bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroscience Intermediate-Level Care Units Staffed by Intensivists: Clinical Outcomes and Cost Analysis
Authors: Kyeremanteng Kwadwo , Hendin Ariel , Bhardwaj Kalpana , Thavorn Kednapa , Neilipovitz Dave , Kubelik Dalibour , D’Egidio Gianni , Stotts Grant , Rosenberg Erin
Published: April 2017

Introduction:

With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit’s care team.

Methods:

Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping.

Results:

A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay.

Conclusion:

An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality neurocritical care.
The Rapidly Aging World: Implications For Marketing
Authors: Gentry James W. , Mittelstaedt Robert A.
Published: April 2017

We raise a number of concerns as to how rapidly the world is ageing, and not just the developed world. Whereas there is much coverage of the forthcoming budget problems facing the developed world in terms of dealing with commitments to the elderly through programmes such as Medicare, Social Security and Medicaid in the USA, there is less awareness that much of the developing world is ageing at a more rapid rate and is, in fact, less prepared for handling its ageing population. The article’s purpose is not only to increase awareness of the coming problems, but also to point out specific issues that marketers need to devote much attention.
Suppressing the molecular signaling pathways involved in inflammation and cancer in breast cancer cell lines MDA-MB-231 and MCF-7 by miR-590
Authors: Sheikholeslami Azar , Nabiuni Mohammad , Arefian Ehsan
Published: April 2017

Breast cancer is the most frequent cancer among women worldwide. Tumor immunology suggests relationships between the immune system, chronic inflammation, and cancer. The immune system may either prevent or promote carcinogenesis. Here, we evaluated molecular signaling pathways common in inflammation and cancer and detected the microRNAs which play pivotal roles in mediating these pathways. Using bioinformatics assays, signaling pathways common in inflammation and cancer, and microRNAs mediating these pathways were identified. MiR-590 was selected and cloned into the pLenti-III-eGFP vector and transfected into the breast cancer cell lines. The expression level of microRNA and the candidate genes was evaluated by real-time quantitative reverse transcription polymerase chain reaction, and the apoptosis level in transfected cells was measured by Annexin V-7AAD assay. The cell migration was tested by real-time quantitative reverse transcription polymerase chain reaction for MMP2/MMP9. The expression levels of miR-590 and the selected genes (i.e. JAK2, PI3K, MAPK1, and CREB) were measured 72 h after transfection. While miR-590 showed an over-expression, the genes were significantly down-regulated. A significant increase was observed in apoptosis level in both cell lines and MMP2/MMP9 was significantly decreased in MDA-MB-231 cells. MiR-590 was selected as a microRNA which triggers and down-regulates critical genes of signaling pathways similar in cancer and inflammation. Following the miR-590 treatment, JAK2, PI3K, MAPK1, and CREB were down-regulated and the apoptosis level was increased in breast cancer cell lines. Apparently, some microRNAs can be good candidates for novel treatments of cancer. Although miR-590 showed good results in this study, further studies are required to investigate the role of miR-590 in breast cancer therapy.
A multi-target protein of hTERTR-FAM96A presents significant anticancer potent in the treatment of hepatocellular carcinoma
Authors: Zhang Meng-Yu , Wang Jie-Ping
Published: April 2017

The abilities to escape apoptosis induced by anticancer drugs are an essential factor of carcinogenesis and a hallmark of resistance to cancer therapy. In this study, we identified hTERTR-FAM96A (human telomerase reverse transcriptase–family with sequence similarity 96 member A) as a new efficient agent for apoptosome-activating and anti-tumor protein and investigated the potential tumor suppressor function in hepatocellular carcinoma. The hTERTR-FAM96A fusion protein was constructed by genetic engineering and its anticancer function of hTERTR-FAM96A was explored in vitro and in vivo by investigating the possible preclinical outcomes. Effects of hTERTR-FAM96A on improvement of apoptotic sensitivity and inhibition of migration and invasion were examined in cancer cells and tumors. Our results showed that the therapeutic effects of hTERTR-FAM96A were highly effective for inhibiting tumor growth and inducing apoptosis of hepatocellular carcinoma cells in H22-bearing nude mice. The hTERTR-FAM96A fusion protein could specifically bind with Apaf-1 and hTERT, which further induced apoptosis of hepatocellular carcinoma cells and improved apoptosis sensitivity. Our results indicated that hTERTR-FAM96A treatment enhanced cytotoxic effects by upregulation of cytotoxic T lymphocyte responses, interferon-γ release, and T lymphocyte infiltration. In addition, hTERTR-FAM96A led to tumor-specific immunologic cytotoxicity through increasing apoptotic body on hepatocellular tumors. Furthermore, hTERTR-FAM96A dramatically inhibited tumor growth, reduced death rate, and prolonged mice survival in hepatocellular carcinoma mice derived from three independent hepatocellular carcinoma mice cohorts compared to control groups. In summary, our data suggest that hTERTR-FAM96A may serve as an efficient anti-tumor agent for the treatment of hepatocellular carcinoma.
BIIB021: A novel inhibitor to heat shock protein 90–addicted oncology
Authors: Yan Liang , Zhang Weiming , Zhang Beibei , Xuan Chao , Wang Daogang
Published: April 2017

Heat shock protein 90 is induced in response to the cell stress. Its overexpression has been reported in many cancers with poor prognosis. It acts as a chaperone to the client proteins, especially the activated oncoproteins in malignancies to protect them from degradation. Heat shock protein 90 inhibition represented anti-cancer effects in many studies. Previous natural product–based compounds are limited by their association with target toxicities. BIIB021 is an orally available, fully synthetic novel small-molecule heat shock protein 90 inhibitor that has shown strong antitumor activities in a large number of preclinical models and is now under clinical investigation. This review will summarize its therapeutic effects and highlight the prospect of targeting heat shock protein 90 in the cancer therapy.
Netrin-1 in cancer: Potential biomarker and therapeutic target?
Authors: Kefeli Umut , Ucuncu Kefeli Aysegul , Cabuk Devrim , Isik Ulas , Sonkaya Alper , Acikgoz Ozgur , Ozden Ercan , Uygun Kazim
Published: April 2017

Netrin-1, a laminin-related protein, is known to be involved in the nervous system development. Recently, Netrin-1’s involvement in other processes such as cell adhesion, motility, proliferation, and differentiation that are important for the development of epithelial tissues has been described. In addition, Netrin-1 and its receptors, deleted in colorectal cancer and uncoordinated-5 homolog, have been linked to apoptosis and angiogenesis. Since these properties are essential for tumor development, Netrin-1 and its receptors have been reported to promote tumorigenesis in many types of cancers. Here, we review the Netrin-1 mediated regulation of cancer, its potential use as a biomarker, and the targeting of the Netrin-1 pathway to treat cancers.
The Experiences of Parents of Pediatric Patients With Acute Lymphoblastic Leukemia, 2 Months After Completion of Treatment
Authors: Muskat Barbara , Jones Heather , Lucchetta Sonia , Shama Wendy , Zupanec Sue , Greenblatt Andrea
Published: April 2017

Diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) can be a highly stressful time for the entire family. While completion of treatment may bring relief to some families, it may also bring about additional anxieties and fear. The primary objective of this article is to present an analysis of the experiences, emotional states, and support needs of parents of pediatric cancer patients 2 months after treatment completion for ALL. Using a qualitative interpretive description approach, transcripts from interviews with 17 parents from the leukemia/lymphoma program of a large urban pediatric cancer center were analyzed using N-Vivo 10 data analysis software. Parents reported simultaneous feelings of relief and apprehension, changing relationships with their health care team and the experience of returning to a life following treatment. Results highlight the need for support for parents on completion of treatment.
Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study
Authors: Patel Minal R. , Resnicow Kenneth , Lang Ian , Kraus Kathleen , Heisler Michele
Published: April 2017

Background. Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated. Aims. We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting. Method. We report a pre–post one-group design pilot study. From an endocrinology clinic, we recruited 104 adults with diabetes who reported financial burdens with their diabetes management or engaged in CRN behaviors. We offered participants the financial burden resource tool we developed, which provided tailored, low-cost resource options for diabetes management and other social needs. Acceptability and self-reported outcomes were assessed 2 months after use of the tool. Results. Mean age of participants was 50.5 years ( SD = 15.3). Participants found the tool highly acceptable across 15 indicators (e.g., 93% “learned a lot,” 98% “topics relevant” 95% “applicable to their lives,” 98% “liked the information”). Significant improvements between baseline and 2-month follow-up were observed for discussion of cost concerns with nurses (19% to 29%, p < .05) and pharmacists (13% to 25.5%, p < .01), not skipping doses of medicines due to cost (11% to 4%, p < .03), and financial management (33.83 to 39.62, p < .007). There were no significant changes in perception of financial burden. Conclusion. A financial burden resource tool is highly acceptable to patients, is easy to administer, and can prompt behavior change. This pilot study supports the need for well-powered trials with longer follow-up to further evaluate the effectiveness of such tools in improving CRN and key outcomes.
Interrelationships Between Health Behaviors and Coping Strategies Among Informal Caregivers of Cancer Survivors
Authors: Litzelman Kristin , Kent Erin E. , Rowland Julia H.
Published: April 2017

Background. Recent research among cancer survivors suggests that health behaviors and coping are intertwined, with important implications for positive behavior change and health. Informal caregivers may have poor health behaviors, and caregivers’ health behaviors have been linked to those of survivors. Aims. This hypothesis generating study assessed the correlations among health behaviors and coping strategies in a population of lung and colorectal cancer caregivers. Method. This cross-sectional study used data from the Cancer Care Outcomes Research & Surveillance Consortium. Caregivers ( n = 1,482) reported their health behaviors, coping, and sociodemographic and caregiving characteristics. Descriptive statistics assessed the distribution of caregivers’ health and coping behaviors, and multivariable linear regressions assessed the associations between health behaviors and coping styles. Results. Many informal caregivers reported regular exercise (47%) and adequate sleep (37%); few reported smoking (19%) or binge drinking (7%). Problem-focused coping was associated with greater physical activity and less adequate sleep (effect sizes [ESs] up to 0.21, p < .05). Those with some physical activity scored higher on emotion-focused coping, while binge drinkers scored lower (ES = 0.16 and 0.27, p < .05). Caregivers who reported moderate daily activity, current smoking, binge drinking, and feeling less well rested scored higher on dysfunctional coping (ES up to 0.49, p < .05). Discussion. Health behaviors and coping strategies were interrelated among informal cancer caregivers. The relationships suggest avenues for future research, including whether targeting both factors concurrently may be particularly efficacious at improving informal caregiver self-care. Conclusion. Understanding the link between health behaviors and coping strategies may inform health behavior research and practice.
Influence of air-induced vibration of aerostatic bearing on the machined surface quality in ultra-precision flycutting
Authors: Gao Qiang , Lu Lihua , Chen Wanqun , Wang Guanglin
Published: April 2017

The performance of potassium dihydrogen phosphate optics in inertial confinement fusion devices is highly affected by its surface topography. This paper theoretically investigates the relationship between the air-induced vibration of aerostatic bearing and high-frequency ripples (amplitudes of around 12 nm, spatial periods in the range of 8–30 mm) on machined surface of potassium dihydrogen phosphate optics. A simulation model, which combines transient computational fluid dynamic analysis and transient dynamic analysis, is proposed to simulate the vibration of tool tip. The three-dimensional flow status of air film is studied based on large eddy simulation method, and air vortex shedding phenomenon is observed, which results in the dynamical change of air film force. The simulated vibration amplitudes of tool tip is 8 nm, and its spatial periods are in the range of 10–24 mm, which agree well with the measured data.
Uncovering hidden geographies and socio-economic influences on fuel poverty using household fuel spend data: A meso-scale study in Scotland
Authors: Mould Ronald , Baker Keith J
Published: April 2017

Internationally, previous studies have investigated the impact of socio-economic and physical dwelling factors on household electricity consumption; however, to date, few such studies have been conducted in the UK. A previous paper identified six studies that have accessed actual (as opposed to modelled) energy consumption or expenditure data and analysed these against sets of technical and socio-economic factors. This paper presents the results of a seventh UK study, representing the first in Scotland, the first to span urban and rural households, and the first to concentrate on households in the lower income deciles. The dataset, which includes records of household expenditure on gas used for space and water heating matched with records of dwelling and household information, is drawn from sources accessed through Renfrewshire Council and analysed using a range of standard statistical techniques. The results uncover evidence for previously unreported geographies of fuel poverty, and in so doing challenges commonly used assumptions, metrics, and approaches to policy making. Key findings include figures showing low income rural households in Scotland are spending significantly more on energy than their urban equivalents, and evidence showing that rural households on lower incomes may be spending more on heating than those on higher incomes.
Electricity in Central America: Paradigms, reforms and the energy trilemma
Authors: Gent Danielle , Tomei Julia
Published: April 2017

A new global energy era is emerging, one driven by the confluence of energy security, climate politics and energy equity issues. This ‘energy trilemma’ is shaping the global political economy of energy, which in turn influences how decisions are made about how energy is provided—referred to as global energy governance. This article analyzes historical and contemporary developments in Central America’s power sectors. This is a region that has long been an implementation space for global policy priorities, but has been overlooked by those engaging with the challenges of the energy trilemma. During the 1990s and 2000s, the statist model of energy governance gave way to a market-led model in the Central American isthmus. This led to the privatization of state-owned utilities and the promotion of a regional electricity market. During this period, the dominance of largely hydro-based renewable electricity generation diminished to be replaced by imported fossil fuel-based generation. Oil price increases during the early 2000s highlighted the region’s dependence on imports, with some countries turning to energy rationing. Increasingly interventionist state policies, which now seek to reduce oil dependence, improve energy efficiency and expand access to electricity, are being pursued in the region. This interventionist turn reflects the pressures of the energy trilemma, although energy security, particularly the need to reduce dependence on imported oil, remains the most important driver.
running into each other: run! run! run! a festival and a collaboration
Authors: Latham Alan , Syng Tan Kai
Published: April 2017

artists and geographers frequently work together. the following essay explores one such on-going collaboration. centering on a festival organized by an artist and a geographer, it explores the productive antagonisms that working through and along disciplinary borders produces.
The Validation of a School-Based, Culturally Grounded Drug Prevention Curriculum for Rural Hawaiian Youth
Authors: Okamoto Scott K. , Helm Susana , Ostrowski Lindsey K. , Flood Lucille
Published: April 2017

The purpose of this study was to validate a school-based, culturally grounded drug prevention curriculum for rural Native Hawaiian youth. Faculty and administrators from eight geographically dispersed middle-, intermediate-, or multilevel schools on Hawai‘i island were interviewed on the cultural relevance and feasibility of implementation of the curriculum (Ho‘ouna Pono). While all participants appreciated the culturally specific content interwoven throughout the curriculum’s structure, several of them expressed concerns that the curriculum would compete with resources needed to implement Common Core national standards. Implications for the implementation, adoption, and sustainability of school-based prevention curricula are discussed.
The Effect of Trigger Finger Injection Site on Injection-Related Pain
Authors: Rosenbaum Yoseph A. , Benvenuti Nikki , Yang Jingzhen , Ruff Michael E. , Awan Hisham M. , Samora Julie Balch
Published: April 2017

Background: Stenosing tenosynovitis, or trigger digit, is a common condition for which patients often seek relief. Corticosteroid injections have been shown to provide relief in many cases, and several different approaches for delivering the injection have been described in the literature. We compared patients’ perception of pain following each of 3 accepted injection methods, namely, palmar proximal, palmar distal, and webspace approaches. Methods: We prospectively followed 38 patients with 39 symptomatic digits in this trial, with varying severities of trigger finger as graded by the Patel and Moradia classification. The patients were divided into 3 groups representing the 3 approaches without randomization, based upon the treating surgeons’ preference. Disabilities of the Arm, Shoulder and Hand and visual analog scale (VAS) pain scores were calculated pre-injection and at 4-week and 8-week follow-up visits. Results: No statistically significant differences in age, sex, affected extremity, grade, or duration of symptoms were observed among the 3 approaches. No statistically significant differences in VAS score were found between the palmar proximal (mean = 6.6, SD = 2.6), palmar distal (mean = 6.0, SD = 2.8), and webspace (mean = 6.8, SD = 1.8) approaches. Conclusion: Our data suggest that injection approach does not affect patient pain perception scores or outcomes. We recommend that the technique that is most comfortable to the surgeon be utilized, with the understanding that one injection alone has a low likelihood of relieving symptoms.
Independent Variables Affecting Outcome of Carpal Tunnel Release Surgery
Authors: Watchmaker Jacqueline D. , Watchmaker Greg P.
Published: April 2017

Background: In making the decision to undergo carpal tunnel release (CTR), patients may consider probability of symptom resolution. Prior studies have examined potential preoperative variables that might influence the postoperative outcome. Few studies, however, contain the sample size, prospective design, and high participant completion rate to provide solid data from which to counsel patients. The purpose of this study was to prospectively evaluate factors that have been implicated or dismissed in past studies as sources of outcome variation following CTR surgery and provide patient-relatable facts that the surgeon might use in preoperative patient counseling. Methods: One thousand thirty-one consecutive patients undergoing open CTR were prospectively enrolled. Preoperative frequency of daytime numbness, nighttime awakening, and duration of symptoms were recorded in addition to physical exam, height, weight, sex, history of diabetes, history of thyroid disease, and severity of electrodiagnostic findings. After surgery, patients reported percent resolution of numbness at defined intervals. Results: Age and sex are the only independent factors that predict the degree of resolution of numbness 6 months following surgery. All other studied variables are not independent factors nor are any paired combinations of factors. Below the age of 50, the average reported resolution of daytime numbness by 6 months is 97.3% (men 91.8% and women 99.4%). After age 50, there is a linear 0.77% decline in average resolution of daytime numbness per year. Conclusions: Age and sex but no other studied factors predict resolution of daytime numbness in a multivariate model of patients undergoing CTR.
Probabilistic modeling of the indoor climates of residential buildings using EnergyPlus
Authors: Buechler Elizabeth , Pallin Simon , Boudreaux Philip , Stockdale Michaela
Published: April 2017

The indoor air temperature and relative humidity in residential buildings significantly affect material moisture durability, heating, ventilation, and air-conditioning system performance, and occupant comfort. Therefore, indoor climate data are generally required to define boundary conditions in numerical models that evaluate envelope durability and equipment performance. However, indoor climate data obtained from field studies are influenced by weather, occupant behavior, and internal loads and are generally unrepresentative of the residential building stock. Likewise, whole-building simulation models typically neglect stochastic variables and yield deterministic results that are applicable to only a single home in a specific climate. The purpose of this study was to probabilistically model homes with the simulation engine EnergyPlus to generate indoor climate data that are widely applicable to residential buildings. Monte Carlo methods were used to perform 840,000 simulations on the Oak Ridge National Laboratory supercomputer (Titan) that accounted for stochastic variation in internal loads, air tightness, home size, and thermostat set points. The Effective Moisture Penetration Depth model was used to consider the effects of moisture buffering. The effects of location and building type on indoor climate were analyzed by evaluating six building types and 14 locations across the United States. The average monthly net indoor moisture supply values were calculated for each climate zone, and the distributions of indoor air temperature and relative humidity conditions were compared with ASHRAE 160 and EN 15026 design conditions. The indoor climate data will be incorporated into an online database tool to aid the building community in designing effective heating, ventilation, and air-conditioning systems and moisture durable building envelopes.
CD14 gene silencing alters the microRNA expression profile of RAW264.7 cells stimulated by Brucella melitensis infection
Authors: Rong Hui , Jiao Hanwei , Hao Yongchang , Pang Feng , Li Guohua , Peng Dongmei , Li Yaying , Wang Yuanzhi , Zhang Hui , Fan Quanshui , Wang Fengyang , Chen Chuangfu , Du Li
Published: April 2017

Innate recognition of Brucella spp. is a key step in the activation of inflammation. CD14 binds PAMPs and is involved in LPS-induced pro-inﬂammatory cytokine release. Previously we showed that knock down of CD14 in RAW264.7 macrophages disrupted Brucella–host interactions. However, its effect on the macrophage microRNA (miRNA) expression profile, especially after stimulation by Brucella infection, is still unclear. To identify miRNAs involved in the macrophage response to Brucella infection, we performed miRNA expression profiling of CD14 knock-down RAW264.7 (224.3) macrophages infected with Brucella melitensis, and demonstrated, for the first time, that CD14 knock down significantly up-regulated the expression of mmu-miR-199a-3p and mmu-miR-183-5p in these conditions. These miRNAs have a well-characterized association with the target genes involved in immune response, inflammatory response, innate immune response, apoptosis processes, anti-apoptosis, cytokine production and cytokine-mediated signaling pathways. Among the 104 inflammation-related candidate target genes of mmu-miR-199a-3p and mmu-miR-183-5p in the 224.3+ B. melitensis group cells, the expression of the Cbl-b, a potential target of mmu-miR-199a-3p, was confirmed to be down-regulated using qRT-PCR and Western blot analysis. Our findings suggest that CD14 functions in the Brucella–host interaction may be through altered miRNA expression, and regulation of Cbl-b proteins.
Analyzing Performance Implications of Selected Audit Committee Characteristics: A Study of Indian Corporate Sector
Authors: Sarpal Shivan
Published: April 2017

The present research work mainly focuses on the audit committee as a key to ensure a sound corporate governance framework in the companies. The insights from the present research work are a novel attempt to figure out the influence of selected audit committee characteristics on the performance of companies listed in India. Results suggest that audit committee size has a curvilinear effect on firm market valuation having an inflexion point of four directors comprising the members of the audit committee. Furthermore, the independent directors on the audit committee start contributing toward better firm accounting performance only after they constitute more than the majority. The audit committee activity has also demonstrated a significant relationship with firm performance in a nonlinear fashion. The above findings have been robust to the several alternative empirical tests and modifications. It also reveals that the findings solely based upon the linear testing of influence of audit committee characteristics are not conclusive in nature. Moreover, the findings generated from the characteristics of audit committee–firm performance association in this study are contingent upon the nature of performance measure being adopted. In relation to it, suitable implications and propositions have been quoted in the last section so as to offer directions to the interested parties.
The Unbearable Sameness of Being and the Logic of Dalit Difference
Authors: Vijayan Anilkumar Payyappilly
Published: April 2017

Delineating three instances of the Dalit differential (Ambedkar’s self-distancing from conservatives and the communists, Chandra Bhan Prasad’s writing and the film discourse from Kerala which equates blackness with essential Dalitness), this article hints at the way in which Dalit discourse is dialectically situated in various historical contexts and discursive systems in order to arrive at the point that untouchability as a political doctrine is not an obsolete project of a bygone era but is very much the built-in mechanism of emancipatory praxis as well as theoretical mediations. As a corollary, the article de-sutures the word untouchability from its unfortunate connection with the body and its visible marker, the skin, and connects it with thought itself. Drawing on Slavoj Žižek’s radical idea that ‘the unbearable is not the difference’, a further argument is put forward: ‘the anti-Dalit’ discursive formation that is happening around us is rooted in what Žižek calls the unbearable, namely the absence of any difference between the self and the projected other.
A single‐blinded, randomized, parallel group superiority trial investigating the effects of footwear and custom foot orthoses versus footwear alone in individuals with patellofemoral joint osteoarthritis: a phase II pilot trial protocol
Authors: Wyndow Narelle , Crossley Kay M. , Vicenzino Bill , Tucker Kylie , Collins Natalie J.
Published: April 2017

Background

Patellofemoral joint osteoarthritis is a common condition, yet information regarding conservative management is lacking. Foot orthoses are an effective intervention for improving pain and function in younger individuals with patellofemoral pain and may be effective in those with patellofemoral osteoarthritis. This pilot study will seek to establish the feasibility of a phase III randomised controlled trial to investigate whether foot orthoses worn in prescribed motion controlled footwear are superior to prescribed motion control footwear alone in the management of patellofemoral osteoarthritis.

Methods/design

This phase II pilot clinical trial is designed as a randomized, single‐blind, parallel group, two arm, superiority trial. The trial will recruit 44 participants from Queensland and Tasmania, Australia. Volunteers aged 40 years and over must have clinical symptoms and radiographic evidence of patellofemoral osteoarthritis to be eligible for inclusion. Those eligible will be randomized to receive either foot orthoses and prescribed motion control shoes, or prescribed motion control shoes alone, to be worn for a period of 4 months. The feasibility of a phase III clinical trial will be evaluated by assessing factors such as recruitment rate, number of eligible participants, participant compliance with the study protocol, adverse events, and drop‐out rate. A secondary aim of the study will be to determine completion rates and calculate effect sizes for patient reported outcome measures such as knee‐related symptoms, function, quality of life, kinesiophobia, self‐efficacy, general and mental health, and physical activity at 2 and 4 months. Primary outcomes will be reported descriptively while effect sizes and 95% confidence intervals will be calculated for the secondary outcome measures. Data will be analysed using an intention‐to‐treat principle.

Discussion

The results of this pilot trial will help determine the feasibility of a phase III clinical trial investigating whether foot orthoses plus motion control footwear are superior to motion control footwear alone in individuals with patellofemoral osteoarthritis. A Phase III clinical trial will help guide footwear and foot orthoses recommendations in the clinical management of this disorder.

Trial registration

Retrospectively registered with the Australian New Zealand Clinical Trials Registry: ACTRN12615000002583. Date registered: 07/01/15.
The effectiveness and cost-effectiveness of a mindfulness training programme in schools compared with normal school provision (MYRIAD): study protocol for a randomised controlled trial
Authors:   the MYRIAD team, Kuyken Willem , Nuthall Elizabeth , Byford Sarah , Crane Catherine , Dalgleish Tim , Ford Tamsin , Greenberg Mark T. , Ukoumunne Obioha C. , Viner Russell M. , Williams J. Mark G.
Published: April 2017

Background

Mindfulness-based approaches for adults are effective at enhancing mental health, but few controlled trials have evaluated their effectiveness or cost-effectiveness for young people. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of a mindfulness training (MT) programme to enhance mental health, wellbeing and social-emotional behavioural functioning in adolescence.

Methods/design

To address this aim, the design will be a superiority, cluster randomised controlled, parallel-group trial in which schools offering social and emotional provision in line with good practice (Formby et al., Personal, Social, Health and Economic (PSHE) Education: A mapping study of the prevalent models of delivery and their effectiveness, 2010; OFSTED, Not Yet Good Enough: Personal, Social, Health and Economic Education in schools, 2013) will be randomised to either continue this provision (control) or include MT in this provision (intervention). The study will recruit and randomise 76 schools (clusters) and 5700 school students aged 12 to 14 years, followed up for 2 years.

Discussion

The study will contribute to establishing if MT is an effective and cost-effective approach to promoting mental health in adolescence.

Trials registration

International Standard Randomised Controlled Trials, identifier: ISRCTN86619085. Registered on 3 June 2016.
Comparative Analysis of Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer According to 2007 and 2013 American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations
Authors: Hanna Wedad M. , Slodkowska Elzbieta , Lu Fang-I , Nafisi Houman , Nofech-Mozes Sharon
Published: April 2017

Purpose

To study the effect of the 2013 updates to the 2007 American Society of Clinical Oncology/College of American Pathologists recommendations for human epidermal growth factor receptor 2 (HER2) testing in breast cancer on testing patterns and interpretation in a large regional reference laboratory.

Patients and Methods

Patient cases with HER2 testing scores for breast biomarker evaluation were selected from our laboratory information system during two 12-month periods (2012 and 2014). The number of tests performed, type of specimens, proportion of HER2-positive and equivocal patient cases, and number of repeat tests on subsequent excisional specimens were examined and compared.

Results

Although the number of samples tested increased between 2012 and 2014 (2,201 v 2,558 patient cases; 2,278 v 2,659 tumors), HER2 positivity remained constant (15.7% v 15.5%, respectively). The number of repeat tests performed within 6 months more than doubled (122 [5.5%) of 2,201 v 302 [11.8%] of 2,558; P < .001), and the proportion of immunohistochemistry (IHC) 2+ tumors was significantly lower in 2014 than in 2012 (20.3% v 25.3%; P < .001). However, the proportion of patient cases with unresolved HER2 statuses (equivocal by IHC and in situ hybridization) was significantly higher in 2014 (four of 2,278 v 90 of 2,660; P < .001).

Conclusion

Our findings indicate that the 2013 updates to the American Society of Clinical Oncology/College of American Pathologists recommendations for HER2 testing in breast cancer did not affect the overall HER2-positivity rate or the proportion of patients eligible for HER2-targeted therapy. The proportion of tests and repeat tests performed increased, as did the number of patient cases categorized as ISH equivocal. The benefit of targeted therapy in the equivocal group is not proven, so targeted therapy should not be considered for patients in this category which should be redefined in future iterations of the recommendations.
When Discounts Raise Costs: The Effect of Copay Coupons on Generic Utilization
Authors: Dafny Leemore , Ody Christopher , Schmitt Matt
Published: April 2017

Branded pharmaceutical manufacturers frequently offer “copay coupons” that insulate consumers from cost-sharing, thereby undermining insurers' ability to influence drug utilization. We study the impact of copay coupons on branded drugs first facing generic entry between 2007 and 2010. To overcome endogeneity concerns, we exploit cross-state and cross-consumer variation in coupon legality. We find that coupons increase branded sales by 60+ percent, entirely by reducing the sales of bioequivalent generics. During the five years following generic entry, we estimate that coupons increase total spending by $30 to $120 million per drug, or $700 million to $2.7 billion for our sample alone. (JEL G22, I13, L11, L65, M31)
The Economics of Rights: Does the Right to Counsel Increase Crime?
Authors: Ater Itai , Givati Yehonatan , Rigbi Oren
Published: April 2017

We examine the broad consequences of the right to counsel by exploiting a legal reform in Israel that extended the right to publicly provided legal counsel to suspects in arrest proceedings. Using the staggered regional rollout of the reform, we find that the reform reduced arrest duration and the likelihood of arrestees being charged. We also find that the reform reduced the number of arrests made by the police. Lastly, we find that the reform increased crime. These findings indicate that the right to counsel improves suspects ' situation, but discourages the police from making arrests, which results in higher crime. (JEL K10, K41, K42)
Financial Incentives, Hospital Care, and Health Outcomes: Evidence from Fair Pricing Laws
Authors: Batty Michael , Ippolito Benedic
Published: April 2017

State laws that limit how much hospitals are paid by uninsured patients provide a unique opportunity to study how financial incentives of health care providers affect the care they deliver. We estimate the laws reduce payments from uninsured patients by 25-30 percent. Even though the uninsured represent a small portion of their business, hospitals respond by decreasing the amount of care delivered to these patients, without measurable effects on a broad set of quality metrics. The results show that hospitals can, and do, target care based on financial considerations, and suggest that altering provider financial incentives can generate more efficient care. (JEL G22, H75, I11, I13, I18)
Clinical utility of riluzole in patients with motor neurone disease (amytrophic lateral sclerosis)
Authors: Thomason Susan S
Published: April 2017

Amyotrophic lateral sclerosis (ALS), also known as motor neurone disease (MND), is a devastating, progressive disease for which there is no cure. This disease affects both upper and lower motor neurones and the patient typically succumbs to respiratory failure within 2 to 4 years. The UK and US regulatory agencies have only endorsed one neuroprotective drug for ALS, riluzole, which has been reported to extend the patient's length of survival by up to 21 months, depending on the study. New drugs and riluzole add-ons have not proven more beneficial than monotherapy with riluzole. This literature review addresses studies on the use of riluzole, updates current literature on the neuroprotectant, highlights National Institute for Health and Care Excellence (NICE) guidance on the use of riluzole for the treatment of MND in the UK and discusses the clinical utility of the drug regarding to multidisciplinary teams, pharmacological management, and adverse events. Optimal use of riluzole is based upon early diagnosis of MND/ALS and offering this medication to patients in the early stage of this fatal disease.
Research roundup
Authors: Costello John
Published: April 2017

John Costello provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail
Boys and men's health: An urgent need to make the investment
Authors: Peate Ian
Published: April 2017

Globally, male life expectancy is lagging 5 years behind female life expectancy and this gap is expected to grow further. Ian Peate explains why gender specific interventions can benefit both genders and calls for an urgent investment in male health policies.
Tobacco control and young people: A guide for school nurses
Authors: Croghan Emma
Published: April 2017

Tobacco smoking remains a public health priority and school nurses have an important role to play in tobacco control. Even though the majority of smoking-related deaths are in people aged 35 years or older, the onset of smoking occurs primarily in adolescence, and most adult smokers report that they began smoking before the age of 18, and over 80% before the age of 20. There is also evidence of early physical harm from child and adolescent smoking.

This article looks at how school nurses can get involved in tobacco control, including whole-school policies and support for individuals.
Evidence-based practice: Why we should all contribute
Authors: Wright Jane
Published: April 2017

Evidence is the cornerstone of best practice and innovation, yet very little school nursing research is published. Jane Wright explains why it is essential to formalise and share the models developed by school nurses locally, and to build the body of knowledge for the profession.
Improving mental health and reducing health inequalities
Authors: Caan Woody
Published: April 2017

This new series provides an overview of a selection of relevant public health research and comments on the findings and methods. This month, Woody Caan looks at four articles focusing on improving mental health and wellbeing, and reducing health inequalities.
Artistic Fallout from the July 2006 War: Momentum, Mediation, and Mediatization
Authors: Syrine Hout
Published: April 2017

A decade after the end of Israel's 2006 war on Lebanon, I spotlight the hitherto under-researched literary portrayals of the conflict. Following an overview of the immediate and (then-) innovative media tools and techniques used to capture its momentum—blogging, video-making, and online comics—and of Arabic-, French-, and English-language literary writings referring to the war, I focus on how literature, which requires time for its “contents” to be distilled into a form removed from emotional immediacy, succeed not only in reflecting it but also in reflectingon itthrough various fictional(izing) prisms. I do so by comparing the methodologies adopted by Nada Awar Jarrar'sA Good Landand Abbas El-Zein'sLeave to Remain: A Memoir, both published in 2009, and by arguing that they share a sense of guilt and hence exhibit an ethical exigency by incorporating particular discourses to mediate and mediatize this war as crisis: the social/humanitarian inA Good Landand the visual/photographic inLeave to Remain.
Arabic Performance Poetry: A New Mode of Resistance
Authors: Muhammad Agami Hassan Muhammad
Published: April 2017

Performance poetry, as a literary term, is known in the Western literature, although some critics may not consider it literary in the first place. This article assumes the applicability of this term to new attempts of some Egyptian youth whose poems share the common features of performance poetry in English literature. Their poetic works are passionate, rhythmic, using aural and visual effects in the background, and dialects in addition to the poet's presentation of the poem face to face with the audience. Regarding the content, their verse has preceded and accompanied the political turmoil Egypt witnessed before, during, and after 25 January Revolution. For this reason, this poetic pattern loudly reflects the concerns, demands, and aspirations of the rebellious generation of youth and the whole Egyptian society. It can be considered the manifestation of the new challenging spirit of the youth in Egypt. The aim of the research is to highlight the similarities between the Anglo-American performance poetry and the literary works of two Egyptian young poets: Hisham al-Gakh and Amr Qatamish. As an interdisciplinary study, literary criticism, cultural criticism including socio-political analysis will be utilized to elucidate how performance poetry represents a new trend of resisting corruption and injustice, as well as a revolution against conventional poetic forms.
Sexual and Gender Minority Adolescents’ Views On HIV Research Participation and Parental Permission: A Mixed‐Methods Study
Authors: Mustanski Brian , Coventry Ryan , Macapagal Kathryn , Arbeit Miriam R. , Fisher Celia B.
Published: April 2017

CONTEXT

Sexual and gender minority adolescents are underrepresented in HIV research, partly because institutional review boards (IRBs) are reluctant to waive parental permission requirements for these studies. Understanding teenagers’ perspectives on parental permission and the risks and benefits of participating in HIV research is critical to informing evidence‐based IRB decisions.

METHODS

Data from 74 sexual and gender minority adolescents aged 14–17 who participated in an online focus group in 2015 were used to examine perspectives on the risks and benefits of participation in a hypothetical HIV surveillance study and the need for parental permission and adequate protections. Data were analyzed thematically; mixed methods analyses examined whether concerns about parental permission differed by whether teenagers were out to their parents.

RESULTS

Most adolescents, especially those who were not out to their parents, would be unwilling to participate in an HIV study if parental permission were required. Perceived benefits of participation included overcoming barriers to HIV testing and contributing to the health of sexual and gender minority youth. Few risks of participation were identified. Adolescents suggested steps that researchers could take to facilitate informed decision making about research participation and ensure minors’ safety in the absence of parental permission; these included incorporating multimedia presentations into the consent process and explaining researchers’ motivations for conducting the study.

CONCLUSIONS

Respondents believed that the benefits of HIV surveillance research outweighed the risks. Requiring parental permission may exclude many sexual and gender minority teenagers from taking part in HIV research, especially if they are not out.
The National Education Board (1929–36) and scientific research in Portugal
Authors: Lopes Quintino
Published: April 2017

The National Education Board (JEN – Junta de Educação Nacional) was created in 1929 during the Military Dictatorship. The purpose of this organization, much favoured by some sectors of Portuguese academiaf and intellectual elite, was the renewal of scientific, pedagogical and national economic policies. Following the example of similar international institutions, such as the Junta para Ampliación de Estudios e Investigaciones Científicas (JAE) of Spain, JEN put in place a set of articulated practices – scholarships at home and abroad, the funding of research centres and the organization of cultural expansion services – targeting the scientific updating and a greater dissemination of Portuguese culture internationally.