bluuebunny/crossref_metadata_2025 huggingface dataset:
Speleothem δ13C record suggests enhanced spring/summer drought in south-eastern Spain between 9.7 and 7.8 ka – A circum-Western Mediterranean anomaly?
Authors: Budsky Alexander , Scholz Denis , Wassenburg Jasper A , Mertz-Kraus Regina , Spötl Christoph , Riechelmann Dana FC , Gibert Luis , Jochum Klaus Peter , Andreae Meinrat O
Published: March 2019

South-eastern Spain is one of the driest regions in Europe and thus, prone to drought. Terrestrial climate records covering the late Glacial and Holocene from this area are sparse. Here, we present a flowstone record from Cueva Victoria, south-eastern Spain, which covers the late Glacial (15 ka) to the mid-Holocene (7 ka) including the Younger Dryas (YD). Between the onset of the Bølling/Allerød (B/A) and the early Holocene, flowstone δ18O values progressively decrease in accordance with sea-surface temperatures in the Alboran Sea, indicating an increase in precipitation in south-eastern Spain and a supra-regional signal of North Atlantic temperature change. At the same time, decreasing δ13C values suggest progressively increasing precipitation and vegetation density. This trend is interrupted by both colder and drier conditions during the YD. Between 9.7 ± 0.3 and 7.8 ± 0.2 ka, a large positive excursion of the δ13C values indicates a strong reduction in vegetation density, probably as a consequence of very dry spring/summer conditions. In combination with the continuously low speleothem δ18O values and a nearly unchanged growth rate, this suggests increased seasonality (i.e. drier spring/summer conditions, but not a strong reduction in annual precipitation). This is consistent with several other climate records from the Western Mediterranean region, showing that the Western Mediterranean realm (Spain, Italy) experienced pronounced spring/summer drought during this time interval. Interestingly, the timing of this dry period coincided with the African Humid Period. This may be part of a teleconnection with the North African Monsoon via the Hadley cell circulation.
Temperature-controlled tundra fire severity and frequency during the last millennium in the Yukon-Kuskokwim Delta, Alaska
Authors: Sae-Lim Jarunetr , Russell James M , Vachula Richard S , Holmes Robert M , Mann Paul J , Schade John D , Natali Susan M
Published: March 2019

Wildfire is an important disturbance to Arctic tundra ecosystems. In the coming decades, tundra fire frequency, intensity, and extent are projected to increase because of anthropogenic climate change. To more accurately predict the effects of climate change on tundra fire regimes, it is critical to have detailed knowledge of the natural frequency and extent of past wildfires and how they responded to past climate variability. We present analyses of fire frequency and temperature from a lake sediment core from the Yukon-Kuskokwim (YK) Delta. Our ca. 1000 macroscopic charcoal record shows more frequent but possibly less severe tundra fires during the first half of the last millennium, whereas less frequent, possibly more severe fires characterize the latter half. Our temperature reconstruction, based on distributional changes of branched glycerol dialkyl glycerol tetraethers (brGDGTs), shows slightly warmer conditions from ca. AD 1000 to 1500, and cooler conditions thereafter (ca. AD 1500 to 2000), suggesting that fire frequency increases when climate is relatively warmer in this region. When wildfires occur more frequently, fire severity may decrease because of limited biomass (fuel source) accumulating between fires. The data suggest that tundra ecosystems are highly sensitive to climate change, and that a warmer climate, which is predicted to develop in the near future, will result in more frequent tundra wildfires.
Palynological insights into global change impacts on Arctic vegetation, fire, and pollution recorded in Central Greenland ice
Authors: Brugger Sandra O , Gobet Erika , Blunier Thomas , Morales-Molino César , Lotter André F , Fischer Hubertus , Schwikowski Margit , Tinner Willy
Published: March 2019

Arctic environments may respond very sensitively to ongoing global change, as observed during the past decades for Arctic vegetation. Only little is known about the broad-scale impacts of early and mid 20th-century industrialization and climate change on remote Arctic environments. Palynological analyses of Greenland ice cores may provide invaluable insights into the long-term vegetation, fire, and pollution dynamics in the Arctic region. We present the first palynological record from a Central Greenland ice core (Summit Eurocore ’89, 72°35’N, 37°38’W; the location of Greenland Ice Core Project GRIP) that provides novel high-resolution microfossil data on Arctic environments spanning AD 1730–1989. Our data suggest an expansion of birch woodlands after AD 1850 that was abruptly interrupted at the onset of the 20th century despite favorable climatic conditions. We therefore attribute this Betula woodland decline during the 20th century to anthropogenic activities such as sheep herding and wood collection in the sub-Arctic. First signs of coal burning activities around AD 1900 coincide with the onset of Arctic coal mining. The use of coal and fire activity increased steadily until AD 1989 resulting in microscopic-size pollution of the ice sheet. We conclude that human impact during the 20th century strongly affected (sub)-Arctic environments. Moreover, ecosystems have changed through the spread of adventive plant species (e.g. Ranunculus acris, Rumex) and the destruction of sparse native woodlands. We show for the first time that optical palynology allows paleoecological reconstructions in extremely remote sites >500 km from potential sources, if adequate methods are used.
The expression and prognostic value of stem cell markers Bmi-1, HESC5:3, and HES77 in human papillomavirus–positive and –negative oropharyngeal squamous cell carcinoma
Authors: Mohamed Hesham , Hagström Jaana , Jouhi Lauri , Atula Timo , Almangush Alhadi , Mäkitie Antti , Haglund Caj
Published: March 2019

Human papillomavirus is detected in over 50% of oropharyngeal squamous cell carcinomas. Human papillomavirus–positive oropharyngeal squamous cell carcinomas differ from human papillomavirus–negative tumors, and both expression patterns are classified as distinct entities. The Bmi-1 oncogene is a well-known member of the mammalian polycomb-group family. HESC5:3 and HES77 are newly developed monoclonal antibodies produced against undifferentiated embryonic stem cells. Our aim was to explore their roles in both human papillomavirus–positive and –negative oropharyngeal squamous cell carcinomas. Our cohort comprised 202 consecutive oropharyngeal squamous cell carcinoma patients diagnosed and treated with curative intent. We used tissue microarray tumor blocks to study the immunohistochemical expression of Bmi-1, HESC5:3, and HES77. We compared the expressions of these stem cell markers with p16 immunoexpression and human papillomavirus status, as well as with other characteristics of the tumor, and with patients’ clinical data and follow-up data. Human papillomavirus– and p16-positive tumors expressed less Bmi-1 and more HESC5:3 than the negative tumors. HES77 expression was high in human papillomavirus–positive oropharyngeal squamous cell carcinoma, but it did not correlate with p16 positivity. In our multivariable model, Bmi-1 and HESC5:3 were still associated with human papillomavirus, but the association between human papillomavirus and HES77 remained absent. In conclusion, Bmi-1, HESC5:3, and HES77 may have a different role in human papillomavirus–positive and human papillomavirus–negative tumors. There was no correlation between Bmi-1, HESC5:3, and HES77 expression and survival.
Feasibility of Early Application of an Advance Directive at the Time of First-Line Palliative Chemotherapy in Patients With Incurable Cancer: A Prospective Study
Authors: ParK Eun-Ju , Lim Yeon Jae , Kim Jae-Joon , Oh Sang-Bo , Oh So Yeon , Park Kwonoh
Published: March 2019

Context:

This study aimed to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments between before and after AD.

Methods:

Patients with advanced cancer who had just started palliative chemotherapy were prospectively enrolled. We assessed attitudes toward chemotherapy, Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) before conducting the AD and subsequently performed the AD after the first cycle of chemotherapy. Follow-up evaluations using same parameters were performed in the next cycle visit.

Results:

During the study period, 104 patients started palliative chemotherapy. Among them, 41 patients (11 with cognitive impairment at baseline, 14 with clinical deteriorations after the first cycle of chemotherapy, 6 with follow-up loss, 7 without proxy, 3 with protocol violations) were excluded, and the AD were recommended in the remaining 64 patients (proportion of AD recommendation: 62%). Among the 64 patients, 44 agreed to conduct the AD (proportion of AD consent: 69%). There were no significant changes before and after AD in terms of HADS and EORTC-QLQ. Attitudes regarding chemotherapy were also unchanged ( P = .773). A total of 36 (82%) patients followed physician’s recommendations, with the exception of 8 patients who terminated chemotherapy due to refusal or loss to follow-up.

Conclusions:

Considering our results showing no significant changes in depression and anxiety scores, QoL, and attitudes toward anticancer treatments after the AD, early integration of the AD at initiation of first-line palliative chemotherapy might be feasible.
Ovarian Carcinosarcoma and Concurrent Serous Tubal Intraepithelial Carcinoma With Next-Generation Sequencing Suggesting an Origin From the Fallopian Tube
Authors: See Sharlene Helene C. , Behdad Amir , Maniar Kruti P. , Blanco Luis Z.
Published: March 2019

Background. Ovarian carcinosarcomas are rare aggressive biphasic tumors. Evidence suggests that these tumors are monoclonal and that the sarcoma component is derived from a stem cell undergoing divergent differentiation. Currently, there remains a paucity of data regarding its origin, with few reports suggesting an association with serous tubal intraepithelial carcinoma (STIC) by immunohistochemistry and genetics. Objective. We sought to determine the relationship of carcinosarcoma to high-grade serous carcinoma and STIC by investigating for similar mutation signatures through next-generation sequencing. Methodology. A case of carcinosarcoma with associated high-grade serous carcinoma and STIC was macrodissected, and next-generation sequencing was performed on each component separately. Results. The STIC, high-grade serous carcinoma component, and chondrosarcoma component were all diffusely positive for p53 and p16 by immunohistochemistry. Next-generation sequencing demonstrated an identical TP53 gene c.376-1G>A 5’ splice site pathogenic mutation in all 3 components. Conclusions. Our findings suggest that carcinosarcomas may also originate from the fallopian tube.
Mind the Gap: Disparities in Cigarette Smoking in Canada
Authors: Chaiton Michael , Callard Cynthia
Published: March 2019

Objectives:

The Government of Canada has proposed an ‘endgame’ target for cigarette smoking that aims to reduce prevalence below 5% by 2035. To meet this difficult goal, it will be necessary to identify populations where interventions will (1) have the greatest impact in reducing the number of smokers and (2) have the greatest impact in addressing smoking disparities.

Method(s):

Using data from the Canadian Community Health Survey, smoking prevalence was estimated for populations that differed with respect to demographic, substance use, and mental health factors. Risk difference, relative risk, and attributable disparity number, which describes the magnitude of the potential impact if the disparity were addressed, were calculated for each group.

Results:

The strongest disparities (relative risk ⩾ 2) were associated with immigration status (for women), substance use, marital status, and lifetime experience of mental health or substance use disorders. The smallest disparities (relative risk ⩽ 1.5) were associated with sexual orientation, household income, immigration status (men), and province of residence. The groups with the largest attributable disparity number were among those who used cannabis, and those who were not immigrants, not married, and white.

Conclusions:

Disparities which were both strong and had a large potential impact on prevalence overall were found for populations facing mental health and substance use concerns. Differences in rankings were found depending on the scale of the measure. Addressing disparities in smoking rates is an important component of developing tobacco endgame strategies.
A Survey of Health Care Professionals’ Knowledge and Experience of Foetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy
Authors: Howlett Helen , Mackenzie Shonag , Strehle Eugen-Matthias , Rankin Judith , Gray William K
Published: March 2019

Background:

Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals.

Methods:

We developed an online survey to determine health care professionals’ (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD.

Results:

There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example.

Conclusions:

We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood.
Musical communication in scaffolding young learners’ expressive agency
Authors: Kondo Shinko
Published: March 2019

In a qualitative study of the nature of musical communication during scaffolding music learning, the most important themes to emerge reflected the role of musical communication in blossoming young learners’ expressive agency. The study focused on two different groups of young piano learners (aged 4–9) during collaborative (listening, creating, and performing) problem-solving experiences. Working as a teacher-researcher in the context of my own studio piano classes, I documented verbal and nonverbal interactions that occurred during the lessons. Data were collected primarily through video observation, field notes and a reflective journal. Analysis included the construction of narrative vignettes from these data. Analysis revealed that the children’s music learning was a creative process of transformation, as they negotiated and renegotiated their own meaning and that of others through musical communication. Possessing their own communicative musicality, learners exhibited ability to share a range of musical understanding and sensitivities through both sound and physical motion. Findings suggest that children’s music learning is not only located in individual minds but is anchored in a communicative landscape and when learners are engaged in musical scaffolding their expressive agency is enabled.
“Give me actual music stuff!”: The nature of feedback in a collegiate songwriting class
Authors: Hill Stuart Chapman
Published: March 2019

This study aimed to understand the nature of feedback that students and teacher exchanged in a workshop-based collegiate songwriting course. Two research questions guided the study: (1) What kinds of feedback do students and teacher give as they respond to each other’s work? and (2) What factors contribute to the culture of feedback in this class? Data sources included field notes from class observations, individual interviews with four informant students, a group interview, and a student-conducted interview of the investigator, who was also the instructor of the class. The analysis generated four themes that describe the feedback culture of this songwriting class: micro feedback, macro feedback, feedback roles, and overall feedback culture. Recommendations for practice and future research are presented.
Pre-performance emotions and music performance anxiety beliefs in young musicians
Authors: Kaleńska-Rodzaj Julia
Published: March 2019

The aim of this study is to investigate the structure and complexity of emotional states experienced by young musicians before entering the stage and to explain the influence of emotional beliefs on their pre-performance emotions. Emotions were elicited with a guided imagery induction, where 222 students aged 9- to 12-years-old recalled their most recent concert memory. They described their emotions on the list of 18 emotions (nine pairs of contrary emotions) and answered three questions measuring music performance anxiety (MPA) beliefs: MPA utility beliefs, MPA regulation beliefs, and audience attitude beliefs. The cluster analysis results show the complexity and multiplicity of emotional states reported by young musicians. Five emotional profiles vary from negative emotions of fear and sadness (High MPA) through a mixture of positive and negative emotions (Moderate MPA, Hesitation, Ambivalence) to positive emotions of confidence, courage and happiness (Composure-Confidence). Beliefs that MPA has negative impact on performance, beliefs of inefficacy in managing MPA and perceived audience pressure rather than support were related to High and Moderate MPA profiles. Practical implications for music education are discussed.
Contact of rough surfaces: Modeling adhesion in advanced multiasperity models
Authors: Violano G , Afferrante L
Published: March 2019

Surface roughness affects several tribological phenomena and in particular adhesion. For many years, multiasperity models have been the most used in the study of rough contacts notwithstanding their evident limitations. In this work, we propose a fair assessment of improved asperity models with adhesion modeled according to the Derjaguin, Muller and Toporov theory, which assumes attractive forces do not deform the surface profiles. Results are given for three enhanced asperity models: the discrete Greenwood and Williamson model, where the effective heights and curvatures of the surface asperities are used rather than a statistical description; the interacting Hertzian asperities model, where the elastic coupling effects are included; the interacting and coalescing Hertzian asperities model, where the coalescence of contact spots is also conveniently considered. A comparison with advanced contact mechanics theories shows that only the interacting and coalescing Hertzian asperities model correctly captures the physics of the problem at all roughness scales.
Parents’ views and experiences of talking about autism with their children
Authors: Crane Laura , Jones Lydia , Prosser Rachel , Taghrizi Morvarid , Pellicano Elizabeth
Published: March 2019

The way an autism diagnosis is disclosed to parents has been found to play a crucial role in their acceptance of, and the way they cope with, their child’s diagnosis. Yet, research into parents’ subsequent experiences of disclosing a diagnosis to their children, and talking to their families about autism more generally, is limited. Using an online survey, the current study examined 558 parents’ experiences of talking about autism with their autistic and non-autistic children. Results demonstrated that most parents ( n = 379, 67.9%) had told their autistic children about their diagnosis. Despite few parents ( n = 163, 20.4%) receiving advice or support regarding the disclosure of the diagnosis, those that had disclosed felt satisfied with the process ( n = 319, 84.2%) and felt confident in talking about autism with their children ( n = 339, 92.4%). Those who had not told their autistic children about the diagnosis largely planned to discuss this with their child in the future ( n = 100, 73.5%), felt confident in doing so ( n = 95, 70.9%) and were satisfied with their decision ( n = 95, 70.4%). Analysis of open-ended data, using thematic analysis, highlighted the importance of openness and the need to tailor explanations to individual children’s needs, while acknowledging that disclosure could often be challenging for parents.
Development and usability testing of a multi-criteria value clarification methods for patients with localized prostate cancer
Authors: de Angst Isabel B , Weernink Marieke GM , Kil Paul JM , van Til Janine A , Cornel Erik B , Takkenberg Johanna JM
Published: March 2019

Current guidelines for the development of decision aids recommend that they have to include a process for helping patients clarify their personal values, for example, by using values clarification methods. In this article, we extensively described the development process of the web-based values clarification method for patients with localized low- to intermediate-risk prostate cancer based on the analytic hierarchy process. With analytic hierarchy process, the relative importance of different attributes of available treatments can be determined through series of pairwise comparisons of potential outcomes. Furthermore, analytic hierarchy process is able to use this information to present respondents with a quantitative overall treatment score and can therefore give actual treatment advice upon patients’ request. The addition of this values clarification method to an existing web-based treatment decision aid for patients with localized prostate cancer is thought to improve the support offered to patients in their decision-making process and their decision quality.
Investigation of mode transition coordination for power-split hybrid vehicles using dynamic surface control
Authors: Xu Defeng , Zhang Jianwu , Zhou Bin , Yu Haisheng
Published: March 2019

For passenger cars propelled by the dedicated compound power-split hybrid powertrain, driveline oscillations-induced vehicle jerks are often excited during clutch-to-clutch shift operations while drive mode changes. To tackle this issue, a coordinated dynamic surface control is developed by integrating clutch slips and motor torque compensation strategies through trajectories tracking of both clutch slip speed and wheel speed. Uncertainties or disturbances are treated to be additional inputs of the system, and model nonlinearities are considered and implemented in discretized form through lookup tables. A complex simulation model including electro-hydraulic system is proposed and validated via experiments. The coordinated controller is validated by collaborative simulation. Numerical examples are made and simulation results verify that the controller is effective and robust enough against parameters uncertainties.
Quantitative measurements of preferential evaporation effects of multicomponent gasoline fuel sprays at ECN Spray G conditions
Authors: Cordier Matthieu , Itani Lama , Bruneaux Gilles
Published: March 2019

A two-tracer laser-induced fluorescence technique is used to quantify the effects of preferential evaporation of multicomponent fuels on the fuel component distribution. The technique is based on the simultaneous detection of the fluorescence of two aromatic tracers with complementary evaporation characteristics matched to different components of a multicomponent fuel. Relative variations in the spatial distribution of tracer distribution as a consequence of preferential evaporation are determined from the ratio of laser-induced fluorescence signals measured within two distinct spectral bands. A thermodynamic model is then used to relate the ratio map with the fuel component map. The accuracy and precision of the method are characterized from determining the laser-induced fluorescence signal ratio within two identical spectral bands. Measurements are performed in a high-pressure high-temperature vessel equipped with an eight-hole injector. The Engine Combustion Network Spray G target conditions are chosen as reference conditions at injection. The only difference with these target conditions is the use of a multicomponent surrogate fuel. Parametric variations around these target conditions are also performed in order to investigate their effect on the preferential evaporation effect. The ambient temperature is varied between 525 and 625 K and the injection pressure is reduced from 200 to 100 bar. The impact of ethanol addition is also studied with two different fuel mixtures in addition to the reference surrogate fuel: E20 and E85 which feature 20% and 85% of pure ethanol within surrogate, respectively. A significant preferential evaporation effect is observed in this condition representative of engine applications and results in a spatial segregation between low- and high-volatility fuel components, respectively, at the tail and tip of the plumes. This effect is enhanced by the addition of ethanol and the decrease in ambient temperature and injection pressure.
The Relationship Between Enhanced Reticulospinal Outflow and Upper Limb Function in Chronic Stroke Patients
Authors: Choudhury Supriyo , Shobhana A. , Singh Ravi , Sen Dwaipayan , Anand Sidharth Shankar , Shubham Shantanu , Baker Mark R. , Kumar Hrishikesh , Baker Stuart N.
Published: March 2019

Background. Recent evidence from both monkey and human studies suggests that the reticulospinal tract may contribute to recovery of arm and hand function after stroke. In this study, we evaluated a marker of reticulospinal output in stroke survivors with varying degrees of motor recovery. Methods. We recruited 95 consecutive stroke patients presenting 6 months to 12 years after their index stroke, and 19 heathy control subjects. Subjects were asked to respond to a light flash with a rapid wrist flexion; at random, the flash was paired with either a quiet or loud (startling) sound. The mean difference in electromyogram response time after flash with quiet sound compared with flash with loud sound measured the StartReact effect. Upper limb function was assessed by the Action Research Arm Test (ARAT), spasticity was graded using the Modified Ashworth Scale (MAS) and active wrist angular movement using an electrogoniometer. Results. StartReact was significantly larger in stroke patients than healthy participants (78.4 vs 45.0 ms, P < .005). StartReact showed a significant negative correlation with the ARAT score and degree of active wrist movement. The StartReact effect was significantly larger in patients with higher spasticity scores. Conclusion. We speculate that in some patients with severe damage to their corticospinal tract, recovery led to strengthening of reticulospinal connections and an enhanced StartReact effect, but this did not occur for patients with milder impairment who could use surviving corticospinal connections to mediate recovery.
Praxagoras of Cos (4th Century BC) and His Innovative Method of a Diverting Enterocutaneous Fistula to Relieve Small Bowel Obstruction
Authors: Tsoucalas Gregory , Laios Konstantinos , Zografos George , Androutsos Georges , Karamanou Marianna
Published: March 2019

Born in an island with huge medical tradition in ancient Greece, Praxagoras of Cos became an esteemed medico-philosopher and surgeon. The evolution made by the Hippocratic School of Medicine further boosted his talent and helped him perform surgical operations, which were believed impossible for his era. Praxagoras introduced an innovative surgical technique to confront small bowel obstruction, by creating an enterocutaneous fistula. This historical review connects all available data to present the life and work of an important medical figure of the ancient Hellenic School.
Reliability estimation for drive axle of wheel loader under extreme small sample
Authors: Cao Leilei , Cao Lulu , Guo Lei , Liu Kui , Ding Xin
Published: March 2019

It is difficult to have enough samples to implement the full-scale life test on the loader drive axle due to high cost. But the extreme small sample size can hardly meet the statistical requirements of the traditional reliability analysis methods. In this work, the method of combining virtual sample expanding with Bootstrap is proposed to evaluate the fatigue reliability of the loader drive axle with extreme small sample. First, the sample size is expanded by virtual augmentation method to meet the requirement of Bootstrap method. Then, a modified Bootstrap method is used to evaluate the fatigue reliability of the expanded sample. Finally, the feasibility and reliability of the method are verified by comparing the results with the semi-empirical estimation method. Moreover, from the practical perspective, the promising result from this study indicates that the proposed method is more efficient than the semi-empirical method. The proposed method provides a new way for the reliability evaluation of costly and complex structures.
Family experiences as a caregiver for patients with Parkinson's disease: a qualitative study
Authors: Dekawaty Ayu , Malini Hema , Fernandes Feri
Published: March 2019

Background

Parkinson's disease is a chronic progressive neurodegenerative disorder with unpredictable symptoms, which leads to stress for individuals caring for their family members. Most patients with Parkinson's disease in Indonesia are cared for by family members. Their treatment requires continuous supervision and a great deal of attention.

Aims

Accordingly, this research explores caregivers' experiences in caring for family members with Parkinson's disease.

Methods

This study is qualitative with a phenomenological design. Participants, selected via a purposive sampling technique, were individuals caring for and living with family members suffering from Parkinson's disease. The data were analysed using the Colaizzi approach.

Results

This research identified four themes: the ways in which members of the family adapt; the impact of the patient's condition on the caregiver; support received in providing care; and the cultural and spiritual meanings the caregiver obtained when providing care.

Conclusion

This study uncovered several aspects that contribute to the understanding of the life of family members as caregivers for Parkinson's disease patients. This research also found there is still limited psychosocial support from health workers, so it is necessary for them to be more proactive in providing support for family members who care for patients with Parkinson's disease.
Real-life outcomes of teriflunomide treatment in patients with relapsing multiple sclerosis: TAURUS-MS observational study
Authors: Kallmann Boris A. , Tiel-Wilck Klaus , Kullmann Jennifer S. , Engelmann Ulrich , Chan Andrew
Published: March 2019

Background:

Teriflunomide is a once-daily oral immunomodulatory agent approved for the treatment of relapsing–remitting multiple sclerosis (MS). We aimed to obtain data on the effectiveness, tolerability, and subject satisfaction with teriflunomide (Aubagio®) under clinical practice conditions in unselected MS patients.

Methods:

This work was a non-interventional, prospective, longitudinal, observational study in 307 sites in Germany.

Results:

A total of 1128 patients were eligible for the efficacy analysis [67.5% female; mean age (± standard deviation) 44.9 ± 9.7 years, range 20–73 years]. Time since first MS symptoms was 10.6 ± 8.2 years, and time since MS diagnosis was 8.9 ± 7.6 years. Expanded Disability Status Scale (EDSS) score at inclusion was 2.3 ± 1.5 (70.4% with score < 3.5). The mean observation period was 16.3 ± 9.1 months. A total of 75.2% had received previous disease-modifying therapies (DMTs) at any time. Of these patients, 504 (44.7%) received no DMT within 6 months of study entry, 593 patients (52.6%) had DMT discontinued prior to study entry [glatiramer acetate in 10.6%, subcutaneous interferon-beta 1a (IFNβ-1a) in 9.3%, intramuscular IFNβ-1a or IFNβ-1b in 6.6% each, azathioprine oral in 0.4%, other in 7.3%, last medication not known in 12.0%]. The mean annualized relapse rate decreased from 0.87 in the 24 months prior to study entry to 0.35 in the 24 months after study entry ( n = 468; p ⩽ 0.001). EDSS and Fatigue Severity Scale remained stable. In patients who received previous MS treatments, Treatment Satisfaction Questionnaire (TSQM-9) values (maximum = 100), for the observation at 24 months improved by 8.1 points for effectiveness, 17.0 points for convenience, and 15.3 points for global satisfaction ( p ⩽ 0.001 each, compared with study entry). In the safety cohort ( n = 1139), the proportion of patients with adverse events (AEs) of any severity was 35.8%, and with serious events 13.0%. The most frequently reported AEs were diarrhea ( n = 55), followed by MS relapse ( n = 48), hair thinning ( n = 38), and viral upper respiratory tract infection ( n = 31).

Conclusions:

Relapse rate was halved during the observation period in comparison with the same time period before study entry. Patient satisfaction with teriflunomide was high in this real-world observation of patients, the majority of whom switched from other DMTs. The safety and tolerability profile of teriflunomide was similar to that reported in previous clinical trials.
Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry
Authors: Meinel Thomas Raphael , Kaesmacher Johannes , Mordasini Pasquale , Mosimann Pascal J. , Jung Simon , Arnold Marcel , Heldner Mirjam Rachel , Michel Patrik , Hajdu Steven D. , Ribo Marc , Requena Manuel , Maegerlein Christian , Friedrich Benjamin , Costalat Vincent , Benali Amel , Pierot Laurent , Gawlitza Matthias , Schaafsma Joanna , Pereira Vitor Mendes , Gralla Jan , Fischer Urs
Published: March 2019

Background and purpose:

In acute ischaemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data point to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. The aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR); and (2) to assess the safety and technical efficacy of MT according to strata of TTR.

Methods:

Using the retrospective multicentre BEYOND-SWIFT registry data (ClinicalTrials.gov identifier: NCT03496064), we compared safety and efficacy of MT in 1461 patients between TTR strata of 0–180 min ( n = 192), 180–360 min ( n = 876) and >360 min ( n = 393). Clinical effect of TTR was evaluated using multivariable logistic regression analyses adjusting for pre-specified confounders [adjusted odds ratios (aOR) and 95% confidence intervals (95% CI)]. Primary outcome was good functional outcome (modified Rankin Scale: mRS 0–2) at day 90.

Results:

Every hour delay in TTR was a significant factor related to mRS 0–2 (aOR 0.933, 95% CI 0.887–0.981) with an estimated 1.5% decreased probability of good functional outcome per hour delay of reperfusion, and mRS 0–1 (aOR 0.929, 95% CI 0.877–0.985). Patients with late TTR had lower rates of successful and excellent reperfusion, higher complication rates and number of passes.

Conclusions:

TTR is an independent factor related to long-term functional outcome. With increasing TTR, interventional procedures become technically less effective. Efforts should be made to shorten TTR through optimized prehospital and in-hospital pathways.
Is ureteral stent an effective way to deliver drugs such as bacillus Calmette-Guérin to the upper urinary tract? An experimental study
Authors: Korkes Fernando , Baccaglini Willy , Silveira Marcel Aranha
Published: March 2019

Background:

We aim to evaluate the distribution in the upper urinary tract of intravesical-delivered fluids, after inducing vesicoureteral reflux (VUR) with a double J stent.

Methods:

In group 1 ( n = 35) patients were maintained in a 20° Trendelenburg position and were evaluated after immediate insertion of ureteral stent, while in group 2 ( n = 16) patients were evaluated after several days with ureteral stent placement. Patients in both groups were submitted to a cystogram with progressive volumes of iodine contrast and were evaluated according to VUR of contrast medium to the renal pelvis. Additionally, in group 2 visual confirmation was performed by endoscopic inspection of upper tract mucosal impregnation with methylene blue.

Results:

In group 1, after immediate insertion of ureteral stent reflux occurred in 51.4% ( n = 18/35), and after several days with ureteral stent placement reflux was observed in 87.5% ( n = 14/16) of patients. Reflux was progressively more frequent according to increasing bladder volume ( p < 0.001). At 60 ml bladder volume no reflux was observed, while at 120 ml, 180 ml, 240 ml, 300 ml and 360 ml bladder volume reflux was observed in 14%, 25%, 41%, 55% and 63% of patients, respectively.

Conclusion:

Retrograde delivery of fluids such as bacillus Calmette-Guérin to the upper urinary tract through double J stents can be effective; however, it is mainly effective after several days with ureteral stent and relatively large volumes might be instilled into the bladder.
Disinfectants: The role of standardised testing to aid selection. Part 2
Authors: Wilkinson Martyn AC , Curran Evonne T , Bradley Christina R
Published: March 2019

Choosing which disinfectant(s) to use in any particular healthcare environment is a far from trivial task and one that is undertaken by Infection Prevention and Control (IPC) professionals on a regular basis. The recent proliferation in the number and type of products designed to disinfect healthcare surfaces makes for a seemingly bewildering range of options. The primary factor to consider is whether the disinfectant is capable of killing the likely (but unknown) microbial challenge. For reusable non-invasive care equipment, standardised testing provides objective evidence for IPC teams. This second paper seeks to explain these tests and the conditions under which they are performed to aid in the IPC teams’ disinfection selection.
Influence of Environmental Design on Team Interactions Across Three Family Medicine Clinics: Perceptions of Communication, Efficiency, and Privacy
Authors: Karp Zaher , Kamnetz Sandra , Wietfeldt Natalie , Sinsky Christine , Molfenter Todd , Pandhi Nancy
Published: March 2019

Objective:

In this study, we explored how two different primary care clinic physical layouts (onstage/offstage and pod-based [PB] designs) influenced pre- and postvisit team experiences and perceptions.

Background:

Protocols encourage healthcare team communication before and after primary care visits to support better patient care. Physical clinic environments may influence these behaviors, but limited research has been performed.

Method:

We conducted observations, three interviews with clinic managers, and six focus groups with 21 providers and staff at three family medicine teaching clinics. Observational data were captured through field notes and spaghetti diagrams. Interviews and focus groups were recorded, transcribed, and analyzed using a grounded theory-based approach to understand how aspects of the clinic environment affected communication, efficiency, and privacy.

Results:

Variations in communication styles and trade-offs between patient contact and privacy emerged as differences. In the onstage/offstage design, colocated teams had increased verbal communication but perceived being isolated from other clinic teams. In contrast, teams in PB clinics communicated with other clinic teams but had more informal patient contact within care-team stations that imposed privacy risk.

Conclusions:

Primary care clinic design appears to alter provider–team and patient–provider communication and flow. Organizations should consider aligning environmental design with desired interaction patterns when building new primary care clinics.
ISIS at Its Apogee: The Arabic Discourse on Twitter and What We Can Learn From That About ISIS Support and Foreign Fighters
Authors: Ceron Andrea , Curini Luigi , Iacus Stefano M.
Published: March 2019

We analyze 26.2 million comments published in Arabic language on Twitter, from July 2014 to January 2015, when Islamic State of Iraq and Syria (ISIS)’s strength reached its peak and the group was prominently expanding the territorial area under its control. By doing that, we are able to measure the share of support and aversion toward the Islamic State within the online Arab communities. We then investigate two specific topics. First, by exploiting the time granularity of the tweets, we link the opinions with daily events to understand the main determinants of the changing trend in support toward ISIS. Second, by taking advantage of the geographical locations of tweets, we explore the relationship between online opinions across countries and the number of foreign fighters joining ISIS.
President Trump Stress Disorder: Partisanship, Ethnicity, and Expressive Reporting of Mental Distress After the 2016 Election
Authors: Krupenkin Masha , Rothschild David , Hill Shawndra , Yom-Tov Elad
Published: March 2019

In the aftermath of the 2016 election, many Democrats reported significant increases in stress, depression, and anxiety. Were these increases real, or the product of expressive reporting? Using a unique data set of searches by more than 1 million Bing users before and after the election, we examine the changes in mental-health-related searches among Democrats and Republicans. We then compare these changes to shifts in searches among Spanish-speaking Latinos in the United States. We find that while Democrats may report greater increases in post-election mental distress, their mental health search behavior did not change after the election. On the other hand, Spanish-speaking Latinos had clear, significant, and sustained increases in searches for “depression,” “anxiety,” “therapy,” and antidepressant medications. This suggests that for many Democrats, expressing mental distress after the election was a form of partisan cheerleading.
Sport Participation and Specialization Characteristics Among Pediatric Soccer Athletes
Authors: McLeod Tamara Valovich , Israel Michael , Christino Melissa A. , Chung Jane S. , McKay Scott D. , Lang Pamela J. , Bell David R. ,   the PRiSM Sports Specialization Research Interest Group, Chan Charles M. , Crepeau Allison , Davis Elizabeth , Fletcher Amanda L. , Laniak Jessica , McCaffrey Kelsie , Pacicca Donna , Riederer Mark , Rizzone Katherine , Rush Jeremy K. , Zaslow Tracy
Published: March 2019

Background:

Soccer is an increasingly popular sport for children and adolescents in the United States. Little is known about participation patterns related to sport specialization.

Purpose:

To investigate soccer participation levels and sport specialization characteristics among youth soccer athletes.

Study Design:

Cross-sectional study.

Methods:

Adolescent athletes aged between 12 and 18 years completed an online survey addressing participant demographics, sports and soccer participation history, and level of specialization. Descriptive analyses characterized participation, while chi-square and Kruskal-Wallis tests assessed the influence of specialization, sex, and grade on survey variables.

Results:

Overall, 83.7% of 746 respondents participated in an organized soccer league outside of school, and 37% played in multiple leagues concurrently. Nearly three-quarters of respondents trained in soccer more than 8 months of the year, with those who participated in club soccer being more likely to train more than 8 months of the year. More respondents were classified as high specialization (37.5%), followed by moderate (35.6%) and low (28.6%) specialization. No differences between sexes were noted for level of specialization or quitting other sports to specialize in soccer, but male athletes were more likely to train more than 8 months per year compared with female athletes. Respondents in older grades (9th-10th and 11th-12th grades) were more likely to be highly specialized and quit other sports to focus on soccer. No differences between grade levels were found among respondents training more than 8 months per year.

Conclusion:

The study findings suggest that many youth soccer athletes participated in multiple teams or leagues at the same time and trained more than 8 months of the year. Characteristics including participation on a club team, level of specialization, and male sex were associated with a greater likelihood of exceeding the 8-month training recommendation.
Taking It to the Next Level: A Field Experiment to Improve Instructor-Student Relationships in College
Authors: Robinson Carly D. , Scott Whitney , Gottfried Michael A.
Published: March 2019

Competing in today’s workforce increasingly requires earning a college degree, yet almost half of all enrolled undergraduates do not graduate. As the costs of dropping out of college continue to rise, instructor-student relationships may be a critical yet underexplored avenue for improving college student outcomes. The present study attempts to replicate and extend a prior study that improved teacher-student relationships at the high school level in a college setting. In this registered report, we test whether an intervention that highlights instructor-student commonalities improves similarity, instructor-student relationships, academic achievement, and persistence for undergraduate students in a large, diverse public university. We found that the intervention increased perceptions of similarity but not downstream relational or academic outcomes. Our exploratory analyses provide one of the first investigations suggesting that instructor-student relationships predict an array of consequential student outcomes in college. These findings show a notable relationship gap: instructors perceived less positive relationships with certain student groups, but on average, students perceived equally positive relationships with their instructors.
Story Hour in the Management Classroom
Authors: Peterson Claudette M. , Peterson Tim O. , Aikens Shontarius D. , Beard Jon W. , Beatty Joy E. , Blair Carrie A. , Lesko Ashley P. , Small Erika E.
Published: March 2019

Using stories written for young children can be effective in the education of college students. Storytelling is a helpful instructional method that is relevant to many management topics. This activity uses picture books, which can be read to students in “story hour” fashion and then tied to management principles being taught. This activity can be done successfully with either undergraduate or graduate students. The activity is described from a general perspective; in the appendices, we provide seven examples of book summaries, learning objectives, teaching notes, potential challenges, and debriefing questions that have been used to address a variety of management topics.