bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Rates of Breastfeeding Initiation
Authors: Grubesic Tony H. , Durbin Kelly M.
Published: August 2016

Background:

Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation.

Objective:

This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting “hot spots” and “cool spots” of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns.

Methods:

Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation.

Results:

Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation.

Conclusion:

Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.
A Breastfeeding Quality Improvement Project in Rural Primary Care
Authors: Dumphy Deborah , Thompson Julie , Clark Myra
Published: August 2016

Background:

Breastfeeding is the gold standard nutrition for infants, and more than three-fourths of US mother–infant couplets initiate breastfeeding at birth. However, breastfeeding rates plummet after hospital discharge, when mother–infant couplets enter primary care. This quality improvement project examined the effect of a primary care intervention on breastfeeding rates from the newborn visit through the 4-month visit.

Objective:

The overall aim of this evidence-based quality improvement project was to increase breastfeeding rates by refining the care provided to a diverse patient population with historically low breastfeeding rates.

Methods:

Two independent groups of mother–infant couplets, a pre-implementation (N = 43) and a post-implementation (N = 45), were longitudinally evaluated on breastfeeding rates at the newborn, 1-month, 2-month, and 4-month well-child visits for exclusive, partial, and any breastfeeding rates. Relationships for the 2 groups were compared using 2-sample t tests, chi-square, and Fisher exact tests.

Results:

Post-implementation rates for any breastfeeding progressively increased at each timepoint. Exclusive breastfeeding increased 40.98% at the 1-month visit, 27.4% at the 2-month visit, and 139% at the 4-month visit.

Conclusion:

The implementation of an evidence-based breastfeeding-friendly office protocol in a rural low breastfeeding rate primary care setting was associated with increased breastfeeding rates.
Exploring ambiguous realms: Access, exposure and agency in the interactions of rural Zambian children
Authors: Clemensen Nana
Published: August 2016

In Hang’ombe Village in southern Zambia, the relative lack of physical boundaries between the activities of family members allow children to observe the actions and discussions of adults on close hand, exposing them to the ambiguities of daily life. Children explore these ambiguities in their interactions, testing social roles and conventions. This article explores the vigilance and creative agency displayed by Hang’ombe children, in an environment spurring their acquisition of distinct social and linguistic skills.
Suffering and thriving: Children’s perspectives and interpretations of poverty and well-being in rural Zambia
Authors: Phiri Douglas Tendai , Abebe Tatek
Published: August 2016

Drawing on the findings of a qualitative research in rural Zambia involving 24 children (9- to 16-year old), this article advances our understandings of the ways in which familial and inter-generational relationships influence the experiences, impacts, conceptualizations and interpretations of poverty. It is argued that boys and girls interpret poverty largely in social and relational terms – ways that mirror social interdependence. Key dimensions of poverty and well-being are discussed from children’s points of view: subjective (depending on individual perceptions and experiences), contextual (impacted by local rural livelihood circumstances), relational (linked with family and community) and processual (tied to the future). This research contributes to literature on childhood poverty and well-being, specifically on how children influence and are influenced by the socio-economic transformations of their community and how they attach meanings to their social and material contexts.
Pure as the angels, wise as the dead: Perceptions of infants’ agency in a Zambian community
Authors: Smørholm Sesilie
Published: August 2016

This article is focused on concepts of agency in relation to unborn and newly born babies in a Zambian community. Through an exploration of local perceptions of unborn and newly born babies’ spirituality and personhood, as well as their developing bodies, I problematize dominating theoretical definitions of children’s agency. The article calls for more relational assessments of children’s agencies that not only focus on children as independent social actors in their own right but also integrate experiences of dependency and vulnerability.
Resisting labour control and optimizing social ties: experiences of women construction workers in Delhi
Authors: Khurana Sakshi
Published: August 2016

Even as employment in the construction industry in India has grown in recent decades, economic insecurities of workers persist. The existing forms of work and labour control, embedded in capitalist and patriarchal relations, are significant for women’s ability to question or resist their conditions of work. To understand the relations among workers and between workers and contractors/employers, this study draws on Scott’s idea of the ‘moral economy’. I argue in this article that in the absence of formal or legal contracts between workers and contractors, women are led to mobilize on their social capital or their valued relations with contractors and co-workers. Women’s responses to their situation may not demonstrate a strong articulation of exploitation in class or feminist terms, but their political sense is informed by ideas of morality and reciprocity in relationships. Their resistance could be strengthened when they collectively act with workers in a similar situation.
Value and nursing home profitability
Authors: Clement Jan
Published: August 2016

Background

Nursing homes in the United States are being challenged to demonstrate the value of the care they deliver. While quality and financial benefits of increasing the value of specific services accrue to nursing home residents and payers, an important unanswered question is whether producing high-value services produces financial benefits for the nursing home.

Aim

This paper examines whether offering high-value services to self-pay long-term care residents is associated with the nursing home’s profitability. Self-pay residents are an important market for nursing homes (29% of revenues) and one where nursing homes have pricing discretion.

Methodology

A multivariate regression model is estimated. Data for the study come from a unique database of per diem prices for self-pay long-term care services for Virginia nursing homes in 2011 combined with five star quality ratings from the Centers for Medicare and Medicaid Services Nursing Home Compare website.

Results

Offering high-value long-term care services is unrelated to operating or total margin of nursing homes.

Conclusions

Nursing homes can offer services to long-term care self-pay residents that are of higher quality and/or have a lower price for than other nursing homes without putting profitability at risk.
Unmanned aerial vehicle trajectory planning by an integrated algorithm in a complex obstacle environment
Authors: Zhang Siyu , Yu Jianqiao , Mei Yuesong , Sun Huadong , Du Yongbo
Published: August 2016

Both the artificial potential field method and direct method for the optimal control problem have shortcomings in terms of effectiveness and computational complexity for the trajectory-planning problem. This paper proposes an integrated algorithm combining the artificial potential field method and direct method for planning in a complex obstacle-rich environment. More realistic unmanned aerial vehicle dynamics equations, which are rarely applied in the traditional artificial potential field method, are considered in this paper. Furthermore, an additional control force is introduced to transcribe the artificial potential field model into an optimal control problem, and the equality/inequality constraints on the description of the shape of the obstacles are substituted by the repulsive force originating from all the obstacles. The Legendre pseudospectral method and virtual motion camouflage are both utilized to solve the modified optimal control problem for comparison purposes. The algorithm presented in this paper improves the performance of solving the trajectory-planning problem in an obstacle-rich environment. In particular, the algorithm is suitable for addressing some conditions that cannot be considered by the traditional artificial potential field method or direct method individually, such as local extreme value points and a large numbers of constraints. Two simulation examples, a single cube-shaped obstacle and a different-shaped obstacle-rich environment, are solved to demonstrate the capabilities and performance of the proposed algorithm.
Effect of rocket exhaust of canisterized missile on adjoining launching system
Authors: Chandra Murty MSR , Sinha PK , Chakraborty D
Published: August 2016

Transient numerical simulations are carried out to study missile motion in a vertical launch system and to estimate the effect of missile exhaust in the adjoining launch structure. Three-dimensional Navier–Stokes equations along with k–ɛ turbulence model and species transport equations are solved using commercial computational fluid dynamics software. Dynamic grid movement is adopted and one degree of freedom trajectory equations are integrated with the computational fluid dynamic solver to obtain the instantaneous position of the missile. Multi-zone grid generation approach with sliding interface method through layering technique is adopted to address the changing boundary problem. The computational methodology is applied to study the missile motion in a scale-down test configuration as well as in the flight condition. The computations capture all essential flow features of test and flight conditions in active cell as well as in adjacent cells. Parametric studies are conducted to study the effect geometrical features and measurement uncertainty in the input data. Computed pressures in the adjacent cells in the launch system match better (∼12%) with the experimental and flight results compared to distant cells.
‘Running out of time’: Exploring the concept of waiting for people with Motor Neurone Disease
Authors: Ferrie Jo , Wiseman Phillippa
Published: August 2016

Waiting is a part of everyday life. It is often characterised by its banality: its quotidian nature. Time spent waiting can be seen as boring, wasted, and at times painful or distressing, or conversely hopeful or full of potential. The experience of Motor Neurone Disease (MND) reveals a population for whom (limited) time has a significant impact on quality of life. This paper will argue that waiting, for people with MND, exemplifies the relationship between time, power and agency. In so doing we can better conceptualise the manifold ways in which time and waiting are experienced through choosing to wait, enforced waiting and waiting when time is known to be ‘running out’. Through a sociological analysis of multiple forms of waiting three key themes emerged that characterised waiting as powerlessness; emotional (as a form of production), and; alternating as an experience between patience and endurance. This paper challenges the passivity, universality and ambivalence ascribed to waiting and instead argues that waiting affects the ‘time left’ for people with MND. It also offers up a lens through which to view time through the multiple textures and tensions of waiting produced through chronic illness.
A domain of influence theorem for thermoelasticity without energy dissipation
Authors: Kumari Bharti , Mukhopadhyay Santwana
Published: August 2016

The present work is concerned with the thermoelasticity theory of Green and Naghdi of type I, II and III. By considering a mixed initial-boundary value problem for an isotropic medium in the context of all three models of type I, II and III in a unified way, we derive an identity in terms of the temperature and potential. On the basis of this identity, we establish the domain of influence theorem for the Green–Naghdi-II model. This theorem implies that for a given bounded support of thermomechanical loading, the thermoelastic disturbance generated by the pair of temperature and potential of the system vanishes outside a well-defined bounded domain. This domain is shown to depend on the support of the load, that is, on the initial and boundary data. It is also shown that under Green–Naghdi-II model, the thermoelastic disturbance propagates with a finite speed that is dependent on the thermoelastic parameters.
Evaluation of Large-Scale Public-Sector Reforms
Authors: Breidahl Karen N. , Gjelstrup Gunnar , Hansen Hanne Foss , Hansen Morten Balle
Published: August 2016

Research on the evaluation of large-scale public-sector reforms is rare. This article sets out to fill that gap in the evaluation literature and argues that it is of vital importance since the impact of such reforms is considerable and they change the context in which evaluations of other and more delimited policy areas take place. In our analysis, we apply four governance perspectives (rational-instrumental perspective, rational interest–based perspective, institutional-cultural perspective, and chaos perspective) in a comparative analysis of the evaluations of two large-scale public-sector reforms in Denmark and Norway. We compare the evaluation process (focus and purpose), the evaluators, and the organization of the evaluation, as well as the utilization of the evaluation results. The analysis uncovers several significant findings including how the initial organization of the evaluation shows strong impact on the utilization of the evaluation and how evaluators can approach the challenges of evaluating large-scale reforms.
Molecular characterisation of parvoviruses from domestic cats reveals emergence of newer variants in India
Authors: Mukhopadhyay Hirak K , Nookala Mangadevi , Thangamani Nobal RK , Sivaprakasam Amsaveni , Antony Prabhakar X , Thanislass Jacob , Srinivas Mouttou V , Pillai Raghavan M
Published: August 2016

Objectives

The present study was undertaken to characterise the viral polypeptide 2 (VP2) gene of parvovirus from domestic cats in India.

Methods

The faecal samples from diarrhoeic/healthy domestic cats were collected from different geographical regions of India for screening by PCR assay followed by sequence analysis of the VP2 gene.

Results

Canine parvovirus (CPV)/feline panleukopenia virus (FPV) infections were found in 12 (11.3%) of 106 faecal samples tested. Two new CPV-2a (297Ala and Asn426) and three FPV strains were identified by VP2 gene analysis. Several unique and existing amino acid mutations were found, suggesting continuous evolution and emergence of newer variants. The phylogenetic analysis of the CPV sequences revealed that the two new CPV-2a strains from Mumbai (MC8) and Puducherry (P15) were clustered together in a single clade but had evolved independently and were ancestrally related to Chinese CPV-2a isolates. The FPV sequences (T-C-6 and T-C-1) from Thrissur, Kerala, formed a different clade (FPV clade) and were closely related to each other and had an ancestral relationship with an FPV isolate from the USA. Another FPV isolate from Goa (GC1) was positioned in the same clade but had evolved independently.

Conclusions and relevance

Detection of CPV in both diarrhoeic/healthy cats and the occurrence of FPV infection in a vaccinated cat provide new insights into parvovirus infections in cats in India.
Efficacy and safety of a three-times-weekly dosing regimen of glatiramer acetate in relapsing–remitting multiple sclerosis patients: 3-year results of the Glatiramer Acetate Low-Frequency Administration open-label extension study
Authors: Khan Omar , Rieckmann Peter , Boyko Alexey , Selmaj Krzysztof , Ashtamker Natalia , Davis Mat D , Kolodny Scott , Zivadinov Robert
Published: August 2016

Background:

The 1-year placebo-controlled (PC) phase of the Glatiramer Acetate Low-Frequency Administration (GALA) study showed that glatiramer acetate 40 mg/mL three times weekly (GA40) significantly reduced annualized relapse rate (ARR) and magnetic resonance imaging (MRI) activity in patients with relapsing–remitting multiple sclerosis. Patients completing the PC phase were invited to an open-label (OL) extension.

Objective:

To evaluate the effects of early start (ES) and delayed start (DS) of GA40 over 3 years.

Methods:

A total of 97.2% of patients completing the PC phase received GA40 in the OL extension. ES ( n = 943) patients received GA40 throughout; DS ( n = 461) patients received placebo during the PC phase and GA40 during the OL phase. Relapse, MRI, disease progression, and safety were evaluated.

Results:

A total of 1041 patients completed 3 years of follow-up. During the OL phase, ES and DS patients showed comparable ARRs (0.20–0.22) and similar numbers of gadolinium-enhancing T1 ( p = 0.49) and new or enlarging T2 lesions ( p = 0.51) at Year 3. ES patients showed significantly smaller changes in gray matter volume than DS patients from Months 12 to 36 (mean difference, 0.371%; p = 0.015), with similar trend in whole-brain volume ( p = 0.080). Adverse events were mild, consistent with the well-established glatiramer acetate (GA) safety profile.

Conclusion:

GA40 conferred treatment benefit over 3 years: sustained low ARR and lesion activity and favorable safety.
Increased ex vivo antigen presentation profile of B cells in multiple sclerosis
Authors: Mathias Amandine , Perriard Guillaume , Canales Mathieu , Soneson Charlotte , Delorenzi Mauro , Schluep Myriam , Du Pasquier Renaud A
Published: August 2016

Background:

Multiple sclerosis (MS) is thought to be T cell mediated but the mechanisms eliciting such a dysregulated adaptative immune response remain enigmatic.

Objective:

To examine the activation profile of antigen-presenting cells (APCs) in MS.

Methods:

A total of 98 study subjects were enrolled including patients suffering from relapsing–remitting, secondary- and primary-progressive (PP) MS, other inflammatory neurological diseases, and healthy controls. Blood monocytes and B cells were stimulated using specific ligands of toll-like receptors (TLRs) or inflammasomes or Epstein–Barr virus (EBV) particles. Their activation profile was determined before or after stimulation by flow cytometry (CD40, CD80, CD83, CD86, and human leukocyte antigen–antigen D related (HLA-DR)) and Luminex assay, measuring the concentration of eight cytokines in culture supernatants. Differences among groups were assessed in a linear model framework.

Results:

We demonstrate that relapsing MS patients exhibit an increased expression of HLA-DR and CD40 ex vivo, mostly at the surface of B cells. Specific stimulations of TLR or inflammasomes enhance the expression of components of the immunological synapse and the cytokine secretion but without differences between categories of study subjects.

Conclusion:

These data suggest that the activation profile of B cells is increased in MS. However, the perception of the danger signal by B lymphocytes and monocytes does not seem to be different in MS patients as compared to control subjects.
Sensor-based monitoring of heating system effectiveness and efficiency in Spanish churches
Authors: Martínez Garrido M. I. , Fort R. , Varas Muriel M. J.
Published: August 2016

The installation of heating systems in buildings and monuments not designed to accommodate such facilities poses technical difficulties, particularly where occupancy and hence system use is sporadic, such as in churches, cathedrals, synagogues, mosques and other places of worship. Furthermore, building materials and architecture may detract from system efficiency. An additional difficulty is the source of energy: when monuments are in remote areas, fuels such as natural gas may not be available, although on occasion they may not be used even when they are available. The present study explores the thermal comfort provided by heating systems generally used in Spanish churches: decentralized gas burner system (propane) and centralized air heating systems (natural gas, fuel oil) based on a new monitoring methodology using temperature, relative humidity and airflow sensors. The church at Talamanca de Jarama (fuel oil) delivered the highest thermal comfort based on environmental conditions, whereas the system installed at Algete (natural gas) was the most energy efficient. The requirements of each heating system were assessed relative to the conservation of the desired indoor conditions, considering energy, comfort and aesthetic factors.
Do Exam Wrappers Increase Metacognition and Performance? A Single Course Intervention
Authors: Soicher Raechel N. , Gurung Regan A. R.
Published: August 2016

Previous research has indicated that an intervention called “exam wrappers” can improve students’ metacognition when they are using wrappers in more than one course per academic term. In this study, we tested if exam wrappers would improve students’ metacognition and academic performance when used in only one course per academic term. A total of 86 students used either exam wrappers (an exercise with metacognitive instruction), sham wrappers (an exercise with no metacognitive instruction), or neither (control). We found no improvements on any of three exams, final grades, or metacognitive ability (measured with the Metacognitive Awareness Inventory, MAI) across conditions. All students showed an increase in MAI over the course of the semester, regardless of condition. We discuss the challenges of improving metacognitive skills and suggest ideas for additional metacognitive interventions.
Teaching With Dogs: Learning About Learning Through Hands-on Experience in Dog Training
Authors: McConnell Bridget L.
Published: August 2016

This paper summarizes a pilot study of an experiential learning technique that was designed to give undergraduate students a greater understanding of the principles and theories of learning and behavior, which is traditionally taught only in a lecture-based format. Students were assigned the role of a dog trainer, and they were responsible for designing and administering empirically and theoretically based training regimens to shelter dogs to teach them new behaviors that would make them more adoptable. Results from student feedback and their performance on assessments suggest that this activity was well-received by the students both for the learning benefit and enjoyment aspect, and this translated to a moderate level on their assessments. Details about how the learning and behavior class was made into an experiential learning course, the outcomes of this experience, and suggestions for improving the educational benefit of this experiential activity are discussed. This hands-on program offers a new alternative for teaching learning and behavior. Future offerings of this course and others like it present ideal opportunities for researching the effectiveness of more experiential methods of teaching and learning.
Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania
Authors: Carthon J. Margo Brooks , Wiltse Nicely Kelly , Altares Sarik Danielle , Fairman Julie
Published: August 2016

Background

Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity.

Purpose

To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007.

Method

We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews.

Discussion

Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises.

Conclusions

The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes.
Sensitivity of Image Features to Noise in Conventional and Respiratory-Gated PET/CT Images of Lung Cancer: Uncorrelated Noise Effects
Authors: Oliver Jasmine A. , Budzevich Mikalai , Hunt Dylan , Moros Eduardo G. , Latifi Kujtim , Dilling Thomas J. , Feygelman Vladimir , Zhang Geoffrey
Published: August 2016

The effect of noise on image features has yet to be studied in depth. Our objective was to explore how significantly image features are affected by the addition of uncorrelated noise to an image. The signal-to-noise ratio and noise power spectrum were calculated for a positron emission tomography/computed tomography scanner using a Ge-68 phantom. The conventional and respiratory-gated positron emission tomography/computed tomography images of 31 patients with lung cancer were retrospectively examined. Multiple sets of noise images were created for each original image by adding Gaussian noise of varying standard deviation equal to 2.5%, 4.0%, and 6.0% of the maximum intensity for positron emission tomography images and 10, 20, 50, 80, and 120 Hounsfield units for computed tomography images. Image features were extracted from all images, and percentage differences between the original image and the noise image feature values were calculated. These features were then categorized according to the noise sensitivity. The contour-dependent shape descriptors averaged below 4% difference in positron emission tomography and below 13% difference in computed tomography between noise and original images. Gray level size zone matrix features were the most sensitive to uncorrelated noise exhibiting average differences >200% for conventional and respiratory-gated images in computed tomography and 90% in positron emission tomography. Image feature differences increased as the noise level increased for shape, intensity, and gray-level co-occurrence matrix features in positron emission tomography and for gray-level co-occurrence matrix and gray-level size zone matrix features in conventional computed tomography. Investigators should be aware of the noise effects on image features.
Could participant-produced photography augment therapeutic interventions for people with intellectual disabilities? A systematic review of the available evidence
Authors: Boulton Natalie E , Williams Jonathan , Jones Robert SP
Published: August 2016

Background:

People with intellectual disabilities are entitled to equitable access to psychological support. Traditional therapeutic approaches often rely on a person’s ability to verbally articulate a description of their life, which can be particularly difficult for emotionally salient information.

Methods:

A systematic literature review was undertaken to determine the evidence base underpinning the use of participant-produced photography within therapeutic settings. Evidence across a range of specialisms was examined in order to extrapolate areas of best practice and make recommendations for its implementation alongside people with intellectual disabilities.

Results:

A systematic search of peer-reviewed journals identified 13 relevant documents. Participant-produced photography showed promise, although evidence pertaining specifically to people with intellectual disabilities was sparse ( n = 2).

Conclusion:

Participant-produced photography within therapeutic settings shows promise for people with intellectual disabilities. Methodological limitations made it difficult to derive firm conclusions regarding the effectiveness of different approaches. Implications for clinical and research practice are discussed.
Cost of vitamin K antagonist anticoagulant treatment in patients with metallic prosthetic valve in mitral position
Authors: Ene Gabriela , Garcia Raso Aránzazu , Gonzalez-Dominguez Weber Almudena , Hidalgo-Vega Álvaro , Llamas Pilar
Published: August 2016

Background:

The initiation of oral anticoagulation therapy after valve replacement surgery requires strict monitoring because these patients are at high risk for the development of thrombotic complications and present an increased risk of bleeding.

Objectives:

The aim of this study was to examine the total healthcare costs of oral anticoagulant treatment with vitamin K antagonists in patients with metallic prosthetic valves in the mitral position.

Methods:

Data from clinical records were used in the study including international normalized ratio results, number of medical visits, type of anticoagulant, use of rescue medication and hospital admissions from related complications. The drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included in the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the diagnosis-related group price for each case.

Results:

We collected data from 151 patients receiving oral anticoagulation therapy with vitamin K antagonist who were diagnosed with mitral prosthesis (n = 90), mitro-aortic prosthesis (n = 57), and mitral and tricuspid prosthesis (n = 4). The total direct healthcare cost was €15302.59, with a mean total cost per patient per year of €1558.15 (±2774.58) consisting of 44.38 (±42.30) for drug cost, €71.41 (±21.43) for international normalized ratio monitoring, €429.52 (±126.87) for medical visits, €26.31 (±28.38) for rescue medication and €986.53 (±2735.68) for related complications.

Conclusion:

Most direct healthcare costs associated with the sampled patients arose from the specialist-care monitoring required for treatment. Good monitoring is inversely related to direct healthcare costs.
The Disappearing Audience and Reflexive Visibility
Authors: Girginova Katerina
Published: August 2016

Contrary to popular opinion and some academic writing that celebrates the renewed visibility of new media audiences, this essay argues that they are increasingly going into retreat. To understand how new media audiences “disappear” from view of one another, I borrow from Brighenti’s typology of visibility and develop the idea of “reflexive visibility.” The latter describes the ability to socially orient ourselves in a digital environment through the textual and contextual cues of others—an activity that is of utmost importance not only to researchers wishing to “see” various audiences but also for audiences writ large, wishing to know themselves.
An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay
Authors: Bracey Daniel N. , Kiymaz Tunc C. , Holst David C. , Hamid Kamran S. , Plate Johannes F. , Summers Erik C. , Emory Cynthia L. , Jinnah Riyaz H.
Published: August 2016

Introduction:

Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden. Comanagement strategies are reported in the literature, but few have addressed orthopedic-hospitalist models. An orthopedic-hospitalist comanagement (OHC) service was established at our hospital to manage hip fracture patients. We sought to determine whether the OHC (1) improves the efficiency of hip fracture management as measured by inpatient length of stay (LOS) and time to surgery (TTS) and (2) whether our results are comparable to those reported in hip fracture comanagement literature.

Methods:

A comparative retrospective–prospective cohort study of patients older than 60 years with an admitting diagnosis of hip fracture was conducted to compare inpatient LOS and TTS for hip fracture patients admitted 10 months before (n = 45) and 10 months after implementation (n = 54) of the OHC at a single academic hospital. Secondary outcome measures included percentage of patients taken to surgery within 24 or 48 hours, 30-day readmission rates, and mortality. Outcomes were compared to comanagement study results published in MEDLINE-indexed journals.

Results:

Patient cohort demographics and comorbidities were similar. Inpatient LOS was reduced by 1.6 days after implementation of the OHC ( P = .01) without an increase in 30-day readmission rates or mortality. Time to surgery was insignificantly reduced from 27.4 to 21.9 hours ( P = .27) and surgery within 48 hours increased from 86% to 96% ( P = .15).

Discussion:

The OHC has improved efficiency of hip fracture management as judged by significant reductions in LOS with a trend toward reduced TTS at our institution.

Conclusion:

Orthopedic-hospitalist comanagement may represent an effective strategy to improve hip fracture management in the setting of a rapidly expanding patient population.
Locative Media and Identity
Authors: Saker Michael , Evans Leighton
Published: August 2016

The role of location-based social networks (LBSNs) on identity is a relatively unexplored area within the growing cannon of work on locative media. Following an exegesis of Giddens’s argument that narrative biographical accounts are critical in self-identity in the modern age and Foucault’s technologies of the self, this article positions LBSN, and in particular Foursquare, as a contributor to self-identity in users’ lives. A close reading of ethnographic and interview data from Foursquare users reveals that in the context of the presentation, maintenance, and reflection upon self-identity, LBSN use can play an integral role in the self-identity of its users. The contribution of LBSN to indicators of user lifestyle, the intentional sharing of particular locations, and user recollection of events and locations are the key features of how LBSNs provide conduits to self-identity. The degree of usage in everyday life is identified as critical in the positioning of LBSN as a key contributor to identity narratives. With the integration of LBSN features into more mainstream social media platforms, this contribution to self-identity in the social media age is resilient to the demise of stand-alone LBSN applications.
Community Federally Qualified Health Centers as Homes for HIV Preexposure Prophylaxis
Authors: Doblecki-Lewis Susanne , Jones Deborah
Published: August 2016

Preexposure prophylaxis (PrEP) for HIV has the potential to reduce HIV incidence in highly affected areas. The Southeastern United States is disproportionately impacted by HIV, and 3 counties in South Florida have the highest incidence of new HIV infections in the United States. This study explored the feasibility, acceptability, and uptake of PrEP in South Florida. Focus groups consisting of providers, administrators, and case managers at HIV-servicing community health centers and federally qualified health centers in South Florida reported broad support but low implementation of PrEP. Generally, participants indicated that the centers were appropriate locations for implementation. However, practical concerns and perceived limitations due to financial, insurance, and immigration status of those who would potentially benefit from the intervention were widely reported. Addressing provider concerns appears necessary for successful expansion of PrEP implementation in highly impacted areas such as South Florida.
Pancreaticopleural Fistula Presenting as Left Neck Swelling
Authors: Senitko Michal , Puchalski Jonathan
Published: August 2016

Pancreaticopleural fistula is an uncommon complication of pancreatitis. It results from communication of the pancreatic duct to the pleural space. The authors describe a case of a 54-year-old man with a history of alcohol abuse and chronic pancreatitis, who presented with left neck swelling, dysphagia, and dyspnea. Computed tomography imaging revealed right pleural effusion and multiloculated fluid collections in and around the pancreas and retroperitoneum with extension through the posterior mediastinum into the left neck. Analysis of the neck aspirate and the pleural effusion showed very elevated amylase levels. This is the first known case of a pancreaticopleural fistula presenting as neck swelling due to cystic fluid collection.
Associations between attitudes toward cosmetic surgery, celebrity worship, and body image among South Korean and US female college students
Authors: Jung Jaehee , Hwang Choon Sup
Published: August 2016

Very little information is known regarding the level of psychological attachment to celebrities needed to influence one’s desire to engage in cosmetic surgery in consumers. More importantly, no previous research examined this in relation to attitudes toward cosmetic surgery and level of body satisfaction in cross-cultural contexts. The present study aimed to examine associations between attitudes toward cosmetic surgery, celebrity worship, and body image among South Korean and US female college students. A total of 370 female undergraduates were recruited for survey from a central university in Seoul, South Korea (n = 196) and a mid-Atlantic university in the US (n = 174). The South Korean participants showed greater acceptance toward cosmetic surgery than did the US participants, whereas the US participants showed more positive attitudes toward their favorite celebrities than did the South Korean participants. For the US participants, the level of body dissatisfaction was negatively associated with acceptance for cosmetic surgery while attitudes toward favorite celebrities was positively associated with acceptance for cosmetic surgery. Findings suggest that cultural contexts affect factors influencing the likelihood of having cosmetic surgery.
Diagnostic Approach to Atypical Parkinsonian Syndromes
Authors: McFarland Nikolaus R.
Published: August 2016

Purpose of Review: Although increasingly recognized, atypical parkinsonian syndromes remain challenging to diagnose and are underrecognized due to overlap with other parkinsonisms. This article provides a diagnostic approach to atypical parkinsonian syndromes, including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies. The goal of this review is to aid the clinician in recognizing key clinical and pathologic features and to raise awareness of recent advances in diagnostics and treatment.

Recent Findings: Diagnostic criteria for atypical parkinsonian syndromes are evolving to encompass increasingly recognized heterogeneity in the presentation of these disorders and information gleamed from clinicopathologic correlations. PSP and CBD in particular now share similar pathologic clinical features and include a number of phenotypic variants. Pathologic diagnoses are increasingly used in clinical practice, and there is frequent reference now by clinicians to tauopathies, including PSP and CBD, and the synucleinopathies, which include MSA and dementia with Lewy bodies (as well as Parkinson disease). Research into biomarkers, including both tissue and imaging modalities and genetics, has the potential to increase disease recognition and make earlier diagnosis and treatment possible. Although novel therapeutics are being studied for atypical parkinsonian syndromes such as PSP, no new breakthrough interventions have emerged for the treatment of PSP, CBD, and MSA. Current therapeutic management for these disorders frequently uses a multidisciplinary team approach.

Summary: The approach to atypical parkinsonian syndromes requires recognition of a constellation of overlapping but distinct clinical features that help with identifying and distinguishing them from Parkinson disease and other similar disorders.
Chorea
Authors: Mestre Tiago A.
Published: August 2016

Purpose of Review: This article reviews the clinical approach to the diagnosis of adult patients presenting with chorea, using Huntington disease (HD) as a point of reference, and presents the clinical elements that help in the diagnostic workup. Principles of management for chorea and some of the associated features of other choreic syndromes are also described.

Recent Findings: Mutations in the C9orf72 gene, previously identified in families with a history of frontotemporal dementia, amyotrophic lateral sclerosis, or both, have been recognized as one of the most prevalent causes of HD phenocopies in the white population.

Summary: The diagnosis of chorea in adult patients is challenging. A varied number of associated causes require a physician to prioritize the investigations, and a detailed history of chorea and associated findings will help. For chorea presenting as part of a neurodegenerative syndrome, the consideration of a mutation in the C9orf72 gene is a new recommendation after excluding HD. There are no new treatment options for chorea, aside from dopamine blockers and tetrabenazine. There are no disease-modifying treatments for HD or other neurodegenerative choreic syndromes.
Ethics of Preclinical Dopamine Transporter Imaging
Authors: Cochrane Thomas I.
Published: August 2016

While dopamine transporter single-photon emission computed tomography (DAT-SPECT) imaging is sensitive and specific when performed in patients with signs or symptoms of parkinsonism, its predictive value is uncertain in healthy subjects, even with patients who have first-degree relatives affected by Parkinson disease. In deciding whether to honor a patient’s request for a DAT-SPECT, neurologists must balance a patient’s autonomy rights with beneficence and nonmaleficence and also consider the distributive justice implications of ordering the test. Generally speaking, the benefits of a DAT-SPECT will be too small to justify its use in an asymptomatic patient concerned about developing Parkinson disease.
Diagnosis and Management of Dystonia
Authors: Shanker Vicki , Bressman Susan B.
Published: August 2016

Purpose of Review: This article highlights the clinical and diagnostic tools used to assess and classify dystonia and provides an overview of the treatment approach.

Recent Findings: In the past 4 years, the definition and classification of dystonia have been revised, and new genes have been identified in patients with isolated hereditary dystonia (DYT23, DYT24, and DYT25). Expanded phenotypes were reported in patients with combined dystonia, such as those with mutations in ATP1A3. Treatment offerings have expanded as there are more neurotoxins, and deep brain stimulation has been employed successfully in diverse populations of patients with dystonia.

Summary: Diagnosis of dystonia rests upon a clinical assessment that requires the examiner to understand the characteristic disease features that are elicited through a careful history and physical examination. The revised classification system uses two distinct nonoverlapping axes: clinical features and etiology. A growing understanding exists of both isolated and combined dystonia as new genes are identified and our knowledge of the phenotypic presentation of previously reported genes has expanded. Genetic testing is commercially available for some of these conditions. Treatment options for dystonia include pharmacologic therapy, chemodenervation, and surgical intervention. Deep brain stimulation benefits many patients with various types of dystonia.
Neuropsychiatric Issues in Parkinson Disease
Authors: Goldman Jennifer G.
Published: August 2016

Purpose of Review: This article reviews the recognition and management of neuropsychiatric issues in Parkinson disease (PD), including mood disorders, cognitive impairment, and behavioral disturbances.

Recent Findings: Patients with PD frequently develop neuropsychiatric issues, and these issues can greatly affect their quality of life. In recent years, mood, cognitive, and behavioral issues in PD have received greater recognition, with increasing attention directed toward improved screening and therapeutic interventions for symptomatic treatment. Taken together as a group, neuropsychiatric issues can be found throughout the whole course of PD, from early in the disease, potentially even in a premotor stage, to the time of diagnosis and later in the course with more advanced disease.

Summary: In the comprehensive care of patients with PD, recognition of neuropsychiatric issues is critical. Advances in therapeutics for the different neuropsychiatric symptoms are still needed, although several pharmacologic and nonpharmacologic options are available. Patient management frequently requires a multidisciplinary approach, with collaboration of neurologists with neuropsychologists, psychologists, psychiatrists, and other health professionals.
Ataxia
Authors: Ashizawa Tetsuo , Xia Guangbin
Published: August 2016

Purpose of Review: This article introduces the background and common etiologies of ataxia and provides a general approach to assessing and managing the patient with ataxia.

Recent Findings: Ataxia is a manifestation of a variety of disease processes, and an underlying etiology needs to be investigated. Pure ataxia is rare in acquired ataxia disorders, and associated symptoms and signs almost always exist to suggest an underlying cause. While the spectrum of hereditary degenerative ataxias is expanding, special attention should be addressed to those treatable and reversible etiologies, especially potentially life-threatening causes. This article summarizes the diseases that can present with ataxia, with special attention given to diagnostically useful features. While emerging genetic tests are becoming increasingly available for hereditary ataxia, they cannot replace conventional diagnostic procedures in most patients with ataxia. Special consideration should be focused on clinical features when selecting a cost-effective diagnostic test.

Summary: Clinicians who evaluate patients with ataxia should be familiar with the disease spectrum that can present with ataxia. Following a detailed history and neurologic examination, proper diagnostic tests can be designed to confirm the clinical working diagnosis.