bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Influencing Sex Differences in Poststroke Functional Outcome
Authors: Lisabeth Lynda D. , Reeves Mathew J. , Baek Jonggyu , Skolarus Lesli E. , Brown Devin L. , Zahuranec Darin B. , Smith Melinda A. , Morgenstern Lewis B.
Published: January 2015

Background and Purpose—

Our objective was to identify factors that contribute to or modify the sex difference in poststroke functional outcome.

Methods—

Ischemic strokes (n=439) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2008–2011). Data were ascertained from interviews (baseline and 90 days post stroke) and medical records. Functional outcome was measured as an average of 22 activities of daily living (ADL)/instrumental ADL items (range, 1–4; higher scores worse function). Tobit regression was used to estimate sex differences and to identify confounding and modifying factors.

Results—

Fifty-one percent were women. Median age was 71 (interquartile range, 59–80) years in women and 64 (interquartile range, 56–77) years in men. Median ADL/instrumental ADL score at 90 days was 2.7 (interquartile range, 1.8–3.6) in women and 2.0 (interquartile range, 1.3–3.1) in men (
P
<0.01); this difference remained after age-adjustment (
P
<0.001). Factors contributing to higher ADL/instrumental ADL scores in women included prestroke function, marital status, prestroke cognition, nursing home residence, stroke severity, history of stroke/transient ischemic attack, and body mass index; prestroke function was the largest contributor. Stroke severity modified the sex difference in outcome such that differences were apparent for mild to moderate but not severe strokes. After adjustment, women still had significantly worse functional outcome than men.

Conclusions—

These findings yield insight into possible strategies and subgroups to target to reduce the sex disparity in stroke outcome; demographics and prestroke and clinical factors explained only 41% of the sex difference in stroke outcome highlighting the need for future research to identify modifiable factors that contribute to sex differences.
Improved Prehospital Triage of Patients With Stroke in a Specialized Stroke Ambulance
Authors: Wendt Matthias , Ebinger Martin , Kunz Alexander , Rozanski Michal , Waldschmidt Carolin , Weber Joachim E. , Winter Benjamin , Koch Peter M. , Freitag Erik , Reich Jenrik , Schremmer Daniel , Audebert Heinrich J.
Published: January 2015

Background and Purpose—

Specialized management of patients with stroke is not available in all hospitals. We evaluated whether prehospital management in the Stroke Emergency Mobile (STEMO) improves the triage of patients with stroke.

Methods—

STEMO is an ambulance staffed with a specialized stroke team and equipped with a computed tomographic scanner and point-of-care laboratory. We compared the prehospital triage of patients with suspected stroke at dispatcher level who either received STEMO care or conventional care. We assessed transport destination in patients with different diagnoses. Status at hospital discharge was used as short-term outcome.

Results—

From May 2011 to January 2013, 1804 of 6182 (29%) patients received STEMO care and 4378 of 6182 (71%) patients conventional care. Two hundred forty-five of 2110 (11.6%) patients with cerebrovascular events were sent to hospitals without Stroke Unit in conventional care when compared with 48 of 866 (5.5%;
P
<0.01%) patients in STEMO care. In patients with ischemic stroke, STEMO care reduced transport to hospitals without Stroke Unit from 10.1% (151 of 1497) to 3.9% (24 of 610;
P
<0.01). The delivery rate of patients with intracranial hemorrhage to hospitals without neurosurgery department was 43.0% (65 of 151) in conventional care and 11.3% (7 of 62) in STEMO care (
P
<0.01). There was a slight trend toward higher rates of patients discharged home in neurological patients when cared by STEMO (63.5% versus 60.8%;
P
=0.096).

Conclusions—

The triage of patients with cerebrovascular events to specialized hospitals can be improved by STEMO ambulances.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01382862.
Between Dialectic and Rhetoric: Rhetorical Questions Expressing Premises in Biblical Prose Argumentation
Authors: Moshavi Adina
Published: January 2015

Rhetorical questions expressing premises are situated at the intersection of two disciplines whose object of study is argumentation: dialectic and rhetoric. This paper examines arguments in biblical prose whose premises take the form of rhetorical questions, utilizing insights from modern dialectical and rhetorical theories of argumentation. The corpus for this study is the prose portions of Genesis-2 Kings. The nearly 130 arguments in the corpus were found to exhibit clear logical structures after undergoing reconstruction, although these structures are not necessarily deductively valid. In this, biblical arguments are typical of argumentation in natural conversation. With a few exceptions, the modes of argumentation can be classified asmodus tollens, denying the antecedent, argument by consequences, or inductive reasoning. The rhetorical question plays a significant rhetorical role in these arguments, boosting the persuasive force of a disputed premise or a less-than-compelling logical relation between premises and conclusion.
Secret Talk and Eavesdropping Scenes: Its Literary Effects and Significance in Biblical Narrative
Authors: Michael Matthew
Published: January 2015

Eavesdropping scenes are common features of ancient and modern literary creations. However, in spite of the contemporary interest in the literary and artistic character of biblical narratives, eavesdropping scenes in biblical narratives have received little scholarly treatment. This paper engages the presence, use and functions of eavesdropping scenes in biblical narrative. In particular, eavesdropping scenes aid characterization, trigger the plots of stories, introduce turning points, and increase the mimetic qualities of the story. On the other hand, eavesdropping scenes breach the borderlines between the private and public spaces by taking readers into the private world of biblical characters. On this discourse level, the reader also becomes an eavesdropper by overhearing/ reading the conversations situated in these eavesdropping scenes. In the same way, the narrator also shares the posture of the eavesdropper in the hearing/retelling of the story to the intended readers.
The Marginal Nun in the Masora of the Cairo Codex of the Prophets: Use and Function
Authors: Martín-Contreras Elvira
Published: January 2015

The sign like a large final nun that appears in the margins of some early manuscripts has been considered another way of expressing the ketib-qere phenomenon. The analysis and study of the more than five hundred occurrences located in the Cairo Codex of the Prophets question this explanation and make it possible to define its use and explain its function in the context of this codex. According to this analysis, the marginal nun is related to the consonantal text without any reference to the reading tradition; its function is to warn that something happens in the consonantal text but not to explain it; and finally, its use in the Cairo Codex is determined by the probability that the spelling of a word might lead to a serious error in understanding.
The Seventy Bulls Sacrificed at Sukkot (Num 29:12-34) in Light of a Ritual Text from Emar (Emar 6, 373)
Authors: Ayali-Darshan Noga
Published: January 2015

This article deals with the seventy bulls offered at Sukkot according to Numbers 29—a number unparalleled in any other Israelite festival for which no persuasive explanation has been adduced to date. In light of a ritual from the ancient Syrian city of Emar (Emar 6, 373: 36-38), it is suggested that the custom reflects an ancient Levantine tradition of sacrificing seventy sacrifices to the seventy gods—the whole pantheon—during the New Year celebration. The evident transformation of the seventy gods into seventy nations by biblical scribes may explain the late rabbinic midrashic tradition according to which the seventy offerings made at Sukkot correspond to the seventy nations.
When God Abandoned the Garden of Eden: A Forgotten Reading of Genesis 3:24
Authors: Eichler Raanan
Published: January 2015

Genesis 3:24, the final verse in the Eden Narrative, states that God stationed “the cherubim and the spinning-sword-flame” east of the garden of Eden, from which he had recently expelled Man. Or so it does in its masoretic version. Four Targumim, however, reflect an ancient, divergent vocalization of the verse’s fourth word. In this vocalization, the verse must be read as stating that God himself settled east of the garden. This divergence profoundly affects the meaning of the entire Eden Narrative. The targumic reading is grammatically and stylistically sound, and, conceptually, it fits well in the verse’s textual setting. Moreover, a deliberate alteration from it to the masoretic reading would fall squarely into an independently identified pattern of theologically-driven changes in vocalization. The targumic reading may therefore be closest to the original authorial intent.
brics Diplomacy within and beyond Russia: The Fifth brics Summit through the Screens of Three Russian Television Channels
Authors: Grincheva Natalia
Published: January 2015

This article explores the discourse around the events of the Fifth brics Summit, as constructed through Russian media coverage across three channels: Russia Today (rt); Channel One Russia (1tv ru); and Russian Television International (rtvi). Through comparative analysis of how the brics Summit was portrayed by different channels, the article aims to highlight the influence of the Russian political discourse, the national media ecology, and the television companies’ missions and agendas in shaping Russia’s image within the brics Summit’s media coverage. The study explores this image through the lens of Russian public diplomacy and tries to evaluate the Russian government’s effectiveness in communicating its political messages to national and international audiences.
Diplomatic Challenges in a Crisis World
Authors: Bjola Corneliu , Constantinou Costas M.
Published: January 2015

The objective of this forum is to provide a framework for intellectual exchange and debate about the role of diplomacy in negotiating global crises and the impact of such crises on the evolution of diplomatic leadership, identity and method. Drawing on theories of leadership, decision-making, power and crisis management, the five contributions to this forum invite readers to reflect upon the analytical implications of theorizing crisis diplomacy.
Variability and Trends of Global Atmospheric Frontal Activity and Links with Large-Scale Modes of Variability
Authors: Rudeva Irina , Simmonds Ian
Published: January 2015

Presented here is a global analysis of frontal activity variability derived from ERA-Interim data over the 34-yr period of January 1979–March 2013 using a state-of-the-art frontal tracking scheme. In December–February over that epoch, there is a northward shift of frontal activity in the Pacific in the Northern Hemisphere (NH). In the Southern Hemisphere (SH), the largest trends are identified in the austral summer and are manifested by a southward shift of frontal activity over the Southern Ocean.

Variability of frontal behavior is found to be closely related to the main modes of atmospheric circulation, such as the North Atlantic Oscillation (NAO) for the Atlantic–European sector in the NH and the southern annular mode (SAM) in the middle and high latitudes of the SH. A signal associated with El Niño and hence emanating from the tropics is also apparent in the behavior of frontal systems over the Pacific by a reduction in the number of fronts in the middle South Pacific and intensification of frontal activity in high and low latitudes throughout the year. It is shown in general that the associations of the large-scale modes with frontal variability are much stronger than with cyclones. This indicates that the quantification of the behavior of fronts is an important component of understanding the climate system. At the very high latitudes, it is also shown here that, in the recent years of rapid sea ice reduction in the Arctic, there have been fewer summer fronts observed over the Canadian Arctic.
Probabilistic Concepts in a Changing Climate: A Snapshot Attractor Picture
Authors: Drótos Gábor , Bódai Tamás , Tél Tamás
Published: January 2015

The authors argue that the concept of snapshot attractors and of their natural probability distributions are the only available tools by means of which mathematically sound statements can be made about averages, variances, etc., for a given time instant in a changing climate. A basic advantage of the snapshot approach, which relies on the use of an ensemble, is that the natural distribution and thus any statistics based on it are independent of the particular ensemble used, provided it is initiated in the past earlier than a convergence time. To illustrate these concepts, a tutorial presentation is given within the framework of a low-order model in which the temperature contrast parameter over a hemisphere decreases linearly in time. Furthermore, the averages and variances obtained from the snapshot attractor approach are demonstrated to strongly differ from the traditional 30-yr temporal averages and variances taken along single realizations. The authors also claim that internal variability can be quantified by the natural distribution since it characterizes the chaotic motion represented by the snapshot attractor. This experience suggests that snapshot-attractor-based calculations might be appropriate to be evaluated in any large-scale climate model, and that the application of 30-yr temporal averages taken along single realizations should be complemented with this more appealing tool for the characterization of climate changes, which seems to be practically feasible with moderate ensemble sizes.
Jane Addams and the “Devil Baby Tales”
Authors: Cromie Thetis R.
Published: January 2015

Jane Addams was a social thinker, a public philosopher, and a leader of the settlement house movement in the United States in the late nineteenth and early twentieth centuries. She developed a method to understand people from backgrounds radically different from her own. This approach, which she called “sympathetic understanding,” involved a dialogic process that included “perplexity” and inquiry. This process resulted in practical actions that resonated with people in the neighborhood surrounding Hull House, the settlement house she founded in Chicago. It also transformed Addams’s own feeling and thinking. The process is illustrated by the “Devil Baby” tales described in Addams’s work. The relationship of her method to empathy with diverse populations and professional empathy in general is discussed.
Evaluation of the Beta Stiffness Index and Carotid Intima–Media Thickness in Asian Patients With Psoriasis
Authors: Kim Soo Young , Yang Hyun Suk , Lee Yang Won , Choe Yong Beom , Ahn Kyu Joong
Published: January 2015

The risk of cardiovascular (CV) events is reportedly elevated in patients with psoriasis. Evaluation of the beta stiffness index (BSI) and carotid intima–media thickness (cIMT) are noninvasive methods of assessing arterial stiffness and subclinical atherosclerosis. We aimed to determine carotid arterial stiffness and cIMT, using high-resolution ultrasonography, in patients with psoriasis compared with controls, and to analyze whether psoriasis is an independent risk factor for atherosclerosis. A total of 54 consecutive patients with psoriasis and 60 age and gender-matched healthy controls were enrolled. Compared with control participants, patients with psoriasis exhibited a significantly higher BSI ( P < .001). The cIMT tended to be higher in patients with psoriasis but statistically not significant ( P = .076). BSI was positively correlated with age, systolic blood pressure, disease severity defined according to history of systemic treatment, and traditional CV risk factors. Also, psoriasis was independently associated with BSI. These findings suggest that psoriasis is an independent risk factor for arterial stiffness, and the BSI is an earlier indicator of atherosclerosis than cIMT in these patients.
Managing the crises – how did local governments react to the financial crisis in 2008 and what explains the differences? The case of Swiss municipalities
Authors: Ladner Andreas , Soguel Nils
Published: January 2015

Swiss municipalities are, to a large extent, responsible for their financial resources. Since these resources primarily depend on income and property taxes from individuals and enterprises, municipality budgets are likely to be directly affected by the current crisis in the financial sector and the economy. This article investigates how municipalities perceived this threat and how they reacted to it. In a nationwide survey conducted at the end of 2009 in all 2596 Swiss municipalities, we asked local secretaries which measures had been launched in order to cope with expected losses in tax income and a possible increase in welfare spending. Did the municipalities rely on Keynesian measures increasing public spending and accepting greater deficits, or did they try to avoid further deficits by using austerity measures and a withdrawal of planned investments? Our results show that only a few municipalities – mainly the bigger ones – expected to be greatly affected by the crisis. Their reactions, however, did not reveal any clear patterns that theory would lead one to expect. Preferences for austerity measures and deficit spending become visible but many municipalities took measures from both theories. The strongest explanatory factors for determining how/why municipalities react are: the municipality’s level of affectedness followed by whether or not the municipality belongs to the French-speaking part of the country. Size also has an impact, whereas the strength of the Social Democrat party is negligible. Explaining what kind of measures municipalities are likely to take is more difficult. However, the more a municipality is affected, the more likely it is to stick to austerity measures.

Points for practitioners

How to react to a financial crisis is not only a challenging question to answer for the scientific community but also for practitioners being confronted with the crucial decisions to be taken. This contribution shows that the theoretical debates stipulating the exclusiveness of deficit spending or austerity measures is hardly reflecting reality, at least not at the local level. Policymakers are well advised to cut down expenditure and to invest where necessary. This is, at least, what can be learned from the practices of the Swiss municipalities after the 2008 crisis.
Properties of SiCp/6061-Al metal matrix composites prepared by infiltrating molten aluminum into ternary packing of SiC preforms
Authors: Qu SG , Lou HS , Li XQ
Published: January 2015

SiC particles reinforced aluminum matrix composites (SiCp/Al) with SiC content of more than 60%, without particle segregation for mirror substrate applications, are prepared by using the improved process. The improved process contains sintering process design, preform quality traceability, and equipment designing. The maximum SiC volume fraction of 70.4% is obtained by optimizing the selection of the following proportion: 71.4% coarse, 7.1% medium, and 21.5% fine particles. The variation of SiC volume fraction is correlated with the percentage of fine particles by using regression analysis. The preforms with the compressive strength above 10.34 MPa are prepared by sintering at 1600℃ for 2 h. Results showed that no defects in the scale of more than 10 µm are observed in the preforms. Due to the generation of a SiO2 layer during the sintering process, the formation of Al4C3 phase was inhibited. As the SiC particle volume fraction increased from 65.6% to 70.4%, the bending strength increased from 483.2 MPa to 585.2 MPa. The elastic modulus also increased from 174.2 GPa to 206.1 GPa, while the coefficient of thermal expansion between 50℃ and 350℃ decreased from 11.02 × 10−6/℃ to 9.53 × 10−6/℃.
TS2: a realistic IEEE1588 time-synchronization simulator for mobile wireless sensor networks
Authors: Huang Yiwen , Li Taihua , Dai Xuewu , Wang Haowen , Yang Yang
Published: January 2015

This paper presents the development of a simulator, TS2 (time-synchronization simulator), for realistically simulating and studying the performance of the IEEE 1588 precise time protocol (PTP) in IEEE 802.15.4 (TI CC2420 chip)-based mobile wireless sensor networks (WSNs). The PTP has the advantage of achieving high time precision at a low cost. It was designed for a wired Ethernet with requirements of symmetric communication paths and accurate time stamping, which is difficult for the low-cost WSNs to meet, as WSNs suffer more from overwhelming transmission delay jitters. An analytic solution to the performance of the PTP in WSNs is not possible, and it is of importance to evaluate the performance by realistic simulation. Based on the open-source OMNeT++ simulation engine, a realistic simulator was developed to simulate the PTP in IEEE 802.15.4 networks. There are two main contributions and benefits of the developed simulator. (1) Reality and fidelity: the WSN node’s various layers (including radio channels and TI CC2420 chip), drifting oscillator clocks and PTPs are simulated realistically. The drifting clock is simulated at an adjustable and higher resolution. (2) Support to both hardware and software time stamping, and the time-stamping uncertainties, by using a separated modular time-stamping module. It also has other features (such as extendibility and code-reusability, mobile WSN nodes, scalability for multi-node, multi-hop simulation). Finally, to demonstrate the simulator’s application to evaluating a PTP-based clock correction algorithm, a direct servo clock adjustment algorithm (i.e., a P controller) for a TI CC2420-based WSN was simulated and its performance was analyzed.
Transnational gentrification: Globalisation and neighbourhood change in Panama’s Casco Antiguo
Authors: Sigler Thomas , Wachsmuth David
Published: January 2015

Drawing upon the case of Panama’s Casco Antiguo, this paper establishes the theoretical concept of ‘transnational gentrification’: a process of neighbourhood change both enabled by and formative of a spatially embedded transnational ‘gentry’ whose locational mobility creates new possibilities for profitable housing reinvestment in geographically disparate markets where such possibilities would not have otherwise existed. Globalisation does not just create a common political-economic structure driving urban change or a common ideology for a gentrifying cohort. In this case, it creates historically and geographically specific connections between places, which themselves can become pathways along which gentrification processes propagate, connecting local capital to international consumer demand. The case of the Casco Antiguo offers a provocative inversion of a standard critical narrative of globalisation, whereby capital is freed from national constraints and able to roam globally while people largely remain place-bound. In the Casco Antiguo, residents are transnational and property developers are local.
Lay Theories About Social Class Buffer Lower-Class Individuals Against Poor Self-Rated Health and Negative Affect
Authors: Tan Jacinth J. X. , Kraus Michael W.
Published: January 2015

The economic conditions of one’s life can profoundly and systematically influence health outcomes over the life course. Our present research demonstrates that rejecting the notion that social class categories are biologically determined—a nonessentialist belief—buffers lower-class individuals from poor self-rated health and negative affect, whereas conceiving of social class categories as rooted in biology—an essentialist belief—does not. In Study 1, lower-class individuals self-reported poorer health than upper-class individuals when they endorsed essentialist beliefs but showed no such difference when they rejected such beliefs. Exposure to essentialist theories of social class also led lower-class individuals to report greater feelings of negative self-conscious emotions (Studies 2 and 3), and perceive poorer health (Study 3) than upper-class individuals, whereas exposure to nonessentialist theories did not lead to such differences. Discussion considers how lay theories of social class potentially shape long-term trajectories of health and affect of lower-class individuals.
How Do Employees Perceive Corporate Responsibility? Development and Validation of a Multidimensional Corporate Stakeholder Responsibility Scale
Authors: El Akremi Assâad , Gond Jean-Pascal , Swaen Valérie , De Roeck Kenneth , Igalens Jacques
Published: January 2015

Recent research on the microfoundations of corporate social responsibility (CSR) has highlighted the need for improved measures to evaluate how stakeholders perceive and subsequently react to CSR initiatives. Drawing on stakeholder theory and data from five samples of employees (N = 3,772), the authors develop and validate a new measure of corporate stakeholder responsibility (CStR), which refers to an organization’s context-specific actions and policies designed to enhance the welfare of various stakeholder groups by accounting for the triple bottom line of economic, social, and environmental performance; it is conceptualized as a superordinate, multidimensional construct. Results from exploratory factor analyses, first- and second-order confirmatory factor analyses, and structural equation modeling provide strong evidence of the convergent, discriminant, incremental, and criterion-related validities of the proposed CStR scale. Two-wave longitudinal studies further extend prior theory by demonstrating that the higher-order CStR construct relates positively and directly to organizational pride and perceived organizational support, as well as positively and indirectly to organizational identification, job satisfaction, and affective commitment, beyond the contribution of overall organizational justice, ethical climate, and prior measures of perceived CSR.
“Who is worthy of my generosity?” Recipient characteristics and the development of children’s sharing
Authors: Malti Tina , Gummerum Michaela , Ongley Sophia , Chaparro Maria , Nola Marta , Bae Na Young
Published: January 2015

Previous research has shown that the majority of 8-year-old children share valuable resources equally with others, whereas 4-year-olds are more likely to favor themselves in their sharing allocations. In this study, we examine whether these patterns of sharing behavior are affected by the needs of the recipient or by the recipient’s previous moral or immoral actions. One-hundred and sixty 4- and 8-year-old children had the opportunity to share stickers with hypothetical recipients who were assigned varying characteristics. For both age groups, sharing increased when recipients were needy (i.e., feels sad or has few toys) and morally deserving (i.e., shares with other children and does not push). The differentiation of sharing based on recipient characteristics increased between 4 and 8 years of age, with 8-year-olds also demonstrating decreased sharing when recipients were morally undeserving (i.e., pushes other children and does not share). Our findings provide evidence that children show increased sharing with recipients who are morally deserving and those who demonstrate need. This suggests that children indirectly reciprocate others’ past moral behavior and behave more altruistically towards those with higher need.
A transagency approach to enabling access to parent-based intervention for language delay in areas of social disadvantage: A service evaluation
Authors: Gibbard Deborah , Smith Clare
Published: January 2015

Primary language delay remains one of the most prevalent developmental delays in early childhood, particularly in disadvantaged areas. Previous research has established language difficulties and social disadvantage being particular risk factors for adverse outcomes later in life. To help prevent low educational achievement and poorer outcomes, early treatment for any speech and language problems is vital. Early intervention and parental involvement in treatment has proven beneficial for pre-school children experiencing language development difficulties. In areas where there is social disadvantage, however, parents often do not engage with treatment. A local service project has evaluated a new, joint-working intervention, Enhanced Parent-Based Intervention (EPBI), which took place in Children’s Centres within areas of social disadvantage. This exploratory study compared the EPBI service with the existing standard parent-based intervention (PBI) and examined the effects on attendance, engagement with treatment and language outcomes for children. When the EPBI service was offered in the disadvantaged areas, take-up and attendance rates increased from 35% to 100% and from 50% to 80% respectively. Children made gains with their language development, and this progress was comparable with language gains made by children from standard PBI groups in areas without social disadvantage. The results of the service evaluation indicated that when parents engage with the intervention, EPBI resulted in positive outcomes for socially disadvantaged children, which could benefit society in the long-term with potential cost savings. Limitations and future developments are discussed.
End-of-life care in the intensive care unit: A patient-based questionnaire of intensive care unit staff perception and relatives’ psychological response
Authors: Hartog Christiane S , Schwarzkopf Daniel , Riedemann Niels C , Pfeifer Ruediger , Guenther Albrecht , Egerland Kati , Sprung Charles L , Hoyer Heike , Gensichen Jochen , Reinhart Konrad
Published: January 2015

Background:

Communication is a hallmark of end-of-life care in the intensive care unit. It may influence the impact of end-of-life care on patients’ relatives. We aimed to assess end-of-life care and communication from the perspective of intensive care unit staff and relate it to relatives’ psychological symptoms.

Design:

Prospective observational study based on consecutive patients with severe sepsis receiving end-of-life care; trial registration NCT01247792.

Setting/participants:

Four interdisciplinary intensive care units of a German University hospital. Responsible health personnel (attendings, residents and nurses) were questioned on the day of the first end-of-life decision (to withdraw or withhold life-supporting therapies) and after patients had died or were discharged. Relatives were interviewed by phone after 90 days.

Results:

Overall, 145 patients, 610 caregiver responses (92% response) and 84 relative interviews (70% response) were analysed. Most (86%) end-of-life decisions were initiated by attendings and only 2% by nurses; 41% of nurses did not know enough about end-of-life decisions to communicate with relatives. Discomfort with end-of-life decisions was low. Relatives reported high satisfaction with decision-making and care, 87% thought their degree of involvement had been just right. However, 51%, 48% or 33% of relatives had symptoms of post-traumatic stress disorder, anxiety or depression, respectively. Predictors for depression and post-traumatic stress disorder were patient age and relatives’ gender. Relatives’ satisfaction with medical care and communication predicted less anxiety ( p = 0.025).

Conclusion:

Communication should be improved within the intensive care unit caregiver team to strengthen the involvement of nurses in end-of-life care. Improved communication between caregivers and the family might lessen relatives’ long-term anxiety.
What’s in a name? A qualitative exploration of what is understood by “palliative care” in the emergency department
Authors: Weil Jennifer , Weiland Tracey J , Lane Heather , Jelinek George A , Boughey Mark , Marck Claudia H , Philip Jennifer
Published: January 2015

Background:

The understanding of what palliative care is, and which patients may benefit from palliative care, has important implications for optimal patient care in all areas of health provision.

Aim:

To explore the understanding of palliative care by healthcare professionals caring for patients with advanced cancer attending emergency departments.

Design:

Qualitative study, with two phases: the first, a series of focus groups with healthcare professionals from various disciplines and settings caring for patients with advanced cancer presenting to emergency departments; the second, semi-structured telephone interviews with emergency healthcare professionals across Australian States and Territories, including outside metropolitan centers. The data were audio-recorded and transcribed, with analysis undertaken using a qualitative thematic analysis.

Setting/participants:

Saturation of themes was reached after 8 focus groups (22 emergency nurses, 21 emergency physicians, 6 oncologists, 6 hospital palliative care clinicians, and 28 community palliative care clinicians) and 11 telephone interviews (8 emergency physicians and 3 emergency nurses), a total of 94 participants.

Results:

The overarching theme was that healthcare professionals held contradictory understandings of palliative care and its application in the emergency department; subthemes highlighted these inconsistencies when the term “palliative” is used, in understandings of and engagement with palliative care services and in perceptions about the practical utility of palliative care.

Conclusion:

There are entrenched contradictions and tensions surrounding the term “palliative care”; confronting these is likely to require more than re-branding, and will promote better care for this vulnerable patient group in the emergency department.
Hospital rapid response team and patients with life-limiting illness: A multicentre retrospective cohort study
Authors: Sulistio Merlina , Franco Michael , Vo Amanda , Poon Peter , William Leeroy
Published: January 2015

Background:

Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered.

Aims:

We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness.

Design/Setting:

A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network.

Results:

We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 years), more likely to come from a residential aged-care facility (29.5% vs 4.1%) and had a shorter hospital stay (10 vs 13 days). Rapid response team consultations resulted in a change to more palliative goals of care in 28.5% of patients, of whom two-thirds had a life-limiting illness.

Conclusion:

Patients with a life-limiting illness had worse outcomes post–rapid response team consultation. Our findings suggest that a routine clarification of goals of care for this cohort, within 3 days of hospital admission, may be advantageous. These discussions may provide clarity of purpose to treating teams, reduce the burden of unnecessary interventions and promote patient-centred care agreed upon in advance of any deterioration.
Life-and-death decision-making in the acute phase after a severe stroke: Interviews with relatives
Authors: de Boer Marike E , Depla Marja , Wojtkowiak Joanna , Visser Marieke C , Widdershoven Guy AM , Francke Anneke L , Hertogh Cees MPM
Published: January 2015

Background:

Decision-making in the acute phase after a severe stroke is complex and may involve life-and-death decisions. Apart from the medical condition and prognosis, quality of life and the deliberation of palliative care should be part of the decision-making process. Relatives play an important role by informing physicians about the patient’s values and preferences. However, little is known about how the patients’ relatives experience the decision-making process.

Aim:

To elicit the perspective of relatives of severe stroke patients with regard to the decision-making process in the acute phase in order to understand how they participate in treatment decisions.

Design:

An exploratory qualitative interview approach guided by the principles of grounded theory.

Settings/participants:

Relatives of severe stroke patients ( n = 15) were interviewed about their experiences in the decision-making process in the acute phase.

Results:

Four categories reflecting relatives’ experiences were identified: (1) making decisions under time pressure, (2) the feeling of ‘who am I’ to decide, (3) reluctance in saying ‘let her die’ and (4) coping with unexpected changes. Following the treatment proposal of the physician was found to be the prevailing tendency of relatives in the decision-making process.

Conclusion:

A better understanding of the latent world of experiences of relatives that influence the decision-making process may help physicians and other health-care providers to better involve relatives in decision-making and enhance the care, including palliative care, for patients with severe stroke in line with their values and preferences. Communication between physician and relatives seems vital in this process.
Characteristics of episodic breathlessness as reported by patients with advanced chronic obstructive pulmonary disease and lung cancer: Results of a descriptive cohort study
Authors: Weingärtner Vera , Scheve Christine , Gerdes Verena , Schwarz-Eywill Michael , Prenzel Regina , Otremba Burkhard , Mühlenbrock Juliane , Bausewein Claudia , Higginson Irene J , Voltz Raymond , Herich Lena , Simon Steffen T
Published: January 2015

Background:

Episodic breathlessness is one form of refractory breathlessness. Better understanding of the symptom is necessary for effective management.

Aim:

The aim was to describe the characteristics of episodic breathlessness in patients with advanced chronic obstructive pulmonary disease or lung cancer.

Design:

This is a longitudinal cohort study. Outcomes were assessed monthly by up to 13 telephone interviews: peak severity (modified Borg scale: 0–10), duration, frequency, and timing of breathlessness episodes. Data from each episode were pooled and analyzed using descriptive statistics. Associations between outcomes were explored by correlation coefficients.

Setting/participants:

Patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease classification stage III or IV) or primary lung cancer (any stage) were recruited in two inpatient units (internal medicine) and two outpatient clinics in Oldenburg, Germany.

Results:

A total of 82 patients (50 chronic obstructive pulmonary disease, 32 lung cancer), mean age (standard deviation) 67 years (8 years) and 36% female, were included reporting on 592 breathlessness episodes (chronic obstructive pulmonary disease: 403, lung cancer: 189). Peak severity was perceived significantly higher in chronic obstructive pulmonary disease patients than in lung cancer patients (mean (standard deviation) Borg scale: 6.2 (2.1) vs 4.2 (1.9); p < 0.001). Episodes described by chronic obstructive pulmonary disease patients were longer than those described by lung cancer patients (median (range): 7 min (0–600) vs 5 min (0.3–120), p = 0.002)). Frequency was similar and most often daily in both groups. Severity and frequency of episodes were correlated in lung cancer patients (r = 0.324, p = 0.009).

Conclusion:

Most breathlessness episodes are short (minutes) and severe with significant differences between chronic obstructive pulmonary disease and lung cancer patients. Effective management strategies are warranted to improve symptom relief and coping.
Intensity cut-points for the Respiratory Distress Observation Scale
Authors: Campbell Margaret L , Templin Thomas N
Published: January 2015

Background:

The Respiratory Distress Observation Scale© is an innovative solution to assessment when a dyspnea report cannot be elicited. The Respiratory Distress Observation Scale has acceptable reliability and validity psychometrics.

Aim:

To identify distress-intensity cut-points of the Respiratory Distress Observation Scale.

Design:

Receiver operating characteristic curve analysis was conducted with inpatients stratified by four levels of respiratory distress—none, mild, moderate, or severe. Patients provided three self-report measures of dyspnea: dichotomous (yes/no); a ranking of none, mild, moderate, or severe; and a numerical rating scale. Respiratory distress was assessed using the Respiratory Distress Observation Scale instrument.

Setting/participants:

Participants were 136 adult inpatients, mean age 61.8 years (standard deviation = 13.18 years), 89.7% African American, and 56.6% female, who were recruited from an urban, tertiary care hospital in the Midwest of the United States.

Results:

In all, 47% ( n = 64) self-reported dyspnea (yes/no). Ranking was distributed as follows: none = 36, mild = 35, moderate = 40, and severe = 25. Numerical rating scale scores ranged from 0 to 10, mean = 4.99 (standard deviation = 2.9). Respiratory Distress Observation Scale scores ranged from 0 to 7, median (interquartile range) = 2 (1–3). Receiver operating characteristic curve analysis–determined Respiratory Distress Observation Scale score of 0–2 suggests little or no respiratory distress; score ≥3 signified moderate to severe distress.

Conclusion:

A Respiratory Distress Observation Scale score ≥3 signifies a patient’s need for palliation of respiratory distress. An end-point for identifying responsiveness to treatment, in other words, respiratory comfort, is Respiratory Distress Observation Scale <3. Because patients with imminent respiratory failure, as typified by dying patients, were not represented yielding lower than expected Respiratory Distress Observation Scale scores, further substantiation is needed to determine moderate or severe cut-points.
Do repeated assessments of performance status improve predictions for risk of death among patients with cancer? A population-based cohort study
Authors: Su Jiandong , Barbera Lisa , Sutradhar Rinku
Published: January 2015

Background:

Prior work has utilized longitudinal information on performance status to demonstrate its association with risk of death among cancer patients; however, no study has assessed whether such longitudinal information improves the predictions for risk of death.

Aim:

To examine whether the use of repeated performance status assessments improve predictions for risk of death compared to using only performance status assessment at the time of cancer diagnosis.

Design:

This was a population-based longitudinal study of adult outpatients who had a cancer diagnosis and had at least one assessment of performance status. To account for each patient’s changing performance status over time, we implemented a Cox model with a time-varying covariate for performance status. This model was compared to a Cox model using only a time-fixed (baseline) covariate for performance status. The regression coefficients of each model were derived based on a randomly selected 60% of patients, and then, the predictive ability of each model was assessed via concordance probabilities when applied to the remaining 40% of patients.

Results:

Our study consisted of 15,487 cancer patients with over 53,000 performance status assessments. The utilization of repeated performance status assessments improved predictions for risk of death compared to using only the performance status assessment taken at diagnosis.

Conclusion:

When studying the hazard of death among patients with cancer, if available, researchers should incorporate changing information on performance status scores, instead of simply baseline information on performance status.
“I Couldn’t Do It to a Kid Knowing What It Did to Me”
Authors: Lambie Ian , Johnston Emma
Published: January 2015

Research has shown that child sexual abuse victims are overrepresented among sexual abuse offenders, leading to the sexually abused–sexual abuser hypothesis. However, a large proportion of child sexual abuse victims do not go on to sexually offend, and such individuals are labeled as resilient victims. Surprisingly few studies have looked at why some male victims of sexual abuse do not go on to offend. In-depth qualitative interviews were conducted with 47 resilient men focusing on their beliefs as to why they had not gone on to sexually abuse others. Results revealed four themes for why the victims did not offend: empathy, morals, lack of sexual desire, or a combination of the previous three. In regard to the process of developing their resiliency, some participants claimed they made a conscious decision, whereas others reported the decision was an unconscious one. The various factors that were reported as contributing to the conscious or unconscious decision (becoming aware of sexual abuse, admitting the experience had happened to them, empathy, social support, and lack of sexual desire to abuse) are discussed, along with the four themes, and the implication of these results for prevention. Finally, conclusions are drawn that the victim–offender pathway is far from inevitable as most participants stated their reason for not offending was directly related to their own experience of sexual abuse victimisation.
Considering how morphological traits of urban fabric create affordances for complex adaptation and emergence
Authors: Wohl Sharon
Published: January 2015

This paper examines how physical and material properties of the urban fabric help enable the evolution of programmatically coherent spatial districts. It considers how contingent and non-linear processes intertwine to manifest in the unfolding of distinct sites and territories. Drawing concepts and terminology from both evolutionary economic geography and the sciences of complexity, it emphasizes how physically situated morphological traits help underpin urban processes of self-organization and emergence.
Modeling of banded structure in friction stir weld in strain rate–hardening materials of Zener–Hollomon type
Authors: Pei Xianjun , Dong Pingsha
Published: January 2015

This article presents a shear localization model for simulating the shear band formation process uniquely associated with friction stir welding. By introducing a thermal and plastic deformation boundary layer definition, the shear band formation process can be modeled as shear localization phenomena using one-dimensional coupled elastic visco-plastic model. Material constitutive behavior is assumed to follow Zener–Hollomon constitutive equation. With this model, shear band width, formation time and propagation speed can be theoretically estimated as a measure of friction stir weldability. As such, the shear band propagation speed serves as a theoretical estimate of the maximum possible welding speed under given base material and welding conditions, such as stir pin rotational speed and torque level. The model is shown to provide reasonable estimates of shear localization parameters when compared with recent experimental data on titanium alloy Ti-6Al-4V. With this model, some fundamental questions such as why titanium alloys are more difficult to weld than aluminum alloys or steels can be more quantitatively addressed. And consequently, potential means for mitigating some of the difficulties in friction stir welding of some of the alloys can be theoretically examined to provide guidance for cost-effective development of welding process parameters for new applications.