bluuebunny/crossref_metadata_2025 huggingface dataset:
The new futility? The rhetoric and role of “suffering” in pediatric decision-making
Authors: Salter Erica K
Published: April 2019

This article argues that while the presence and influence of “futility” as a concept in medical decision-making has declined over the past decade, medicine is seeing the rise of a new concept with similar features: suffering. Like futility, suffering may appear to have a consistent meaning, but in actuality, the concept is colloquially invoked to refer to very different experiences. Like “futility,” claims of patient “suffering” have been used (perhaps sometimes consciously, but most often unconsciously) to smuggle value judgments about quality of life into decision-making. And like “futility,” it would behoove us to recognize the need for new, clearer terminology. This article will focus specifically on secondhand claims of patient suffering in pediatrics, but the conclusions could be similarly applied to medical decisions for adults being made by surrogate decision-makers. While I will argue that suffering, like futility, is not sufficient wholesale justification for making unilateral treatment decisions, I will also argue that claims of patient suffering cannot be ignored, and that they almost always deserve some kind of response. In the final section, I offer practical suggestions for how to respond to claims of patient suffering.
Factors Affecting Procurement of Finance from Short-term Sources by MSEs in Barak Valley, Assam
Authors: Uddin Tapadar Md. Iqbal , Dey Nikhil Bhusan , Adhikari Kingshuk
Published: April 2019

Micro and small enterprises (MSEs) play an important role in the development of Indian economy. Finance is the lifeblood of MSEs. They get finance from both long-term sources and short-term sources. There are various factors affecting procurement of finance from long-term sources and short-term sources by the enterprises. The present study has assessed the relative importance of factors affecting procurement of finance from short-term sources by MSEs in the Barak Valley of Assam. The enterprises which are registered with District Industries and Commerce Centres of the three districts of the valley, namely Cachar, Karimganj and Hailakandi as on 31 March 2012 and which are still functioning have been studied. Sample size of the study is 246 of which 81.71 per cent are micro enterprises and 18.29 per cent are small enterprises. The study is based on primary data. The sampling technique of the study is ‘convenience sampling’. Arithmetic mean, rank and standard deviation have been used for data analysis. The hypotheses are tested with the help of the statistical technique ‘Mann–Whitney U test’.
Scale Development and Validation for Measuring the Adoption of Mobile Banking Services
Authors: Chawla Deepak , Joshi Himanshu
Published: April 2019

Mobile banking (m-banking) has provided new opportunities to banks to engage more effectively with customers. With increasing smartphone penetration and affordable internet connectivity, both urban and rural India are witness to an increase in the number of mobile internet users. A majority of the recent studies on m-banking are focused on developed countries. Among Indian studies, a majority of them focus on internet banking, not many exist that explore the factors which influence user attitude (ATT) and intentions to adopt m-banking. This article aims to propose a scale to study m-banking adoption and validate it in the Indian context. An exploratory study was conducted through a literature review, a focus group discussions and some personal interviews. Exploratory factor analysis (EFA) was carried out which resulted in seven factors labelled as ease of use (EOU), ATT, lifestyle (LS), convenience (CON), efficiency (EFF), trust (TR) and behavioural intention (BI). The measurement model was estimated using confirmatory factor analysis to test the reliability and validity of the scale. The study improves the technology acceptance model (TAM) by adding TR, CON and EFF as relevant factors. The scale also integrates LS to the existing factors and focuses on both socio-technical aspects. The scale can be used by banks to assess how consumers perceive their m-banking service and identify gap areas and opportunities for developing viable m-banking services.
“I Never Saw a Future”: Childhood Trauma and Suicidality Among Sexual Minority Women
Authors: Creighton Genevieve M. , Oliffe John L. , Broom Alex , Rossnagel Emma , Ferlatte Olivier , Darroch Francine
Published: April 2019

While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities.
A Mother in Jeopardy: The Ethics of Pregnancy and Chemotherapy
Authors: Baumrucker Steven J. , Vogel Wendy H. , Stolick Robert M. , Adkins Russell W. , Holland Heather , VandeKieft Gregg , Eastridge Angela
Published: April 2019

JM is a 32-year-old primagravida with polycystic ovary disease. She had extreme difficulty conceiving and was started on clomiphene 6 months ago by her fertility specialist. After doubling the dose on the sixth cycle, she successfully became pregnant. On her second prenatal visit at 12 weeks gestation, an ovarian cyst was detected. Ultrasound showed a complex ovarian mass with nodules on the bowel and abdominal wall. There was mild-to-moderate peritoneal fluid. Cytology showed adenocarcinoma of ovarian origin. Further workup demonstrated advanced stage III epithelial ovarian cancer. JM was referred to GYN-oncology who felt pregnancy-sparing debulking was not an option. The oncologist recommended termination of pregnancy due to the risks of delaying chemotherapy. JM refused, citing her fertility difficulties in the past and her desire to carry the pregnancy to term “even if it kills me.” She tells the oncologist she cannot bear the thought of terminating her pregnancy under any circumstances. The oncologist wants to comply with her wishes but feels the patient is making a choice that would result in harm to herself. The oncology team requests an ethics consult.
Delivering Performance Feedback to Teachers Using Technology-Based Observation and Coaching Tools
Authors: Rodgers Wendy J. , Kennedy Michael J. , VanUitert Victoria J. , Myers Anna Moriah
Published: April 2019

Effective professional development (PD) for teachers should be directly and intricately linked to their teaching practice. One way to link PD to practice is for administrators or coaches to provide performance feedback based on classroom observations, accompanied by reflection and coaching. This type of PD can be time-consuming and difficult to manage in practice, but technology offers ways to facilitate performance feedback. This article highlights a multimedia observation tool capable of documenting teachers’ instructional moves in real time with the intent of providing a teacher with unbiased, descriptive data used to fuel coaching conversations. Additional multimedia options are provided for observing instruction and providing critical performance feedback with the intent of improving student learning outcomes.
Bug-in-Ear Coaching for Teacher Candidates: What, Why, and How to Get Started
Authors: Regan Kelley , Weiss Margaret P.
Published: April 2019

Practice-based opportunities are provided throughout a teacher preparation program. During these opportunities, teachers demonstrate learned skills and strategies and receive performance feedback. Real-time feedback is delivered when the teaching behavior is occurring, allowing for more immediate and, typically, more targeted performance feedback. A technology-enabled practice for providing real-time feedback is bug-in-ear (BIE) coaching. This article provides a step-by-step guide for BIE coaching.
Adverse Childhood Experiences and Amygdalar Reduction: High-Resolution Segmentation Reveals Associations With Subnuclei and Psychiatric Outcomes
Authors: Oshri Assaf , Gray Joshua C. , Owens Max M. , Liu Sihong , Duprey Erinn Bernstein , Sweet Lawrence H. , MacKillop James
Published: April 2019

The aim of the present study was 2-fold: (1) to utilize improved amygdala segmentation and exploratory factor analysis to characterize the latent volumetric structure among amygdala nuclei and (2) to assess the effect of adverse childhood experiences (ACEs) on amygdalar morphometry and current psychiatric symptoms. To investigate these aims, structural (T1) MRI and self-report data were obtained from 119 emerging adults. Regression analysis showed that higher ACE scores were related to reduced volume of the right, but not the left, amygdalar segments. Further, exploratory factor analysis yielded a two-factor structure, basolateral and central-medial nuclei of the right amygdala. Stractual equation modeling analyses revealed that higher ACE scores were significantly related to a reduced volume of the right basolateral and central-medial segments. Furthermore, reduction in the right basolateral amygdala was associated with increased anxiety, depressive symptoms, and alcohol use. This association supports an indirect effect between early adversity and psychiatric problems via reduced right basolateral amygdalar volume. The high-resolution segmentation results reveal a latent structure among amygdalar nuclei, which is consistent with prior work conducted in nonhuman mammals. These findings extend previous reports linking early adversity, right amygdala volume, and psychopathology.
Outcomes following peritoneal dialysis catheter removal with reinsertion or permanent transfer to haemodialysis
Authors: Kwan Jia Rui , Chong Tze Tec , Low Gerard ZX , Low Gabriel WT , Htay Htay , Foo Marjorie WY , Tan ChiehSuai
Published: April 2019

Introduction:

Long-term use of peritoneal dialysis catheter is associated with complications such as infection and malfunction, necessitating removal of catheter with subsequent reinsertion or permanent transfer to haemodialysis. This study aims to investigate the outcome in patients who underwent reinsertion.

Methods and materials:

A single-centre retrospective study was performed in Singapore General Hospital for all adult incident peritoneal dialysis patients between January 2011 and January 2016. Study data were retrieved from patient electronic medical records up till 1 January 2017.

Results:

A total of 470 patients had peritoneal dialysis catheter insertion with median follow-up period of 29.2 (interquartile range = 16.7–49.7) months. A total of 92 patients required catheter removal. Thirty-six (39%) patients underwent catheter reinsertion. The overall technique survival at 3 and 12 months were 83% and 67%. Median time to technique failure of the second catheter was 6.74 (interquartile range = 0–50.2) months. The mean survival for patients who converted to haemodialysis and re-attempted peritoneal dialysis was comparable (54.9 ± 5.5 vs 57.3 ± 3.6 months; p = 0.75). Twelve (13%) patients had contraindication for peritoneal dialysis and were excluded from analysis. Of 11 patients who required catheter removal due to malfunction, 7 (64%) underwent catheter reinsertion and 6 (86%) patients ultimately converted to haemodialysis during study period. Of the 69 patients who had catheter removal due to infection, 29 (42%) underwent catheter reinsertion and 8 (28%) patients eventually converted to haemodialysis during the study period.

Conclusion:

Patient survival was comparable between patients who re-attempted peritoneal dialysis and patients who transferred to haemodialysis. Patients who had previous catheter removal due to infections had favourable technique survival than those due to catheter malfunction.
Medical Encounters for Youth With Autism Spectrum Disorder: A Comprehensive Review of Environmental Considerations and Interventions
Authors: Straus Jolie , Coburn Sarah , Maskell Stephanie , Pappagianopoulos Jessica , Cantrell Kathryn
Published: April 2019

Approximately 1 in 59 youth are currently diagnosed with autism spectrum disorder (ASD), a neurodevelopmental disorder. In comparison to typically developing peers, youth with ASD encounter hospitalization at higher rates due to their heightened health care needs. While visiting the hospital is a stressor for youth with neurotypical needs, the experience contains unique challenges for those with ASD. This systematic literature review highlights research that considers the psychosocial impact of the hospital environment on the coping and adjustment of youth with ASD. Specifically, the review focuses on recommendations and interventions that may be used by health care professionals while supporting this population as they encounter the health care system. Ninety-six articles were identified as meeting inclusion and exclusion criteria. The findings suggest that practicing clinicians should implement a wide variety of interventions for youth with ASD including diversion techniques, comfort positions, and picture schedules. Although there are published evidence-based interventions for supporting youth with ASD in the hospital, most clinicians lack ASD-specific training. This article concludes with recommendations for future research.
Adaptive fuzzy finite-time fault-tolerant funnel control of nonlinear systems with actuators failures
Authors: Chen Ming , Wang Huanqing , Li Xiaohua , Liu Xiaoping
Published: April 2019

This article investigates adaptive fuzzy finite-time fault-tolerant funnel control of nonlinear systems with actuators failures, which contain outage, loss of effectiveness and stuck modes. The principal control objectives are ensure that the trajectory of the tracking error can be limited to the predefined area in finite time and whether the actuators are at faults or not. First, the original error equation is changed into a new one by introducing the revised funnel variable, which will be employed to design the controller later. Second, the required conditions for the existence of the adaptive fuzzy finite-time fault-tolerant controller are provided using backstepping technology, fuzzy logic system, and finite-time Lyapunov stability theory. Theoretical analysis verifies that all the signals of the closed-loop system are semi-globally practically finite-time stable. Finally, a numerical example illustrates that the proposed method can effectively improve the steady-state and transient-state performance of the system in finite time.
The Effect of Valgus Control Instruction Exercises on Pain, Strength, and Functionality in Active Females With Patellofemoral Pain Syndrome
Authors: Emamvirdi Mahsa , Letafatkar Amir , Khaleghi Tazji Mehdi
Published: April 2019

Background:

Patellofemoral pain syndrome (PFPS) is sometimes related to excessive hip adduction and internal rotation, as well as knee valgus during weightbearing activities in females. Research on injury prevention and rehabilitation strategies has shown the positive effects of valgus control instruction (VCI) exercise programs in training.

Hypothesis:

A VCI program would result in a positive change in pain, eccentric hip muscle torque, and performance in females with PFPS.

Study Design:

Controlled laboratory study.

Level of Evidence:

Level 1.

Methods:

Sixty-four amateur female volleyball players from our university (age, 18-25 years) with PFPS and equal years of exercise experience were randomly divided into VCI (n = 32; age, 22.1 ± 5.88 years) and control (n = 32; age, 23.1 ± 6.49 years) groups. Function (single, triple, and crossover hops), strength (hip abductor and external rotators), pain (visual analog scale), and knee valgus angle (single-leg squat) were assessed at baseline and after intervention.

Results:

There was a significant difference before and after implementation of the VCI program with regard to pain (49.18% ↓, P = 0.000), single-leg hop test (24.62% ↑, P = 0.000), triple-hop test (23.75% ↑, P = 0.000), crossover hop test (12.88% ↑, P = 0.000), single-leg 6-m timed hop test (7.43% ↓, P = 0.000), knee dynamic valgus angle (59.48% ↓, P = 0.000), peak abductor to adductor eccentric torque ratio (14.60% ↑, P = 0.000), peak external (59.73% ↑, P = 0.023) and internal rotator (15.45% ↑, P = 0.028) eccentric torques, and the ratio of peak external to internal rotator eccentric torque (40.90% ↑, P = 0.000) ( P < 0.05).

Conclusion:

PFPS rehabilitation and prevention programs should consider VCI exercises to decrease pain, improve strength, and increase athletes’ functional performance.

Clinical Relevance:

This study investigated the effect of VCI exercises on knee valgus angle, pain, and functionality of individuals with PFPS. The VCI program improves performance, knee dynamic valgus angle, and strength in participants with PFPS. A controlled and optimal knee valgus angle during a functional task is the most important factor for injury prevention specialists. VCI training can be used as a supplemental method to prevent and treat lower extremity injury in patients with PFPS.
Perceptual Tuning Influences Rule Generalization: Testing Humans With Monkey-Tailored Stimuli
Authors: Ravignani Andrea , Filippi Piera , Tecumseh Fitch W.
Published: April 2019

Comparative research investigating how nonhuman animals generalize patterns of auditory stimuli often uses sequences of human speech syllables and reports limited generalization abilities in animals. Here, we reverse this logic, testing humans with stimulus sequences tailored to squirrel monkeys. When test stimuli are familiar (human voices), humans succeed in two types of generalization. However, when the same structural rule is instantiated over unfamiliar but perceivable sounds within squirrel monkeys’ optimal hearing frequency range, human participants master only one type of generalization. These findings have methodological implications for the design of comparative experiments, which should be fair towards all tested species’ proclivities and limitations.
Infectious Disease Risk in Dialysis Patients: A Transdisciplinary Approach
Authors: Lamarche Caroline , Iliuta Ioan-Andrei , Kitzler Thomas
Published: April 2019

Purpose of review:

Infections are a major contributor to morbidity and mortality in end-stage renal disease (ESRD) patients. A better understanding of the interplay between infectious processes and ESRD may eventually lead to the development of targeted treatment strategies aimed at lowering overall disease morbidity and mortality. Monogenic causes are a major contributor to the development of adult chronic kidney disease (CKD). Recent studies identified a genetic cause in 10% to 20% of adults with CKD. With the introduction of whole-exome sequencing (WES) into clinical mainstay, this proportion is expected to increase in the future. Once patients develop CKD/ESRD due to a genetic cause, secondary changes, such as a compromised immune status, affect overall disease progression and clinical outcomes. Stratification according to genotype may enable us to study its effects on secondary disease outcomes, such as infectious risk. Moreover, this knowledge will enable us to better understand the molecular interplay between primary disease and secondary disease outcomes.

Sources of information:

We conducted a literature review using search engines such as PubMed, PubMed central, and Medline, as well as cumulative knowledge from our respective areas of expertise.

Methods:

This is a transdisciplinary perspective on infectious complications in ESRD due to monogenic causes, such as autosomal dominant polycystic kidney disease (ADPKD), combining expertise in genomics and immunology.

Key findings:

In ADPKD, infection is a frequent complication manifesting primarily as lower urinary tract infection and less frequently as renal infection. Infectious episodes may be a direct consequence of a specific underlying structural abnormality, for example the characteristic cysts, among others. However, evidence suggests that infectious disease risk is also increased in ESRD due to secondary not-well-understood disease mechanisms. These disease mechanisms may vary depending on the underlying nature of the primary disease. While the infectious disease risk is well documented in ADPKD, there are currently insufficient data on the risk in other monogenic causes of ESRD. WES in combination with novel technologies, such as RNA sequencing and single-cell RNA sequencing, can provide insight into the molecular mechanisms of disease progression in different monogenic causes of CKD/ESRD and may lead to the development of novel risk-stratification profiles in the future.

Limitations:

This is not a systematic review of the literature and the proposed perspective is tainted by the authors’ point of view on the topic.

Implications:

WES in combination with novel technologies such as RNA sequencing may enable us to fully unravel underlying disease mechanisms and secondary disease outcomes in monogenic causes of CKD and better characterize individual risk profiles. This understanding will hopefully facilitate the development of novel targeted therapies.
Viewing diaries in an age of new media: An exploratory analysis of mobile phone app diaries versus paper diaries
Authors: Lev-On Azi , Lowenstein-Barkai Hila
Published: April 2019

This exploratory study inquires into the validity and reliability of dedicated mobile phone diary applications. We developed Watchy, a dedicated mobile viewing diary application, and compared users’ compliance and usage patterns with those of users of the paper viewing diaries. Participants received paper diaries or installed mobile diary apps, with or without daily reminders, to document their viewings over a 4-day period. Documentation was more extensive in the smartphone app with reminder group compared to the paper diary group. Reminders increased documentation rates. Extent of documentation decreased as the experiment progressed for mobile app users. Findings suggest that mobile viewing diaries are an important tool for viewing studies, yet their use requires careful planning.
At the Crossroads of the Body and the Word: Interrogating Culture Through a Performance Paradigm
Authors: Kishore Sushant
Published: April 2019

This article is an empirical reflection on interdisciplinary research. Surveying theories of performance and performativity, it proposes performance as a heuristic tool to breach and bridge the divide between Literature and Culture. The scriptocentricism of academia that reiterates the imperialist ideals and ideas of knowledge, history, and culture itself often ignores or dismisses the lived and embodied “texts” of culture. Performance paradigm can help shift this skewed status quo of “the word.” The appeal of performance studies lies in its attempt to elevate the body to the same status as the word, tracing performatives of identity, culture, history, myth, and more and offering a holistic critique of culture through this kaleidoscope. As a product of qualitative research in contemporary Hindu Nationalism, this article advocates the performance paradigm as an effective tool in the study of ethnic nationalism as an embodied and a discursive cultural phenomenon.
Doing Legitimacy in Talk: The Production of Leader–Follower Relationship in Spiritual Consultation Interactions
Authors: Chin Sin Zi , Seng Hui Zanne , Chan Mei Yuit
Published: April 2019

Spiritual leaders achieve power over their followers through various means. Often overlooked is what happens in the interaction between spiritual leaders and their followers in the creation and legitimation of the leader’s power. In this study, we examined the discursive construction of leader–follower relationship in consultation interactions between a spiritual leader and his followers. Fifteen consultation sessions were analyzed using the discourse analytical approach. The analysis focused on legitimation and discursive strategies used by the leader to legitimize his power over his followers. The findings show that a set of strategies are relied on as standard procedure by the leader to reinforce his authority, used when interacting with a compliant followership. However, a different set of strategies are deployed in situations when the leader’s authority is challenged. The results reveal that the authority of the leader is not a natural given, but needs to be actively negotiated and defended in the ongoing process of interaction.
Investigating the Moderating Role of Culture on the Relationship Between Appraisals and Symptoms of Posttraumatic Stress Disorder
Authors: Bernardi Jessica , Jobson Laura
Published: April 2019

Appraisals play a central role in posttraumatic stress disorder (PTSD). Accumulating cross-cultural psychology research has demonstrated that culture affects the way in which individuals appraise an experience. However, there is little empirical work considering the influence of culture on appraisals in PTSD. In this study, we investigated the influence of culture on trauma-related appraisals and PTSD symptoms, with a particular focus on appraisals related to control. Trauma-related appraisals and PTSD symptoms were assessed in European Australian ( n = 71) and Asian Australian ( n = 73) adult trauma survivors. The group (European Australian vs. Asian Australian) was found to moderate the relationship between control, responsibility, and agency-focused appraisals (mental defeat, mastery, present control, and self-blame) and PTSD symptoms. Findings suggest that the relationship between these appraisal types and PTSD is influenced by the extent to which an individual emphasizes the independent self-construal. The cross-sectional design prevents causal inferences being drawn from the findings. Implications for culturally informed PTSD models and treatments are discussed.
Are Reserved Constituencies Dalit Centric? Experience from Uttar Pradesh
Authors: Singh Shilp Shikha , Ali Manjur
Published: April 2019

In the state of Uttar Pradesh, Dalits have largely been elected only from the reserved seats, and their representation from non-reserved seats has remained negligible. Apart from ensuring political presence, how do reserved seats impinge on the Dalit politics within the constituency? Who determines the election outcome in the reserved seats? The article argues that in the reserved seats of the State of Uttar Pradesh, Dalit votes remain at best adjunct votes, to the core support base of the respective parties. There is evidence of systemic political backlash from non-Dalit voters against Dalit voters in reserved constituencies. Various parties play a significant role in orchestrating this backlash to help their candidates win. The weak position of the Bahujan Samaj Party (BSP), the party of Dalits in the reserved seats, is an indication of such a backlash. This backlash is largely aimed at the dominant Dalit group, the Chamars, who are treated as political untouchables by one and all, across caste and class.
Preservation Methods Influence the Biomechanical Properties of Human Lateral Menisci: An Ex Vivo Comparative Study of 3 Methods
Authors: Jacquet Christophe , Erivan Roger , Sharma Akash , Pithioux Martine , Parratte Sebastien , Argenson Jean-Nöel , Ollivier Matthieu
Published: April 2019

Background:

Three main meniscal preservation methods have been used over the past decade: cryopreservation, freezing, and freezing with gamma irradiation.

Hypothesis:

All 3 preservation methods will result in similar biomechanical properties as defined by tensile and compression testing.

Study Design:

Controlled laboratory study.

Methods:

A total of 24 human lateral menisci were collected from patients who underwent total knee arthroplasty. Inclusion criteria were patients younger than 70 years with primary unilateral (medial) femorotibial knee osteoarthritis. Each meniscus was divided into 2 specimens cross-sectionally. One specimen was systematically cryopreserved and constituted the control (Cy; –140°C), and the other specimen was used for either the simple frozen group (Fr; –80°C) or the frozen+irradiated group (FrI; –80°C + 25-kGy irradiation). Compression and tensile tests were performed to analyze the elasticity modulus (Young modulus) in compression, the elasticity modulus in tension, the tensile force at failure, and the rupture profile of the tensile stress-strain curve.

Results:

A significant difference in the mean compression elasticity modulus was observed between the Cy and Fr groups (28.86 ± 0.77 vs 37.26 ± 1.08 MPa, respectively; P < .001) and between the Cy and FrI groups (28.86 ± 0.77 vs 45.92 ± 1.09 MPa, respectively; P < .001). A significant difference in the mean tensile elasticity modulus was also observed between the Cy and Fr groups (11.66 ± 0.97 vs 19.97 ± 1.37 MPa, respectively; P = .008) and between the Cy and FrI groups (11.66 ± 0.97 vs 45.25 ± 1.39 MPa, respectively; P < .001). There were no significant differences between the control and study groups in tensile force at failure. The analysis of the stress-strain curve revealed a slow-slope curve with a nonabrupt rupture (ductile material) for the Cy samples versus a clear rupture of the curve for the Fr and FrI samples (more fragile material).

Conclusion:

Cryopreservation allows for more elastic and less fragile tissue compared with simple freezing or freezing plus irradiation.

Clinical Relevance:

The study results exhibit the detrimental effect of simple freezing and freezing plus irradiation on human meniscal mechanical properties. If these effects occur in menisci prepared for allograft procedures, important differences could appear in the graft’s mechanical behavior and thus patient outcomes.
Hands-on Gross Anatomy Instruction Improves Clinical Imaging Skills Among Cardiovascular Fellows
Authors: O’Leary JM , McNeely DE , Damp JA , Wells QS , Nanney L , Mendes L
Published: April 2019

Introduction:

Multi-modality imaging is a crucial component of cardiovascular (CV) fellowship training and requires knowledge of CV anatomy for interpretation. We hypothesized that hands-on anatomy education would improve the imaging interpretation skills of CV fellows.

Methods:

The first-year CV fellowship class completed a hands-on cadaveric anatomy session correlated with clinical imaging. Fellows’ ability to identify CV structures on cardiac imaging was assessed using a 30-question assessment tool administered at baseline and 1 week and 6 months post intervention. Advanced CV fellows (second or third year) who had not attended the session were also tested. Scores were expressed as median [interquartile range].

Results:

Among 9 first-year fellows, the majority reported no formal anatomy training since medical school (N = 7) and rated their knowledge of CV anatomy as fair or poor (N = 7) prior to the intervention. The median assessment score was higher 1 week after intervention vs baseline (24 [23-25] vs 19 [17-21]; P = .013) and remained higher than baseline at 6 months (26 [26-28] vs 19 [17-21]; P = .009). The 6-month post-intervention score for first-year fellows was not significantly different than that of senior fellows (n = 10) not exposed to the intervention (26 [26-28] vs 26 [23-27]; P = .434).

Conclusions:

Gross anatomy instruction improved first-year CV fellows’ interpretation of CV imaging. Anatomic instruction may be a useful adjunct to multi-modality imaging education.
Key paediatric messages from the 2018 European Respiratory Society International Congress
Authors: Nenna Raffaella , Hunt Katie A. , Dassios Theodore , Collins Jennifer J.P. , Rottier Robbert J. , Liu Norrice M. , Rottier Bart , Goutaki Myrofora , Karadag Bülent , Prayle Andrew , Fernandes Ricardo M. , Parisi Giuseppe Fabio , Barben Jürg , Rubbo Bruna , Snijders Deborah , Makrinioti Heidi , Hall Graham , Pijnenburg Mariëlle W. , Grigg Jonathan
Published: April 2019

In this article, the Group Chairs and early career members of the European Respiratory Society (ERS) Paediatric Assembly highlight some of the most interesting findings in the field of paediatrics which were presented at the 2018 international ERS Congress.
Venous thromboembolism risk in psychiatric in-patients: a multicentre cross-sectional study
Authors: Ellis Natalie , Grubb Carla-Marie , Mustoe Sophie , Watkins Eleanor , Codling David , Fitch Sarah , Stirland Lucy , Quraishy Munzir , Jenkinson Josie , Harrison Judith
Published: April 2019

Aims and method

We assessed venous thromboembolism (VTE) risk, barriers to prescribing VTE prophylaxis and completion of VTE risk assessment in psychiatric in-patients. This was a cross-sectional study conducted across three centres. We used the UK Department of Health VTE risk assessment tool which had been adapted for psychiatric patients.

Results

Of the 470 patients assessed, 144 (30.6%) were at increased risk of VTE. Patients on old age wards were more likely to be at increased risk than those on general adult wards (odds ratio = 2.26, 95% CI 1.51–3.37). Of those at higher risk of VTE, auditors recorded concerns about prescribing prophylaxis in 70 patients (14.9%). Only 20 (4.3%) patients had a completed risk assessment.

Clinical implications

Mental health in-patients are likely to be at increased risk of VTE. VTE risk assessment is not currently embedded in psychiatric in-patient care. There is a need for guidance specific to this population.
Poor Glycemic Control Is Associated With Impaired Bone Accrual in the Year Following a Diagnosis of Type 1 Diabetes
Authors: Weber David R , Gordon Rebecca J , Kelley Jennifer C , Leonard Mary B , Willi Steven M , Hatch-Stein Jacquelyn , Kelly Andrea , Kosacci Oksana , Kucheruk Olena , Kaafarani Mirna , Zemel Babette S
Published: April 2019

Context

Type 1 diabetes (T1D) is associated with an increased fracture risk across the life course. The effects on bone accrual early in the disease are unknown.

Objective

To characterize changes in bone density and structure over the year following diagnosis of T1D and to identify contributors to impaired bone accrual.

Design

Prospective cohort study.

Setting

Academic children’s hospital.

Participants

Thirty-six children, ages 7 to 17 years, enrolled at diagnosis of T1D.

Outcomes

Whole body and regional dual-energy X-ray absorptiometry and tibia peripheral quantitative computed tomography obtained at baseline and 12 months. The primary outcome was bone accrual assessed by bone mineral content (BMC) and areal bone mineral density (aBMD) velocity z score.

Results

Participants had low total body less head (TBLH) BMC (z = −0.46 ± 0.76), femoral neck aBMD (z = −0.57 ± 0.99), and tibia cortical volumetric BMD (z = −0.44 ± 1.11) at diagnosis, compared with reference data, P < 0.05. TBLH BMC velocity in the year following diagnosis was lower in participants with poor (hemoglobin A1c ≥7.5%) vs good (hemoglobin A1c <7.5%) glycemic control at 12 months, z = −0.36 ± 0.84 vs 0.58 ± 0.71, P = 0.003. TBLH BMC velocity was correlated with gains in tibia cortical area (R = 0.71, P = 0.003) and periosteal circumference (R = 0.67, P = 0.007) z scores in participants with good, but not poor control.

Conclusions

Our results suggest that the adverse effects of T1D on BMD develop early in the disease. Bone accrual following diagnosis was impaired in participants with poor glycemic control and appeared to be mediated by diminished bone formation on the periosteal surface.
Associations of Plasma CD36 and Body Fat Distribution
Authors: Wang Yeli , Koch Manja , di Giuseppe Romina , Evans Kirsten , Borggrefe Jan , Nöthlings Ute , Handberg Aase , Jensen Majken K , Lieb Wolfgang
Published: April 2019

Context

CD36 is a class B scavenger-receptor involved in the uptake of fatty acids in liver and adipose tissue. It is unknown whether plasma CD36 levels are related to liver fat content or adipose tissue in the general population.

Methods

We measured plasma CD36 from 575 participants of the community-based PopGen cohort who underwent MRI to quantify visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver signal intensity (LSI), a proxy for liver fat content. Nonalcoholic fatty liver disease (NAFLD) was defined as LSI ≥3.0 in the absence of high alcohol intake. The relations between plasma CD36 and body mass index (BMI), VAT, SAT, LSI, and NAFLD were evaluated via multivariable-adjusted linear and logistic regression analysis.

Results

Plasma CD36 concentrations were correlated with BMI (r = 0.11; P = 0.01), SAT (r = 0.16; P < 0.001), and VAT (r = 0.15, P < 0.001) but not with LSI (P = 0.44). In multivariable-adjusted regression models, mean BMI values rose across CD36 quartiles [quartile 1 (Q1), 27.8 kg/m2; Q4, 28.9 kg/m2; P-trend = 0.013). Similarly, VAT (Q1, 4.13 dm3; Q4, 4.71 dm3; P-trend < 0.001), and SAT (Q1, 7.61 dm3; Q4, 8.74 dm3; P-trend < 0.001) rose across CD36 quartiles. Plasma CD36 concentrations were unrelated to LSI (P-trend = 0.36) and NAFLD (P-trend = 0.64). Participants with NAFLD and elevated alanine aminotransferase (ALT), a marker for liver damage, had higher CD36 compared with participants with NAFLD and normal ALT.

Conclusions

Higher plasma concentrations of CD36 were associated with greater general and abdominal adiposity but not with liver fat content or NAFLD in this community-based sample. However, plasma CD36 may reflect more severe liver damage in NAFLD.
Multiple Lenders, Strategic Default, and Covenants
Authors: Attar Andrea , Casamatta Catherine , Chassagnon Arnold , Décamps Jean-Paul
Published: April 2019

We study capital markets in which investors compete by designing financial contracts to control an entrepreneur’s ability to side trade and default on multiple loans. We show that covenants may have anticompetitive effects: in particular, they prevent investors from providing additional funds and reduce the entrepreneur’s investment capacity. As a result, a large number of inefficient allocations is supported at equilibrium. We propose a subsidy mechanism similar to guarantee funds in financial markets that efficiently controls the entrepreneur’s side trading and sustains the competitive allocation as the unique equilibrium one. (JEL D21, D82, D86, G21, G32)
Using equivalence class counts for fast and accurate testing of differential transcript usage
Authors: Cmero Marek , Davidson Nadia M. , Oshlack Alicia
Published: April 2019

Background: RNA sequencing has enabled high-throughput and fine-grained quantitative analyses of the transcriptome. While differential gene expression is the most widely used application of this technology, RNA-seq data also has the resolution to infer differential transcript usage (DTU), which can elucidate the role of different transcript isoforms between experimental conditions, cell types or tissues. DTU has typically been inferred from exon-count data, which has issues with assigning reads unambiguously to counting bins, and requires alignment of reads to the genome. Recently, approaches have emerged that use transcript quantification estimates directly for DTU. Transcript counts can be inferred from 'pseudo' or lightweight aligners, which are significantly faster than traditional genome alignment. However, recent evaluations show lower sensitivity in DTU analysis compared to exon-level analysis. Transcript abundances are estimated from equivalence classes (ECs), which determine the transcripts that any given read is compatible with. Recent work has proposed performing a variety of RNA-seq analysis directly on equivalence class counts (ECCs).

Methods: Here we demonstrate that ECCs can be used effectively with existing count-based methods for detecting DTU. We evaluate this approach on simulated human and drosophila data, as well as on a real dataset through subset testing.

Results: We find that ECCs have similar sensitivity and false discovery rates as exon-level counts but can be generated in a fraction of the time through the use of pseudo-aligners.

Conclusions: We posit that equivalence class read counts are a natural unit on which to perform differential transcript usage analysis.
Optimal Dynamic Product Development and Launch for a Network of Customers
Authors: Sunar Nur , Birge John R. , Vitavasiri Sinit
Published: April 2019

Network products such as mobile apps and computer games are of paramount importance, as these products constitute a large value in today’s economy. Motivated by this observation, the paper “Optimal Dynamic Product Development and Launch for a Network of Customers” considers a firm that dynamically chooses its effort to develop a product for a network of customers represented by a connected graph. The technology of the product evolves as a stochastic process that depends on the firm’s dynamic efforts over time. In addition to dynamically choosing its development effort, the firm chooses when to launch or abandon the product. If the firm launches the product, the firm also chooses a selling price, a promotional price, and a target customer to offer the promotion to. Once the target customer adopts the product, the product diffuses over the customer network based on the topology of the graph and the selling price. The paper provides the explicit solution of the firm’s jointly optimal development, launch, and post-launch strategies for any connected network, and introduces metrics that allow ordering customer networks with respect to the firm’s optimal expected discounted profit, launch technology, and consumer surplus.
Effective Removal of Hexavalent Chromium from Polluted Water using Phoenix sylvestris Seed Powder as Adsorbent
Authors: MEGHANA P. KARUNASRI , PRAVALIKA K. VENKATA , SRIRAM P. JANAKI , RAVINDHRANATH K.
Published: April 2019

Phoenix sylvestris seed powder (PSSP) was investigated as an adsorbent for the removal of chromium(VI) ions from water using batch extraction method. The conditions for the maximum extraction were optimized. The adsorption capacity was found to be 22.5 mg/g at pH= 2, contact time: 60 min, PSSP dosage: 0.40 g/500mL, rpm: 300 and temp.: 28 ± 2 ºC and found to be more suitable adsorbant than compared to other reported adsorbents in the literature. Co-ions even in five-fold excess were less interfered. Regeneration studies revealed that Phoenix sylvestris seed powder can be used up to three cycles. The method developed was successfully applied to polluted water/industrial effluents samples.
Production Process of Hand Sanitizer from Vietnamese Coconut Oil
Authors: TRAN THIEN HIEN , THI HUYEN TRANG TRAN , PHAM HUY QUOC , VU-QUANG HIEU , NGUYEN TRINH DUY , THINH PHAM VAN , HONG NHAN LE THI , QUYNH ANH PHAN NGUYEN , CANG MAI HUYNH , BUI LE MINH
Published: April 2019

Currently, hand sanitizers are seen as an indispensable household product, which not only cleanses and protects the skin from bacteria but also confers skin-softening function. With the objective of research and development the process for producing hand-sanitizer from coconut oil, this study aimed to optimize the production conditions to provide a natural-derived and low-cost hygienic product. The two factors that characterized the standard for product evaluation are the level of foaming and durability of the emulsion, which reflects the cleansing ability of the product from the saponification reaction. Upon analysis, the coconut oil/NaOH ratio of 5.5:1, the alkaline solution concentration of 10 %, 3 h reaction, 80 ºC, stirring speed of 300 rpm, pH 8 and 1:2 dilution rate were found to be the optimal reaction conditions for the highest cleaning ability. In addition, other substances are used for finalizing the product such as moisturizing glycerol, dipropylene glycol, softener skin coca amidopropyl betaine, preservatives dimethylol dimethyl hydantoin, thickener hydroxyethyl cellulose, colour and essential oils.
New Strategies for New Literacies - Digital Strategy Backpack Samplers
Authors: Strause Shufang Shi , Wilson Nance
Published: April 2019

The skills and strategies of effective communication are at the heart of literacy teaching and learning; engaging with digital technologies to communicate puts new demands on teachers and students. The communication tools of the 21st century require a rethinking of our 19th century educational approach to fully integrate digital tools into the classroom.  We must help pre-service teachers learn how to leverage technology to build students’ communication skills across the curriculum. The authors describe two different Digital Strategy Backpacks that were integrated into a pre-service teacher education instructional technology class.  The backpacks illustrate how learners apply communication skills and strategies with a range of technologies.  The authors acknowledge that the Digital Strategy Backpacks are just a taste of this technique, however, we contend that they demonstrate how teachers and teacher educators can put communication goals at the front and center of teaching with technology.
“I Got Confused Reading It”: Using Backchannels to Collaboratively Build Meaning with Texts
Authors: Seglem Robyn , Haling Linda
Published: April 2019

This study explores the use of backchannels, real-time online conversations taking place simultaneously with spoken discussions (the front channel), as one approach to meaning-making through discussion. Using transcripts of front and backchannel discussions, we examine how undergraduate preservice teachers utilize backchannels to talk about class-assigned texts. Although previous research has suggested that backchannels can create distractions, our study found that participants within the backchannel groups were able to create meaning through their interactions. We used five types of talk (analytic, personal, intertextual, transparent, and performative) to aid in our analysis. While we found evidence of all types of talk in the transcripts, analytical talk dominated the conversations, suggesting that backchannels can indeed encourage close readings of texts. In addition, we found that the nature of the online environment created a sixth category of talk. This type of talk, which we called negotiation, allowed participants in the backchannel to define and react to the digital space they interacted within. Findings point to increased engagement in class discussion and the potential of backchannels as a way to effectively integrate technology into instruction.
An Educational Paradigm in the Midst of Shifting: Students’ and Professors’ Attitudes toward Classroom Technology
Authors: McSpadden Emalinda L.
Published: April 2019

Many community college educators struggle with the notion of technology as integral to classroom learning, concerned about changing the very nature of what classroom learning means. For students, there are similar concerns regarding classroom experience, especially if students come from different educational backgrounds, generations, or levels of technological expertise. This qualitative research study compares student and professor experiences of classroom-specific technology use, and findings indicate convergent and divergent themes among students and professors specific to their classroom technology experiences. Students and professors agree that technology should be used in classrooms, despite sometimes hindering creativity and becoming a distraction. Students and professors disagreed in their satisfaction with amounts of classroom technology use and assurance in the efficacy of that technology use. These findings provide valuable insights and fundamental guiding principles for assessing the relationship between users and classroom technology.