bluuebunny/crossref_metadata_2025 huggingface dataset:
A Qualitative Framework for Collecting and Analyzing Data in Focus Group Research
Authors: Onwuegbuzie Anthony J. , Dickinson Wendy B. , Leech Nancy L. , Zoran Annmarie G.
Published: January 2017

Despite the abundance of published material on conducting focus groups, scant specific information exists on how to analyze focus group data in social science research. Thus, the authors provide a new qualitative framework for collecting and analyzing focus group data. First, they identify types of data that can be collected during focus groups. Second, they identify the qualitative data analysis techniques best suited for analyzing these data. Third, they introduce what they term as a micro-interlocutor analysis, wherein meticulous information about which participant responds to each question, the order in which each participant responds, response characteristics, the nonverbal communication used, and the like is collected, analyzed, and interpreted. They conceptualize how conversation analysis offers great potential for analyzing focus group data. They believe that their framework goes far beyond analyzing only the verbal communication of focus group participants, thereby increasing the rigor of focus group analyses in social science research.
Understanding the Processes of Translation and Transliteration in Qualitative Research
Authors: Regmi Krishna , Naidoo Jennie , Pilkington Paul
Published: January 2017

There has been growing interest in the use of qualitative methods in health research amongst health and social care professionals. Good qualitative cross-cultural research analysis is not an easy task as it involves knowledge of different approaches, techniques and command of the appropriate languages. This article aims to discuss and explore some of the key processes and concepts involved in conducting translation and transliteration of qualitative research.
The Mall Method: Applied in a Study of Inhabitants' Appreciation of Urban Cultural Heritage Areas
Authors: Swensen Grete , Sæter Oddrun
Published: January 2017

Criticism has been directed at traditional approaches to cultural heritage management, as reflected in legislation and policy, for ignoring elements integral to community perceptions of cultural heritage. Although discussions on the right to define are lively, there has been less focus directed towards the significance which personal affiliations and memory play in the processes of forming people's conceptions of important cultural heritage assets and valuable places. But how does one achieve insight into the subjective appreciations of heritage environments? The point of this article is to show how new subjective methodological approaches, tested by what is identified in this article as the Mall Method, can reveal subjective narratives and perspectives linked to inhabitants' everyday life in urban contexts, and to their memories of places. This article searches for subjective meanings of places and landscapes, realized by a stall in a town mall. The method is evaluated in the light of the importance of situated knowledge and subjectivity.
The Subjectivity Problem: Improving Triangulation Approaches in Metaphor Analysis Studies
Authors: Armstrong Sonya L. , Davis Hope Smith , Paulson Eric J.
Published: January 2017

Metaphor analysis procedures for uncovering participant conceptualizations have been well-established in qualitative research settings since the early 1980s; however, one common criticism of metaphor analysis is the trustworthiness of the findings. Namely, accurate determination of the conceptual metaphors held by participants based on the investigation of linguistic metaphors has been identified as a methodological issue because of the subjectivity involved in the interpretation; that is, because they are necessarily situated in specific social and cultural milieus, meanings of particular metaphors are not universally constructed nor understood. In light of these critiques, this article provides examples of two different triangulation methods that can be employed to supplement the trustworthiness of the findings when metaphor analysis methodologies are used.
A Critical Reflection on the Use of Translators/Interpreters in a Qualitative Cross-Language Research Project
Authors: Berman Rachel C. , Tyyskä Vappu
Published: January 2017

Based on experiences from a qualitative research project on immigrant women's English language acquisition, we critiqued the traditional positivist model, and identified a number of issues related to the engagement of translators/interpreters in feminist and community-based research. The issues that we identified amount to serious questions about ambiguities and ownership of translated language content; assumptions about community familiarity and cultural similarity between researchers, translators, and participants; negotiation of power and authority in the research process; and the risks faced by translators. In the end, though individual research team members bear responsibility over these shortcomings and need to strive to make our research practices more inclusive and equitable, the institutional context of research imposes severe limitations on the ideal alternative model of working with translators and interpreters as co-researchers.
Transitioning from Clinical to Qualitative Research Interviewing
Authors: Hunt Matthew R. , Chan Lisa S. , Mehta Anita
Published: January 2017

In this paper one aspect of the transition that must be made by experienced clinicians who become involved in conducting qualitative health research is examined, specifically, the differences between clinical and research interviewing. A clinician who is skillful and comfortable carrying out a clinical interview may not initially apprehend the important differences between these categories and contexts of interviewing. This situation can lead to difficulties and diminished quality of data collection because the purpose, techniques and orientation of a qualitative research interview are distinct from those of the clinical interview. Appreciation of these differences between interview contexts and genres, and strategies for addressing challenges associated with these differences, can help clinician researchers to become successful qualitative interviewers.
Duration, Dominance and Depth in Telephone and Face-to-Face Interviews: A Comparative Exploration
Authors: Irvine Annie
Published: January 2017

Traditionally, methodological textbooks have advised that the telephone mode is not well suited to the task of qualitative interviewing. At the same time, there are well-rehearsed arguments as to why telephone interviews may be a useful option in some circumstances. Despite this debate, there remains very limited systematic empirical exploration of differences in the process and outcomes of qualitative telephone vs. face-to-face interviews. Based on a recent ‘mode comparison’ study that sought to contribute to this gap in methodological knowledge, analysis of the overall duration, dominance and depth of talk between researcher and participant in a small set of telephone and face-to-face interviews revealed the following findings. (i) Despite much variation in individual interview length, telephone interviews were typically, and on average, shorter than those conducted face-to-face. (ii) The shorter duration of telephone interviews was a result of the participant speaking for less time, rather than a proportional reduction in talk from both parties. Additionally, in telephone interviews, participants generally held the floor for shorter stretches at a time. (iii) The researcher did slightly more talking during telephone interviews than in face-to-face interactions. Combined with the reduced amount of participant talk, this meant that the researcher tended to hold the floor for a greater proportion of the time in telephone interviews. (iv) To a moderate degree, the shorter length of telephone interviews could be accounted for by a reduction in coverage of themes. However, the principal explanation appeared to lie in a tendency for telephone interview participants to provide relatively less detail or elaboration. In this article, we consider why these differences may occur, if and how they might matter to the research, and how we might wish to modify interview practices in response.
Intergenerational Dialogue Exchange and Action: Introducing a Community-Based Participatory Approach to Connect Youth, Adults and Elders in an Alaskan Native Community
Authors: Wexler Lisa
Published: January 2017

The broad goals of the community-based participatory research (CBPR) include community engagement, capacity building, developing practical solutions for community concerns and knowledge building. This article describes the data generation and sharing process as it relates to the goals of CBPR and health promotion in an American Indian/Alaska Native communities. The project described herein, “Investigating Inupiaq Cultural Resilience: A Pilot Study, “ achieved these goals in a tribal context by fostering intergenerational dialogue through data collection. The intergenerational exchange served to collect data for a community-based participatory study and provide an opportunity for communication between Elders, adults and youth. By providing an arena for intergenerational sharing, the format encouraged cross-age connections and in doing so, supported, in a broad sense, the transmission of cultural knowledge. The article describes the process and articulates the ways it supports the CBPR goals of engagement, practical relevance, knowledge generation and health promotion.
Doing Ethnographic Research in Chinese Families - Reflections on Methodological Concerns from Two Asian Cities
Authors: Leng Goh Esther Chor , Göransson Kristina
Published: January 2017

This paper compares and contrasts the ethnographic practices of two non-native researchers - a Singaporean researcher studying families in mainland China and a Swedish researcher studying Chinese families in Singapore. A novel conceptual frame of ‘radius of observation positions’ has been proposed to explicate the extent of intrusion and intimacy to which researchers may venture in the private family domain. The opportunities and challenges of two positions of observation within this radius are discussed. The choice of position is largely influenced by the interacting forces of the contextual and cultural factors as well as the personhood of the researcher. The authors call for special attention to cultural sensitivity in conducting Chinese family research. Families are embedded in culture, and the possibility of accessing family spaces hinges on one's awareness of the intricacies of family cultures and realistic assessment of one's strengths and limitations in handling complex family dynamics.
Ethics in Qualitative Research: A View of the Participants' and Researchers' World from a Critical Standpoint
Authors: Aluwihare-Samaranayake Dilmi
Published: January 2017

This paper illustrates how certain ethical challenges in qualitative research necessitate sustained attention of two interconnected worlds: the world of the researcher and the world of the participant. A critical view of some of the ethical challenges in the participants' and researchers' world reveals that how we examine both these worlds' effects how we design our research. In addition, it reflects the need for researchers to develop an ethical research vocabulary at the inception of their research life through multiple modes. The modes may include dialogue in the spoken and written and visual to affect their aims to adhere to the principles of respect, beneficence, nonmaleficence, and justice in a way that is mutually beneficial to the participant and the researcher. Further, the deliberations in this paper reveal that a critical conscious research ethics are embedded in the unfolding research ethics process involving the participants and the researchers, and both the participant and researcher add equal weight to the transparency of the ethical process and add value to building methodological and ethical rigor to the research.
Hermeneutics as Research Approach: A Reappraisal
Authors: McCaffrey Graham , Raffin-Bouchal Shelley , Moules Nancy J.
Published: January 2017

Hermeneutics as a research practice, if it is to remain true to its philosophical origins, involves reappraisal and reinterpretation in relation to its cultural contexts. Among the threads of connection affecting hermeneutic practice are the exigencies of academic institutions and evolving cross-cultural perspectives. This article addresses these issues from the perspective of exploring hermeneutics for a research study of nurses' relational practice on acute care mental health units from Buddhist perspectives. The exploration is, as hermeneutics must be, both a review and a refashioning, a looking back in order to look forward.
In-Depth Interviewing with Healthcare Corporate Elites: Strategies for Entry and Engagement
Authors: Goldman Ellen F. , Swayze Susan
Published: January 2017

Interviewing corporate elites has received limited attention in the methodological literature. Such elites are considered highly difficult to gain access to and, if involved, are believed to use their power asymmetry to dominate the interview. Understanding the context is considered essential to elite access, interview conduct, and interpretation of findings. The healthcare sector provides interesting challenges for in-depth elite interviewing, including historical norms regarding interview access, types, and duration. In this article, the authors report on the strategies used to gain access to and engage healthcare elites who participated in multiple personal interviews using the Seidman in-depth phenomenological interviewing method. Techniques for identifying and recruiting potential participants, scheduling and preparing for the interview, and establishing rapport are described. Concept mapping is presented as a way of fully engaging the elites in the tripartite interview process and facilitating trustworthiness. The lessons learned offer important strategies for those undertaking phenomenological research with elites.
Management of a Large Qualitative Data Set: Establishing Trustworthiness of the Data
Authors: White Debbie Elizabeth , Oelke Nelly D. , Friesen Steven
Published: January 2017

Health services research is multifaceted and impacted by the multiple contexts and stakeholders involved. Hence, large data sets are necessary to fully understand the complex phenomena (e.g., scope of nursing practice) being studied. The management of these large data sets can lead to numerous challenges in establishing trustworthiness of the study. This article reports on strategies utilized in data collection and analysis of a large qualitative study to establish trustworthiness. Specific strategies undertaken by the research team included training of interviewers and coders, variation in participant recruitment, consistency in data collection, completion of data cleaning, development of a conceptual framework for analysis, consistency in coding through regular communication and meetings between coders and key research team members, use of N6™ software to organize data, and creation of a comprehensive audit trail with internal and external audits. Finally, we make eight recommendations that will help ensure rigour for studies with large qualitative data sets: organization of the study by a single person; thorough documentation of the data collection and analysis process; attention to timelines; the use of an iterative process for data collection and analysis; internal and external audits; regular communication among the research team; adequate resources for timely completion; and time for reflection and diversion. Following these steps will enable researchers to complete a rigorous, qualitative research study when faced with large data sets to answer complex health services research questions.
Breathing in the Mud: Tensions in Narrative Interviewing
Authors: Beuthin Rosanne E.
Published: January 2017

This article explores important questions around the often taken for granted approach to interviewing within narrative inquiry. When I applied an interview approach that emphasized the dialogical, performative, and social, tensions were provoked that muddied my assumptions and equilibrium. By sharing my story, I invite readers to reflect upon the researcher's role in interviewing. I address tensions that arose between (a) presence and performance, (b) equality and power, (c) leading and following, (d) insider and outsider, (e) influence and neutrality, and (f) trust and responsibility. I come to describe the craft of co-constructing stories with another as breathing in the mud—a dynamic process in which the researcher moves between the tensions of getting stuck in one moment and finding brilliant presence in the next. Discussion focuses on how a researcher might use tensions as catalysts that ignite clarity and advance how narrative interviewing is enacted.
So you Really Want to Interview Me?: Navigating “Sensitive” Qualitative Research Interviewing
Authors: Brayda Winsome Chunnu , Boyce Travis D.
Published: January 2017

This article discusses the qualitative interviewing techniques that the authors used to conduct their respective dissertation research in Jamaica and South Carolina. (The research in Jamaica examined the implementation of primary education policies. The research in South Carolina delved into the life history of Benner C. Turner, a controversial college president.) Most of the literature about interviewing focuses on asking the right questions; in contrast, this article discusses the challenges of interviewing. In this article, selected interviews are used from both studies to examine the difficulties these researchers encountered when conducting “sensitive” interviews, the risks female researchers face in unfamiliar places, and the challenges of working in international settings (which requires interpersonal skills and cultural competency). While the task of research interviewing is complex, the authors provide ideas that can be used to navigate such moments.
Explicating Positionality: A Journey of Dialogical and Reflexive Storytelling
Authors: Carter Celina , Lapum Jennifer L. , Lavallée Lynn F. , Martin Lori Schindel
Published: January 2017

Qualitative researchers must be aware of and explicit about their social background as well as political and ideological assumptions. To facilitate this awareness, we believe that researchers need to begin with their own story as they seek to understand the stories of others. Taking into account the vulnerable act of storytelling, it is salient to consider how to share personal narratives in an authentic way within academic settings. In this article, we share our process and reflections of engaging in reflexive and dialogical storytelling. The focus of the article is the re-storying of one researcher's experience as she and her research team explore her emotions and positionality prior to conducting research on First Nations men's narratives of identity. We integrate a series of methodological lessons concerning reflexivity throughout the re-storying.
The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity
Authors: Boniakowski Anna E , Davis Frank M , Phillips Amanda R , Robinson Adina B , Coleman Dawn M , Henke Peter K
Published: January 2017

Objectives

The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair.

Methods

A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function.

Results

Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386).

Conclusions

When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.
Cytomegalovirus Infection in Heart-Transplant Recipients in a Central Region of Italy
Authors: Dalessandro M. , Falasca K. , Racciatti D. , Zingariello P. , Cacciatore P. , Scarinci A. , Ceccomancini A. , Di Giammarco G. , Pizzigallo E. , Vecchiet J.
Published: January 2017

Cytomegalovirus (CMV) infection occurs very often after solid organ transplantation and is often a life-threatening complication of long-term immunosoppressive therapy. Actually it is unknown which type of drug is indicated to control the infection in immunocompromised patients. We studied 10 consecutive patients who had undergone heart-transplantation and in which CMV infection was the commonest post-transplant infectious disease. Our results suggest a careful monitoring of IgG seropositivity in heart transplant patients, especially when it is not possible to know the serum status of the donor.
Transvaginal Diffusion of Synthetic Peptides
Authors: Basson E. , Van Der Bijl P. , Van Eyk A.D.
Published: January 2017

Topical microbicide peptides are being developed to combat the transfer of HIV, but little is known about the permeation of these compounds through vaginal epithelium. The object of the present study is to investigate the in vitro permeation of synthetic transport peptides through vaginal mucosa. The permeation kinetics of three FITC (fluorescein isothiocyanate)-labelled peptides MEA-5 (Mw = 2911.4 Da), MDY-19 (Mw = 2409.5 Da) and PCI (Mw = 2325 Da) across human vaginal mucosa was studied by means of a continuous flow-through diffusion system. Permeability studies were conducted at concentrations of 1 mM, 0.75 mM and 0.5 mM in PBS buffer at 37°C and 20°C, respectively, and over a time period of 24 h, using fluorospectrophotometry as detection method. Effects of a surfactant on MDY-19 permeation and de-epithelialisation of the vaginal mucosa were also studied. Statistical tests used included an ANOVA and Duncan's multiple range test to establish steady state diffusion kinetics. All three peptides readily penetrate vaginal mucosa. Microbicides may be coupled to MDY-19 and PCI to be transported transmucosally. Although increased size of the peptide/microbicides complex may decrease mucosal permeability, this could possibly be overcome by the addition of a permeation enhancer, e.g. a surfactant. Removal of the vaginal epithelium increased the flux rates of the peptides across the mucosa and may have implications for a more rapid uptake of these and other microbicides in vivo. Concentration- and temperature- dependency of peptide flux rates must be taken into consideration when performing in vitro permeability studies.
Activation of the Bradykinin System by Angiotensin-Converting Enzyme Inhibitors
Authors: Sharma J.N.
Published: January 2017

The Bradykinin (BK) system has a very significant role in the regulation of blood pressure (BP). Hence, reduced activity of BK receptors mediated via decreased circulating endogenous kinin might explain the cause of high BP. This system also governs the activation of the angiotensin system at various axes in control of the physiological BP. The BK receptor antagonists can block the hypotensive action of angiotensin-converting enzyme inhibitors (ACEIs) in hypertensive and normotensive animals. The hypotensive action of BK is highly increased with ACEIs or kininase II inhibitor treatment. The development of specific BK agonists may provide a new direction to explore the experimental approach for examining the role of BK in hypertension.
A primary role for kinin B1 receptor in inflammation, organ damage, and lethal thrombosis in a rat model of septic shock in diabetes
Authors: Tidjane N , Hachem A , Zaid Y , Merhi Y , Gaboury L , Girolami J-P , Couture R
Published: January 2017

Diabetes mellitus and septic shock increase the incidence of mortality by thrombosis. Although kinin B1 receptor (B1R) is involved in both pathologies, its role in platelet function and thrombosis remains unknown. This study investigates the expression, the inflammatory, and pro-thrombotic effects of B1R in a model of septic shock in diabetic rats. Sprague-Dawley rats were made diabetic with streptozotocin (STZ) (65 mg/kg, i.p.). Four days later, control and STZ-diabetic rats were injected with lipopolysaccharide (LPS) (2 mg/kg, i.p.) or the vehicle. B1R antagonist (SSR240612, 10 mg/kg by gavage) was given either acutely (12 and 24 h prior to endpoint analysis) or daily for up to 7 days. Moreover, a 7-day treatment was given either with cyclooxygenase (COX)-2 inhibitor (niflumic acid, 5 mg/kg, i.p.), non-selective COX-1 and COX-2 inhibitor (indomethacin, 10 mg/kg, i.p.), non-selective nitric oxide synthase (NOS) inhibitor (L-NAME, 50 mg/kg by gavage), iNOS inhibitor (1400W, 5 mg/kg, i.p.), or heparin (100 IU/kg, s.c.). The following endpoints were measured: edema and vascular permeability (Evans blue dye), B1R expression (qRT-PCR, western blot, flow cytometry), aggregation in platelet-rich plasma (optical aggregometry), and organ damage (histology). Rats treated with STZ, LPS, and STZ plus LPS showed significant increases in edema and vascular permeability (heart, kidney, lung, and liver) and increased expression of B1R in heart and kidney (mRNA) and platelets (protein). Lethal septic shock induced by LPS was enhanced in STZ-diabetic rats and was associated with lung and kidney damage, including platelet micro-aggregate formation. SSR240612 prevented all these abnormalities as well as STZ-induced hyperglycemia and LPS-induced hyperthermia. Similarly to SSR240612, blockade of iNOS and COX-2 improved survival. Data provide the first evidence that kinin B1R plays a primary role in lethal thrombosis in a rat model of septic shock in diabetes. Pharmacological rescue was made possible with B1R antagonism or by inhibition of iNOS and COX-2, which may act as downstream mechanisms.
A Bayesian meta-analytic approach for safety signal detection in randomized clinical trials
Authors: Odani Motoi , Fukimbara Satoru , Sato Tosiya
Published: January 2017

Background/Aim:

Meta-analyses are frequently performed on adverse event data and are primarily used for improving statistical power to detect safety signals. However, in the evaluation of drug safety for New Drug Applications, simple pooling of adverse event data from multiple clinical trials is still commonly used. We sought to propose a new Bayesian hierarchical meta-analytic approach based on consideration of a hierarchical structure of reported individual adverse event data from multiple randomized clinical trials.

Methods:

To develop our meta-analysis model, we extended an existing three-stage Bayesian hierarchical model by including an additional stage of the clinical trial level in the hierarchical model; this generated a four-stage Bayesian hierarchical model. We applied the proposed Bayesian meta-analysis models to published adverse event data from three premarketing randomized clinical trials of tadalafil and to a simulation study motivated by the case example to evaluate the characteristics of three alternative models.

Results:

Comparison of the results from the Bayesian meta-analysis model with those from Fisher’s exact test after simple pooling showed that 6 out of 10 adverse events were the same within a top 10 ranking of individual adverse events with regard to association with treatment. However, more individual adverse events were detected in the Bayesian meta-analysis model than in Fisher’s exact test under the body system “Musculoskeletal and connective tissue disorders.” Moreover, comparison of the overall trend of estimates between the Bayesian model and the standard approach (odds ratios after simple pooling methods) revealed that the posterior median odds ratios for the Bayesian model for most adverse events shrank toward values for no association. Based on the simulation results, the Bayesian meta-analysis model could balance the false detection rate and power to a better extent than Fisher’s exact test. For example, when the threshold value of the posterior probability for signal detection was set to 0.8, the false detection rate was 41% and power was 88% in the Bayesian meta-analysis model, whereas the false detection rate was 56% and power was 86% in Fisher’s exact test.

Limitations:

Adverse events under the same body system were not necessarily positively related when we used “system organ class” and “preferred term” in the Medical Dictionary for Regulatory Activities as a hierarchical structure of adverse events. For the Bayesian meta-analysis models to be effective, the validity of the hierarchical structure of adverse events and the grouping of adverse events are critical.

Conclusion:

Our proposed meta-analysis models considered trial effects to avoid confounding by trial and borrowed strength from both within and across body systems to obtain reasonable and stable estimates of an effect measure by considering a hierarchical structure of adverse events.
The value of computed tomography in detecting distal radioulnar joint instability after a distal radius fracture
Authors: van Leerdam R. H. , Wijffels M. M. E. , Reijnierse M. , Stomp W. , Krijnen P. , Schipper I. B.
Published: January 2017

This study evaluated the value of computed tomography scans for the diagnosis of distal radioulnar joint instability. A total of 46 patients, conservatively treated for a unilateral distal radius fracture, were evaluated. Clinical instability was tested using the stress test and clunk test. A computed tomography scan of both wrists was performed in pronation and supination. Two independent observers reviewed the computed tomography scans using: the radioulnar line, subluxation ratio, epicentre and radioulnar ratio methods. Radiological distal radioulnar joint instability was assessed by comparing the measurements of the injured wrist with those of the contralateral uninjured wrists. A total of 22 patients had clinical instability of whom 12 suffered from pain in the injured wrist. Distal radioulnar joint instability was diagnosed on computed tomography in 29 patients. Reliability analysis between clinical and radiological evaluations showed at best moderate, but generally poor agreement. The diagnostic ability of computed tomography for identifying distal radioulnar joint instability seems limited.

Level of evidence: IV
Fingolimod initiation in multiple sclerosis patients is associated with potential beneficial cardiovascular autonomic effects
Authors: Hilz Max J. , Wang Ruihao , de Rojas Leal Carmen , Liu Mao , Canavese Francesca , Roy Sankanika , Hösl Katharina M. , Winder Klemens , Lee De-Hyung , Linker Ralf A.
Published: January 2017

Background:

Fingolimod slows heart rate (HR) due to vagomimetic effects and might cause additional cardiovascular autonomic changes. While the time course of HR changes is well described, the extent and course of cardiovascular autonomic changes upon fingolimod initiation has not yet been evaluated. This study, therefore, intended to assess cardiovascular autonomic changes during the first 6 h after fingolimod initiation.

Methods:

In 21 patients with relapsing-remitting multiple sclerosis (RRMS), we recorded respiration (RESP), electrocardiographic RR interval (RRI), systolic and diastolic blood pressure (BPsys, BPdia) at rest, before and 0.5, 1, 2, 3, 4, 5, and 6 h after fingolimod initiation. We calculated parameters of total autonomic modulation [RRI standard deviation (RRI-SD), RRI coefficient of variation (RRI-CV), RRI-total powers], mainly sympathetic cardiac modulation [RRI low frequency (LF) powers], sympathetic BP modulation (BPsys-LF powers), parasympathetic modulation [square root of the mean squared difference of successive RRIs (RMSSD), RRI high frequency (HF) powers], sympatho-vagal cardiac balance (RRI-LF/HF ratios), and baroreflex sensitivity (BRS). We compared parameters between the eight measurements [analysis of variance (ANOVA) or Friedman test with post-hoc analysis; significance: p < 0.05].

Results:

After fingolimod initiation, RESP, BPsys, and BPsys-LF powers remained unchanged while RRIs, RRI-CV, RRI-SD, RRI-total powers, RRI-LF powers, RMSSD, RRI-HF powers, and BRS increased after 1 h and rose to peak values occurring after 5, 1, 2, 2, 1, 4, 4, and 4 h, respectively. After 3 h, BPdia had decreased significantly and was lowest after 5 h. RRI-LF/HF ratios decreased to a nadir after 4 h.

Conclusions:

The increases in parasympathetic and overall cardiac autonomic modulation and in BRS seen with fingolimod initiation are theoretically beneficial for the MS patient’s cardiovascular system. However, long-term studies must show whether these effects persist or are attenuated (e.g. due to S1P1 receptor down-regulation upon continued fingolimod therapy).
The First Use of Bolus Calculator With Speech Analyzer
Authors: Mazurczak Karolina , Pańkowska Ewa , Ładyżyński Piotr , Foltyński Piotr
Published: January 2017

Background:

The insulin therapy in type 1 diabetes involves a wide array of restrictions in patients and their families. One of those is a difficulty in estimation of the insulin dose programmed for each meal. The purpose of the study is an assessment of functionalities related to the expert system VoiceDiab—a calculator of meal boluses.

Methods:

The sample group composed of 54 patients, aged 3-52, all suffering from type 1 diabetes, treated with the insulin pump, taking part in the clinics RCT (for adults and a pediatrician), with a randomized allocation to a surveyed group and cross-over. The research methodology was based upon questionnaires and open-ended questions.

Results:

40% of respondents recognized the application’s usefulness as high (18 of 47), giving it 10 points, and easy to use (70%). Disadvantages of this app comprised lack of some products in the application database (n = 23), troubles with the mobile range ( n = 4), and no option of a manual data input for processing purposes (n = 23). Advantages, that have been mentioned the most frequently included facilitation of measurements (n = 7), enhanced life quality of the patient (n = 8), and a guarantee of prompt and thorough calculations (n = 22). Of the surveyed individuals, 50% reached their diet, while 100% gave a top grade to the application, claiming it had contributed to a more efficient metabolic control.

Conclusion:

The pilot scheme of the expert system VoiceDiab has potential to become an application, facilitating dosing of the meal insulin and improving the comfort and safety of insulin administering. However, it needs to be modified, as mentioned by the users who have tested the system.
The Role of Hospitality Service Quality in Third Places for the Elderly: An Exploratory Study
Authors: Lee Ji-Eun , Severt Denver
Published: January 2017

This study examines the role of hospitality service quality in a third place for the elderly using a Continuing Care Retirement Community (CCRC) setting. The study builds from the relational theory of third places testing the causal relationships among resident needs, place meaning, and loyalty outcomes. The study extends the theory by applying it to the CCRC context through using data that were collected from 157 CCRC residents in the southeastern portion of the United States. The proposed relational third-place model using the construct of place meaning was tested using confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results indicated that resident needs (tangibles, instrumental support, and emotional support) positively influenced place meaning, and in turn place meaning positively impacted resident loyalty outcomes. Through the relational theory of third places, the CCRC is a meaningful place to residents, and CCRC residents are loyal to the community. Most importantly, the results of the study identified that service quality strongly impacted place meaning in the CCRC. Theoretically, the study provided valid and reliable support suggesting that the construct of place meaning is applicable to the CCRC setting. Practically, this study provides empirical support for the importance of providing a rich hospitality service culture through strengthening instrumental support, emotional support, and tangibles. In this way, management should establish a culture that is rich in hospitality and service through the enhancement of tangibles, empathetic and interactive staff care. Finally, this rich culture will lead to enhanced place attachment as supported by this exploratory study.
Carotid ultrasound features of anomalous left vertebral artery originating from the aortic arch proximal to the left subclavian artery
Authors: Wakita Masayuki , Takei Ran , Miyashita Fumio , Hamada Yuki , Ohyama Satoshi , Matsuoka Hideki , Takashima Hiroshi
Published: January 2017

We present three cases of anomalous origin of the left vertebral artery (LVA) detected during the evaluation of stroke. The VA usually enters the transverse foramen of the sixth cervical vertebra (C6), but an anomalous LVA originating from the aorta frequently enters at a higher level. In our series, ultrasound of the LVA showed entry at C4 in two patients and at C5 in one patient. These findings suggested anomalous LVA origin, and three-dimensional computed tomography demonstrated the LVA arising from the aorta proximal to the left subclavian arteries. Carotid duplex ultrasound is useful for the diagnosis of this anomaly.
Afraid to roam: The unlevel playing field of Pokémon Go
Authors: Salen Tekinbaş Katie
Published: January 2017

All games contain conflict, and all good games have uncertain outcomes. Whether conflict over resources, knowledge, or territory, to name a few types, games challenge players to overcome obstacles in interesting and fun ways. Pokémon Go challenges players to find and capture Pokémon, which requires time, patience, skill, and the freedom to access the game map (i.e., spaces in the real world) to its fullest extent. When players are denied full access, either through a technical glitch in the game—like when a server crashes or when networks become unavailable—or through real or imagined threats of violence or harassment, the game becomes inherently unfair. How might we make sense of issues of accessibility, privilege, and race raised by the game? When players say “I might die if I keep playing” (Akil, 2016), what might we learn about the limits of mobility and the ways in which pervasive play comes to be embedded in society?
Health informatics in UK Medical Education: an online survey of current practice
Authors: Walpole Sarah , Taylor Paul , Banerjee Amitava
Published: January 2017

Objective

Health informatics has growing importance in clinical practice with successive General Medical Council recommendations. However, prior data suggest that undergraduate medical education largely neglects this area. An up-to-date, UK-wide view of health informatics training in medical schools is required.

Design

An online survey was developed using current guidance and recommendations of UK professional bodies.

Participants and Setting

Senior academic staff and health informatics educators at all 34 UK medical schools were invited to complete the survey.

Main outcome measures

Quantitative and qualitative data regarding health informatics in the undergraduate medical curriculum.

Results

A total of 26/34 (76%) of UK medical schools responded and 23 provided full information. Aspects most frequently mentioned were literature searching and research governance. Seventeen per cent of respondents felt there was little or no HI training, although clinical record keeping was addressed by all medical schools. Pedagogies used to teach health informatics were self-directed learning (78%) to lecture based (70%), seminars (70%), informal teaching in clinical settings (57%) and problem-based learning (22%). Health informatics was usually integrated vertically and horizontally across the curriculum (76%). Assessment and updates of the health informatics curriculum are limited (57 and 41%, respectively). Thirty-two per cent of respondents reported a low level of confidence among students to use health informatics as doctors. In the most up-to-date survey of health informatics teaching in UK medical schools, there are three major findings. First, the proportion of health informatics in the medical undergraduate curriculum is low. Second, there was variation in content, pedagogy and timing across medical schools. Third, health informatics is rarely assessed and course content is not regularly updated.

Conclusions

There is a role for national guidelines and further research in this area of the curriculum which is rapidly gaining in prominence.
Strategic contracting as a source of organizational success
Authors: Cummins Tim
Published: January 2017

In this essay I reflect on the fundamental impact of global networked communications on trading relationships and the overall value chain. Based on my observations as Executive Director of the International Association for Contract and Commercial Management, I argue that the influences and complexity of today's market conditions demands fresh approaches to the way that relationships are formed and managed, promoting the role of contracts in shaping organizations and determining their success. I conclude that in a modern networked economy, the contracting process provides the essential glue that ensures integrity across the links in the value chain. Therefore contracting, until now the ugly duckling of commercial endeavor, must take center stage as a strategically critical capability that will be strengthened through the academic rigor and research such a professional practice demands.
An ecosystem lens: Putting China’s digital music industry into focus
Authors: Tang Diming , Lyons Robert
Published: January 2017

The digital disruption of the global music industry hits the value chain for recorded music hard. In China, new digital service providers began to amass large user bases, offering a variety of services based on e-commerce and social messaging applications. In a low-intellectual property environment, these services have become the primary sources of digital music streaming via the Internet and increasingly through mobile telephony. This article reviews the literature on the value chains within the Chinese music industry, compares a classic business ecosystem model with a more recent model, and examines available user data on current Chinese music streaming services. We then suggest an ecosystem framework toward understanding the digital music industry in China and discuss how this framework maps to recent developments in China’s digital music industry.
Unexpected Internalization of a Pulmonary Artery Band in a Porcine Model of Tetralogy of Fallot
Authors: Jalal Zakaria , Roubertie François , Fournier Emmanuelle , Dubes Virginie , Benoist David , Naulin Jerome , Delmond Samantha , Durand Marlène , Haissaguerre Michel , Bernus Olivier , Thambo Jean-Benoit
Published: January 2017

Background:

We report our experience of an unexpected complication of internalization of a pulmonary artery (PA) band in the vascular lumen, which occurred in a chronic porcine model of repaired tetralogy of Fallot (TOF).

Methods:

Twelve piglets were divided into 3 groups: (1) TOF model animals (PA band plus pulmonary valvotomy, n = 4), (2) pulmonary insufficiency (PI) animals (pulmonary valvotomy, n = 4), and (3) control animals (n = 4). A nonabsorbable, coated braided polyester tape was used to perform the main pulmonary artery banding. Echocardiography was performed 4 months postoperatively. After each animal was euthanized, PA histological analysis was performed in animals with band internalization.

Results:

Significant postsurgical pulmonary regurgitation and right ventricular enlargement were present in the TOF and PI, compared with control animals, whereas no significant pulmonary stenosis was observed in TOF animals when compared with PI group. Postmortem examination of all TOF animals revealed the constricting band to be intact but partially internalized into the PA lumen, allowing blood flow around the stenosis. Histological sections of the banded PA in the area of internalization showed a significant disorganization of the medial layer, with significant scarring and fibrotic reaction surrounding the outside of the band and the presence of inflammatory cells suggesting a significant inflammatory response during band internalization.

Conclusions:

Band internalization may occur after PA banding using a nonabsorbable, coated braided polyester tape in a chronic porcine model of repaired TOF. This unusual complication was likely due to the type of material used for banding.
The Hemodynamic Effects and Safety of Repetitive Levosimendan Infusions on Children With Dilated Cardiomyopathy
Authors: Suominen Pertti , Mattila Niklas , Nyblom Olle , Rautiainen Paula , Turanlahti Maila , Rahkonen Otto
Published: January 2017

Background:

Limited treatment options are available for children with decompensated dilated cardiomyopathy (DCM), while they wait for either functional recovery or heart transplantation. We evaluated the safety of repetitive levosimendan infusions and short-term and long-term impacts of the therapy in this patient population.

Methods:

Eighty-one repetitive levosimendan infusions administered to 20 patients with DCM at severe or end stage of the disease in the pediatric intensive care unit were analyzed retrospectively. Echocardiographic assessments were reinterpreted by two experienced pediatric cardiologists. The mean follow-up time after therapy was 9.8 ± 3.3 years.

Results:

The median age of the patients at the time of the first levosimendan infusion was 1.1 years (interquartile range: 0.3-2.1). Transient hypotension was reported in 17.3% of the infusions. No significant changes in the mean ejection fraction were detected after repetitive levosimendan infusion (31.6 ± 12.5 vs 33.1 ± 12.4; P = .39) or for the laboratory parameters for the group as a whole. In 7 (35%) of 20 patients, the mean ejection fraction improved from 20% ± 12% to 35% ± 11% ( P = .003). The administration of concomitant medications and time may have contributed to the healing process of these patients. Two patients were removed from the transplantation waiting-list owing to clinical recovery after six months of therapy. The long-term survival rate was 70% (n = 14 of 20).

Conclusions:

Repetitive levosimendan infusions in children with DCM appeared to be hemodynamically well tolerated without severe adverse events. Although one-third of the children had a good response to repetitive levosimendan infusions, no overall significant improvement in ventricular performance could be found in this heterogenous DCM patient population, which included the patients in end-stage heart failure.