identification was 48.8%, with correct fluid spread reached in only 51.2% of patients.
Application of the Novel Ventilation Mode FLow-Controlled EXpiration (FLEX): A Crossover Proof-of-Principle Study in Lung-Healthy Patients
Authors: Wirth Steffen , Springer Sebastian , Spaeth Johannes , Borgmann Silke , Goebel Ulrich , Schumann Stefan
Published: April 2017

BACKGROUND:

Traditionally, mechanical ventilation is achieved via active lung inflation during inspiration and passive lung emptying during expiration. By contrast, the novel FLEX (FLow-controlled EXpiration) ventilator mode actively decreases the rate of lung emptying. We investigated whether FLEX can be used during intraoperative mechanical ventilation of lung-healthy patients.

METHODS:

In 30 adult patients scheduled for neurosurgical procedures, we studied respiratory system mechanics, regional ventilation, oxygenation, and hemodynamics during ventilation with and without FLEX at positive end-expiratory pressure (PEEP) of 5 and 7 cm H2O. The FLEX system was integrated into the expiratory limb and modified the expiratory flow profile by continuously changing expiratory resistance according to a computer-controlled algorithm.

RESULTS:

Mean airway pressure increased with PEEP by 1.9 cm H2O and with FLEX by 1 cm H2O (all P < .001). The expiratory peak flow was 42% lower with FLEX than without FLEX (P < .001). FLEX caused significant shifts in aeration from ventral to the dorsal lung regions. Respiratory mechanics, end-tidal carbon dioxide partial pressure, oxygenation, and hemodynamics were independent from FLEX and PEEP. We observed no critical incidents or FLEX malfunctions in any measurement that would have required an intervention or termination of the FLEX mode.

CONCLUSIONS:

FLEX can be used in lung-healthy patients who are mechanically ventilated during general anesthesia. FLEX improves the homogeneous distribution of ventilation in the lungs.
Determination of Perioperative Blood Loss: Accuracy or Approximation?
Authors: Lopez-Picado A. , Albinarrate A. , Barrachina Borja
Published: April 2017

BACKGROUND:

Various different interventions can be used to reduce surgical blood loss; however, there is no “gold standard” for accurately measuring the volume of perioperative blood loss, and this makes it difficult to assess the efficacy of these interventions.

METHODS:

We used data from a previous multicenter double-blind randomized clinical trial in patients undergoing total hip arthroplasty in which we compared 2 regimens for administering tranexamic acid versus placebo. We assessed direct measures (external blood loss) and indirect estimates (using the formulas of Bourke, Gross, Mercuriali, and Camarasa and a new formula we have developed) using analysis of variance to compare estimated volumes of blood loss among the study groups. In addition, intraclass correlation coefficients (ICCs) and Bland–Altman diagrams were used to compare the estimated volumes of blood loss obtained with each formula.

RESULTS:

The mean estimated external blood loss was 909 ± 324 mL, and the mean estimates of blood loss calculated using the formulas of Gross, Bourke and Smith, and Camarasa were 1308 ± 555, 1091 ± 454, and 1641 ± 945 mL, respectively, whereas we obtained a value of 1511 ± 919 mL with the new formula at day 2. In all cases, the results favored the use of tranexamic acid (P < .0001). Comparing results of the new and other formulas, we found moderate-to-low agreement (in terms of ICCs) except for that of Camarasa (ICC: 0.992). The limits of agreement with the new formula ranged from −378 to 93 in the case of the comparison with Camarasa’s formula and from −2226 to 959 for external blood loss, the difference depending on the magnitude of the estimate to a large extent.

CONCLUSIONS:

Formulas that take into account both anthropometric and laboratory parameters are useful for evaluating the efficacy of interventions aiming to decrease blood loss but do not ensure that the values obtained are sufficiently accurate for absolute measuring.
One Sustained Moment: The Constant Re-creation of Caribbean Sexualities
Authors: King Rosamond S.
Published: April 2017

King responds to essays by noted scholars Faith Smith and Lisa Outar critiquing her 2014 book Island Bodies: Transgressive Sexualities in the Caribbean Imagination. In particular, she addresses the choice to examine interracial relationships between Caribbean men of color and foreign white woman rather than between Caribbean people of African and Indian descent. King also addresses recent portrayals of Caribbean trans people and of Caribbean women who desire other women, in particular Shani Mootoo's Moving Forward Sideways Like a Crab. Several recent court cases related to Caribbean sexuality and nonbinary gender are addressed. King ends by introducing her current research project, which uses existing and imagined archives to examine Afro-Trinidadian women's protest and performance in the late nineteenth century.
Introduction: Art as Caribbean Feminist Practice
Authors: Davis Annalee , Gardner Joscelyn , James Erica Moiah , Philogene Jerry
Published: April 2017

This special section focuses on the work of women whose artistic practices are grounded in a feminist ethos and engage multiple and nuanced meanings of the Caribbean and its diaspora across linguistic, geographic, material, and formal boundaries. Through diverse written and visual contributions, the section presents the Caribbean as a critical space that recognizes an existing foundation yet facilitates and expands conversations between artists and writers who have shaped and are shaping local and global art discourses using intertextual formal art practices. It aims to mark the archive of Caribbean art history through its focus on the remarkable contributions of women from the Dutch-, English-, Spanish-, French-, and Creole-speaking Caribbean to the making of this history as well as the ongoing cultivation of arts practice and discourses.