bluuebunny/crossref_metadata_2025 huggingface dataset:
Transnational civil society and informal public spheres in the nuclear non-proliferation regime
Authors: Norman David J
Published: May 2018

Scholars charting the emergence of transnational public spheres often focus on the socio-spatial sites that are generated by civil society organisations in their interactions with the institutions of global governance. These sites can reflect either strong public spheres within the formal decision-making structures of international regimes, or segmented and general public spheres on their periphery. In practice, they all suffer key democratic deficiencies in the ability to either communicatively generate public opinion or achieve collective will-formation. I argue that if civil society organisations can successfully weave together both general and segmented public spheres on the periphery of international regimes, their individual democratic deficiencies could be addressed. To demonstrate evidence of these interconnected ‘informal public spheres’, I turn to the nuclear non-proliferation regime, where public deliberation has been largely invisible and ineffectual within the formal decision-making structures of the nuclear Non-Proliferation Treaty. The emergence of a new civil society organisation-led ‘humanitarian initiative’ on the periphery of the regime, comprising multi-stakeholder initiatives in conjunction with civil society organised social forums, reflects the interconnection of segmented and general public spheres. This innovative initiative has effectively enhanced transnational public debate on disarmament, while gaining crucial political traction within the regime.
Relationship between the intention–behavior gap and self-efficacy for physical activity during childhood
Authors: Isa Tsunenori , Ueda Yuya , Nakamura Ryo , Misu Shogo , Ono Rei
Published: May 2018

This study investigated the relationship of a gap between the intent to be physically active and actual participation in physical activity (‘intention–behavior gap’) and self-efficacy for physical activity during childhood. A self-report questionnaire was used to collect information from 946 children from the fourth and sixth grades in Japan on self-efficacy, intention, and physical activity. Children with an intention–behavior gap (high intent–low activity or low intent–high activity) had higher self-efficacy scores than those with low intent and low activity (27.66 or 27.65 vs. 21.69; p < .001). They had lower self-efficacy scores than those with high intent and high activity (27.66 or 27.65 vs. 30.56; p < .001). Children with an intention–behavior gap had lower self-efficacy for physical activity than those who intended to be and were physically active. Such children may benefit from education interventions that focus on improving self-efficacy.
The iron fist in the velvet glove? Testing the militarization/community policing paradox
Authors: Koslicki Wendy M , Willits Dale
Published: May 2018

A number of police militarization scholars have explored the paradox of the simultaneous emergence of community policing and militarism in the United States. Several researchers have suggested that police militarization and community policing may be cohesive strategies of state control, with community policing being the “velvet glove” that wraps the “iron fist” of militarization in palatable rhetoric. Alternatively, it has been suggested that these two policing strategies are incoherent, having emerged as a result of the state’s disorganized attempts to maintain control in the face of significant societal changes. To date, little research has examined the link between community policing and police militarization specifically. This study uses community policing data from the 2013 LEMAS survey to examine variation in military equipment acquisition data from the Department of Defense’s 1033 Program between the years 2012 and 2014. Results show that departments engaging in certain community policing activities are significantly less likely to acquire general military equipment, firearms, and military vehicles. These findings suggest that these policing strategies are not necessarily coherent and potentially support the argument that community policing efforts can buffer militarization. However, these results also highlight the need for more empirical research on existing theories of militarization, as well as the causes and effects of police militarism and community policing activities.
Effect of spray impingement distance on piston top fuel adhesion in direct injection gasoline engines
Authors: Luo Hongliang , Nishida Keiya , Uchitomi Shintaro , Ogata Youichi , Zhang Wu , Fujikawa Tatsuya
Published: May 2018

Direct injection is an attractive technology for improving fuel economy and engine performance in gasoline engines. However, the adhered fuel formed on the piston surface has significant influence on the combustion efficiency and emissions. To obtain a better understanding of fuel adhesion, this work involved investigation of the spray and impingement on a flat wall through a mini-sac injector with a single hole. Different impingement distances and injection pressures were investigated. The evolution of the impinging spray was obtained by the Mie scattering method. The refractive index matching method was applied to measure fuel adhesion. The mass, area, and thickness of adhesion under different conditions were compared. The experimental results show that the fuel adhesion on the wall increases significantly with a large impingement distance. Moreover, the maximum thickness increases and the thickness uniformity of the fuel adhesion declines under a large impingement distance condition.
Challenges to goals of “Recovery”: A narrative analysis of neoliberal/ableist policy effects on two mothers of young children with autism
Authors: Sherfinski Melissa
Published: May 2018

This narrative inquiry shows the barriers and possibilities that the current US education context poses for two mothers of pre-kindergarten sons with autism. Specifically, this work is contextualized within the growing universal pre-kindergarten reform which provides a mixed delivery (public and private) implementation. Presented with the context of choice among school sites and the expectation of mothers to provide energy for the reform through their involvement in the universal pre-kindergarten “machine,” mothers of children with autism experienced unique challenges. An in-depth Bakhtinian analysis examining the mothers’ uses of heteroglossia and polyphony shows the complexities of how they presented an oscillating “double-consciousness,” working between machine expectations and narratives of “recovery,” meaning desiring normalization in line with the expectations of early childhood experts, children, and local policies. Neither the machine metaphor nor the narrative of recovery was sufficient to negotiate the challenges of education for the families, and mothers used strategies of recycling, resisting, and re-appropriating discourses to navigate. While universal pre-kindergarten was effective in improving the academic performance of children with mild autism, it did not always support the goals of inclusive and democratic education. Therefore, mothers began to question their choice of public school context and began to consider private universal pre-kindergarten sites, even though this might jeopardize the Individualized Education Plans that they worried their children needed, particularly for social purposes. The implications address both the mechanism for shifts from public to private choice in the current US education context, and the need for a reparative project that critically addresses relationships between homes and schools.
Moralizing meat consumption: Bringing food and feeling into education for sustainable development
Authors: Bruckner Heide K , Kowasch Matthias
Published: May 2018

This article critiques the way the topic of meat and its consumption is addressed in geography education within the remit of education for sustainable development (ESD). We argue that current approaches perpetuate normative food discourse by: (a) framing participation in the food system solely in terms of consumption; (b) simplifying and moralizing food systems as ‘good’ or ‘bad’; and (c) largely omitting animals from a discussion of meat and agriculture. As a result, students learn that their role is to consume ‘good’ not ‘bad’ meat, but are ill-equipped to analyse the political–economic, cultural and affective dimensions of food. Meat and consumption topics, although rarely addressed, fall under the broader pedagogy of ESD. Although emancipatory approaches to ESD explore contradictions inherent in and personal aspects of sustainability, ESD in practice often leads to binary schemata of ‘right’ and ‘wrong’. Based on our qualitative review of geography curricula in Austria and Germany (Lower Saxony and Bremen), we find that they neglect meat production and consumption, but that these subjects can be addressed within broader topics about sustainability and agricultural land use. Interviews with secondary school teachers and students indicate that ESD ignores the interpersonal, relational and more-than-human elements of food systems. However, we show that students still rank animal welfare as an important component of sustainability. This indicates that they are influenced by education beyond institutional settings and, furthermore, highlights opportunities for making students aware of the visceral (dis)connections they make between taste and political economy. Finally, we suggest future directions for ESD in order that these links can be explored, probing students to develop their own ethics of the gut.
Safety and efficacy of a new outreach distal access catheter, TACTICS, for coil embolization of unruptured intracranial aneurysms
Authors: Matsushige Toshinori , Sakamoto Shigeyuki , Ishii Daizo , Shinagawa Katsuhiro , Shimonaga Koji , Hosogai Masahiro , Kawasumi Tomohiro , Oshita Junpei , Okazaki Takahito , Kurisu Kaoru
Published: May 2018

Background and purpose

Current large-bore catheters can be easily and safely placed in the intracranial vessels for the stabilization of microcatheters in several neurointervention scenarios. We considered that a novel 3.4 French catheter (TACTICS, Technorat Corporation, Aichi, Japan) might be useful for intermediate/distal access in a triaxial system. Here, we present our initial experience using the TACTICS catheter for treatment of intracranial aneurysms.

Materials and methods

A total of 35 endovascular coils were placed to embolize unruptured intracranial aneurysms of the anterior circulation using the TACTICS catheter between December 2016 and November 2017. These procedures were retrospectively reviewed to assess aneurysmal obliteration (Raymond’s classification), the volume embolization ratio (VER) and procedural complications in comparison with 96 conventional coil treatments during the 3-year period up to 2016. Data were matched for aneurysmal morphology (location, maximum diameter and aspect ratio) by the propensity method.

Results

In all procedures, the TACTICS catheter was atraumatically landed beyond the carotid siphon. There were no hemorrhagic or symptomatic ischemic complications. After propensity matching, 68 procedures were assessed (34 in each group). Achievement of Raymond’s scale 1 (complete occlusion) showed the same frequency in both groups (50% vs. 50%, p = 0.23). The VER was significantly higher with the TACTICS catheter than with the conventional method (34.0% vs. 28.7%, p = 0.003).

Conclusion

We reviewed our initial experience of the TACTICS catheter. It can be used as an intermediate catheter for safe and effective endovascular coil embolization of anterior circulation aneurysms.
Algorithms, ontology, and social progress
Authors: Iliadis Andrew
Published: May 2018

Recently, media and communication researchers have shown an increasing interest in critical data studies and ways to utilize data for social progress. In this commentary, I highlight several useful contributions in the International Panel on Social Progress (IPSP) report toward identifying key data justice issues, before suggesting extra focus on algorithmic discrimination and implicit bias. Following my assessment of the IPSP’s report, I emphasize the importance of two emerging media and communication areas – applied ontology and semantic technology – that impact internet users daily, yet receive limited attention from critical data researchers. I illustrate two examples to show how applied ontologies and semantic technologies impact social processes by engaging in the hierarchization of social relations and entities, a practice that will become more common as the Internet changes states towards a ‘smarter’ version of itself.
A Real-World Setting Study: Which Glucose Meter Could Be the Best for POCT Use? An Easy and Applicable Protocol During the Hospital Routine
Authors: Mancini Alessio , Esposto Giampaolo , Manfrini Silvana , Rilli Silvia , Tinti Gessica , Carta Giuseppe , Petrolati Laura , Vidali Matteo , Barocci Simone
Published: May 2018

The aim of this retrospective study is to evaluate the reliability and robustness of six glucose meters for point-of-care testing in our wards using a brand-new protocol. During a 30-days study period a total of 50 diabetes patients were subjected to venous blood sampling and glucose meter blood analysis. The results of six glucose meters were compared with our laboratory reference assay. GlucoMen Plus (Menarini) with the 82% of acceptable results was the most robust glucose meter. Even if the Passing-Bablok analysis demonstrates the presence of constant systematic errors and the Bland-Altman test highlighted a possible overestimation, the surveillance error grid analysis showed that this glucose meter can be used safely. We proved that portable glucose meters are not always reliable in routinely clinical settings.
Continuous Glucose Monitoring: Current Use in Diabetes Management and Possible Future Applications
Authors: Vettoretti Martina , Cappon Giacomo , Acciaroli Giada , Facchinetti Andrea , Sparacino Giovanni
Published: May 2018

The recent announcement of the production of new low-cost continuous glucose monitoring (CGM) sensors, the approval of marketed CGM sensors for making treatment decisions, and new reimbursement criteria have the potential to revolutionize CGM use. After briefly summarizing current CGM applications, we discuss how, in our opinion, these changes are expected to extend CGM utilization beyond diabetes patients, for example, to subjects with prediabetes or even healthy individuals. We also elaborate on how the integration of CGM data with other relevant information, for example, health records and other medical device/wearable sensor data, will contribute to creating a digital data ecosystem that will improve our understanding of the etiology and complications of diabetes and will facilitate the development of data analytics for personalized diabetes management and prevention.
Trapped as a Good Worker: The Influence of Coercive Acquaintance Advertising on Work Outcomes
Authors: Yuan Bocong , Li Jiannan , Zeng Guojun
Published: May 2018

This article examines the organization phenomenon of coercive acquaintance advertising, which is born of social media context and emerging in tourism and hospitality industry. Empirical results analyzing the multisource and time-lagged data collected from 358 travel agency employees provide general support for our hypotheses. Specifically, this article finds that the practice of coercive acquaintance advertising leads employees to suffer from interrole conflict arising from being a worker and “friend” simultaneously on their personal social media networks, which in turn can affect their job performance, job satisfaction, and turnover intention. In addition, such mediation process can be strengthened by the high-level of employee’s feedback sensitivity such that there is the moderated mediation mechanism in the relationships between coercive acquaintance advertising and employee work outcomes. The findings have theoretical and practical implications for researchers and practitioners.
Effect of Security on Hostels’ Price Premiums: A Hedonic Pricing Approach
Authors: Cró Susana , Martins António Miguel , Simões José Manuel , Calisto Maria de Lurdes
Published: May 2018

This article evaluates the impact of security in the hostel industry on the willingness to pay by customers. More specifically, given the importance of security in the decision to travel and in the choice of a given destination, we analyze the impact of security guest reviews on a consumer-generated website on hostel room prices. Furthermore, we investigate whether the impact of security guest reviews on the hostel room prices is higher for the hostels located in the countries with the lowest ranking in the Global Peace Index. Finally, we examine whether females and older guests are willing to pay a premium in terms of price for a hostel with a higher level of security. For this purpose, we estimate a hedonic price function for a sample of consumer reviews of 477 hostels in 22 worldwide capitals, with different levels of peace, from Hostelworld. The results highlight the importance of security on the determination of hostel room prices. We find that customers are willing to pay a higher premium in terms of price, in the least worldwide peaceful countries, for a hostel room with higher levels of security. In the case of women and older guests, the premium they are willing to pay is higher.
Principles for Thinking about the Future and Foresight Education
Authors: Bengston David N.
Published: May 2018

Most fields of study have introductory textbooks with the word “principles” in the title: “Principles of Economics,” “Principles of Ecology,” and many others. The principles explained in these textbooks are the core unifying and ordering concepts for their respective fields. They provide a frame of reference for students who are new to the field and taking the first steps toward mastering it. The abundance of “principles” textbooks and long history of the use of core principles in education suggest that a clear set of unifying principles may be a useful way to teach students how to productively think about and understand complex topics. This article identifies and describes a set of core principles for thinking about the future based on a review of more than 50 years of published futures research literature. The ten principles are as follows: The future is (1) plural; (2) possible, plausible, probable, and preferable; (3) open; (4) fuzzy; (5) surprising; (6) not surprising; (7) fast; (8) slow; (9) archetypal; and (10) inbound and outbound. The principles are described and their potential educational use is discussed. Core futures principles may be useful for introducing students of all ages to thinking about and preparing for the future.
A Collet–Sicard syndrome due to internal carotid artery dissection associated with cerebral amyloid angiopathy–related inflammation
Authors: Saliou Vanessa , Ben Salem Douraied , Ognard Julien , Guellec Dewi , Marcorelles Pascale , Rouhart François , Zagnoli Fabien , Timsit Serge
Published: May 2018

Background:

Cerebral amyloid angiopathy–related inflammation is a rare condition with approximately 100 reported cases. Its clinical manifestations are varied. We report here a novel presentation of this disease.

Case presentation:

A 61-year-old Caucasian man presented with rapidly progressive paralysis of the IX, X, XI and XII right cranial nerves associated with right central facial nerve palsy. Brain computed tomography angiography and cerebral catheter angiography found a focal fusiform enlargement of the distal cervical portion of the right internal carotid artery, related to a pseudo-aneurysm suggesting an evolution of a dissection and intra-cranial vessel dysplasia. Brain magnetic resonance imaging showed multiple asymmetrical subcortical regions of hyperintensity on T2 fluid-attenuated inversion recovery sequences. Punctiform cortical hyposignals on T2-weighted gradient echo magnetic resonance imaging sequences were mostly congruent with the white matter hyperintensities. There was a decreased cerebral perfusion at the frontal hyperintense fluid-attenuated inversion recovery region. Spectrometry identified a lactate–lipid peak. A brain biopsy showed intravascular amyloid deposits. Corticosteroid therapy was initiated, leading to a dramatic improvement of both clinical condition and magnetic resonance imaging brain lesions.

Conclusion:

This case report suggests that extra-cranial vasculitis and dysplasia can exceptionally be found in patients satisfying cerebral amyloid angiopathy–related inflammation criteria.
Perceptions of elites and (asymmetric) sorting
Authors: Davis Nicholas T.
Published: May 2018

Conventional wisdom suggests that citizens who recognize party polarization exhibit well-sorted preferences. Curiously, however, this extant research has not grappled sufficiently with how pervasive perceptual biases might moderate the relationship between perceptions of elites and sorting. In this manuscript, I show that perceived out-group dissimilarity affects sorting, albeit in an asymmetric manner: perceived out-group dissimilarity corresponds to greater sorting for persons with right-leaning identities compared to those with left-leaning ones. I then analyze the 1992–1996 ANES Panel Study and find that these patterns mostly hold, with one caveat: sorting also shapes perceptions of out-group dissimilarity. These findings offer preliminary evidence of the existence of a feedback loop between perceptions of elites and sorting.
Overview of Self-Management Resources Used by Canadian Chronic Kidney Disease Clinics: A National Survey
Authors: Donald Maoliosa , Gil Sarah , Kahlon Bhavneet , Beanlands Heather , Straus Sharon , Herrington Gwen , Manns Braden , Hemmelgarn Brenda R.
Published: May 2018

Background:

Chronic kidney disease (CKD) clinics across Canada provide tailored care for patients with CKD with an aim to slow progression and prevent complications. These clinics provide CKD self-management resources; however, there is limited information about what resources are being used by clinics. We undertook a survey of CKD clinics across Canada to identify self-management resources for adults aged 18 years and over with CKD categories 1 to 5 and not requiring dialysis or transplant.

Objective:

To identify and collate self-management resources (eg, strategies, tools, educational materials) used by CKD clinics across Canada for adults with CKD (categories 1 to 5, not requiring kidney replacement therapy).

Design:

Self-administered, semistructured electronic survey.

Setting, participants:

Canadian CKD clinics with previously identified contact information.

Methods and measurements:

We contacted 57 CKD English-speaking clinics and invited them to complete an online survey. The survey was available from October 2016 to January 2017 and consisted of 17 questions regarding the use and attributes of self-management resources including topic, delivery format, provider, target population, where the intervention was provided, and resource languages.

Results:

Forty-four clinics (77%) completed the survey. The most common topic was modality education provided in print format, by nurses. The most frequently used resource was the Kidney Foundation of Canada (KFOC) Living With Kidney Disease manual. We also identified that the majority of resources were available in English, targeting both patients and caregivers in the outpatient setting.

Limitations:

Our survey included Canadian adult CKD clinics, which may not be generalizability to other settings, such as care of people with CKD in primary care.

Conclusions:

Adult CKD clinics across Canada provide some similar resources, but also provide many different self-management resources. Even though some of the same resources were used by multiple clinics, the way they were provided them (ie, provider, location, delivery format) varied by the individual clinics. Knowledge of self-management resources currently provided in CKD clinics, along with synthesis of the literature and patient preferred self-management strategies, will inform the design and development of a novel self-management intervention that is patient-centric and adheres to the principles of self-management.
Xanthine oxidase inhibitors and sepsis
Authors: Ramos Maria Fátima de Paula , Monteiro de Barros Alceni do Carmo Morais , Razvickas Clara Versolato , Borges Fernanda T , Schor Nestor
Published: May 2018

Xanthine oxidase activation occurs in sepsis and results in the generation of uric acid (UrAc) and reactive oxygen species (ROS). We aimed to evaluate the effect of xanthine oxidase inhibitors (XOis) in rats stimulated with lipopolysaccharide (LPS). LPS (10 mg/kg) was administered intraperitoneally (i.p.) immediately after allopurinol (Alo, 2 mg/kg) or febuxostat (Feb, 1 mg/kg) every 24 h for 3 days. To increase UrAc levels, oxonic acid (Oxo) was administered by gavage (750 mg/kg per day) for 5 days. Animals were divided into the following 10 groups (n = 6 each): (1) Control, (2) Alo, (3) Feb, (4) LPS, (5) LPSAlo, (6) LPSFeb, (7) Oxo, (8) OxoLPS, (9) OxoLPSAlo, and (10) OxoLPSFeb. Feb with or without Oxo did not aggravate sepsis. LPS administration (with or without Oxo) significantly decreased the creatinine clearance (ClCr) in LPSAlo (60%, P < 0.01) versus LPS (44%, P < 0.05) and LPSFeb (35%, P < 0.05). Furthermore, a significant increase in mortality was observed with LPSAlo (28/34, 82%) compared to LPS treatment alone (10/16, 63%) and LPSFeb (11/17, 65%, P < 0.05). In addition, increased levels of thiobarbituric acid reactive substances (TBARS), tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 were observed at 72 h compared to the groups that received LPS and LPSFeb with or without Oxo. In this study, coadministration of Alo in LPS-induced experimental sepsis aggravated septic shock, leading to mortality, renal function impairment, and high ROS and proinflammatory IL levels. In contrast, administration of Feb did not potentiate sepsis, probably because it did not interfere with other metabolic events.
Peritoneal dialysis and colonic angiodysplasia bleeding: Are they connected?
Authors: Riva Hilary , Mangano Stefano , Minoretti Claudio , Giannini Olivier , Bonforte Giuseppe
Published: May 2018

Angiodysplasia is the most common gastrointestinal vascular lesion and a frequent cause of hidden bleeding. Here, we present the case of two patients with severe colonic angiodysplasia-related anemia on peritoneal dialysis. Several attempts to reduce gastrointestinal bleeding have been made without a definitive solution. For these patients, peritoneal dialysis was considered better than hemodialysis because anticoagulation is not needed. However, later the switch from peritoneal dialysis to hemodialysis has been made and an improvement of anemia, due to the cessation of the gastrointestinal bleeding, has been noted. Chronic kidney disease patients are at high risk of bleeding for several reasons. Our hypothesis is that filling the abdomen with peritoneal dialysis solution increases the peritoneal pressure, worsening the colonic venous blood flow and probably peritoneal dialysis with this mechanism sustains the angiodysplasia bleeding. Our conclusions are that peritoneal dialysis indication and peritoneal dialysis prescription should be evaluated with attention in patient with colonic angiodysplasia for its uncertain effect on bleeding.
Impact of Personality Disorder Cluster on Depression Outcomes Within Collaborative Care Management Model of Care
Authors: George Merit P. , Garrison Gregory M. , Merten Zachary , Heredia Dagoberto , Gonzales Cesar , Angstman Kurt B.
Published: May 2018

Background: Previous studies have suggested that having a comorbid personality disorder (PD) along with major depression is associated with poorer depression outcomes relative to those without comorbid PD. However, few studies have examined the influence of specific PD cluster types. The purpose of the current study is to compare depression outcomes between cluster A, cluster B, and cluster C PD patients treated within a collaborative care management (CCM), relative to CCM patients without a PD diagnosis. The overarching goal was to identify cluster types that might confer a worse clinical prognosis. Methods: This retrospective chart review study examined 2826 adult patients with depression enrolled in CCM. The cohort was divided into 4 groups based on the presence of a comorbid PD diagnosis (cluster A/nonspecified, cluster B, cluster C, or no PD). Baseline clinical and demographic variables, along with 6-month follow-up Patient Health Questionnaire–9 (PHQ-9) scores were obtained for all groups. Depression remission was defined as a PHQ-9 score <5 at 6 months, and persistent depressive symptoms (PDS) was defined as a PHQ-9 score ≥10 at 6 months. Adjusted odds ratios (AORs) were determined for both remission and PDS using logistic regression modeling for the 6-month PHQ-9 outcome, while retaining all study variables. Results: A total of 59 patients (2.1%) had a cluster A or nonspecified PD diagnosis, 122 patients (4.3%) had a cluster B diagnosis, 35 patients (1.2%) had a cluster C diagnosis, and 2610 patients (92.4%) did not have any PD diagnosis. The presence of a cluster A/nonspecified PD diagnosis was associated with a 62% lower likelihood of remission at 6 months (AOR = 0.38; 95% CI 0.20-0.70). The presence of a cluster B PD diagnosis was associated with a 71% lower likelihood of remission at 6 months (AOR = 0.29; 95% CI 0.18-0.47). Conversely, having a cluster C diagnosis was not associated with a significantly lower likelihood of remission at 6 months (AOR = 0.83; 95% CI 0.42-1.65). Increased odds of having PDS at 6-month follow-up were seen with cluster A/nonspecified PD patients (AOR = 3.35; 95% CI 1.92-5.84) as well as cluster B patients (AOR = 3.66; 95% CI 2.45-5.47). However, cluster C patents did not have significantly increased odds of experiencing persistent depressive symptoms at 6-month follow-up (AOR = 0.95; 95% CI 0.45-2.00). Conclusions: Out of the 3 clusters, the presence of a cluster B PD diagnosis was most significantly associated with poorer depression outcomes at 6-month follow-up, including reduced remission rates and increased risk for PDS. The cluster A/nonspecified PD group also showed poor outcomes; however, the heterogeneity of this subgroup with regard to PD features must be noted. The development of novel targeted interventions for at-risk clusters may be warranted in order to improve outcomes of these patients within the CCM model of care.
Software-Based Postoperative Communication With Patients Undergoing Spine Surgery
Authors: Goz Vadim , Anthony Christopher , Pugely Andrew , Lawrence Brandon , Spina Nicholas , Brodke Darrel , Spiker William Ryan
Published: May 2018

Study Design:

Observational study.

Objectives:

Perioperative patient anxiety is a major concern in orthopedic surgery. Mobile messaging applications have been used in a number of healthcare settings. The goal of this project is to develop a novel mobile messaging application aimed at decreasing perioperative patient anxiety in spine surgery patients.

Methods:

Postoperative recovery journals were collected from patients undergoing spine surgery. Journals were used as a framework to develop a software-messaging library. A subsequent cohort of patients received daily text messages with educational material regarding their recovery for 14 days after discharge from their operative admission. Patients ranked the usefulness of the survey on day 14; further feedback was obtained via interviews.

Results:

Nineteen postoperative recovery journals were collected and analyzed. Content regarding postoperative recovery was compiled. The pilot group consisted of 21 patients. Average rating of the application on a 1 to 5 scale with 5 being “very useful” was 4.57. Of the 12 patients available for postoperative interviews, 11 felt the content of the messages was relevant. Nine of 12 patients felt the application made it less likely for them to call clinic.

Conclusions:

The study presents a unique mobile phone messaging tool to offer patients support in the 2 weeks following spine surgery. The tool was felt to be useful by nearly all patients, had a high degree of patient engagement, and made the majority of patients less likely to call clinic.
Undergraduate Plastic Surgery Education: A National Survey of Clerkship Directors
Authors: Morzycki Alexander , LeBlanc Martin , Williams Jason
Published: May 2018

Background:

The delivery of medical education has received increased attention in recent years due to ongoing time and financial constraints faced by medical educators. Given the recent calls to action by the Carnegie Foundation and Health Canada, an evaluation of the specialty education sector is warranted. To our knowledge, this is the first assessment of the Canadian plastic surgery undergraduate clerkship curriculum.

Method:

An anonymous electronic survey was distributed to the plastic surgery clerkship directors of all Canadian medical schools (N = 17). The survey consisted of Likert scales and open-ended short answer questions. Themes included general clerkship information, exposure characteristics, teaching characteristics, resource characteristics, and challenges and barriers faced by clerkship directors.

Results:

Survey response rate was 88%. All responding schools offered a clerkship rotation of varying length in time (1-4 weeks). Students had the most exposure to breast surgery (100%) and general plastic surgery (100%) and the least exposure to aesthetic surgery (40%). Sixty percent of schools indicated the use of modern educational methods. Resources available for teaching students varied. Rotations received excellent feedback from medical students (67%). More than half of respondents would like to see a universal, nationally formulated plastic surgery clerkship curriculum.

Conclusion:

There is significant heterogeneity in the delivery of plastic surgery clerkship in Canada. A number of areas for improvement have been identified. We hope to establish a national plastic surgery clerkship task force to address the concerns raised here and improve the delivery of undergraduate medical education. Assessment of students based on a national curriculum may help in decision-making regarding plastic surgery program admissions by introducing an element of standardization to clerkship exposure.
Innervation of the Flexor Digitorum Profundus: A Systematic Review
Authors: Hwang Kun , Bang Seung Jun , Chung Sook Hyun
Published: May 2018

Purpose:

The aim of this study was to review the innervation of the flexor digitorum profundus (FDP).

Methods:

In PubMed and Scopus, terms (Flexor digitorum profundus OR FDP) AND (innervation OR nerve) were used, resulting in 233 and 281 papers, respectively. After excluding 142 duplicates, 73 abstracts were reviewed. Forty-seven abstracts were excluded, 26 full papers were reviewed, and 17 papers were analyzed.

Results:

In most cases (97.6%), the index FDP was innervated by the anterior interosseous nerve (AIN). Dual innervation from the AIN and ulnar nerve (UN) was observed in 2.4% of papers. In majority (76.8%), the middle FDP received dual innervation from the AIN and the UN. The rest was innervated by the AIN only (22.0%) or the UN only (1.2%). In most cases (85.4%), the ring FDP was innervated by the UN only. The rest (14.6%) received dual innervation from the AIN and the UN. In majority of cases (64.6%), the little FDP was innervated by the UN only. The rest (35.4%) received dual innervation from the AIN and the UN. The AIN entered the FDP at 107.63 (8.80) mm from the elbow, corresponding to 26.75% (2.17%) of the forearm length, measured proximally. The average number of AIN branches to the FDP was 2.27 (1.33). The average number of UN branches to the FDP was 1.37 (0.94). In 8.8% of limbs, a communicating branch supplied the FDP. Among the limbs with a communicating branch, 32.3% had branches supplying the FDP.

Conclusion:

The results of this study may be useful in managing nerve injury patients.
One Versus 2 Venous Anastomoses in Free Flap Surgery: A Systematic Review and Meta-Analysis
Authors: Matthews Jennifer L. K. , Alolabi Noor , Farrokhyar Forough , Voineskos Sophocles H.
Published: May 2018

Background:

The necessity of a second venous anastomosis in free flap surgery is controversial. The purpose of this systematic review is to determine whether venous flap failure and reoperation rates are lower when 2 venous anastomoses are performed. The secondary objective is to determine whether venous flap failure and reoperation rates are lower when the 2 veins are from 2 different drainage systems.

Methods:

A comprehensive search of the literature identified relevant studies. Investigators independently extracted data on rates of flap failure and reoperation secondary to venous congestion. A meta-analysis was performed; odds ratios (ORs) were pooled using a random-effects model and 95% confidence intervals (CIs).

Results:

Of 18 190 studies identified, 15 were included for analysis. The mean sample size was 287 patients (minimum = 102, maximum = 564). No statistically significant difference in venous flap failure was found when comparing 1 versus 2 venous anastomoses (OR: 1.35; 95% CI: 0.46-3.93). A significant decrease in reoperation rate due to venous congestion was shown (OR: 3.03; 95% CI: 1.64-5.58). The results favor using 2 veins from 2 different systems over veins from the same system (OR: 0.16; 95% CI: 0.02-1.27).

Conclusions:

There is low-quality evidence suggesting that the use of 2 venous anastomoses will lower the rate of reoperation due to venous congestion. There are insufficient data published to meaningfully compare outcomes of flaps with 2 venous anastomoses from different systems to flaps with anastomoses from the same system.
Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis
Authors: Johnson Jordan E. , Fullmer Joshua A. , Nielsen Chaseton M. , Johnson Joshua K. , Moorman Claude T.
Published: May 2018

Background:

There is an association between throwing activity and glenohumeral internal rotation deficit (GIRD). An 18° to 20° deficit has been adopted as the standard definition of pathological GIRD, but specific findings as to how GIRD relates to an injury are inconsistent.

Purpose:

To systematically review the literature to clarify the definition of GIRD diagnosis for adolescent and adult overhead athletes and to examine the association between GIRD and an increased risk of injuries in these athletes.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review of the literature was performed. Observational studies comparing glenohumeral internal rotation range of motion (ROM) in injured and uninjured overhead athletes were included for the meta-analysis. Studies of adolescent and adult athletes were analyzed separately. ROM was compared for the injured and uninjured groups, and a weighted mean GIRD was estimated. To account for potential heterogeneity across studies, both fixed- and random-effects models were used to calculate a standardized mean difference (SMD).

Results:

Nine studies of level 3 or 4 evidence were included. From these, 12 study groups (4 adolescent, 8 adult) comprising 819 overhead athletes (226 injured, 593 uninjured) were included in the meta-analysis. The estimated SMD in GIRD between the injured and uninjured groups was 0.46 (95% CI, 0.15-0.77; P < .01) for the overall sample. The between-group effect was larger for adults (SMD, 0.60 [95% CI, 0.18 to 1.02]; P < .01) than adolescents (SMD, 0.20 [95% CI, –0.24 to 0.63]; P = .13). The weighted mean GIRD for the injured and uninjured groups was 13.8° ± 5.6° and 9.6° ± 3.0°, respectively, which also differed by age group. Moderate study heterogeneity was observed ( I2 = 69.0%).

Conclusion:

Based on this systematic review, the current definition of pathological GIRD may be too conservative, and a distinct definition may be required for adolescent and adult athletes. While the results indicate a link between internal rotation deficits and upper extremity injuries in the overhead athlete, higher quality prospective research is needed to clarify the role that GIRD plays in future injuries to overhead athletes of various ages.
Conspicuous Reviewing: Affiliation with High-status Organizations as a Motivation for Writing Online Reviews
Authors: Kovács Balázs , Horwitz Suzanne
Published: May 2018

The vast amount of reviews available online presents a paradox: Why do reviewers spend hours writing them? Here we demonstrate in three studies that one reason people write online reviews is to bolster their public identity by conspicuously affiliating with high-status products or organizations. First, we conducted a set of surveys and found that participants are more likely to post online reviews of restaurants that are higher status, controlling for their familiarity and liking of the restaurant. Second, we found that individual differences in status consumption motivation predicted increased desire to post reviews. Third, we conducted an experiment and found that participants were more likely to review the higher versus lower status restaurant.
An Informatics Approach to Implement Support for Shared Decision Making for Primary Prevention Statin Therapy
Authors: Ye Siqin , Leppin Aaron L. , Chan Amy Y. , Chang Nancy , Moise Nathalie , Poghosyan Lusine , Montori Victor M. , Kronish Ian
Published: May 2018

Background. Shared decision making (SDM) is recommended prior to initiation of statin therapy for primary prevention but is underutilized. We designed an informatics decision-support tool to facilitate use of the Mayo Clinic Statin Choice decision aid at the point-of-care and evaluated its impact. Methods. Using an iterative approach, we designed and implemented a single-click decision-support tool embedded within the electronic health records (EHRs) to automate the calculation of 10-year atherosclerotic cardiovascular disease (ASCVD) risk and populate the Statin Choice decision aid. We surveyed primary care providers at two clinics regarding their attitudes about SDM before and after deployment of intervention, as well as their usage of and perceived competence regarding SDM for primary prevention statin therapy. Three-month web traffic to the Statin Choice website was calculated before and after deployment of the intervention. Results. Pre–post surveys were completed by 60 primary care providers (24 [40%] attending physicians and 36 [60%] housestaff physicians). After deployment of the EHR tool, respondents were more aware of the Statin Choice decision aid ( P < 0.001), reported being more competent regarding SDM ( P = 0.047), and reported using decision aids more often when considering statin initiation ( P = 0.043). There was no significant change in attitudes about SDM as measured through the Patient Provider Orientation Scale (pre 4.23 ± 0.40 v. post 4.16 ± 0.38, P = 0.11) and the SDM belief scale (pre 21.4 ± 2.1 v. post 21.1 ± 2.0, P = 0.35). Web-based usage rates for the Statin Choice decision aid increased from 3.4 to 5.2 per 1,000 outpatient clinic visits ( P = 0.002). Conclusions. Implementation of a point-of-care decision-support tool increased the usage of decision aids for primary prevention statin therapy. This effect does not appear to be mediated by any concomitant changes in physician attitude toward SDM.
Applying Metacognition Through Patient Encounters and Illness Scripts to Create a Conceptual Framework for Basic Science Integration, Storage, and Retrieval
Authors: Hennrikus Eileen F , Skolka Michael P , Hennrikus Nicholas
Published: May 2018

Problem:

Medical school curriculum continues to search for methods to develop a conceptual educational framework that promotes the storage, retrieval, transfer, and application of basic science to the human experience. To achieve this goal, we propose a metacognitive approach that integrates basic science with the humanistic and health system aspects of medical education.

Intervention:

During the week, via problem-based learning and lectures, first-year medical students were taught the basic science underlying a disease. Each Friday, a patient with the disease spoke to the class. Students then wrote illness scripts, which required them to metacognitively reflect not only on disease pathophysiology, complications, and treatments but also on the humanistic and health system issues revealed during the patient encounter. Evaluation of the intervention was conducted by measuring results on course exams and national board exams and analyzing free responses on the illness scripts and student course feedback. The course exams and National Board of Medical Examiners questions were divided into 3 categories: content covered in lecture, problem-based learning, or patient + illness script. Comparisons were made using Student t-test. Free responses were inductively analyzed using grounded theory methodology.

Context:

This curricular intervention was implemented during the first 13-week basic science course of medical school. The main objective of the course, Scientific Principles of Medicine, is to lay the scientific foundation for subsequent organ system courses. A total of 150 students were enrolled each year. We evaluated this intervention over 2 years, totaling 300 students.

Outcome:

Students scored significantly higher on illness script content compared to lecture content on the course exams (mean difference = 11.1, P = .006) and national board exams given in December (mean difference = 21.8, P = .0002) and June (mean difference = 12.7, P = .016). Themes extracted from students’ free responses included the following: relevance of basic science, humanistic themes of empathy, resilience, and the doctor-patient relationship, and systems themes of cost, barriers to care, and support systems.

Lessons learned:

A metacognitive approach to learning through the use of patient encounters and illness script reflections creates stronger conceptual frameworks for students to integrate, store, retain, and retrieve knowledge.
Policy Initiatives for Governance of Socially Sustainable Development: India’s Account of Incessant Endeavors
Authors: Dongre Anil P.
Published: May 2018

Societal development in a sustainable way is always treated as a better goal than the economic and political development of the society. Rather, it would be pertinent to say that without social development we cannot attend to the economic and political development of mankind. Keeping this thought alive, policy makers in India since the beginning of policy implementation after independence focused more rigorously on strategizing programs and plans for achieving socially sustainable development. This article aims to discuss policies, programs, and strategies formulated and implemented by the Government of India, subjected to social development. It elaborates on the constitutional provisions, planning endeavors, trends and analysis of the attribute of sustainable development such as education, employment policies and strategies, and gender equality and women empowering policies of the government.