bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Ambient Nitrogen Dioxide Concentrations in the Vicinity of Industrial Complex Area, Thailand
Authors: Tunlathorntham Supitchaya , Thepanondh Sarawut
Published: March 2017

The AERMOD dispersion model was evaluated for its performance in predicting 1-hour average nitrogen dioxide (NO2) concentrations in the vicinity of the largest petrochemical industrial complex in Thailand during the period between January 2012 and December 2013. Measured data from 10 ambient air monitoring stations were intensively used to compare with modeled results. Model results indicated that the tier 1 approach (full conversion of NOx to NO2) provided the most accurate results compared with other tiers. It also performed very well in predicting the extreme end of NO2 concentrations. With an absence of emission data from mobile sources, tier 1 was concluded as the most appropriate scheme for prediction of ambient NO2 ground-level concentrations in this study.
Insights Into the Morphology of the East Asia PM2.5 Annual Cycle Provided by Machine Learning
Authors: Wu Daji , Zewdie Gebreab K , Liu Xun , Kneen Melanie Anne , Lary David John
Published: March 2017

The abundance of airborne particulate matter with an aerodynamic equivalent diameter of 2.5 µm or less (PM2.5) is a significant environmental and health issue. Many tools have been used to examine the relationship between PM2.5 abundance and meteorological variables, but some of the relationships are nonlinear, non-Gaussian, and even unknown. Machine learning provides a broad range of practical algorithms to help examine this issue. In this study, we use machine learning to classify the morphology of PM2.5 seasonal cycles in East Asia. Machine learning is able to objectively classify the seasonal cycles and, without a priori assumption, is able to clearly distinguish between urban and rural areas. We show an example of this in the Sichuan Basin of China. Furthermore, machine learning is also able to provide physical insights by identifying the key factors associated with each distinct shape of the seasonal cycle, such as highlighting the key role played by the topography and the built environment.
Neurological Deficits After Long-term Pyrethroid Exposure
Authors: Hansen Martin Rune Hassan , Jørs Erik , Lander Flemming , Condarco Guido , Debes Fróði , Tirado Bustillos Noemi , Schlünssen Vivi
Published: March 2017

Pyrethroid pesticides have been suggested to be a cause of Parkinson disease and other neurodegenerative diseases. To investigate this, a cross-sectional study was conducted among 120 Bolivian public health vector program spray men, primarily exposed to pyrethroids. Pesticide exposure and central nervous system (CNS) symptoms were determined by a structured interview, whereas neuromotor and neurocognitive performance was assessed using the computerized Behavioral Assessment and Research System and CATSYS system. Individuals exposed to higher levels reported significantly more CNS symptoms (adjusted odds ratio per quintile of cumulative exposure = 2.01 [1.22-3.31]). There was no association seen between pyrethroid exposure and neuromotor performance. Higher spraying intensity was associated with significantly worse neurocognitive performance in structural equation models (adjusted β per quintile = −0.405 [−0.660 to −0.150]), and workers only exposed to pyrethroids performed worse than workers also exposed to other pesticides (adjusted β = −1.344 [−2.224 to −0.464]). Chronic pyrethroid exposure may cause deterioration in neurocognitive performance, and exposure control is recommended.
Early Results of Minimally Invasive Percutaneous Plate Osteosynthesis for Fractures of the Distal Tibia: A Retrospective Case Series and Review of the Literature
Authors: Akra Gabriel A , Lazarides Stefanos , Nanu Ananda M
Published: March 2017

Minimally invasive percutaneous plate osteosynthesis was developed on the concept that preservation of the soft tissue envelope during surgical management of distal tibial fractures is of paramount importance. We report on our early experience using this technique over a 1-year period with 14 such injuries that were treated by a locking compression plate via minimally invasive surgery. The surgical reduction was excellent in most of the cases and all fractures healed uneventfully. One superficial infection and a wound slough were the only complications recorded. The mean follow-up was at 15 months, and all patients were satisfied with a mean ankle-hindfoot score of 84. Early results of such management are very encouraging.
Invisible Desires in Ghana and Kenya: Same-Sex Erotic Experiences in Cross-Sex Oriented Lives
Authors: Spronk Rachel
Published: March 2017

This article explores the tension between same-sex sexual practices and eroticism, on the one hand, and theoretical investigations on sexual diversity, on the other. The author’s analysis is based on research in Ghana and Kenya over the last two decades. A significant proportion of the people she met have (had) experience with same-sex sexual practices at some point in their life. Their choice to start and continue with it and in what form differed considerably per person and over their life course. These diverse possibilities throw an interesting light on the question of sexual diversity, which tends to be locked in a Western paradigm based on binary oppositions of female vs male, homosexual vs heterosexual and non-Western vs Western. While this paradigm has been criticized, theory on sexual diversity nevertheless inclines towards focusing on difference from the norm as its standpoint and therefore always implies non-heterosexuality. The author argues that African contemporary realities suggest innovative analytical directions of global heuristic value. Rather than focusing on self-realization based on notions of individualization, she explores the notion of well-being as put forward by Michael Jackson in Life within Limits: Well-Being in a World of Want (2011). She explores how realizing gendered and sexual well-being is a constant struggle rather than a linear path, and how diversity comes into being as erotic practices that are generated through phases in life course.
Intimate Subjects and Virtual Spaces: Rethinking Sexuality as a Category for Intimate Ethnographies
Authors: Dasgupta Rohit K , Dasgupta Debanuj
Published: March 2017

Social networking sites and digital technologies have created opportunities for young people in India to establish virtual intimate connections. In this article, the authors analyze the intimate exchanges between young men on two different digital platforms – Facebook and Planet Romeo. An analysis of the intimate virtual exchanges reveals technologies of queer neoliberal subject formation within contemporary India. Queer neoliberal subject formation refers to the emergence of a sexual subject of rights, one that is a consumer-citizen within the Indian free-market economy. The article highlights two ways in which bodies are being queered within present day India. First, the authors discuss the case of run-away young men, whose bodies are marked as failure, a kind of ‘delinquent’ subject by an ensemble of state and civil-society formations. The young men are escaping violence from male elders, and poor living conditions in peri-urban Kolkata. Their bodies come to signify a queer figure within neoliberal notions of success and enterprise. Second, they interrogate the ways in which homosexuality is an emergent juridico–political category in India. The Supreme Court of India ruling on 11 December 2013, which reinstated the anti-sodomy provisions of the Indian Penal Code (IPC 377), is the site for the sedimentation of ‘homosexual’ as a subject of legal rights. The homosexual is being presented as a subject of conjugal love. Conjugality is represented as a private good, as the right to consume intimacy within private space. Representation of intimacy and celebration of conjugal love is found through the growth of dating websites in India along with the proliferation of media texts such as memes, poems and illustrative images found online commemorating conjugality. Our ethnographic analysis of the virtual exchanges among runaway young men and young gay identified men reveal how neoliberal subject formation in India remains incomplete.
Reorienting Participation, Distance and Positionality: Ethnographic Encounters with Gender and Sexual Minority Migrants
Authors: Giametta Calogero
Published: March 2017

In this article, the author reflects on how complementing an interview-based methodological approach with participation may be conducive to creating nuanced knowledges about processes of identification, belonging and marginalization. The thoughts he elaborates on emerge from two experiences of fieldwork conducted with gender and sexual minority migrants in the UK and France. He dwells on the uses that social researchers make of some well-established methods when doing research fieldwork: participant observation, researcher’s distance, and positionality. In so doing, the author activates the queer signifier to help us think through how the words researchers use, and where they are situated, influence their sensibilities as investigators of the social.
Parliaments, constitutional conventions, and popular sovereignty
Authors: White Stuart
Published: March 2017

There is growing interest in the United Kingdom in holding a constitutional convention (CC) to deliberate possible reforms to the political system. What form should a CC take? Having identified a range of possible models, we examine their merits according to stated normative criteria, focusing specifically on (1) how CC membership is determined, (2) whether a CC should have agenda-setting power and (3) whether it should have power to send proposals to binding referendum. We find good reasons to support a ‘citizen majority’ membership (chosen in a near-random fashion from the general public), agenda-setting power and referendum power. However, none of these features is likely to be the most appropriate in all contexts. Further design issues concerning citizen-majority conventions, such as whether they ought to include politicians as a minority or exclude them, are also considered. While the immediate focus of discussion is the United Kingdom, the core argument has wider relevance.
Risk factors for infant mortality in rural and urban Nigeria: evidence from the national household survey
Authors: Adewuyi Emmanuel Olorunleke , Zhao Yun , Lamichhane Reeta
Published: March 2017

Aims: This study investigates the rural–urban differences in infant mortality rates (IMRs) and the associated risk factors in Nigeria. Methods: The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural–urban residence, was analyzed using complex samples statistics. A multivariable logistic regression analysis was computed to explore the adjusted relationship and identify risk factors for infant mortality. Results: In rural and urban Nigeria, IMRs were 70 and 49 deaths per 1000 live births, respectively. Risk factors in rural residence were past maternal marital union (adjusted odds ratio (AOR): 1.625, p = 0.020), small birth size (AOR: 1.550, p < 0.001), birth interval <24 months (AOR: 2.057, p < 0.001), residence in North-East (AOR: 1.346, p = 0.038) and North-West (AOR: 1.653, p < 0.001) regions, and cesarean delivery (AOR: 2.922, p = 0.001). Risk factors in urban residence were poor wealth index (AOR: 2.292, p < 0.001), small birth size (AOR: 2.276, p < 0.001), male gender (AOR: 1.416, p = 0.022), birth interval <24 months (AOR: 1.605, p = 0.002), maternal obesity (AOR: 1.641, p = 0.008), and cesarean delivery (AOR: 1.947, p = 0.032). Conclusions: Infants in rural residence had higher rates of mortality than their urban counterparts and disparities in risk factors exist between the residences.
(Re)making sex: A praxiography of the gender clinic
Authors: Latham J.R.
Published: March 2017

This article traces the multiple enactments of sex in clinical practices of transgender medicine to argue against the presumed singularity of ‘transexuality’. Using autoethnography to analyse my own experience as a trans patient, I describe my clinical encounters with doctors, psychiatrists and surgeons in order to theorise sex as multiple. Following recent developments in science and technology studies (STS) that advance the work of Judith Butler on sex as performatively reproduced, I use a praxiographic approach to argue that treatment practices produce particular iterations of what sex (and transexuality) ‘is’ and how these processes limit and foreclose other trans possibilities. I consider the ethical, political and material-discursive implications of treatment practices and offer a series of reflections about the effects and effectiveness of current clinical practices and the possibilities for intervening in such processes in order that, following Annemarie Mol, we might (re)make sex (and transexuality) differently.
Weber and Simmel on the formation of norms, rules and laws
Authors: Härpfer Claudius , Kaden Tom
Published: March 2017

In this dialogue, Simmel and Weber meet in Berlin in 1907 and talk about rules and regularities in social life. Their conversation revolves around two editions of a book by Rudolf Stammler, which Simmel had reviewed about 10 years before and which Weber planned to review in the near future. After a discussion about the German card game Skat, they encounter the double meaning of ‘rule’ as both a description of a process and a normative expectation. They situate this within their respective works and develop new ideas for what would become Weber’s basic sociological terms.
Photovoice: Adult Patients of Hospice Braşov (Romania) on what it means to Live with Cancer
Authors: Scârneci-Domnişoru Florentina
Published: March 2017

This visual essay presents a series of photos which were the result of a more wide-ranging project conducted by the Romanian Hospice Casa Speranței in Brasov. The photos were taken by adult cancer patients of the Hospice as a way for them to illustrate their own visualisation of their experience of this disease. The patients were asked to add a descriptive text to the images; the photos were then grouped into categories and brought together to form a narrative. Photovoice was used to elicit a personal perspective on the patient’s experience of what it means to live with an incurable disease such as cancer.
Aspects of a boy’s childhood as a complex social construct in comics
Authors: Leah Cross Judith
Published: March 2017

The depiction of boyhood in the Western world of comics underwent a subtle transformation in the shadow of the Second World War. Major artists of these sequential artistic texts (such as Schultz and Spiegelman) fine-tuned key elements in the set of resources they drew on, effectively changing how readers/viewers engage with the young male protagonists in comics. The shift in affect was realized in storylines; instead of these being driven by external, performance-oriented representations of ‘boyhood’ punctuated by mischievous deeds or heroic exploits, drama was created by a much more complex and nuanced depiction of boyhood that explored the internal emotional and psychological worlds of main boy characters. Drawing on representative examples from two different sets of comics, this article applies a bi-modal, semiotic approach that specifically addresses how facial expressions, gaze and speech/thought bubbles, elements of the interpersonal meta-function, construct a more complex representation of boyhood.
Transitivity of kinetic typography: theory and application to a case study of a public service advertisement
Authors: He Xianzhong
Published: March 2017

With the advance of computer technology, kinetic typography, the animation of moving text, is becoming widely used in human communication. Yet, to date, there have been few social semiotic and multimodality studies in this area. This article draws on a case analysis of a national television public service advertisement in China to demonstrate how the concept of transitivity can be used to understand the meaning-making processes of kinetic typography. Kress and Van Leeuwen’s Reading Images: The Grammar of Visual Design (2006[1996]) transitivity of visual grammar and Leão’s ‘A systemic functional approach to the analysis of animation in film opening titles’ (2013) transitivity system of animation are applied in the analysis. The results show that their models can be basically applied to the analysis of kinetic typography. However, they also have restrictions that can be improved. For this reason, the author proposes an extended model of transitivity for the analysis of kinetic typography. The article ends with a discussion of some cross-cultural aspects of the analysed advertisement.
A visual semiotic analysis of sperm donors’ baby photos as major marketing material at the s[u]permarket
Authors: Bokek-Cohen Ya’arit
Published: March 2017

This article presents a semiotic visual analysis of 48 sperm donors’ baby photos from six of the largest American sperm banks, using Kress and Van Leeuwen’s method of ‘reading images’ described in Reading Images: The Grammar of Visual Design (2006). Donor baby photos, conceptualized as self-advertisements, serve to engage prospective sperm users because of their liminal nature. The following issues are addressed: How do sperm donors use baby photos to transmit messages to prospective recipients? What are the cultural values conveyed via the photos? Is there a correspondence between donors’ verbal narratives and meanings encoded in baby photos? Furthermore, a new category of ‘chosen/selected’ images is proposed for classifying photos that were neither made for the purpose of the study nor found by the researcher. The photo selection is strategic and serves to engage sperm recipients in imaginary relations with donors. Furthermore, subversive messages tacitly transmitted in baby photos desemiotize some of the stated values in the verbal narratives.
Understanding gender inequality and the role of the work/family interface in contemporary academia: An introduction
Authors: Dubois-Shaik Farah , Fusulier Bernard
Published: March 2017

This double special issue gathers a series of nuanced critically conceptual and case-study research showing that in the contemporary European context, despite regional differences in gender regimes, political and economic demands and organizational cultures, work/life balance policies and their translation into practice remains a highly ambiguous issue. Although work/life balance policies have undoubtedly entered the university institutional spaces, they are deterred by opposing institutional policy logics and particularly ‘greedy’ logics of the organizing of work that still aligns to outdated work-exclusive masculine organizational culture (outdated because men too are suffering the effects, and because the academic environment is feminized). Moreover, there are lingering gender stereotypes around the value and attribution of home and work duties, which are having a significant impact upon women’s professional and private spheres and experiences in academic work. The gathered research shows how university institutions are still quite far from having addressed the core issues that undermine women’s career advancement and their possibilities to access to academic membership and leadership, still obliging them (and their male counterparts) to align with a work and membership (selection and progression) logic and organization that does not take into consideration parenthood, family and personal spheres of life.
Proof-of-Concept Evaluation of the SailValve Self-Expanding Deep Venous Valve System in a Porcine Model
Authors: Boersma Doeke , Vink Aryan , Moll Frans L. , de Borst Gert J.
Published: March 2017

Purpose: To evaluate the SailValve, a new self-expanding deep venous valve concept based on a single polytetrafluoroethylene cusp floating up and down in the bloodstream like a sail, acting as a flow regulator and allowing minimal reflux to reduce thrombogenicity. Methods: Both iliac veins of 5 pigs were implanted with SailValve devices; the first animal was an acute pilot experiment to show the feasibility of accurately positioning the SailValve via a femoral access. The other 4 animals were followed for 2 weeks (n=2) or 4 weeks (n=2) under a chronic implantation protocol. Patency and valve function were evaluated directly in all animals using ascending and descending phlebography after device placement and at termination in the chronic implant animals. For reasons of clinical relevance, a regimen of clopidogrel and calcium carbasalate was administered. Histological analysis was performed according to a predefined protocol by an independent pathologist. Results: Deployment was technically feasible in all 10 iliac veins, and all were patent directly after placement. No perioperative or postoperative complications occurred. Ascending phlebograms in the follow-up animals confirmed the patency of all valves after 2 or 4 weeks. Descending phlebograms showed full function in 5 of 8 valves. Limited reflux was seen in 1 valve (4-week group), and the function in the remaining 2 valves (2-week group) was insufficient because of malpositioning. No macroscopic thrombosis was noted on histology. Histology in the follow-up groups revealed a progressive inflammatory reaction to the valves. Conclusion: This animal study shows the potential of the SailValve concept with sufficient valve function after adequate positioning and no (thrombogenic) occlusions after short-term follow-up. Future research is essential to optimize valve material and long-term patency.
Long Noncoding RNA PVT1 Promotes EMT and Cell Proliferation and Migration Through Downregulating p21 in Pancreatic Cancer Cells
Authors: Wu Bao-Qiang , Jiang Yong , Zhu Feng , Sun Dong-Lin , He Xiao-Zhou
Published: March 2017

Background and Aim:

Long noncoding RNA-plasmacytoma variant translocation 1 is identified to be highly expressed and exhibits oncogenic activity in a variety of human malignancies, including pancreatic cancer. However, little is known about the overall biological role and mechanism of plasmacytoma variant translocation 1 in pancreatic cancer so far. In this study, we investigated the effect of plasmacytoma variant translocation 1 on pancreatic cancer cell proliferation and migration as well as epithelial–mesenchymal transition.

Methods:

Pancreatic cancer tissue specimens and cell line were used in this study, with normal tissue and cell line acting as control.

Results:

It showed that plasmacytoma variant translocation 1 expression was significantly upregulated in pancreatic cancer tissues or cell line compared to normal groups. Plasmacytoma variant translocation 1 downregulation significantly inhibited zinc finger E-box-binding protein 1/Snail expression but promoted p21 expression, and it also inhibited the cell proliferation and migration. Additionally, p21 downregulation enhanced, and p21 overexpression repressed, zinc finger E-box-binding protein 1/Snail expression and cells proliferation in PANC-1 cells. However, p21 downregulation reversed the effect of plasmacytoma variant translocation 1 downregulation on zinc finger E-box-binding protein 1/Snail expression and cell proliferation and migration.

Conclusion:

Plasmacytoma variant translocation 1 promoted epithelial–mesenchymal transition and cell proliferation and migration through downregulating p21 in pancreatic cancer cells.
Dependability and Treatment Sensitivity of Multi-Item Direct Behavior Rating Scales for Interpersonal Peer Conflict
Authors: Daniels Brian , Volpe Robert J. , Briesch Amy M. , Gadow Kenneth D.
Published: March 2017

Direct behavior rating (DBR) represents a feasible method for monitoring student behavior in the classroom; however, limited work to date has focused on the use of multi-item scales. The purposes of the study were to examine the (a) dependability of data obtained from a multi-item DBR designed to assess peer conflict and (b) treatment sensitivity of Direct Behavior Rating Multi-Item Scales (DBR-MIS) constructed using factor-derived and individualized methods. Analyses were performed using teacher ratings of 65 students (53 boys, 12 girls) between 6 and 12 years old. Results of decision studies indicated that an acceptable criterion of dependability (ϕ > .70) for low-stakes, intraindividual decision making could be achieved using a three-item scale across eight occasions, a four- or five-item scale across four occasions, or a six-item scale across three occasions. Subsequent analyses verified that a six-item DBR demonstrated acceptable treatment sensitivity when ratings were conducted on 3 days during baseline and 3 days during treatment with methylphenidate. Implications for practice and future research are discussed.
Shame and Transformation in the Theory and Practice of Adult Learning and Education
Authors: Walker Jude
Published: March 2017

Shame both stymies and motivates learning; it prevents adults from participating in educational programs yet, with accompanied self-examination, it can be the catalyst for transformation. While fundamental for understanding adult learning, shame is (shamefully) inadequately theorized in the field of adult education: We don’t talk enough about shame. The purpose of this article is to spark a conversation about shame in adult learning and education and to inspire the transformative learning community to undertake further empirical and theoretical analyses of shame in adult learning. As Dirkx implored us over a decade ago, we need to stop shying away from emotions in adult learning and to begin to courageously engage that which lies in the unconscious but which drives our everyday actions and interactions. Shame is at the core of who we are—and who we can become—as adult learners and educators.
Indications and Outcomes From 32 Consecutive Patients for the Treatment of Rectal Lesions by Transanal Minimally Invasive Surgery
Authors: García-Flórez Luis J. , Otero-Díez Jorge L. , Encinas-Muñiz Ana I. , Sánchez-Domínguez Luis
Published: March 2017

Background: The aim of this study was to evaluate the feasibility, safety, perioperative morbidity, and short-term outcomes of the transanal minimally invasive surgery (TAMIS) technique. Methods: This is a descriptive review of prospectively collected data from 32 consecutive patients who underwent TAMIS procedures in our colorectal unit over a 40-month period. GelPOINT Path port was used in all cases. Demographic data, indications, tumor characteristics, morbidity, and follow-up data were collected. Primary endpoints included feasibility, safety, perioperative morbidity, and resection quality. Results: Fifteen adenomas, 12 carcinomas, 1 gastrointestinal stromal tumor, and 1 neuroendocrine tumor were locally excised. Additionally, 3 pelvic abscesses were drained transanally using the TAMIS port. Mean distance from the anal verge was 5.6 ± 1.5 cm. Early postoperative complications occurred in 22%, with only one case of major complication (3.1%) requiring reoperation, and no postoperative mortality. Four carcinomas were understaged (33.3%) and 1 adenoma overstaged (6.7%) preoperatively. Three carcinomas were not suspected preoperatively (25%). Microscopic positive lateral margin was found in one case, and no affected deep margin was found. Fragmentation rate was 6.9%, 2 cases, both lesions over 20 cm2. In cases of fit patients with high-risk carcinomas, 2 underwent immediate salvage surgery and another 2 refused and were treated with adjuvant radiotherapy. With a median follow-up of 26 months, the overall recurrence rate was 10.3%, 1 adenoma and 2 carcinomas. Conclusion: TAMIS seems to be a safe and reproducible procedure for local excision of well-selected rectal lesions with low morbidity and good functional outcomes.
A preliminary investigation of a school-based musical theater intervention program for children with intellectual disabilities
Authors: Zyga Olena , Russ Sandra W , Meeker Heather , Kirk Jodi
Published: March 2017

The presence of an intellectual disability may cause a child to have significant deficits in social skills and emotion regulation abilities across development. A vital next step is to find interventions that can be delivered in the school environment and across disability categories that target socioemotional factors. The current study investigated the feasibility of delivering a school-based musical theater program to students with intellectual disability across a range of school settings. A within-group repeated-measures design was used to analyze pre- and post-video recordings of the intervention program, which were coded for six domains of socioemotional ability across all participants ( n = 47). Results showed that significant gains across all domains were observed. However, these gains related to school- and individual-level student factors, such as grade level, severity of disability, and baseline social skill ability.
P.S. for post-Soviet: A glimpse to a life of persons with intellectual disabilities
Authors: Gevorgianiene Violeta , Sumskiene Egle
Published: March 2017

This article focuses on the situation of persons with intellectual disabilities in the developing post-Soviet countries and aims to review the extent to which services offered to them promote values of the Convention on the Rights of Persons with Disabilities and empower these persons to lead fulfilling lives. Interviews with experts revealed that post-Soviet countries form a peculiar cluster among other developing countries, which has specific attributes. First of all, there prevails a strong stigmatization, which consequently leads to the predominant silent mandate to isolate those with intellectual disabilities in big residential care institutions. Second, the governments’ lack political will to start the reforms and initiatives of nongovernmental organizations which they do not sustain (or, assumingly, are even suppressed). As a result, persons with intellectual disabilities find themselves stuck between the Soviet tradition of exclusion and simulated superficial reforms.
Feasibility and utility of an integrated medical imaging and informatics smartphone system for management of acute stroke
Authors: Shkirkova Kristina , Akam Eftitan Y , Huang Josephine , Sheth Sunil A , Nour May , Liang Conrad W , McManus Michael , Trinh Van , Duckwiler Gary , Tarpley Jason , Vinuela Fernando , Saver Jeffrey L ,   for the UCLA Stroke Systems of Care Study Group
Published: March 2017

Background

Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members are essential for optimal acute stroke care.

Aim

To characterize the feasibility and utility of the Synapse Emergency Room mobile (Synapse ERm) informatics system.

Methods

We implemented the Synapse ERm system for integration of clinical data, computerized tomography, magnetic resonance, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center.

Results

From May 2014 to October 2014, the Synapse ERm application was used by 33 stroke team members in 84 Code Stroke alerts. Patient age was 69.6 (±17.1), with 41.5% female. Final diagnosis was: ischemic stroke 64.6%, transient ischemic attack 7.3%, intracerebral hemorrhage 6.1%, and cerebrovascular-mimic 22.0%. Each patient Synapse ERm record was viewed by a median of 10 (interquartile range 6–18) times by a median of 3 (interquartile range 2–4) team members. The most used feature was computerized tomography, magnetic resonance, and catheter angiography image display. In-app tweet team, communications were sent by median 1 (interquartile range 0–1, range 0–13) users per case and viewed by median 1 (interquartile range 0–3, range 0–44) team members. Use of the system was associated with rapid treatment times, faster than national guidelines, including median door-to-needle 51.0 min (interquartile range 40.5–69.5) and median door-to-groin 94.5 min (interquartile range 85.5–121.3). In user surveys, the mobile information platform was judged easy to employ in 91% (95% confidence interval 65%–99%) of uses and of added help in stroke management in 50% (95% confidence interval 22%–78%).

Conclusion

The Synapse ERm mobile platform for stroke team distribution and integration of clinical and imaging data was feasible to implement, showed high ease of use, and moderate perceived added utility in therapeutic management.
Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients
Authors: Jobs Alexander , Simon Ronja , de Waha Suzanne , Rogacev Kyrill , Katalinic Alexander , Babaev Valentin , Thiele Holger
Published: March 2017

Background:

The prognostic impact of pneumonia and signs of systemic inflammation in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. The aim of the present study was thus to investigate the association of pneumonia and the inflammation surrogate C-reactive protein with all-cause mortality in patients admitted for ADHF.

Methods:

We analysed data of 1939 patients admitted for ADHF. Patients were dichotomised according to the presence or absence of pneumonia. The primary endpoint of all-cause mortality was determined by death registry linkage.

Results:

In total, 412 (21.2%) patients had concomitant pneumonia. Median C-reactive protein levels were higher in patients with compared to patients without pneumonia (24.9 versus 9.8 mg/l, respectively; P<0.001). All-cause mortality was significantly higher in patients with pneumonia ( P<0.001). In adjusted Cox regression models, pneumonia as well as C-reactive protein were independently associated with in-hospital mortality. Only C-reactive protein remained as independent predictor for long-term mortality.

Conclusion:

Pneumonia is relatively common in ADHF and a predictor for in-hospital mortality. However, inflammation in general seems to be more important than pneumonia itself for long-term prognosis. Compared to community-acquired pneumonia studies, C-reactive protein levels were rather low and therefore pneumonia might be over-diagnosed in ADHF patients.
Developing reflective dispositions through collaborative knowledge-building during small group Bible study
Authors: Toh Tze Keong , Koh Joyce Hwee Ling , Chai Ching Sing
Published: March 2017

This article explores the use of a constructivist pedagogical approach to cultivate reflective dispositions during small group Bible study. Conducted in a local church Bible class setting ( n = 12), the instructional design emulated the reflective thinking process, while adopting collaborative knowledge-building as its pedagogical framework. Results showed that the participants exhibited dispositions of reflective thinking in terms of open-mindedness, rootedness and responsibility in the social learning environment. Results also showed that participants were more confident of their own beliefs at the end of the course, and arrived at the desired biblical understanding with respect to the study topic.
A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques
Authors: Kravvas Georgios , Al-Niaimi Firas
Published: March 2017

[Formula: see text]

Introduction:

Acne is a common condition that can result in permanent scarring. Acne scars can be broken down into three categories: atrophic; hypertrophic; and keloidal. Atrophic scars can be further sub-classified into: ice pick; rolling; and boxcar.

Objectives and Methods:

We have performed a comprehensive literature search of the last ten years in order to determine the efficacy and adverse reactions of commonly used treatments against post-acne scarring.

Results:

A total of 36 relevant articles were identified on the following interventions: subcision (n = 10), dermabrasion (n = 1), microneedling (n = 8), dermal fillers (n = 5), and chemical peeling (n = 12).

Discussion:

Improvement in the appearance of post-acne scarring following subcision is in the range of 10–100%. Microdermabrasion achieved the least significant results. A total of 27.3% patients did not achieve any benefit despite eight treatment sessions, and only 9.1% achieved good results. All patients treated with microneedling achieved some improvement in scar appearance in the range of 31–62%. Dermal fillers also led to favourable outcomes. In particular, treatment with PPMA led to improvement in 84% of patients. Utilising chemical peels, trichloroacetic acid (TCA) CROSS achieved >70% improvement in 73.3% of patients, whereas 20% glycolic acid did not lead to any improvement in 25%.

Conclusion:

Post-acne scarring is a common and challenging condition with no easy and definitive solution. The above interventions have been used with varying degrees of efficacy, each having both pros and cons. All have been deemed to be safe with few and transient adverse reactions. However, further trials with a larger number of patients are necessary in order to reach more concrete conclusions regarding their efficacy.
Change in Depression Symptoms Through Emerging Adulthood
Authors: Domene José F. , Arim Rubab G. , Law Danielle M.
Published: March 2017

Existing research suggests there may be important association between mental health and the employment that emerging adults obtain during the transition into the workforce. Hierarchical linear modeling (HLM) was used to examine the trajectories of emerging adults’ depression symptoms over a 4-year period, as a function of two characteristics of employment: type of work (i.e., full-time or not) and job satisfaction (i.e., highly satisfied with work or not). The sample consisted of 793 young Canadians drawn from the National Longitudinal Survey of Children and Youth. On average, depression symptoms decreased significantly over time. Full-time employment was associated with lower initial levels of depression and a slower decrease in symptoms. Higher job satisfaction also associated with lower initial levels of depression symptoms. These results suggest it is important to consider both these characteristics of employment to more fully understand how employment is connected to depression symptoms over time.
Association of Lead Levels and Cerebral Palsy
Authors: Bansal Neha , Aggarwal Anju , Faridi M. M. A. , Sharma Tusha , Baneerjee B. D.
Published: March 2017

Background: Cerebral palsy is a common motor disability in childhood. Raised lead levels affect cognition. Children with cerebral palsy may have raised lead levels, further impairing their residual cognitive motor and behavioral abilities. Environmental exposure and abnormal eating habits may lead to increased lead levels. Aims and Objectives: To measure blood lead levels in children with cerebral palsy and compare them with healthy neurologically normal children. To correlate blood lead levels with environmental factors. Material and Methods: Design: Prospective case-control study. Setting: Tertiary care hospital. Participants: Cases comprised 34 children with cerebral palsy, and controls comprised 34 neurologically normal, age- and sex-matched children. Methods: Clinical and demographic details were recorded as per proforma. Detailed environmental history was recorded to know the source of exposure to lead. These children were investigated and treated as per protocol. Venous blood was collected in ethylenediaminetetraacetic acid vials for analysis of blood lead levels. Lead levels were estimated by Schimadzu Flame AA-6800 (atomic absorption spectrophotometer). Data were analyzed using SPSS version 17. P < .05 was taken as significant. Results: Mean blood lead levels were 9.20 ± 8.31 µg/dL in cerebral palsy cases and 2.89 ± 3.04 µg/dL in their controls ( P < .001). Among children with cerebral palsy, 19 (55.88%) children had blood lead levels ≥5 µg/dL. Lead levels in children with pica were 12.33 ± 10.02 µg/dL in comparison to children with no history of pica, 6.70 ± 4.60 µg/dL ( P = .029). No correlation was found between hemoglobin and blood lead levels in cases and controls. Conclusion: In our study, blood lead levels are raised in children with cerebral palsy. However, further studies are required to show effects of raised levels in these children.
A comparison of service organisation and guideline compliance between two adjacent European health services
Authors: McElwaine Paul , McCormack Joan , McCormick Michael , Rudd Anthony , Brennan Carmel , Coetzee Heather , Cotter Paul E , Doyle Rachel , Hickey Anne , Horgan Frances , Loughnane Cliona , Macey Chris , Marsden Paul , McCabe Dominick , Mulcahy Riona , Noone Imelda , Shelley Emer , Stapleton Tadhg , Williams David , Kelly Peter , Harbison Joseph
Published: March 2017

Introduction

Outcomes in stroke patients are improved by a co-ordinated organisation of stroke services and provision of evidence-based care. We studied the organisation of care and application of guidelines in two neighbouring health care systems with similar characteristics.

Methods

Organisational elements of the 2015 National Stroke Audit (NSA) from the Republic of Ireland (ROI) were compared with the Sentinel Stroke National Audit Programme (SSNAP) in Northern Ireland (NI) and the United Kingdom (UK). Compliance was compared with UK and European guidelines.

Results

Twenty-one of 28 ROI hospitals (78%) reported having a stroke unit (SU) compared with all 10 in NI. Average SU size was smaller in ROI (6 beds vs. 15 beds) and bed availability per head of population was lower (1:30,633 vs. 1:12,037 p < 0.0001 Chi Sq). Fifty-four percent of ROI patients were admitted to SU care compared with 96% of UK patients ( p < 0.0001). Twenty-four–hour physiological monitoring was available in 54% of ROI SUs compared to 91% of UK units ( p < 0.0001). There was no significant difference between ROI and NI in access to senior specialist physicians or nurses or in SU nurse staffing (3.9/10 beds weekday mornings) but there was a higher proportion of trained nurses in ROI units (2.9/10 beds vs. 2.3/10 beds ( p = 0.02 Chi Sq).

Conclusion

Whilst the majority of hospitals in both jurisdictions met key criteria for organised stroke care the small size and underdevelopment of the ROI units meant a substantial proportion of patients were unable to access this specialised care.
Validation and comparison of two stroke prognostic models for in hospital, 30-day and 90-day mortality
Authors: Dutta Dipankar , Cannon Abigail , Bowen Emily
Published: March 2017

Introduction

We aimed to validate and compare two clinical prognostic models for mortality which include the National Institutes of Health Stroke Scale (NIHSS); the Age and NIHSS Score (ANS) and case mix model (CMM) of the Sentinel Stroke National Audit Program (SSNAP). The NIHSS on admission was also tested as a prognostic score.

Patients and methods

Prospectively collected data from the SSNAP register for a cohort of patients (ischaemic and haemorrhagic stroke) admitted over 1 year to Gloucestershire Royal Hospital, England were accessed. The ANS and CMM were calculated and tested for in hospital, 30-day and 90-day mortality using calibration plots with Hosmer–Lemeshow tests, receiver operating characteristics curves and other measures of prognostic accuracy.

Results

Of 848 patients, 110 (12.9%) died in hospital, 112 (13.2%) at 30 days and 164 (19.2%) at 90 days. Calibration for all three scores was good, although Hosmer–Lemeshow test p values were <0.05 with the NIHSS alone for in hospital and 30-day deaths, suggesting deviation from good fit. The c-statistics for in hospital, 30-day and 90-day mortality were ANS (0.783, 0.782, 0.779) and CMM (0.783, 0.774, 0.758), respectively. The NIHSS alone showed fair discrimination but performed less well. A NIHSS score ≥6 was associated with significant mortality ( p < 0.0001) in comparison to a score <6.

Conclusion

A simple prognostic model containing age and admission NIHSS only, performed as well as a more complex score at predicting in hospital, 30-day and 90-day mortality. Admission NIHSS recording should be encouraged for stroke registries.
Metabolomics analysis identifies different metabotypes of asthma severity
Authors: Reinke Stacey N. , Gallart-Ayala Héctor , Gómez Cristina , Checa Antonio , Fauland Alexander , Naz Shama , Kamleh Muhammad Anas , Djukanović Ratko , Hinks Timothy S.C. , Wheelock Craig E.
Published: March 2017

In this study, we sought to determine whether asthma has a metabolic profile and whether this profile is related to disease severity.

We characterised the serum from 22 healthy individuals and 54 asthmatics (12 mild, 20 moderate, 22 severe) using liquid chromatography–high-resolution mass spectrometry-based metabolomics. Selected metabolites were confirmed by targeted mass spectrometry assays of eicosanoids, sphingolipids and free fatty acids.

We conclusively identified 66 metabolites; 15 were significantly altered with asthma (p≤0.05). Levels of dehydroepiandrosterone sulfate, cortisone, cortisol, prolylhydroxyproline, pipecolate and N-palmitoyltaurine correlated significantly (p<0.05) with inhaled corticosteroid dose, and were further shifted in individuals treated with oral corticosteroids. Oleoylethanolamide increased with asthma severity independently of steroid treatment (p<0.001). Multivariate analysis revealed two patterns: 1) a mean difference between controls and patients with mild asthma (p=0.025), and 2) a mean difference between patients with severe asthma and all other groups (p=1.7×10−4). Metabolic shifts in mild asthma, relative to controls, were associated with exogenous metabolites (e.g.dietary lipids), while those in moderate and severe asthma (e.g. oleoylethanolamide, sphingosine-1-phosphate, N-palmitoyltaurine) were postulated to be involved in activating the transient receptor potential vanilloid type 1 (TRPV1) receptor, driving TRPV1-dependent pathogenesis in asthma.

Our findings suggest that asthma is characterised by a modest systemic metabolic shift in a disease severity-dependent manner, and that steroid treatment significantly affects metabolism.
Concordance between upper and lower airway microbiota in infants with cystic fibrosis
Authors: Prevaes Sabine M.P.J. , de Steenhuijsen Piters Wouter A.A. , de Winter-de Groot Karin M. , Janssens Hettie M. , Tramper-Stranders Gerdien A. , Chu Mei Ling J.N. , Tiddens Harm A. , van Westreenen Mireille , van der Ent Cornelis K. , Sanders Elisabeth A.M. , Bogaert Debby
Published: March 2017

Nasopharyngeal and oropharyngeal samples are commonly used to direct therapy for lower respiratory tract infections in non-expectorating infants with cystic fibrosis (CF).

We aimed to investigate the concordance between the bacterial community compositions of 25 sets of nasopharyngeal, oropharyngeal and bronchoalveolar lavage (BAL) samples from 17 infants with CF aged ∼5 months (n=13) and ∼12 months (n=12) using conventional culturing and 16S-rRNA sequencing.

Clustering analyses demonstrated that BAL microbiota profiles were in general characterised by a mixture of oral and nasopharyngeal bacteria, including commensals likeStreptococcus,Neisseria,VeillonellaandRothiaspp. and potential pathogens likeStaphylococcus aureus,Haemophilus influenzaeandMoraxellaspp. Within each individual, however, the degree of concordance differed between microbiota of both upper respiratory tract niches and the corresponding BAL.

The inconsistent intra-individual concordance between microbiota of the upper and lower respiratory niches suggests that the lungs of infants with CF may have their own microbiome that seems seeded by, but is not identical to, the upper respiratory tract microbiome.