bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Neuropsychological Functioning Between Adults With Early- and Late-Onset DSM-5 ADHD
Authors: Lin Yu-Ju , Gau Susan Shur-Fen
Published: September 2017

Objective: We aimed to compare the visually dependent neuropsychological functioning among adults with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD who recalled symptom onset by and after age 7 and non-ADHD controls. Method: We divided the participants, aged 17 to 40 years, into three groups—(a) ADHD, onset <7 years (early-onset, n = 142); (b) ADHD, onset between 7 and <12 years (late-onset, n = 41); (c) non-ADHD controls ( n = 148)—and compared their neuropsychological functioning, measured by the Cambridge Neuropsychological Testing Automated Battery. Results: Both ADHD groups had deficits in attention and signal detectability, spatial working memory, and short-term spatial memory, but only the early-onset group showed deficits in alertness, set-shifting, and planning after controlling for age, sex, and psychiatric comorbidities. There was no statistical difference between the two ADHD groups in neuropsychological functioning. Conclusion: DSM-5 criteria for diagnosing adult ADHD are not too lax regarding neuropsychological functioning.
Supervision of Indigenous research students: considerations for cross-cultural supervisors
Authors: Wilson Denise
Published: September 2017

Essential to Indigenous research students’ development is their preparation to undertake Indigenous research with an appropriate Indigenous approach. Preparing Indigenous students to conduct research with Indigenous communities requires their adequate and proper preparation, although this does not always happen. Getting the research story right is key to better understanding the persistent, complex and multidimensional inequities in the access, use and quality of health services Indigenous peoples face. Successful preparation of Indigenous students is contingent on quality student–supervisor relationships. The literature indicates that Indigenous student supervision undertaken by non-Indigenous supervisors can be hindered. Two vignettes demonstrate problems with cross-cultural supervision of Indigenous research students’ experiences. An examination of cross-cultural supervision practices highlights the need to prepare Indigenous students in Indigenous research methodologies to optimise outcomes to reflect Indigenous peoples’ realities. Following an overview of approaches to undertake research with Indigenous people, strategies to support cross-cultural supervision are suggested.
‘Culture is a Meritocracy’: Why Creative Workers’ Attitudes may Reinforce Social Inequality
Authors: Taylor Mark , O’Brien Dave
Published: September 2017

The attitudes and values of cultural and creative workers are an important element of explaining current academic interest in inequality and culture. To date, quantitative approaches to this element of cultural and creative inequality have been overlooked, particularly in British research. This article investigates the attitudes of those working in creative jobs with a unique dataset: a web survey of creative workers’ attitudes (n = 2487). Using principal components analysis and regression, we have three main findings. First, in contrast to Richard Florida’s thesis on the attitudes and values of ‘the creative class’, our respondents’ attitudes were no more meritocratic than those of the general population. Second, those with the strongest belief in meritocracy in the sector are those in the most privileged positions, specifically those are best rewarded by the sector. Third, our research provides support for existing qualitative research on attitudes in the cultural sector, in which the worst rewarded workers are most aware of structural inequality. We conclude that the attitudes held by creative workers, and who holds which attitudes, make it unlikely that access to the sector and trajectories of individual progression within the sector will change. These findings also have important implications for current public interest in whether access to creative work is limited to those from privileged backgrounds.
Beyond the Western gaze: Families of choice in Poland
Authors: Mizielińska Joanna , Stasińska Agata
Published: September 2017

Research into queer intimacies and families has been largely conducted from and about the Western (specifically Anglo-American) context. It very often (re)presents a hegemonic, mono-normative paradigm and vision of intimacy and family life, and profoundly influences the scope and methods of such research in other localities. This article uses findings from a large-scale mixed methods study called Families of Choice in Poland which was designed to examine the diversity of intimate and familial practices of non-heterosexual lives. It highlights how geo-temporal conditions shape LGBTQ relational lives and, as such, unsettles the dominant Western knowledge on queer kinship.
Becoming fertile in the land of organic milk: Lesbian and queer reproductions of femininity and motherhood in Sweden
Authors: Dahl Ulrika
Published: September 2017

This article draws on popular culture, ethnographic materials and mainstream commercials to discuss contemporary understandings of the relationship between fertility, pregnancy and parenthood among lesbians and other queer persons with uteruses. It argues that, on the one hand, same-sex lesbian motherhood is increasingly celebrated as evidence of Swedish gender and sexual exceptionalism and, on the other, queers who wish to challenge heteronormative gender disavow both the relationship between fertility and femininity, and that of pregnancy and parenthood. The author argues that in studying queer family formation, we must move beyond addressing heteronormativity and begin studying how gender, sexuality, race and class get reproduced in queer kinship stories.
Unsettling lesbian motherhood: Critical reflections over a generation (1990–2015)
Authors: Gabb Jacqui
Published: September 2017

This article explores how advancements in equality rights combine with attitudinal changes in UK society and LGBTQ communities to impact on the experience of lesbian mothers over a generation. The author reflects on ordinary moments where sexuality and relationships become meaningful and situate emotions at the heart of analytical enquiry because it is through emotional interactions that micro–macro networks of relations intersect. Autobiography is combined with original data from empirical research to provide analytical entry points, which aims to advance understanding and also facilitate reflection on how we understand and come to know queer parenthood. Whilst there are now many routes into lesbian motherhood and the stigma of queer kinship is diminishing, this article demonstrates the need to problematize the prevailing narratives of coupledom that are emerging and tease apart the conflation of temporal progression, progressive rights and narratives of progress.
‘Unqueer’ kinship? Critical reflections on ‘marriage fraud’ in mainland China
Authors: Zhu Jingshu
Published: September 2017

This article explores the controversial kinship practice in mainland China of ‘gay’ men marrying unwitting women. It questions the ‘marriage fraud’ discourse that condemns the men involved while pitying their wives, or tongqis. Taking an ethnographic approach, this article considers the major flaws of this popular discourse: the idealized-package of marriage–love–sex, the oft-neglected difficulties of living outside marriage, and most importantly, the essentialization of homosexuality. It also examines the im/possibility for married ‘gay’ men to be honest in their marriages. Finally, it cautions that honesty, if used as a decontextualized ethical yardstick for queer kinship, may obscure the racist and homophobic prejudices that exist both outside and inside queer communities. Accordingly, this article proposes that we shift to ‘opacity’ as an epistemological, methodological and ethical parameter that radically queers kinship (studies).
Space invaders: Queer and trans bodies in fertility clinics
Authors: Epstein Rachel
Published: September 2017

This article draws on three narratives from a Canadian research project on LGBTQ people and fertility clinics to illustrate how LGBTQ bodies, identities and family configurations are frequently misrecognized and unintelligible in the fertility clinic context. The flow of the patient through the clinic is disrupted by the inability of clinic staff to disentangle the assumptive links made between body parts, gametes, gender, sex, sexual orientation, sexual practice and family configuration. The author explores how the ‘gender and kinship labour’ and processes of objectification that typically operate in the fertility clinic to bolster conventional masculinities and femininities break down in relation to queer and trans bodies, and offers the beginnings of a framework to assist practitioners, and others, to conceptualize and work more effectively with LGBTQ people.
(Un)equal Treatment? Elderly care and disability services for people with dementia in Finland
Authors: Hoppania Hanna-Kaisa , Mäki-Petäjä-Leinonen Anna , Nikumaa Henna
Published: September 2017

The rights of older people to care have become a major political and legal issue with the ageing populations of many European and OECD countries. Finland is an interesting case in this respect because in 2013, extensive new legislation was passed there concerning the rights of the older population to access care services. This article describes the context in which the ‘Act on Supporting the Functional Capacity of the Older Population and on Social and Health Services for Older Persons’ (980/2012 Elderly Care Act) was drafted, and what the Act aims to accomplish. It argues that while the Act is ambitious and symbolically significant, it remains unsatisfactory in practice. This is the case especially for people with dementia, who end up being disadvantaged. We compare the Elderly Care Act with other relevant legislation, in particular legislation pertaining to disability services, and estimate the significance of the law from the perspective of older people with dementia. We also discuss the situation in Finland in relation to the global situation of people with dementia as the UN Convention on the Rights of Persons with Disabilities was recently ratified in Finland. We show that disability legislation, rather than elderly care legislation, should be the framework through which the right to services should be secured for people with dementia.
Social structures, power and resistance in monist sociology: (New) materialist insights
Authors: Fox Nick J , Alldred Pam
Published: September 2017

Though mainstream sociological theory has been founded within dualisms such as structure/agency, nature/culture, and mind/matter, a thread within sociology dating back to Spencer and Tarde favoured a monist ontology that cut across such dualistic categories. This thread has been reinvigorated by recent developments in social theory, including the new materialisms, posthumanism and affect theories. Here we assess what a monist or ‘flat’ ontology means for sociological understanding of key concepts such as structures and systems, power and resistance. We examine two monistic sociologies: Bruno Latour’s ‘sociology of associations’ and DeLanda’s ontology of assemblages. Understandings of social processes in terms of structures, systems or mechanisms are replaced with a focus upon the micropolitics of events and interactions. Power is a flux of forces or ‘affects’ fully immanent within events, while resistance is similarly an affective flow in events producing micropolitical effects contrary to power or control.
Exploring the relationship between letter recognition and handwriting in early literacy development
Authors: Reutzel Pamela , Mohr Kathleen AJ , Jones Cindy D
Published: September 2017

Previous research has demonstrated correlation between letter-naming and letter-writing fluency, and a relationship between letter-naming fluency and successful reading development. Awareness of critical features of letters has received less attention as a part of handwriting development, but it is theorized to also play a role in letter-writing fluency. This study sought to delineate possible components of letter-writing fluency using four related tasks with kindergarten students. Results confirm the correlation between letter-naming and letter-writing fluency and indicate that recognition and manipulation of critical letter features correlate with letter-writing fluency. Findings suggest that awareness of critical features could be a part of early literacy instruction.
The legal macroscope: Experimenting with visual legal analytics
Authors: Lettieri Nicola , Altamura Antonio , Malandrino Delfina
Published: September 2017

This work presents Knowlex, a web application designed for visualization, exploration, and analysis of legal documents coming from different sources. Understanding the legal framework relating to a given issue often requires the analysis of complex legal corpora. When a legal professional or a citizen tries to understand how a given phenomenon is disciplined, his attention cannot be limited to a single source of law but has to be directed on the bigger picture resulting from all the legal sources related to the theme under investigation. Knowlex exploits data visualization to support this activity by means of interactive maps making sense out of heterogeneous documents (norms, case law, legal literature, etc.). Starting from a legislative measure (what we define as Root) given as input by the user, the application implements two visual analytics functionalities aiming to offer new insights on the legal corpus under investigation. The first one is an interactive node graph depicting relations and properties of the documents. The second one is a zoomable treemap showing the topics, the evolution, and the dimension of the legal literature settled over the years around the norm of interest. The article gives an overview of the research so far conducted presenting the results of a preliminary evaluation study aiming at evaluating the effectiveness of visualization in supporting legal activities as well as the effectiveness of Knowlex, the usability of the proposed system, and the overall user satisfaction when interacting with its applications.
Design and evaluation of line symbolizations for origin–destination flow maps
Authors: Koylu Caglar , Guo Diansheng
Published: September 2017

We present the results of a user study comparing variants of commonly used line symbolizations for directed origin–destination flow maps. Our design and evaluation consisted of five line symbolizations that employ a combination of following visual variables: arrowheads, origin–destination coloring (color hue, and value), line shortening, line width, tapered edges (varying width from wide to narrow, and narrow to wide), and curvature asymmetry and strength. To guide our evaluation, we used a task-by-type typology and chose four representative tasks that are commonly used in flow map reading: identifying dominant direction of flows, flows with the highest magnitude (volume), spatial focusing of long flows toward a destination, and clusters of high net-exports (net-outflow). We systematically analyzed user responses and task performance which we measured by task completion time and accuracy. We designed a web-based flow mapping and testing framework and recruited the participants from Amazon Mechanical Turk. To demonstrate the application and user experiment, we used 16 commodity flow data sets in the United States from 2007 and systematically rotated the layouts to evaluate the effect of layout orientation. From this study, we can conclude that there is potential usefulness for all of the five symbolizations we tested; however, the influence of the design on performance and perception depends on the type of the task. Also, we found that data and layout orientation have significant effects on performance and perception of patterns in flow maps which we attribute to the change in visual saliency of node and flow patterns in relation to the way users scan the map. We recommend that the choice of line symbolization should be guided by a task taxonomy which end users are expected to perform. We discuss various design trade-offs and recommendations and potential future work for designing and evaluating line symbolizations for flow mapping.
Evaluation of an Intimate Partner Violence Training for Home Visitors Using the Theory of Planned Behavior
Authors: Abildso Christiaan G. , Dyer Angela , Kristjansson Alfgeir L. , Mann Michael J. , Bias Thomas , Coffman Jessica , Vasile Emily , Davidov Danielle
Published: September 2017

Introduction. Intimate partner violence (IPV) is a public health issue with recent intervention focus by home visiting programs with at-risk families in the United States. Home visitors are typically required to assess IPV but feel unprepared to do so and desire training. Our aim was to evaluate the impact of a daylong IPV training on the intention to enact three key IPV behaviors (screening, making referrals, and safety planning) using the theory of planned behavior. Method. Survey of 125 home visitors in West Virginia was conducted before and after a daylong IPV training. Results. The IPV training had a positive impact on intention to perform the three behaviors of interest, with the greatest impact on the intention to conduct IPV screenings. Discussion. Results provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing intentions to conduct activities related to IPV. The impact on IPV screening intention is promising because screening is the first step in addressing IPV. Conclusion. The IPV training proved beneficial in increasing intentions and such trainings should be expanded, but further study is needed to link intentions to subsequent behaviors to address IPV with at-risk families.
Fatty acid is a potential agent for bone tissue induction: In vitro and in vivo approach
Authors: Cardoso Guinea BC , Chacon Erivelto , Chacon Priscila GL , Bordeaux-Rego Pedro , Duarte Adriana SS , Saad Sara T Olalla , Zavaglia Cecilia AC , Cunha Marcelo R
Published: September 2017

Our hypothesis was to investigate the fatty acid potential as a bone induction factor. In vitro and in vivo studies were performed to evaluate this approach. Oleic acid was used in a 0.5 wt.% concentration. Polycaprolactone was used as the polymeric matrix by combining solvent-casting and particulate-leaching techniques, with a final porosity of 70 wt.%, investigated by SEM images. Contact angle measurements were produced to investigate the influence of oleic acid on polycaprolactone chains. Cell culture was performed using adipocyte-derived stem cells to evaluate biocompatibility and bioactivity properties. In addition, in vivo studies were performed to evaluate the induction potential of oleic acid addition. Adipocyte-derived stem cells were used to provide differentiation after 21 days of culture. Likewise, information were obtained with in vivo data and cellular invagination was observed on both scaffolds (polycaprolactone and polycaprolactone /oleic acid); interestingly, the scaffold with oleic acid addition demonstrated that cellular migrations are not related to the surrounding tissue, indicating bioactive potential. Our hypothesis is that fatty acid may be used as a potential induction factor for bone tissue engineering. The study’s findings indicate oleic acid as a possible agent for bone induction, according to data on cell differentiation, proliferation, and migration.

Impact statement

The biomaterial combined in this study on bone regeneration is innovative and shows promising results in the treatment of bone lesions. Polycaprolactone (PCL) and oleic acid have been studied separately. In this research, we combined biomaterials to assess the stimulus and the speed of bone healing.
Seclusion of Students with Disabilities: An Analysis of Due Process Hearings
Authors: Connolly Jennifer F.
Published: September 2017

In the last several years, there has been growing concern about the use of seclusion in schools. Little is known about its use, particularly with students with disabilities. This article presents the findings from an analysis of 26 due process hearings taking place nationwide over a 12-year period containing a description of the use of seclusion. For the purpose of this study, seclusion is defined as “the involuntary confinement of a student alone in a room . . . from which the student is physically prevented from leaving” (Council for Children With Behavioral Disorders, p. 1). Findings from this analysis include the following: (a) students of all ages and both genders with significant cognitive and behavioral disorders were subject to seclusion, (b) the rationale for the use of seclusion did not always involve a safety concern, and (c) students experienced an escalation in behavior upon being placed in seclusion, along with high frequencies and long duration of the seclusion event. Most of the students in the study had physical and mental health conditions that may affect the safety and efficacy of seclusion, and long-term effects of unknown etiology occurred for students in the sample, including transition into more restrictive school settings.
An e-Chart Review of Chaplains’ Interventions and Outcomes: A Quality Improvement and Documentation Practice Enhancement Project
Authors: Stang Vivian B.
Published: September 2017

In Canada, the spiritual care landscape in health care settings is becoming more regulated and standardized documentation is part of this rigorous environment. Staff chaplains at The Ottawa Hospital participated in a Quality Improvement project that aimed to advance patient-centered care through better charting practices. A sample of 104 spiritual-care assessments that had been posted on the patient electronic health record was examined. This chart review focused on chaplains’ activities that were reported as interventions as well as chaplain-reported outcomes for the patient. These interventions and outcomes were coded into discreet categories in order to get a better sense of the activities and the impact of their work. The chaplains’ electronic charting content and practices were evaluated. Chaplains found that the Quality Improvement process was beneficial as they updated their electronic templates in order to meet the new reporting requirements of the College of Registered Psychotherapists of Ontario.
Hospital Characteristics Affecting HealthCare Chaplaincy and the Provision of Chaplaincy Care in the United States: 2004 vs. 2016
Authors: Handzo George , Flannelly Kevin J. , Hughes Brian P.
Published: September 2017

This study replicates, expands and analyzes a 2004 survey examining six hospital characteristics influencing three measures of chaplain employment in large, small, for-profit and nonprofit hospitals. The relationship between hospital characteristics and hiring Board Certified Chaplains was minor and inconsistent across time. The results indicate that religiously affiliated hospitals employed more full-time chaplains and that chaplain full-time equivalents were inversely related to hospital size in both surveys. The current survey suggests that urban and religiously affiliated hospitals were more likely to hire chaplains. The sampling method proved problematic, precluding meaningful conclusions but the study focus and questions remain important for future investigation based on this pilot effort.
Recent Progress in Chaplaincy-Related Research
Authors: Fitchett George
Published: September 2017

In light of the continued growth of chaplaincy-related research this paper presents an overview of important findings. The review summarizes research in six broad areas: what chaplains do; the importance of religion and spiritual care to patients and families; the impact of chaplains’ spiritual care on the patient experience; the impact of chaplain care on other patient outcomes; spiritual needs and chaplain care in palliative and end of life care; and chaplain care for staff colleagues. It concludes with a description of several innovative and important new studies of chaplain care and notes areas for future investigation.
Corrective Osteotomies of Phalangeal and Metacarpal Malunions Using Patient-Specific Guides: CT-Based Evaluation of the Reduction Accuracy
Authors: Hirsiger Stefanie , Schweizer Andreas , Miyake Junichi , Nagy Ladislav , Fürnstahl Philipp
Published: September 2017

Background: Surgical planning of corrective osteotomies is traditionally based on conventional radiographs and clinical findings. In the past 10 years, 3-dimensional (3D) preoperative planning approaches with patient-specific guides have been developed. However, the application of this technology to posttraumatic deformities of the metacarpals and phalangeal bones has not yet been investigated. Our goal was to evaluate the feasibility of the surgical application to the latter and to evaluate the extent and precision of correction. Methods: We present results of 6 patients (8 osteotomies) treated with phalangeal or metacarpal corrective osteotomy. Deformities were located in the third ray in 1, fourth ray in 3, and fifth ray in 4 cases. Six malunited metacarpal bones (1 intra-articular) and 2 deformed proximal phalanges were treated. Computer-based 3D preoperative planning using the contralateral hand as a template allowed the production of 3D-printed patient-specific guides that were used intraoperatively for navigation. The precision of the reduction was assessed using pre- and postoperative computed tomography by comparing the postoperative bone model with the preoperatively simulated osteotomy. Range of motion and grip strength were documented pre- and postoperatively. Results: The mean follow-up time was 6 months (range: 5-11 months). Rotational deformity was reduced from a mean of 10.0° (range: 7.2°-19.3°) preoperatively to 2.3° (range: 0.7°-3.7°) postoperatively, and translational incongruency decreased from a mean of 1.4 mm (range: 0.7-2.8 mm) to 0.4 mm (range: 0.1-0.9 mm). Conclusion: Preliminary results indicate that a precise reduction for corrective osteotomies of metacarpal and phalangeal bones can be achieved by using 3D planning and patient-specific guides.
Urticarial reaction following endovascular embolization of an orbital arteriovenous malformation (AVM) with n-butyl cyanoacrylate (nBCA) glue
Authors: Sinha Kunal R , Duckwiler Gary , Rootman Daniel B
Published: September 2017

Orbital arteriovenous malformations (AVMs) are rare vascular lesions that may be managed with endovascular embolization followed by surgical resection. Embolization is often accomplished with n-butyl-2-cyanoacrylate (nBCA), which is considered to be a safe and effective liquid occlusive agent. Localized vascular inflammation has been associated with endovascular nBCA use in histopathologic studies, but reports of systemic hypersensitivity reactions following endovascular embolization with nBCA are rare. We present a case of a 26-year-old male who developed an intermittent systemic urticarial reaction without cardiopulmonary compromise beginning four weeks after nBCA embolization of an orbital AVM. Subsequent skin allergy testing performed by an allergist confirmed hypersensitivity to nBCA glue and the patient has since been successfully managed with daily oral antihistamines. Awareness of this rare potential complication of endovascular embolization with nBCA will aid in the counseling and management of patients with AVMs.
A review of the physical and physiological demands associated with cricket fast and spin bowlers
Authors: Vickery Will , Dascombe Ben J , Scanlan Aaron T
Published: September 2017

Understanding the demands associated with cricket match-play is essential for the development and implementation of training programs to improve the conditioning status of players. With the recent expansion of playing formats in cricket, particularity Twenty20 cricket, coaching staff must ensure that training programs are specific to each playing position and also give consideration to each match format. The current literature collectively highlights that the physical and physiological demands associated with cricket vary considerably across playing positions and match formats. Further, there is a growing body of research detailing the physical and physiological responses of cricket bowlers during training and match-play. Thus, this review provides an overview of the current literature examining the physical and physiological demands of fast and spin bowlers during competitive match-play, training and simulation protocols. Unsurprisingly, the current research suggests that the physical and physiological demands associated with fast bowling differ considerably to spin bowlers. However, the current research also indicates that the use of game-based activities rather than the traditional, net-based training may more closely replicate the demands of match-play. Based on this information, coaches may be able to develop tailored conditioning programs for cricket players specific to match formats. Greater research into the physical and physiological demands elicited during cricket training and match-play may further improve knowledge on the efficacy and validity of current training techniques used in cricket.
Timing of Meal Insulin and Its Relation to Adherence to Therapy in Type 1 Diabetes
Authors: Datye Karishma A. , Boyle Claire T. , Simmons Jill , Moore Daniel J. , Jaser Sarah S. , Sheanon Nicole , Kittelsrud Julie M. , Woerner Stephanie E. , Miller Kellee M.
Published: September 2017

The purpose of this study is to examine timing of meal insulin and further determine whether an association exists between timing of meal insulin and missed meal insulin doses. The cohort included 4768 T1D Exchange clinic registry participants <26 years with type 1 diabetes ≥1 year. Chi-square tests, t-tests, and regression were used to assess the relationship between participant characteristics and timing of meal insulin and missed meal doses, respectively. Timing of meal insulin and association with missed meal doses was analyzed using logistic regression. In all, 21% reported administering insulin several minutes before, 44% immediately before, 10% during, and 24% after meal. Participants who gave insulin prior to a meal had significantly lower HbA1c than those who gave insulin during or after meal (8.4% ± 1.5% vs 8.8% ± 1.6%, adjusted P < .001), but no significant association was observed regarding DKA events. Those who reported missing ≥1 insulin dose per week had higher HbA1c (9.8% ± 1.9% vs 8.3% ± 1.3%, adjusted P < .001) and were more likely to experience at least one DKA event (9% vs 5%, adjusted P = .001) compared with those who rarely missed a meal insulin dose. Participants who reported administering insulin during or after a meal were more likely to report missing ≥1 meal insulin dose per week compared with those who administered insulin before a meal (28% vs 14%, adjusted P < .001). Premeal insulin was associated with lower HbA1c and fewer missed meal insulin doses. Providers may use this information to discuss the benefits of premeal insulin on glycemic control and adherence to therapy.
Undiagnosed Partial Ornithine Transcarbamylase Deficiency Presenting Postoperatively as Agitated Delirium
Authors: Goldstein E. D. , Cannistraro R. , Atwal P. S. , Meschia J. F.
Published: September 2017

Partial ornithine transcarbamylase deficiency (pOTCD), an enzymatic defect within the urea cycle, is an increasingly recognized etiology for hyperammonemia of unclear source following a stressor within female adults. Here we present a case of newly diagnosed pOTCD following a systemic stressor and prolonged hospitalization course. From a neurological perspective, prompt recognition provided the patient with a swift and near complete recovery. We briefly review the pertinent literature pertaining to this genetically based condition including historical context and current therapeutic approaches. Given the potential morbidity of prolonged hyperammonemia, neurohospitalists need to be aware of partial ornithine transcarbamylase as an entity.
Recurrent Graves’ hyperthyroidism after prolonged radioiodine-induced hypothyroidism
Authors: Salman Fariha , Oktaei Hooman , Solomon Solomon , Nyenwe Ebenezer
Published: September 2017

Background:

Radioactive iodine (RAI) is the most cost effective therapy for Graves’ disease (GD). Patients with GD who have become hypothyroid after therapeutic RAI, rarely develop recurrence of disease. Herein we describe a case of recurrence of thyrotoxicosis after 2 years of hypothyroidism.

Methods:

We present the clinical features, laboratory findings, imaging and management of an unusual case of recurrent hyperthyroidism.

Results:

A 48-year-old male presented to the emergency room with a 2-day history of palpitation, chest discomfort and 30 pounds of weight loss. Examination was remarkable for rapid and irregular pulse, diffuse thyromegaly and brisk deep tendon reflexes but no eye changes or tremors. Laboratory tests showed thyroid-stimulating hormone (TSH) of <0.004 (0.3–5.6 mIU/ml), free thyroxine (FT4) 4.96 (0.9–1.8 ng/dl), free triiodothyronine (FT3) >20 (1.8–4.7 pg/ml), total thyroxine >800 (80–200 ng/dl). Electrocardiogram showed atrial fibrillation with rapid ventricular response. RAI uptake and scan showed a homogenous gland with 54% uptake in 6 h and 45% in 24 h. He was treated with propranolol and propylthiouracil with some clinical improvement. He subsequently underwent RAI therapy and developed hypothyroidism after 8 weeks. Hypothyroidism was treated with levothyroxine. At 2 years after RAI ablation, he again developed symptoms of hyperthyroidism and had suppressed TSH. The levothyroxine dose was stopped, 3 weeks after discontinuing levothyroxine, he remained hyperthyroid with TSH of 0.008 and FT4 of 1.62 and FT3 of 4.8. RAI uptake demonstrated 17% uptake at 24 h.

Conclusion:

Recurrent hyperthyroidism in GD is uncommon after development of post-ablative hypothyroidism. Our case illustrates the need for continued surveillance.
Undiagnosed and diagnosed diabetes mellitus among hospitalised acute heart failure patients in Botswana
Authors: Mwita Julius Chacha , Magafu Mgaywa Gilbert Mjungu Damas , Omech Bernard , Tsima Billy , Dewhurst Matthew J , Goepamang Monkgogi , Mashalla Yohana
Published: September 2017

Objective:

The objective of this study was to determine the burden of diagnosed and undiagnosed type 2 diabetes mellitus among patients hospitalised with acute heart failure in Botswana.

Methods:

The study enrolled 193 consecutive patients admitted with acute heart failure to the medical wards at Princess Marina Hospital in Gaborone. Patients were classified as previously known diabetics, undiagnosed diabetics (glycated haemoglobin ≥ 6.5%) or as non-diabetics (glycated haemoglobin < 6.5%). Data on other comorbid conditions such as hypertension, atrial fibrillation, ischaemic heart disease, stroke, and renal failure were also collected.

Results:

The mean (SD) age of the participants was 54.2 (17.1) years and 53.9% were men. The percentage of known and undiagnosed diabetes mellitus was 15.5% and 12.4%, respectively. Diabetic patients were significantly more likely to have hypertension (77.8% vs 46.0%, p < 0.001), ischaemic heart disease (20.4% vs 5.0%, p < 0.001), chronic kidney disease (51.3% vs 23.0%, p  < 0.001), and stroke (20.4% vs 5.8%, p  < 0.01). In addition, diabetics were older than non-diabetics (61.0 years vs 51.6 years, p  < 0.001).

Conclusion:

About 27.9% of patients admitted with acute heart failure in Botswana had diabetes, and almost half of them presented with undiagnosed diabetes. These findings indicate that all hospitalised patients should be screened for diabetes.
Towards a Broader Value Discourse: Understanding Sustainable and Public Value Potential
Authors: Keränen Joona
Published: September 2017

The current value discourse tends to be characterized by economic benefits and costs. This may resonate with business actors, but customers and society are increasingly interested in environmental, social and public value as well. This article discusses why and how practitioners and scholars should take sustainable and public value potential into account, and move towards a broader value discourse that would resonate with both business and society.
Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians
Authors: Stanojevic Sanja , Graham Brian L. , Cooper Brendan G. , Thompson Bruce R. , Carter Kim W. , Francis Richard W. , Hall Graham L.
Published: September 2017

There are numerous reference equations available for the single-breath transfer factor of the lung for carbon monoxide (T LCO); however, it is not always clear which reference set should be used in clinical practice. The aim of the study was to develop the Global Lung Function Initiative (GLI) all-age reference values forT LCO.

Data from 19 centres in 14 countries were collected to defineT LCOreference values. Similar to the GLI spirometry project, reference values were derived using the LMS (lambda, mu, sigma) method and the GAMLSS (generalised additive models for location, scale and shape) programme in R.

12 660T LCOmeasurements from asymptomatic, lifetime nonsmokers were submitted; 85% of the submitted data were from Caucasians. All data were uncorrected for haemoglobin concentration. Following adjustments for elevation above sea level, gas concentration and assumptions used for calculating the anatomic dead space volume, there was a high degree of overlap between the datasets. Reference values for Caucasians aged 5–85 years were derived forT LCO, transfer coefficient of the lung for carbon monoxide and alveolar volume.

This is the largest collection of normativeT LCOdata, and the first global reference values available forT LCO.
Science of Biosimilars
Authors: Harvey R. Donald
Published: September 2017

Biosimilar therapeutic proteins in oncology offer the potential to decrease costs while providing safety and efficacy profiles consistent with their respective reference or originator products. Biosimilars have a number of important differences from generic small-molecule drugs, including manufacturing processes that are unique from their reference products. These differences may affect biosimilars through posttranslational modifications that can occur in specific cellular production lines, and these modifications have potential effects on protein structure, function, clinical pharmacology, and immunogenicity. Regulatory agencies expect these differences to be identified, analyzed, and minimized through iterative processes and extensive preclinical efforts. Generic naming of biosimilars reflects the nonproprietary reference product name along with a meaningless four-letter suffix to ensure that each product can be uniquely identified for prescribing and pharmacovigilance purposes. Labeling information for biosimilars reflects a greater detail of comparisons to reference products than conventional generic drugs, which ensures that prescribers can understand the source of information and have a complete understanding of the therapeutic profile of each biosimilar agent. Postmarketing surveillance programs will be required to evolve and ensure optimal pharmacovigilance reporting, because the potential for unexpected adverse events with biosimilars is higher than with conventional generic agents as a result of different manufacturing processes and different clinical trial designs and durations. The existing filgrastim biosimilars are likely to be joined soon by therapeutic monoclonal antibodies, including rituximab, trastuzumab, and bevacizumab, on the basis of patent expiration dates and clinical trial results.
An X-ray shielded irradiation assay reveals EMT transcription factors control pluripotent adult stem cell migration in vivo in planarians
Authors: Abnave Prasad , Aboukhatwa Ellen , Kosaka Nobuyoshi , Thompson James , Hill Mark A. , Aboobaker A. Aziz
Published: September 2017

Migration of stem cells underpins the physiology of metazoan animals. For tissues to be maintained, stem cells and their progeny must migrate and differentiate in the correct positions. This need is even more acute after tissue damage by wounding or pathogenic infections. Inappropriate migration also underpins the formation of metastasis. Despite this, few mechanistic studies address stem cell migration during repair or homeostasis in adult tissues. Here, we present a shielded X-ray irradiation assay that allows us to follow stem cell migration in planarians. We demonstrate that we can use this system to study the molecular control of stem cell migration and show that snail-1, snail-2 and zeb-1 EMT transcription factor homologs are necessary for cell migration to wound sites and for the establishment of migratory cell morphology. We also observed that stem cells undergo homeostatic migration to anterior regions without local stem cells, in the absence of injury, maintaining tissue homeostasis. This requires the polarity determinant notum. Our work establishes planarians as a suitable model for further in depth study of the processes controlling stem cell migration in vivo.
Small-molecule Wnt agonists correct cleft palates in Pax9 mutant mice in utero
Authors: Jia Shihai , Zhou Jing , Fanelli Christopher , Wee Yinshen , Bonds John , Schneider Pascal , Mues Gabriele , D'Souza Rena N.
Published: September 2017

Clefts of the palate and/or lip are among the most common human craniofacial malformations and involve multiple genetic and environmental factors. Defects can only be corrected surgically and require complex life-long treatments. Our studies utilized the well-characterized Pax9−/− mouse model with a consistent cleft palate phenotype to test small-molecule Wnt agonist therapies. We show that the absence of Pax9 alters the expression of Wnt pathway genes including Dkk1 and Dkk2, proven antagonists of Wnt signaling. The functional interactions between Pax9 and Dkk1 are shown by the genetic rescue of secondary palate clefts in Pax9−/−Dkk1f/+;Wnt1Cre embryos. The controlled intravenous delivery of small-molecule Wnt agonists (Dkk inhibitors) into pregnant Pax9+/− mice restored Wnt signaling and led to the growth and fusion of palatal shelves, as marked by an increase in cell proliferation and osteogenesis in utero, while other organ defects were not corrected. This work underscores the importance of Pax9-dependent Wnt signaling in palatogenesis and suggests that this functional upstream molecular relationship can be exploited for the development of therapies for human cleft palates that arise from single-gene disorders.
Healthcare marketing: Does marketing strategy address essential markets?
Authors: McIntosh Bryan , Bouteri Stavroula
Published: September 2017

Participants in the study were major pharmaceutical companies, it was striking to note that the prevalence of a short sales rather than strategic marketing orientation at senior management and Board level. Symptomatic of this result was the general finding that a businesses's intended overall strategy was rarely translated into expected results. A critical reason emerged – a disconnection between key stakeholders in the communication of strategy. While many businesses had internal communication functions, there was a lack of clarity about organisational fit and role. The findings suggested that businesses should embrace a broader marketing strategy and more specifically apply ‘marketing like activities’ or tried and tested marketing tools to their internal stakeholder market so as to mirror communication to external markets. The recommendations suggest a working model as a basis for a ‘trialogue’ between internal stakeholders, strategic leadership and external markets in the context of a business's strategy.
What can be done to raise midwives' awareness of female genital mutilation?
Authors: Oginni Jadesola
Published: September 2017

Female genital mutilation (FGM) is a safeguarding issue on which many midwives and health professionals in the UK have limited knowledge. This review synthesises the available literature and examines the resulting themes: cultural sensitivity, training, language and cultural differences, all of which can act as barriers to safeguarding women in maternity services. By understanding the effects of FGM, midwives in the areas where FGM is less prevalent will be better able to care for these women when they encounter them, which may be increasingly likely, as the numbers of women migrating to the UK grow.
The Newborn Infant Physical Examination: Incorporating the theory into midwifery education
Authors: Jones Tracey , Furber Christine
Published: September 2017

Background

The Newborn Infant Physical Examination (NIPE) can be performed by any qualified health professional, although changes to the roles of health professionals has led to an increase in midwives undertaking continuing professional development (CPD) modules, in order to embrace the NIPE role.

Aim

The curriculum planning team at the University of Manchester recognised the diverse structures of CPD modules throughout the UK and sought to incorporate the theoretical component of NIPE training into pre-registration midwifery education.

Methods

The team consulted with local and national stakeholders to assess the need for NIPE education, and the possible challenges.

Findings

Evaluations from the first cohort of students have been positive, especially in relation to increased employability.

Conclusions

Including the theory of the NIPE into pre-registration midwifery education has been successful, although support to develop the clinical elements of the NIPE is still needed.
World Breastfeeding Week
Authors: Axcell Claire
Published: September 2017

The benefits of breastfeeding are well known, but the process is not always easy. Women need to be supported and empowered during this emotional and inmportant time, writes Claire Axcell
An inspirational approach to writing
Authors: O'Connell Suzanne
Published: September 2017

Inspiration is a key priority for Wilmslow Grange Community Primary when it comes to writing. Suzanne O'Connell finds out more
Effective teacher review and appraisal practices
Authors: Rossiter Brian
Published: September 2017

The School Teachers' Pay and Conditions Document applies to all maintained schools and the majority of academies. In this article Brian Rossiter shares good appraisal practice as part of the Professional Development Review cycle and performance-related pay
Microneedling and melasma: delivering successful patient solutions
Authors: Christie Andrew R
Published: September 2017

Melasma is a hormone-related and ultraviolet radiation-activated form of hyperpigmentation that appears as bilateral facial macules. It is often claimed to be the most challenging type of hyperpigmentation to treat, as there is a high risk of the condition becoming worse. As melanocytes are highly sensitive to heat and collateral damage created by keratinocyte thermolysis, microneedling delivers innovative and effective results, while respecting melanocyte integrity. A corrective cascade is activated by the release of regulatory growth factors for quick and impressive outcomes. Treatment with microneedling is suitable for all Fitzpatrick skin types and heritages. Combination therapies with microneedling, including the infusion of active depigmenting agents, deliver even greater treatment versatility and results. Patient commitment to the daily topical application of both pigment-blockers and a high sun protection factor enable further long-term management of this chronic, recalcitrant skin condition.
Risk management and pharmacovigilance in non-medical prescribing decisions
Authors: Mather Linda , Maw Gillian
Published: September 2017

This is the final article in a series of three in which the authors have discussed non-medical prescribing in the context of the law and explored how it applies to the field of aesthetic medicine. The aim of this article is to educate aesthetic practitioners about minimising risks associated with prescribing. The authors will consider the elements of prescribing risk, discuss common drug errors and outline the main types of adverse drug reactions.