bluuebunny/crossref_metadata_2025 huggingface dataset:
Transmission, Penumbra and Leaf Positional Accuracy in Commissioning and Quality Assurance Program of a Multileaf Collimator for Step-and-Shoot IMRT Treatments
Authors: Pasquino Massimo , Borca Valeria Casanova , Catuzzo Paola , Ozzello Franca , Tofani Santi
Published: July 2019

Aims and background

The performance characteristics of a commercial multileaf collimator (MLC) for intensity modulated radiation therapy (IMRT) and a comprehensive quality assurance program (QA) to be performed during the commissioning of the MLC were investigated.

Materials and methods

The midleaf transmission and interleaf leakage, the in-plane penumbra and its in-plane/cross-plane variation, the cross-plane penumbra and its in-plane/cross-plane variation, and the leaf positional accuracy of a high-energy photon (6 MV) Sli Precise Elekta linear accelerator were measured. Kodak EDR2 Ready Pack film was used for MLC transmission measurement; for the other characterization measurements we used Kodak X-Omat XV2 Ready Pack film placed at 5 cm depth in a solid RW3 phantom. Each film was digitized with a laser scanning photodensitometer VXR-12 Plus using the Omni Pro-Accept 6.0A film dosimetry system and converted to dose by means of H&D curves. The dose calibration measurements were performed with a Farmer ionization chamber according to the guidelines of the IAEA Technical Report No. 277.

Results

The average midleaf transmission and interleaf leakage were 1.8% ± 0.1% and 2.1% ± 0.2%, respectively. The average value of the cross-plane penumbra was 5.4 mm ± 0.3 mm with maximum variation less than 0.4 mm and 1.0 mm in the in-plane and cross-plane direction, respectively. The average value of the in-plane penumbra was 3.2 mm ± 0.2 mm and 3.5 mm ± 0.2 mm for the step side and groove side of the leaves, respectively. A dose profile perpendicular to the direction of the leaf travel passing through the central axis shows a tongue-and-groove effect of about 33%. The positional accuracy of the leaves was investigated according to AAPM Report No. 72 TG50; the deviation of the net optical density along all the match lines was less than ± 20%. Moreover, the results obtained with a step field technique showed a positional accuracy of less than 1 mm.

Conclusions

The results suggest the necessity of extensive knowledge of the MLC dosimetric characteristics for IMRT applications in order to allow physicists to study their influence on treatment delivery and to perform a comprehensive routine QA program of the investigated parameters.
Primary Small Cell Bladder Carcinoma: A Case Report and Review of the Current Literature
Authors: Zachos loannis , Papatsoris Athanasios G , Sountoulides Petros , Podimatas Thomas , Politis Panagiotis , Repanti Maria , Vandoros Gerasimos , Chrisofos Michael , Deliveliotis Charalambos
Published: July 2019

Primary small cell bladder carcinoma is an extremely rare and highly aggressive tumor. Unfortunately, the optimal therapeutic strategy for the tumor is still unknown. Recently, a two-stage system for limited and extensive small cell bladder carcinoma has been suggested in analogy to the practiced staging and treatment of small cell lung carcinoma. We present a new case of small cell bladder carcinoma and discuss relevant current literature.
Tumor-Like Multiple Sclerosis: Report of Four Cases and Literature Review
Authors: Caroli Emanuela , Salvati Maurizio , Ferrante Luigi
Published: July 2019

Aims and background

Classical multiple sclerosis plaques usually have typical features on gadolinium-enhanced MRI scan. This non-neoplastic demyelinating process of the central nervous system generally does not produce focal space-occupying lesions associated with ring enhancement. However, atypical appearance of demyelinating lesions simulating a brain tumor is a possible well-known phenomenon.

Methods

We present our experience with 4 cases of multiple sclerosis indistinguishable clinically and neuroradiologically from a cerebral tumor. All patients underwent surgery.

Results

Histological examinations of all cases were positive for multiple sclerosis plaques.

Conclusions

The presented cases demonstrate the importance of considering a demyelinating disease in the differential diagnosis of a tumor-like brain lesion.
A Career Stage Analysis of the U.S. Federal Employees’ Job Satisfaction and Turnover Intention: A Comprehensive Overview
Authors: Lee Hyung-Woo
Published: July 2019

This study examines how the determinants of job satisfaction and turnover intention are different across employee’s career stages, using a large-scale data set from U.S. federal agencies. A comprehensive examination of career stage differences provides a sophisticated understanding of the multifaceted nature of job satisfaction and turnover intention factors. The trajectory of career stage differences is linear, and the impact of career stages is rather minimal when it comes to the determinants of job satisfaction, whereas the differences in terms of turnover intention were more drastic and salient. Also, the patterns of career stage effect were more complicated than proposed in the existing studies. The implications of these findings are explored for future research and practitioners.
The Teen Screen for Dating Violence: An Item Response Theory Analysis
Authors: Emelianchik-Key Kelly , Colvin Kimberly F.
Published: July 2019

There continues to be a lack of fundamental knowledge regarding assessment, conceptualization, and treatment of teen dating violence (TDV). This deficiency of knowledge becomes even greater when examining gender differences in violence experience, perpetration, and perception. This article details the item response theory (IRT) analysis of the Teen Screen for Dating Violence (TSDV) and includes an assessment of differential item functioning (DIF) reported by gender. The TSDV examines adolescents’ perception, experience, perpetration, and exposure to violence, while also exploring support systems. The study participants included males and females between 13 and 21 years of age. Further refinement of the TSDV contributes to a more accurate and comprehensive conceptualization of TDV measurement. The results of this study support the use of the TSDV to assess for TDV in the adolescent population. The DIF analysis reveals that many of the items function differently for males and females, which provides evidence indicating that how TDV is experienced, perceived, and perpetrated differs across gender. The TSDV can assist clinicians in early TDV prevention, intervention, and education for males and females. It can also assist researchers in more accurately estimating perpetration, experience, and conceptualization of the three violence facets (emotional, physical, and sexual) in males and females. To further expand TDV knowledge, we offer recommendations for the use of the TSDV in various settings. The TSDV is a vital tool for clinicians, supervisors, and researchers to implement to mitigate the TDV epidemic and help bridge the gap in mental health services.
Comparison of Alemtuzumab Versus Basiliximab Induction Therapy in Elderly Kidney Transplant Recipients: A Single-Center Experience
Authors: Yakubu Idris , Ravichandran Bharath , Sparkes Tracy , Barth Rolf N. , Haririan Abdolreza , Masters Brian
Published: July 2019

Background:

The optimal choice of induction immunosuppression for elderly kidney transplant recipients remains unclear. Although alemtuzumab has been associated with escalating risk of death and graft loss in this population, this risk has not been adequately explored. The purpose of this study was to compare the safety and efficacy of alemtuzumab with basiliximab induction in this population.

Methods:

This is a retrospective matched cohort study of kidney transplant recipients aged ≥65 years. Patients who received alemtuzumab induction were matched (1:2) to a basiliximab control. The primary outcome was allograft survival. The incidence of acute rejection, infection, and all-cause mortality was measured.

Results:

Fifty-one and 102 patients were included in the alemtuzumab and basiliximab groups, respectively. Baseline demographics were similar between groups, except for more living donor transplant recipients in the alemtuzumab group (26/51 [51%] vs 31/102 [30.4%], P = .02). Acute cellular rejection occurred more frequently within the first year in the basiliximab group ( P = .02). There was no difference in rates of infection within the first year. Graft and patient survival rates were similar over the follow-up period. Patients receiving basiliximab had a higher glomerular filtration rate at 2 years posttransplant (59 mL/min/1.73 m2 vs 49 mL/min/1.73 m2, P = .03).

Conclusions:

Alemtuzumab induction is associated with similar outcomes to basiliximab in elderly kidney transplant recipients.
Perception of Entrepreneurial Ecosystem: Testing the Actor–Observer Bias
Authors: Manimala Mathew J. , Thomas Princy , Thomas P. K.
Published: July 2019

Entrepreneurial ecosystem is the interacting socio-economic environment that facilitates entrepreneurs to start and develop their enterprises. A vibrant and supportive entrepreneurial ecosystem is necessary for the start-up and growth of an enterprise. The entrepreneurial action would largely depend on the perception of entrepreneurs about the ecosystem. In this context, a study was designed to understand the perceptions of actors (entrepreneurs) and observers (non-entrepreneurs) on various components of the entrepreneurial ecosystem. Data for this study were collected from 296 entrepreneurs and 315 non-entrepreneurs from India, who responded to a 77-item questionnaire by giving their ratings of various aspects of the ecosystem on a 5-point scale. Findings of the study showed that perceptions of the entrepreneurial ecosystem were significantly different for most of the subgroups. Most notable among these differences was those between entrepreneurs and non-entrepreneurs, where the mean scores on all dimensions were found to be significantly higher for non-entrepreneurs than for entrepreneurs except for entrepreneurial capability which was found to be higher for entrepreneurs. Hence, the hypothesis of actor–observer bias in the perceptions of entrepreneurs and non-entrepreneurs is supported.
Workplace Spirituality and Job Satisfaction: Exploring Mediating Effect of Organization Citizenship Behaviour
Authors: Garg Naval , Punia B. K. , Jain Anuradha
Published: July 2019

This decade witnesses renewed interest in research studies on workplace spirituality (WSP). The present research investigates the relationship between WSP and job satisfaction (JS) with the help of two approaches. First, with the help of necessary condition analysis (NCA), it is explored that whether WSP is a necessary condition for the occurrence of JS. Second, the mediation effect of organizational citizenship behaviour (OCB) in association amid WSP and JS is examined using Baron and Kenny’s (1986) technique of mediation analysis. A sample of 194 managers working in insurance companies is collected for the study. The study reports a positive correlation between all three variables of the study. Further, WSP does not come out as a necessary condition for JS. A partial mediation effect of OCB is reported. Practical implications and limitations are also discussed in the article.
Analysing wages and labour institutions in China: An unfinished transition
Authors: Périsse Muriel , Séhier Clément
Published: July 2019

The rise of wages in China would seem to indicate that the demographic dividend has reached its end. A more refined approach reveals, however, that the situation of Chinese workers has not really improved: even though real wages are rising, the share of wages in the nation’s wealth has not kept pace. The reason for this is China’s position within global value chains, where the employment relationship is not solely governed by the employer–employee power relationship, but by contractual relations established between ‘lead firms’ and subcontractors. This situation echoes labour institutional economist JR Commons’ concept of ‘competitive menace’ and analyses of the structural imbalance of power in the employer/employee relationship. We argue that despite the Chinese government’s desire for industrial upgrading and its intention to develop internal labour markets, Chinese labour institutions have shown significant resistance to change making it hard to envisage any shift towards a Fordist regime of capital accumulation based on a virtuous cycle of mass production and mass consumption.

JEL codes: B52, J30
Racialized Experiences of Black Nursing Professionals and Certified Nursing Assistants in Long-Term Care Settings
Authors: Truitt Anjali R. , Snyder Cyndy R.
Published: July 2019

Introduction. This study explores the ways in which racism-related stress affects the well-being and career trajectories of Black nursing professionals and certified nursing assistants and their strategies for coping with such stress. Method. Semistructured interviews were conducted to explore racism-related stress and coping strategies. Data were analyzed using content analysis. Results. Findings illuminate how Black nursing professionals and certified nursing assistants experience both subtle and explicit racism in the workplace from a variety of actors, including patients, peers, and supervisors. Coping strategies included consultation with personal support systems, such as friends outside of work or family members. Participants described barriers to advancement, including disparate educational and mentoring experiences, and a lack of policies or standards to address racial bias and discrimination in their work settings. Discussion. Facilitating diversity in nursing and supporting nursing professionals of color requires multipronged approaches that include collaborations between education systems and employers.
Extremal properties and self-preserving behavior
Authors: Barrett Nathaniel
Published: July 2019

In this reply to the commentaries of Lyon and Swenson, I clarify the arguments of my article, “On the nature and origins of cognition as a form of motivated activity.” In particular, I focus on the nature of self-preserving behavior, considered not only as a basic and universal form of cognitive behavior but also as a key example of cognition as form of motivated activity. I clarify that my approach affirms the importance of self-preserving behavior but questions the widespread assumption that this and other varieties of motivated behavior can be explained as the product of homeostatic mechanisms. I suggest that extremal properties can not only do a better job of explaining homeostasis-like behaviors, but they can also be extended to other kinds of motivated behavior that are not homeostasis-like. Finally, I emphasize the explanatory promise of extremal properties with respect to fundamental questions about the emergence of order in living and nonliving systems.
Influence of Inflammatory and Oxidative Stress Pathways on Longitudinal Symptom Experiences in Children With Leukemia
Authors: Hockenberry Marilyn J. , Pan Wei , Scheurer Michael E. , Hooke Mary C. , Taylor Olga , Koerner Kari , Montgomery David , Whitman Susan , Mitby Pauline , Moore Ida
Published: July 2019

Purpose:

The purpose of this study was to explore the influence of oxidative stress (F2-isoprostanes) and inflammatory (interleukin [IL]-8) biomarkers on symptom trajectories during the first 18 months of childhood leukemia treatment.

Method:

A repeated-measures design was used to evaluate symptoms experienced by 218 children during treatment. A symptom cluster (fatigue, pain, and nausea) was explored over four time periods: initiation of post-induction therapy, 4 and 8 months into post-induction therapy, and the beginning of maintenance therapy (12 months postinduction). F2-isoprostanes and IL-8 were evaluated in cerebrospinal fluid (CSF) samples collected at baseline (diagnosis) and then at the four time periods. The longitudinal relationships of these biomarkers with the symptom cluster were examined using the longitudinal parallel process.

Results:

Pain and fatigue levels were highest during the post-induction phases of treatment and decreased slightly during maintenance therapy, while nausea scores were relatively stable. Even in the later phases of treatment, children continued to experience symptoms. CSF levels of the biomarkers increased during the post-induction phases of treatment. Early increases in the biomarkers were associated with more severe symptoms during the same period; patients who had increased biomarkers over time also experienced more severe symptoms over time.

Conclusions:

Findings reveal that children experienced symptoms throughout the course of leukemia treatment and support hypothesized longitudinal relationships of oxidative stress and inflammatory biomarkers with symptom severity. Activation of the biomarker pathways during treatment may explain underlying mechanisms of symptom experiences and identify which children are at risk for severe symptoms.
Outcomes and complications following non-oncologic total femoral replacement
Authors: Christ Alexander B , Mendez Logan , Gausden Elizabeth B , Blevins Jason L , Bostrom Mathias P , Sculco Peter K
Published: July 2019

Background:

Non-oncologic total femoral replacement (TFR) is utilised as a limb-salvage option in the setting of massive bone loss during revision total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, complication rates, including infection and reoperation, remain a concern.

Methods:

In this study, 16 consecutive TFRs from a single institution with an average clinical follow-up of 4 years were retrospectively reviewed. Indications for TFR, previous surgeries, implants used, complications, reoperations, and ambulatory status at final follow-up were recorded.

Results:

The reoperation rate was 50%, and those patients averaged 2 additional surgeries after TFR. The most common reason for reoperation was infection with a 33% incidence of a new periprosthetic infection and an overall infection rate of 44% (7/16). 6/7 were managed with irrigation and debridement and implant retention. Dual-mobility and constrained acetabular liners were used consistently, and no patient experienced a subsequent dislocation. At final follow-up, 81% were ambulatory but only 2 patients (13%) could walk without an assistive device. No patient required amputation.

Conclusions:

While TFR achieved limb salvage in all patients with fair clinical outcomes, patients were at high risk for new or persistent infection and reoperation. Dual-mobility and constrained acetabular liners were effective in preventing dislocation is this cohort.
Evaluation of the Use of Compressive Stockings Impregnated With Hesperetin-Based Nanocapsules in the Healing of Venous Ulcers: A Case Report
Authors: Menezes Paula dos Passos , Gomes Cristiane Vilaça Campos , Carvalho Yasmim Maria Barbosa Gomes de , Santos Nayara Gomes Lima , Andrade Valléria Matos , Oliveira Ana Maria Santos , Lima Cláudio Moreira de , Araújo Adriano Antunes de Souza
Published: July 2019

Venous ulcers are a more severe complication of chronic venous insufficiency, significantly compromising patient quality of life (QoL). Compressive stockings are still the gold standard treatment method with alternative therapies currently being evaluated. In this perspective, we investigate the influence of compressive stockings impregnated with hesperetin-based nanocapsules in the healing process of venous ulcers. Compressive stockings impregnated with hesperetin-based nanocapsules were applied to a consenting patient for 6 months following all relevant ethical principles for patient studies. The patient was evaluated at baseline (T0), 3 months (T3), and 6 months (T6), using photographic register (healing) probes to measure skin melanin, erythema and hydration parameters, and venous diameters, followed by questionnaires regarding QoL and pain perception. Healing was observed at the 3-month time point and with 91.6% and 93.1% of retraction area in larger ulcers of the right leg and lateral portion of the left leg, respectively. The deepest ulcer in a medial portion of the left leg healed 47.3%. A reduction of all measured skin parameters was observed, indicating a possible hesperetin effect. The scores of QoL and pain were, respectively, in the ranges of 91.6 to 31.2 and 7 to 0. Reduction in venous diameters also indicates healing function. These preliminary findings suggest that compressive stockings impregnated with hesperetin nanocapsules enhance venous ulcer healing. Further clinical trial controlled by placebo, involving a greater number of patients, is required to confirm the findings of this case report.
Noninvasive Neuromonitoring of Hypothermic Circulatory Arrest in Aortic Surgery
Authors: Stewart J. A. , Särkelä M. O. K. , Salmi T. , Wennervirta J. , Vakkuri A. P. , Vainikka T. L. S. , Suojaranta R. , Mäki K. , Ilkka V. H. , Viertiö-Oja H. , Salminen U.-S.
Published: July 2019

Background and Aims:

Circulatory arrest carries a high risk of neurological damage, but modern monitoring methods lack reliability, and is susceptible to the generalized effects of both anesthesia and hypothermia. The objective of this prospective, explorative study was to research promising, reliable, and noninvasive methods of neuromonitoring, capable of predicting neurological outcome after hypothermic circulatory arrest.

Materials and Methods:

Thirty patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta were recruited in a single center and over the course of 4 years. Neuromonitoring was performed with a four-channel electroencephalogram montage and a near-infrared spectroscopy monitor. All data were tested off-line against primary neurological outcome, which was poor if the patient suffered a significant neurological complication (stroke, operative death).

Results:

A poor primary neurological outcome seen in 10 (33%) patients. A majority (63%) of the cases were emergency surgery, and thus, no neurological baseline evaluation was possible. The frontal hemispheric asymmetry of electroencephalogram, as measured by the brain symmetry index, predicted primary neurological outcome with a sensitivity of 79 (interquartile range; 62%–88%) and specificity of 71 (interquartile range; 61%–84%) during the first 6 h after end of circulatory arrest.

Conclusion:

The hemispheric asymmetry of frontal electroencephalogram is inherently resistant to generalized dampening effects and is predictive of primary neurological outcome. The brain symmetry index provides an easy-to-use, noninvasive neuromonitoring method for surgery of the thoracic aorta and postoperative intensive care.
Becoming clowns: How do digital technologies contribute to young children’s play?
Authors: Lafton Tove
Published: July 2019

Research concerning play and technology is largely aimed at expanding the knowledge of what technological play may be and, to a lesser extent, examines what happens to children’s play when it encounters digital tools. In order to explore some of the complexity in play, this article elaborates on how Latour’s concepts of ‘translation’ and ‘inscription’ can make sense of a narrative from an early childhood setting. The article explores how to challenge ‘taken-for-granted knowledge’ and create different understandings of children’s play in technology-rich environments. Through a flattened ontology, the article considers how humans, non-humans and transcendental ideas relate to one another as equal forces; this allows for an understanding of play as located within and emerging from various networks. The discussion sheds light on how activation of material agents can lead us to look for differences and new spaces regarding play. Play and learning are no longer orchestrated by what is already known; rather, they become co-constructed when both the children and the material world have a say in constructing the ambiguity of play. Lastly, the discussion points to how early years practitioners need tools to challenge their assumptions of what play might become in the digital age.
Treatment Indications in Clinical Practice and Applied Research on Psychosocial Interventions for People With Dementia
Authors: Charras Kevin , Dramé Moustapha
Published: July 2019

A recent review of Cochrane meta-analyses on psychosocial interventions (PIs) concludes that clinical trials fail to confirm PIs effective for all types of dementia at every stage of the disease. This article describes how and to what extent it is necessary to identify treatment indications when researching PIs and employing them in clinical practice. Twelve Cochrane reviews on PIs for people with dementia, selected because of their systematic methodology, were searched to identify outcomes related to treatment indications (dosage, type of dementia, severity…). The authors identified several research and practice issues that related to treatment indications: sample profiling, hypothesizing and statistical interpretation, external validity, effectiveness of interventions, contraindications and limits of interventions, and tailoring. Developing an effective PI requires empirical, developmental, exploratory, and confirmatory development stages to achieve credibility and robustness.
Biosignals to Detect the Imbalance of Explicit and Implicit Affect in Dementia: A Pilot Study
Authors: Han Doug Hyun , Ga Hyuk , Kim Sun Mi , Kim Soyoung , Chang Joon Seok , Jang Sunghyuk , Lee Sang Hoon
Published: July 2019

Background:

We assessed implicit and explicit emotion in older patients with dementia using biosignals.

Methods:

Fifty patients with dementia and 34 healthy individuals watched 3 videos that aimed to elicit various emotional responses. Electroencephalogram and heart rate variability were recorded.

Results:

Patients with dementia experienced less fun and more fear than controls. The high frequency (HF) from the baseline in response to funny stimulation as well as HF from neutral to fear stimulation in the dementia group increased further than in the control group. The slow wave (SW)–fast wave (FW) ratio from neutral to funny stimulation in the control group increased further than in the dementia group. The SW-FW from neutral to fear stimulation was further decreased in the dementia group than in the control group.

Conclusions:

Although patients with dementia were more sensitive to implicit affect, they showed more enhanced imbalance between positive and negative affect in explicit affect assessment.
Outcome Measurement of School-Based SEL Intervention Follow-Up Studies
Authors: Ura Sarah K. , Castro-Olivo Sara M. , d’Abreu Ana
Published: July 2019

Recent meta-analyses confirm that social–emotional learning (SEL) interventions are effective in increasing academic, social, and emotional outcomes via direct skills instruction. With skill development serving as a primary mechanism of change in SEL interventions, we argue for the accurate measurement of skills as an important component of SEL research. Using the Collaborative for Academic, Social, and Emotional Learning (CASEL) model, we evaluate 111 studies included in a recent meta-analysis to determine the match between constructs targeted in interventions and SEL skill competency, as well as the measurement of skills and instruments used to evaluate programs. Findings indicate a general trend in the measurement of broad outcomes, rather than skills taught in programs, and limited measurement across CASEL five-competency model. Utility of measuring outcomes specific to competencies taught in intervention across SEL domains are discussed.
Insufficient Balance Recovery Following Unannounced External Perturbations in Persons With Stroke
Authors: Handelzalts Shirley , Steinberg-Henn Flavia , Levy Sigal , Shani Guy , Soroker Nachum , Melzer Itshak
Published: July 2019

Background. Persons with stroke (PwS) are at increased risk of falls, especially toward the paretic side, increasing the probability of a hip fracture. The ability to recover from unexpected loss of balance is a critical factor in fall prevention. Objectives. We aimed to compare reactive balance capacity and step kinematics between PwS and healthy controls. Methods. Thirty subacute PwS and 15 healthy controls were exposed to forward, backward, right, and left unannounced surface translations in 6 increasing intensities while standing. Single step threshold, multiple step threshold, and fall threshold (ie, perturbation intensity leading to a fall into harness system) were recorded as well as reactive step initiation time, step length, and step velocity. Results. Twenty-five PwS fell into harness system during the experiment while healthy controls did not fall. Fourteen out of 31 falls occurred in response to surface translations toward the nonparetic side, that is, falling toward the paretic side. Compared with healthy controls, PwS demonstrated significantly lower fall threshold and multiple step threshold in response to forward, backward, and lateral surface translations. Impairments were more pronounced in response to forward surface translation and toward the nonparetic side (ie, loss of balance toward the paretic side). A trend toward significant shorter step length in response to lateral surface translations was found in PwS compared with healthy controls. Conclusions. Findings highlight the importance of assessing reactive balance capacity in response to perturbations in different directions and intensities in addition to the routine assessment in PwS.
Re-theorising the pre-adolescent child in School Age Care
Authors: Hurst Bruce
Published: July 2019

School Age Care is a setting that is little researched and the research that has been conducted has not often sought the perspectives of older children. This article describes a participatory and ethnographic research project that sought a deeper insight into older children’s experiences of an Australian School Age Care setting, seeking their views about how to successfully program for other children their age. Older children in School Age Care are commonly spoken of as rebellious, bored, disruptive and unsuited to School Age Care. The Foucauldian theories underpinning the research challenged the normative developmental discourses that circulate School Age Care. The research shows that older children have access to these developmental and maturational discourses. The participants actively engaged with language, architecture and resources in the School Age Care setting to actively construct themselves as a more mature, distinct category of child. The findings suggest that School Age Care practitioners should be aware of how developmental discourses are both enacted by children and reinforced through programming design and consider the impacts of segregating routines and practices on children’s play and leisure. While this research does not ‘solve’ the question of older children in School Age Care, it unsettles dominant understandings, therefore inviting practitioners to imagine new programming approaches that might improve School Age Care for older children.
Prognostic Value of Doppler Ultrasound in Triplets Conceived by In Vitro Fertilization: A Case Report and Review of the Literature
Authors: Zafra Rita , Conway Lauren , Solomon Nadia
Published: July 2019

Umbilical artery Doppler ultrasound—which informs on maternal-fetal-placental blood flow—may be the most valuable surveillance tool in triplet pregnancies, crucial to diagnose early fetal growth restriction. To illustrate the prognostic value of Doppler ultrasound and launch a discussion of its role in multiple gestational, high-risk pregnancy, we present the case of a 42-year-old woman with trichorionic triamniotic triplet pregnancy conceived by in vitro fertilization, who showed early signs of poor outcome for one of the triplets via umbilical artery Doppler by the 23rd week and middle cerebral artery Doppler by the 29th week of gestation.
Pectoralis Major Rupture in Military Academy Athletes
Authors: Chan Andrew G. , Balazs George C. , Haley Chad A. , Posner Matthew A. , Rue John-Paul H. , Owens Brett D.
Published: July 2019

Background:

Pectoralis major ruptures are rare injuries that can occur at several parts of the muscle. Little is known of the pathoanatomic process and performance following pectoralis major ruptures in young athletes.

Purpose/Hypothesis:

The objective of this study was to describe a series of pectoralis major ruptures in military academy athletes at the US Military Academy and US Naval Academy. We hypothesized that military academy athletes will demonstrate a different rupture location than previously reported in older patients.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective case series was performed by analyzing all electronic medical records and imaging software for consecutive pectoralis major ruptures undergoing surgical repair within the student population at 2 military academies. The primary outcome of interest was rupture pattern and location. We also assessed functional recovery following surgery by analyzing push-up performance on the biannual Army Physical Fitness Test and Navy Physical Readiness Test.

Results:

From 2005 to 2017, a total of 19 cases of pectoralis major ruptures occurred in military academy cadets. Patients ranged in age from 19 to 23 years, with a mean age of 20 years. All injuries occurred during sports activity, with bench press as the most common mechanism of injury (n = 10; 53%). The most common rupture location was the musculotendinous junction (n = 10; 53%), followed by pectoralis major tendon insertion (n = 8; 42%), and only 1 bony avulsion was noted. Physical activity performance following the rupture was negatively affected. The mean ± SD number of push-ups preinjury was 73.20 ± 12.10, which decreased following injury and surgery (66.50 ± 11.98; P = .037).

Conclusion:

Military academy athletes in our study cohort demonstrated a different type of rupture location than has been reported in older cohorts, with the majority experiencing tearing at a location other than the tendon itself. Performance was also negatively affected immediately following repair, but moderate improvement was observed as time from surgery increased.
Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms
Authors: Lynch Thomas R. , Hempel Roelie J. , Whalley Ben , Byford Sarah , Chamba Rampaul , Clarke Paul , Clarke Susan , Kingdon David G. , O'Mahen Heather , Remington Bob , Rushbrook Sophie C. , Shearer James , Stanton Maggie , Swales Michaela , Watkins Alan , Russell Ian T.
Published: July 2019

Background

Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.

Aims

To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).

Method

RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.

Results

After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.

Conclusions

The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls' limited opportunities to report these.
CsTFL1 inhibits determinate growth and terminal flower formation through interaction with CsNOT2a in cucumber
Authors: Wen Changlong , Zhao Wensheng , Liu Weilun , Yang Luming , Wang Yuhui , Liu Xingwang , Xu Yong , Ren Huazhong , Guo Yangdong , Li Cong , Li Jigang , Weng Yiqun , Zhang Xiaolan
Published: July 2019

Cucumber (Cucumis sativus L.) is an important vegetable crop that carries on vegetative growth and reproductive growth simultaneously. Indeterminate growth is favourable for fresh market under protected environments, whereas determinate growth is preferred for pickling cucumber in the once-over mechanical harvest system. The genetic basis of determinacy is largely unknown in cucumber. In this study, map-based cloning of the de locus showed that the determinate growth habit is caused by a non-synonymous SNP in CsTFL1. CsTFL1 is expressed in the subapical regions of the shoot apical meristem, lateral meristem and young stems. Ectopic expression of CsTFL1 rescued the terminal flower phenotype in the Arabidopsis tfl1-11 mutant and delayed flowering in wild-type Arabidopsis. Knockdown of CsTFL1 resulted in determinate growth and formation of terminal flowers in cucumber. Biochemical analyses indicated that CsTFL1 interacts with a homolog of the miRNA biogenesis gene CsNOT2a; CsNOT2a interacts with FDP. Cucumber CsFT directly interacts with CsNOT2a and CsFD, and CsFD interacts with two 14-3-3 proteins. These data suggest that CsTFL1 competes with CsFT for interaction with CsNOT2a-CsFDP to inhibit determinate growth and terminal flower formation in cucumber.
Quantification of Agility Testing with Inertial Sensors after a Knee Injury
Authors: KIM KYOUNG JAE , GAILEY ROBERT , AGRAWAL VIBHOR , GAUNAURD IGNACIO , FEIGENBAUM LUIS , BENNETT CHRISTOPHER , FELT VIOLET , BEST THOMAS M.
Published: July 2019

Introduction

A common criterion in decision making regarding return to sport (RTS) after knee ligament injury is that athletes should achieve symmetrical bilateral movement between the injured limb and the noninjured limb. Body-worn wireless inertial measurement units (IMU) can provide clinicians with valuable information about lower-limb kinematics and athletic performance.

Methods

The IMU-based novel kinematic metrics were developed. The Transitional Angular Displacement of Segment (TADS) and Symmetry Index (SI) measures that quantify lower-limb motions and interlimb symmetry during the 4-m side step test (FmSST) were developed. Test–retest reliability was measured in 20 healthy adults. Experimental application of the metrics was also determined in 15 National Collegiate Athletic Association Division I collegiate athletes who completed rehabilitation after a knee ligament injury.

Results

The intraclass correlation coefficient for test–retest reliability for FmSST, TADS right lower limb, TADS left lower limb, and TADS SI was 0.90 (95% confidence interval, [0.61–0.95]); 0.87 [0.63–0.96]; 0.89 [0.64–0.96], and 0.81 [0.58–0.92], respectively. The differences between TADS SI at baseline (preinjury) and RTS were also compared with those between the total times for performing the FmSST at baseline and RTS. There was no significant difference in the FmSST times between baseline and RTS (P = 0.32); however, TADS SI at the time of RTS was significantly lower than at baseline (P = 0.046). A large effect size (d = −1.04) was observed for the change in TADS SI from baseline to RTS.

Conclusions

Using IMU sensor technology can provide quantitative and discrete analysis to detect kinematic differences during agility after a knee ligament injury in the field or nonlaboratory setting. This approach has the potential to help clinicians improve decisions about rehabilitation at a time when an athlete is reintegrating back into sport.
Harnessing radiation to improve immunotherapy: better with particles?
Authors: Durante Marco , Formenti Silvia
Published: July 2019

The combination of radiotherapy and immunotherapy is one of the most promising strategies for cancer treatment. Recent clinical results support the pre-clinical experiments pointing to a benefit for the combined treatment in metastatic patients. Charged particle therapy (using protons or heavier ions) is considered one of the most advanced radiotherapy techniques, but its cost remains higher than conventional X-ray therapy. The most important question to be addressed to justify a more widespread use of particle therapy is whether they can be more effective than X-rays in combination with immunotherapy. Protons and heavy ions have physical advantages compared to X-rays that lead to a reduced damage to the immune cells, that are required for an effective immune response. Moreover, densely ionizing radiation may have biological advantages, due to different cell death pathways and release of cytokine mediators of inflammation. We will discuss results in esophageal cancer patients showing that charged particles can reduce the damage to blood lymphocytes compared to X-rays, and preliminary in vitro studies pointing to an increased release of immune-stimulating cytokines after heavy ion exposure. Pre-clinical and clinical studies are ongoing to test these hypotheses.
Use of artificial neural network for pretreatment verification of intensity modulation radiation therapy fields
Authors: Mahdavi Seied Rabie , Tavakol Asieh , Sanei Mastaneh , Molana Seyed Hadi , Arbabi Farshid , Rostami Aram , Barimani Sohrab
Published: July 2019

Objective:

The accuracy of dose delivery for intensity modulated radiotherapy (IMRT) treatments should be determined by an accurate quality assurance procedure. In this work, we used artificial neural networks (ANNs) as an application for the pre-treatment dose verification of IMRT fields based two-dimensional-fluence maps acquired by an electronic portal imaging device (EPID).

Methods:

The ANN must be trained and validated before use for the pretreatment dose verification. Hence, 60 EPID fluence maps of the anteroposterior prostate and nasopharynx IMRT fields were used as an input for the ANN (feed forward type), and a dose map of those fluence maps that were acquired by two-dimensional Array Seven29TM as an output for the ANN.

Results:

After the training and validation of the neural network, the analysis of 20 IMRT anteroposterior fields showed excellent agreement between the ANN output and the dose map predicted by the treatment planning system. The average overall global and local γ field pass rate was greater than 90% for the prostate and nasopharynx fields, with the 2 mm/3% criteria.

Conclusion:

The results indicated that the ANN can be used as a fast and powerful tool for pretreatment dose verification, based on an EPID fluence map.

Advances in knowledge:

In this study, ANN is proposed for EPID based dose validation of IMRT fields. The proposed method has good accuracy and high speed in response to problems. Neural network show to be low price and precise method for IMRT fields verification
Expertise and Discretionary Bonus Decisions
Authors: Abernethy Margaret A. , Hung Chung-Yu , van Lent Laurence
Published: July 2019

We examine the association between managers’ expertise and their discretionary bonus decisions in a hospital setting. We hypothesize that high-expertise managers make decisions that encourage cooperation among their subordinates. However, low-expertise managers cannot do so because their lower levels of knowledge, experience, and domain expertise prevent them from having sufficient personal influence to persuade other professionals to cooperate. We find that high-expertise managers make two types of bonus decisions: (1) keep a smaller share of the bonus pool than what they are entitled to retain and (2) allocate the remainder to subordinates more evenly after adjusting for the underlying heterogeneity in their productivity. We also find evidence that high-expertise managers whose bonus decisions reflect their support for cooperation have higher department performance than all other managers.

This paper was accepted by Suraj Srinivasan, accounting.
Atete: A Multi-functional Deity of Oromo Women with Particular Emphasis on Human Rights and Conflict Resolution Management
Authors: Hussein Temam Hajiadem
Published: July 2019

The roles of women in any society were the focuses of many researchers. Some of them compared with the role of men in the development of human rights and conflict resolution concluded that the women role was limited. But this is not true for Oromo women. For this reason, this paper briefly discusses the roles of Atete Oromo women deity in socio-cultural lives of the Oromo nation. The research explores how Oromo women used this deity to defend their rights and solve the arising conflict in society peacefully. It also outlines special cultural and ritual objects women used to promote peace, human rights, social justice; to overcome natural disasters through prayers and to strike cosmos balance between the creator and creatures. There is a dearth of written material which deals with Atete, the researcher, therefore, depend on some data that come from interviews, informant narration, Atete hymns and observation of the ceremony for many years. Later, these sources were cross-checked with other fragmentary written materials. Based on the investigation and analysis of these sources, the writer concluded that the Oromo society developed a highly sophisticated Atete institution to safeguard women rights and protect the rights of the weak group at least from the time of Gadaa advent. Ever since they also used it for solving the arising conflict in Oromo. Moreover, contrary to what many earlier writers have suggested, Atete is not only confined to fertility matter but also deal with many issues that affect all Oromo groups including male as this investigation establishes.
Research: Mental health
Authors: Greener Mark
Published: July 2019

Mark Greener summarises the latest findings on helping those with mental health conditions
Reflections on the Domestic Violence Disclosure Scheme (England and Wales)
Authors: Duggan Marian
Published: July 2019

The Domestic Violence Disclosure Scheme (DVDS) aims to reduce harm through improving access to background information for people with concerns about a romantic partner’s behaviour. This reduction is predicated on the disclosure recipient taking steps to ensure their safety, either by managing the situation or ending the relationship. As fewer than half of the thousands of annual applications result in disclosures, and no information is held about any subsequent steps taken by applicants or recipients, it is unclear whether or not the DVDS is actually reducing domestic violence. Nonetheless, Scotland and Northern Ireland have implemented their own variations of this policy, as have some Canadian and Australian states.

This policy analysis draws on empirical research into the DVDS in terms of its national and local operation in order to assess the strengths and limitations of its capacity to reduce harm. The analysis outlines how the policy may be difficult to access; deflect – rather than prevent – harm; shift safeguarding responsibilities onto the most vulnerable; and be incorrectly interpreted in terms of outcome. The paper makes recommendations for improvement in order to enhance the policy’s efficacy.
Afferent Loop Syndrome Due to Volvulus of the Afferent Limb
Authors: Desai Aditi , Manvar Amar , Ho Sammy
Published: July 2019

A 78-year-old woman with a history of stage IIB gastric adenocarcinoma with previous Billroth II subtotal gastrectomy was admitted with pancreatitis, with subsequent development of fevers and acute jaundice. Transabdominal ultrasound demonstrated bile duct obstruction. An endoscopic retrograde cholangiopancreatography was attempted, but the lumen of the afferent limb appeared distorted without an obstructing lesion. A computed tomography scan demonstrated volvulus of the afferent limb near the gastrojejunal anastomosis, with afferent limb dilation and significant biliary dilation.