bluuebunny/crossref_metadata_2025 huggingface dataset:
Immigration Effects on Violence Contextualized
Authors: Painter-Davis Noah
Published: July 2015

This study examines the relationship between Latino immigration and violence in the context of the geographic diversification of immigrants to emerging destinations. Drawing on research on immigration and literature on assimilation and place stratification, I identify circumstances in which immigration may either increase or decrease violence. I use 2001–2004 arrest data from the National Incident-Based Reporting System and the crime reporting programs of California, New York, and Texas to evaluate these circumstances. Most notably, I examine whether effects of immigration on violent offending of specific racial/ethnic groups (Latino, white, black) vary depending on whether the movement of immigrants is into established or emerging immigrant destinations and whether immigration’s effects vary by race/ethnicity within particular destinations. Findings suggest that immigration’s influence on black and Latino violence is contextualized by destination type; immigration has violence-reducing effects on Latinos and blacks in established localities but neutral or violence-increasing effects in emergent destinations.
Performance and Apprehension of the Mass in an Urban Catholic School
Authors: LeBlanc Robert Jean
Published: July 2015

This article examines students’ literacy practices during Mass and other Catholic religious services in a multilingual, multiethnic urban Catholic school in Philadelphia, Pennsylvania. It discusses three dimensions of their literacy practice: (a) how parents, teachers, and priests draw on the tradition of Catholic schooling and ritual to structure what constitutes literacy during Mass; (b) how students use body posture and performative orientations to the text of the liturgy to engage in these structured practices; and (c) how students strategically use these performative literacy practices for advantage and social positioning. These results invite complicating what literacy practices are valued in contemporary urban Catholic school and how opportunities to draw on these literacy practices are unequally distributed among students for unequal gain.
The Transparency–Power Nexus
Authors: Flyverbom Mikkel , Christensen Lars Thøger , Hansen Hans Krause
Published: July 2015

Although transparency is often believed to mitigate the negative effects of power by providing access to the hidden sides of organizational and political life, extant research fails to specify how transparency more fundamentally relates to power. To make sense of this relationship, this article develops an analytical language along two dimensions: “observational control” and “regularizing control.” Within this framework, we look at (a) attempts to carry out control through observation, (b) identity-oriented forms of normative control, (c) strategically ambiguous articulations of transparency, and (d) attempts to normalize and institutionalize behavior across organizational settings through the use of reporting and ranking systems. In the concluding section, we discuss how our conceptualization might nuance and enrich future studies of the transparency–power nexus and we point to some important implications for management practitioners.
Experimental study the impact forces of tumbling mills
Authors: Soleymani MM , Fooladi Mahani M , Rezaeizadeh M
Published: July 2015

Impact forces are one of the mechanisms for grinding in mill. This takes place when the particles elevated by the lifters get into cascade motion and their fall on the load causes the breakage of other particles. The present paper aimed to study the impact forces in terms of variables like: mill speed, solid charge filling (ball filling), slurry concentration, and slurry filling. In this work, the influence of these operating parameters was investigated using a pilot mill. To this end, a copper ore was used to prepare slurry at different solid concentration. The tests covered a range of slurry filling from 0 to 2 with five different balls filling between 12% and 36% of mill volume and six different speeds between 60% and 85% of critical speed. The results delineate that the increase in the mill speed leads to a remarkable increase in the amount and frequency of the impact forces. Increasing the charge volume leads to decrease the maximum impact forces. The results show that with the increase in slurry filling and the resulting formation of a pool, the impact forces will decrease. Moreover, it is found that with the increase in slurry concentration, the slurry will act as a damper decreasing the impact forces.
Experimental verification of differences in subjective annoyance responses using a jury test to compare the noise emissions of straight and curved sections of an urban railway
Authors: Ji Hae Young , Koo Dong Hoe , Kim Jae Chul
Published: July 2015

The urban railway, which has both ground-level and underground sections, is a major means of transportation in the city of Seoul. Environmental noise problems have been encountered in residential areas near the railway on ground-level sections. To assess the extent of this problem, many countries have adopted the method of A-weighted equivalent sound pressure level ( LpAeq). However, it may be not reasonable to apply the same evaluation method on all sections of a railway, since the acoustic characteristics of railway noise are highly variable, and its effect on human psychology is complex. Thus, since each person reacts differently to noise, psychological approaches have been utilized to analyze the effects of noise. The aim of this study is to determine an appropriate method for the assessment of railway-generated noise. First, the characteristics of railway-generated noise on straight and curved sections of track were compared by looking at aspects such as the waveforms of the sound pressure and the characteristics of frequency patterns. After that, the subjective annoyance response was analyzed by performing a jury test and a survey in order to understand how people react differently to similar sounds on the two test sections of track.
Degradation of postural control with aging
Authors: Baltich Jennifer , von Tscharner Vinzenz , Nigg Benno M
Published: July 2015

Aging negatively impacts the ability to maintain postural stability due to degraded control systems. The entropic half-life, a non-linear variable that quantifies the transition of sample entropy with increasing time scales, quantifies the time that elapses before old positional information no longer influences, or is no longer related to, the control mechanisms that regulate the movement at the current center of pressure location. The entropic half-life provides a more representative and comprehendible way of detecting changes in complexity using measurement units of time. The purpose of this study was to determine the effects of aging on the magnitude and temporal structure of the center of pressure movement during quiet single-limb stance. Center of pressure data of 24 older and 24 younger subjects were analyzed. The complexity of the temporal structure of the center of pressure signal was quantified by calculating the entropic half-life of the center of pressure in the medio-lateral and anterior–posterior directions. The magnitude of movement was quantified using excursion of the center of pressure in the medio-lateral and anterior–posterior directions, the path length, and the 95% ellipse area of the center of pressure. The older subjects demonstrated a significantly shorter entropic half-life for the center of pressure in the anterior–posterior direction ( p < 0.001), longer excursions of the center of pressure in the medio-lateral ( p < 0.001) and anterior–posterior ( p = 0.001) directions, increased center of pressure path lengths ( p < 0.001), and increased 95% ellipse areas of the center of pressure ( p < 0.001). The results from this study showed that even though older subjects demonstrated more frequent postural adjustments (shorter entropic half-life), this did not help to reduce the magnitude of movement of their center of pressure during quiet stance, thus indicating an impaired peripheral and/or central neuromuscular control mechanism.
Capacity for Visual Features in Mental Rotation
Authors: Xu Yangqing , Franconeri Steven L.
Published: July 2015

Although mental rotation is a core component of scientific reasoning, little is known about its underlying mechanisms. For instance, how much visual information can someone rotate at once? We asked participants to rotate a simple multipart shape, requiring them to maintain attachments between features and moving parts. The capacity of this aspect of mental rotation was strikingly low: Only one feature could remain attached to one part. Behavioral and eye-tracking data showed that this single feature remained “glued” via a singular focus of attention, typically on the object’s top. We argue that the architecture of the human visual system is not suited for keeping multiple features attached to multiple parts during mental rotation. Such measurement of capacity limits may prove to be a critical step in dissecting the suite of visuospatial tools involved in mental rotation, leading to insights for improvement of pedagogy in science-education contexts.
On the acoustics of a turning mid turbine frame with embedded design in a two-stage test-turbine
Authors: Faustmann C , Zerobin S , Spataro R , Marn A , Heitmeir F , Göttlich E
Published: July 2015

The paper deals with the investigation of the noise generation in the two-stage two-spool test turbine located at the Institute for Thermal Turbomachinery and Machine Dynamics (ITTM) at Graz University of Technology. The facility is a continuously operating cold-flow open-circuit plant which is driven by pressurized air. The flow path is formed by a transonic turbine stage (high pressure, HP) followed by a low pressure (LP) turbine stage consisting of a turning mid turbine frame and a counter-rotating LP rotor. Downstream of the low pressure turbine the measurement section is instrumented with acoustic sensors. The acquisition system consists of a fully circumferentially traversable microphone array located at the outer casing. Two configurations of turning mid turbine frames were tested. The baseline is an intermediate turbine duct with 16 turning struts. The second one is a new embedded concept for the turning mid turbine frame with two zero-lift splitters placed in the struts’ passages. In total 48 vanes (16 struts plus 32 splitter vanes) guide the flow from the HP rotor to the LP rotor. In order to determine the noise emission of both configurations the microphones signal spectra and the emitted sound power level are compared. The acoustic field is characterized by azimuthal and radial modes by means of a microphone array traversed over 360°. In the multi-splitter configuration, the overall sound power level depending on the blade passing frequency of the HP turbine is reduced by 7 dB and depending on the blade passing frequency of the LP turbine by 4 dB, respectively. The overall effect is a reduction of the acoustic emission for the turning mid turbine frame with embedded design.
A Model of Sustainability for Professional Organizations: Using a Learning Management System to Offer Continuing Education
Authors: Sparrow Gregory S.
Published: July 2015

Professional membership organizations have long maintained their exposure and revenue stream through a variety of traditional avenues, most notably memberships, sponsored conferences, and professional journals. The synergy of this three-tiered model has depended on a certain enhanced status derived from membership benefits and proprietary information that can be marketed separately to non-members. Given the recent threats to this model due to the advent of the Internet, I present an example of an organization—International Association for the Study of Dream (IASD)—which has harnessed its annual conference assets to create an online continuing education program with the help of a learning management system, Moodle. I chose this organization not only because I have been involved in this project but also because I believe IASD is one of the first membership organizations to successfully create this fourth tier of outreach and revenue generation.
Dual Angiotensin Receptor and Neprilysin Inhibition with Sacubitril/Valsartan in Chronic Systolic Heart Failure
Authors: Lillyblad Matthew P.
Published: July 2015

Objective: To evaluate the clinical role of sacubitril/valsartan, a novel angiotensin–neprilysin inhibitor, for the treatment of chronic heart failure with a reduced ejection fraction (HFrEF). Data Sources: A search of PubMed was conducted using a combination of the search terms sacubitril, valsartan, LCZ696, neprilysin inhibition, natriuretic peptide system, renin-angiotensin system, and heart failure with reduced ejection fraction. Bibliographies of all retrieved articles were reviewed for relevant literature. All references included were published between 1980 and May 2015. Study Selection/Data Extraction: All studies and review articles that contained data describing the use of sacubitril/valsartan in HFrEF were reviewed. Data Synthesis: HFrEF remains a disease of high morbidity and mortality. Natriuretic peptide (NP) augmentation has emerged as a most promising neurohormonal target in HFrEF. NPs provide vasodilatory, natriuretic, diuretic, and antiproliferative actions to help support the failing heart. Neprilysin, a neutral endopeptidase, is a primary pathway for NP metabolism. Combined inhibition of the renin angiotensin aldosterone system and neprilysin augments the beneficial natriuretic peptide pathway while providing direct antagonism to increases in angiotensin II. In the landmark PARADIGM HF trial, the neprilysin inhibitor sacubitril added to valsartan significantly improved morbidity and mortality over enalapril, a standard of care in HFrEF. Application of these results to clinical practice requires careful considerations of trial design, study patient population, and clinical monitoring. Conclusions: Sacubitril/valsartan significantly improved morbidity and mortality in patients with chronic HFrEF but will require careful application to “real-world” populations of HFrEF.
Normal load moving on magneto-elastic transversely isotropic half-space with irregular and hydrostatic initial stress
Authors: Singh AK , Mistri KC , Chattopadhyay A
Published: July 2015

The present paper investigates the effect of initial stress, irregularity depth, irregularity factor and magneto-elastic coupling parameter on the dynamic response due to a normal moving load with constant velocity on the free surface of an irregular magneto-elastic transversely isotropic half-space under the state of hydrostatic initial stress. The expressions for normal stress and shear stress are obtained in closed form analytically. The considerable effect of initial stress, irregularity depth, irregularity factor and magneto-elastic coupling parameter on normal stress and shear stress are computed numerically and depicted by means of graphs. Moreover, comparative study highlighting the effect of various types of irregularity viz. rectangular irregularity, parabolic irregularity and no irregularity on the normal stress and shear stress is a key feature of the study.
The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels
Authors: Paek Seung Chun , Zhang Ning J. , Wan Thomas T. H. , Unruh Lynn Y. , Meemon Natthani
Published: July 2015

This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e., nurse staffing levels that each individual nursing home must retain by its state staffing standards) and analyzed the policy impact. The study findings indicated that state staffing standards for the categories of registered nurse, licensed nurse, or total nurse are positively related to registered nurse, licensed nurse, or total nurse staffing levels, respectively. Nursing homes more actively responded to licensed staffing requirements than total staffing requirements. However, nursing homes did not increase their staffing levels as much as those required by state staffing standards. It is possibly because the quality-oriented inspection allows flexibility in nursing homes’ control of nurse staffing levels.
The Role of Alcohol Consumption Patterns and Pro-Social Bystander Interventions in Contexts of Gender Violence
Authors: Fleming Wm. Michael , Wiersma-Mosley Jacquelyn D.
Published: July 2015

Studies have shown that people differ in their likelihood of intervening as a bystander in situations of violence, but it is unclear how these actions relate to the use of alcohol. Two studies ( N = 1,525) examined the relationship between alcohol use and pro-social bystander interventions in situations of physical and sexual coercion. Studies 1 and 2 provided cross-sectional evidence that alcohol use, along with alcohol expectancies, predicted patterns of bystander interventions, depending on gender. Discussion centers on the importance of including alcohol as another facet in understanding the role of pro-social bystander interventions.
PANORAMA: An approach to performance modeling and diagnosis of extreme-scale workflows
Authors: Deelman Ewa , Carothers Christopher , Mandal Anirban , Tierney Brian , Vetter Jeffrey S , Baldin Ilya , Castillo Claris , Juve Gideon , Król Dariusz , Lynch Vickie , Mayer Ben , Meredith Jeremy , Proffen Thomas , Ruth Paul , Ferreira da Silva Rafael
Published: July 2015

Computational science is well established as the third pillar of scientific discovery and is on par with experimentation and theory. However, as we move closer toward the ability to execute exascale calculations and process the ensuing extreme-scale amounts of data produced by both experiments and computations alike, the complexity of managing the compute and data analysis tasks has grown beyond the capabilities of domain scientists. Thus, workflow management systems are absolutely necessary to ensure current and future scientific discoveries. A key research question for these workflow management systems concerns the performance optimization of complex calculation and data analysis tasks. The central contribution of this article is a description of the PANORAMA approach for modeling and diagnosing the run-time performance of complex scientific workflows. This approach integrates extreme-scale systems testbed experimentation, structured analytical modeling, and parallel systems simulation into a comprehensive workflow framework called Pegasus for understanding and improving the overall performance of complex scientific workflows.
Self-Monitoring for High School Students With Disabilities
Authors: Clemons Lachelle L. , Mason Benjamin A. , Garrison-Kane Linda , Wills Howard P.
Published: July 2015

Self-monitoring interventions are well supported within the empirical literature as improving classroom engagement for students with disabilities. However, studies implementing self-monitoring interventions in high school settings are rarely conducted despite their potential to improve student academic and behavioral outcomes. In an investigation of an unobtrusive, self-monitoring application loaded on a handheld device, classroom engagement and perceived academic benefits were assessed in a withdrawal design for three high school students with different disabilities (specific learning disability, autism, and intellectual disability) in varied instructional arrangements. Direct observation data supported the intervention as effective in improving classroom engagement for all three students during intervention and maintenance phases.
When the past seeps into the present: The role of press agencies in circulating new historical narratives and restructuring collective memory during and after the Holocaust transitional justice
Authors: Herfroy-Mischler Alexandra
Published: July 2015

This article examines the role of national and international journalism practices during and after the Holocaust transitional justice process, based on a comparative study of press agency coverage of Switzerland’s neutrality during World War II investigated from the mid-1990s. By studying the transitional justice process (1995–2002), and the 11 years following it (2002–2013), one can observe the media’s capacity to create a dedicated domain where previously written historical narratives may be discussed and re-aligned with the updated historical data. What emerges from this analysis is threefold. On one hand, the polarization of the coverage, as well as resistance from the national Swiss press agency and Swiss society to adopt an updated narrative concerning its role during World War II, is identified. On the other hand, the failure of local newswire services to provide a domain where public debate could take place at the end of the transitional justice process is exposed. Finally, the consequences of a monopoly on the national news while reporting on civil initiatives towards unofficial reconciliation and adaptation of the narrative, after the completion of the transitional justice process, are identified and questioned.
Statistics and the media: A statistician’s view
Authors: McConway Kevin
Published: July 2015

How should statisticians interact with journalists? The author, an academic statistician, has worked with journalists in several ways over the years. The article explores the many-sided relationship between scientists, journalists and the public, from the point of view of the statisticians involved. One pessimistic view of the role of numbers in news is that they are there largely for rhetorical reasons, to increase the credibility and authority of a story. The author would not subscribe to that view, but it does point to a potential need to educate readers as well as journalists in dealing with numbers, and the article briefly discusses a checklist intended to help the consumers of media stories about risks to choose what to ignore. The article concludes by presenting some reasons for being optimistic about the position of statistics in journalism.
Digital watchdogs? Data reporting and the news media’s traditional ‘fourth estate’ function
Authors: Felle Tom
Published: July 2015

As governments throughout the world transition to storing and releasing vast amounts of numerical information digitally, journalists are increasingly using digital data reporting as an investigative tool to report on issues in the public interest and to hold government – elected officials and bureaucracy – to account. Through a series of qualitative interviews with 26 data journalists in 17 countries, this article examines the impact that digital data reporting is having on the traditional role of journalism as a fourth estate. Findings suggest the emergence of digital data reporting as a key tool in accountability journalism. Data journalism is seen as a new method of investigating and telling stories in ways that can inform and engage the public on a larger scale. However, the failure of popular ‘tabloid’ journalism to engage with data journalism means that a new technologically adept and data-informed elite class might be on the rise, with important implications for democratic processes in advanced societies.
Arguments Against a Configural Processing Account of Familiar Face Recognition
Authors: Burton A. Mike , Schweinberger Stefan R. , Jenkins Rob , Kaufmann Jürgen M.
Published: July 2015

Face recognition is a remarkable human ability, which underlies a great deal of people’s social behavior. Individuals can recognize family members, friends, and acquaintances over a very large range of conditions, and yet the processes by which they do this remain poorly understood, despite decades of research. Although a detailed understanding remains elusive, face recognition is widely thought to rely on configural processing, specifically an analysis of spatial relations between facial features (so-called second-order configurations). In this article, we challenge this traditional view, raising four problems: (1) configural theories are underspecified; (2) large configural changes leave recognition unharmed; (3) recognition is harmed by nonconfigural changes; and (4) in separate analyses of face shape and face texture, identification tends to be dominated by texture. We review evidence from a variety of sources and suggest that failure to acknowledge the impact of familiarity on facial representations may have led to an overgeneralization of the configural account. We argue instead that second-order configural information is remarkably unimportant for familiar face recognition.
Is Utilitarianism Risky? How the Same Antecedents and Mechanism Produce Both Utilitarian and Risky Choices
Authors: Lucas Brian J. , Galinsky Adam D.
Published: July 2015

Philosophers and psychologists have long been interested in identifying factors that influence moral judgment. In the current analysis, we compare the literatures on moral psychology and decision making under uncertainty to propose that utilitarian choices are driven by the same forces that lead to risky choices. Spanning from neurocognitive to hormonal to interpersonal levels of analysis, we identify six antecedents that increase both utilitarian and risky choices (ventromedial prefrontal cortex brain lesions, psychopathology, testosterone, incidental positive affect, power, and social connection) and one antecedent that reduces these choices (serotonin activity). We identify the regulation of negative affect as a common mechanism through which the effects of each antecedent on utilitarian and risky choices are explained. By demonstrating that the same forces and the same underlying mechanism that produce risky choices also promote utilitarian choices, we offer a deeper understanding of how basic psychological systems underlie moral judgment.
Distinguishing Intrapsychic From Interpersonal Motives in Psychological Theory and Research
Authors: Leary Mark R. , Raimi Kaitlin Toner , Jongman-Sereno Katrina P. , Diebels Kate J.
Published: July 2015

Many psychological phenomena have been explained primarily in terms of intrapsychic motives to maintain particular cognitive or affective states—such as motives for consistency, self-esteem, and authenticity—whereas other phenomena have been explained in terms of interpersonal motives to obtain tangible resources, reactions, or outcomes from other people. In this article, we describe and contrast intrapsychic and interpersonal motives, and we review evidence showing that these two distinct sets of motives are sometimes conflated and confused in ways that undermine the viability of motivational theories. Explanations that invoke motives to maintain certain intrapsychic states offer a dramatically different view of the psychological foundations of human behavior than those that posit motives to obtain desired interpersonal outcomes. Several phenomena are examined as exemplars of instances in which interpersonal and intrapsychic motives have been inadequately distinguished, if not directly confounded, including cognitive dissonance, the self-esteem motive, biases in judgment and decision making, posttransgression accounts, authenticity, and self-conscious emotions. Our analysis of the literature suggests that theorists and researchers should consider the relative importance of intrapsychic versus interpersonal motives in the phenomena they study and that they should make a concerted effort to deconfound intrapsychic and interpersonal influences in their research.
Safety, Threat, and Stress in Intergroup Relations
Authors: Boyer Pascal , Firat Rengin , van Leeuwen Florian
Published: July 2015

Contact between people from different groups triggers specific individual- and group-level responses, ranging from attitudes and emotions to welfare and health outcomes. Standard social psychological perspectives do not yet provide an integrated, causal model of these phenomena. As an alternative, we describe a coalitional perspective. Human psychology includes evolved cognitive systems designed to garner support from other individuals, organize and maintain alliances, and measure potential support from group members. Relations between alliances are strongly influenced by threat detection mechanisms, which are sensitive to cues that express that one’s own group will provide less support or that other groups are dangerous. Repeated perceptions of such threat cues can lead to chronic stress. The model provides a parsimonious explanation for many individual-level effects of intergroup relations and group-level disparities in health and well-being. This perspective suggests new research directions aimed at understanding the psychological processes involved in intergroup relations.
Position Effects in Choice From Simultaneous Displays
Authors: Bar-Hillel Maya
Published: July 2015

From drop-down computer menus to department-store aisles, people in everyday life often choose from simultaneous displays of products or options. Studies of position effects in such choices show seemingly inconsistent results. For example, in restaurant choice, items enjoy an advantage when placed at the beginning or end of the menu listings, but in multiple-choice tests, answers are more popular when placed in the middle of the offered list. When reaching for a bottle on a supermarket shelf, bottles in the middle of the display are more popular. But on voting ballots, first is the most advantageous position. Some of the effects are quite sensible, whereas others are harder to justify and can aptly be regarded as biases. This article attempts to put position effects into a unified and coherent framework and to account for them simply by using a small number of familiar psychological principles.
Persistent Pulmonary Hypertension in a Neonate With Transposition of Great Arteries and Intact Ventricular Septum
Authors: Karimi Mohsen , Kirshbom Paul M. , Kopf Gary S. , Steele Margaret M. , Sullivan Jill M.
Published: July 2015

Transposition of the great arteries (TGA) with intact ventricular septum (IVS) has very favorable short- and long-term surgical outcome. Although rare, when associated with persistent pulmonary hypertension (PPH), it exhibits significant mortality risk and management challenges. We report the case of a neonate with TGA with IVS and PPH who underwent successful early surgical repair with emphasis on clinical management and review of the literature.
Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part II
Authors: Chin Alvin J. , Watrous Raymond L.
Published: July 2015

Background:

In the absence of an accessible chronic animal model of the Fontan circulation, computational modeling can provide insights into this unique circulatory arrangement, especially how differently it behaves from the normal mammalian circulation. Many groups have focused on refining a single element of the entire Fontan circulation—the total cavopulmonary connection (TCPC). Yet, only modest improvements in transplant-free survival have resulted. From an engineering perspective, optimizing the performance of a complex, multiparameter system requires an understanding of how the performance is affected by the full set of system parameters.

Methods:

We evaluated the hemodynamic impact of nine physiological perturbations in the two-year-old (yo) patient with hypoplastic left heart syndrome having a Fontan rearrangement (using our previously described lumped-parameter multicompartment model of both pulmonary and systemic circulations). In cases where comparison is appropriate, we evaluated the hemodynamic impact of analogous pathophysiologies in the normal two-year-olds. We operated the model in open-loop mode in order to expose the magnitude of the impact of uncompensated physiological perturbations.

Results:

Without the benefit of compensatory mechanisms, a valvar regurgitant fraction of 50% is sufficient to drop the cardiac index (CI) to 2.0 L/min/m2 or less. Aortopulmonary collateral flow of 0.6 L/min (1.1 L/min/m2) or 0.5 L/min (0.9 L/min/m2), sufficient to raise the ratio of pulmonary flow to systemic flow (Qp/Qs) to no higher than 1.2 or 1.5 (fenestration present or absent, respectively), is the maximum which could be tolerated (CI = 2.0 L/min/m2) without the help of compensatory mechanisms. Ventricular end-diastolic elastance (stiffness) changes have dramatic effects on CI in a Fontan circulatory arrangement.

Conclusions:

Several components of the Fontan circulation other than the TCPC actually have equal, or greater, impact on CI under certain conditions.
Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease
Authors: Piggott Kurt D. , Soni Meshal , Decampli William M. , Ramirez Jorge A. , Holbein Dianna , Fakioglu Harun , Blanco Carlos J. , Pourmoghadam Kamal K.
Published: July 2015

Background:

Acute kidney injury (AKI) and fluid overload have been shown to increase morbidity and mortality. The reported incidence of AKI in pediatric patients following surgery for congenital heart disease is between 15% and 59%. Limited data exist looking at risk factors and outcomes of AKI or fluid overload in neonates undergoing surgery for congenital heart disease.

Methods:

Neonates aged 6 to 29 days who underwent surgery for congenital heart disease and who were without preoperative kidney disease were included in the study. The AKI was determined utilizing the Acute Kidney Injury Network criteria.

Results:

Ninety-five neonates were included in the study. The incidence of neonatal AKI was 45% (n = 43), of which 86% had stage 1 AKI. Risk factors for AKI included cardiopulmonary bypass time, selective cerebral perfusion, preoperative aminoglycoside use, small kidneys by renal ultrasound, and risk adjustment for congenital heart surgery category. There were eight mortalities (five from stage 1 AKI group, three from stage 2, and zero from stage 3). Fluid overload and AKI both increased hospital length of stay and postoperative ventilator days.

Conclusion:

To avoid increased risk of morbidity and possibly mortality, every attempt should be made to identify and intervene on those risk factors, which may be modifiable or identifiable preoperatively, such as small kidneys by renal ultrasound.
Subaortic Area at Risk for Development of Obstruction After Surgical Repair of Atrioventricular Septal Defect
Authors: Pontailler Margaux , Capderou André , Lebret Emmanuel , Vergnat Mathieu , Ly Mohammed , Roussin Régine , Belli Emré
Published: July 2015

Background:

Morphology of the left ventricular outflow tract (LVOT) in atrioventricular septal defects (AVSDs) has been reported to be at risk for development of obstruction. The purpose of the present study was to identify the incidence, the risk factors, and the surgical outcomes of subaortic stenosis in repaired AVSDs.

Methods:

Records of 427 consecutive patients who underwent anatomical repair for all types of AVSDs from January 2000 to December 2012 were reviewed. Outcomes, independent risk factors, reoperation, and death were analyzed.

Results:

In a median follow-up of five years (range: 17 months-11.8 years), eight patients required nine reoperations for subaortic stenosis. Study group (n = 11) included three additional patients for whom repair was performed in a different institution. Median delay for reoperation was 11.9 years (range: 1.3-19.4 years). Surgical relief of subaortic stenosis was obtained by means of the enlargement of the LVOT: resection of fibrous structures in all reoperated patients and associated with septal myectomy in four. Two patients required a modified Konno procedure. Five reoperations were associated with left atrioventricular valve repair or replacement. Statistical analysis didn’t reveal any morphologic or demographic risk factors. No early or late death occurred.

Conclusion:

The development of subaortic stenosis after repair of AVSD remains a rare complication in midterm follow-up (incidence: 1.9%). The performance of preventive gesture during repair seemed to be unjustified. The surgical management of this reoperation consists of a simple and safe procedure.
Achieving Benchmark Results for Neonatal Palliation of Hypoplastic Left Heart Syndrome and Related Anomalies in an Emerging Program
Authors: Dodge-Khatami Ali , Chancellor William Z. , Gupta Bhawna , Seals Samantha R. , Ebeid Makram R. , Batlivala Sarosh P. , Taylor Mary B. , Salazar Jorge D.
Published: July 2015

Background:

Results of surgical management of hypoplastic left heart syndrome (HLHS) and related anomalies are often compared to published benchmark data which reflect the use of a variety of surgical and hybrid protocols. We report encouraging results achieved in an emerging program, despite a learning curve at all care levels. Rather than relying on a single preferred protocol, surgical management was based on matching surgical strategy to individual patient factors.

Methods:

From 2010 to 2014, a total of 47 consecutive patients with HLHS or related anomalies with ductal-dependent systemic circulation underwent initial surgical palliation, including 30 Norwood stage I, 8 hybrid stage I, and 9 salvage-to-Norwood procedures. True hybrid procedures entailed bilateral pulmonary artery banding and ductal stenting. In the salvage-to-Norwood strategy, ductal stenting was withheld in favor of continued prostaglandin infusion in anticipation of a deferred Norwood procedure. Cardiac comorbidities (obstructed pulmonary venous return, poor ventricular function, and atrioventricular valve regurgitation) and noncardiac comorbidities influenced the choice of treatment strategies and were analyzed as potential risk factors for extracorporeal membrane oxygenation (ECMO) support or in-hospital mortality.

Results:

Overall hospital survival was 81% (Norwood 83.3%, hybrid 88%, “salvage” 67%; P = .4942). Extracorporeal membrane oxygenation support was used for eight (17%) patients with two survivors. For cases with obstructed pulmonary venous return (n = 10, 21%), management choices favored a hybrid or salvage strategy ( P = .0026). Aortic atresia (n = 22, 47%) was treated by a Norwood or salvage-to-Norwood. No cardiac, noncardiac, or genetic comorbidities were identified as independent risk factors for ECMO or discharge mortality in a multivariable analysis.

Conclusions:

Our emerging program achieved outcomes that compare favorably to published benchmark data with respect to hospital survival. These results reflect rigorous interdisciplinary teamwork and a flexible approach to surgical palliation based on matching surgical strategy to patient factors. With major associated cardiac/noncardiac comorbidity and antegrade coronary flow, a true hybrid with ductal stenting was our preferred strategy. For high-risk situations such as aortic atresia with obstructed pulmonary venous return, the salvage hybrid-bridge-to-Norwood strategy may help achieve survival albeit with increased resource utilization.
Outcome in Children Operated for Membranous Subaortic Stenosis
Authors: Tefera Endale , Gedlu Etsegenet , Bezabih Abebe , Moges Tamirat , Centella Tomasa , Marianeschi Stefano , Nega Berhanu , van Doorn Carin , Sasson Lior , Teodori Michael
Published: July 2015

Background:

The optimal surgical procedure for treatment of fibromembranous subaortic stenosis has been a subject of debate. We report our experience with patients treated for membranous subaortic stenosis using membrane resection alone and membrane resection plus aggressive septal myectomy.

Methods:

Patients followed in the pediatric cardiology clinic of a university hospital, who had undergone surgery for subaortic stenosis between 2002 and 2013 were reviewed. Recurrence of subaortic membrane, residual left ventricular outflow gradient, and aortic valve function were analyzed.

Results:

Forty-six patients underwent surgery for subaortic membrane. Of these, 19 had membrane resection plus aggressive septal myectomy, while 27 had membrane resection alone. Mean age at surgery for the membrane resection group was 7.7 ± 3.9 years and 10.9 ± 3.6 years for the membrane resection plus aggressive myectomy group. Preoperative subaortic gradient for the membrane resection group was 75.5 ± 26.7 mm Hg and 103.2 ± 39.7 mm Hg for the membrane resection plus aggressive myectomy group. The mean follow-up left ventricular outflow tract gradient was 42.3 ± 31.3 mm Hg in the membrane resection group, while it was 11.6 ± 6.3 mm Hg in the aggressive septal myectomy group. Nine patients from the membrane resection group had significant regrowth of the subaortic membrane during the follow-up period, while none of the aggressive septal myectomy group had detectable membrane on echocardiography. Seven of the nine patients with recurrence of the subaortic membrane underwent subsequent membrane resection plus aggressive septal myectomy. Intraoperative finding in all these redo cases was recurrence (growth) of a subaortic membrane.

Conclusion:

Aggressive septal myectomy offers less chance of recurrence, freedom from reoperation, and an improved aortic valve function. This is especially important in sub-Saharan settings where a chance of getting a second surgery is unpredictable.
What is an Effective Approach with Providers Who Authorize Absences to Avoid Negative Responses from Malingering Employees?
Authors: Kalina Christine M. , Haag Annette B.
Published: July 2015

The panel approach provides a forum for sharing ideas, viewpoints, and perspectives. Panel members come with expertise from a variety of case management arenas and have agreed to share their opinions and perspectives in response to specific questions or scenarios. Opinions and perspectives are those of the panel members, and do not necessarily represent the views of AAOHN, the Editor, or the Publisher. We encourage readers to submit their questions or scenarios for the panel. This month's panel members include Norman DePaul Brown, Christine M. Kalina, and Annette B. Haag.
Burden of HIV-Related Neuropathic Pain in the United States
Authors: Mann Rachael , Sadosky Alesia , Schaefer Caroline , Baik Rebecca , Parsons Bruce , Nieshoff Edward , Stacey Brett R. , Tuchman Michael , Nalamachu Srinivas
Published: July 2015

Background:

HIV-related neuropathic pain (HIV-NeP) is common; however, the burden of HIV-NeP is not well-understood.

Methods:

The cross-sectional study aimed to characterize the HIV-NeP burden. A total of 103 patients with HIV-NeP recruited during routine office visits completed a questionnaire to assess patient-reported outcomes, including pain severity, health status, sleep, mood, and lost productivity. Physicians completed a 6-month retrospective chart review.

Results:

The sample was predominantly male and not employed for pay. A majority (75.7%) of patients experienced moderate or severe pain. Pain interference, general health, physical health, and depression were worse among patients with more severe pain (all Ps < .006). Most (87.4%) patients were prescribed at least 1 medication for NeP. HIV-related neuropathic pain was associated with 36.1% work impairment. Adjusted annualized costs increased with increasing pain severity ( P < .0001).

Conclusion:

The impact of HIV-NeP on health status, physical function, and depression increases with severity, resulting in substantial clinical and economic burden.
Antiretroviral Therapy Outcomes in Patients with Severe Mental Illness
Authors: Karstaedt Alan S. , Kooverjee Sadhna , Singh Lucille , Jeenah Yasmien , Jonsson Gregory
Published: July 2015

A retrospective cohort analysis was performed to describe outcomes and retention in care on antiretroviral therapy (ART) of 53 patients with severe mental illness (SMI). Diagnoses were psychosis secondary to HIV (24 patients), psychosis not otherwise specified (12), mania with or without psychosis (9), depression with psychotic features (4), and schizophrenia and bipolar mood disorder (2 each). The median baseline CD4 count was 66/mm3 and viral load was 5.4 log10 copies/mL. Thirteen (25%) patients were lost to follow-up (10 within 6 months), 3 were transferred out, and 3 died. By week 96, 29 (85%) of 34 (64%) patients still in care had a viral load <400 copies/mL and 26 (76%) a viral load <25 copies/mL. Median CD4 count increased to 307/mm3. Twenty-seven of 34 patients discontinued antipsychotic medication. Patients with SMI and advanced HIV infection responded well to ART. The first 6 months was important for retention in care.
Identifying Perceived Barriers along the HIV Care Continuum
Authors: Kulkarni Sarah , Hoffman Susie , Gadisa Tsigereda , Melaku Zenebe , Fantehun Mesganaw , Yigzaw Muluneh , El-Sadr Wafaa , Remien Robert , Tymejczyk Olga , Nash Denis , Elul Batya
Published: July 2015

Increasing the proportion of HIV-positive individuals who link promptly to and are retained in care remains challenging in sub-Saharan Africa, but little evidence is available from the provider perspective. In 4 Ethiopian health facilities, we (1) interviewed providers and peer educators about their perceptions of service delivery- and patient-level barriers and (2) observed provider–patient interactions to characterize content and interpersonal aspects of counseling. In interviews, providers and peer educators demonstrated empathy and identified nonacceptance of HIV status, anticipated stigma from unintended disclosure, and fear of antiretroviral therapy as patient barriers, and brusque counseling and insufficient counseling at provider-initiated testing sites as service delivery-related. However, observations from the same clinics showed that providers often failed to elicit patients’ barriers to retention, making it unlikely these would be addressed during counseling. Training is needed to improve interpersonal aspects of counseling and ensure providers elicit and address barriers to HIV care experienced by patients.
Building Problem Forums
Authors: Vealey Kyle P.
Published: July 2015

This article describes the use of problem forums in undergraduate professional writing courses as a technique for facilitating and sustaining learning from increasingly complex, messy, and wicked problems that are characteristic of 21st-century work. Problem forums are designed to scaffold project team discussions of rhetorical, technical, or collaborative difficulties that have unexpectedly slowed or halted their work. Problem forums are thus intended to facilitate and sustain continual learning on project teams.
A Comparison of Pharmaceutical Product Performance of Albuterol Inhalers Available in the United States and Those Obtained in a Mexican Border Town
Authors: Nocella Meira , Kilber Emily , Witmer Brittney , Karlage Kelly , Myrdal Paul
Published: July 2015

Background: American residents travel to Mexico to purchase medications for a fraction of US cost and frequently without prescription requirements. A previous bioequivalence study found differences in lung function measures between 2 brands of Mexican-manufactured albuterol inhalers (both 100 µg/puff). An investigation of the pharmaceutical performance of different inhalers available may illuminate why different clinical results may be observed and offer insight to consumer and provider expectations of such products. Objective: The purpose of this study is to provide some reasonable expectations for a medical tourist who shops in Mexico for albuterol metered dose inhalers (MDIs) or for their health care providers by comparing pharmaceutical product performance of the consumer-available brands. Methods: Five different albuterol MDI products were purchased in Nogales, Mexico. The albuterol content was quantified through high-performance liquid chromatography. The inhalers were analyzed to determine the amount of the albuterol dose that can be considered respirable and compared with the findings from 2 US innovator products. Results: The mean respirable mass for each brand of albuterol MDI was compared with that of the other 4 brands and the 2 US innovator products using Student’s t test. All evaluations showed significant differences ( P < .05) except for 3 comparisons (Sacrusyt vs Assal, P = .89; Xeneric-S vs non-US Ventolin, P = .98; Victory vs US Proventil HFA, P = .06). Conclusion: Since pharmaceutical variability was found among the albuterol MDIs evaluated in this study, consumers and clinicians should appreciate possible differences in product performance of albuterol MDIs obtained in Mexico.