bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding College Students’ Acceptance of Cloud Classrooms in Flipped Instruction: Integrating UTAUT and Connected Classroom Climate
Authors: Yang Harrison H. , Feng Lin , MacLeod Jason
Published: March 2018

Cloud classrooms provide many advantages in higher education. However, little is known about the social influence of peer relationships on students’ acceptance of cloud classrooms. This study utilized structural equation modeling to examine a model that integrates the Universal Theory of Acceptance and Use of Technology (UTAUT) and Connected Classroom Climate (CCC). Effort expectancy, social influence, and CCC were found to significantly impact cloud classroom acceptance by college students. Performance expectancy and facilitating conditions, however, did not affect acceptance. These findings contribute understanding that can support decision-making for the cloud classroom, with particular emphasis on increasing college students’ acceptance and use of such technology. Administrators, researchers, and practitioners can use this knowledge to guide their implementation, improvement, and assessment of cloud classrooms. In addition, beyond the cloud classroom, our identification of this relationship between CCC and students’ acceptance represents new knowledge to guide other contexts of online learning.
Atrazine affects craniofacial chondrogenesis and axial skeleton mineralization in zebrafish (Danio rerio)
Authors: Walker Benjamin S , Kramer Alexander G , Lassiter Christopher S
Published: March 2018

Atrazine is a commonly used herbicide that has previously been implicated as an endocrine-disrupting compound. Previous studies have shown that estrogenic endocrine-disrupting compounds affect the development of the heart, cartilage, and bone in zebrafish ( Danio rerio). To determine whether atrazine has effects similar to other endocrine disruptors, zebrafish embryos were treated with a range of atrazine concentrations. Atrazine treatment at a low concentration of 0.1 µM resulted in significant differences in craniofacial cartilage elements, while concentrations ≥1 µM led to decreased survival and increased heart rates. Fish treated with ≥1 µM atrazine also developed with delayed vertebrae mineralization. Higher concentrations of atrazine caused gross craniofacial defects and decreased hatching rates. Further studies into the molecular pathways disrupted in these developmental processes could shed light on a link between endocrine-disrupting compounds and developmental abnormalities.
Large Vessel Arteriopathy After Cranial Radiation Therapy in Pediatric Brain Tumor Survivors
Authors: Nordstrom Matthew , Felton Erin , Sear Katherine , Tamrazi Benita , Torkildson Joseph , Gauvain Karen , Haas-Kogan Daphne A. , Chen Josephine , Buono Benedict Del , Banerjee Anuradha , Samuel David , Saloner David , Tian Bing , Roddy Erika , Hess Christopher , Fullerton Heather , Mueller Sabine
Published: March 2018

Among childhood cancer survivors, increased stroke risk after cranial radiation therapy may be caused by radiation-induced arteriopathy, but limited data exist to support this hypothesis. Herein, we assess the timing and presence of cerebral arteriopathy identified by magnetic resonance angiography (MRA) after cranial radiation therapy in childhood brain tumor survivors. In a cohort of 115 pediatric brain tumor survivors, we performed chart abstraction and prospective annual follow-up to assess the presence of large vessel cerebral arteriopathy by MRA. We identified 10 patients with cerebral arteriopathy. The cumulative incidence of arteriopathy 5 years post–cranial radiation therapy was 5.4% (CI 0.6%-10%) and 10 years was 16% (CI 4.6%-26%). One patient had an arterial ischemic stroke 2.4 years post–cranial radiation therapy in the distribution of a radiation-induced stenotic artery. We conclude that large vessel arteriopathies can occur within a few years of cranial radiation therapy and can become apparent on MRA in under a year.
Soleus H-Reflex and Its Modulation With Vibration in Idiopathic Toe Walkers and Typically Developing Children
Authors: Rossi Essi Marttinen , Nevalainen Päivi , Mäenpää Helena , Lauronen Leena
Published: March 2018

Idiopathic toe walking is a relatively common developmental condition often leading to secondary problems such as pain and muscle contractures in the lower extremities. The cause of idiopathic toe walking is unknown, which hinders the development of treatment strategies. To test whether children with idiopathic toe walking have functional alterations in their spinal motor circuits, we studied the properties of the soleus H-reflex and its modulation with vibration in 26 idiopathic toe walkers and 16 typically developing children. At the group level, the H-reflex properties did not differ, but at the individual level, in 7 of 25 idiopathic toe walkers, some of the H-reflex parameters fell out of normal limits of typically developing children. However, the H-reflex was suppressed by vibration to the Achilles tendon similarly in both the idiopathic toe walkers and typically developing children. In conclusion, idiopathic toe walking in some children can be associated with functional alterations in their spinal motor circuits.
Contributions to Depressed Affect in Latina Women: Examining the Effectiveness of the Moms’ Empowerment Program
Authors: Stein Sara F. , Grogan-Kaylor Andrew C. , Galano Maria M. , Clark Hannah M. , Graham-Bermann Sandra A.
Published: March 2018

Intimate partner violence (IPV) is a significant social and public health problem that includes physical violence, sexual violence, threats of physical or sexual violence, stalking, and psychological aggression by an intimate partner. Estimates suggest that 35% of Latinas living in the United States experience IPV in their lifetime, with known severe negative outcomes. One mental health consequence of concern is depression, which disproportionately affects IPV-exposed Latinas. The present study tested the effectiveness of the Moms’ Empowerment Program (MEP), a culturally adapted intervention to reduce depressive symptoms among IPV-exposed Spanish-speaking Latina mothers. Additional psychosocial predictors of levels of depressed affect over time are examined, including levels of post-traumatic stress, IPV exposure, positive parenting, parental acceptance of children’s negative emotions, and maternal employment. Participants ( N = 72) were assigned to a treatment or a wait-list comparison condition, and those in the treatment group completed a 10-week group intervention addressing the unique problems associated with IPV exposure, mental health, and parenting among Spanish-speaking Latinas. Results of multilevel modeling revealed that participation in the MEP was associated with significant reductions in depressed affect. Lower levels of post-traumatic stress and higher levels of positive parenting, maternal acceptance of children’s negative emotions, and maternal employment predicted lower levels of depressed affect. The amount of total IPV exposure was not significantly associated with the extent of depressed affect. The MEP represents a culturally tailored, evidence-based intervention to reduce depressed affect among Spanish-speaking Latinas. The clinical implications of the additional predictors of levels of depressed affect are discussed.
The Relevance of Victimization Experiences for Predicting the Development of Threat Symptoms During Adolescence and Early Adulthood
Authors: Wojciechowski Thomas W.
Published: March 2018

The “threat” portion of the threat/control override symptom constellation is characterized by the belief by an individual that others seek to do them harm. There has yet to be an examination of the link between perceived threat symptomatology and the experience of victimization, despite the fact that both constructs are linked to the perpetration of violent behavior. Furthermore, there has yet to be research which examines the heterogeneity in developmental patterns of threat symptomatology. The present research utilized the Pathways to Desistance data to model the developmental heterogeneity in perceived threat symptomatology across adolescence and early adulthood using group-based trajectory modeling. A series of multinomial logistic regression models were then estimated to examine the relevance of victimization experiences for predicting trajectory group assignment. A five-group model of development during adolescence and early adulthood best fit the threat symptom data. Victimization experienced prior to age 16 predicted assignment to all groups in the model characterized by presentation of threat symptoms at some point during the study. Victimization experienced between ages 16 and 23 predicted assignment to the High Chronic group and marginally predicted assignment to the Accelerating group. These results indicate that victimization does indeed predict the presentation of perceived threat symptomatology. This indicates that presentation of threat symptoms may be indicative of a history of victimization. Proper screening of those presenting threat symptoms may help to better orient treatment plans for modalities centered on victimization experiences. Future research should investigate the possibility that threat symptoms mediate the relationship between victimization and violent behavior.
Medical Management of Endocarditis Caused by Stenotrophomonas maltophilia: A Case Report
Authors: Shah Sunish , King Madeline , Rose Lucia
Published: March 2018

A 44-year-old female was found to be systemically ill at dialysis and admitted to the hospital. Days into the hospitalization, her blood cultures from dialysis were positive with Stenotrophomonas maltophilia bacteremia with a levofloxacin minimum inhibitory concentration (MIC) of 1. She was discharged on ciprofloxacin 500 mg orally (PO) daily on hospital day 2 to complete a 14-day course. Weeks later, she was again found to be bacteremic at dialysis and sent back to the hospital. She was started on empiric antibiotics upon admission until further identification. Blood cultures again revealed S. maltophilia with a levofloxacin MIC of 32. Antibiotics were tailored to trimethoprim/sulfamethoxazole (TMP-SMX) until susceptibilities for additional agents were available. Further workup revealed mitral valve endocarditis. She was subsequently discharged on both minocycline 100 mg PO every 12 hours and TMP-SMX 1 DS PO daily with a planned duration of 6 weeks. Due to ongoing readmissions for hyperkalemia, TMP-SMX was discontinued and her regimen was modified to ceftazidime 1 g intravenously (IV) after HD plus minocycline 100 mg PO every 12 hours. She was deemed clinically and microbiologically cleared based on follow-up assessments. To our knowledge, this is the first case of S. maltophilia endocarditis treated with oral minocycline in combination with another antibiotic.
Validation of a thermo- and a hydromechanical model of a brake system for high-speed rail applications
Authors: Petry Matthias , Lamjahdy Abdelkrim , Jawad Ali , Markert Bernd , Murrenhoff Hubertus
Published: March 2018

This research deals with a numerical and experimental investigation of the vibratory frequency and the thermal response of a railway brake disc and pad under varying conditions. Railway brake systems play a vital role in passenger safety and comfort. The performance of disc brakes with regard to the dynamic effects like brake torque oscillations and brake judder depends on the contact properties and wear surfaces. Brake fading occurs due to accumulated frictional heat thereby reducing the stopping power. For an improved understanding of the complex processes of a brake system during long-term braking, a comprehensive numerical investigation is performed initially using the finite element software Abaqus for a thermomechanical and modal analysis. While the thermomechanical analysis based on the calculations of frictional heat is used to investigate the increase of temperature during braking, the contact pressure is a crucial parameter that influences the distribution of temperature both on the brake disc and on the pads. The modal analysis is used to investigate the frequency behaviour of the vibrations. Then, a simulation model of a self-energised electrohydraulic brake provides the results of brake force oscillations with regard to the observed topologies of the brake disc’s wear surface, which is measured at a full-scale test rig by an enlarged experimental set-up. In addition to the dynamic brake force, the set-up contains the online measurement of the side face run-out and the temperature of one side of a ventilated brake disc. By comparing the results of our experimental and numerical investigations, the simulation models are validated. Future research should focus on a thermomechanical analysis that considers heating, cooling, and the wear effects. A detailed implementation of the contact pressure distribution between the brake pads and disc can lead to a more precise prediction of brake torque oscillations. The achieved results can be used to improve riding comfort and resolve safety critical problems in high-speed trains.
Assessing ice margin fluctuations on differing timescales: Chronological constraints from Sermeq Kujatdleq and Nordenskiöld Gletscher, central West Greenland
Authors: Kelley Samuel E , Briner Jason P , O’Hara Sandy L
Published: March 2018

The observational record of ice margin position reveals asynchrony in both the timing and magnitude of Greenland Ice Sheet (GrIS) margin fluctuations and illustrates the complex reactions of ice sheets to climatic perturbations. In this study, we reconstruct the timing and pattern of middle- and late-Holocene GrIS margin fluctuations at two locations, ~190 km apart, in central West Greenland using radiocarbon-dated sediment cores from proglacial-threshold lakes. Our results demonstrate that deglaciation occurs at both sites during the early Holocene, with the ice sheet remaining in a smaller-than-present ice margin configuration until ~500 years ago when it readvanced into lake catchments at both sites. At our northern site, Sermeq Kujatdleq, the late-Holocene advance of the GrIS approached maximum position during the past 280 years, with the culmination of the advance occurring at AD 1992–1994, and modern retreat was underway by AD 1998–2001. In contrast, field and observational evidence suggest that the GrIS at our southern site, Nordenskiöld Gletscher, has been advancing or stable throughout the 20th century. These results, in conjunction with previous work in the region, highlight the asynchronous nature of late-Holocene advances and subsequent modern retreat, implying that local variability, such as ice velocity or ice dynamics, is responsible for modulating ice margin response to changes in climate on these decadal to centennial timescales. Additional high-resolution records of past ice sheet fluctuations are needed to inform and more accurately constrain our predictions of future cryosphere response to changes in climate.
Internal wars in history: Triggered by natural disasters or socio-ecological catastrophes?
Authors: Lee Harry F
Published: March 2018

Chaotic events that might be regarded as proximate causes in triggering war have rarely been considered in the large- N quantitative studies of historical warfare. Furthermore, it has not been fully determined which types of chaotic events, natural disasters or socio-ecological catastrophes, are more influential in modulating the likelihood of wars. This study is based on the incidents of 5368 natural disasters, 1478 famines, 5700 epidemics, 456 nomadic invasions, and 1315 internal wars in the agricultural region (including wheat and rice regions) of China in AD 1470–1911, together with Poisson regression and Granger Causality analyses, to explore the catalytic effect of natural disasters and socio-ecological catastrophes in modulating the likelihood of wars in history. The comparison between the wheat and the rice regions is focused. This is the first large- N inter-regional quantitative analysis on this topic. Our statistical results show that, in general, socio-ecological catastrophes are the proximate triggers of internal wars. Specifically, internal wars are triggered by epidemics in the wheat region, and they are ignited by famines in the rice region in historic China. In addition, internal wars in the two agro-ecological zones are revealed to be context-dependent. Also, conceptual models about the synergy of natural disasters and socio-ecological catastrophes in causing internal wars in the wheat and the rice regions are proposed, respectively. The above findings supplement the Malthusian theory by demonstrating the inter-connection among various mortality factors, which has rarely been examined empirically in academia. Moving beyond historic China, researchers are encouraged to boil down war data in other parts of the world by geographic regions in the course of their statistical analysis to examine each region individually in follow-up studies.
Why librarians can’t fight fake news
Authors: Sullivan M. Connor
Published: March 2018

In the wake of the panic over fake news that followed the 2016 US presidential election, librarians and other information professionals are being urged to “take leadership in the current crisis” (Jacobson, 2017: 24). The response from the profession has been to reaffirm the core values of librarianship and to hold up traditional services as a means for combating misinformation. The problem is that these solutions are offered in the absence of a full understanding of the real danger of misinformation, which is “not just [that] misinformation is ‘out there,’” but “what misinformation does to our mind” (Ecker, 2015: 22). Misinformation research in other fields directly challenges the solutions proposed by library professionals and casts doubts on their underlying assumptions. This article provides an overview of the library and information science approach to misinformation in the United States, discusses the shortcomings of that approach, and points to possible next steps for remedying the problem.
Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team
Authors: Egede-Nissen Veslemøy , Sellevold Gerd Sylvi , Jakobsen Rita , Sørlie Venke
Published: March 2018

Background:

The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges.

Purpose:

The aim is to explore minority healthcare providers, trained nurses and nurses’ assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context.

Research method:

The study has a qualitative design, using narrative interviews, and a phenomenological–hermeneutic analysis method to explore the experiences of challenges in dementia care.

Ethical considerations:

The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services.

Participation and research context:

Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit.

Findings:

The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness.

Discussion:

The findings are discussed considering Løgstrup’s ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood.

Conclusion:

The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.
Social protests, discontent and politics in southern and eastern Europe
Authors: Campos Lima Maria da Paz , Martín Artiles Antonio
Published: March 2018

Taking into consideration the debate on the role of social movements and of trade unions in organising social protests, in the light of contentious and conventional politics, this article examines participation in demonstrations in Europe and the political attitudes of the participants. The article uses data from the European Social Survey to examine the differences and similarities between European countries in respect of mobilisation levels over the past decade, arguing that distrust and dissatisfaction with political institutions might be a necessary condition but not a sufficient one to justify resorting to contentious politics. The article reveals the contrasts between the levels of mobilisation in southern European countries (Portugal and Spain) and Central and Eastern European (CEE) countries (Hungary and Poland) and examines the patterns and (re)configuration of the profile of the protestors in the 2002–2014 period.
Vietnamese American Women’s Beliefs and Perceptions About Breast Cancer and Breast Cancer Screening: A Community-Based Participatory Study
Authors: Nguyen-Truong Connie Kim Yen , Nguyen Kim Quy Vo , Nguyen Thai Hien , Le Tuong Vy , Truong Anthony My , Rodela Keara
Published: March 2018

Introduction: Although breast cancer (BC) rates are declining in White non-Hispanic American women, they are increasing among Vietnamese American women (VAW) at 1.2% (95% confidence interval [0.1, 2.2]) per year. BC screening rates (64%) are below the national rates (81.1%). This article explores VAW’s beliefs about BC and screening. Method: Using community-based participatory qualitative descriptive methods, 40 VAW were recruited from Oregon, and four focus groups were conducted. A directed content analysis was used. Results: Main themes were as follows: deferred to a health care provider or relying on self-detection and symptoms; fear of BC versus fear of procedural pain; limited knowledge; motivation by observing others’ journey in BC death or survivorship; body image concern; “living carefree,” “good fortune—having good health”; and coverage for a mammogram expense means health care access. Discussion: Tailored interventions should address mammogram knowledge, fear, erroneous information, body image, fate and luck, and promoting access.
Simulated Provocations: A Hypermedia Radio Theatre for Reflection on Classroom Management
Authors: Arvola Mattias , Samuelsson Marcus , Nordvall Mathias , Ragnemalm Eva L.
Published: March 2018

Background. Learning to manage a classroom is a difficult but important part of teacher education. Earlier research on simulations for learning classroom management has highlighted the difficulty of supporting reflection.

Purpose. This case study explores and evaluates the design of a simulation for student teachers’ reflection on classroom management.

Design. The design process resulted in the scenario-based SIMPROV simulation, which was made in the form of a hypermedia radio theatre that students go through in pairs or triads. Authoritarian, authoritative, democratic, and compliant leadership styles were built into the choices student teachers made.

Evaluation. The simulation was evaluated in two courses where the participants’ level of reflection and perceived knowledge improvement was measured using a questionnaire. Forty-three first-year student teachers, 48 third-year student teachers, and 38 of the student teachers’ mentors participated in the evaluation.

Results. The results indicate that participants engaged in reflection and understanding to a high degree, and only to a low degree in critical reflection or habitual action.

Conclusions. The conclusions are that the scenario-based simulation designed as a hypermedia radio theatre supported knowledge improvement, understanding, and reflection and that social interaction during and after simulation sessions was an important feature.
Survival, Signaling, and Security: Foster Carers’ and Residential Carers’ Accounts of Self-Harming Practices Among Children and Young People in Care
Authors: Evans Rhiannon E.
Published: March 2018

Research on clinicians’ interpretations of self-harming practices has shown that they can often be negative. To date there has been limited consideration of other professionals’ narratives, notably those working in social care. This article presents focus group and interview data generated with foster carers ( n = 15) and residential carers ( n = 15) to explore the symbolic meanings ascribed to self-harm among the children and young people they care for. Three repertoires of interpretation are presented: survival, which conceives self-harm as a mechanism for redefining the identity of “looked-after”; signaling, which understands self-harm as a communicative tool for the expression of emotion; and security, which sees self-harming practices as testing the authenticity and safety of the caring relationship. Through their focus on sociocultural narratives, carers position themselves as experts on self-harm due to their intimacy with young people’s social worlds. This construction potentially creates distance from health professionals, which is problematic given the current privileging of interprofessional working.
When Your Pregnancy Echoes Your Illness: Transition to Motherhood With Inflammatory Bowel Disease
Authors: Ghorayeb Jihane , Branney Peter , Selinger Christian P. , Madill Anna
Published: March 2018

Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept— Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.
“Like Every Normal Person?!” The Paradoxical Effect of Aging With Schizophrenia
Authors: Mushkin Peli , Band-Winterstein Tova , Avieli Hila
Published: March 2018

Studies on aging with schizophrenia have focused mainly on the adversities of aging with mental illness. The present study, however, examined the subjective experience of well-being among individuals with schizophrenia. Taking a phenomenological reflective life-world approach, in-depth, semistructured interviews with 18 aging individuals with schizophrenia were thematically analyzed. Four main themes emerged: (a) “I love the pills . . . they are very helpful”: A balanced course of the illness as a basis for well-being in old age; (b) “I’m going to have my own exhibition at the museum”: Self-fulfillment as promoting well-being; (c) “It’s just like a family here”: Experiencing a sense of belonging; and (d) “I live like everyone else”: Aging as an opportunity for normalization. Alongside hardship, the participants perceived old age as a “window of opportunity,” enabling the fulfillment of lifelong desires for a social life, acceptance, and a satisfying occupation. Implications regarding interventions with this unique population are discussed.
Comparative Analysis of Three-Dimensional Nasal Shape of Casts from Patients With Unilateral Cleft Lip and Palate Treated at Two Institutions Following Rotation Advancement Only (Iowa) or Nasoalveolar Molding and Rotation Advancement in Conjunction With Primary Rhinoplasty (New York)
Authors: Hosseinian Banafsheh , Rubin Marcie S. , Clouston Sean A. P. , Almaidhan Asma , Shetye Pradip R. , Cutting Court B. , Grayson Barry H.
Published: March 2018

Objectives:

To compare 3-dimensional nasal symmetry in patients with UCLP who had either rotation advancement alone or nasoalveolar molding (NAM) followed by rotation advancement in conjunction with primary nasal repair.

Design:

Pilot retrospective cohort study.

Materials and Methods:

Nasal casts of 23 patients with UCLP from 2 institutions were analyzed; 12 in the rotation advancement only group (Iowa) and 11 in the NAM, rotation advancement with primary nasal repair group (New York). Casts from patients aged 6 to 18 years were scanned using the 3Shape scanner and 3-dimensional analysis of nasal symmetry performed using 3dMD Vultus software, Version 2507, 3dMD, Atlanta, GA. Cleft and noncleft side columellar height, nasal dome height, alar base width, and nasal projection were linearly measured. Inter- and intragroup analyses were performed using t tests and paired t tests as appropriate.

Results:

A statistically significant difference in mean-scaled 3-dimensional asymmetry index was found between groups with group 1 having a larger measure of asymmetry (4.69 cm3) than group 2 (2.56 cm3; P = .02). Intergroup analysis performed on the most sensitive linear measure, alar base width, revealed significantly less asymmetry on average in group 2 than in group 1 ( P = .013).

Conclusion:

This study suggests the NAM followed by rotation advancement in conjunction with primary nasal repair approach may result in less nasal asymmetry compared to rotation advancement alone.
Modifications in Presurgical Nasoalveolar Molding Treatment of Bilateral Cleft Lip and Palate Patients With Severely Malpositioned Premaxillae
Authors: Titiz Serap , Aras Isil
Published: March 2018

Objective:

The aim of this study was to evaluate a modified presurgical nasoalveolar molding (PNAM) treatment for patients with bilateral cleft lip and palate (BCLP) with severely malpositioned premaxillae.

Setting:

This study was conducted at the Faculty of Dentistry, Department of Orthodontics, Ege University, Bornova, Izmir, Turkey.

Method:

Retention arms were manufactured using a mold that we developed, and prefabricated retraction apparatuses were applied to the plaster model obtained from the patient. During the acrylic curing process, the flanges of the appliances were elongated into the sulcus without including the premaxilla. The premaxilla was aligned with the midline with an elastic band system, and the lip hanger was constructed with 0.023-in stainless steel wire. Elastic bands were stretched between the retraction apparatuses and the lip hanger based on the desired force. Nasal stents were added to the retention arms when the cleft width was reduced to less than 6 mm.

Conclusion:

The modified PNAM treatment enabled faster derotation of the premaxilla and earlier initiation of retraction. The prefabricated retraction apparatus and retention arm provided efficient PNAM for patients with BCLP.
Incidence of Drug Interactions Identified by Clinical Pharmacists in Veterans Initiating Treatment for Chronic Hepatitis C Infection
Authors: Ottman Andreina A. , Townsend Mary L. , Hashem Mohamed G. , DiMondi Vincent P. , Britt Rachel B.
Published: March 2018

Background: Many direct-acting antivirals (DAAs) have drug-drug interactions (DDIs) with the potential to affect efficacy and safety. Objective: To describe the incidence and severity of DDIs with DAAs identified by the hepatitis C virus (HCV) clinical pharmacist within a Veterans Affairs health care system. Methods: This single-center, retrospective cohort study evaluated patients with HCV treated with DAA therapy. Primary end points included the total number of identified DDIs, percentage of patients with at least 1 DDI, mean number of DDIs per patient, and the number of DDIs by severity category. Additional end points included characterization of interacting drugs, clinical consequence of interaction, intervention recommended, acceptance rate of actionable recommendations, and achievement of sustained virological response 12 weeks after treatment (SVR12). Results: A total of 300 patients were included. There were 554 identified DDIs, and 80.3% of patients had at least 1 DDI, with an average of 1.85 DDIs per patient; 76% of the DDIs identified were categorized as either a potentially clinically significant or critical interaction. The most common DDIs involved acid suppression agents (20%). Patient monitoring was the most commonly recommended intervention (59%), followed by dose modification of the interacting medication (30%). There was no difference in SVR12 between patients with at least 1 DDI compared with those with no DDIs (94.8% vs 95.8%; P = 0.73). There were a total of 227 actionable recommendations, with an acceptance rate of 84.1%. Conclusions: This study suggests that DDIs are prevalent among patients treated with DAAs for HCV. A HCV clinical pharmacist can help optimize patient care by identifying DDIs and recommending interventions to providers.
Mental Health Among Help-Seeking Urban Women: The Relationships Between Adverse Childhood Experiences, Sexual Abuse, and Suicidality
Authors: Hamdullahpur Kevin , Jacobs Kahá:wi J. , Gill Kathryn J.
Published: March 2018

Adverse childhood experiences (ACEs) and adult mental health were explored in a sample of urban Aboriginal ( n = 83) and non-Aboriginal ( n = 89) women. Childhood sexual abuse (CSA) was associated with negative home environments, teenage pregnancy, lifetime suicide attempts, and treatment seeking. Aboriginal women with CSA witnessed higher levels of physical/sexual abuse of family members. The severity of current psychological distress was associated with a history of childhood neglect. The results indicate that CSA rarely occurs in isolation, and that multiple ACEs are strongly associated with suicide attempts and treatment seeking in adulthood. Future studies should focus on the role of CSA in suicidality, as well as familial, community, and cultural protective factors.
Decreasing dialysis catheter rates by creating a multidisciplinary dialysis access program
Authors: Rosenberry Patricia M , Niederhaus Silke V , Schweitzer Eugene J , Leeser David B
Published: March 2018

Introduction:

Centers for Medicare and Medicaid Services have determined that chronic dialysis units should have <12% of their patients utilizing central venous catheters for hemodialysis treatments. On the Eastern Shore of Maryland, the central venous catheter rates in the dialysis units averaged >45%. A multidisciplinary program was established with goals of decreasing catheter rates in order to decrease central line–associated bloodstream infections, decrease mortality associated with central line–associated bloodstream infection, decrease hospital days, and provide savings to the healthcare system.

Methods:

We collected the catheter rates within three dialysis centers served over a 5-year period. Using published data surrounding the incidence and related costs of central line–associated bloodstream infection and mortality per catheter day, the number of central line–associated bloodstream infection events, the costs, and the related mortality could be determined prior to and after the initiation of the dialysis access program.

Results:

An organized dialysis access program resulted in a 82% decrease in the number of central venous catheter days which lead to a concurrent reduction in central line–associated bloodstream infection and deaths. As a result of creating an access program, central venous catheter rates decreased from an average rate of 45% to 8%. The cost savings related to the program was calculated to be over US$5 million. The decrease in the number of mortalities is estimated to be between 13 and 27 patients.

Conclusion:

We conclude that a formalized access program decreases catheter rates, central line–associated bloodstream infection, and the resultant hospitalizations, mortality, and costs. Areas with high hemodialysis catheter rates should develop access programs to better serve their patient population.
The Diving Bell and the Butterfly Revisited: A Fatal Case of Locked-in Syndrome in a Man With Epstein-Barr Virus–Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
Authors: Poston Jacqueline N , Dorer Russell , Aboulafia David M
Published: March 2018

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare variant of DLBCL. The natural history of this subtype is poorly understood. Incomplete literature in the era of rituximab suggests that patients with EBV-positive DLBCL have similar outcomes to patients with EBV-negative DLBCL when treated with rituximab and anthracycline-based chemotherapy regimens; however, there are few prospective studies on this subtype and little is known about the risk of central nervous system (CNS) relapse with EBV-positive DLBCL. Herein, we describe the case of a 64-year-old man who presented with stage IIA EBV-positive DLBCL. His international age-adjusted International Prognostic Index (IPI) was 2. He achieved a complete response to 6 cycles of rituximab combined with chemotherapy consisting of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin. After 10 days of completion of chemotherapy, he had a fulminant neurologic decline manifested by diffuse weakness followed by a locked-in syndrome; he could only communicate by moving his eyes. He had been deemed at low risk for CNS relapse based on the application of the recently developed CNS-IPI score of 2 (1 point for age >60 years and 1 point for lactate dehydrogenase higher than normal) and consequently did not receive therapy for CNS prophylaxis. A limited postmortem autopsy revealed extensive lymphoma throughout the brain, particularly in the deep basal nuclei, midbrain, pons, centrum semiovale, and corpus callosum. This presentation of CNS relapse is rare and has not yet been described in EBV-positive DLBCL. We discuss some of the unique aspects of this case including the clinical manifestations of locked-in syndrome and its differential diagnosis and the uncertain benefits of CNS prophylaxis in this clinical context.
Portals between worlds: A study of the experiences of children aged 7–11 years from primary schools in Wales making music outdoors
Authors: Adams Dylan , Beauchamp Gary
Published: March 2018

There has been increasing interest in the educational value of outdoor learning around the world and in the United Kingdom. This is reflected in the statutory curricula of each country. At present, however, there has been little research into the potential of music-making in the outdoors. This study investigated how changing the physical location of learners’ music-making to outdoor environments impacted on children aged 7–11 years. Seven classes of children and their teachers, from six different primary schools, created music for a ceremonial performance in various outdoor locations in Wales. These activities were video-recorded and after their musical performances, the children were interviewed using video-stimulated reflective dialogue (VSRD) in semi-structured interviews. Their teachers also took part in semi-structured interviews, but without the use of VSRD. The resultant iterative analysis of data revealed four overlapping and interwoven themes: freedom, emotion, senses and agency. In addition, the interviews revealed that the combination of the setting (including the ritual structure of the activity), the move from the school setting and the four themes (emotion, senses, freedom, agency) contribute to create a ‘vortex’ effect, potentially drawing the children into a state of liminality and peak experience, before achieving a state of calm focus. All of these factors are summed up in a tentative model of the impact of music-making outdoors with children aged 7–11 years.
Challenged and changed: Quiet ego and posttraumatic growth in mothers raising children with autism spectrum disorder
Authors: Wayment Heidi A , Al-Kire Rosemary , Brookshire Kristina
Published: March 2018

Posttraumatic growth theory posits that when life circumstances are perceived as stressful, secondary appraisal processes can be recruited in ways to facilitate both coping efforts and personal growth. Using a mixed-methods approach, we found mothers’ most challenging experiences involved child behavior (e.g. aggression, communication, and social issues) and psychosocial impacts (e.g. lack of social support, perceived judgment of others, perceived loss, and personal distress). Descriptions of most rewarding experiences reflect posttraumatic growth frameworks including constructive perceptions about themselves, life, and their relationships as well as evidence for what Maercker and Zoellner call illusory types of posttraumatic growth. Quantitative data were subjected to a hierarchical regression analysis for self-reported posttraumatic growth and included mothers’ demographics, child functioning, and psychosocial measures. As predicted, posttraumatic growth was positively associated with social support from mothers’ most important network member and quiet ego characteristics, a type of eudaimonic motivation. Contrary to expectation, neither autism spectrum disorder–related rumination nor time since diagnosis (or their interaction) was associated with posttraumatic growth. Discussion focuses on the practical implications of our findings that posttraumatic growth-related coping includes both constructive and illusory forms and the importance of social support and eudaimonic motivation in facilitating positive forms of secondary coping.
Temporal trend and regional disparity in osteoarthritis hospitalisations in Sweden 1998–2015
Authors: Kiadaliri Aliasghar A , Rinaldi Giulia , Lohmander L Stefan , Petersson Ingemar F , Englund Martin
Published: March 2018

Aim: This study investigated time trend and regional disparities in hospitalisations due to osteoarthritis (OA) among people aged ≥20 years in Sweden from 1998 through 2015. Methods: National and regional data on hospital admissions with a primary diagnosis of OA were collected from the National Patient Register. The absolute and relative regional disparities were assessed using the absolute weighted mean difference from overall mean and the index of disparity. We applied joinpoint regression for temporal trend analysis of hospitalisations and the Mann–Kendall trend test for disparity measures. Changes in number of OA hospitalisations between 1998–2000 and 2013–2015 were analysed using two counterfactual scenarios. Results: During 1998–2015, OA hospitalisations constituted 2.0% of all hospitalisations, with higher proportions among women (58.7%) and those aged 70–74 years (18.0%). The age-standardised rate of OA hospitalisation and its proportions from all and musculoskeletal disorders hospitalisations rose, on average, by >2.0% per year during the study period. OA hospitalisation rates rose statistically significantly in all age groups except for the youngest and oldest age groups. The proportion of hip OA from all OA hospitalisations declined, while the opposite was observed for knee OA. The relative regional disparities declined in men, and the absolute regional disparities rose among women over time. The population growth and ageing could explain only about one third of the observed increases in the absolute number of OA hospitalisations between 1998–2000 and 2013–2015. Conclusions: OA hospitalisations have increased substantially, suggesting the need to improve OA prevention and primary-care management in Sweden.
Mitigating noise-induced hearing loss after blast injury
Authors: Muzaffar SJ , Orr L , Rickard RF , Coulson CJ , Irving RM
Published: March 2018

Introduction

Whilst hearing injuries are not life threatening they may have a profound impact on the victim’s ability to understand and interact with the world around them. Noise-induced hearing loss is a common occupational injury and hearing impairment as a consequence of noise and blast exposure remains the most common injury in both war and peace for military personnel. Health and Safety legislation has made an impact and in the future innovative approaches to mitigate against acoustic injury sustained in the work place will be fundamental. For the Armed Forces, noise exposure during conflict is unpredictable. Furthermore, recent events in the UK and elsewhere have highlighted the potential civilian impact of blast injuries on hearing in the acute setting. No well-established protocol for the management of acute, blast-induced hearing injury currently exists.

Methods

Narrative review is supported by electronic literature searches of PubMed, Embase and the Cochrane Library. Synthesis of published literature and production of flow charts for the acute setting are part of the Emergency Preparedness, Resilience and Response programme.

Results

Whilst there is a lack of high-quality randomised controlled trials, there are a number of studies that may inform our choice of acute management. Animal studies of acute acoustic trauma have shown the potential protective effects of corticosteroids. Human data may be extrapolated from sudden onset sensorineural hearing loss where again there is evidence for the use of corticosteroids. Less certainty exists around the use of other treatments including antioxidants. Intratympanic administration of corticosteroids may be superior to oral administration, particularly in the salvage setting. No evidence exists specifically pertaining to the paediatric population.

Conclusion

Prompt identification of any hearing deficit followed by administration of glucocorticoids either orally or via intratympanic preparations is the mainstay of management. Further research is needed to identify the optimum acute management.
Early literacy research, 2006–2015: A decade of measured progress
Authors: Teale William H , Whittingham Colleen E , Hoffman Emily Brown
Published: March 2018

This review examines patterns found in early (preschool-grade 3) literacy research appearing in English-language publications during the period from 2006 through 2015. It focuses on studies related to early literacy learning and teaching in home and school/school-like environments. The review sought to answer two questions: (1) What has early literacy research focused on over the past decade? and (2) What has that body of research contributed to our enhanced understanding of early literacy development, teaching, and learning? The results report on patterns of publishing early literacy research found in scholarly journals, topics researched, ages of children researched, characteristics of the populations researched, and designs used in early literacy research. In addition, qualitative analyses report on the content and trends of the research for a sample of studies for each of seven facets of early literacy research: phonics, phonological awareness, reading fluency, vocabulary, reading comprehension, writing, and digital literacies, as well as for the umbrella terms emergent literacy/early literacy/beginning reading. The results found from these analyses are discussed through an historical lens which identified four patterns characterizing early literacy research of 2006–2015: accretion, the influence of "scientifically valid" research, limited response to increasingly diverse student populations, and increased research focus on younger children.