bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-time reverse transcription polymerase chain reaction method for detection of Canine distemper virus modified live vaccine shedding for differentiation from infection with wild-type strains
Authors: Wilkes Rebecca P. , Sanchez Elena , Riley Matthew C. , Kennedy Melissa A.
Published: February 2014

Canine distemper virus (CDV) remains a common cause of infectious disease in dogs, particularly in high-density housing situations such as shelters. Vaccination of all dogs against CDV is recommended at the time of admission to animal shelters and many use a modified live virus (MLV) vaccine. From a diagnostic standpoint for dogs with suspected CDV infection, this is problematic because highly sensitive diagnostic real-time reverse transcription polymerase chain reaction (RT-PCR) tests are able to detect MLV virus in clinical samples. Real-time PCR can be used to quantitate amount of virus shedding and can differentiate vaccine strains from wild-type strains when shedding is high. However, differentiation by quantitation is not possible in vaccinated animals during acute infection, when shedding is low and could be mistaken for low level vaccine virus shedding. While there are gel-based RT-PCR assays for differentiation of vaccine strains from field strains based on sequence differences, the sensitivity of these assays is unable to match that of the real-time RT-PCR assay currently used in the authors’ laboratory. Therefore, a real-time RT-PCR assay was developed that detects CDV MLV vaccine strains and distinguishes them from wild-type strains based on nucleotide sequence differences, rather than the amount of viral RNA in the sample. The test is highly sensitive, with detection of as few as 5 virus genomic copies (corresponding to 10−1 TCID50). Sequencing of the DNA real-time products also allows phylogenetic differentiation of the wild-type strains. This test will aid diagnosis during outbreaks of CDV in recently vaccinated animals.
Coxiella burnetii serology assays in goat abortion storm
Authors: Emery Michelle P. , Ostlund Eileen N. , Ait Ichou Mohamed , Ballin Jeff D. , McFarling David , McGonigle Luanne
Published: February 2014

Many commercial antibody detection enzyme-linked immunosorbent assay (ELISA) kits for Q fever utilize the Nine Mile (Montana tick) strain of Coxiella burnetii as antigen. An ELISA kit manufactured in France employs ovine placenta-sourced antigen and has been used in Europe. Sera from goats experiencing a Q fever abortion storm in the United States were used to compare the sensitivity and specificity of these 2 ELISA formats and the Q fever complement fixation test (CFT). Latent class estimates of sensitivity ranged from 97% to 100% with a specificity of 95–100% for the 2 ELISA kits. Estimates for sensitivity and specificity of the CFT were 89% and 82%, respectively. There was not a significant increase in ELISA sensitivity observed with the ovine-sourced antigen kit in this study. Real-time polymerase chain reactions performed on a portion of the sera found that 15 out of 20 sera were congruent across 4 tests for positive and negative sera.
The Study on Evaluation and Improvement of Quality of Life in Patients With Advanced Cancer by China’s Hospice Program
Authors: Deng Di , Lin Weider , Law Frieda
Published: February 2014

This multicenter study evaluated the quality of life (QOL) of patients with advanced cancer and assessed the improvement in patients’ QOL by hospice service program, using McGill Quality of Life Questionnaire-Hong Kong version (MQOL-HK) questionnaire in China’s 32 hospice centers from March to June, 2012. Among 640 recruited cases, data of 630 patients were analyzed. Differences in patients’ pre- and posthospice QOL were evaluated. Compared to prehospice results, patients’ QOL scores improved significantly in physical, psychological, existential, and support domains after 3 weeks of hospice services. Some items were not thus classified primarily due to cross-cultural adaptation. The MQOL-HK questionnaire could effectively measure QOL in Chinese hospice patients and their QOL could be improved by hospice services. Psychological, existential, and support services should be emphasized during patients’ initial 3 weeks of hospice admission.
A Systematic Review of the Literature on Screening for Exercise-Induced Asthma
Authors: Worrell Kelly , Shaw Michele R. , Postma Julie , Katz Janet R.
Published: February 2014

Asthma is a major cause of illness, missed school days, and hospitalization in children. One type of asthma common in children is exercise-induced asthma (EIA). EIA causes airway narrowing with symptoms of cough and shortness of breath during exercise. The purpose of this article is to review the literature relevant to screening children and adolescents for EIA and to inform development of a school nurse–led EIA screening program. A systematic review of EIA screening tests was conducted by searching PUBMED for key terms. Sixty-seven articles were identified; after review only seven met the inclusion criteria. The most common screening test was the 6-min exercise challenge. School-based screening programs have the potential to identify EIA among undiagnosed children and adolescents. School nurses are health professionals with the knowledge and skills necessary to develop successful screening programs in the school setting. Based on results of the literature review, we present implications for developing screening programs in schools to identify children with undiagnosed EIA.
Evaluation of a School-Based Program Aimed at Preventing Depressive Symptoms in Adolescents
Authors: Garmy Pernilla , Jakobsson Ulf , Carlsson Katarina Steen , Berg Agneta , Clausson Eva K.
Published: February 2014

The aim of this pilot study was to evaluate the implementation of a universal school-based cognitive behavioral program whose target is to prevent depressive symptoms in adolescents. The study had a quasi-experimental design with pretest, posttest, and a 1-year follow-up and provides an illustrative calculation for the implementation costs of the intervention. Sixty-two students (aged 14) and seven tutors participated. A majority of the students and all of the tutors were satisfied with the intervention. The students, both females and males, rated their depressed symptoms as significantly lower after the course; and for the females, this was maintained 1-year postintervention. The implementation costs for the initial 2 years were about US$300 per student. Positive effects of a universal school-based cognitive behavioral intervention aiming at preventing depressive symptoms in adolescents were found, especially among females.
Competing in Value-based Health Care
Authors: Hamid Kamran S. , Nwachukwu Benedict U. , Ellis Scott J.
Published: February 2014

The US health care system is transitioning to a value-based model of health care in which providers will be rewarded for delivering services that achieve excellent clinical outcomes with efficient cost utilization. The concept of “value” in health care (defined as health outcomes achieved per dollar spent) is rapidly spreading as physicians and health systems brace for the paradigm shift from “fee-for-volume” to “fee-for-value” reimbursement. What constitutes good value versus poor value in health care remains nebulous at this time. Various specialties across medicine and within orthopaedics are seeking to better demonstrate value delivered to patients, payers, and policy makers. The objective of this article is to develop a framework for defining and measuring value in foot and ankle surgery. In this new era of health care, we believe that a working knowledge of value and its determinants will be imperative for foot and ankle surgeons to unify research and quality improvement efforts so as to demonstrate the value of services rendered within the subspecialty.

Level of Evidence: Level V, expert opinion.
Comparison of Surgical Techniques of 111 Medial Malleolar Fractures Classified by Fracture Geometry
Authors: Ebraheim Nabil A. , Ludwig Todd , Weston John T. , Carroll Trevor , Liu Jiayong
Published: February 2014

Background:

Evaluation of operative techniques used for medial malleolar fractures by classifying fracture geometry has not been well documented.

Methods:

One hundred eleven patients with medial malleolar fractures (transverse n = 63, oblique n = 29, vertical n = 7, comminuted n = 12) were included in this study. Seventy-two patients had complicating comorbidities. All patients were treated with buttress plate, lag screw, tension band, or K-wire fixation. Treatment outcomes were evaluated on the basis of radiological outcome (union, malunion, delayed union, or nonunion), need for operative revision, presence of postoperative complications, and AOFAS Ankle-Hindfoot score.

Results:

For transverse fractures, tension band fixation showed the highest rate of union (79%), highest average AOFAS score (86), lowest revision rate (5%), and lowest complication rate (16%). For oblique fractures, lag screws showed the highest rate of union (71%), highest average AOFAS score (80), lowest revision rate (19%), and lowest complication rate (33%) of the commonly used fixation techniques. For vertical fractures, buttress plating was used in every case but 1, achieving union (whether normal or delayed) in all cases with an average AOFAS score of 84, no revisions, and a 17% complication rate. Comminuted fractures had relatively poor outcomes regardless of fixation method.

Conclusions:

The results of this study suggest that both tension bands and lag screws result in similar rates of union for transverse fractures of the medial malleolus, but that tension band constructs are associated with less need for revision surgery and fewer complications. In addition, our data demonstrate that oblique fractures were most effectively treated with lag screws and that vertical fractures attained superior outcomes with buttress plating.

Level of Evidence:

Level III, retrospective comparative series.
Financing Sustainability and Stakeholder Engagement
Authors: Wang XiaoHu , Hawkins Christopher , Berman Evan
Published: February 2014

Financial support is critical to sustain and improve the implementation of sustainability policies and initiatives. How capable are local governments to finance sustainability? Why are some governments more financially able than others to fund sustainability? How does stakeholder engagement improve financial capacity for sustainability? This study provides an explanation for sustainability funding that emphasizes political behaviors of institutional players in budgetary decision making. Using a database from U.S. cities, we find that an effective approach to enhance financial capacity for sustainability is to engage stakeholders to mobilize political support and technical expertise needed in resource allocation decisions for sustainability. Specific strategic actions to enhance financial capacity are recommended as part of a long-term and structured effort to sustain sustainability funding in local government.
Update on Perioperative Right Heart Assessment Using Transesophageal Echocardiography
Authors: Bartels Karsten , Karhausen Jörn , Sullivan Breandan L. , Mackensen G. Burkhard
Published: February 2014

Purpose of the review. This review aims to summarize recent findings relevant for perioperative 2- and 3-dimensional imaging of the right heart with transesophageal echocardiography. Special attention is given to developments that are likely to affect future approaches for prevention and therapy of perioperative right heart failure. Recent findings. Three-dimensional transesophageal echocardiography techniques are becoming more common for the evaluation of anatomy, volumes, and functional indices. Summary. Right heart failure continues to contribute to morbidity and mortality in the context of cardiothoracic surgery. The advent and widespread clinical use of innovative tools permitting more accurate echocardiographic assessment of the right heart will open the door to renewed interest in novel therapeutic strategies.
The Nature of Sleep in 10 Bedridden Elderly Patients With Disorders of Consciousness in a Japanese Hospital
Authors: Matsumoto Masaru , Sugama Junko , Nemoto Tetsu , Kurita Toshiharu , Matsuo Junko , Dai Misako , Ueta Miyuki , Okuwa Mayumi , Nakatani Toshio , Tabata Keiko , Sanada Hiromi
Published: February 2014

No previous study has satisfactorily clarified the nature of sleep in elderly bedridden people with disorders of consciousness (DOC). The objective of the present study was to clarify the sleep states of 10 elderly bedridden patients with DOC in a Japanese hospital to facilitate provision of evidence-based nursing care and appropriate adjustment of patients’ environments. Nocturnal polysomnography recordings were analyzed according to the standard scoring criteria, and the patients’ sleep stages and quality were investigated. Of the 10 patients, 9 showed slow wave sleep (SWS), 4 showed very high values for sleep efficiency (96–100%), and in 3 of these patients, the percentage of SWS was ≥ 20%. Furthermore, three of these four patients had 200 or more changes in sleep stage. Although the mechanism is unknown, the amount of SWS combined with the value of sleep efficiency suggests that the quality of sleep is poor in elderly bedridden patients with DOC. Further study is needed to determine better indicators of good sleep in this population.
Interethnic Affiliations and Everyday Demarcations of Youth in Finland
Authors: Kivijärvi Antti
Published: February 2014

In this article, affiliations between ethnic majority and minority youth in leisure surroundings around Finland are scrutinised. It is asked how these affiliations are formulated: To what extent they are based on individual choices and factors such as ethnicity, class and locality? The twofold data of the study consists of (1) interviews of ethnic minority youth (n = 38) and (2) observations and interviews of ethnic majority and minority youth (n = 13) conducted in the fields of youth work. The results of the study indicate that peer affiliations among ethnic minority youth are determined through complex positionalities. Even though in the interview data most youth present themselves as individuals not constrained by structural factors, in the observation data affiliations are generally formulated through processes in which ethnicity, class and locality are intertwined. In contrast to ‘common knowledge’, deprived urban localities and rural areas offer fruitful spaces for interethnic affiliations.
Digital Participation at the Margins
Authors: Campos Ricardo , Simões José Alberto
Published: February 2014

In this article we examine how the internet and other digital technologies are used by Portuguese Afro-descendant youth living in contexts of socio-economic deprivation. More specifically, based on a set of interviews held with rappers, we pursue a discussion on the significance of the concepts of digital inclusion and participation, arguing that young people’s online practices reflect not only distinct ways of digital participation but also cultural engagement. By studying black amateur rap, our main goal is to examine how disadvantaged young people use the internet and other digital technologies and how these apparatuses may be employed for cultural expression and identity construction. Our research shows, on the one hand, how crucial a strategic use of these devices can be for amateur cultural production, on the other hand, how these platforms contribute to build an enlarged circuit of ethicized cultural expression. Therefore, we argue that digital participation contributes to reverse the cultural devaluation experienced by these black communities, working as a mechanism of individual and cultural empowerment.
Media Life of the Young
Authors: Westlund Oscar , Bjur Jakob
Published: February 2014

This is a thorough investigation into contemporary young people and their media life. The article conceptualizes a typology of media life, drawing on a theoretical body involving the sociology of generations, life course research, media life and individualization. This empirically derived typology makes a strong instrument for an understanding of the media life of the young, furnishing insights into how they have constructed their use of media. The investigation is based on a robust national survey with Swedes born 1994–2001, conducted in 2010 and focusing on four media: television, gaming, the Internet and mobile devices. Two of the findings are particularly surprising. Firstly, the results reveal that the young generally lead heterogeneous media lives, varying with age and sex. Secondly, although some young people literarily live their life in media, there are also de facto young who live a life without media. This is particularly pronounced for gaming and mobile use.
Sliding friction and wear properties of friction linings with friction-promoting grease applied
Authors: Ma W , Zhu ZC , Xu L , Chen GA
Published: February 2014

The rheological properties of a commercial friction-promoting grease (FPG) were investigated using a cone and plane rheometer. Two friction tests were conducted at a low sliding rate (1 mm/s) using a wire rope (designed for mining use) and a commercial friction lining material. One involved dry-friction and the other greased conditions. The corresponding coefficient of friction (COF) in each case was determined and used to evaluate the effect of application of the FPG on the lifting performance of a hoist under normal conditions. In addition, experiments involving high-speed sliding friction between the wire rope and the friction material were also performed (with and without the FPG). Different sliding speeds and applied loads were used. The aim was to obtain the tribological behavior of the friction material in conditions that simulate a severe working environment for the hoist. The experimental results were analyzed and combined with the rheological properties of the FPG. The FPG can substantially protect the friction lining from wear and simultaneously provide an adequate COF (about 0.356) between the friction pair under normal working conditions. When the working conditions are severe, an increase in sliding speed causes a decrease in the COF. However, a larger load does not necessarily result in a smaller COF. Increasing the sliding speed or the load both aggravate the wear of the friction lining.
TIRC7 and HLA-DR axis contributes to inflammation in multiple sclerosis
Authors: Frischer JM , Reindl M , Künz B , Berger T , Schmidt S , Milford EL , Knosp E , Lassmann H , Utku N
Published: February 2014

Background and objective:

Interactions between TIRC7 (a novel seven-transmembrane receptor on activated lymphocytes) and its ligand HLA-DR might be involved in the inflammatory process in multiple sclerosis (MS).

Methods:

Methods comprised immunohistochemistry and microscopy on archival MS autopsies, proliferation-, cytokine-, and surface-staining assays using peripheral blood lymphocytes (PBLs) from MS patients and an in vitro model.

Results:

TIRC7 was expressed in brain-infiltrating lymphocytes and strongly correlated with disease activity in MS. TIRC7 expression was reduced in T cells and induced in B cells in PBLs obtained from MS patients. After ex vivo activation, T cell expression of TIRC7 was restored in patients with active MS disease. The interaction of TIRC7+ T lymphocytes with cells expressing HLA-DR on their surface led to T cell proliferation and activation whereas an anti-TIRC7 mAb preventing interactions with its ligand inhibited proliferation and Th1 and Th17 cytokine expression in T cells obtained from MS patients and in myelin basic protein-specific T cell clone.

Conclusion:

Our findings suggest that TIRC7 is involved in inflammation in MS and anti-TIRC7 mAb can prevent immune activation via selective inhibition of Th1- and Th17-associated cytokine expression. This targeting approach may become a novel treatment option for MS.
Supporting work for people with multiple sclerosis
Authors: Doogan Catherine , Playford E Diane
Published: February 2014

People with multiple sclerosis experience some of the highest rates of unemployment among groups of individuals with severe and chronic disabilities. While unpredictable relapses, physical and cognitive symptoms all may play a role in job loss, it is more likely that job loss can be attributed to a complex interaction between disease-related factors and contextual factors, such as the working environment, and employer attitudes. This interaction leads to the concept of work instability, that is, the mismatch between work demands and the individual’s capacity to meet these demands. Vocational rehabilitation services aim to provide people with multiple sclerosis vocational assessment, rehabilitation and support to enable them to find, regain or remain in work and access other occupational and educational opportunities. Such services consist of a multidisciplinary team with the ability to provide education around disclosure, and work-place accommodations, offer emotional support, maintain work performance, liaise with employers, and support to re-enter the workplace. Helpful interventions include early disclosure, proper workplace accommodation, education of employers, and government-funded initiatives to support disabled employees. Future research needs to agree on methods of recording outcomes and evaluate specific vocational rehabilitation interventions.
The pain and pleasure of roller derby: Thinking through affect and subjectification
Authors: Pavlidis Adele , Fullagar Simone
Published: February 2014

Writing about pain in roller derby challenges us to rethink old dichotomies that separate mind and body, ‘real’ and virtual, feminine and masculine. The ‘tough’ roller derby ‘girl’, willing and able to endure pain for the pleasure of the game, has become a powerful figure in contemporary western popular culture. Our analysis of roller derby reveals women’s complex relation to pain and pleasure, as part of a feminist reimagining of sport. Through an analysis of derby texts we explore how painful affects are mobilized in particular ways: to imagine collective belonging, to invent alternative feminine subjectivities, and to mark out the limits of self and other. In this way we endeavour to think through the affective experience of derby and how sport might become more gender inclusive as a transformational cultural site. The embodiment of pain is not simply one of ‘overcoming’, but a corporeal relation that is productive of multiple feminine subjectivities.
How could you think that?!?!: Understanding intentions to engage in political flaming
Authors: Hutchens Myiah J , Cicchirillo Vincent J , Hmielowski Jay D
Published: February 2014

Communication scholars have both lauded and questioned the Internet’s role in facilitating democracy. However, few studies have examined aggressive communication behavior in online political discussion spaces. Two studies were conducted to examine use of aggressive discussion behaviors online, otherwise known as flaming. Study one utilized a survey of 289 undergraduate students at a large public university. Study two utilized a survey of 305 individuals who frequent political blogs. Results from both studies suggest that individuals are more likely to engage in political flaming when their beliefs are directly challenged. In addition, results indicate that whether an individual’s identity is known or unknown did not influence their intention to flame within the student sample. In the blog-user sample, we found that direct challenges when identities were not known increased intention to flame. Finally, we examine the relationship between political flaming and several individual-level variables.
Borderlands as spaces: Creating third spaces and fractured landscapes in medieval Northern Finland
Authors: Ylimaunu Timo , Lakomäki Sami , Kallio-Seppä Titta , Mullins Paul R , Nurmi Risto , Kuorilehto Markku
Published: February 2014

Cultural anthropologists and historians have successfully adopted a borderlands perspective to investigate interaction, power, and identity between emerging or expanding state societies. This article develops an archaeological approach to such interstitial landscapes. It conceptualizes borderlands as spaces where people engage the material world under very specific geopolitical circumstances and create very specific materialities and subjectivities in the process. Political, social, and ideological dynamics between state societies produce two kinds of cultural spaces: hybrid “third spaces” and “fractured landscapes.” Although seemingly contradictory, these often emerge side by side in the same physical space. We illustrate this process by exploring the expansion of the Catholic Church and the Swedish kingdom to the Northern Ostrobothnian coast in northern Finland during the Middle Ages (ca. 1300–1600). During this era, church buildings and cemeteries became sites where locals, ecclesial officials, and state agents negotiated their relations through complex material and spatial practices.
Complexity and the inherent limits of explanation and prediction: Urban codes for self-organising cities
Authors: Moroni Stefano
Published: February 2014

The purpose of this article is to explore what kind of (land-use) regulation is more compatible with a radical acceptance of the idea of the complexity of socio-spatial systems and of the intrinsic limits of explanation and prediction. The article applies insights from complexity sciences to planning practice, critically comparing different land-use regulatory instruments (in particular, patterning-instruments and framework-instruments). The main result and conclusion is that it is necessary to embrace the challenge of complexity and self-organisation, and consequently to start profound revision of regulatory instruments.
Staffs’ perceptions of the ethical landscape in psychiatric inpatient care: A qualitative content analysis of ethical diaries
Authors: Pelto-Piri Veikko , Engström Karin , Engström Ingemar
Published: February 2014

This study presents a qualitative description of situations at work that staff members perceive as giving rise to ethical issues. All staff members working with patients across seven wards were given the opportunity to freely describe ethical considerations in an ethical diary over the course of one week. One hundred and five staff members kept a diary. The diaries were analysed with qualitative content analysis where four dominant themes emerged: good care, order and clarity, loyalty, and inadequacy. These results contain statements in which patients are respected and listened to, as well as statements that express a desire for relatively strict, routine-based care. Relatively few statements were of a reflective or discussing nature which highlights the need for clinical ethical support. There is a need of a visible and supportive leadership which encourages ethical reflection. Reflections on real cases could provide an opportunity to challenge existing practices and thereby promote ethical awareness.
Facilitating Vocabulary in Toddlers Using AAC
Authors: Solomon-Rice Patti L. , Soto Gloria
Published: February 2014

Toddlers benefiting from augmentative and alternative communication (AAC) often demonstrate delayed expressive vocabulary. However, a paucity of AAC intervention research exists for children under the age of 3. There have also been few AAC studies comparing language intervention techniques across children of any age. This study investigated two intervention techniques on the expressive vocabulary of three toddlers who were beginning AAC users. In one condition (focused stimulation), the speech-language pathologist (SLP) verbally modeled each target word 10 times during an intervention session. In the other condition (augmented input), the SLP modeled each target word 10 times during an intervention session by simultaneously speaking the word and using the child’s AAC system. The results revealed the participants’ expressive vocabulary improved during both conditions and was sustained and generalized for two of the three toddlers. The study provides preliminary, empirically based guidelines to consider during communication intervention with toddlers who are learning to use AAC.
Cognitive Stimulation for Portuguese Older Adults With Cognitive Impairment
Authors: Alves Jorge , Alves-Costa Filipa , Magalhães Rosana , Gonçalves Óscar F. , Sampaio Adriana
Published: February 2014

Although some studies point to cognitive stimulation as a beneficial therapy for older adults with cognitive impairments, this area of research and practice is still lacking dissemination and is underrepresented in many countries. Moreover, the comparative effects of different intervention durations remain to be established and, besides cognitive effects, pragmatic parameters, such as cost-effectiveness and experiential relevance to participants, are seldom explored. In this work, we present a randomized controlled wait-list trial evaluating 2 different intervention durations (standard = 17 vs brief = 11 sessions) of a cognitive stimulation program developed for older adults with cognitive impairments with or without dementia. 20 participants were randomly assigned to the standard duration intervention program (17 sessions, 1.5 months) or to a wait-list group. At postintervention of the standard intervention group, the wait-list group crossed over to receive the brief intervention program (11 sessions, 1 month). Changes in neuropsychological, functionality, quality of life, and caregiver outcomes were evaluated. Experience during intervention and costs and feasibility were also evaluated. The current cognitive stimulation programs (ie, standard and brief) showed high values of experiential relevance for both intervention durations. High adherence, completion rates, and reasonable costs were found for both formats. Further studies are needed to definitively establish the potential efficacy, optimal duration, cost-effectiveness, and experiential relevance for participants of cognitive intervention approaches.
Reactions and Interventions for Delusions in Nursing Home Residents with Dementia
Authors: Cohen-Mansfield Jiska , Golander Hava , Arnheim Giora , Cohen Rinat
Published: February 2014

This is a qualitative and quantitative study examining institutional staff members’ reactions to delusions experienced by nursing home residents. Participants were 38 nursing home residents aged 65 and older, diagnosed with dementia. Data were collected from 8 nursing homes in Israel between June 2007 and January 2009. Assessments included Behavioral Pathology in Alzheimer’s Disease Rating Scale, Neuropsychiatric Inventory: Nursing Home version, Etiological Assessment of Psychotic Symptoms In Dementia, Activities of Daily Living, and Mini-Mental State Examination. A wide variety of interventions with dementia-related symptoms was found to be effective to varying degrees. This included general approaches for a variety of symptoms as well as symptom-specific interventions. Caregivers do not always seem to be aware that multiple approaches are available to them when dealing with dementia. The most effective approaches may be those tailored to the individual. Combining interventions may increase overall effectiveness. Caregiver’s experience and the institutional culture may affect the choice of intervention used, either positively or negatively.
A Home Balance Exercise Program Improves Walking in People With Cerebellar Ataxia
Authors: Keller Jennifer L. , Bastian Amy J.
Published: February 2014

Background. Physical therapy intervention is the primary treatment for gait ataxia and imbalance in individuals with cerebellar damage. Our aim was to determine if a home balance exercise program is feasible for improving locomotor and balance abilities in these individuals. Methods. A total of 14 patients with cerebellar ataxia participated in a 6-week individualized home-based balance exercise program and attended 5 testing sessions (2 pretraining, 1 midtraining, 1 posttraining, and 1 one-month follow-up visit). Pretraining, posttraining, and follow-up testing included a neurological assessment, clinical gait and balance tests, and laboratory assessments of balance and walking. Participants kept logs of the frequency and level of balance challenge during their training. Results. Walking speed improved across visits, as did stride length, percentage double-limb support time, Timed Up and Go (TUG), and Dynamic Gait Index. Post hoc comparisons in these measures revealed that significant rehabilitative improvements occurred over the 6-week training period, and all but TUG gains were retained 1 month later. There were no changes across the other measures for the group. Regression analysis indicated that improvements in walking speed were affected by the level of balance challenge but not by age, ataxia severity, proprioception, or duration of exercise. Conclusions. Improvement in locomotor performance in people with cerebellar ataxia was observable after a 6-week home balance exercise program. The exercise program must be designed to provide a significant challenge to the person’s balance.
The Persistent and Broadly Modulating Effect of Inhibitory rTMS in Nonfluent Aphasic Patients
Authors: Tsai Po-Yi , Wang Chih-Pin , Ko James S. , Chung Yeh-Mei , Chang Ya-Wen , Wang Jian-Xiang
Published: February 2014

Background. While prior preliminary studies have broadened our understanding of how repetitive transcranial magnetic stimulation (rTMS) improves language outcomes in stroke patients with nonfluent aphasia, the evidence base of the effectiveness of this method remains inadequate. Objective. In this study, we aimed to strengthen the evidence that this approach improves language performance and to identify characteristics of patients predisposed to benefit most from this treatment. Methods. Fifty-six stroke patients with nonfluent aphasia were randomly allocated to a real or a sham stimulation group: Group A (n = 33), who underwent 10 sessions of 1-Hz rTMS over the contralesional pars triangularis (PTr), and Group B (n = 23), who received sham 1-Hz stimulation. We performed the Picture Naming Test and the Concise Chinese Aphasia Test (CCAT) at the baseline, post-rTMS intervention, and at 3-month follow-up. Results. Group A showed significantly greater improvement than Group B in CCAT scoring ( P < .001), object-naming accuracy ( P = .01), and naming reaction time ( P = .004). The CCAT scoring and naming testing changes for Group A were persistent at 3 months following intervention ( P = .008). Patients who had a lower contralesional rest motor threshold (rMT) were predisposed to a favorable therapeutic outcome ( P = .006), independent of aphasia type, severity, and duration. Conclusions. The results of this study provide evidence that inhibitory rTMS, through downregulating the circuitry of the right pars triangularis (PTr), achieves a persistent and broadly modulating effect, irrespective of aphasia severity and subtype. Patients who show lower rMT in the right motor system would seem to benefit the most from inhibitory rTMS.
A Configurational Approach to Project Delays
Authors: Krohwinkel Anna
Published: February 2014

While qualitative comparative analysis (QCA) has often been portrayed as an alternative to mainstream statistical methods, there is a growing debate on how the techniques can be combined. This article shows how, using a sequential design, the integration of a large- N survival analysis with a smaller- N QCA yielded new insights about the reasons for project delay in a multiproject organization. While the regression served to trace significant explanatory variables and their net effects, the QCA nuanced these findings by demonstrating how variables combine across distinct categories of cases. As a result, the differing logics underlying externally and internally generated delays were elucidated. Implications for our understanding of multiproject organizing and for mixed methods research are discussed.
News, Discussion, and Associative Issue Ownership
Authors: Kleinnijenhuis Jan , Walter Annemarie S.
Published: February 2014

Associative issue ownership refers to one of the prerequisites for representative democracy—public awareness of the issue priorities of competing political parties. This article addresses the question of how the instability of associative issue ownership at the micro level of individual voters, which could be due in part to election news and political discussion, adds up to the relative stability of associative issue ownership at the macro level. The data come from a panel survey and a content analysis of newspapers and television news bulletins in the 2010 Dutch Parliamentary Election Campaign. Cross-nested multilevel logistic regression models were applied to estimate the impact of political news and political discussion on different respondents for different parties and issues. The findings show how contagion, by traditional issue ownership associations, explains the relative stability at the macro level in spite of volatility at the micro level. Campaign news and political discussion increase the likelihood of contagion by traditional issue priorities of political parties, while also evoking change due to their convergence on the issues of the campaign, from which the parties that own these issues take advantage, among others the VVD and the PVV in the 2010 campaign.
Return to Play After Infectious Mononucleosis
Authors: Becker Jonathan A. , Smith Julie Anne
Published: February 2014

Context:

Infectious mononucleosis is a disease primarily of adolescence and early adulthood. The risk of splenic injury and chronic fatigue make return-to-play decisions a challenge for the clinician caring for athletes with infectious mononucleosis.

Evidence Acquisition:

Data were obtained from the PubMed and MEDLINE databases through December 2012 by searching for epidemiology, diagnosis, clinical manifestations, management, and the role of the spleen in infectious mononucleosis.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Infectious mononucleosis is commonly encountered in young athletes. Its disease pattern is variable and can affect multiple organ systems. Supportive care is the cornerstone, with little role for medications such as corticosteroids. Physical examination is unreliable for the spleen, and ultrasound imaging has limitations in its ability to guide return-to-play decisions. Exercise does not appear to place the young athlete at risk for chronic fatigue, but determining who is at risk for persistent symptoms is a challenge.

Conclusion:

Return-to-play decisions for the athlete with infectious mononucleosis need to be individualized because of the variable disease course and lack of evidence-based guidelines.
Minimizing anticholinergic drug prescribing in older hospitalized patients: a full audit cycle
Authors: Tay Hui Sian , Soiza Roy L , Mangoni Arduino A
Published: February 2014

Introduction:

Anticholinergic drugs are associated with poor outcomes in older patients but no specific intervention strategies aimed at reducing anticholinergic drug exposure have been described.

Objectives:

To identify whether a consultant-led medication review targeting anticholinergics would reduce anticholinergic drug exposure [number of anticholinergic drugs and Anticholinergic Risk Scale (ARS) score].

Methods:

The first phase of the audit included 70 consecutive admissions (mean age 84 years, 53 women). ARS score was calculated on admission and after initial consultant review. Re-audit was undertaken on another 70 consecutive admissions (mean age 83 years, 43 women) after introducing a system of informing the responsible consultant of the ARS score at their first review.

Results:

Drugs with anticholinergic effects ( n = 53) were prescribed preadmission to 45/140 (32%) of patients. Consultant geriatrician review reduced ARS scores ( p = 0.01), especially following the introduction of the information system ( p = 0.002). In the first arm of the audit, 51 (73%) patients had ARS of 0 after a consultant’s review compared with 47 (67%) patients on admission, whilst 67 (96%) patients had ARS of 2 or less after a consultant’s review compared with 63 (90%) patients on admission. In the second arm of the audit, 59 (84%) patients had ARS of 0 after a consultant’s review compared with 48 (69%) patients on admission, whilst 70 (100%) patients had ARS of 2 or less after a consultant’s review compared with 69 (99%) patients on admission. Anticholinergic drugs were either stopped, or their dose reduced, in 35% of patients in the first arm of the audit and in 73% of patients in the re-audit (odds ratio 5.0, 95% confidence interval 1.4–17.8).

Conclusion:

Consultant-led medication review (standard practice) was effective at reducing anticholinergic drug exposure in the acute setting. A system of alerting clinicians to patients prescribed anticholinergic medications further reduced anticholinergic drug exposure.
Fathers’ Perspectives on Supports and Barriers That Affect Their Fatherhood Role
Authors: Roberts Dontae’ , Coakley Tanya M. , Washington Tyreasa J. , Kelley Allyson
Published: February 2014

This qualitative study explored resident and nonresident fathers’ perspectives about factors that facilitated and inhibited their ability to play a positive and active role in their children’s lives. A total of 30 fathers were recruited from a support/mentoring group and from the general population to complete a semi-structured, audio-taped interview. A content analysis revealed that both groups of fathers were committed to maintaining a relationship with their children, and that by being present, they protected their children, helped them emotionally and financially, helped in their overall development, acted as a role model, and shared parenting responsibilities with their children’s mothers. Factors that facilitated parenting for resident and nonresident fathers included receiving proper guidance about fathering, a positive mother−father relationship, support from family, and church. Inhibiting factors were more prevalent for nonresident fathers that included mothers obstructing the father−child relationship, negative views/remarks about them as fathers, father−child visitation that is contingent upon child support, and fathers’ financial difficulties. The findings suggest a need for coparenting counseling, faith-based interventions, and employment services to address the complex socio-economic challenges that fathers face.
The Participation Decision Study
Authors: Ficaj Margaret Y. , Tanner Judith A.
Published: February 2014

The 2011 participation decision study involved exploration into the impact of the external education environment on the decision for private school participation in Federal funding, one deliberately declining player in the No Child Left Behind Act of 2001(NCLB) choice and competition equation. In the qualitative collective case, three religiously triangulated Michigan private school decision-makers submitted to semi-structured interviews. Analysis of the external environmental factors was through the lens of Gould and Eldredge’s (1977) environmentally oriented theory, punctuated equilibria philosophy of change. Analysis involved layering, direct interpretation, categorical aggregation, and cross-comparison of two external environmental categories identified at literature review ( NCLB-content and privatization-dynamic) with numerous major and sub-groupings and space for newly emergent material. The category privatization-dynamics emerged as significant influence, as did the major theme trust and the sub-themes motivational intent, competency, consistency, grapevine, creativity or inspiration, restrictions on curriculum, lack of awareness of opportunities available, and fear of failure. The study included five specific recommendations for leaders of change to explain, predict, and improve organizational performance toward greater synchronization in operation of the NCLB choice and competition mechanisms.
Analytical Study of Usage of Electronic Information Resources at Pharmacopoeial Libraries in India
Authors: Tyagi Sunil
Published: February 2014

The objective of this study is to know the rate and purpose of the use of e-resource by the scientists at pharmacopoeial libraries in India. Among other things, this study examined the preferences of the scientists toward printed books and journals, electronic information resources, and pattern of using e-resources. Non-probability sampling specially accidental and purposive technique was applied in the collection of primary data through administration of user questionnaire. The sample respondents chosen for the study consists of principle scientific officer, senior scientific officer, scientific officer, and scientific assistant of different division of the laboratories, namely, research and development, pharmaceutical chemistry, pharmacovigilance, pharmacology, pharmacogonosy, and microbiology. The findings of the study reveal the personal experiences and perceptions they have had on practice and research activity using e-resource. The major findings indicate that of the total anticipated participants, 78% indicated that they perceived the ability to use computer for electronic information resources. The data analysis shows that all the scientists belonging to the pharmacopoeial libraries used electronic information resources to address issues relating to drug indexes and compendia, monographs, drugs obtained through online databases, e-journals, and the Internet sources—especially polices by regulatory agencies, contacts, drug promotional literature, and standards.
“Just Having a Job”
Authors: Lindstrom Lauren , Hirano Kara A. , McCarthy Colleen , Alverson Charlotte Y.
Published: February 2014

This study examined career development and early employment experiences for four young adults with intellectual and developmental disabilities. Researchers used a multiple-method, multiple case-study longitudinal design to explore career development within the context of family systems, high school and transition programs, adult services, and early and continued experiences in the labor market. Data sources included school and rehabilitation records, job observations, and interviews with young adults, family members, high school special education personnel, employers, and adult agency staff ( N = 39). During the early career years, participants maintained stable employment, but earned annual wages well under the federal poverty line. Employment opportunities seemed to be influenced by family advocacy and expectations, school-based work experiences, job development services, and work environments.
Screening for lung cancer: time for large-scale screening by chest computed tomography
Authors: Shlomi Dekel , Ben-Avi Ronny , Balmor Gingy Ronen , Onn Amir , Peled Nir
Published: February 2014

Lung cancer is the leading cause of cancer death worldwide. Age and smoking are the primary risk factors for lung cancer. Treatment based on surgical removal in the early stages of the disease results in better survival. Screening programmes for early detection that used chest radiography and sputum cytology failed to attain reduction of lung cancer mortality. Screening by low-dose computed tomography (CT) demonstrated high rates of early-stage lung cancer detection in a high-risk population. Nevertheless, no mortality advantage was manifested in small randomised control trials. A large randomised control trial in the USA, the National Lung Screening Trial (NLST), showed a significant relative reduction of 20% in lung cancer mortality and 6.7% reduction in total mortality, yet no reduction was evidenced in the late-stage prevalence. Screening for lung cancer by low-dose CT reveals a high level of false-positive lesions, which necessitates further noninvasive and invasive evaluations. Based primarily on the NLST eligible criteria, new guidelines have recently been developed by major relevant organisations. The overall recommendation coming out of this collective work calls for lung cancer screening by low-dose CT to be performed in medical centres manned by specialised multidisciplinary teams, as well as for a mandatory, pre-screening, comprehensive discussion with the patient about the risks and advantages involved in the process. Lung cancer screening is on the threshold of a new era, with ever more questions still left open to challenge future studies.