bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Choice in Adolescents With Cleft Lip and/or Palate: The Importance of Shared Decision-Making
Authors: Wogden Francesca , Norman Alyson , Dibben Louise
Published: May 2019

Objective:

Limited research has studied the involvement of children in medical decision-making. The aim of the study was to understand the involvement of adolescents with cleft lip and/or palate (CL/P) in decisions about elective surgeries and treatments.

Design:

Parents and professionals completed mixed-methods questionnaires about the degree to which children had been involved in choices about elective treatments. Data were analyzed using content analysis. Young people aged 12 to 25 years were asked to take part in semistructured interviews. The data were analyzed using inductive thematic analysis.

Setting:

Questionnaire data collection took place online, and interview data were collected via messenger or telephone-based interviews.

Participants:

The study employed 30 participants; 11 young people (3 male, 8 female), 17 parents (13 mothers, 4 fathers), and 5 professionals (2 surgeons, 2 speech and language therapists, and 1 pediatric dentist).

Results:

Five main themes were identified. These reflected participants feeling that with increasing age should come increased involvement in decision-making and that it was important for adolescents to “have a voice” during decision-making. Parents, peers, and health professionals were identified as influencing decisions. Most adolescents reported overall satisfaction with their involvement in decision-making but sometimes felt “left in the dark” by professionals or under pressure from parents. A desire to improve speech and/or appearance was as an area where adolescents wanted to be more involved in decision-making.

Conclusions:

Shared decision-making is an important factor for psychological well-being by promoting autonomy and self-esteem among adolescents with CL/P.
Depicting Science in a Public Debate: The Philippine Legal Challenge Against GMO Eggplant
Authors: Ponce de Leon Inez Z. , Custodio Pamela A. , David Clarissa
Published: May 2019

In 2015, the Philippine Supreme Court ruled against the field testing of Bt eggplant, a genetically modified crop. This decision was covered extensively in the local press, forcing scientists to defend their research. We used qualitative, inductive analysis to examine how three news outlets constructed science in their coverage of the issue. We found that science was constructed through four themes: science searched for proof, absolute consensus had to be reached, the characteristics of scientific inquiry are used to discredit scientists, and science is aware of its logical limits. These findings have implications for the public acceptance of innovations.
Work overload is related to increased risk of error during chemotherapy preparation
Authors: Carrez Laurent , Bouchoud Lucie , Fleury Sandrine , Combescure Christophe , Falaschi Ludivine , Sadeghipour Farshid , Bonnabry Pascal
Published: May 2019

Purpose

Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations.

Method

Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%–10%, 10%–30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively.

Results

Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05).

Conclusion

Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.
Understanding the Role of the Corporation in Sustainability Transitions
Authors: Delmas Magali A. , Lyon Thomas P. , Maxwell John W.
Published: May 2019

The state of the planet calls for large-scale sustainability transitions involving systemic adoption of markedly better environmental and social practices. The objective of this symposium is to better understand the role of corporations in promoting such systemic change. We present four case studies—representing diverse industries and change mechanisms—-to investigate corporate leadership in sustainability transitions. The cases examine a wide range of mechanisms used by corporations to progress toward sustainability, such as political coalition building and information strategies through eco-labels, socially responsible investing, and the public statements of CEOs. In this introduction, we discuss the challenges associated with both achieving and studying systemic change, explain the rationale for a case study approach, describe the findings from the case studies, and draw some general conclusions on the mechanisms by which firms may be able to lead, or at least participate in, systemic change in the different phases of sustainability transitions.
Variation in femoral anteversion in patients requiring total hip replacement
Authors: Pierrepont Jim W , Marel Ed , Baré Jonathan V , Walter Leonard R , Stambouzou Catherine Z , Solomon Michael I , McMahon Stephen , Shimmin Andrew J
Published: May 2019

Background:

Optimal implant alignment is important for total hip replacement (THR) longevity. Femoral stem anteversion is influenced by the native femoral anteversion. Knowing a patient’s femoral morphology is therefore important when planning optimal THR alignment. We investigated variation in femoral anteversion across a patient population requiring THR.

Methods:

Preoperatively, native femoral neck anteversion was measured from 3-dimensional CT reconstructions in 1215 patients.

Results:

The median femoral anteversion was 14.4° (−27.1–54.5°, IQR 7.4–20.9°). There were significant gender differences (males 12.7°, females 16.0°; p < 0.0001). Femoral anteversion in males decreased significantly with increasing age. 14% of patients had extreme anteversion (<0° or >30°).

Conclusions:

This is the largest series investigating native femoral anteversion in a THR population. Patient variation was large and was similar to published findings of a non-THR population. Gender and age-related differences were observed. Native femoral anteversion is patient-specific and should be considered when planning THR.
How the normative resistance of anarchism shaped the state monopoly on violence
Authors: Newell Michael E.
Published: May 2019

Rather than an assumption of statehood, the state’s monopoly on the legitimate use of force is better understood as a normative ideal that regulates behavior, and constitutes states as the sole legitimate authority on violence. Existing literature on this norm has explored its development in response to piracy in the early to mid-1800s, but it has overlooked significant developments that occurred in response to the violence of transnational anarchist terrorism. Anarchist philosophers in the late 1800s resisted the normative basis of the state monopoly on violence and articulated their own competing claims. While their normative ideas failed to gain widespread acceptance, they elicited significant responses by states. In the Rome Conference of 1898 and the St. Petersburg Protocol, states reiterated the constitutive aspects of the state monopoly norm, and articulated new, deeper obligations to coordinate anti-anarchist policies. State officials considered a protean form of collective security against the anarchists, and applied the state monopoly norm to the control of the violence of individual, rather than corporate, non-state actors for the first time. Similar to trends identified in existing literature on the state monopoly norm, this article notes that the response to the anarchists was bolstered by their perception as “outsiders of authority,” or violators of core constitutive norms of state authority. This trend and these broader historical dynamics are explained with reference to theoretical literature on normative resistance.
Toll-like receptors 2 and 6 mediate apoptosis and inflammation in ischemic skeletal myotubes
Authors: Patel Hemanshu , Yong Cissy , Navi Ali , Shaw Sidney G , Shiwen Xu , Abraham David , Baker Daryll M , Tsui Janice CS
Published: May 2019

Critical limb ischemia (CLI) is associated with skeletal muscle damage. However, the pathophysiology of the muscle damage is poorly understood. Toll-like receptors (TLR) have been attributed to play a role in ischemia-induced tissue damage but their role in skeletal muscle damage in CLI is unknown. TLR2 and TLR6 expression was found to be upregulated in skeletal muscle of patients with CLI. In vitro, ischemia led to upregulation of TLR2 and TLR6 by myotubes, and activation of the downstream TLR signaling pathway. Ischemia-induced activation of the TLR signaling pathway led to secretion of the pro-inflammatory cytokine interleukin-6 and muscle apoptosis, which were abrogated by neutralising TLR2 and TLR6 antibodies. Our study demonstrates that TLR2 and TLR6 are upregulated in ischemic muscle and play a role in ischemia-induced muscle damage. Thus, manipulating the TLR pathway locally may be of potential therapeutic benefit.
Intensive online videogame involvement: A new global idiom of wellness and distress
Authors: Snodgrass Jeffrey G. , Dengah H. J. François , Polzer Evan , Else Robert
Published: May 2019

Extending classic anthropological “idioms of distress” research, we argue that intensive online videogame involvement is better conceptualized as a new global idiom, not only of distress but also of wellness, especially for emerging adults (late teens through the 20s). Drawing on cognitive anthropological cultural domain interviews conducted with a small sample of U.S. gamers ( N = 26 free-list and 34 pile-sort respondents) (Study 1) and a large sample of survey data on gaming experience ( N = 3629) (Study 2), we discuss the cultural meaning and social context of this new cultural idiom of wellness and distress. Our analysis suggests that the “addiction” frame provides a means for gamers to communicate their passion and commitment to online play, even furthering their enthusiasm for the hobby and community in the process, but also a way for players to express and even resolve life distress such as depression and loneliness. The American Psychiatric Association (APA) has recently included “Internet gaming disorder” (IGD) as a possible behavioral addiction, akin to gambling, warranting further consideration for eventual formal inclusion in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Our study leads us to suggest that clinicians only sparingly use IGD as a clinical category, given that medical and gamer understandings of “addictive” play differ so markedly. This includes better distinguishing positive online gaming involvement—also sometimes framed by gamers as “addictive”—from other play patterns more clearly entailing distress and dysfunction.
Hazardous intersections: Crossing disciplinary lines in developmental psychology
Authors: Sperry Douglas E. , Miller Peggy J. , Sperry Linda L.
Published: May 2019

This article extends Lemieux’s concern for the interdisciplinary tension between philosophy and sociology to the intradisciplinary tension within psychology between approaches to the study of children focusing on universal principles and approaches adopting a contextual lens. This tension arises both in how development is defined and in the methods chosen for its study. This tension is exemplified in terms of the recent American preoccupation with the Word Gap (WG), a supposed difference of 30 million words heard by socioeconomically diverse children by the age of 4 that is blamed for educational disparities throughout the school years. The article discusses the political implications of WG discourse as it gives rise to the erasure of language practices of diverse Americans and obscures the role that the educational system plays in fostering a ‘one-size-fits-all’ instructional model. The article concludes with a discussion of attempts to combat the deficit model that the WG discourse reproduces.
‘Don’t hold me back’: Using poetic inquiry to explore university educators’ experiences of professional development through the Scholarship of Teaching and Learning
Authors: Loads Daphne , Marzetti Hazel , McCune Velda
Published: May 2019

Institutional schemes that offer financial and other support to carry out Scholarship of Teaching and Learning projects have a valuable part to play in the personal and professional development of academic staff. We investigated the experiences of 12 recipients of the University of Edinburgh Scholarship of Teaching and Learning (SoTL) Scheme awards, drawing on a poetic inquiry approach in order to understand what that development meant to them. We found that poetic inquiry surfaced stumbling points and frustrations as well as triumphs and transformation and provided insight into the kinds of emotional and practical support required by participants. Unexpectedly, it also shed light on methodological issues for the researchers.
Using body mass index ignores the intensive training of elite special force personnel
Authors: Tafeit Erwin , Cvirn Gerhard , Lamprecht Manfred , Hohensinn Markus , Moeller Reinhard , Hamlin Michael , Horejsi Renate
Published: May 2019

Body mass index is a common and well-known measure in daily life. A body mass index higher than 25 is assumed to be an indicator for overweight and obesity and a high amount of total body fat. But body mass index overestimates body fat in subjects with high muscle mass and underestimates it in persons with a low lean body mass, especially in elderly and diseased persons. In the present study, we investigate the performance of the body mass index as a measure of body fatness and its ability to distinguish between well-trained and untrained subjects. Twenty-one well-trained male members of a police task force named “Cobra” and 38 non-active controls, matched by age, weight and height were participants of the study. The age range of these subjects was between 30 and 45 years. Subcutaneous adipose tissue thicknesses and body fat distributions were measured non-invasively by an optical device named the “Lipometer.” Statistics were performed with SPSS. We found that the body mass index did not show a difference between the two groups, whereas all Lipometer results were able to discriminate significantly between the trained and untrained subjects. Furthermore, the receiver operating characteristic curve analysis was calculated and all Lipometer measurements provided significant results up to a correct classification of all subjects of 86.4%, which was for the lateral thigh body site. In conclusion, the body mass index was not able to recognize the difference between trained and untrained participants, while body fat distribution measured with the Lipometer was able to distinguish more clearly the large body fat differences between these two groups.

Impact statement

Body mass index (BMI) is a common measure of body fatness but overestimates body fat in subjects with high muscle mass. We have developed previously a device named “Lipometer,” an alternative way to measure body fatness. We show herein that the Lipometer is able to distinguish more clearly (than the BMI) the large body fat differences between well-trained and untrained subjects. Thus, the Lipometer is superior to BMI with respect to body fat measurements.
Antecedents of Health-Promoting Leadership and Workload as Moderator
Authors: Turgut Sarah , Schlachter Svenja , Michel Alexandra , Sonntag Karlheinz
Published: May 2019

This study builds on the theory of planned behavior and investigates antecedents of health-promoting leadership behaviors (HPL behaviors): positive health-promoting leadership attitude (HPL attitude) as well as perceived health-promoting leadership norms (perceived HPL norms), and lack of perceived health-promoting leadership behavioral control (perceived HPL behavioral control). Furthermore, based on the conservation of resources theory, these antecedents are conceptualized as personal and job resources with managers’ perceived workload being examined as a moderating boundary condition, suggesting that workload as a job demand facilitates resource loss. A survey was administered to 315 managers. Data were analyzed using hierarchical linear regression analysis and moderation analysis. Results revealed that HPL attitude and perceived HPL norms were positively related to HPL behaviors, whereas a lack of perceived HPL behavioral control was negatively related to HPL behaviors. Furthermore, high workload weakened the relationship between perceived HPL norms and HPL behaviors. Workload did not moderate the relationships between the antecedents HPL attitude and lack of perceived HPL behavioral control, and HPL behaviors. Organizations should offer interventions to foster positive HPL attitude, give managers opportunities for HPL behavioral control, and promote perceived HPL norms. They should acknowledge that high workload may inhibit perceived HPL norms. Intervention approaches with regard to personnel and organizational development for practitioners are discussed. This study contributes to the literature by testing direct antecedents of HPL behaviors. Moreover, this study is the first to test workload as a boundary condition.
Human activity recognition via smart-belt in wireless body area networks
Authors: Zhu Yuhong , Yu Jingchao , Hu Fengye , Li Zhijun , Ling Zhuang
Published: May 2019

Human activity recognition based on wireless body area networks plays an essential role in various applications such as health monitoring, rehabilitation, and physical training. Currently, most of the human activity recognition is based on smartphone, and it provides more possibilities for this task with the rapid proliferation of wearable devices. To obtain satisfactory accuracy and adapt to various scenarios, we built a smart-belt which embedded the VG350 as posture data collector. This article proposes a hierarchical activity recognition structure, which divides the recognition process into two levels. Then a multi-classification Support Vector Machine algorithm optimized by Particle Swarm Optimization is applied to identify five kinds of conventional human postures. And we compare the effectiveness of triaxial accelerometer and gyroscope when used together and separately. Finally, we conduct systematic performance analysis. Experimental results show that our overall classification accuracy is 92.3% and the F-Measure can reach 92.63%, which indicates the human activity recognition system is accurate and effective.
Predictors of Aortic Valve Repair Failure
Authors: Yanagawa Bobby , Mazine Amine , El-Hamamsy Ismail
Published: May 2019

Aortic valve repair is the preferred approach for the treatment of severe aortic insufficiency (AI), as it allows patients to keep their native aortic valve, thus substantially reducing the risk of prosthesis-related complications. Several studies have documented excellent long-term outcomes of aortic valve repair. The major complication of this operation is AI recurrence, with ensuingneed for reoperation. The surgical experience accumulated over the last two decades has allowed for better understanding of the mechanisms of recurrent AI after aortic valve repair. Herein, we review the current state of knowledge on predictors of aortic valve repair failure. These include unaddressed annular dilation, residual cusp prolapse or retraction, commissural orientation, and use of patch material. This enhanced understanding has led to the development of increasingly refined techniques and improved patient outcomes. Continued follow-up and detailed data collection at the time of surgery, together with three-dimensional echo imaging, will allow further improvements in aortic valve repair.
The role of the advanced scrub practitioner
Authors: Al-Hashemi Jennifer
Published: May 2019

The roles of all healthcare professionals have changed considerably over the years and the nurse in particular has been affected. These changes have been influenced by the following guidance, Code of Professional Conduct (UKCC 1992) and Code of Professional Conduct (NMC 2004). Such changes involve the whole area of advancing roles in perioperative nursing, such as the nurse working as advanced scrub practitioner (ASP) (formally known as first assistant). Boss (2002) mentions that these new role developments are concerned with principles such as serving the interests of patients, providing holistic care, developing professional skills and knowledge and being accountable and responsible for your individual actions. Nurses acting as an ASP have many matters to contend with, such as autonomy, duty of care and other legal issues, and professional accountability. This paper explores these issues in more detail.
Seedling Selection Using Molecular Approach for Ex Situ Conservation of Critically Endangered Tree Species (Vatica bantamensis (Hassk.) Benth. & Hook. ex Miq.) in Java, Indonesia
Authors: Kusuma Yayan Wahyu C. , Ariati Siti R. , Risna Rosniati A. , Mitsuyuki Chika , Suyama Yoshihisa , Isagi Yuji
Published: May 2019

Ex situ conservation is an important complementary strategy for in situ to conserve endangered plant species. However, the limited areas designated for ex situ conservation such as in botanic gardens have become a great challenge for conservation practitioners and scientists attempting to optimally conserve the genetic diversity of targeted plant species. Our study aimed to assess genetic diversity and structure of wild seedlings of Vatica bantamensis, an endemic and critically endangered dipterocarp from Java (Indonesia). We also estimated genetic differentiation between the wild seedlings and existing ex situ collection and evaluated the genetic diversity preserved in the ex situ collection. Our analysis, using 730 single-nucleotide polymorphisms loci, showed that wild seedlings exhibited higher genetic diversity than the ex situ collection (nucleotide diversity, µ = 0.26 and 0.16, respectively). Significant genetic differentiation was also detected ( FST = 0.32) between wild seedlings and ex situ collection. Furthermore, we found high kinship within the ex situ collection suggesting low genetic diversity since the founding collection. We also detected three distinct genetic clusters from all samples combined (analysis of molecular variance, ϕ = 0.48, p < .001), with two clusters present in the wild seedlings that were not represented in the ex situ collection. We recommend that supplementary collections from the two newly identified genetic clusters in the wild seedlings should be incorporated to increase genetic diversity in the ex situ collection. Furthermore, our study demonstrated that understanding the population genetics of targeted endangered species provides better results for ex situ conservation strategies.
Quantitative diffusion magnetic resonance imaging for prediction of human papillomavirus status in head and neck squamous-cell carcinoma: A systematic review and meta-analysis
Authors: Payabvash Seyedmehdi , Chan Aimee , Jabehdar Maralani Pejman , Malhotra Ajay
Published: May 2019

Purpose

Head and neck squamous-cell carcinoma (HNSCC) related to human papillomavirus (HPV) infection represents a distinct biological and prognostic subtype compared to the HPV-negative form. Prior studies suggest a correlation between the apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) of primary tumor lesion and HPV status in HNSCC. In this meta-analysis, we compared the average ADC of primary lesion between HPV-positive and HPV-negative HNSCC.

Methods

A comprehensive literature search of PubMed and Embase was performed. Studies comparing the average ADC on echo-planar DWI of primary tumor lesions between HPV-positive and HPV-negative HNSCC were included. The standardized mean difference was calculated using fixed- and random-effects models. Tau-squared estimates of total heterogeneity and Higgins inconsistency index ( I2 test) were determined.

Results

A total of five studies, pooling data of 264 patients, were included for meta-analysis. Among these five studies, three had included oral cavity, hypopharyngeal, and/or laryngeal HNSCC in addition to oropharyngeal subsite. Primary lesions were comprised of 185 HPV-negative and 79 HPV-positive HNSCC. The meta-analysis showed lower average ADC values in HPV-positive HNSCC compared to the HPV-negative form, with a standardized mean difference of 0.961 (95% confidence interval 0.644–1.279; p < 0.0001). Since there was no significant heterogeneity in analysis ( p = 0.3852), both random- and fixed-effects models resulted in the same estimates of overall effect.

Conclusions

HPV-positive HNSCC primary lesions have a lower average ADC compared to the HPV-negative form, highlighting the potential application of quantitative diffusion magnetic resonance imaging as a noninvasive imaging biomarker for prediction of HPV status.
Combined effect of posttraumatic stress disorder and prescription opioid use on risk of cardiovascular disease
Authors: Scherrer Jeffrey F , Salas Joanne , Lustman Patrick , Tuerk Peter , Gebauer Sarah , Norman Sonya B , Schneider F David , Chard Kathleen M , van den Berk-Clark Carissa , Cohen Beth E , Schnurr Paula P
Published: May 2019

Aim

Prescription opioid analgesic use (OAU) is associated with increased risk of cardiovascular disease (CVD). OAU is more common in patients with than without posttraumatic stress disorder (PTSD), and PTSD is associated with higher CVD risk. We determined whether PTSD and OAU have an additive or multiplicative association with incident CVD.

Methods and results

Veterans Health Affairs patient medical record data from 2008 to 2015 was used to identify 2861 patients 30–70 years of age, free of cancer, CVD and OAU for 12 months before index date. We defined a four-level exposure variable: 1) no PTSD/no OAU, 2) OAU alone, 3) PTSD alone and 4) PTSD+OAU. Cox proportional hazard models estimated the association between the exposure variable and incident CVD. The mean age was 49.0 (±11.0), 85.7% were male and 58.3% were White, 34.4% had no PTSD/no OAU, 32.9% had PTSD alone, 10.6% had OAU alone, and 22.1% had PTSD+OAU. Compared with patients with no PTSD/no OAU, those with PTSD alone were not at increased risk of incident CVD (hazard ratio = 0.82; 95% confidence interval (CI): 0.63–1.17); however, OAU alone and PTSD+OAU were both significantly associated with incident CVD (hazard ratio = 1.99; 95% CI:1.36–2.92 and hazard ratio = 2.20; 95% CI: 1.61–3.02). There was no significant additive or multiplicative PTSD and OAU association with incident CVD.

Conclusion

OAU is associated with nearly a two-fold increased risk of CVD in patients with and without PTSD. Despite no additive or multiplicative interaction effects, the high prevalence of OAU in PTSD may represent a novel contributor to the elevated CVD burden among patients with PTSD.
Identifying causes of persistent HIV viremia in adult patients at an academic medical center
Authors: Steinbrink Julie , Imlay Hannah , Rao Krishna , Riddell James
Published: May 2019

Objectives:

Despite many advances in medicine, not all individuals with HIV are able to achieve complete virologic suppression. This retrospective study identifies variables associated with persistent HIV viremia in an academic clinic.

Methods:

We studied 66 HIV-infected patients with a viral load of >200 copies/mL over 1 year, with controls matched 1:1 via a propensity score utilizing age at diagnosis, era of diagnosis, gender, and initial CD4 count. We collected data on multiple variables including medications, adherence, comorbidities, hospitalizations, and insurance status. Conditional logistic regression was used for unadjusted and adjusted analyses.

Results:

A total of 66 viremic cases/matched controls were included. Fewer viremic patients were on antiretroviral therapy for all 12 months (45% vs 77%; odds ratio: 0.33, p = .018) and fewer were of white race (52% vs 70%; odds ratio: 0.49, p = .053). Hospitalization (11% vs 3%; odds ratio: 10, p = .028), underinsurance (20% vs 1%; odds ratio: 5.87, p = .022), and conflicting personal beliefs about their disease (17% vs 3%; odds ratio: 5.5, p = .027) were more common in viremic patients. Psychiatric illness increased the odds of viremia in patients who had four or more visits (odds ratio: 1.63/6.64 with four/five clinic visits, respectively).

Conclusion:

Psychiatric illness is an important contributor to the presence of persistent viremia in HIV-infected patients and deserves further study.
Appropriability: Theorisation essay on the role of appropriation in the second-hand item purchase process
Authors: Dehling Aurélie , Vernette Eric
Published: May 2019

This article presents a theorisation essay on the role of appropriation in the second-hand item purchase process. It highlights the concept of appropriability, which is defined as the relative potential of an object to become a consumer’s complete and entire possession. An item’s appropriability potential is relative to the prevalence of displayed traces from a previous owner or owners and the nature of the motivation that led to its acquisition. It also affects both the phases of a second-hand object’s appropriation process: (1) the Distancing phase, the intensity of which varies according to the prevalence of the Other’s trace and (2) the Absorption phase, the strategies of which – Denial, Creativity and Mastery – are defined by the nature of the purchase motivation.
Impact of Partnership Between Children’s HeartLink and IQIC Database With a Pediatric Cardiology and Cardiovascular Surgery Center in Brazil
Authors: Croti Ulisses Alexandre , Murakami Alexandre Noboru , De Marchi Carlos H. , Borim Bruna Cury , Dearani Joseph A. , Overman David , Hickey Patricia , Jenkins Kathy
Published: May 2019

Background:

Aiming at fostering local development of cardiology and cardiovascular surgery centers in developing countries, the nonprofit organization Children’s HeartLink (CHL) encourages centers to participate in the International Quality Improvement Collaborative Database for Congenital Heart Disease (IQIC). The definition of parameters and data to evaluate patient treatment provides an opportunity to improve quality of care, reducing morbidity and mortality. The objective of the study was to analyze the outcomes of the partnership between CHL and IQIC database with a single pediatric cardiology and cardiovascular surgery center for seven years providing continuous follow-up to guide actions aiming at morbidity and mortality reduction in patients with pediatric and congenital heart diseases.

Methods:

Data were collected from January 2011 to December 2017 independently and with external audits and included preoperative information (demographic data, nutritional status, chromosomal abnormalities), Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, and postoperative information such as infections or complications within the first 30 days or until hospital discharge and/or death.

Results:

In the preoperative period, there was a trend toward an increase in the number of newborn patients. The postoperative period showed significant surgical procedure variations between groups for RACHS-1 risk category ( P = .003), prevalence of risk categories 2 and 3, and an increase in risk categories 4, 5, and 6, mainly in the last two years. Decreases in surgical site infection ( P = .03), bacterial sepsis, and other infections (both P < .001) were observed. At the 30-day postoperative follow-up, there was a decrease of in-hospital ( P = .16) and 30-day ( P = .14) mortality.

Conclusion:

The partnership between CHL and this seven-year analysis of IQIC database demonstrated structural and human flaws, whose resolution led to significant decrease in infection and reduction in mortality despite an increase in the complexity of our pediatric and congenital heart disease population.
Children’s Heart Assessment Tool for Transplantation (CHAT) Score: A Novel Risk Score Predicts Survival After Pediatric Heart Transplantation
Authors: Fraser Charles D. , Grimm Joshua C. , Zhou Xun , Lui Cecillia , Giuliano Kate , Suarez-Pierre Alejandro , Crawford Todd C. , Magruder J. Trent , Hibino Narutoshi , Vricella Luca A.
Published: May 2019

Background:

Given the shortage of donor organs in pediatric heart transplantation (HTx), pretransplant risk stratification may assist in organ allocation and recipient optimization. We sought to construct a scoring system to preoperatively stratify a patient’s risk of one-year mortality after HTx.

Methods:

The United Network for Organ Sharing database was queried for pediatric (<18 years) patients undergoing HTx between 2000 and 2016. The population was randomly divided in a 4:1 fashion into derivation and validation cohorts. A multivariable logistic regression model for one-year mortality was constructed within the derivation cohort. Points were then assigned to independent predictors ( P < .05) based on relative odds ratios (ORs). Risk groups were established based on easily applicable, whole-integer score cutoffs.

Results:

A total of 5,700 patients underwent HTx; one-year mortality was 10.7%. There was a similar distribution of variables between derivation (n = 4,560) and validation (n = 1,140) cohorts. Of the 12 covariates included in the final model, nine were allotted point values. The low-risk (score 0-9), intermediate-risk (10-20), and high-risk (>20) groups had a 5.18%, 10%, and 28% risk of one-year mortality ( P < .001), respectively. Both intermediate-risk (OR = 2.46, 95% confidence interval [95% CI]: 1.93-3.15; P < .001) and high-risk (OR = 9.24, 95% CI: 6.92-12.35; P < .001) scores were associated with an increased risk of one-year mortality when compared to the low-risk group.

Conclusions:

The Children’s Heart Assessment Tool for Transplantation score represents a pediatric-specific, recipient-based system to predict one-year mortality after HTx. Its use could assist providers in identification of patients at highest risk of poor outcomes and may aid in pretransplant optimization of these children.
Workforce Cost Model for Expanding Congenital and Rheumatic Heart Disease Services in Kenya
Authors: Kontchou Nelly-Ange T. , McCrary Andrew W. , Schulman Kevin A.
Published: May 2019

Background:

Cardiovascular disease is the number one global killer, with over three quarters of these deaths arising from the populations of low- and middle-income countries (LMICs). Addressing the burden of cardiovascular disease in LMICs must include medical and surgical services for these patients. In this article, we model the needs and costs to scale up the cardiac provider workforce in Kenya, which can be adapted to other LMICs based on country-specific workforce hours and workforce salaries.

Methods:

Using published epidemiological reports from sub-Saharan Africa, we structured the model based on the expected disease burden of congenital and rheumatic disease in a simulated 1,000-person population. Services modeled include clinic visits, echocardiograms, diagnostic cardiac catheterizations, interventional catheterizations, and heart surgery. Costs were modeled based on Kenyan public sector salaries. After scaling the model, we created a sensitivity analysis of change in service duration and salaries.

Results:

Based on a 1,000-person Kenyan population, we estimate that 2.5 heart surgeries will be needed every year, with a corresponding annual workforce cost of US$526. Including accompanying services of clinic visits, echocardiograms, and both diagnostic and interventional cardiac catheterizations, the total annual workforce cost is US$899. Based on estimated productive hours for public sector workforce, 196 full-time equivalent cardiac surgeons will be needed for the entire population of Kenya (2017 figure).

Conclusions:

We present a model for appropriate cardiovascular service staffing based on disease burden and workforce costs. This model can be scaled up as needed to plan for local capacity building.
Long-Term Fate of the Neoaortic Root After Neonatal Ross Operation: A Case Series
Authors: Pradegan Nicola , Castaldi Biagio , Azzolina Danila , Stellin Giovanni , Vida Vladimiro L.
Published: May 2019

The aim of this study is to analyze the adaptation properties of the pulmonary autograft in four infants who underwent the Ross operation before one year of life. The patients underwent serial echocardiographic assessments of the autograft diameters at short- and long-term follow-up and values were reported as the Z scores for normal aortic and pulmonary diameters. At a median follow-up time of 18.5 years (range: 18.2-19.4 years), all the patients are alive, none requiring autograft reinterventions. This series shows excellent adaptation potential of the “infant pulmonary autograph” in the long-term, during somatic growth of the patient.
Hepatic Vein Incorporation Into the Azygos System in Heterotaxy and Interrupted Inferior Vena Cava
Authors: Montesa Christine , Karamlou Tara , Ratnayaka Kanishka , Pophal Stephen G. , Ryan Justin , Nigro John J.
Published: May 2019

Background:

Patients with heterotaxy, single ventricle and interrupted inferior vena cava are at risk of developing significant pulmonary arteriovenous malformations and cyanosis, and inequitable distribution of hepatic factor has been implicated in their development. We describe our experience with a technique for hepatic vein incorporation that reliably provides resolution of cyanosis and presumably equitable hepatic factor distribution.

Methods:

A retrospective review of a single-surgeon experience was conducted for patients who underwent this modified Fontan operation utilizing an extracardiac conduit from the hepatic veins to the dominant superior cavopulmonary connection. Preoperative characteristics and imaging, operative details, and postoperative course and imaging were abstracted.

Results:

Median age at operation was 5 years (2-10 years) and median weight was 19.6 kg (11.8-23 kg). Sixty percent (3/5) of patients had Fontan completion without cardiopulmonary bypass, and follow-up was complete at a median of 14 months (range 1-20 months). Systemic saturations increased significantly from 81% ± 1.9% preoperatively to 95% ± 3.5% postoperatively, P = .0008. Median length of stay was 10 days (range: 7-14 days). No deaths occurred. One patient required reoperation for bleeding and one was readmitted for pleural effusion. Postoperative imaging suggested distribution of hepatic factor to all lung segments with improved pulmonary arteriovenous malformation burden.

Conclusions:

Hepatic vein incorporation for patients with heterotaxy and interrupted inferior vena cava should optimally provide equitable pulmonary distribution of hepatic factor with resolution of cyanosis. The described technique is performed through a conventional approach, is facile, and improves cyanosis in these complex patients.
The Search for Data, the Only True Justice
Authors: St. Louis James D.
Published: May 2019

The practice of congenital heart surgery faces intense public scrutiny. Collaboration is key to improve our processes and outcomes. Croti and colleagues report on one such collaboration between Children’s Heart Link, IQIC, and a Brazilian congenital heart program and demonstrate the value of this approach convincingly.
Clinicopathological Characteristics of Hirschsprung’s Disease With Emphasis on Diagnosis and Management: A Single-Center Study in the Kingdom of Saudi Arabia
Authors: Howsawi Abdulaziz , Bamefleh Hanaa , Al Jadaan Saud , Crankson Stanley , Alkhilaiwi Rakan , Al-Essa Rakan , Aljahdali Fares , Al Nemari Jameel , Al Aqeely Khalid , Al Howti Sultan , Al Juhaiman Majed , Bin Dajim Nayef
Published: May 2019

Introduction: Hirschsprung’s Disease (HD) is a motor disorder of the gut caused by the failure of neural crest cells to migrate craniocaudally into the bowel during intestinal development, resulting in a functional obstruction. The majority of patients with HD are diagnosed in the neonatal period when they present with symptoms of distal intestinal obstruction. Aim: This study aims to identify the clinic-pathological characteristic of HD patients in our institution in KSA and comparing it with local and international data. Materials and Methods: This retrospective cohort study was conducted in King Abdulaziz Medical City (KAMC), a tertiary care center in Riyadh, Kingdome of Saudi Arabia (KSA). Results: A total of 54 patients (72% male) were diagnosed with HD. Forty-eight patients (89%) were born at term, and 6 were pre-term. Sixty-three percent of the patients presented in the neonatal period. Twenty-two patients (41%) underwent one-stage endorectal pull-through procedure, 23 patients (43%) two-stage endorectal pull-through, and 9 patients (16%) had three-stage endorectal pull-through. Five out of 54 patients had ganglion cells seen on FS but were absent in the permanent section. Therefore, the concordance rate was 90.8%. Conclusion: FS biopsy is a necessary method to determine the level of aganglionosis intraoperatively in HD, but the definitive diagnosis should be with permanent section. Also, the choice of surgical operation type (single-stage or multi-stage pull-through) depends on the patient’s clinical condition.
Modeling Organizational Project Management
Authors: Müller Ralf , Drouin Nathalie , Sankaran Shankar
Published: May 2019

The contemporary discourse on organizational project management (OPM) complements project, program, and portfolio management with emerging elements, such as governance, projectification, the project management office (PMO), and organizational design. This creates the need for an integrated model that defines the content and roles in OPM. This article addresses this by conceptually developing a seven-layered model that organizes 22 OPM elements, ranging from the corporate level to the management of individual projects. A theory is developed to explain the interaction of the elements and the layers within the model.
Acalabrutinib monotherapy in patients with chronic lymphocytic leukemia who are intolerant to ibrutinib
Authors: Awan Farrukh T. , Schuh Anna , Brown Jennifer R. , Furman Richard R. , Pagel John M. , Hillmen Peter , Stephens Deborah M. , Woyach Jennifer , Bibikova Elena , Charuworn Prista , Frigault Melanie M. , Hamdy Ahmed , Izumi Raquel , Linghu Bolan , Patel Priti , Wang Min Hui , Byrd John C.
Published: May 2019

Key Points

Acalabrutinib had good tolerability in patients with relapsed or refractory CLL who were intolerant to ibrutinib. Acalabrutinib demonstrated a high response rate (81%) in patients with relapsed or refractory CLL who were intolerant to ibrutinib.
Outcomes reported on the management of COPD exacerbations: a systematic survey of randomised controlled trials
Authors: Mathioudakis Alexander G. , Moberg Mia , Janner Julie , Alonso-Coello Pablo , Vestbo Jørgen
Published: May 2019

Randomised controlled trials (RCTs) evaluating the management of acute exacerbations of chronic obstructive pulmonary disease (COPD) report heterogeneous outcome measures, thus rendering their results incomparable, complicating their translation into clinical practice. As a first step in the development of a core outcome set that will aim to homogenise outcome measures in future RCTs, we assessed the outcomes reported in recent relevant RCTs and systematic reviews.

We conducted a methodological systematic review (https://www.crd.york.ac.uk/prospero/registration number CRD42016052437) of RCTs and systematic reviews on COPD exacerbation management indexed on Medline and PubMed during the last decade. We evaluated their methodology, specifically focusing on the reported outcome measures.

Based on 123 RCTs and 38 systematic reviews, we found significant variability in the outcomes reported and in their definition. Mortality, which was assessed in 82% of the included trials, was the most frequently assessed outcome, followed by the rate of treatment success or failure (63%), adverse events (59%), health status, symptoms and quality of life (59%), lung function (47%), and duration of exacerbations (42%).

The significant heterogeneity in the selection and definition of outcome measures in RCTs and systematic reviews limits the interpretability and comparability of their results, and warrants the development of a core outcome set for COPD exacerbations management.
Exploring the potential benefits of digital health technology for the management of COPD: a qualitative study of patient perceptions
Authors: Slevin Patrick , Kessie Threase , Cullen John , Butler Marcus W. , Donnelly Seamas C. , Caulfield Brian
Published: May 2019

Engaging chronic obstructive pulmonary disease (COPD) patients to actively participate in self-management has proven difficult. Digital health technology (DHT) promises to facilitate a patient-centred care model for the management of COPD by empowering patients to self-manage effectively. However, digital health studies in COPD have yet to demonstrate significant patient outcomes, suggesting that this research has still to adequately address the needs of patients in the intervention development process. The current study explored COPD patients' perceptions of the potential benefits of DHT in the self-management and treatment of their disease.

A sample of convenience was chosen and participants (n=30) were recruited from two Dublin university hospitals and each underwent a qualitative semi-structured interview. Thematic analysis of the data was completed using NVivo 12 software.

Six themes were identified: symptom management, anxiety management, interaction with physician, care management, personalising care and preventative intervention.

In our findings, patients reported a willingness to take a more active role in self-management using DHT. They perceived DHT potentially enhancing their self-management by improving self-efficacy and engagement and by supporting healthcare professionals to practise preventative care provision. The findings can be used to inform patient-centred COPD digital interventions for researchers and clinicians who wish to develop study aims that align with the needs and preferences of patients.