bluuebunny/crossref_metadata_2025 huggingface dataset:
The pursuit of college for all: Ends and means in ‘no excuses’ charter schools
Authors: Lamboy Lily , Lu Amanda
Published: July 2017

In recent years, ‘No Excuses’ charter schools have been hailed as a promising solution to closing the ‘achievement gap’ between low-income students of color and their high-income White peers. These schools, which have the explicit goal of college completion for all, measure success in terms of standardized test performance and college acceptance rates. Schools use rigid instructional and disciplinary practices to achieve success along these dimensions. And they are broadly successful, boasting test scores and college acceptance rates that are higher than average for the students they serve. For this reason, No Excuses schools are proliferating rapidly, dominating the educational landscape in low-income minority-serving urban districts. In this article, we argue that a focus on these standardized test performance and college acceptance drives schools to participate in practices that may impede other essential aspects of student learning and development. We outline a research agenda for social scientists, philosophers, and policymakers interested in evaluating the holistic success of these schools. We focus on four key components: the goal of college-for-all itself and its effects on student outcomes, instructional practices geared toward success on standardized exams, disciplinary practices that demand rigid physical and psychological conformity and punish minor infractions, and teacher practices that traumatize students and/or fail to meet the needs of students who encounter significant trauma in their homes and neighborhoods. We conclude that more information is needed before reformers can embrace No Excuses schools as a mechanism for eradicating inequality and promoting educational and psychosocial growth for students in poor communities of color. This research agenda is urgent as No Excuses charter networks are growing rapidly, and we urge policymakers and social scientists to take this task seriously before continuing to charter these schools wholesale.
The Effect of Alternative E-mail Contact Timing Strategies on Response Rates in a Self-administered Web Survey
Authors: Lewis Taylor , Hess Karl
Published: July 2017

The Federal Employee Viewpoint Survey is an annual survey of over 800,000 permanently employed civilian personnel from 87 agencies. First administered in 2002, the web-based survey measures a broad range of employee perceptions, attitudes, and behaviors, serving as a valuable tool for human resources managers to determine which aspects of an organization are working well and which may require intervention. The data collection protocol begins by sending all sampled individuals an initial invitation to participate. Thereafter, nonrespondents are sent weekly reminder e-mails. These notifications are typically sent on Tuesday mornings. In this article, we present results from an experiment investigating two alternative protocols varying when survey notification and reminder e-mails are sent. Interestingly, the stable Tuesday morning strategy produced a significantly higher response rate than the two alternatives, and we analyze timestamp information from one of the alternatives to help provide insight as to why.
The Influence of Team Composition on Attacking and Defending in Football
Authors: Gelade Garry A.
Published: July 2017

This article examines the effects of team composition on the performance of European football (soccer) teams. The scorelines of 1,822 matches involving 98 first-tier teams were analyzed in terms of the overall ability of the teams and the spread of player abilities (heterogeneity) within them. As expected, total team ability has a beneficial effect on performance; the number of goals a team scores is positively related to its own ability and negatively related to the ability of its opponents. Team heterogeneity on the other hand has both beneficial and detrimental effects on performance. Heterogeneous teams score more goals than homogeneous teams, but they also concede more goals. As the effect of heterogeneity on goals conceded is greater than its effect on goals scored, the net effect of heterogeneity is to depress overall performance. The results are discussed in terms of Steiner’s framework of group dynamics.
Accelerated lifetime tests on e-textiles: Design and fabrication of multifunctional test bench
Authors: De Pasquale Giorgio , Mura Andrea
Published: July 2017

The development of e-textiles and conductive fabrics is strongly supported by the rapid growth of wearable electronics. Unfortunately, the fast development of production technologies for smart textiles has not been followed by standard design methods and validation procedures to certificate the electro-mechanical reliability of e-textiles. Then, the design of test procedures able to control the sources of failure in combination with cross-talk effects (e.g. between load and wear, cyclic loads and current flow, etc.) is crucial. Standard tests already used for traditional fabrics are not satisfactory in predicting the lifetime of e-textiles. This paper introduces the design of innovative machine to assess the performances and reliability of smart fabrics under fully controllable conditions.
Assessing the Electoral Impact of the 2010 Oregon Citizens’ Initiative Review
Authors: Gastil John , Knobloch Katherine R. , Reedy Justin , Henkels Mark , Cramer Katherine
Published: July 2017

The Oregon Citizens’ Initiative Review (CIR) distinguishes itself by linking a small deliberative body to the larger electoral process. Since 2010, CIR citizen panels have been a legislatively authorized part of Oregon general elections to promote a more informed electorate. The CIR gathers a representative cross-section of two dozen voters for 5 days of deliberation on a single ballot measure. The process culminates in the citizen panelists writing a Citizens’ Statement that the secretary of state inserts into the official Voters’ Pamphlet sent to each registered voter. This study analyzes the effect of one such Citizens’ Statement from the 2010 general election. In Study 1, an online survey experiment found that reading this Statement influenced Oregon voters’ values trade-offs, issue knowledge, and vote intentions. In Study 2, regression analysis of a cross-sectional phone survey found a parallel association between the Statement’s use and voting choices but yielded some mixed findings.
Use of Complementary Traditional Chinese Medicines by Adult Cancer Patients in Taiwan: A Nationwide Population-Based Study
Authors: Kuo Yi-Ting , Chang Tung-Ti , Muo Chih-Hsin , Wu Mei-Yao , Sun Mao-Feng , Yeh Chia-Chou , Yen Hung-Rong
Published: July 2017

Background. Many patients with cancer seek complementary and alternative medicine treatments. We investigated the use of traditional Chinese medicine (TCM) by adult cancer patients in Taiwan. Methods. We reviewed the Registry for Catastrophic Illness Patients Database of Taiwan, and included all adult patients diagnosed cancer, based on the International Classification of Diseases (ninth revision), from 2001 to 2009 and followed until 2011. This database allowed categorization of patients as TCM users (n = 74 620) or non-TCM users (n = 508 179). All demographic and clinical claims data were analyzed. Results. Compared with non-TCM users, TCM users were younger and more likely to be female, white-collar workers, and reside in highly urbanized areas. The average interval between cancer diagnosis and TCM consultation was 15.3 months. The most common cancer type was breast cancer in TCM users (19.4%), and intrahepatic bile duct cancer in non-TCM users (13.6%). The major condition for which TCM users visited clinics were endocrine, nutritional and metabolic diseases, and immunity disorders (23.2%). A total of 33.1% of TCM users visited TCM clinics more than 9 times per year and their time from diagnosis to first TCM consultation was 5.14 months. The most common TCM treatment was Chinese herbal medicine. The common diseases for which cancer patients sought TCM treatment were insomnia, malaise and fatigue, dizziness and headache, gastrointestinal disorders, myalgia and fasciitis, anxiety, and depression. Overall, TCM users had a lower adjusted hazard ratio (aHR) for mortality (aHR = 0.69, 95% CI = 0.68-0.70) after adjustment for age, sex, urbanization of residence, occupation, annual medical center visits, and annual non–medical center visits. Conclusions. This study provides an overview of TCM usage among adult cancer patients in Taiwan. TCM use varied among patients with different types of cancer. Physicians caring for cancer patients should pay more attention to their patients’ use of complementary TCM.
Learning to Disclose
Authors: Schwartz Joni , Schwartz Rebecca
Published: July 2017

This autoethnographic research project examines the transformational learning of a transracial adoptive adult mother and daughter through the lens of postcolonialism. As collaborative researchers, adult adoptee and adoptive mother, examine this lifelong learning experience through critical self-reflection, qualitative meta-analysis, and autoethnographic research methods within the overarching historical and sociopolitical context of Haiti. The findings address the lived complexities of increasingly hybrid families, particularly around the contentious boundaries of race, nationality, and colonial history, as they impact transformational learning. Color blindness and racial identity development for both mother and daughter within their relationship are explored. Implications for adult educators around the use of autoethnography to engage the social imagination and employ disclosure toward transformative learning are discussed.
Statistical models for the number of successful cyber intrusions
Authors: Leslie Nandi O , Harang Richard E , Knachel Lawrence P , Kott Alexander
Published: July 2017

We propose several generalized linear models (GLMs) to predict the number of successful cyber intrusions (or “intrusions”) into an organization’s computer network, where the rate at which intrusions occur is a function of the following observable characteristics of the organization: (i) domain name system (DNS) traffic classified by their top-level domains (TLDs); (ii) the number of network security policy violations; and (iii) a set of predictors that we collectively call the “cyber footprint” that is comprised of the number of hosts on the organization’s network, the organization’s similarity to educational institution behavior, and its number of records on scholar.google.com . In addition, we evaluate the number of intrusions to determine whether these events follow a Poisson or negative binomial (NB) probability distribution. We reveal that the NB GLM provides the best fit model for the observed count data, number of intrusions per organization, because the NB model allows the variance of the count data to exceed the mean. We also show that there are restricted and simpler NB regression models that omit selected predictors and improve the goodness-of-fit of the NB GLM for the observed data. With our model simulations, we identify certain TLDs in the DNS traffic as having a significant impact on the number of intrusions. In addition, we use the models and regression results to conclude that the number of network security policy violations is consistently predictive of the number of intrusions.
Health Research Ethics: Between Ethics Codes and Culture
Authors: Gheondea-Eladi Alexandra
Published: July 2017

This article is meant to describe and analyze some of the ethical difficulties encountered in a pilot research on treatment decisions of patients with chronic viral hepatitis C infection in Romania. It departs from an overview of the main ethics codes, and it shows that social health research on patients falls in between institutional codes of ethics. Furthermore, the article moves on to analyze so-called “important moments” of empirical research, such as the implementation of the ethical protocol, dealing with informal payments and with information on shady actions, as well as requests of information from interviewed patients and deciding when and if to breach confidentiality. In an attempt to evaluate the ad hoc solutions found in the field, the concluding remarks discuss these issues at the threshold of theory and practice.
The Synergistic Effect of Microwave Radiation and Hypergravity on Rats and the Intervention Effect of Rana Sylvatica Le Conte Oil
Authors: Sun Wei , Yang Yudan , Yu Hongmei , Wang Luowei , Pan Su
Published: July 2017

Aim:

The phenomena of hypergravity and microwave radiation are widespread, which cause more and more concern for the hazards to human health. The aim of this study was to investigate the synergistic effect of microwave radiation and hypergravity on rats and observe the protective effect of Rana sylvatica Le conte oil.

Methods:

Rats were exposed to microwave radiation and hypergravity, and the rat weight, the climbing pole height, serum enzyme activities, blood urea nitrogen concentration, and total antioxidant capacity were detected.

Results:

The climbing pole height, the activities of choline acetyl transferase and cholinesterase, and the total antioxidant capacity decreased, whereas the activities of alanine aminotransferase, aspartate aminotransferase, areatine kinase, isocitric dehydrogenase, hydroxybutyrate dehydrogenase, and the blood urea nitrogen concentration increased in the hypergravity irradiation group as compared with the others.

Conclusion:

These results imply that the motion and nervous system of rats might be affected critically by the synergistic effect of microwave radiation and hypergravity, and it causes damage to most rat organs, such as the bone, skeletal muscle, liver, heart, and kidney, and the antioxidant effect is also damaged, while the injury resulted from it could be protected by Rana sylvatica Le conte oil.
When do past events require explanation? Insights from social psychology
Authors: Bruckmüller Susanne , Hegarty Peter , Teigen Karl Halvor , Böhm Gisela , Luminet Olivier
Published: July 2017

Some past events incite more wonder about their causes than do others. For example, negative events require explanation more than positive events. We review social psychologists’ theoretical and empirical insights on what kinds of past events “beg explanation.” We draw on attribution theory that became popular among psychologists from the 1960s onward, on research on counterfactual reasoning, and on conversational and discursive critiques of attribution theory. We argue that factors predicting what is or is not perceived as requiring explanation are culturally and historically grounded, and that accordingly, what begs explanation varies between contexts and can change over time. Yet, drawing on the distinction between content and process, we argue that there are recognizable patterns across time and space. Specifically, we propose the relationship between events and background expectations as a rather stable predictor of what begs explanation—and as a level of analysis that can unite seemingly disparate approaches.
History as the narrative of a people: From function to structure and content
Authors: Hilton Denis J , Liu James H
Published: July 2017

We summarize our perspective on social representations of history first presented by Liu and Hilton and extended in later publications. We situate our functional approach in the context of contemporary social psychological approaches to intergroup relations, particularly realistic conflict theory, social identity theory, and the literature on social cognition/stereotypes. We note that this approach leads us to analyze social representations of events and people as narratives, with properties of verisimilitude rather than factuality often governing their acceptability. We highlight the moral functions of historical figures for a group, as well as the lessons (schemas) afforded by historical events, and analyze history as a symbolic reserve for constructing social identities with historical narratives. We review evidence supporting our functional analysis of the group functions of social representations of history and focus on the “charters” that sometimes form the core of these representations. We identify future challenges, in particular the need to better understand how to characterize the narrative structure and elements of social representations of history.
‘11 November 1918, an exceptional day!’: Flashbulb memories of the World War I Armistice in Belgium from a psychological and a historical perspective
Authors: Luminet Olivier , Spijkerman Rose
Published: July 2017

Flashbulb memories are memories that are consistent, vivid, detailed and retained with high confidence for the circumstances in which people heard about distinctive and emotional news. We show that under some circumstances, flashbulb memories can distort the memory people will keep for (historical) events, and in other situations, flashbulb memories can strengthen them. Subsequently, we present historical sources indicating that remote flashbulb memories can be studied under methodologically sound conditions. Using the Armistice of the World War I in Belgium as a case study, we hope to make historians more aware of the existence and importance of flashbulb memories in historical sources. This may provide new perspectives for understanding the significance of events and the ways through which historical narratives are reconstructed.
Dupuytren’s disease: my personal view
Authors: Warwick D.
Published: July 2017

Dupuytren’s disease is a heterogenous condition for which a palette of treatment options is required. Randomized control trial evidence is sparse; design challenges, such as validated outcome measures, blinding, equipoise, funding and assessment of recurrence, may limit further data accrual. Recurrence has different significance with different treatments and so rates are not directly comparable. The risk of any treatment is a function of both the chance of a complication and the clinical sequelae of that complication. The patient must be intimately involved in choosing treatment and is often trading rapid recovery for a higher chance of recurrence. Health economies are strained and as custodians of healthcare, surgeons should consider whether many patients even need treatment. To minimize the chance of complex, hazardous and expensive revision surgery, a low threshold for primary skin grafting should be applied, especially for those who are young, have dense disease or vulnerable genes.
Fungal infections
Authors: Bryant Michael
Published: July 2017

Fungal infections are common, and are a significant burden to patients. In the UK, a wide range of pathogens commonly affect the skin. The clinical manifestations differ depending on the site of the infection. Rashes are often mistaken for dermatitis as well as psoriasis, and effective treatment can be delayed. The majority of these conditions can be managed in primary care, but will occasionally need referral to a dermatologist. Systemic fungal infection can involve other organs, including the respiratory, cardiovascular and central nervous systems, and occur particularly in patients who are immunosuppressed or who have recently travelled to areas where specific fungal infections are endemic. It is important for GPs to be aware of these conditions and to refer appropriately.
Hyperhidrosis
Authors: Webber Lucy
Published: July 2017

Hyperhidrosis (HH) is a disorder involving the secretion of sweat in excess of that required for normal physiological thermoregulation. Most patients with HH experience some degree of functional and psychological dysfunction as a result of their condition. Despite this, a huge majority of patients do not recognise their excessive sweating as a medical condition. This article aims to cover the diagnosis, management and referral of patients with HH.
Small Protected Areas as Stepping-Stones for Jaguars in Western Mexico
Authors: Luja Víctor H. , Navarro Carlos J. , Torres Covarrubias Luis Alberto , Cortés Hernández Mauricio , Vallarta Chan Ignacio Luis
Published: July 2017

The jaguar ( Panthera onca) is one of the most endangered felids in the world. Its distribution has been reduced by 50% globally, and the species continues to be hunted illegally. We provide data on jaguar abundance, sex ratio, seasonal and daily activity, and site fidelity in La Papalota—a 368-ha natural protected area in Nayarit, western Mexico. La Papalota is located between two areas with high priority for the conservation of the jaguar: Marismas Nacionales Biosphere Reserve and the San Blas-San Juan area. Over a period of 4,240 trap nights (14 months), we collected 130 independent photos of six different individuals (one adult male, three adult females, one subadult female, and one cub). Jaguars use La Papalota all year round, and we were able to document three pregnancies. We suggest that, although a small protected area like our study site cannot provide an entire home range for even a single jaguar, it and similar reserves can play a crucial role as stepping-stones for jaguars moving across highly modified landscapes.
Xanthogranulomatous colloid cyst of the third ventricle: Alter your surgical strategy
Authors: Swaminathan Ganesh , Jonathan Gandham E , Patel Bimal , Prabhu Krishna
Published: July 2017

Colloid cysts are the most common benign neoplasms of the anterior third ventricle, mostly located at the level of the foramen of Monro and can often manifest as sudden onset headache or loss of consciousness. These cysts often have a well-defined cyst wall, mucinous or watery intracystic fluid and have a fairly good plane with the surrounding parenchyma. Occasionally, intracystic haemorrhage can lead to xanthogranulomatous inflammatory changes within the cyst resulting in focal thickening of the cyst wall and adhesion to the surrounding structures. Here we describe a case of xanthogranulomatous colloid cyst which is a very rare variant of colloid cyst.
Bi-functional oxidized dextran–based hydrogel inducing microtumors: An in vitro three-dimensional lung tumor model for drug toxicity assays
Authors: Kedaria Dhaval , Vasita Rajesh
Published: July 2017

Cancer is a serious death causing disease having 8.2 million deaths in 2012. In the last decade, only about 10% of chemotherapeutic compounds showed productivity in drug screening. Two-dimensional culture assays are the most common in vitro drug screening models, which do not precisely model the in vivo condition for reliable preclinical drug screening. Three-dimensional scaffold–based cell cultures perhaps mimic tumor microenvironment and recapitulate physiologically more relevant tumor. This study was carried out to develop bi-functional oxidized dextran–based cell instructive hydrogel that provides three-dimensional environment to cancer cells for inducing microtumor. Oxidized dextran was blended with thiolated chitosan to fabricate an in situ self-gelable hydrogel (modified dextran–chitosan) in a one-step process. The hydrogels characterization revealed cross-linked network structure with highly porous structure and water absorption. The modified dextran–chitosan hydrogel showed reduced hydrophobicity and has reduced protein absorption, which resulted in changing the A549 cell adhesiveness, and encouraged them to form microtumor. The cells were proliferated in clusters having spherical morphology with randomly oriented stress fiber and large nucleus. Further microtumors were studied for hypoxia where reactive oxygen species generation demonstrated 15-fold increase as compared to monolayer culture. Drug-sensitivity results showed that microtumors generated on modified dextran–chitosan hydrogel showed resistance to doxorubicin with having 33%–58% increased growth than two-dimensional monolayer model at concentrations of 25–100 µM. In summary, the modified dextran–chitosan scaffold can provide surface chemistry that induces three-dimensional microtumors with physiologically relevant properties to in vivo tumor including growth, morphology, extracellular matrix production, hypoxic phenotype, and drug response. This model can be potentially utilized for drug toxicity studies and cancer disease modeling to understand tumor phenotype and progression.
Costs Associated With Intravenous Darbepoetin Versus Epoetin Therapy in Hemodialysis Patients: A Randomized Controlled Trial
Authors: Woodland Andrea L. , Murphy Sean W. , Curtis Bryan M. , Barrett Brendan J.
Published: July 2017

Background:

Anemia of chronic kidney disease is associated with adverse outcomes and a reduced quality of life. Erythropoiesis-stimulating agents (ESAs) have improved anemia management, and 2 agents are available in Canada, epoetin alfa (EPO) and darbepoetin alfa (DA). EPO and DA are considered equally effective in achieving target hemoglobin (Hb), but it is not clear whether there is a cost difference. There have been few head-to-head comparisons; most published studies are observational switch studies.

Objective:

To compare the cost of DA and EPO and to determine the dose conversion ratio over a 12-month period.

Design:

Randomized controlled trial.

Setting:

Canadian outpatient hemodialysis center.

Patients:

Eligible patients were adult hemodialysis patients requiring ESA therapy.

Measurements:

The primary outcome was ESA cost (Can$) per patient over 12 months. Secondary outcomes included the dose conversion ratio, deviation from target ranges in anemia indices, iron dose and cost, and time and number of dose changes.

Methods:

An open-label randomized controlled trial of intravenous (IV) DA versus EPO was conducted in 50 hemodialysis patients. Participants underwent a minimum 6-week run-in phase followed by a 12-month active study phase. ESA and iron were dosed using a study algorithm.

Results:

The median cost was $4179 (interquartile range [IQR]: $2416-$5955) for EPO and $2303 (IQR: $1178-$4219) for DA with a difference of $1876 ( P = .02). The dose conversion ratio was 280:1 (95% confidence interval [CI]: 197-362:1) at the end of the run-in phase, 360:1 (95% CI: 262-457:1) at the 3-month point of the active phase, and 382:1 (95% CI: 235-529:1) at the 6-month point of the active phase. There were no significant differences between the 2 groups in weekly iron dose, Hb, serum ferritin, or transferrin saturation. The number of dose changes and the time to Hb stability were similar.

Limitations:

Results may not be generalizable to hemodialysis units without algorithm-based anemia management, with subcutaneous ESA administration, or to the nondialysis chronic kidney disease population. The effective conversion ratio between EPO and DA is known to increase at higher doses; the Hb targets used in the study were slightly higher than those recommended today so it is possible that the doses used were also higher. Because of this, the cost savings estimated for DA could differ somewhat from the savings realizable in current practice.

Conclusions:

In this study of hemodialysis patients with comparable anemia management, IV DA cost $1876 less per year per patient than IV EPO. The dose conversion ratio was greater than 350:1 by the 3-month point.

Trial registration:

ClinicalTrials.gov (NCT02817555).
The diagnostic accuracy of ultrasonography for soft tissue lipomas: a systematic review
Authors: Rahmani George , McCarthy Peter , Bergin Diane
Published: July 2017

Background

Ultrasound has been used in the diagnosis of soft-tissue lesions for well over a decade. Lipomas are the most common, benign, soft-tissue tumor and comprise adipose tissue. The sensitivity and specificity of diagnosing lipomas on ultrasound vary greatly in the literature.

Purpose

To perform a systematic review on ultrasonography in soft-tissue lipomas to better ascertain the true diagnostic value of this test.

Material and Methods

A systematic review of the diagnostic value of ultrasound in lipomas was performed where possible in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the literature was conducted using several well-known databases Scopus®, PubMed®, Ovid® Medline, and Web of Science®.

Results

A total of 455 articles were identified in the initial literature search. Six papers were included in the final systematic review, which revealed an overall sensitivity and specificity of 86.87% (95% confidence interval [CI] = 82.14–90.73) and 95.95% (95% CI = 93.75–97.54), respectively.

Conclusion

Ultrasound is a useful tool in the diagnosis of superficial lipomas with good sensitivity and even better specificity and should continue to be the first line investigation in such cases.
The Efficacy of Yoga as a Form of Treatment for Depression
Authors: Bridges Ledetra , Sharma Manoj
Published: July 2017

The purpose of this article was to systematically review yoga interventions aimed at improving depressive symptoms. A total of 23 interventions published between 2011 and May 2016 were evaluated in this review. Three study designs were used: randomized control trials, quasi-experimental, and pretest/posttest, with majority being randomized control trials. Most of the studies were in the United States. Various yoga schools were used, with the most common being Hatha yoga. The number of participants participating in the studies ranged from 14 to 136, implying that most studies had a small sample. The duration of the intervention period varied greatly, with the majority being 6 weeks or longer. Limitations of the interventions involved the small sample sizes used by the majority of the studies, most studies examining the short-term effect of yoga for depression, and the nonutilization of behavioral theories. Despite the limitations, it can be concluded that the yoga interventions were effective in reducing depression.
An Ecocritical Perspective of Arundhati Roy’s The God of Small Things
Authors: Kunhi Rukhaya M. , Kunhi Zeenath Mohamed
Published: July 2017

This study is an ecofeminist reading of Arundhati Roy’s The God of Small Things focusing on how the novelist utilizes various techniques signaling modes of revolt of Nature in terms of the muted group theory and backchannel communication motifs. The novelist also apostrophizes Nature to blur dialectical pairs. Cartesian dualism is extended to the culture/nature dichotomy. Roy encompasses the subaltern of the human race within the downtrodden, the predominant being the image of woman imprisoned in the presets of immanence. On another level, the author refers to animals and plants that required a voice that told the story of Nature or of innate instinct through the medium of human beings: an inverted form of apologues where the story of humans was told through animals. Symbiotic relationships of nature gather strength as they are foregrounded by Roy through relations of metaphor and metonymy exhibiting underlying principles of kinship. The survival instinct of the female characters is delineated through the language of ecology and emblematizes the dismantling of boundaries in the culture/nature dialectical pair.
Harmonizing Beliefs With Realities: Social Support Among Older Puerto Ricans With Disabilities
Authors: Guzzardo Mariana T. , Adams Wallis E. , Todorova Irina L. G. , Falcón Luis M.
Published: July 2017

Older Puerto Ricans of the diaspora live with evident health and socioeconomic disparities, heightening their need for support. They also provide a unique transnational case in which to explore the exchange of support. This study aims to understand the informal social support experiences of older Puerto Ricans with disabilities. Data are based on the translated transcripts of 25 interviews with Spanish-speaking, Island-born Puerto Ricans living in Boston. We identify four themes through thematic analysis: (a) making sense of responsibility within valued familial relationships, (b) conceptualizing friends as family, (c) finding resolve and meaning despite isolation, and (d) (not) asking for help. These themes delineate an incongruence between their beliefs and their lived experiences of social support, as well as how this contradiction is sometimes harmonized. Whereas some older Puerto Ricans with disabilities have support to rely on, others are isolated and lack support to address the challenges of functional impairment.
Using the Principle Based Model to Improve Well-Being in School: A Mixed-Methods Pilot Study
Authors: Rees-Evans Dean , Pevalin David J.
Published: July 2017

The contemporary school environment in England has been identified as stressful for both staff and pupils. School-based interventions aimed at improving well-being and mental health have shown mixed results. The Principle Based Model (PBM) of Mind, Consciousness, and Thought is an untried intervention in English schools and as a working model there is a paucity of research into its potential. The aim of this mixed-methods pilot study was to investigate the effectiveness of the PBM as a means of increasing the psychological well-being of staff and pupils. The study was a 16-week pre, post, and follow-up study using the Friedman Well-Being Scale (FWBS) as a measure of psychological well-being, and analyzed using matched sample t tests and repeated measures ANOVA. The study was carried out in a high school in the east of England with 10 staff and nine pupils. The staff and pupils involved received the PBM as a psychoeducational program. During the follow-up period, six members of staff and one pupil were interviewed and the transcripts analyzed using Thematic Analysis. The pre to post total FWBS scores showed an increase in psychological well-being for both staff and pupils but only the change for pupils was statistically significant. Post to follow-up total FWBS scores for both staff and pupils showed no significant change. This study provides some initial evidence to suggest that the PBM may be a useful tool for schools to utilize in attempting to increase psychological well-being.
Sex and Race/Ethnic Disparities in Food Security and Chronic Diseases in U.S. Older Adults
Authors: Vaccaro Joan A. , Huffman Fatma G.
Published: July 2017

Objective: The purpose of this study was to determine the relationships among sex, race/ethnicity, and food security with the likelihood of cancer, diabetes, cardiovascular disease, and lung disease for older adults. Method: Complex sample analysis by logistic regression models for chronic diseases were conducted from National Health and Nutrition Examination Surveys, 2011 to 2012 and 2013 to 2014, for N = 3,871 adults aged ≥55 years. Results: Being female with low food security was associated with lung disease and diabetes. Poverty, rather than low food security, was associated with cardiovascular diseases. Minority status was independently associated with low food security and diabetes. Discussion: Food insecurity, sex, and race/ethnicity were associated with chronic diseases in a representative sample of U.S. older adults.
Good Student/Bad Student
Authors: Jocius Robin
Published: July 2017

This study situates young adolescents’ multimodal composing practices within two figured worlds—school and creative multimodal production. In a microanalysis of two focal students’ multimodal processes and products, I trace how pedagogical, interactional, and semiotic resources both reified and challenged students’ developing identities as multimodal composers. This research illustrates the necessity of critical perspectives on the design and implementation of multimodal composing activities for academic purposes.
Antithrombotic Therapy during and after Intracoronary Stenting
Authors: Panning Chad A
Published: July 2017

Objective:

To evaluate the impact on patient outcomes of antithrombotic therapy during and after intracoronary stenting.

Data Sources:

A MEDLINE search (1966-July 2000) for English-language clinical trials and review articles using the search terms stent and coronary with one or more of the following search terms: abciximab, tirofiban, orofiban, xemilofiban, eptifibatide, aspirin, heparin, enoxaparin, tinzaparin, dalteparin, hirudin, danaparoid, dipyridamole, cilostazol, dextran, warfarin, anticoagulant, ticlopidine, and Clopidogrel. References from these articles were reviewed for additional articles. Pharmaceutical companies were contacted to identify unpublished studies. A total of 177 sources were initially identified.

Study Selection:

Studies were selected through an unblinded individual review for prospective, randomized clinical trials evaluating patient outcomes related to antithrombotic therapy during or after intracoronary stent placement. Additional human and animal studies were included for background and introductory information.

Data Extraction:

Patient characteristics in each study were compared with those of the overall stent population. The primary end point measurements were defined. The completeness of follow-up and power analysis was assessed.

Data Synthesis:

Intracoronary stenting is now a common modality for maintaining patency of occluded arteries. Antithrombotic therapy during coronary artery stent placement is changing as knowledge about the pathophysiology of thrombus formation expands and new medications become available. Development of new stent placement techniques, new stent designs, and methods of restenosis irradiation or prevention have coincided with evolving antithrombotic regimens.

Conclusions:

The current antithrombotic regimen used in coronary artery stenting is complex, but has a lower incidence of hemorrhagic complications and thrombosis compared with previous anticoagulant regimens. Antithrombotic therapy may need to be tailored to individual patient contraindications.
The Role of Heparin in the Thrombolytic Treatment of Acute Myocardial Infarction
Authors: Stoneman David K. , Mauro Vincent F.
Published: July 2017

Objective:

To review the literature to determine the most appropriate role of heparin when using thrombolytic therapy.

Data Sources:

English-language journal articles published between 1985 and 1991.

Study Selection:

Ten trials comparing the effects of thrombolytic therapy with and without heparin. Desired outcomes that the authors were interested in were coronary vessel patency, reocclusion, recurrent ischemia, reinfarction, mortality, and bleeding complications.

Data Extraction:

Studies were assessed based on methodology.

Data Synthesis:

The concurrent use of heparin with tissue plasminogen activator (tPA) enhances coronary vessel patency without significantly increasing the risk of bleeding complications. The concurrent use of heparin with streptokinase enhances survival; however, the risk of bleeding associated with heparin use is unclear at present. Data are not currently available for anistreplase. Studies are underway to further address the role of heparin with thrombolytic therapy.

Conclusions:

Based on data currently available, it appears that beginning intravenous heparin during the first hour of the tPA infusion and continuing heparin for 24 hours appears most appropriate and has a minimal risk of bleeding. Delaying heparin for 9–12 hours after the streptokinase infusion appears to produce clinical benefits; however, it is not clear whether these benefits outweigh the potential risks of bleeding.
Albumin Audit Results and Guidelines for Use
Authors: Gales Barry J. , Erstad Brian L.
Published: July 2017

Objective:

To identify patients receiving albumin, develop guidelines for albumin use, and examine distribution and billing procedures.

Design:

Case series.

Setting:

Tertiary care center.

Patients:

All patients received albumin in a four-week period. Patients were identified concurrently using intensive care unit surveys and the pharmacy computer system, and retrospectively using billing statements. Data were analyzed from 73 of 79 patients (92.4 percent); 6 (7.6 percent) had no record of albumin being ordered or administered. Pediatric patient data were used only in the financial calculations.

Data Collection:

Demographics and albumin dosages were recorded for all patients. Prescribing service and indications for use were recorded in adults. Albumin administered was compared with the amount billed to each patient.

Main Results:

Sixty adult patients aged 14–91 y (median 62) received 1–69 units (median 4 units [1 unit=12.5 g albumin]) and 470 total units. Surgical services prescribed albumin in 73 percent and medical services in 27 percent of the patients. Common indications for albumin included volume expansion (65 percent), as intraoperative fluid (13 percent), and to increase urine output (10 percent). The pharmacy computer system identified 63 percent of the patients. Of these, 13 percent were not billed for albumin they received. Examinations of patient billing statements found that up to $17,740 a year (15 percent) of albumin administered is not billed. The floor-stock distribution system used in the intensive care units contributed to most errors.

Conclusions:

Recommendations addressing the problems identified in this audit were made to the pharmacy, medical, nursing, and billing departments. Guidelines for albumin use were formulated and approved by the hospital's pharmacy and therapeutics committee.
Application of Decision Analysis in Antibiotic Formulary Choices
Authors: Szymusiak-Mutnick Barbara , Mutnick Alan H.
Published: July 2017

Objective:

To introduce the reader to the fundamentals involved in using decision analysis as a tool in evaluating the associated costs and effectiveness of comparable therapeutic agents.

Data Sources:

Currently available literature citations were used to provide the reader with basic references whose purpose is to provide a step-by-step approach for using Decision Analysis in conducting a cost-effective comparison of three commonly used antibiotics. Data were gathered from a previously conducted retrospective chart review where the three antibiotics were used for either prophylactic, empiric, or documented infections. Although this study was limited by its retrospective nature, the reader can use the data to appreciate the fundamentals of decision analysis.

Conclusions:

The continually changing climate in healthcare and the added visibility of pharmacologic agents in the treatment and prevention of disease has increased pressure on pharmacy departments to provide therapeutic agents that are cost-effective. Decision analysis can be used to compare therapeutic agents, in terms of financial as well as clinical outcomes, in a structured fashion that all members of the health care team can understand. The application of Decision analysis is appropriate for many therapeutic agents, not just antibiotics.
Foscarnet-Associated Penile Ulcerations
Authors: Cadle Richard M. , Hamill Richard J.
Published: July 2017

Objective:

To report a case of foscarnet-induced penile ulcerations and review literature related to this adverse effect.

Data Sources:

Case reports and review articles identified by a computerized search (MEDLINE) and manual search (Index Medicus).

Data Synthesis:

Foscarnet is a pyrophosphate analog antiviral agent that is approved by the Food and Drug Administration for treating cytomegalovirus retinitis in patients with AIDS. It also is used investigationally for other indications and human herpesvirus infections. Adverse effects include nephrotoxicity, anemia, ionized calcium abnormalities, and penile ulcerations. The majority of penile ulcers have developed within two weeks following initiation of foscarnet therapy with dosages of 180–200 mg/kg/d. Most cases required discontinuation of foscarnet to resolve the penile lesions. A postulated mechanism for this effect is inflammatory contact dermatitis from exposure to urine with elevated concentrations of foscarnet. We report a case of foscarnet-induced penile ulcerations that resolved after discontinuing this agent.

Conclusions:

Foscarnet can induce penile ulcerations. Increased awareness of this phenomenon, along with meticulous genital hygiene and urination practices, are required for its prevention.
Aprotinin: No Justification for Current Use
Authors: Cooper Brad E
Published: July 2017

Objective:

To review the pharmacology, pharmacokinetics, clinical efficacy, and safety of aprotinin.

Data Identification:

A literature search using Grateful Med from 1991 to 1994 and the search term “aprotinin” was performed.

Study Selection:

Open and controlled trials were reviewed.

Data Extraction:

Studies evaluating aprotinin for use in primary and repeat coronary artery bypass graft (CABG) surgery were evaluated and results of the effects of aprotinin on decreasing transfusion requirements as well as adverse effects were summarized.

Data Synthesis:

Many European studies have shown that aprotinin reduces blood loss and transfusion requirements during CABG. More recently, two studies in the US and one in Canada have been published that confirm the effects of aprotinin on blood loss, but raise questions concerning its safety. Combined data indicate that aprotinin is associated with an increased incidence of renal failure, and there are trends toward increases in myocardial infarction, graft occlusion, and mortality. There is no question that aprotinin reduces blood loss during CABG. How much it will save depends on surgical skill and the use of other blood conservation techniques. There are many theoretical benefits to patients from this reduction in blood loss. Whether the benefits of aprotinin administration exceed the risks associated with its use has not been adequately assessed, and further multicenter trials are currently in progress. Whether the cost of aprotinin is counterbalanced by a reduction in transfusion requirements will vary, depending on the cost and amount of blood products used at the specific institution, but this type of analysis does not account for the cost of adverse effects of aprotinin or transfusions, and no pharmacoeconomic evaluations have been published.

Conclusions:

Until studies can demonstrate a positive benefit/risk ratio in terms of patient outcome, aprotinin should not be added to the formulary or used in patients undergoing CABG.
Use of Benchmarking Techniques to Justify the Evolution of Antibiotic Management Programs in Healthcare Systems
Authors: Schentag Jerome J , Paladino Joseph A , Birmingham Mary C , Zimmer Gabrial , Carr James R , Hanson Stephen C
Published: July 2017

Objective:

To apply basic benchmarking techniques to hospital antibiotic expenditures and clinical pharmacy personnel and their duties, to identify cost savings strategies for clinical pharmacy services.

Design:

Prospective survey of 18 hospitals ranging in size from 201 to 942 beds. Each was asked to provide antibiotic expenditures, an overview of their clinical pharmacy services, and to describe the duties of clinical pharmacists involved in antibiotic management activities. Specific information was sought on the use of pharmacokinetic dosing services, antibiotic streamlining, and oral switch in each of the hospitals.

Results:

Most smaller hospitals (<300 beds) did not employ clinical pharmacists with the specific duties of antibiotic management or streamlining. At these institutions, antibiotic management services consisted of formulary enforcement and aminoglycoside and/or vancomycin dosing services. The larger hospitals we surveyed employed clinical pharmacists designated as antibiotic management specialists, but their usual activities were aminoglycoside and/or vancomycin dosing services and formulary enforcement. In virtually all hospitals, the yearly expenses for antibiotics exceeded those of Millard Fillmore Hospitals by $2,000–3,000 per occupied bed. In a 500-bed hospital, this difference in expenditures would exceed $1.5 million yearly. Millard Fillmore Health System has similar types of patients, but employs clinical pharmacists to perform streamlining and/or switch functions at days 2–4, when cultures come back from the laboratory.

Conclusions:

The antibiotic streamlining and oral switch duties of clinical pharmacy specialists are associated with the majority of cost savings in hospital antibiotic management programs. The savings are considerable to the extent that most hospitals with 200–300 beds could readily cost-justify a full-time clinical pharmacist to perform these activities on a daily basis. Expenses of the program would be offset entirely by the reduction in the actual pharmacy expenditures on antibiotics.