bluuebunny/crossref_metadata_2025 huggingface dataset:
The extent to which TOEFL iBT speaking scores are associated with performance on oral language tasks and oral ability components for Japanese university students
Authors: Ockey Gary J. , Koyama Dennis , Setoguchi Eric , Sun Angela
Published: June 2014

The purpose of this study was to determine the extent to which performance on the TOEFL iBT speaking section is associated with other indicators of Japanese university students’ abilities to communicate orally in an academic English environment and to determine which components of oral ability for these tasks are best assessed by TOEFL iBT. To achieve this aim, TOEFL iBT speaking scores were compared to performances on a group oral discussion, picture and graph description, and prepared oral presentation tasks, and their component scores of pronunciation, fluency, grammar/vocabulary, interactional competence, descriptive skill, delivery skill, and question answering. Participants were Japanese university students ( N = 222), who were English majors in a Japanese university. Pearson product–moment correlations, corrected for attenuation, between scores on the speaking section of TOEFL iBT and the three university tasks indicated strong relationships between the TOEFL iBT speaking scores and the three university tasks and high or moderate correlations between the TOEFL iBT speaking scores and the components of oral ability. For the components of oral ability, pronunciation, fluency, and vocabulary/grammar were highly associated with TOEFL iBT speaking scores while interactional competence, descriptive skill, and delivery skill were moderately associated with TOEFL iBT speaking scores. The findings suggest that TOEFL iBT speaking scores are good overall indicators of academic oral ability and that they are better measures of pronunciation, fluency and vocabulary/grammar than they are of interactional competence, descriptive skill, and presentation delivery skill.
Arterial blood pressure and vascular function in human saphenous vein
Authors: Momin A , Sharabiani MTA , Wendler O , Angelini GD , Desai J
Published: June 2014

Hypertension is a risk factor for accelerated saphenous vein (SV) graft disease and endothelial dysfunction in a number of vascular territories. We examined the relationship between blood pressure (BP) and vascular function in SV from 94 male patients undergoing coronary artery bypass grafting (CABG). Patients were pretreated with respect to cholesterol (3.4±1.2 mmol/L) and BP (systolic 139±22 mmHg, diastolic 74±13 mmHg). All patients were taking aspirin, 85% statins, 50% angiotensin-converting enzyme inhibitors and 70% beta-blockers. We demonstrate in human SV rings ex vivo that increased BP has no effect on acetylcholine-mediated vasodilatation (p=0.58), nor on the constrictor response to L-NMMA (p=0.98), but has a positive association with the constrictor response to phenylephrine (p=0.008) and a negative correlation with the vasodilator response to sodium nitroprusside (p=0.03). These results may provide further explanation for the high incidence of early vein graft failure after CABG in hypertensive patients and support an aggressive approach to optimize BP before surgery.
Shifting paradigms: People-centred models, active regional development, space-blind policies and place-based approaches
Authors: Bentley Gill , Pugalis Lee
Published: June 2014

There is gathering academic and policy momentum, although not without challenge, critique and ferocious debate, that an apparent ‘place-based’ mode of activity has emerged. Such a paradigm shift may in part be explained as a response to the deficiencies of ‘people-centred’ models, active regional development and space-blind policies. This article critically reviews some of the primary literatures relating to these competing, contradictory and also complementary methods of development. The place-based mode of working can be conceptualised as potentially offering the scope, through supportive institutional frameworks and collaborative means of governance, for developing embedded, multi-scalar and multi-annual strategies that are tailored to the complex geographies, capabilities, knowledge-sets, assets and resources of particular places (and networks of places). Whilst appearing to offer a panacea for securing economic growth in a sustainable and socially inclusive manner that releases the potential, creativity and knowledge of local actants, the dominant narrative associated with the place-based approach has not escaped critique and controversy. It is our contention that place-based thinking reflects the continual search for solutions to address territorial, social and economic inequalities and development capacities. Whether it provides a workable policy solution will be contingent on a number of factors, not least spatial context in terms of social, cultural, economic and institutional characteristics. Reflecting the multiplicity of places, place-based approaches, in raising questions about the relationship between scales of operation and institutional structures, are a subset of broader debates and issues concerning not only what works but also where.
Supra-aortic low-dose contrast-enhanced time-resolved magnetic resonance (MR) angiography at 3 T: comparison with time-of-flight MR angiography and high-resolution contrast-enhanced MR angiography
Authors: Lee Youn-Joo , Kim Bum-soo , Koo Ja-Sung , Kim Bom-Yi , Jang Jinhee , Choi Hyun Seok , Jung So-Lyung , Ahn Kook-Jin
Published: June 2014

Background

Low-dose, time-resolved, contrast-enhanced, magnetic resonance angiography (TR-CEMRA) has been described previously; however, a comparative study between low dose TR-CEMRA and time-of-flight MRA (TOF-MRA) in the diagnosis of supra-aortic arterial stenosis has not yet been published.

Purpose

To demonstrate the feasibility and effectiveness of low-dose TR-CEMRA compared with TOF-MRA, using high-resolution contrast-enhanced MRA (HR-CEMRA) as the reference standard.

Material and Methods

This prospective study consisted of 30 consecutive patients. All patients underwent TOF-MRA of the neck and circle of Willis and supra-aortic HR-CEMRA, followed by supra-aortic low-dose TR-CEMRA. Gadoterate meglumine (Gd-DOTA, Dotarem®, Guerbet, Roissy CdG Cedex, France) was injected at a dose of 0.1 mmol/kg for HR-CEMRA, followed by a 0.03 mmol/kg bolus for low-dose TR-CEMRA. Three readers evaluated the assessibility and image quality, and then two readers classified each stenosis into the following categories: normal (0–30%), mild stenosis (31–50%), moderate (51–70%), severe (71–99%), and occlusion.

Results

TR-CEMRA and HR-CEMRA showed a greater number of assessable arterial segments than TOF-MRA ( P < 0.01). For TR-CEMRA, 29 cases showed within or better than the diagnostic range, whereas all 30 cases were in the diagnostic range for TOF-MRA and HR-CEMRA. For evaluation of stenosis in a total of 743 arterial segments, both TR-CEMRA and TOF-MRA results agreed with those of HR-CEMRA in 729 segments (98.1%), with excellent inter-observer agreement of TR-CEMRA; stenosis was overestimated in nine segments (1.2%) and underestimated in five segments (0.7%). For diagnosis of stenosis using 30% as the cut-off value on HR-CEMRA, the sensitivity and specificity were 88.2% and 99.3%, respectively, for the TR-CEMRA procedure, versus 94.1% and 99.6%, respectively, for TOF-MRA.

Conclusion

Low-dose TR-CEMRA is feasible and effective in the diagnosis of supra-aortic arterial stenosis, and could be more useful option than TOF-MRA.
Surgical Treatment of Symptomatic Superior Labrum Anterior-Posterior Tears in Patients Older Than 40 Years
Authors: Erickson John , Lavery Kyle , Monica James , Gatt Charles , Dhawan Aman
Published: June 2014

Background:

Successful arthroscopic repair of symptomatic superior labral tears in young athletes has been well documented. Superior labral repair in patients older than 40 years is controversial, with concerns for residual postoperative pain, stiffness, and higher rates of revision surgery.

Purpose:

To analyze the published data on the surgical treatment of superior labral injuries in patients aged ≥40 years, including those with concomitant injuries to the rotator cuff.

Study Design:

Systematic review.

Methods:

A systematic review of the literature was performed using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The MEDLINE database via PubMed and the Cochrane Database of Systematic Reviews were searched for articles related to superior labrum anterior-posterior (SLAP) tears. Studies were included if they met the following criteria: the study contained at least 1 group of patients who had undergone arthroscopic repair of a type II or IV SLAP lesion with a minimum 2-year follow-up, objective and/or functional scoring systems were used to evaluate postoperative outcomes, and the mean patient age was ≥40 years for at least 1 treatment arm or subgroup analysis. Studies were excluded if the article was a review or if the article included data for SLAP type I, III, or V to X tears or Bankart lesions.

Results:

While several authors reported equivalent outcomes of SLAP repair in patients both older than 40 years and younger than 40 years, others demonstrated significantly higher failure rates in the older cohort. Decreased patient satisfaction and increasing complications, including postoperative stiffness and reoperations, occur at higher rates as the patient age increases. The literature demonstrates that biceps tenotomy and tenodesis are reliable alternatives to SLAP repair and that biceps tenotomy is a viable revision procedure for failed SLAP repair. With concomitant rotator cuff tears, the evidence favors debridement or biceps tenotomy over SLAP repair.

Conclusion:

While studies show that good outcomes can be obtained with SLAP repair in an older cohort of patients, age older than 40 years and workers’ compensation status are independent risk factors for increased surgical complications. The cumulative evidence supports labral debridement or biceps tenotomy over labral repair when an associated rotator cuff injury is present.
Numerical study of co-firing pulverized coal and biomass inside a cement calciner
Authors: Mikulčić Hrvoje , von Berg Eberhard , Vujanović Milan , Duić Neven
Published: June 2014

The use of waste wood biomass as fuel is increasingly gaining significance in the cement industry. The combustion of biomass and particularly co-firing of biomass and coal in existing pulverized-fuel burners still faces significant challenges. One possibility for the ex ante control and investigation of the co-firing process are computational fluid dynamics (CFD) simulations. The purpose of this paper is to present a numerical analysis of co-firing pulverized coal and biomass in a cement calciner. Numerical models of pulverized coal and biomass combustion were developed and implemented into a commercial CFD code FIRE, which was then used for the analysis. Three-dimensional geometry of a real industrial cement calciner was used for the analysis. Three different co-firing cases were analysed. The results obtained from this study can be used for assessing different co-firing cases, and for improving the understanding of the co-firing process inside the calculated calciner.
Partnerships for development: Municipal solid waste management in Kasese, Uganda
Authors: Christensen David , Drysdale David , Hansen Kenneth , Vanhille Josefine , Wolf Andreas
Published: June 2014

Municipal solid waste management systems of many developing countries are commonly constrained by factors such as limited financial resources and poor governance, making it a difficult proposition to break with complex, entrenched and unsustainable technologies and systems. This article highlights strategic partnerships as a way to affect a distributed agency among several sets of stakeholders to break so-called path dependencies, which occur when such unsustainable pathways arise, stabilize and become self-reinforcing over time. Experiences from a North–South collaborative effort provide some lessons in such partnership building: In Uganda and Denmark, respectively, the World Wildlife Fund and the network organization access2innovation have mobilized stakeholders around improving the municipal solid waste management system in Kasese District. Through a municipal solid waste management system characterization and mapping exercise, some emergent lessons and guiding principles in partnership building point to both pitfalls and opportunities for designing sustainable pathways. First, socio-technical lock-in effects in the municipal solid waste management system can stand in the way of partnerships based on introducing biogas or incineration technologies. However, opportunities in the municipal solid waste management system can exist within other areas, and synergies can be sought with interlinking systems, such as those represented with sanitation.
Assessing Perceived Emotional Intelligence in Adolescents
Authors: Pedrosa Ignacio , Suárez-Álvarez Javier , Lozano Luis M. , Muñiz José , García-Cueto Eduardo
Published: June 2014

Adolescence is a critical period of life during which significant psychosocial adjustment occurs and in which emotional intelligence plays an essential role. This article provides validity evidence for the Trait Meta-Mood Scale–24 (TMMS-24) scores based on an item response theory (IRT) approach. A sample of 2,693 Spanish adolescents ( M = 16.52 years and SD = 1.38), of whom 51.1% were boys, completed the TMMS-24. The three-dimensional structure of the TMMS-24 was confirmed, showing adequate psychometric properties for assessing adolescents. With one exception, the IRT analyses showed that the items have a reasonable fit to Samejima’s Gradual Response Model. In addition, all three dimensions exhibit the best measurement precision around the mean of the latent trait levels. Again, with one exception (Item 23), all items have a moderate to very high discrimination power.
Mutational Analyses of the FMR1 Gene in Chinese Pediatric Population of Fragile X Suspects
Authors: Luo Shiyu , Huang Wen , Xia Qiuping , Du Qian , Wu Lingqian , Duan Ranhui
Published: June 2014

CGG repeat expansion is the most common cause of fragile X syndrome. Numerous efforts have been made to identify novel mutations in patients with intellectual disability, developmental delay, and/or autism. To evaluate the mutational spectrum in the at-risk Chinese population, 60 pediatric patients presenting fragile X traits but normal-sized CGG repeats were sequenced for all 17 exons and regulatory regions in FMR1. A c.879A>C mutation, reported to alter a neighboring splicing, was detected in a severely retarded male and his normal mother. However, the exon junction appears unaffected. A 237-kb deletion covering the entire FMR1 was identified to cause moderate intellectual disability and marked hyperactivity in an 8-year-old boy. The 5′ and 3′ breakpoints were buried in the surrounding long interspersed and short interspersed elements, respectively. In general, missense mutations do not commonly cause fragile X syndrome, whereas deletions should be considered with caution in patient referrals presenting with developmental delay and/or ordinary retardation.
Psychosocial Predictors and HIV-Related Behaviors of Old Adults Versus Late Middle-Aged and Younger Adults
Authors: Prati Gabriele , Mazzoni Davide , Zani Bruna
Published: June 2014

Objective: We investigated the psychosocial predictors and HIV-related behaviors of old adults versus late middle-aged and younger adults. Method: A demographically representative sample of residents in Italy aged 18 to 75 years ( n = 2,018) was subdivided into three age groups: (a) younger adults (18-49 years), (b) late middle-aged adults (50-59 years), and (c) old adults (60-75 years). Interviews were conducted using computer-assisted telephone survey methodology. Results: Despite reporting similar levels of sexual risk behaviors, late middle-aged and old adults were less likely to use condoms and to have ever had an HIV test. The levels of HIV/AIDS knowledge, risk perception, perceived behavioral control, and behavioral intentions toward condom use were lower among old adults compared with younger adults. Old adults were less likely to have discussed HIV/AIDS with friends, relatives, or health professionals. Discussion: Old adults should be included in prevention efforts targeting knowledge, perceptions, and intentions toward condom use. Future studies should be cautious when overgeneralizing the results to all individuals aged 50 and older.
High-performance polymer nanocomposites having a biosafe amino acid by incorporating modified nanozirconia with a flame-retardant coupling agent
Authors: Mallakpour Shadpour , Mani Leila
Published: June 2014

A lot of polymeric materials are flammable, requiring modification to decrease their flammability. Nanoparticle (NP) fillers are very attractive for this purpose as they can improve both the physical and the flammable properties of the nanocomposites (NCs). Zirconium oxide (ZrO2) is one of the NPs having flame-retardant property. For the first time, ZrO2 NPs were modified using a fire-resistant modifier and then the chiral NCs were prepared via incorporating modified ZrO2-NPs into the poly(amide–imide) matrix. By decreasing the flammability of these NCs, severe aggregation of ZrO2-NPs could be reduced by surface modification. The surface modification of ZrO2 and the synthesis of NCs were performed through ultrasonic irradiations. The resulting modified ZrO2 and NPs-reinforced composites were characterized by different analyses. Field-emission scanning electron microscopy and transmission electron microscopy results proved that ZrO2-NPs were homogeneously distributed after the surface modification and successfully incorporated into the PAI matrix. The grafting of modifier on the surface of ZrO2 was confirmed by thermogravimetric analysis (TGA) and Fourier transform infrared spectroscopy techniques. TGA also showed high thermally stable and flame-retardant properties of the obtained NCs.
Experimental study on combustion mode transition effects in a strut-based scramjet combustor
Authors: Yang Qingchun , Hu Jichao , chang Juntao , Zong Youhai , Bao Wen
Published: June 2014

A strut-based scramjet combustor was operated in three different combustion modes under Mach 2.5 inflow conditions, scramjet mode, weak ramjet mode, and strong ramjet mode. The combustion mode transition effects are investigated through ground experiments. The scramjet mode occurred below the overall fuel equivalence ratio of around 0.44. Transition from the scramjet mode to the weak ramjet mode occurred at ER ∼ 0.44, accompanied by a sudden increase in thrust. By contrast, transition from the weak ramjet mode to strong ramjet mode occurred at ER ∼ 0.6125, accompanied by a sudden decrease in thrust. In particularly, combustion mode transitions significantly change the dominant characteristics of the flow field.
Analytical and experimental stability investigation of a hardware-in-the-loop satellite docking simulator
Authors: Zebenay M , Boge T , Krenn R , Choukroun D
Published: June 2014

The European Proximity Operations Simulator of the DLR-German Aerospace Center is a robotics-based simulator that aims at validating and verifying a satellite docking phase. The generic concept features a robotics tracking system working in closed loop with a force/torque feedback signal. Inherent delays in the tracking system combined with typical high stiffness at contact challenge the stability of the closed-loop system. The proposed concept of operations is hybrid: the feedback signal is a superposition of a measured value and of a virtual value that can be tuned in order to guarantee a desired behavior. This paper is concerned with an analytical study of the system’s closed-loop stability, and with an experimental validation of the hybrid concept of operations in one dimension. The robotics simulator is modeled as a second-order loop-delay system and closed-form expressions for the critical delay and associated frequency are derived as a function of the satellites’ mass and the contact dynamics stiffness and damping parameters. A numerical illustration sheds light on the impact of the parameters on the stability regions. A first-order Pade approximation provides additional means of stability investigation. Experiments were performed and test results are described for varying values of the mass and the damping coefficients. The empirical determination of instability is based on the coefficient of restitution and on the observed energy. There is a very good agreement between the critical damping values predicted by the analysis and observed during the tests. The contact duration shows also a very good fit between analysis and experiment. In addition, results from a one-dimensional contact experiment carried on an air-floating testbed are successfully emulated using the proposed hybrid docking simulator. This illustrates the flexibility of the hybrid simulator, where various contact dynamics can be emulated without changing any hardware elements.
Adaptive nonsingular terminal sliding mode guidance law against maneuvering targets with impact angle constraint
Authors: Wang Weihong , Xiong Shaofeng , Liu Xiaodong , Wang Sen , Ma Lujin
Published: June 2014

Under the existence of the unknown target acceleration, guidance law that guarantees imposing a predetermined impact angle relative to a maneuvering target’s flight direction is proposed in this paper. The prespecified impact angle is defined in terms of a time-varying desired line of sight angle for a maneuvering target. Then, the problem of impact angle guidance law design is transformed to a problem of state tracking. To deal with the unknown target acceleration, an extended state observer is utilized to estimate it instead of simply treating it as zero. In order to avoid the singularity in the terminal phase of guidance and eliminates the need of a priori knowledge of the uncertainty upper bound, an adaptive nonsingular terminal sliding mode control scheme is adopted to design the sliding surface. The switching gain is not necessary to be determined in advance but adjusted according to the adaptive rule. Numerical simulations are implemented to demonstrate the effectiveness of the proposed guidance law.
Multi-objective optimization of lean and sweep angles for stator and rotor blades of an axial turbine
Authors: Asgarshamsi Abolhassan , Benisi Ali Hajilouy , Assempour Ahmad , Pourfarzaneh Hossein
Published: June 2014

The axial turbine is one of the most challenging components of gas turbines for industrial and aerospace applications. With the ever-increasing requirement for high-aerodynamic performance blades, three-dimensional aerodynamic shape optimization is of great importance. In this research, the rear part of a gas turbine consisting of a one-stage axial turbine is optimized numerically. A useful optimization algorithm is presented to improve the efficiency and/or pressure ratio of the axial turbine with two different objective functions. The three-dimensional blade-shape optimization is employed to study the effects of the turbine stator and rotor lean and sweep angles on the turbine performance. The investigation is carried out at the turbine design speed. By coupling a verified computational fluid dynamics simulation code with the genetic algorithm, an automated design procedure is prepared. Geometry candidates for the optimization algorithm are generated by re-stacking of the two-dimensional airfoil sections. Three-dimensional, turbulent, and compressible flow field is numerically investigated via a Navier–Stokes solver to calculate various objective functions. Experimental results of the gas turbine are used for specifying the boundary conditions and validation of the simulation results. The proposed method results in 1.3% and 1.5% improvements in the turbine stage efficiency in design speed and reduced mass parameter at choke condition, respectively.
Experimental investigations on effects of tip clearance in mixed-flow compressor performance
Authors: Rajakumar D Ramesh , Ramamurthy S , Govardhan M
Published: June 2014

Experimental investigations were carried out to study the effect of tip clearance (between impeller and stationary shroud) in a mixed-flow compressor stage. Two configurations, namely constant and variable clearance gaps, between impeller and stationary shroud were considered. For the purpose of the present investigations, a mixed-flow compressor stage was designed, fabricated, and experimentally evaluated. The flow investigations were carried out in a closed-circuit compressor rig. Detailed steady and unsteady flow measurements were carried out for three clearance gaps, namely 0.5 mm, 0.75 mm, and 0.9 mm. Through the experimental investigations, it was found that the constant tip-clearance configurations showed better performance in terms of pressure ratio and efficiency as compared to variable clearance configurations. For a given configuration, the pressure ratio and efficiency of the stage decrease with increase in the tip gap without indicating any optimum value. Tip-clearance flow had considerable effect on the flow through the diffuser.
Characterisation of debris from laser and mechanical cutting of bone
Authors: Rachmanis Nikolaos , McGuinness Garrett B , McGeough Joseph A
Published: June 2014

Laser cutting of bones has been proposed as a technology in orthopaedic surgery. In this short study, the laser–bone interaction was examined using a pulsed erbium-doped yttrium aluminium garnet laser and compared to a conventional cutting technique. Microscopic analysis revealed the nature of waste debris and showed higher proportions of finer particles for conventional sagittal sawing compared to laser cutting.
Theoretical analysis and mathematical modelling of a high-pressure pump in the common rail injection system for diesel engines
Authors: Qian Dexing , Liao Ridong
Published: June 2014

In this paper, a study on the performance of a high-pressure pump of the common rail fuel injection system is presented. The mathematical models established include: (i) the fluid model for the pump chamber and rail which takes the structural deformation and interface leakage into consideration; (ii) the nonisothermal fluid–structure interaction model for the leakage at the piston/cylinder interface; and (iii) the unified model for the physical properties of the fuel such as dynamic viscosity, density and isobaric specific heat capacity versus pressure and temperature relationships. The factors leading to the loss of the pump volumetric efficiency during the four phases of the pump working cycle are theoretically analysed. Both differential and iterative methods are applied in the numerical solution of the model. The leakage model was validated against the measured leakage rates, and showed satisfactory results. A parametric study is carried out to analyze the effects the piston diameter has on the establishment process of the chamber pressure, the piston/cylinder interface leakage and the compression stroke. Results show that the impacts of the leakage, the compression stroke and the suction loss on the volumetric efficiency loss of the pump all increase with the nominal rail pressure.
Social background and life-course risks as determinants of social assistance receipt among young adults in Sweden, Norway and Finland
Authors: Kauppinen Timo M , Angelin Anna , Lorentzen Thomas , Bäckman Olof , Salonen Tapio , Moisio Pasi , Dahl Espen
Published: June 2014

We analyse the determinants of social assistance receipt among young adults in three Nordic countries, focusing on social-background and life-course events during early adulthood. We ask whether they are related differently to short-term and long-term receipt. Short-term poverty could be more individualized than long-term poverty which can be expected to be more strongly related to social background. We applied generalized ordinal logit modelling to longitudinal register-based data. Both social-background and life-course factors were found to be important, but our results did not confirm the hypothesis of social background predicting mostly long-term receipt and life-course factors predicting mostly short-term receipt. Leaving the parental home early and parental social assistance receipt were important determinants of social assistance receipt, and both factors predicted longer duration of receipt as well. We found some differences between the countries, which may be related to differences in youth unemployment and social welfare systems.
Trade union membership retention in Europe: The challenge of difficult times
Authors: Waddington Jeremy
Published: June 2014

Throughout most of Europe, trade union membership is in decline, despite a vast range of initiatives intended to reverse this decline. This article explores why members retain their union membership, through surveys conducted in 14 union organizations in 12 countries. It highlights the importance of workplace representation for the provision of support to members. The article also assesses how the reasons that underpin membership retention might be incorporated into union organizing and renewal strategies.
The Coconstruction of Couples’ Roles in Parenting Children With a Chronic Health Condition
Authors: McNeill Ted , Nicholas David , Beaton John , Montgomery Gert , MacCulloch Radha , Gearing Robin , Selkirk Enid
Published: June 2014

In this study we explored the ways that mothers and fathers of children who have a chronic health condition coconstructed their parenting roles. We wanted to move beyond the standard focus on individual parenting behaviors and use a grounded theory approach to better capture the dyadic and interpersonal gestalt of how parents worked out their roles. We explored multiple factors that influenced their decision making and the unique models that each couple developed. We held conjoint qualitative interviews with 20 couples from the Toronto area, as well as follow-up interviews with individual partners in five of these couples. Our findings introduce several concepts (such as role negotiation, complementarity and symmetry of roles, and “good enough” role performance) that form an explanatory model. A key finding is the diversity of ways in which couples adapted to the parenting challenges they faced. Implications in conceptual, clinical, and research areas are presented.
Dapagliflozin for the Treatment of Type 2 Diabetes Mellitus
Authors: Aylsworth Andrew , Dean Zachary , VanNorman Cody , Nkemdirim Okere Arinze
Published: June 2014

Objective: To review the pharmacology, pharmacokinetics, clinical trials, and adverse effects of dapagliflozin, a sodium glucose co-transporter 2 (SGLT-2) inhibitor. Data Sources: Data were gathered from articles indexed in PubMed, International Pharmaceutical from (2006 to April 2014) was performed using the following terms “dapagliflozin,” “SGLT-2 inhibitor,” and “Farxiga.” Abstracts and manufacturer’s package insert were also used as an additional reference. Study Selection and Data Extraction: All English language prospective randomized, double-blinded trials evaluating the efficacy of dapagliflozin for the treatment of type 2 diabetes were identified. Data Synthesis: We evaluated 9 clinical trials with dapagliflozin as monotherapy or add-on therapy. Results from these studies demonstrated that dapagliflozin to be noninferior to metformin in treatment naïve patients for reduction in A1C. Additionally, dapagliflozin was noninferior to glimepiride when added on to metformin. As an add-on therapy to insulin, insulin sensitizers or sitagliptin, dapagliflozin was found to be clinically effective compared to placebo. Finally, in all of the clinical trials increased risk of urinary infection was common in dapagliflozin group. Conclusion: As the second SGLT-2 inhibitor approved in the United States, dapagliflozin is safe and effective for treatment of type 2 diabetes mellitus. It appears to have no increased cardiovascular risk and provides a moderate benefit for patients with high blood pressure or those who are overweight. However, dapagliflozin was found to be associated with nasopharyngitis, mycotic infections, and genital or urinary tract infections. This medication may be best used as adjunctive therapy for patients not well-controlled on other antidiabetic agents. However, caution should be taken when used in patients at risk of urinary tract infections and dehydration.
Reconciling Multiple Hypertension Guidelines to Promote Effective Clinical Practice
Authors: Salvo Marissa , White C. Michael
Published: June 2014

The new Joint National Committee 8 (JNC-8) blood pressure guidelines were recently published, and there are some major changes from JNC-7. There are also differences between JNC-8 and hypertension guidelines created by major organizations in North America and around the world published from 2013 to the present. In the face of conflicting evidence, it is difficult for practicing clinicians to reconcile these differences and to incorporate new guidance into their practice. This commentary will identify similarities and differences between guidelines, provide some literature context in the areas of differing recommendations, and then provide advice to enhance patient care.
Talonavicular Arthroscopy for Osteochondral Lesions
Authors: Ross Keir A. , Seaworth Christine M. , Smyth Niall A. , Ling Jeffrey S. , Sayres Stephanie C. , Kennedy John G.
Published: June 2014

Background:

Traditional treatment of talonavicular osteochondral lesions (OCLs) requires an open procedure. Arthroscopic microfracture of talonavicular OCLs may provide a viable, minimally invasive approach. The purpose of this study was to describe an arthroscopic approach for treatment of talonavicular OCLs, describe the proximity of arthroscopic portals to important structures in cadaver specimens, and report magnetic resonance imaging (MRI) findings and clinical outcomes of this technique.

Methods:

Five cadaver specimens were dissected so proximity of portals to adjacent tendons and neurovascular structures could be assessed. Subsequently, 3 athletic patients with OCLs of the talonavicular joint were treated with arthroscopic debridement and microfracture. Patient records and imaging studies were retrospectively reviewed.

Results:

In the cadaver specimens, the mean distance between the neurovascular bundle and the medial border of the extensor hallucis longus (EHL) was 9.0 (range, 8 to 10) mm. The saphenous nerve was located a mean of 6.8 (range, 6 to 7) mm from the medial border of the tibialis anterior tendon. Therefore, portals were placed just medial to the EHL and tibialis anterior tendon to avoid the neurovascular bundle and saphenous nerve, respectively. In all patients, access, identification of the OCL, debridement, and microfracture were successfully performed. All patients demonstrated improvements in Foot and Ankle Outcome Scores and Short Form–12 scores and began gradual return to activity within 12 weeks following the operation. No significant complications occurred. MRI indicated signal consistent with reparative fibrocartilage in all patients.

Conclusion:

Talonavicular arthroscopy allowed visualization, curettage, synovectomy, loose body removal, and microfracture of OCLs that would have otherwise required an open approach. At early follow-up, all patients had returned to their previous activity levels. Arthroscopy of the talonavicular joint was a viable approach for microfracture of OCLs.

Level of Evidence:

Level IV, case series.
Comparison of Lag Screw Versus Buttress Plate Fixation of Posterior Malleolar Fractures
Authors: Erdem Mehmet Nuri , Erken H. Yener , Burc Halil , Saka Gursel , Korkmaz Mehmet Fatih , Aydogan Mehmet
Published: June 2014

Background:

The goal of this study was to report the results of selective open reduction and internal fixation of fractures of the posterior malleolus with a posterolateral approach and to compare the results of the 2 techniques.

Methods:

We prospectively evaluated 40 patients who underwent posterior malleolar fracture fixation between 2008 and 2012. The patients were treated with a posterolateral approach. We assigned alternating patients to receive plate fixation and the next screw fixation, consecutively, based on the order in which they presented to our institution. Fixation of the posterior malleolus was made with lag screws in 20 patients and a buttress plate in 20 patients. We used American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM) of the ankle, and radiographic evaluations as the main outcome measurements. The mean follow-up was 38.2 (range, 24-51) months.

Results:

Full union without any loss of reduction was obtained in 38 of the 40 patients. We detected a union with a step-off of 3 mm in 1 patient in the screw group and a step-off of 2 mm in 1 patient in the plate group. At the final follow-up, the mean AOFAS score of the patients regardless of fixation type was 94.1 (range, 85-100). The statistical results showed no significant difference between the patients regardless of the fixation type of the posterior malleolus in terms of AOFAS scores and ROM of the ankle ( P > .05).

Conclusions:

Good (AOFAS score of 94/100) and equivalent (within 3 points) results were obtained using the 2 techniques (screws or plate) for fixation after open reduction of posterior malleolar fragments.

Level of Evidence:

Level II, prospective case series.
Syndesmotic Fixation in Supination-External Rotation Ankle Fractures
Authors: Kortekangas Tero H. J. , Pakarinen Harri J. , Savola Olli , Niinimäki Jaakko , Lepojärvi Sannamari , Ohtonen Pasi , Flinkkilä Tapio , Ristiniemi Jukka
Published: June 2014

Background:

This study compared mid-term functional and radiologic results of syndesmotic transfixation with no fixation in supination external rotation (SER) ankle fractures with intraoperatively confirmed syndesmosis disruption. Our hypothesis was that early-stage good functional results would remain and unfixed syndesmosis disruption in SER IV ankle fractures would not lead to an increased incidence of osteoarthritis.

Methods:

A prospective study of 140 operatively treated patients with Lauge-Hansen SER IV (Weber B) ankle fractures was performed. After bony fixation, the 7.5-Nm standardized external rotation stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. The patients were randomized to either syndesmotic screw fixation (13 patients) or no syndesmotic fixation (11 patients). After a minimum of 4 years of follow-up (mean, 58 months), ankle function and pain (Olerud-Molander, a 100-mm visual analogue scale [VAS] for ankle function and pain) and quality of life (RAND-36) of all 24 patients were assessed. Ankle joint congruity and osteoarthritis were assessed using mortise and lateral projection plain weight-bearing radiographs and magnetic resonance imaging (MRI; 3T) scans.

Results:

Improvement in Olerud-Molander score, VAS, and RAND-36 showed no significant difference between groups during the follow-up. In the syndesmotic transfixation group, improvements in all functional parameters and pain measurements were not significant, whereas in the group without syndesmotic fixation, the Olerud-Molander score improved from 84 to 93 ( P = .007) and the pain (VAS) score improved from 11 to 4 ( P = .038) from 1 year to last follow-up. X-ray or MRI imaging showed no difference between groups at the last follow-up visit.

Conclusion:

With the numbers available, no significant difference in functional outcome or radiologic findings could be detected between syndesmosis transfixation and no-fixation patients with SER IV ankle fracture after a minimum of 4 years of follow-up.

Level of Evidence:

Level II, prospective comparative study.
The FFOCI and Other Measures and Models of OCPD
Authors: Crego Cristina , Samuel Douglas B. , Widiger Thomas A.
Published: June 2014

The Five Factor Obsessive Compulsive Inventory (FFOCI) was developed in part to facilitate a shift from the categorical classification of personality disorder to a dimensional trait model, more specifically, the five-factor model (FFM). Questions though have been raised as to whether obsessive–compulsive personality disorder (OCPD) can be understood as a maladaptive variant of FFM conscientiousness. The present study provides a further validation of the FFOCI, emphasizing in particular its association with FFM conscientiousness, as well as comparing alternative measures and models of OCPD. A total of 380 undergraduates (obtained in two samples of 274 and 106), including 146 oversampled for OCPD traits (93 for the first sample and 53 for the second), completed the FFOCI, measures of general personality, OCPD trait scales, and alternative measures of OCPD. Results supported the validity of the FFOCI as a measure of OCPD and maladaptive variants of FFM traits, as well as identifying substantive differences among the alternative measures of OCPD, particularly with respect to their relationship with FFM conscientiousness, antagonism, and introversion.
The Nax Channel
Authors: Noda Masaharu , Hiyama Takeshi Y.
Published: June 2014

Na x, which is preferentially expressed in the glial cells of sensory circumventricular organs in the brain, is a sodium channel that is poorly homologous to voltage-gated sodium channels. We previously reported that Na x is a sodium concentration ([Na+])-sensitive, but not a voltage-sensitive channel that is critically involved in body-fluid homeostasis. Nax-knockout mice do not stop ingesting salt even when dehydrated and transiently develop hypernatremia. [Na+] in body fluids is strictly controlled at 135 to 145 mM in mammals. Although the set point must be within this range, Na x was shown to have a threshold value of ~150 mM for extracellular [Na+] ([Na+]o) for activation in vitro. Therefore, the [Na+]o dependency of Na x in vivo is presumably modified by an as yet unidentified mechanism. We recently demonstrated that the [Na+]o dependency of Na x in the subfornical organ was adjusted to the physiological range by endothelin-3. Pharmacological experiments revealed that endothelin receptor B signaling was involved in this modulation of Na x gating through protein kinase C and ERK1/2 activation. In addition, we identified a case of essential hypernatremia caused by autoimmunity to Na x. Occurrence of a ganglioneuroma composed of Schwann-like cells that robustly expressed Na x was likely to induce the autoimmune response in this patient. An intravenous injection of the immunoglobulin fraction of the patient’s serum, which contained anti-Na x antibodies, into mice reproduced the patient’s symptoms. This review provides an overview of the physiological functions of Na x by summarizing our recent studies.
Involvement of Children With Autism Spectrum Disorder (ASD) in the Child Protection System
Authors: Hall-Lande Jennifer , Hewitt Amy , Mishra Shweta , Piescher Kristine , LaLiberte Traci
Published: June 2014

The present study provides information about children with autism spectrum disorder (ASD) who are involved in the child protection system in a large, Midwestern state. Findings revealed that children with ASD (and children with other disabilities) were more likely to receive services from the child protection system (CPS) than children without disabilities. Children with ASD in CPS were more likely to be elementary school-age (6–10 years) and Caucasian than other children involved in CPS. Children diagnosed with ASD and other disabilities were significantly overrepresented for physical abuse as the primary reason for involvement in CPS. Parental mental health issues were more evident than was expected for families of children with ASD (17%) as compared with children diagnosed with other disabilities (10%) and children not diagnosed with any disability (10%). The implications of these findings as they relate to interventions for children with ASD in CPS are discussed.
AAFP and ISFM Guidelines for Diagnosing and Solving House-Soiling Behavior in Cats
Authors: Carney Hazel C , Sadek Tammy P , Curtis Terry M , Halls Vicky , Heath Sarah , Hutchison Pippa , Mundschenk Kari , Westropp Jodi L
Published: June 2014

Rationale:

These Guidelines have been developed by the American Association of Feline Practitioners (AAFP) and the International Society of Feline Medicine (ISFM) as a resource for veterinary practitioners who want to better understand and manage the important clinical condition of house-soiling in their feline patients. The Guidelines offer straightforward, practical solutions that, in most cases, will help veterinarians and cat owners prevent, manage or entirely remediate feline house-soiling behavior.

Evidence base:

The Guidelines include scientifically documented information when it is available. However, because research is often lacking, some recommendations reflect the accumulated clinical experience of the authors.
Coping with a diagnosis of breast cancer among Omani women
Authors: Al-Azri Mohammed H , Al-Awisi Huda , Al-Rasbi Samira , Al-Moundhri Mansour
Published: June 2014

The aim of this study was to identify coping strategies experienced by Omani women after breast cancer diagnosis. Individual semistructured interviews were conducted with 19 women diagnosed with breast cancer. Several coping strategies were identified including denial, optimism, withdrawal, Islamic beliefs and practices, and the support of family members and health-care providers, but Islamic beliefs and practices were the commonest. Health-care professionals should be aware of and respect women’s coping strategies and encourage them to use to reduce the psychological symptoms. They should also make family members and friends aware of their role in supporting and encouraging coping strategies.
Specific traumatic events during childhood as risk factors for posttraumatic stress disorder development in adults
Authors: Schoedl Aline F , Costa Mariana P , Fossaluza Victor , Mari Jair J , Mello Marcelo F
Published: June 2014

To evaluate differences in early life events (ELE) on adult victims of severe interpersonal violence among patients who developed posttraumatic stress disorder (PTSD) and control group. Adult victims of interpersonal violence were evaluated to diagnose the presence of PTSD and ELE. 308 subjects were included, 141 in patient’s group (PTSD+) and 167 in control group (PSTD-). PTSD+ group had more severe PTSD, depressive symptoms and higher ETI scores than PTSD- group. Patients in PTSD+ group had a more frequent history of ELE. Some ELE were more significant for the development of this predisposition.
A pilot study of the effects of eplerenone add-on therapy in patients taking renin–angiotensin system blockers
Authors: Kawada Noritaka , Isaka Yoshitaka , Kitamura Harumi , Rakugi Hiromi , Moriyama Toshiki
Published: June 2014

Hypothesis:

This study determined the parameters for predicting the clinical effects of eplerenone (Ep) add-on therapy on blood pressure (BP) and proteinuria in patients taking angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II type I receptor blockers (ARBs).

Materials and methods:

Patients were treated with a gradual increase of Ep to a final dose of 50 mg/day for 2 months. In 35 patients, the efficacy of Ep was evaluated by peripheral BP, proteinuria, and the transtubular K gradient (TTKG). Fifteen patients had additional analysis for central BP, plasma renin activity (PRA) and plasma aldosterone concentration (PAC), measured in the supine position, and 24-hour urine collection before and after receiving Ep.

Results:

Ep add-on therapy reduced the mean arterial pressure ( p=0.0005) and central BP ( p=0.009) independently to the baseline PAC. Ep induced PRA, but failed to show effects on PAC, TTKG, or albuminuria. Correlation analysis showed inverse relationships between the percent reduction in albuminuria and baseline PAC.

Conclusions:

Ep add-on therapy in patients taking renin–angiotensin system blockers is expected to reduce BP, even in patients with low PAC. In contrast, the anti-proteinuric action of Ep is dependent on baseline plasma aldosterone levels. TTKG is not appropriate for evaluating the efficacy of Ep.