bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical properties, morphology, and Mullins effect of thermoplastic elastomers based on polypropylene and waste ethylene–propylene–diene terpolymer powder compatibilized by styrene–butadiene–styrene block copolymer
Authors: Song Xianfen , Wang Zhaobo , Wang Baoxiang
Published: January 2014

Thermoplastic elastomers (TPEs) based on polypropylene (PP)/waste ethylene–propylene–diene terpolymer powder (WEPDMP) composites were prepared by melt compounding, and the composites were compatibilized by styrene–butadiene–styrene block copolymer (SBS). The effects of SBS compatibilizer on mechanical, morphological properties, and the Mullins effect of the TPEs were investigated systematically. Experimental results indicate that SBS had a good compatibilization effect on the PP/WEPDMP composites. Compared with PP/WEPDMP composites, the tensile strength and the elongation at break went through a maximum value at an SBS content of 6 phr, which were improved by 49.4 and 170.3%, respectively. Morphology study shows that the interface interaction of the PP/WEPDMP composites compatibilized by SBS was strong, which contributed to the significantly improved mechanical properties. Mullins effect results show that the softening obviously appeared after the second loading–unloading cycle, while the maximum stress decreased slightly at the later cycles and the internal friction loss of PP/SBS/WEPDMP composites was lower than that of PP/WEPDMP composites, indicating the elasticity of PP/WEPDMP TPE is improved by the incorporation of SBS.
Dynamic mechanical properties, thermal, mechanical properties and morphology of long glass fiber-reinforced thermoplastic polyurethane/acrylonitrile–butadiene–styrene composites
Authors: He Min , Zhang Daohai , Guo Jianbing , Wu Bin
Published: January 2014

A series of the long glass fiber–reinforced thermoplastic polyurethane elastomers and acrylonitrile–butadiene–styrene (LGF/TPU/ABS) composites with different content of LGFs were prepared using self-designed impregnation device. Dynamic mechanical properties of the LGF/TPU/ABS composites have been investigated using dynamic mechanical thermal analysis. The results indicated that the content of LGFs and scanning frequency have some effect on the dynamic mechanical properties and glass transition of LGF/TPU/ABS composites. In the meantime, the Arrhenius relationship has been used to calculate the activation energy of α-transition of the LGF/TPU/ABS composites. The thermogravimetric analysis thermograms of the LGF/TPU/ABS composites were found to decrease in two steps. The good dispersion of the LGFs in the matrix resins is obtained from scanning electron micrographs. In addition, effects of the LGF contents on mechanical properties of LGF/TPU/ABS composites were investigated.
Prenatal Yoga in Late Pregnancy and Optimism, Power, and Well-Being
Authors: Reis Pamela J. , Alligood Martha R.
Published: January 2014

The study reported here explored changes in optimism, power, and well-being over time in women who participated in a six-week prenatal yoga program during their second and third trimesters of pregnancy. The study was conceptualized from the perspective of Rogers’ science of unitary human beings. A correlational, one-group, pre-post-assessment survey design with a convenience sample was conducted. Increases in mean scores for optimism, power, and well-being were statistically significant from baseline to completion of the prenatal yoga program. Findings from this study suggested that yoga as a self-care practice that nurses might recommend to promote well-being in pregnant women.
The Science of Unitary Human Beings Continues to Flourish
Authors: Karnick Paula M.
Published: January 2014

Much of the nursing discipline scoffed at Martha Rogers’ (1914-1994) theory of unitary human beings for many years. Rogers was a visionary. She saw things others never could imagine. Her theory lives on today and if one is open to the possibles, one may actually see what Rogers conceptualized, a differemt way of looking at the human experience and caring for patients.
Conducting End-of-Life Research
Authors: Kavanaugh Karen L. , Campbell Margaret L.
Published: January 2014

Conducting studies at the end of life is often challenging for researchers due to the sensitive nature of the research, the vulnerability of the participants and the inherent methodological complexities. Methodological challenges include identifying and gaining access to eligible research participants, estimating the duration of patient survival time in the study, minimizing the potential burden of data collection, and attending to issues of consent and confidentiality. In this paper, the authors identify challenges when conducting end-of-life research and draw from collective research experiences to describe strategies to achieve success.
Nursing in Portugal
Authors: Baumann Steven L.
Published: January 2014

This global perspectives column on nursing in Portugal is based primarily on an edited transcript of an interview by the author with Nuno Miguel Dias Pereira, who has a master’s degree in nursing management and is a doctoral nursing student at Lisbon University. The interview took place on June 7, 2013. In additional to being a doctoral student, Mr. Periera has a position at the Portuguese Institute of Oncology in Lisbon.
Economic Crisis, Poverty and Social Policy in Mexico
Authors: Castillo Fernández Dídimo , Arzate Salgado Jorge
Published: January 2014

This article describes the structural characteristics and socioeconomic effects of the neoliberal model that was implemented in Mexico at the beginning of the 1980s. Employment conditions, informal and precarious labor, and poverty generated by neoliberalism are analyzed. The article examines how the economic crisis has been dealt with through macroeconomic policies and social development by the Mexican Government. The characteristics of the public welfare system and the social policies that have been used during this neoliberal period are scrutinized. The program Oportunidades (Opportunities) as the primary national effort made by the government to combat extreme poverty is examined in detail. It has a social policy focus and is assistance-based which has yielded public financing at a high cost with limited poverty reduction. It is proposed that there are intrinsic limitations to these kinds of policy, leading to an increase in fragmented and ineffectual programs.
Reframing employee voice: a case study in Sri Lanka’s export processing zones
Authors: Gunawardana Samanthi J
Published: January 2014

Labour-intensive workplaces in export processing zones (EPZs) are typically characterized as ‘sweatshop-like’, devoid of voice mechanisms. Using ethnographic data in a Sri Lankan EPZ apparel factory and focusing on social interaction on the shop floor, the findings demonstrated the way workers exercised formal and informal voice individually and collectively. These findings are understood against a theoretical dialogue between interdisciplinary perspectives of voice across different bodies of literature. Ethnographic insights on the enactment of voice illuminate the importance of worker agency and the social and cultural contextual nature of exercising voice in the workplace.
Structural and instrumentation design of a microelectromechanical systems biaxial accelerometer
Authors: Zou Ting , Angeles Jorge
Published: January 2014

Microscale biaxial accelerometers are required to be sensitive to applied accelerations and manufacturable by means of microelectromechanical systems technology. In order to meet these requirements, a compliant realization of biaxial accelerometers, dubbed simplicial biaxial accelerometers, has been proposed, as reported in this paper. Notched joints, to realize what is termed Π-joints in the parallel-robots literature, are employed and then improved by the introduction of Lamé-shaped hinges serving as flexible joints. The sensitivity of the simplicial biaxial accelerometers in estimating accelerations is investigated and validated by means of finite element analysis. The sensing system is embedded in the simplicial biaxial accelerometers, with piezoresistive sensing technology adopted in the instrumentation design. Using the principles of piezoresistive sensing, the electronic layout is developed for the accelerometer. Through the piezoresistive analysis implemented on the finite element model of the simplicial biaxial accelerometers, the matrix that maps voltage signals into acceleration signals is derived. By virtue of both the structural and electronic designs, the accelerometer is observed to be sensitive to accelerations in its plane, but fairly insensitive to accelerations in any of the other four directions of the rigid-body motion. Finally, prototypes were fabricated with microelectromechanical systems technology to test the microfabrication feasibility of the structure and measurement system of the accelerometer. Test results are the subject of a forthcoming paper.
Numerical solution for dynamic analysis of semicircular curved beams acted upon by moving loads
Authors: Nikkhoo Ali , Kananipour Hassan
Published: January 2014

The present study proposes a dynamic numerical solution for deflections of curved beam structures. In order to extract characteristic equations of an arch under an in-plane constant moving load, an analysis procedure based on the Euler–Bernoulli beam theory considering polar system is conducted. A prismatic semicircular arch with uniform cross section, in various boundary conditions, is assumed. Radial and tangential displacements, as well as bending moments are obtained using differential quadrature method as a well-known numerical method. In addition to parametric studies, a curved steel bridge as an actual application is analyzed by the mentioned method. By using this differential quadrature technique, the function values and some partial derivatives are approximated by weighting coefficients. Convergence study is carried out to demonstrate the stability of the present method. In order to confirm the high level of accuracy of this approach, some comparisons are made between the results obtained by selected methods such as differential quadrature method, Galerkin method, and finite element method. The results show that in the structural problems with specific geometry, using differential quadrature method, which is independent of domain discretization, is proven to be efficient.
Bending and contact fatigue strength of innovative steels for large gears
Authors: Gorla Carlo , Rosa Francesco , Conrado Edoardo , Albertini Horacio
Published: January 2014

Large gears for wind turbine gearboxes require high performances and cost-effective manufacturing processes. Heat distortion in the heat treatment phase and the consequent large grinding stock are responsible for high manufacturing costs due to reduced productivity. A research project aimed at the identification of new materials, manufacturing and heat treatment processes has been performed. Air quenchable alloy steels, combined with a specifically developed case hardening and heat treatment process, have been identified as an interesting solution, both from the point of view of cost effectiveness, thanks to reduced distortions and grinding stock, and for the environmental sustainability. The research project has been completed by the manufacturing of a full-scale gear, on which the whole process has been validated. Nevertheless, in order to judge the applicability of these steels to large gears, data from specific tests on the performances against typical gear failure modes, like bending and contact fatigue, are necessary as well. Single tooth fatigue bending tests and disc-on-disc contact fatigue tests have therefore been performed on two innovative materials, respectively, a high hardenability steel and a bainitic structure steel, and on a reference traditional case hardening steel. The results of these tests, which provide useful data for gear designers, are presented and discussed in this paper.
Catching Eyes
Authors: Böckler Anne , van der Wel Robrecht P. R. D. , Welsh Timothy N.
Published: January 2014

Direct eye contact and motion onset are two powerful cues that capture attention. In the present study, we combined direct gaze with the sudden onset of motion to determine whether these cues have independent or shared influences. Participants identified targets presented randomly on one of four faces. Initially, two faces depicted direct gaze, and two faces depicted averted gaze. Simultaneously with or 900 ms before target presentation, one face with averted gaze switched to direct gaze, and one face with direct gaze switched to averted gaze. When gaze transitions and target presentation were simultaneous, the greatest response-time facilitation occurred at the location of the sudden onset of direct gaze. When target presentation was delayed, direct-gaze cues maintained a facilitatory influence, whereas motion cues induced an inhibitory influence. These findings reveal that gaze cues and motion cues at the same location influence information processing via independent and concurrently acting social and nonsocial attention channels.
Synergistic effects of BuChE non-UU phenotype and paraoxonase (PON1) 55 M allele on the risk of systemic lupus erythematosus: influence on lipid and lipoprotein metabolism and oxidative stress, preliminary report
Authors: Bahrehmand F , Vaisi-Raygani A , Rahimi Z , Ahmadi R , Kiani A , Tavilani H , Vaisi-Raygani H , Pourmotabbed T
Published: January 2014

There is some evidence indicating lipid peroxidation can affect progression of atherosclerosis, cardiovascular diseases (CVDs) and glomerulonephritis in systemic lupus erythematosus (SLE) patients. Human butyrylcholinesterase (BuChE) and paraoxonase-1 (PON1) are two major bioscavenger enzymes that are associated with inflammation, oxidative stress and lipid metabolism. Hyperlipidemia, increase in lipid oxidation reactions and defects in antioxidant status may lead to increased oxidative stress and high frequency of CVDs in SLE. It has also been suggested that deficiency in the function of the antioxidant system and an increase in reactive oxygen release (ROS) may play an important role in the pathogenesis of SLE. This study is the first investigation to examine the association of BuChE phenotypes, PON1 (L55M; PON-55-M) polymorphism, the levels of malondialdehyde (MDA), neopterin, lipid-lipoprotein and activities of BuChE and arylesterase activity (ARE) of PON with severity of SLE.

The present case-control study consisted of 109 SLE patients and 101 gender- and age-matched, unrelated healthy control subjects from the population of west Iran. We found that the PON-55-M allele and BuChE non-UU act synergistically to increase the risk of SLE by 2.5 times (1.03–6.7, p = 0.044). There was a significant negative correlation between severity of SLE with serum BuChE activity ( R = −0.31, p < 0.001) and positive correlation with serum neopterin level. The SLE patients with the PON-55-M (M/L + M/M) allele or with BuChE non-UU phenotype had significantly lower serum ARE and BuChE activities than those with PON-55-L/L or BuChE-UU phenotypes, respectively. In addition, their serum levels of MDA, neopterin and LDL-C were significantly elevated, suggesting that these individuals are more susceptible to CVD. However, further studies are needed to shed more light on the contribution of the M allele of PON1 and non-UU phenotypes of BuChE in the development of SLE in different ethnicities.
A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis
Authors: Shaharir SS , Ghafor AH Abdul , Said MS Mohamed , Kong NCT
Published: January 2014

Introduction

Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE).

Objective

The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients.

Methods

Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN.

Results

A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies ( p < 0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage ( p < 0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage.

Conclusion

Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage.
Simultaneous changes in serum HMGB1 and IFN-α levels and in LAIR-1 expression on plasmatoid dendritic cells of patients with juvenile SLE.. New therapeutic options?
Authors: Kanakoudi-Tsakalidou F , Farmaki E , Tzimouli V , Taparkou A , Paterakis G , Trachana M , Pratsidou-Gertsi P , Nalbanti P , Papachristou F
Published: January 2014

We investigated the simultaneous changes in serum levels of HMGB1 and IFN-α as well as in LAIR-1 expression on plasmatoid dendritic cells (pDCs) of juvenile systemic lupus erythematosus (jSLE) patients in order to explore their involvement in the disease pathogenesis and their correlation with disease activity and other characteristics. In total, 62 blood samples were studied from 26 jSLE patients (18 girls), aged 8–16 years. Twenty healthy subjects (16 girls) of comparable age were included as healthy controls (HCs). Concentrations of serum HMGB1 and IFN-α were assessed by ELISA and LAIR-1 expression on pDCs by five-color flow cytometry. The disease activity index was assessed by SLEDAI and ECLAM scores. It was found that mean serum levels both of HMGB1 and IFN-α were significantly increased in jSLE patients compared to HCs and in jSLE patients with active disease with or without active nephritis compared to those with inactive disease. Mean serum levels of HMGB1 were positively correlated with levels of IFN-α and both were positively correlated with the SLEDAI and ECLAM scores. The expression of LAIR -1 on pDCs of jSLE patients was significantly lower than that of HCs. In conclusion, our findings indicate that serum HMGB1 not only represents a potential marker of disease activity but together with the lack of LAIR-1 inhibitory function may contribute to the sustained inflammatory action of IFN-α in jSLE. In this regard, blocking the action of HMGB1 and its receptors or enhancing the expression/inhibitory function of LAIR-1 on pDCs should be included in future immune interventions for controlling jSLE.
Organizational evolution at Lybrand, Ross Bros. and Montgomery in the twentieth century
Authors: Chandar Nandini , Collier Deirdre , Miranti Paul
Published: January 2014

This article examines the evolution of practice strategy and organizational structure at the US accounting firm Lybrand, Ross Bros. & Montgomery from its inception in 1898 through to its merger with Price Waterhouse in 1998. We focus on the interaction between the firm and its broader economic, social and political contexts as we analyze key drivers of organizational change. The accounting enterprise developed a dual strategy involving both horizontal integration and service diversification for adapting successfully to changes in markets, professional knowledge, technology and regulation. Organizational learning was fundamental to its successful evolution in scale and scope as it enabled the firm to develop strategies and structures that responded effectively to changing external challenges and opportunities.
Factors Associated With Futile End-Of-Life Intensive Care in a Cancer Hospital
Authors: Cruz Vasco Moscovici da , Camalionte Lucimara , Caruso Pedro
Published: January 2014

Background:

Management of critically ill patients involves weighing potential benefit of advanced life support against preserving quality of life, avoidance of futile measures and rational use of resources.

Aim:

Our study aims to identify the predisposing factors involved in the institution and maintenance of futile intensive care support in terminally ill cancer patients in whom no additional treatment for the malignant disease would be offered.

Design:

We retrospectively analysed the medical records of patients who died in a tertiary cancer hospital (Hospital A C Camargo, São Paulo, Brazil) during an eight month period. Medical futility was defined when a patient, despite having been stated in the hospital records as having no possible lifespan extending treatment, was admitted to intensive care and received advanced life support. These cases were compared to controls who received palliative end-of-life care.

Results:

Three hundred and forty-seven deaths were recorded, of which 238 did not undergo futile treatment, 71 received full code treatment and 38 received futile treatments. Statistically significant predisposing factors for medical futility were, in our analysis, lack of palliative care team consultation (p < 0.001) and hematologic malignancy (p = 0.036). Qualitative analysis of medical records traced futile treatments to physicians’ lacking proactive attitudes in considering prognosis and talking to families.

Conclusions:

We conclude that a significant minority of end-of-life care consists of futile treatments. Strategies to increase Oncologists’ and Critical Care specialists’ alertness to these issues and expand indications of Palliative Care consultations are recommended.
Episodes of Mental Health Treatment Among a Nationally Representative Sample of Children and Adolescents
Authors: Saloner Brendan , Carson Nicholas , Cook Benjamin Lê
Published: January 2014

Despite renewed national interest in mental health care reform, little is known about treatment patterns among youth in the general population. Using longitudinal data from the Medical Expenditure Panel Survey, we examined both initiation and continuity of mental health treatment among 2,576 youth aged 5 to 17 with possible mental health treatment need (defined as a high score on a parent-assessed psychological impairment scale, fair/poor mental health status, or perceived need for counseling). Over a 2-year period, fewer than half of sampled youth initiated new mental health treatment. Minority, female, uninsured, and lower-income youth were significantly less likely to initiate care. Only one third of treatment episodes met criteria for minimal adequacy (≥4 provider visits with psychotropic medication treatment or ≥8 visits without medication). Episodes were significantly shorter for Latino youth. Efforts to strengthen mental health treatment for youth should be broadly focused, emphasizing not only screening and access but also treatment continuity.
Compliance with safe handling guidelines of antineoplastic drugs in Jordanian hospitals
Authors: Al-Azzam Sayer I , Awawdeh Banan T , Alzoubi Karem H , Khader Yousef S , Alkafajei Ahmed M
Published: January 2014

Objective

To evaluate the compliance of healthcare workers with standard safety guidelines during the preparation and administrations of antineoplastic medications.

Design

A cross-sectional survey study.

Setting

All hospitals in Jordan where healthcare workers are involved in preparation and administration of antineoplastic medications.

Participants

All healthcare workers who are involved in preparation and administration of antineoplastic medications in Jordanian hospitals.

Intervention

A questionnaire that covered information about work place, healthcare workers, and use of personal protective equipments during handling of antineoplastic medications was self-filled by each participant.

Main outcome measures

Compliance rates with workplace requirements, healthcare workers, and use of personnel protective equipments.

Results

Majority of participants (74.2%), representing nine out of 15 (60%) hospitals, reported full compliance of workplace with all requirements of the guidelines. Items with full compliance in all hospitals were availability of policies and procedures for safe handling of antineoplastic agents, availability of reporting system, and availability of sharp containers. Concerning healthcare workers’ guidelines, worker with full compliance were 46.4% of participants. Items with least compliance rate were working inside biological safety cabinet (65.1%) and having training program on handling chemotherapy medications (66.7%). Finally, concerning items-related personal protective equipments, only 10.7% of participants reported full compliance. Items with least compliance rates were wearing goggles (eye protection), shoe cover, and hair cover.

Conclusions

Results of this study showed the levels of compliance with guidelines pertaining to work place and workers who prepare and administer antineoplastic medications. Among other points, compliance with guidelines pertaining to wearing personnel protective equipments was limited and required further improvement.
Why do European political groups call the roll?
Authors: Finke Daniel
Published: January 2014

Research on legislative behaviour in the European Parliament is heavily reliant on recorded votes. Previous theoretical work has uncovered competing selection mechanisms that might cause a vote to be recorded. It has been argued that European Political Groups call the roll because the voting mode affects MEPs’ voting decisions. However, the underlying causal mechanism, as well as the size and direction of this effect, remains a matter of dispute. Drawing on a unique dataset, the article puts these arguments to an empirical test, the results suggesting that European Political Groups are more likely to call the roll if they stand to benefit from an overall lower level of voting cohesion. Moreover, I find that roll-call votes are frequently motivated by position-taking rather than by policy-seeking motives. These findings have significant, but ambivalent, implications for the analysis of recorded votes in the European Parliament.
Does disclosure matter? Integrating organizational learning and impression management theories to examine the impact of public disclosure following failures
Authors: Desai Vinit M
Published: January 2014

The typically disparate literatures on organizational learning and impression management have both separately sought to examine how organizations respond following failure, with the former asking how organizations learn from these events and the latter investigating how organizations use public disclosures to manage perceptions following these events. This study integrates these perspectives to ask how disclosures might impact learning through failure. The study distinguishes between major and minor failures, asserting that public disclosures exert a distinct influence on learning through either form of experience. Related hypotheses are tested on failures arising within the US air-traffic control system. Although no support is obtained for predictions about major failures, the study finds that facilities can learn through minor failures but the process is impeded by public disclosures, suggesting the notable influence that these disclosures have over audiences’ perceptions of the organization or its role in these events. This approach addresses a longstanding tension regarding why some organizations learn more effectively than others by emphasizing how organizations shape interpretations of their experience.
The medical record as legal document: When can the patient dictate the content? An ethics case from the Department of Neurology
Authors: Accordino Robert , Kopple-Perry Nicholas , Gligorov Nada , Krieger Stephen
Published: January 2014

Confidentiality of health information is increasingly relevant in the era of electronic medical records. We discuss the case of a hospitalized patient who requested a neurology consultation for an episode he described as an “LSD-like” (Lysergic acid diethylamide) flashback. The patient expressed concern that the episode was a residual effect of past drug use, but subsequently requested that his drug use not be documented. Involved in a custody battle, he feared that if his records were released to the court he could lose custody of his children. Ethical concerns arose with regards to the physician’s competing obligations with a duty to record information accurately and honestly, respect patient autonomy, and maintain patient confidentiality. We discuss the decision of the team to document the patient’s drug use by arguing that the obligation to maintain confidentiality did not supersede the primary role of the medical record as a complete and accurate account, which cannot be altered at a patient’s behest.
Brief Eclectic Psychotherapy for an Older Dutch Woman With Late-Onset Posttraumatic Stress Disorder Complicated by a Cerebral Vascular Accident
Authors: Gielkens Ellen M. J. , van Alphen Bas , Sobczak Sjacko , Segal Daniel L.
Published: January 2014

Posttraumatic stress disorder (PTSD) is a mental disorder that is known to have deleterious psychological, physical, and social impacts on individuals. Recognition of PTSD in older adults is difficult due to the complicated presentation taking into account that PTSD symptoms may be masked by other psychiatric and/or somatic diagnoses that are more common in older adults. Furthermore, some older adults may underreport their PTSD symptoms, and the relationship between current symptoms and distant traumas may be difficult to detect. Limited empirical research has been done on the manifestation, course, and treatment of PTSD in older adults. In this article, the literature on PTSD in older adults is reviewed, including discussion of common diagnostic problems, illustrated by a case report of an older woman with late-onset PTSD after a cerebral vascular accident (CVA). In conclusion, identifying PTSD in older adults can be difficult. However, detecting PTSD in older adults is critically important so that possibly hidden or masked trauma symptoms can be addressed in treatment, even if there are complicating factors such as a CVA.
Effect of Cilostazol Prescribed in a Pragmatic Treatment Program for Intermittent Claudication
Authors: Lee Constance , Nelson Peter R.
Published: January 2014

Background:

Controlled trials of cilostazol for claudication demonstrate improvements in walking distance and quality of life. Without the structure of a study environment, it is not certain that cilostazol has similar efficacy.

Method:

Retrospective review of patients prescribed cilostazol for claudication was undertaken. Patients were advised to stop smoking and increase exercise but no formal programs were instituted. The primary outcome measure was patient-reported improvement in claudication symptoms. Secondary outcomes were smoking cessation and participation in regular exercise.

Results:

Over a 2-year period, 77 patients were prescribed cilostazol as initial treatment for claudication. Follow-up for 3 months was available for 69 (90%) patients. Noncompliance was reported in 20% of patients. Of the overall group, 58% (73% of compliant patients) of patients reported improvement in claudication symptoms, 4% of patients reported smoking cessation, and 7% reported regular exercise.

Conclusion:

Despite minimal behavior modification, up to 70% of patients taking cilostazol report an improvement in claudication symptoms with few side effects.
Nationwide Comparative Impact of Thoracic Endovascular Aortic Repair of Acute Uncomplicated Type B Aortic Dissections
Authors: Shah Tejas R. , Rockman Caron B. , Adelman Mark A. , Maldonado Thomas S. , Veith Frank J. , Mussa Firas F.
Published: January 2014

Objective:

Thoracic endovascular aortic repair (TEVAR) for acute uncomplicated type B aortic dissection (TBAD) remains controversial. This study aims to evaluate the impact of TEVAR on mortality, morbidity, length of stay (LOS), and discharge status in patients with acute uncomplicated TBAD.

Methods:

We analyzed the National Inpatient Sample from 2009 and 2010. Patients were categorized according to the type of treatment: TEVAR or medical management. Outcomes, including mortality, stroke, myocardial infarction (MI), acute renal failure, discharge disposition, and LOS, were compared between the treatment groups.

Results:

We identified 4706 patients with TBAD. Mean age was 67 years and 55% were male. Treatment options included TEVAR in 504 and medical management in 4202. The overall adjusted in-hospital mortality was similar for both the groups (8.5% for TEVAR vs 10.3% for medical management, P = .224). The TEVAR carried higher risk of stroke (odds ratio [OR] = 1.61, 95% confidence interval [CI] = [1.14-2.27]; P = .0073). The TEVAR was associated with prolonged LOS (12 vs 5.6 days, P < .0001) and patients were less likely to be discharged home (OR 0.73, 95% CI 0.54-0.99; P = .013). When stratified by age, all outcomes were similar between the 2 groups, with the exception of longer LOS with TEVAR.

Conclusions:

Thoracic endovascular aortic repair for acute uncomplicated TBAD was associated with similar in-hospital mortality, MI, and renal failure as compared to medical management. The TEVAR had higher rate of stroke up to the age 70 years and longer LOS. Because extending TEVAR to less complicated patients could only decrease TEVAR mortality rates, these findings support the more widespread use of TEVAR to treat patients with uncomplicated TBAD.
Using data envelopment analysis and the analytical hierarchy process to find node influences in a social network
Authors: Fox William P. , Everton Sean F.
Published: January 2014

In a social network analysis the output provided includes many measures and metrics. For each of these measures and metrics, the output provides the ability to obtain a rank ordering of the nodes in terms of these measures. We might use this information in decision making concerning disrupting or deceiving a given network. All is fine when all the measures indicate the same node as the key or influential node. What happens when the measures indicate different key nodes? Our goal in this paper is to explore two methodologies to identify the key players or nodes in a given network. We apply two procedures to analyze these outputs to find the most influential nodes as a function of the decision makers’ inputs. We use data envelopment analysis as a method to optimize efficiency of the nodes over all criteria and use the analytical hierarchy process (AHP) as a process to consider both subjective and objectives inputs through pairwise comparison matrices. We illustrate our results using two common networks from the literature: the kite network and the information flow network. We discuss some basic sensitivity analysis that can be applied to the methods. We find the AHP method as the most flexible method to weight the criterion based upon the decision makers’ inputs or the topology of the network.
Usefulness of the endotoxin activity assay as a biomarker to assess the severity of endotoxemia in critically ill patients
Authors: Ikeda Toshiaki , Ikeda Kazumi , Suda Shingo , Ueno Takuya
Published: January 2014

The aim of this study was to investigate the prevalence of endotoxemia in critically ill Japanese patients using the endotoxin activity assay, a newly developed rapid assay of endotoxin. The endotoxin levels (EA levels) in the blood of 314 patients admitted to our university hospital’s intensive care unit (ICU) were measured within 24 h of admission, and its correlation with disease severity and outcome examined. In addition, the EA levels in 61 samples from healthy volunteers were measured. EA level was 0.39 ± 0.25 (mean ± SD) in patients admitted to the ICU and 0.10 ± 0.09 in healthy controls. There was less overlap of EA level distribution between patients and controls compared with previous reports measuring EA level in mainly Caucasian populations. Our patients’ EA levels were significantly correlated with disease severity criteria and 28-d mortality. When EA and procalcitonin levels were used concomitantly, disease severity could be assessed more precisely than when either marker was used alone. These results suggest that EA level is a useful marker for disease severity assessment and outcome prediction in critically ill patients.
The technofossil record of humans
Authors: Zalasiewicz Jan , Williams Mark , Waters Colin N , Barnosky Anthony D , Haff Peter
Published: January 2014

As humans have colonised and modified the Earth’s surface, they have developed progressively more sophisticated tools and technologies. These underpin a new kind of stratigraphy, that we term technostratigraphy, marked by the geologically accelerated evolution and diversification of technofossils – the preservable material remains of the technosphere (Haff, 2013), driven by human purpose and transmitted cultural memory, and with the dynamics of an emergent system. The technosphere, present in some form for most of the Quaternary, shows several thresholds. Its expansion and transcontinental synchronisation in the mid 20th century has produced a global technostratigraphy that combines very high time-resolution, great geometrical complexity and wide (including transplanetary) extent. Technostratigraphy can help characterise the deposits of a potential Anthropocene Epoch and its emergence marks a step change in planetary mode.
Misplacement of Left Ventricular Vent as a Cause of Cardioplegia Failure During Routine Open-Heart Surgery
Authors: Talwar Sachin , Rajashekhar Palleti , Jha Aandrei Jivendra , Airan Balram
Published: January 2014

We report an unusual cause of failure of successful delivery of antegrade cardioplegia through the aortic root that was caused by the accidental passage of the left ventricular vent catheter across the aortic valve producing acute aortic regurgitation. This problem is best prevented.
Cardiac Catheter Procedures During Extracorporeal Life Support
Authors: Panda Biswa R. , Alphonso Nelson , Govindasamy Maheshkumar , Anderson Benjamin , Stocker Christian , Karl Tom R.
Published: January 2014

Background:

Extracorporeal life support (ECLS) is a valuable tool for situations in which cardiac disease acutely threatens the life of a child. Residual anatomic lesions have a strong negative influence on survival when ECLS is used after cardiac operations. Accurate diagnostic information is essential, and although noninvasive studies are preferred (eg, echocardiography and thoracic computed tomographic angiography), they are not always logistically practical nor adequate in complex situations under the loading and nonpulsatile flow conditions of ECLS.

Methods:

We analyzed our experience (February 2009 to August 2012) with cardiac ECLS for 59 children. Of the 59 children, 22 (median age and weight 19.5 days and 4 kg) with advanced cardiac dysfunction had catheter studies performed during support.

Results:

The 22 patients had 28 studies, without major adverse events relating to the procedure or transport. Problems leading to further therapeutic procedures (catheter based seven, hybrid two, or surgical eight) were discovered in 17 of the 22 patients. For 22 catheterized patients, total time on ECLS, weaning probability, and survival to discharge were 151.6 ± 122.6 hours, 81%, and 68%, respectively, similar to that for the 37 cardiac support patients not requiring catheter studies during support ( P = 0.94, 0.37, and 0.59, respectively).

Conclusion:

Assuming that undiscovered anatomic and/or hemodynamic issues would have had a strong negative influence on survival, we may conclude that the risk–benefit ratio was positive and favorable. Catheter studies during ECLS are safe and should be performed expeditiously when diagnostic questions cannot be resolved by noninvasive means.
Results of Data Verification of the Japan Congenital Cardiovascular Database, 2008 to 2009
Authors: Tomotaki Ai , Miyata Hiroaki , Hashimoto Hideki , Murakami Arata , Ono Minoru
Published: January 2014

Background:

Since 2008, data concerning pediatric cardiovascular surgeries performed in Japan have been collected in the Japan Congenital Cardiovascular Surgery Database (JCCVSD). We assessed the quality of the JCCVSD data through data verification activities conducted in 2010.

Methods:

During 2008 to 2009, 3345 patients with 4327 procedures at 25 hospitals were registered in the JCCVSD. Among them, six sites were selected for data verification. The completeness of case registration was assessed by comparison with original operational logs. Also, data accuracy of patient demographics, surgical outcomes, and processes were assessed with 10% of the registered cases by comparison with medical records.

Results:

Verification of case registration completeness involved 968 (28.9%) patients and 1279 (29.1%) procedures. As to completeness, we confirmed 1266 (99.0%) of the 1279 procedures. Data accuracy was verified for 129 (3.9%) patients. Accuracy of status of discharge and 30 and 90 days after surgery were very high (99.2%, 100%, and 100%, respectively). Data items with numeric information exhibited lower exact accuracy due to typing error and inconsistent use of rounding; however, the differences between the submitted and the original data were not statistically significant.

Conclusions:

High completeness and acceptable range of data accuracy were verified for the data submitted to the JCCVSD in 2008 to 2009. The high accuracy regarding follow-up outcomes was especially noteworthy. The initial success of the JCCVSD should be strengthened through further sophistication of registration protocol, continual training of data managers and auditors, and rigorous expansion of verification activities.
Palliative Switch
Authors: Perez-Negueruela Carolina , Mayol Javier , Cesar Sergi , Muchart Jordi , Segura Susana , Caffarena-Calvar Jose Maria
Published: January 2014

The first-stage palliation of newborns with single-ventricle anatomy and transposed great arteries can be very challenging when associated with systemic ventricular outflow obstruction and aortic arch obstruction. Often, the initial intervention is a stage I Norwood procedure. We present the case of a newborn with double inlet left ventricle, discordant ventriculoarterial connection with restrictive ventricular foramen, and severe aortic arch obstruction. A hybrid procedure was performed initially as a means of addressing hemodynamic instability. Three months later, a palliative arterial switch procedure was performed as an alternative to the combined Norwood-Glenn procedure. Palliative arterial switch combined with arch reconstruction can be an effective surgical option in these complex, challenging patients.
Surgical Options in Rheumatic Mitral Valve Disease in Children
Authors: Kumar Arkalgud Sampath
Published: January 2014

In children with rheumatic heart disease, conservative valve surgery is the best option whenever feasible. Surgeons must develop an attitude and interest in valve repair techniques that can be easily learned. Patients who undergo valve repair at an early age are at risk of requiring additional surgery over time. Mechanical valve replacement, nonetheless, should be reserved for situations where more conservative approaches are not feasible.
Race, Hegemonic Masculinity, and the “Linpossible!”
Authors: Park Michael K.
Published: January 2014

In February 2012, Jeremy Lin, the first American of Taiwanese and Chinese descent to play in the National Basketball Association (NBA), led the Knicks to seven straight victories while establishing an NBA scoring record. This study analyzes how U.S. mass media contextualized Lin’s meteoric rise in the NBA and explores assumptions grounded in the media coverage of Lin, including how race and masculinity are defined within a dominant ideological field and how notions of a hegemonic masculinity define the “other.” This article looks at mass media as a site of complicity for the construction and maintenance of hegemonic masculinity by examining media representations and sports media columnists’ coverage of Jeremy Lin’s meteoric rise in the NBA from February 5 to March 15, 2012. Critical discourse analysis reveals that the majority of mainstream news media outlets did not overtly racialize Lin’s meteoric rise to stardom. However, the research uncovered several instances of racialized coverage and the incorporation of emasculation discourse to reinforce and police hegemonic notions of masculinity. Furthermore, the intense “media mania” referred to as “Linsanity” operated to preserve the dominant discourse of masculinity by confirming the “low expectations” inscribed in Asian male bodies, making Lin’s success “miraculous” and “warranting” intense media attention.
Satire or Send-Up? Paddy Power and Blind Football
Authors: de Haan Donna , Osborne Angela , Sherry Emma
Published: January 2014

In 2010, a television advertisement aired in the lead up to the 2010 World Blind Football Championships featuring the English Blind Football Team and a cat became the most controversial advert of the year. This article uses a case study approach to examine the public relations (PR) and communications activities that followed in the fallout from the advert’s broadcast. It shows how the sport organisation’s approach to PR can be characterised by a symbolic interaction approach to PR, developed post hoc, and concerned with creating a favourable impression of the organisation through the manipulation of messaging and argues that this method had questionable ameliorative impact. It further argues that for a niche sport, a more appropriate approach to PR is found in a relationship management approach to PR and communications, as this approach embeds PR at a strategic level and is an effective method for organisations seeking to take strategic control of the communications about their sport. The adoption of strategic relationship management principles to PR offers opportunities to engender a more sophisticated public understanding of disability in sport, increase its popularity, and ensure that elite athletes with a disability are able to attract sponsors and vital funds.
The Scholarly Merit of Social Media Use Among Clinical Faculty
Authors: Cocchio Craig , Awad Nadia
Published: January 2014

Background: Social media (SoMe) platforms such as blogs, Twitter, and Facebook are increasingly becoming incorporated into education and scientific communities. In fields such as emergency medicine, clinicians have established communication channels through SoMe to engage in academic and clinical discussions for the purposes of professional growth. While the use of SoMe as an educational tool within the classroom has been previously described, its use as a professional tool has not been adequately investigated. Objective: To assess the perception of SoMe as an academic tool among deans of accredited health care professional schools in the United States. Methods: An electronic cross-sectional survey was distributed to deans of accredited medical, nursing, and pharmacy schools across the United States to assess the knowledge of SoMe, attitudes toward academic merit, and challenges to incorporating SoMe into scholarly activity. Responses were analyzed using descriptive statistics. Results: Of 188 responses (response rate = 22%), 162 (86%) agreed publication in a peer-reviewed journal ranked highest in academic merit, followed by publishing in medical Web sites (157, 84%), publication in a university-based newsletter (147, 78%), and personal medical education blog (150, 80%). Fifty-one (31%) of respondents stated that volume of viewership would improve academic merit, while 85 (52%) believed a peer-review process would improve academic merit. Conclusion: Although professional SoMe activities should not replace traditional publications, the result of this study suggest establishing a peer-review process to improve validity of such activities.