bluuebunny/crossref_metadata_2025 huggingface dataset:
Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson’s disease patients
Authors: Prizer Lindsay P , Gay Jennifer L , Perkins Molly M , Wilson Mark G , Emerson Kerstin G , Glass Anne P , Miyasaki Janis M
Published: March 2017

Background:

A palliative approach is recommended in the care of Parkinson’s disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson’s disease patients.

Aim:

To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson’s disease patients and their reported referral practices.

Design:

A cross-sectional survey study of neurologists.

Setting/participants:

A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology’s clinician database.

Results:

Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = −16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral.

Conclusion:

Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.
Social Jetlag Among Night Workers is Negatively Associated with the Frequency of Moderate or Vigorous Physical Activity and with Energy Expenditure Related to Physical Activity
Authors: Alves Mariana Silva , Andrade Raphael Zardini , Silva Graciele Cristina , Mota Maria Carliana , Resende Sabrina Gonçalves , Teixeira Kely Raspante , Gonçalves Bruna Fernandes , Crispim Cibele Aparecida
Published: March 2017

This cross-sectional study analyzed the association between physical activity (PA) and social jetlag (SJL) among shift workers. We evaluated 423 employees, aged between 18 and 60 years, who worked in a poultry-processing company in Brazil. Physical activity levels (PAL) were determined by the short form of the International Physical Activity Questionnaire (IPAQ-SF). SJL was calculated as the absolute difference between the time of mid-sleep on work and free days. The percentage of workers insufficiently active was high on all shifts, with no significant differences between the 3 shifts. The amount of time spent in sedentary behavior on workdays did not differ between shifts. Among night-shift workers, negative associations were observed between SJL and 1) the duration and weekly energy expenditure while walking; 2) the frequency of moderate and vigorous PA; and 3) the total energy expenditure related to PA. Even though PAL did not differ among workers on different shifts, we found a high prevalence of subjects who were insufficiently active or too sedentary among all groups. Also, SJL was negatively associated with PA in night-shift workers. These results suggest that PA should be encouraged among shift workers and that SJL may be an important factor in reducing PA in this cohort.
The Role of Technologies, Behaviors, Gender, and Gender Stereotype Traits in Adolescents’ Cyber Aggression
Authors: Wright Michelle F.
Published: March 2017

The present study focused on the impact of gender and gender stereotype traits (i.e., masculinity, femininity) on cyber aggression perpetration utilizing different technologies (i.e., social-networking sites, gaming consoles, mobile phones) and behaviors (i.e., cyber relational aggression, cyber verbal aggression, hacking). Participants included 233 eighth graders (108 female; Mage = 13.26, SD = 0.36) from two middle schools in the Midwestern United States. Adolescents completed questionnaires on their endorsement of masculinity and femininity traits as well as how often they engaged in cyber aggression perpetration (i.e., cyber relational aggression, cyber verbal aggression, hacking) through mobile phones, social-networking sites, and gaming consoles. Findings indicated that boys and girls with more feminine traits engaged in more cyber relational aggression through social-networking sites and mobile phones, while boys and girls who endorsed more masculine traits perpetrated this behavior and cyber verbal aggression more often through online gaming. In addition, these boys and girls engaged in more hacking through all technologies when compared with girls and boys who reported more feminine traits. Results of this study indicate the importance of delineating gender stereotype traits, behaviors, and technologies when examining cyber aggression perpetration.
Spoil the Rod and Save the Child: Socioeconomic Predictors of Harsh Discipline by Parents, Egyptian Case Study
Authors: Mohammed Nisreen Yacoub , Samak Yasser Abdelazim Abdelmawgoud
Published: March 2017

The purpose of this article is to investigate the use of harsh disciplinary methods by parents as corrective techniques for their children, and the resulting behavioral aspects in the affected children. Sociodemographic predictors are tested for estimating the impact of harsh disciplining by parents. A primary survey of a sample of 1,751 children 10 to 12 years of age across 12 provinces of Assiut Governorate in Egypt is considered. The analysis is carried out using exploratory factor analysis and confirmatory factor analysis. Structural equation modeling is used for testing the significance of the seven predictors. The findings show that harsh disciplining is significantly affected by the age, education level, income level, and marital status of parents. Harsh disciplining is evident for different dimensions: “beating for discipline,” “beating while children grow up,” “beating with a stick can discipline children,” and “children should not be listened to.” Some parents believe that beating will help in correcting the behavior of their children and in instilling desirable attitudes in them. This approach has ill effects, but it can only be corrected by addressing the poor economic conditions and education of the parents.
Prevention Strategies Against HIV Transmission: A Proactive Approach
Authors: Carrion Antonio J. , Miles Jovan D. , Mosley Juan F. , Smith Lillian L. , Prather April S. , Gurley Marcus M. , Phan Linh D. , Everton Emily C.
Published: March 2017

Human immunodeficiency virus (HIV) has now transformed into a manageable chronic condition. Highly active antiretroviral therapy (HAART) has proven efficacious at controlling the disease progression. Based on compelling evidence, the Department of Health and Human Services (DHHS) and the Infectious Disease Society of America (IDSA) developed guidelines for the management of persons infected with HIV. However, there are approximately 50 000 new cases of HIV in the United States each year. In this article, we review proactive methods to reduce the transmission of HIV, which include reinforcing patient education, gel-coated condoms that destroy HIV, HIV vaccinations, and adequately utilizing pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Further development and consistent utilization of innovative prevention tools can significantly reduce the incidence of HIV infections regardless of HIV status.
Small business revivalism: employment relations in small and medium-sized enterprises
Authors: Mallett Oliver , Wapshott Robert
Published: March 2017

This e-special issue focuses on employment relations in the context of ‘small business revivalism’ and an ‘enterprise culture’ that has sought to establish a so-called ‘entrepreneurial economy’. Economic restructuring and other political, social and economic changes in the 1970s and 1980s led to an increase in the number and prominence of small and medium-sized enterprises, with implications for the working lives of many people who are now more likely to work as self-employed, freelancers or members of smaller organizations. This e-special issue presents research from Work, employment and society that considers important elements of these changes, including debates about the influences of businesses’ external and internal environments, family relations and government policy. This introduction provides a general overview of the field of employment relations in small and medium-sized enterprises and the 11 articles included in the e-special issue.
Lower kidney allograft survival in African–Americans compared to Hispanic–Americans with lupus
Authors: Gonzalez-Suarez M L , Contreras G
Published: March 2017

Background and objective

African–Americans and Hispanic–Americans with lupus are the two most common minority groups who receive kidney transplants in the USA. It is unknown if African–Americans and Hispanic–Americans with lupus have similar outcomes after kidney transplantation. In this study, we assessed whether African–Americans compared to Hispanic–Americans have worse kidney allograft survival after risk factors of rejection and other prognostic factors were matched between both groups.

Methods

Out of 1816 African–Americans and 901 Hispanic–Americans with lupus, who received kidney transplants between 1987 and 2006 and had complete records in the UNOS program, 478 pairs were matched in 16 baseline predictors and follow-up time employing a predicted probability of group membership. The primary outcome was kidney allograft survival. Main secondary outcomes were rejection, allograft failure attributed to rejection, and mortality.

Results

Matched pairs were predominantly women (81%) with the mean age of 36 years. 96% were on dialysis before transplantation. 89% of recipients received kidneys from deceased donors and 15.5% from expanded criteria donors. 12% of recipients had zero HLA mismatch. African–Americans compared to Hispanic–Americans had lower cumulative allograft survival during 12-year follow-up ( p < 0.001). African–Americans compared to Hispanic–Americans had higher rates of rejection (10.4 vs 6.73 events/100 patients-years; p = 0.0002) and allograft failure attributed to rejection (6.31 vs 3.99; p = 0.0023). However, African–Americans and Hispanic–Americans had similar mortality rates (2.71 vs 2.31; p = 0.4269).

Conclusions

African–Americans compared to Hispanic–Americans with lupus had lower kidney allograft survival when recognized risk factors of rejection were matched between groups.
Adopting a music-to-heart rate alignment strategy to measure the impact of music and its tempo on human heart rate
Authors: van Dyck Edith , Six Joren , Soyer Esin , Denys Marlies , Bardijn Ilka , Leman Marc
Published: March 2017

Music is frequently used as a means of relaxation. Conversely, it is used as a means of arousal in sports and exercise contexts. Previous research suggests that tempo is one of the most significant determinants of music-related arousal and relaxation effects. Here we investigate the specific effect of music tempo, but also more generally, the influence of music on human heart rate. We took the pulses of 32 participants in silence, and then we played them non-vocal, ambient music at a tempo corresponding to their heart rates. Finally, we played the same music again, either with the tempo increased or decreased by a factor of 45%, 30%, or 15%; or maintaining the same tempo as in the first playing. Mixed-design ANOVA tests revealed a significant increase in heart rate while listening to the music as compared with silence ( p < .05). In addition, substantial decreases in tempo (-45% or -30%) could account for smaller subsequent heart rate reductions ( p < .05). We neither found links between increases in tempo (+15%, +30%, and +45%) and heart rate change, nor small decreases (-15%). In addition, neither effects of gender, music training, nor of musical preference were found. This indicates that during passive music listening, music exerts a general arousal effect on human heart rate, which might be regulated by tempo. These results are a major contribution to the way in which music may be used in everyday activities.
The Patriarchy Index: A New Measure of Gender and Generational Inequalities in the Past
Authors: Szołtysek Mikołaj , Klüsener Sebastian , Poniat Radosław , Gruber Siegfried
Published: March 2017

This article presents a new measure of family-driven age- and gender-related inequalities. This composite measure, which we call the Patriarchy Index, combines a range of variables related to familial behavior that reflect varying degrees of sex- and age-related social inequality across different family settings. We demonstrate the comparative advantages of the index by showing how 266 historical populations from the Atlantic coast of Europe to Moscow scored on the patriarchy scale. We then compare the index with contemporary measures of gender discrimination, and find a strong correlation between historical and current inequality patterns. Finally, we explore how variation in patriarchy levels across Europe is related to the socioeconomic and institutional characteristics of the regional populations, and to variation across these regions in their degree of demographic centrality and environmental conditions. The results confirm previous findings that family organization is a crucial generator of social inequality, and point to the importance of considering the historical context when analyzing the current global contours of inequality.
Effect of age, sex and body weight on the serum concentrations of cobalamin and folate in cats consuming a consistent diet
Authors: Hill Sarah A , Cave Nicholas J , Forsyth Sandra
Published: March 2017

Objectives

Multiple feline diseases involving the gastrointestinal tract, pancreas, liver and biliary tract are known to cause abnormal serum cobalamin and folate concentrations. Measuring the serum concentration of these vitamins can therefore be a helpful diagnostic tool. However, factors other than disease, in particular age, have also been suggested to have an effect on the serum concentration of cobalamin and folate. In previous studies, the dietary intake was not standardised, or even known, despite diet being the prinicpal source of both vitamins. Therefore, we evaluated the effect of age, sex and body weight on the serum concentration of folate and cobalamin in cats fed the same diet.

Methods

The serum cobalamin and folate concentrations were measured in 65 apparently healthy cats in a nutrition colony that had been fed an identical diet. A linear model was used to test the relationship between the serum concentration of cobalamin and folate with the variables age, sex and body weight.

Results

There was a large variation in the serum concentration of both folate and cobalamin, despite identical intake. Serum cobalamin was inversely associated with age ( P = 0.002), and males had higher concentrations than females ( P = 0.039). Serum folate was positively associated with age ( P = 0.01).

Conclusions and relevance

Independent of diet, serum cobalamin concentration decreases with age. Changes in gastrointestinal function, microflora or metabolism may be responsible. Older cats may be more susceptible to cobalamin deficiency secondary to inappetence or gastrointestinal disease.
Factors that support Indigenous involvement in multi-actor environmental stewardship
Authors: Reo Nicholas J , Whyte Kyle P , McGregor Deborah , Smith MA (Peggy) , Jenkins James F
Published: March 2017

Regional, multi-actor environmental collaborations bring together diverse parties to achieve environmental protection and stewardship outcomes. Involving a range of participants helps involve alternative forms of knowledge, expertise, and perspectives; it may also present greater challenges in reaching agreements, particularly when both Indigenous and non-Indigenous parties are involved. The authors conduct a cross-case study of 39 regional partnerships involving Indigenous nations from the Great Lakes basin of North America with the aim of determining the factors that enable Indigenous partners to remain engaged in multi-actor collaborations. Six characteristics influenced Indigenous nations’ willingness to remain engaged: respect for Indigenous knowledges, control of knowledge mobilization, intergenerational involvement, self-determination, continuous cross-cultural education, and early involvement. Being attentive of these factors can help partnerships achieve their environmental goals by keeping important partners at the table.
Evaluation of Best-Fit Probability Distribution Models for the Prediction of Inflows of Kainji Reservoir, Niger State, Nigeria
Authors: Mamman Mohammed J , Martins Otache Y , Ibrahim Jibril , Shaba Mohammed I
Published: March 2017

The analysis of time series is essential for building mathematical models to generate synthetic hydrologic records, to forecast hydrologic events, to detect intrinsic stochastic characteristics of hydrologic variables, as well as to fill missing and extend records. To this end, various probability distribution models were fitted to river inflows of Kainji Reservoir in New Bussa, Niger State, Nigeria. This is to evaluate the probability function that is best suitable for the prediction of their values and subsequently using the best model to predict for both the expected maximum and minimum monthly inflows at some specific return periods. Three models, ie, Gumbel extreme value type I (EVI), log-normal (LN), and normal (N), were evaluated for the inflows and the best model was selected based on the statistical goodness-of-fit test. The values of goodness-of-fit test for Kainji hydropower dam are as follows: r = 0.96, R2 = 0.99, SEE = 0.0087, χ2 = 0.0054, for Gumbel (EVI); r = 0.79, R2 = 0.85, SEE = 0.02, χ2 = 0.31 for LN; and r = 0.0.75, R2 = 0.0.68, SEE = 0.056, χ2 = 1376.39 for N. For the Kainji hydropower dams, the Gumbel (EVI) model gave the best fit. These probability distribution models can be used to predict the near-future reservoir inflow at the Kainji hydropower dams.
Aquaporin-4-autoimmunity in patients with systemic lupus erythematosus: A predominantly population-based study
Authors: Asgari Nasrin , Jarius Sven , Laustrup Helle , Skejoe Hanne PB , Lillevang Soeren T , Weinshenker Brian G , Voss Anne
Published: March 2017

Background:

Serum immunoglobulin G targeting the astrocyte water channel aquaporin-4 (AQP4) in the central nervous system (CNS) is a biomarker for neuromyelitis optica spectrum disease (NMOSD). Co-existence of NMOSD with systemic lupus erythematosus (SLE) putatively suggests susceptibility to antibody-mediated autoimmune disease.

Objective:

To estimate the prevalence of NMOSD in SLE and investigate the immunogenetic background for an association of NMOSD and SLE.

Methods:

The study included a predominantly population-based cohort with clinical and serological investigations of 208 patients with SLE, followed prospectively since 1995. All patients received immunosuppressive treatment. NMOSD was evaluated retrospectively based on the 2015 International Panel for NMOSD Diagnosis (IPND) criteria. Polymorphisms in programmed cell death protein 1 (PDCD-1) PD-1.3 G/A were genotyped. AGP4-IgG and other autoantibodies, including myelin oligodendrocyte glycoprotein (MOG), was determined blinded to clinical diagnosis.

Results:

Of 208 patients with SLE, 45(22%) had neuropsychiatric (NP) SLE, and CNS involvement predominated in 30 of 45 (67%) patients. Serum AQP4-IgG was detected in 2 of 30 (6.7%) neuropsychiatric SLE (NPSLE) patients both of whom had myelitis and antiphospholipid syndrome; one patient also had myasthenia gravis. None had MOG-IgG. PD-1.3A allele was not associated with SLE nor with NPSLE.

Conclusion:

AQP4-IgG autoimmune syndrome may rarely co-exist with SLE, and such patients have other NMOSD-typical syndromes such as myelitis.
Collecting visual voices: Understanding identity, community, and the meaning of participation within gay rodeos
Authors: Capous-Desyllas Moshoula , Johnson-Rhodes Marina
Published: March 2017

Rodeos have been an integral part of American cowboy culture since the 1800s, however, it wasn’t until the 1970s when gay rodeos began to form and challenge some of the assumptions about ‘cowboys,’ ‘sexuality,’ and ‘masculinity.’ The purpose of this ethnographic study was to utilize participant-driven photo-elicitation (PDPE) method to understand how individuals who participate in gay rodeos experience their identities and the meanings they attribute to their participation in this queer subculture. The diverse images shared by the participants illustrate their unique identities and the various meanings they attribute to their participation in gay rodeo. The findings from this study serve to highlight various aspects of the gay rodeo subculture and the role of gay rodeo as a site of support and solidarity for LGBTQ communities. In this study, gay rodeo emerges as a space of contestation, resistance and reification of gender norms and heterosexuality. The findings call into question tensions that exist when trying to dismantle sexual minority stereotypes while simultaneously perpetuating white hegemonic masculinity through the pervasive image of the gay cowboy. Interrogating the ways in which gay rodeo participants simultaneously reinforced and challenged hegemonic masculinity helps to understand how the idealized (hetero)sexual images of cowboys connected to symbolic power, strength and self-worth, position gay rodeo participants. This research study also reveals that participants of gay rodeo, who travel within and across the USA in order to participate in rodeo events, experiment with multiple non-heterosexual identities as they search for spaces and communities away from compulsory heterosexuality.
Gaali cultures: The politics of abusive exchange on social media
Authors: Udupa Sahana
Published: March 2017

On the rapidly expanding social media in India, online users are witness to a routine exchange of abusive terms and accusations with choicest swearwords hurled even for the seemingly non-inflammatory political debates. This article draws upon anthropology of insult to uncover the distinctness, if at all, of online abuse as a means for political participation as well as for the encumbering it provokes and relations of domination it reproduces as a result. In so doing, the article critiques the conception of ludic as anti-hegemonic in the Bakhtin tradition, and develops an emic term “gaali” to signal the blurred boundaries between comedy, insult, shame, and abuse emerging on online media, which also incite gendered forms of intimidation. Gaali, it argues, is best conceptualized through the metaphor of “sound” as distinct from what recent new media studies theorize as “voice.”
Evolution of Mentoring Relationships Involving Young Male Offenders Transitioning from a Juvenile Justice Centre to the Community
Authors: Hanham José , Tracey Danielle
Published: March 2017

This qualitative longitudinal study focused on adolescent males who were being formally mentored during their transition from a juvenile justice centre to the community. Pre-release, the young men feared being exposed to negative peer influences and uncertainty about the future. In response to this anxiety, the young men valued the mentor as a guide, confidant and “watchdog”. Post-release, the concerns of the young men turned to a sense of disconnection, institutionalisation and difficulties securing employment. Here, the young men required their mentors to be reliable, build confidence and assist with educational and occupational opportunities. The findings both inform our theoretical understanding of mentoring and provide direction for supporting young offenders in the transition back into the community.
Could There Be a Silver Lining to Zika?
Authors: Killian Caitlin
Published: March 2017

Public health crises around Thalidomide and Rubella changed American public opinion around abortion policy. But could the spread of Zika do the same amid an outbreak of new state-level abortion restrictions?
How Long Should Routine EEG Be Recorded to Get Relevant Information?
Authors: Doudoux Hannah , Skaare Kristina , Geay Thomas , Kahane Philippe , Bosson Jean L. , Sabourdy Cécile , Vercueil Laurent
Published: March 2017

Objective. The optimal duration of routine EEG (rEEG) has not been determined on a clinical basis. This study aims to determine the time required to obtain relevant information during rEEG with respect to the clinical request. Method. All rEEGs performed over 3 months in unselected patients older than 14 years in an academic hospital were analyzed retrospectively. The latency required to obtain relevant information was determined for each rEEG by 2 independent readers blinded to the clinical data. EEG final diagnoses and latencies were analyzed with respect to the main clinical requests: subacute cognitive impairment, spells, transient focal neurologic manifestation or patients referred by epileptologists. Results. From 430 rEEGs performed in the targeted period, 364 were analyzed: 92% of the pathological rEEGs were provided within the first 10 minutes of recording. Slowing background activity was diagnosed from the beginning, whereas interictal epileptiform discharges were recorded over time. Moreover, the time elapsed to demonstrate a pattern differed significantly in the clinical groups: in patients with subacute cognitive impairment, EEG abnormalities appeared within the first 10 minutes, whereas in the other groups, data could be provided over time. Conclusion. Patients with subacute cognitive impairment differed from those in the other groups significantly in the elapsed time required to obtain relevant information during rEEG, suggesting that 10-minute EEG recordings could be sufficient, arguing in favor of individualized rEEG. However, this conclusion does not apply to intensive care unit patients.
CTSA Institution Responses to Proposed Common Rule Changes: Did They Get What They Wanted?
Authors: Rivera Suzanne M. , Nichols Lisa , Brako Lois , Croft Genevieve , Russo Toni , Tran Tara
Published: March 2017

In 2015, the U.S. Department of Health and Human Services (HHS) and 15 other federal departments and agencies proposed revisions to the Federal Policy for the Protection of Human Subjects. In this Notice of Proposed Rulemaking (NPRM), the departments sought to strengthen, modernize, and make more effective human subjects regulations while reducing administrative burden, delay, and ambiguity. We reviewed public comments from National Institutes of Health (NIH)-funded Clinical and Translational Science Awards (CTSA) institutions on key provisions of the NPRM to understand how the proposed changed were received at research-intensive institutions. CTSA institutions responding to the proposed rule were predominantly opposed to the major proposals, including proposed changes to the treatment of de-identified biospecimens, demonstrating a lack of support from academic medical centers. In January 2017, a Final Rule was issued. We compare the Final Rule to what was proposed.
Sexual Behaviors and Sexually Transmitted Infections Among Male Veterans and Nonveterans
Authors: Evans Mark W. , Borrero Sonya , Yabes Jonathan , Rosenfeld Elian A.
Published: March 2017

Little is known about the sexual health of male veterans. This study used nationally representative data from the 2011 to 2013 National Survey of Family Growth to compare sexual behaviors and history of sexually transmitted infections (STIs) between male veterans and nonveterans. The sample included 3,860 men aged 18 to 44 years who reported ever having sex with a man or woman. The key independent variable was veteran status. Sexual behavior outcomes included ≥6 lifetime female partners, ≥10 lifetime partners of either sex, ≥2 past-year partners of either sex, having past-year partners of both sexes, and condom nonuse at last vaginal sex. STI outcomes included past-year history of chlamydia, gonorrhea, or receiving any STI treatment; lifetime history of herpes, genital warts, or syphilis; and an aggregate measure capturing any reported STI history. Logistic regression models were used to evaluate associations between veteran status and each outcome. In models adjusting for age, race/ethnicity, education, income, and marital status, veterans had significantly greater odds than nonveterans of having ≥6 lifetime female partners ( OR = 1.5, 95% CI [1.02, 2.31]). In models adjusting for age and marital status, veterans had significantly greater odds of having partners of both sexes in the past year ( OR = 4.8, 95% CI [1.2, 19.8]), and gonorrhea in the past year ( OR = 3.2, 95% CI [1.2, 8.5]). Male veterans were thus significantly more likely than nonveterans to have STI risk factors. Health care providers should be aware that male veterans may be at higher risk for STIs and assess veterans’ sexual risk behaviors.
Adaptive designs: The Swiss Army knife among clinical trial designs?
Authors: Bretz Frank , Gallo Paul , Maurer Willi
Published: March 2017

There has been considerable progress in the development and implementation of adaptive designs over the past 30 years. A major driver for this class of novel designs is the possibility to increase the information value of clinical trial data to enable better decisions, leading to more efficient drug development processes and improved late-stage success rates. In the first part of this article, we review the development of adaptive designs from different perspectives. We trace back key historical papers, report on landmark adaptive design clinical trials, review major cross-industry collaborations, and highlight key regulatory guidance documents. In the second, more technical part of this article, we address the question of whether it is possible to define factors which guide the choice between a fixed or an adaptive design for a given trial. We show that in non-linear regression models with a moderate variance of the responses, the first-stage sample size of an adaptive design should be chosen sufficiently large in order to address variability in the interim parameter estimate. In conclusion, the choice between an adaptive and a fixed design depends in a sensitive manner on the specific statistical problem under investigation.
Effectiveness of motivational interviewing for improving physical activity self-management for adults with type 2 diabetes: A review
Authors: Soderlund Patricia Davern
Published: March 2017

Objectives

This review examines the effectiveness of motivational interviewing for physical activity self-management for adults diagnosed with diabetes mellitus type 2. Motivational interviewing is a patient centered individually tailored counseling intervention that aims to elicit a patient’s own motivation for health behavior change. Review questions include (a) How have motivational interviewing methods been applied to physical activity interventions for adults with diabetes mellitus type 2? (b) What motivational interviewing approaches are associated with successful physical activity outcomes with diabetes mellitus 2?

Methods

Database searches used PubMed, CINAHL, and PsycINFO for the years 2000 to 2016. Criteria for inclusion was motivational interviewing used as the principal intervention in the tradition of Miller and Rollnick, measurement of physical activity, statistical significance reported for physical activity outcomes, quantitative research, and articles written in English.

Results

A total of nine studies met review criteria and four included motivational interviewing interventions associated with significant physical activity outcomes.

Discussion

Findings suggest motivational interviewing sessions should target a minimal number of self-management behaviors, be delivered by counselors proficient in motivational interviewing, and use motivational interviewing protocols with an emphasis placed either on duration or frequency of sessions.
Assessment of microRNA and gene dysregulation in pulmonary hypertension by endoarterial biopsy
Authors: Rothman Abraham , Restrepo Humberto , Sarukhanov Valeri , Evans William N. , Wiencek Robert G. , Williams Roy , Hamburger Nicole , Anderson Kylie , Balsara Jasmine , Mann David
Published: March 2017

MicroRNAs (miRNAs) may regulate a number of genes, each of which may have a variety of functions. We utilized an endoarterial biopsy catheter to assess the dysregulation of miRNAs in a porcine shunt model of pulmonary hypertension (PH). Two Yucatan micropigs underwent surgical anastomosis of the left pulmonary artery to the descending aorta. Endoarterial biopsy samples were obtained at baseline, and at regular intervals during the progression of PH. RNA, isolated from biopsy samples, was analyzed by Illumina miRNA expression microarrays (containing ∼1200 human miRNAs), Affymetrix Porcine GeneChips, Bioconductor, and GeneSpring. We examined a total of 925 genes in a PH whole genome microarray. Biopsy samples showed that 39 miRNAs were downregulated and 34 miRNAs were upregulated compared to baseline. The number of PH‐associated genes reported to be controlled by each of the dysregulated miRNAs was in the range of 1–113. The five miRNAs that had the largest number of PH‐associated genes were: miR‐548c‐3p, miR‐520d‐3p, miR‐130a‐5p, miR‐30a‐3p, and miR‐let‐7g‐3p. Several of the dysregulated miRNAs have been associated with molecular pathways and biologic processes involved in PH. Among 29 miRNAs, which were predicted to be dysregulated by a systems biology approach, we found four that were dysregulated in our porcine shunt model. An endoarterial biopsy technique was successful in showing that a large number of miRNAs are dysregulated in a porcine shunt model of PH. Many of these miRNAs control multiple PH‐associated genes, molecular pathways, and biologic processes. Endoarterial biopsy offers potential experimental and clinical diagnostic value.
Euglycaemic ketoacidosis in a non-diabetic primigravida following an appendicectomy
Authors: Dikowita Dinushi Dilanka , Kumanan Thirunavukarasu , Muhunthan Kopalasuntharam , Arulmoli Janaki
Published: March 2017

Pregnancy creates significant alterations in energy metabolism which itself is a physiological adaptation to provide continuous flow of energy metabolites to the foetus. The state of insulin resistance created by hormonal changes in pregnancy enables free flow of glucose to the foetus and allows its absorption through facilitated diffusion. As glucose is preferentially available for the foetus, maternal fasting glucose level would be less than that of a non-pregnant state and in contrast plasma ketones and free fatty acids levels are elevated, resulting in a state of accelerated starvation. These metabolic alterations place a pregnant woman at a higher risk of developing euglycaemic ketoacidosis when allowed to fast for prolonged periods due to medical, surgical and psychological reasons. We report a rare case of euglycaemic ketoacidosis causing severe increased anion gap metabolic acidosis in a non-diabetic mother following surgery for appendicitis at a gestation of 27 weeks.
Penile rehabilitation after nerve-sparing prostatectomy: Fact or fiction?
Authors: Hamm Rebecca , Terry Tim R , Bates Anthony S
Published: March 2017

A 65-year-old man is seen in the clinic two months after a robot-assisted bilateral nerve-sparing radical prostatectomy. He is completely continent and has been since the catheter was removed. The main reason for his referral is erectile dysfunction. Pre-operatively his SHIM score was 25 (maximum score 25). He currently experiences some thickening with stimulation, and an erection hardness score of 2. He has a pleasurable sensation of orgasm during which he remains dry. His sex drive remains normal. He has a long-standing history of hypertension and raised LDL cholesterol, managed with amlodipine and simvastatin respectively. He has no other overt cardiovascular or ischaemic heart disease, and he is not a diabetic, but has an elevated fasting glucose of 6.0 mmol per litre. He stopped smoking five years ago, is 5 feet 11 inches tall, a weight of 95 kg, has a waist measurement of 44 inches (BMI 29 – upper end of overweight) (range <18.50 underweight; 18.50–24.99 healthy weight; 25.00–29.99 overweight; >30.00 obese). He performs no regular exercise. His wife is 60. He is keen to try to regain his erectile function.
Microparticle Formation in Peritoneal Dialysis
Authors: Akbari Shareef , Abou-Arkoub Rima , Sun Suzy , Hiremath Swapnil , Reunov Arkadiy , McCormick Brendan B. , Ruzicka Marcel , Burger Dylan
Published: March 2017

Background:

Injury to the mesothelial layer of the peritoneal membrane during peritoneal dialysis (PD) is implicated in loss of ultrafiltration capacity, but there are no validated biomarkers for mesothelial cell injury. Microparticles (MPs) are 0.1 to 1.0 µm membrane vesicles shed from the cell surface following injury and are sensitive markers of tissue damage. Formation of MPs in the peritoneal cavity during PD has not been reported to date.

Methods:

We designed a single-center, proof of concept study to assess whether peritoneal solution exposure induces formation of mesothelial MPs suggestive of PD membrane injury. We examined MP levels in PD effluents by electron microscopy, nanoparticle tracking analysis (NTA), flow cytometry, procoagulant activity, and Western blot.

Results:

NTA identified particles in the size range of 30 to 900 nm, with a mean of 240 (SE: 10 nm). MP levels increased in a progressive manner during a 4-hour PD dwell. Electron microscopy confirmed size and morphology of vesicles consistent with characteristics of MPs as well as the presence of mesothelin on the surface. Western blot analysis of the MP fraction also identified the presence of mesothelin after 4 hours, suggesting that MPs found in PD effluents may arise from mesothelial cells.

Conclusions:

Our results suggest that MPs are formed and accumulate in the peritoneal cavity during PD, possibly as a stress response. Assessing levels of MPs in PD effluents may be useful as a biomarker for peritoneal membrane damage.
Public Views on Pulse Oximetry Screening for Critical Congenital Heart Disease
Authors: Kumar Praveen , Iyengar Hari , Kumar Prerna
Published: March 2017

Objectives:

To understand public views on pulse oximetry screening for critical congenital heart disease.

Methods:

Two hundred thirteen adults read a brief vignette describing the importance of early detection of critical congenital heart disease and then answered five questions on a five-point scale of how likely or unlikely they were to support pulse oximetry screening. Responses were tabulated and analyzed using a Fisher exact test, and logistic regression was used to estimate odds ratios for adjusted associations using generalized estimating equations.

Results:

Almost 90% of all participants expressed support for routine pulse oximetry screening. The possibility of false positives leading to a delay in discharge, and the potential need for transfer to another facility lowered support but did not reach a statistical significance. The overall support for pulse oximetry screening was strong and consistent between different participant demographics.

Conclusion:

A large majority of participants in this study support pulse oximetry screening for the early detection of critical congenital heart disease.
Type IV Total Anomalous Pulmonary Venous Connection
Authors: St Louis James D. , Turk Elizabeth M. , Jacobs Jeffrey P. , O’Brien James E.
Published: March 2017

Background:

Mortality associated with correction of type IV total anomalous pulmonary venous connection (TAPVC) is generally reported in combination with other anatomic types. The objective of this study is to review surgical outcomes associated with the repair of type IV TAPVC by analyzing a multi-institutional cohort specific for this group. We also analyze patient-specific variables that may contribute to poor operative outcomes.

Methods:

A retrospective review of the Pediatric Cardiac Care Consortium (PCCC) registry identified patients who underwent repair of type IV TAPVC between 1982 and 2007. Variables reviewed included gender, prematurity, age at repair, anatomic pattern, presence of obstruction, associated anomalies, and operative mortality. Subclassifications were defined as type IV A (2+2 pattern), type IV B (3+1 pattern), and type IV C (bizarre).

Results:

Of the 2,248 patients with the diagnosis of TAPVC, 215 belonged to type IV. For type IV, the overall unadjusted mortality was 26%. There was no difference in mortality based on the particular anatomic drainage pattern. Twenty-eight percent had partial obstruction of the pulmonary venous return, with no patient having complete obstruction. Patients with obstruction had a significantly greater mortality than those without obstruction (39% vs 20%, P = .005). Approximately 16% of patients who present with obstruction of some pulmonary vein(s) underwent an emergency repair.

Conclusion:

Type IV TAPVC is a rare disease with a diverse anatomic presentation. Even though a small number of the patients with obstruction underwent emergent repair, mortality remained significant. This likely represents the intrinsic lung pathology that must be considered in the postoperative period.
Cardiac Function After Tetralogy of Fallot/Complete Atrioventricular Canal Repair
Authors: Stephens Elizabeth H. , Tingo Jennifer , Najjar Marc , Yilmaz Betul , Levasseur Stéphanie , Dayton Jeffrey D. , Mosca Ralph S. , Chai Paul , Quaegebeur Jan M. , Bacha Emile A.
Published: March 2017

Background:

Repair of complete atrioventricular canal (CAVC) with tetralogy of Fallot (TOF) is a challenging operation increasingly being performed as a complete, primary repair in infancy. Previous studies have focused on perioperative outcomes; however, midterm valve function, ventricular function, and residual obstruction have received little attention.

Methods:

We retrospectively reviewed 20 patients who underwent CAVC/TOF repair (January 2005 to December 2014). A two-patch repair was used in all patients to correct the CAVC defect. Tetralogy of Fallot repair included transannular patch in 11 (65%) patients and valve-sparing in 6 (35%) patients.

Results:

The average age at surgery was 72 ± 122 weeks, 40% were male, and 80% had trisomy 21. Mean echo follow-up was 3.0 ± 3.0 years. There were no in-hospital or late mortalities. The rate of reoperation was 20%. At the latest follow-up, moderate left atrioventricular valve regurgitation was present in three (15%) patients and mild stenosis present in seven (35%) patients. One (5%) patient had moderate right ventricular outflow tract (RVOT) obstruction. The valve-sparing population was smaller at the time of surgery than the non-valve-sparing cohort (body surface area: 0.28 ± 0.04 vs 0.42 ± 0.11, P = .002) and less likely to have had a previous shunt (0% vs 64%, P = .01). Among the valve-sparing patients (six), at the latest follow-up, moderate pulmonary insufficiency was present in two (33%) patients.

Conclusion:

Repair of CAVC concomitant with TOF can be performed with low mortality and acceptable perioperative morbidity. Management of the RVOT remains a challenge for the long term.
Child Care Experiences Among Dual Language Learners in the United States
Authors: Espinosa Linda M. , LaForett Doré R. , Burchinal Margaret , Winsler Adam , Tien Hsiao-Chuan , Peisner-Feinberg Ellen S. , Castro Dina C.
Published: March 2017

Although quality center-based child care is helpful in promoting school readiness for dual language learners (DLLs), little is known about the nonparental child care that young DLL children experience. DLL status is often confounded with immigrant status, ethnicity, and poverty. Using nationally representative data from the Early Childhood Longitudinal Study–Birth Cohort, we examined child care experiences with repeated cross-sectional analyses at 9, 24, and 52 months for DLL and non-DLL children. After accounting for demographic and contextual factors, we found few differences in the quality and type of child care experienced by DLL children and children who hear only English in the home. Child care experiences were more related to country of origin, ethnicity, or immigrant status than DLL status. Nonparental caregivers were more likely to speak the child’s home language in home-based care than center care. Findings illustrate the importance of distinguishing among DLL status, socioeconomic status, ethnicity, country of origin, and immigrant status when considering the child care experiences of DLLs.
Cleveland Clinic Imaging Institute’s “Commitment to Respect” and Impact on Quality of Care and Patient Satisfaction
Authors: Creagh Carl , Flamm Scott D , Madonia Heather , O’Keefe Patrick , Ricaurte Frank , Triner Jean
Published: March 2017

Cleveland Clinic’s Imaging Institute implemented a “Commitment to Respect” initiative and survey process in March 2013 with the goal of improving communication and teamwork among employees and, in turn, improving patient satisfaction. Since the rollout of this initiative, we have worked to increase acceptance of the process, improve the survey response, and more fully incorporate results into staff development. Now that we have 4 years of annual data for analysis, we can state based on feedback from caregivers that the process has had a positive effect on relationships between radiologists and frontline clinical staff. The survey identifies behaviors that individuals were not previously aware of, allowing staff members to make changes based on this feedback. Additionally, institute leaders are able to reinforce the respectful behaviors of those scoring well and support the efforts of those whose scores need improvement. Both scenarios are reinforced through the radiologist annual performance review process.
Autism spectrum disorder in Qatar: Profiles and correlates of a large clinical sample
Authors: Alshaban Fouad , Aldosari Mohammed , El Sayed Zakaria , Tolefat Mohammed , El Hag Saba , Al Shammari Hawra , Ghazal Iman , Fombonne Eric
Published: March 2017

Autism spectrum disorder (ASD) is an increasingly prevalent disorder. Although around 15% of cases are caused by specific genetic causes, most cases involve a complex and variable combination of genetic risk and environmental factors that are not yet identified. There is a paucity of studies on ASD in Qatar, mostly in the form of case reports and genetic causes. The current study was designed to describe the clinical characteristics of ASD and its correlates in Qatar. Individuals with ASD were recruited from the Shafallah Center for Children with Special Needs which is the largest special needs center in Qatar. Within the sample of 171 individuals with ASD, 47% were ethnic Qataris, while 53% were nonethnic Qataris (Arabs and other nationalities). The analysis included the following factors: nationality, age, gender, socioeconomic status, consanguinity, prenatal/postnatal complications, and comorbidities. Eighty percent of the identified cases were males, with a 4:1 male to female ratio. Additionally, 83% of the families had one proband, 9.9% with 2 probands, and 7.1% with more than two. Comorbid conditions included: intellectual disabilities (ID) in 83% and epilepsy in 18.8%. 76.6% of subjects were nonverbal. There were 3 (1.8%) children with Rett’s syndrome, 3 (1.8%) with Fragile X, and 1 (0.6%) with tuberous sclerosis. There are currently no publications that clarify the mean age of diagnosis in Qatar, however, the present study showed that more than half of the diagnosed cases were among the ages of 7–14 years (56%). The effect of consanguinity as a risk factor was not found to be significant.