bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Renal Replacement Therapy in Critically Ill Patients: Monitoring Circuit Function
Authors: Holt A. W. , Bierer P. , Bersten A. D. , Bury L. K. , Vedig A. E.
Published: January 2019

There is currently no universally accepted method to monitor circuit function or guidelines for circuit replacement during continuous renal replacement therapies (CRRT). The objectives of this study were to diagnose the causes of circuit failure, identify factors responsible for circuit clotting and determine a predictive monitor of circuit function. The CRRT technique used in this study was continuous venovenous haemodialysis (CVVHD). Continuous monitoring of circuit pressures (pre- and post-haemofilter and their difference: the transfilter pressure gradient) was used to diagnose the causes of circuit failure. In circuits ceasing due to clotting, the factors thought to contribute, anticoagulation, haematocrit and platelet count, were measured at the commencement of CVVHD and every eight hours thereafter until circuit failure. Monitors of circuit function, creatinine clearance and plasma to diafiltrate urea ratio were measured every eight hours and compared to the transfilter pressure gradient. During a three-month period data was collected on five consecutive patients (41 consecutive haemofilters). Clotting of the haemofilter (63%) and air detection chamber (7.5%) were the most common identifiable causes of circuit failure. The duration of their circuit life was described using multiple regression analysis, i.e. hours of filter life = -82.8 + (Δ platelet count x 0.25) + (Δ haematocrit x 3.6) + (circuit flow [ml/min] x 4) R2 = 0.77. A rise in transfilter pressure gradient and a fall in haemofilter function discriminated clotted filters with falling function (decrease in creatinine clearance and urea ratio) from unclotted filters. In any circuit an increase of 26 mmHg or more in the transfilter pressure gradient accurately predicted circuit failure due to clotting and imminent cessation of function. Increases in platelet count, haematocrit, and low circuit flows are important determinants of haemofilter life. The measurement of transfilter pressure gradient across the haemofilter is an accurate bedside monitor of circuit function.
Anaesthesia for Children with Mucopolysaccharidoses
Authors: Moores C. , Rogers J. G. , Mckenzie I. M. , Brown T. C. K.
Published: January 2019

The mucopolysaccharidoses are a group of inherited disorders of metabolism, with varying clinical manifestations. A number of them present anaesthetic difficulties. This paper presents a summary table of the syndromes and reviews our experience over ten years with patients with these diagnoses. The clinical presentations, anaesthetic management, and complications are described. The effect of age and diagnosis on airway difficulties was studied. There were 31 patients, 28 of whom required anaesthesia, on a total of 99 occasions, for 115 procedures. The patients with Hunter, Hurler and Maroteaux-Lamy syndromes had significantly more airway difficulties as they grew older, and compared with patients in this group with other syndromes. Patients with Hurler's syndrome may have coronary artery involvement and one patient was given fentanyl and pancuronium for this reason. He proved impossible to intubate and an emergency tracheostomy was performed.
The Taste of Intravenous Thiopentone
Authors: Nor N. B. M. , Fox M. A. , Metcalfe I. R. , Russell W. J.
Published: January 2019

Patients sometimes notice an onion or garlic taste before losing consciousness with thiopentone. An assessment of 113 patients revealed that 42% of patients noticed this taste. The effect was observed less in older patients. There was no statistically significant difference in the incidence between men and women. Premedicated patients had a lower incidence, but this was explained by the greater proportion of older patients receiving a premedication. If the taste effect of thiopentone is genetically determined then it is a different gene to thiocarbamate which has about 75% tasters.
A Randomized Double-Blinded Comparison of Metoclopramide, Ondansetron and Cyclizine in Day-Case Laparoscopy
Authors: Watts S. A.
Published: January 2019

This study determined the overall incidence of postoperative nausea and vomiting (PONV) in 38 patients undergoing laparoscopic gynaecological procedures who received a standardized propofol/isoflurane anaesthetic but no pre-operative antiemetic. A further 166 patients similarly anaesthetized were then randomly allocated to receive either metoclopramide 10 mg, ondansetron 4 mg, or cyclizine 50 mg as an intravenous antiemetic immediately pre-induction. Overall incidence of PONV was determined for all groups and the relative efficacy of the three antiemetic agents assessed. Fifty per cent of patients in the initial group (no antiemetic) reported significant nausea and/or vomiting up to 24 hours postoperatively. The incidence of PONV in the metoclopramide group was 24%, in the ondansetron group 20%, and in the cyclizine group 51%. There was no detectable difference in relative efficacy between ondansetron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group who received no PONV prophylaxis. Both metoclopramide and ondansetron may potentially decrease the incidence of PONV following gynaecologic laparoscopy by up to 50% when administered intravenously prior to a propofol/isoflurane anaesthetic.
Alveolar Overdistension is an Important Mechanism of Persistent Lung Damage following Severe Protracted ARDS
Authors: Finfer S. , Rocker G.
Published: January 2019

It is now widely accepted that mechanical ventilation may damage the lung, but the mechanism of lung damage is not clear. Possible causes include overdistension of aerated alveoli by inappropriately large tidal volumes (volutrauma), shear stresses generated during the recruitment and de-recruitment of lung units at the junction of aerated and collapsed lung, and infective or ischaemic necrosis of persistently collapsed lung. Computerized tomography allows noninvasive assessment of lung structure during and after acute lung injury, and may provide insight into the mechanism of lung damage. Using serial high resolution computed tomography we documented lung structure one month after recovery from severe protracted adult respiratory distress syndrome (ARDS) in three patients who required mechanical ventilation for between 86 and 97 days; the computed tomograms were repeated at between 5 and 14 months. All three patients had persistent abnormalities of lung structure which were most marked in the anterior regions of the lung. These findings suggest that overdistension of non-dependent lung regions is the main mechanism of lung damage persisting after recovery from severe protracted ARDS.
A Simple Method for Frequent Monitoring of Gastric Carbon Dioxide
Authors: Corke C. F. , Prisco G. , Gizycki P. , Selvakumaran A.
Published: January 2019

Intragastric Pco2 has been recognized to rise in states of gastric hypoperfusion. A device including a gas-permeable balloon on a conventional sump nasogastric tube (TRIP catheter, Tonometrics) has permitted simple measurement of the intragastric Pco2 following equilibration of intragastric Pco2 with saline in the balloon. This method is slow to equilibrate and time-consuming. We describe an automated method using air instead of saline in the balloon with measurement using capnography. Equilibration is much faster using air and the automated system permits measurements to be taken at regular intervals (10 minutes) without additional workload.
Acupuncture and Postoperative Vomiting in Day-Stay Paediatric Patients
Authors: Schwager K. L. , Baines D. B. , Meyer R. J.
Published: January 2019

The stimulation of the acupuncture point P6 has been used to prevent nausea and vomiting in the adult population. It has, however, been subject to limited comparative evaluation in children. We proposed that stimulation of P6 and the analgesic point Li4 would reduce the incidence of postoperative vomiting. Eighty-four unpremedicated paediatric patients having day-stay surgery (circumcision or herniotomy/orchidopexy) were included in a randomized, double-blind, placebo-controlled study of transcutaneous stimulation of P6 and Li4 or no stimulation. The incidence of vomiting was recorded for 24 hours postoperatively. There was no statistically significant difference in total postoperative vomiting in those patients who were stimulated, compared with the control group (P=0.909), or between any group for postoperative vomiting in the recovery ward, day-stay ward or at home. For all groups, vomiting was more common within the first four hours and more likely to occur in the day-stay ward.
Positive Serology to Legionella Longbeachae in Patients with Adult Respiratory Distress Syndrome
Authors: Konecny P. , Bell A. J.
Published: January 2019

In an observational study we measured the Legionella longbeachae antibody titre rise in patients mechanically ventilated for more than eight days during a two-month period. The patients were divided into two groups on the basis of the presence or absence of the adult respiratory distress syndrome (ARDS).

In nine patients with ARDS all showed an antibody rise consistent with recent infection with Legionella long-beachae with a rise in titre (six patients) or a high titre after eight to ten days of ventilation (three patients). Three patients without ARDS did not show a rise in titre.

Culture of the environment, ventilator circuits, humidifiers and humidification water did not reveal an environmental source of Legionella longbeachae in the Intensive Care Unit. Legionella longbeachae may be implicated as a pathogenic organism in ARDS, or as a secondary nosocomial infection. Alternatively the antibody titre rise may represent an epiphenomenon and may not be related to Legionella longbeachae infection.
Ventilator-CPAP with the Siemens Servo 900C Compared with Continuous Flow-CPAP in Intubated Patients: Effect on Work of Breathing
Authors: Aerts J. G. J. V. , Van Den Berg B. , Bogaard J. M.
Published: January 2019

The effects of continuous positive airway pressure (CPAP) provided by the Siemens Servo 900C ventilator were compared with a continuous flow system (CF-CPAP) in patients weaning from the ventilator.

Thirteen patients were studied using both systems at a CPAP level of 0.5 kPa. Additional work of breathing (Wapp) and derived variables were determined in relation to the minute volumes of the patients. The Wapp imposed by the ventilator exceeded the Wapp of CF-CPAP in all patients. The difference in Wapp between ventilator- and CF-CPAP was greater at higher ventilatory needs. The increments in Wapp imposed by the ventilator were positively correlated with the actual end-expiratory pressures (EEP). The EEP increasingly exceeded the preset CPAP level of the ventilator at higher minute volumes.

An inspiratory threshold due to a gradient between EEP and preset CPAP greatly increased the Wapp imposed by the ventilator. As this threshold was attributed to the resistance of the PEEP device of the ventilator, it indicates that the additional work related to the expiratory valve should be taken into account when the Siemens Servo 900C ventilator is used for weaning purposes.
Perioperative Management of Intra-Partum Seizure
Authors: Cheng A. Y. , Kwan A.
Published: January 2019

A young nulliparous woman previously diagnosed with pregnancy-induced hypertension suffered a seizure during active first stage labour. Pre-seizure blood pressure was borderline high but she did not fulfill other criteria for pre-eclampsia. She underwent emergency caesarean section for presumed eclampsia. Postoperatively, she deteriorated neurologically. CT scan showed an intracranial haemorrhage requiring neurosurgical intervention.

The similarities of presentation of a primary cerebrovascular event and eclampsia following an intra-partum seizure made the differential diagnosis difficult.
Opioid Requirements and Responses in Asians
Authors: Lee A. , Gin T. , Oh T. E.
Published: January 2019

The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. Much of the pharmacogenetic work has focused on the metabolism of codeine, morphine and pethidine, and there are some differences between Chinese and Caucasians. Asians may receive less analgesia because they are more likely to experience, or are less tolerant of the adverse effects of opioids.

Despite this, ethnic factors are probably only a small contributor to the inter-individual variation in opioid requirements. Unlike earlier studies, recent larger studies using patient-controlled analgesia have shown similar opioid usage between Asians and Caucasians in the postoperative period. An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
Apparatus for Emergency Transtracheal Ventilation
Authors: Morley D. , Thorpe C. M.
Published: January 2019

Twenty anaesthetists were asked what equipment they would use to ventilate a patient after having performed an emergency cricothyroid puncture. Six systems were described and these were assessed for efficiency in delivery of oxygen through a 14 gauge cannula. Delivery of oxygen depended on the pressure achieved within the system. Apparatus utilizing a Bain circuit achieved volumes of around 200 ml for each double-handed squeeze of the reservoir bag. Use of a system taught on the Advanced Trauma and Life Support (ATLS) course resulted in higher system pressures and consequently greater volumes of oxygen delivered. Use of the oxygen flush with this system provides the highest flow rate and system pressure which results in 628 ml being delivered for a one second compression.
Evidence-Based Medicine and Anaesthesia: Uneasy Bedfellows?
Authors: Horan B. F.
Published: January 2019

The term “evidence-based medicine” first appeared in the medical literature in 1992 and is in widespread use today. It is timely to examine the concept's relevance to anaesthetic practice as well as the validity of the premises on which it rests. An important difference between anaesthesia and the specialties which treat disease is that in anaesthesia there is very little research done with real outcomes as its end-point. Surrogate or intermediate outcomes predominate as the end-points of anaesthetic research, which is a weakness when the results serve as the evidence on which to base clinical decisions. Furthermore, in interventions which require personal skill, dexterity or decision-making, caution must be exercised in assuming that equally good outcomes are achievable by all. Key members of the Cochrane Collaboration, among the most prominent advocates of evidence-based medicine, promote the belief that much valid scientific evidence is to be found in sources outside the peer-reviewed published literature. This assertion must be treated with caution. Furthermore, some techniques central to the search for the evidence on which to base practice, including meta-analysis and multicentre trials, are prone to errors through incorrect application. Evidence-based medicine appears to have less to offer anaesthesia than it does to the “treating” specialties.
Simulating Acculturation Dynamics Between Migrants and Locals in Relation to Network Formation
Authors: Paolillo Rocco , Jager Wander
Published: January 2019

International migration implies the coexistence of different ethnic and cultural groups in the receiving country. The refugee crisis of 2015 has resulted in critical levels of opinion polarization on the question of whether to welcome migrants causing clashes in receiving countries. This scenario emphasizes the need to better understand the dynamics of mutual adaptation between locals and migrants and the conditions that favor successful integration. Agent-based simulations can help achieve this goal. In this work, we introduce our model MigrAgent and our preliminary results. The model synthesizes the dynamics of migration intake and postmigration adaptation. It explores the different acculturation outcomes that can emerge from the mutual adaptation of a migrant population and a local population depending on their degree of tolerance. With parameter sweeping, we detect how different acculturation strategies can coexist in a society and in different degrees among various subgroups. The results show higher polarization effects between a local population and a migrant population for fast intake conditions. When migrant intake is slow, transitory conditions between acculturation outcomes emerge for subgroups, for example, from assimilation to integration for liberal migrants and from marginalization to separation for conservative migrants. Relative group sizes due to speed of intake cause counterintuitive scenarios such as the separation of liberal locals. We qualitatively compare the processes of our model with the German portion sample of the survey “Causes and Consequences of Socio-Cultural Integration Processes Among New Immigrants in Europe,” finding preliminary confirmation of our assumptions and results.
Multi-parametric model predictive control for autonomous steering using an electric power steering system
Authors: Lee Junho , Chang Hyuk-Jun
Published: January 2019

Electric power steering systems have been used to generate assist torque for driver comfort. This study makes use of the functionality of electric power steering systems for autonomous steering control without driver torque. A column-type electric power steering test bench, equipped with a brushless DC motor as an assist motor, and the Infineon TriCore AURIX TC 277 microcontroller was used in this study. Multi-parametric model predictive control is based on a model predictive control–based approach that employs a multi-parametric quadratic programming technique. This technique allows the reduction of the huge computational burden resulting from the online optimization in model predictive control. The proposed controller obtains an optimal input based on multi-parametric quadratic programming at each sampling time. The weighting matrix definition, which is the main task when designing the proposed controller, was analyzed. The experimental results of the step response of the steering wheel angle verified the tracking ability of the proposed controller for different ranges of the prediction horizon. Since the computational loads are directly related to functional safety, the results of this study support the use of the multi-parametric model predictive control scheme as an effective control method for autonomous steering control.
Women and ICT: A Study on Access and Perceptions in North India
Authors: Singh Sumanjeet , Singh Surender , Kumar Anil
Published: January 2019

The potential of information and communication technology (ICT) as a tool to reduce gender inequality and strengthen the position of women in a society is increasingly recognized. However, a significant gender digital divide is also observed, which is reflected in women’s low level of access and use of ICT as compared to men due to socio-economic, structural, psychological and institutional barriers. In this context, this article aims to explore the state of Indian women with regard to access, usage and effects of ICT tools. It analyses respondents’ perceptions on ICT in relation to betterment of women’s conditions and also explores the reasons for poor access and usage of ICT among Indian women. The article is based on a study of cross-sectional survey data collected from women respondents residing in rural and urban areas of six states of India, namely Haryana, Uttarakhand, Rajasthan, Punjab, Himachal Pradesh and Uttar Pradesh. This article argues that it is imperative to make ICT more accessible and affordable for Indian women in order for them to garner its benefits.
Elevated procalcitonin levels in anaphylaxis
Authors: Joo Shiang Ang
Published: January 2019

Background:

The most common role procalcitonin play in current-day medicine is in the diagnosis and management of sepsis. Aside from sepsis, there are other known causes of elevated procalcitonin, for example, trauma and severe pancreatitis. We herein present a case of markedly elevated procalcitonin levels with an unusual cause, that is, anaphylaxis.

Case report:

A young lady presented to our hospital consecutively for anaphylaxis. Both presentations were associated with a markedly elevated procalcitonin level. She was discharged with an epinephrine autoinjector after the second visit. Recognition of anaphylaxis as a cause of elevated procalcitonin level can potentially change management as shown in this case report. This case report also highlights the importance of history taking and not to over rely on investigation results for patient management.
The Evaluation Process, Administrator Feedback, and Teacher Self-Efficacy
Authors: Mireles-Rios Rebeca , Becchio John A.
Published: January 2019

The teacher evaluation process provides opportunity for instructional feedback and teacher improvement, but also may influence the beliefs teachers have about the quality of their own work and their confidence levels as a teacher. Self-efficacy plays a vital role in determining teacher effectiveness and the students‘ academic experience, but little is known about the impact the teacher evaluation process has on teacher self-efficacy. Interview data from 28 high school teachers indicated that the pre-observation meeting has potential to significantly benefit teachers. In addition, feedback from administrators that included both strengths and weaknesses during the post-observation phase seemed to have the most influence on teachers’ self-confidence. Implications of this study's findings were provided and may be useful for administrators to conduct teacher evaluations in a manner that serves to enhance teacher self-efficacy.
Principals' Perspectives of a Race to the Top-Style Teacher Evaluation System
Authors: Wieczorek Douglas , Clark Brandon , Theoharis George
Published: January 2019

Set in a collective bargaining state in the Northeastern U.S., this exploratory case study investigated how a sample of 12 public school principals interpreted new teacher evaluation processes required by Race to the Top (RTTT). Principals reported that the RTTT evaluation system disrupted established routines and contractual guidelines for evaluating all their teachers and held principals more accountable for supervision and evaluation processes. The embedded evaluation protocols and rubrics established clearer expectations for teachers‘ performance, and aligned state-, district-, and school-level instructional goals. However, principals believed the RTTT policy emphasis on teachers’ ratings raised concerns about their teachers' employment status, professional growth, and instructional improvement. Our findings suggest that principals may have difficulty balancing instructional supervision and evaluation processes in these types of high-stakes policy systems.
The African American Male AVID Initiative: A Study of Implementation and Impact on Student Aspirations and School Performance
Authors: Watt Karen M. , Huerta Jeffery , Butcher Jennifer
Published: January 2019

This is a study of five high schools awarded external funding to implement a project, the African American Male Initiative (AAMI). During the first year of implementation, interviews, focus groups, surveys, and student academic transcripts provided sources of data. Survey data showed that AAMI students exhibited high aspirations and anticipations for college. In addition, significant positive correlations were found between the number of people students communicate with about college and financial aid requirement information and their level of college knowledge. Characteristics such as African American male mentoring and advocacy, raised expectations, and forming a “brotherhood” emerged from focus group data.
Cyberbullying and Victimization and Youth Suicide Risk: The Buffering Effects of School Connectedness
Authors: Kim JaHun , Walsh Elaine , Pike Kenneth , Thompson Elaine A.
Published: January 2019

Bullying has been linked to adolescent suicidal behavior. With dramatic increases in social media use among youth, understanding the influence of cyberbullying on adolescent suicidal behavior has become central to prevention efforts. This study examined the potential protective role of school connectedness in the relationship between cyberbullying and suicide risk behavior. Data were from 93 adolescents participating in a longitudinal study of an intervention to prevent health-risk behavior including suicidal behavior. Hierarchical logistic regression was used to examine the influence of cyberbullying and school connectedness on adolescent suicidal behavior. Findings indicated that being a victim of cyberbullying, but not a perpetrator, was associated with increased risk of suicide and that connections to school moderated this relationship in that, among youth who were victims of cyberbullying, those more connected to school were less likely to report suicidal behavior. Implications for school-based suicide prevention and school nurse practice are discussed.
Noonan Syndrome Case Report: PTPN11 and Other Potential Genetic Factors Contributing to Lethal Hypertrophic Right Ventricular Cardiomyopathy
Authors: Daoud Elena , Zwick David
Published: January 2019

Noonan syndrome is a genetic condition with a heterogeneous phenotype and multisystem involvement. The pathogenesis of this disorder has been attributed to the mutations in the RAS/MAPK signaling pathway involved in cell proliferation and differentiation. The most common clinical presentations are related to cardiovascular abnormalities with congestive heart failure as the most common mechanism of death. We present the autopsy findings from a Noonan syndrome patient who died as a result of an unusual form of right ventricular obstruction associated with a rare PTPN11 variant previously reported without details of the cardiac findings. Discussion follows that includes overview of the incidence, genetic causes, types of right-sided obstructive lesions, PTPN11 genotype—cardiac phenotype correlations, and other potential mechanisms that may contribute to disease heterogeneity.
Systems, levels, and structural theory: Waltz’s theory is not a systemic theory (and why that matters for International Relations today)
Authors: Donnelly Jack
Published: January 2019

Most in International Relations today, whatever their view of structural realism, would agree with Robert Jervis that Waltz’s theory is “the most truly systemic of our theories of international politics.” I argue that it is, in fact, the antithesis. Waltz, despite his systemic starting point, produced an analytic theory. Waltz’s redefinition of a system as “composed of a structure and of interacting units” replaced the “systemic” understanding of a system as parts of particular types related in particular ways to make a whole with emergent properties with an analytic model of characterless units interacting with one another and with a reified structure. Waltz, I argue, was led to this stunning reversal by his application of: a levels and units frame; a reified conception of structure; a mistaken exclusion of the attributes of units that make them parts of the system; a vision of systems as derivative constraints on otherwise more or less autonomous units; and certain peculiar ideas about the nature of theory. In the final section, I argue that “relationalism” today is not merely reviving, but extending, “systemic” approaches in International Relations and is now poised to make the sort of transformative contribution that Waltz promised but did not deliver.
Exploring trajectories of emergency department visits using a laboratory-based indicator of serious illness
Authors: Ben-Assuli Ofir , Padman Rema , Shabtai Itamar
Published: January 2019

Repeated emergency department visits have become a serious challenge worldwide. Despite prior research indicating that laboratory results may provide early alerts about such patients on their upcoming adverse events, few studies have examined their role as a critical indicator of the stability of a patient’s medical condition over time. We model and analyze the developmental trajectories of patients’ creatinine levels, a key laboratory marker of serious illness, as a potential risk stratification mechanism across many emergency department visits. We apply group-based statistical methodology to electronic health record data of 70,385 patients, with 3–15 emergency department visits, to identify and profile these trajectories for the entire population, for males and for females. Results reveal three distinct creatinine-based trajectory groups over time with significantly differing characteristics that may enable targeted interventions for each group. Future research will incorporate additional disease markers to identify longitudinal factors leading to repeated emergency department visits.
Using Reflexive Interviewing to Foster Deep Understanding of Research Participants’ Perspectives
Authors: Pessoa Alex Sandro Gomes , Harper Erin , Santos Isabela Samogim , Gracino Marina Carvalho da Silva
Published: January 2019

It is usual that researchers, in the process of transcribing interviews or even during data analysis, realize that important issues were superficially mentioned by the interviewees, but for several possible reasons, these topics were not explored by the researcher in-depth or properly. It is also common during the interview to not realize that certain content evoked by the participants are connected to the research questions that originated the study. Similarly, some content brought in by the interviewees may seem confusing, contradictory, or even insufficient to be subjected to protocols of qualitative data analysis. This article aims to present a technique that allows researchers to have a deeper and more accurate understanding of the subjective topics that may emerge through a qualitative approach: the reflexive interview. This technique consists of the engagement of the interviewer and interviewee in the process of elaboration and collective understanding of the interviewee’s perspectives and experiences. Rather than only reporting their experiences descriptively, interviewees, with the support of interviewers, have the opportunity to share the meanings of the reality surrounding them and the events of their own lives, without being interpreted arbitrarily only by the interviewer. This article intends to conceptualize the reflexive interview, pointing out its benefits and the procedures necessary to employ it in a qualitative study. Two case studies are presented to the reader to illustrate the reflexivity processes that can engage participants through this resource, as well as how reflexive interviewing promotes a deep understanding of participants’ perspectives. Finally, general recommendations are provided, including examples of questions that can compose a script of a reflexive interview. It is hoped that this article provides a new resource for researchers interested in more accurately embodying participants’ perspectives and experiences.
Temperature evolution of the train brake disc during high-speed braking
Authors: Wang Zhizhong , Han Jianmin , Liu Xiaolong , Li Zhiqiang , Yang Zhiyong , Chen Erqing
Published: January 2019

Temperature evolution of the train brake disc during high-speed braking was investigated using in situ experiments, theoretical analysis, and finite element modeling. The experimental results show that the temperature distribution on the friction surface experienced the formation of a hot ring first, then expansion and duration of the hot ring. Alternative hot spot and cold zone were observed on the friction surface, which is attributed to the local contact in the friction couple and heterogeneous heat dissipation condition in the disc. The corresponding maximum temperature in the disc increased rapidly first, kept stable then, and decrease slowly in the end. The one-dimensional heat conduction equation was applied to predict the maximum temperature variation and was found to be in agreement with the experimental results. Furthermore, the maximum temperature evolution and the temperature distribution of the disc at the braking time of 45 s were simulated by the finite element method, which is satisfactory. In additional, the temperature variation caused the corresponding fluctuation of instantaneous frictional coefficient and thermal stress distribution in the disc, which results in the thermal damages.
The impact of body mass index on resource utilization and outcomes of children admitted to a pediatric intensive care unit
Authors: Sharma Kamal , Raszynski Andre , Totapally Balagangadhar R
Published: January 2019

Introduction:

Obesity is associated with poor health outcomes but may be protective in intensive care unit patients. The objective of this study is to describe the characteristics of underweight, normal weight, and obese children, and to compare their length of stay, resource utilization, and mortality.

Methods:

The charts of 1447 patients who were admitted to a tertiary-level pediatric intensive care unit during 1 calendar year were reviewed. Patients were divided into three groups: underweight (<5th percentile), normal (5th–95th percentiles), and obese (>95th percentile). Body mass index for age percentile was used for children older than age 2 years, and weight-for-height percentile was used for children younger than age 2 years. Demographic data, Pediatric Index of Mortality 2 score, Pediatric Index of Mortality 2 risk of mortality, hospital mortality, hospital length of stay, the use and duration of ventilator support, hemodynamic support, and dialysis were determined.

Results:

Fifteen percent of children were underweight, while 61.5% were normal weight and 23.5% were obese; 54.9% of the patients were male. The overall mortality was 1.87%, with no significant difference between the three weight groups. The racial distribution, prevalence, and duration of invasive and noninvasive ventilation, and the use of vasopressors, central venous lines, and dialysis were similar between three groups. Tube feeding and parenteral nutrition were used more often in the underweight group. Pediatric intensive care unit and hospital lengths of stays were higher in underweight children. Underweight children were younger when compared to normal or obese children. Pediatric Index of Mortality 2 scores and Pediatric Index of Mortality 2 risk of mortality scores were higher in underweight children.

Conclusion:

There were no significant differences between the three weight groups in mortality. Underweight children were younger and sicker, and received tube feeding and parenteral nutrition more frequently.
Health Care Services and the Elderly: Utilization and Satisfaction in the Aftermath of the Turkish Health Transformation Program
Authors: Caner Asena , Cilasun Seyit Mumin
Published: January 2019

With the implementation of the health transformation program, Turkey has gone through substantial changes in its health system in the last decade. This study relies on two nationally representative data sets to investigate health service utilization and satisfaction of the elderly. In particular, it examines the share of elderly who have an unmet need for medical care and who could not afford a medical examination or treatment over the years 2006 to 2015, using data from the Turkish Survey of Income and Living Conditions. It also examines the utilization of health services and satisfaction from these services by the elderly in years 2004 to 2015 using data from the Turkish Life Satisfaction Survey. This study finds that utilization has increased and, coinciding with the introduction of the family medicine system, the percentage of patients choosing primary care facilities has increased. The share of the elderly with unmet need and those who could not afford health care have declined. Notwithstanding, overall satisfaction increased only until 2011-2012. Understanding the utilization and satisfaction of the elderly is important, because along with many other countries, the population is aging in Turkey. In the near future, health care needs of the elderly will have a higher priority on the agenda of policy makers.
Adherence to Exercise Programs in Older Adults: Informative Report
Authors: Rivera-Torres Solymar , Fahey Thomas D. , Rivera Miguel A.
Published: January 2019

This informative report focuses on filling information gaps regarding adherence to physical activity and exercise in the health care spectrum of older adults (OA) and an overview of the benefits of physical activity for OA. Healthy People 2000, 2010, and 2020 are public health programs from the U.S. Department of Health and Human Services that set national goals and objectives for promoting health and preventing disease. The programs include 10 leading health indicators that reflect major health problems, which concern OA. Exercise and physical activity are among the most important factors affecting health and longevity, but exercise adherence is a significant hindrance in achieving health goals in the OA. Exercise adherence in OA is a multifactorial problem encompassing many biopsychosocial factors. Factors affecting adherence in the OA include socioeconomic status, education level, living arrangements, health status, pacemakers, physical fitness, and depression. Improving adherence could have a significant impact on longevity, quality of life, and health care costs.
Development and Evaluation of an Integrated Digital Patient Platform During Oncology Treatment
Authors: De Regge Melissa , Decoene Elsie , Eeckloo Kristof , Van Hecke Ann
Published: January 2019

Background:

Patient platforms are seen as promising technologies in an integrated care approach to involve cancer patients in their own health care and to support them in managing their personal health information. However, few digital platforms have been codesigned with patients and caregivers.

Objective:

To develop, implement, and evaluate the feasibility and applicability of a digital oncology platform (DOP) for patients with cancer.

Method:

A mixed-method study was used, employing a survey, interviews, and logged data from caregivers and patients. The DOP was designed in cooperation with Information Technology (IT) staff, caregivers, and patients.

Results:

The DOP was actively used by half of the patients. These active patients were positive about the DOP. Caregivers acknowledged the added value but also indicate that additional workload was involved. Oncology nurse specialists are the users of the platform. General practitioners have indicated their interest in the platform.

Conclusion:

Thanks to the codesign process, the DOP could be tailored to the expectations of the end users. This study provides insight into which DOP functionalities the patients were interested in and includes further recommendations for implementation.
Baseline and interim functional imaging with PET effectively risk stratifies patients with peripheral T-cell lymphoma
Authors: Mehta-Shah Neha , Ito Kimiteru , Bantilan Kurt , Moskowitz Alison J. , Sauter Craig , Horwitz Steven M. , Schöder Heiko
Published: January 2019

The prognosis of peripheral T-cell lymphoma (PTCL) is heterogenous. Baseline or interim imaging characteristics may inform risk-adapted treatment paradigms. We identified 112 patients with PTCL who were consecutively treated with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)/CHOP-like regimens with the intent to consolidate with an autologous transplant. Baseline (n = 93) and interim (after 4 cycles, n = 99) positron emission tomography (PET) images were reevaluated, and we calculated baseline total metabolic tumor volume (TMTV). Interim PET (iPET) responses were graded visually by 5-point score (i5PS) and by percentage change of standardized uptake value. By univariate analysis, predictors of event-free survival (EFS) included Prognostic Index for Peripheral TCL (PIT) higher than 1 (hazard ratio [HR], 1.83; P = .021), International Prognostic Index (IPI) higher than 3 (HR, 2.01; P = .021), high TMTV (>125 cm3; HR, 3.92; P = .003), and positive iPET (HR, 3.57; P < .001). By multivariate analysis, high baseline TMTV predicted worse overall survival (OS; HR, 6.025; P = .022) and EFS (HR, 3.861; P = .005). Patients with i5PS of 1 to 3 had a longer median OS and EFS (104 months, 64 months) than those with i5PS of 4 to 5 (19 months, 11 months; P < .001). Four-year OS and EFS for patients with i5PS of 1 to 3 and PIT of 1 or less were 85% and 62%, respectively. However, 4-year OS and EFS for those with i5PS of 4 to 5 and PIT higher than 1 were both 0% (P < .001). In multivariate analysis, after controlling for IPI and PIT, i5PS was independently prognostic for EFS (HR, 3.400 95% confidence interval, 1.750-6.750; P < .001) and OS (HR, 10.243; 95% confidence interval, 4.052-25.891; P < .001). In conjunction with clinical parameters, iPET helps risk stratify patients with PTCL and could inform risk-adapted treatment strategies. Prospective studies are needed to confirm these findings.
Endothelial signaling by neutrophil-released oncostatin M enhances P-selectin–dependent inflammation and thrombosis
Authors: Setiadi Hendra , Yago Tadayuki , Liu Zhenghui , McEver Rodger P.
Published: January 2019

In the earliest phase of inflammation, histamine and other agonists rapidly mobilize P-selectin to the apical membranes of endothelial cells, where it initiates rolling adhesion of flowing neutrophils. Clustering of P-selectin in clathrin-coated pits facilitates rolling. Inflammatory cytokines typically signal by regulating gene transcription over a period of hours. We found that neutrophils rolling on P-selectin secreted the cytokine oncostatin M (OSM). The released OSM triggered signals through glycoprotein 130 (gp130)–containing receptors on endothelial cells that, within minutes, further clustered P-selectin and markedly enhanced its adhesive function. Antibodies to OSM or gp130, deletion of the gene encoding OSM in hematopoietic cells, or conditional deletion of the gene encoding gp130 in endothelial cells inhibited neutrophil rolling on P-selectin in trauma-stimulated venules of the mouse cremaster muscle. In a mouse model of P-selectin–dependent deep vein thrombosis, deletion of OSM in hematopoietic cells or of gp130 in endothelial cells markedly inhibited adhesion of neutrophils and monocytes and the rate and extent of thrombus formation. Our results reveal a paracrine-signaling mechanism by which neutrophil-released OSM rapidly influences endothelial cell function during physiological and pathological inflammation.
A moderate role for cognitive models in agent-based modeling of cultural change
Authors: Abrams Marshall
Published: January 2019

Purpose

Agent-based models are typically “simple-agent” models, in which agents behave according to simple rules, or “complex-agent” models which incorporate complex models of cognitive processes. I argue that there is also an important role for agent-based computer models in which agents incorporate cognitive models of moderate complexity. In particular, I argue that such models have the potential to bring insights from the humanistic study of culture into population-level modeling of cultural change.

Methods

I motivate my proposal in part by describing an agent-based modeling framework, POPCO, in which agents’ communication of their simulated beliefs depends on a model of analogy processing implemented by artificial neural networks within each agent. I use POPCO to model a hypothesis about causal relations between cultural patterns proposed by Peggy Sanday.

Results

In model 1, empirical patterns like those reported by Sanday emerge from the influence of analogies on agents’ communication with each other. Model 2 extends model 1 by allowing the components of a new analogy to diffuse through the population for reasons unrelated to later effects of the analogy. This illustrates a process by which novel cultural features might arise.

Conclusions

The inclusion of relatively simple cognitive models in agents allows modeling population-level effects of inferential and cultural coherence relations, including symbolic cultural relationships. I argue that such models of moderate complexity can illuminate various causal relationships involving cultural patterns and cognitive processes.
In situ non-invasive multianalytical methodology to characterize mosaic tesserae from the House of Gilded Cupids, Pompeii
Authors: Marcaida Iker , Maguregui Maite , Morillas Héctor , Prieto-Taboada Nagore , Veneranda Marco , Fdez-Ortiz de Vallejuelo Silvia , Martellone Alberta , De Nigris Bruno , Osanna Massimo , Madariaga Juan Manuel
Published: January 2019

Mosaics, one of the most important decorative artworks in the Roman culture, were usually elaborated with a set of tesserae joined with lime or others binders to form geometric or figurative decorations. The identification of both substrate and colored compounds of the tesserae is a challenge for chemists and archaeologists. In this work, two mosaics present in the House of Gilded Cupids from the Archaeological Park of Pompeii were analyzed in situ by non destructive techniques. Raman and Diffuse Reflectance Infrared Fourier Transform (DRIFT) spectroscopies were used for the molecular and mineralogical characterization, and hand-held energy dispersive X-ray fluorescence (HH-EDXRF) spectrometry and Laser Induced Breakdown Spectroscopy (LIBS) for the elemental analysis. LIBS in-depth analysis was performed to obtain insights about the thickness of the pictorial layer determining that the thickness of red and orange pictorial layers was higher than 140 μm. The results showed that white tesserae were mainly composed by calcite, while local black colored volcanic rocks were used to manufacture black tesserae. Red and orange tesserae were composed by a calcite-based matrix with a hematite pictorial layer applied over it. Orange color was obtained by diluting hematite in the calcite matrix. Principal component analysis (PCA) of the XRF data was performed to observe differences and/or similarities between the analyzed mosaics; the samples projection of the PCA showed clear groupings.