bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Cerebellar Syndrome, Conjunctivitis, and Hearing Loss Associated with Low-Dose Cytarabine Administration
Authors: Cersosimo Robert J. , Carter Ricardo T. , Matthews S. James , Coderre Maryann , Karp Daniel D.
Published: February 2017

An unusual reaction associated with chronic low-dose cytarabine is described. A 77-year-old man complained of three to four weeks of hearing loss and progressive inability to walk without assistance. He had received two courses of cytarabine 100 mg sc/wk for the management of myelofibrosis myeloid metaplasia over 21 months. He received a total of 3 g over seven months during his first course followed ten months later with 1.2 g over four months. Conjunctivitis was also identified on physical examination at the time of his admission. He was admitted to the neurology service where a complete neurological work-up with consultations from the ophthalmology, audiology, hematology, and ear, nose, and throat services failed to identify a cause of his symptoms. Cytarabine was discontinued on the suspicion that his symptoms were drug induced. The conjunctivitis resolved completely with ophthalmic antibiotics and corticosteroids. His hearing slowly improved over three to four weeks, and he was able to ambulate with a walker. He continued to improve at home although some hearing loss remained three months after his initial presentation. Although conjunctivitis and neurotoxicity are well-known complications of high-dose cytarabine, there are no prior reports of these reactions after low-dose therapy. Hearing loss, which has not been previously reported with cytarabine alone, appears to be a new complication of cytarabine administration.
Bioelectrical Impedance in Clinical Practice
Authors: Zarowitz Barbara J. , Pilla Alison M.
Published: February 2017

Bioelectrical impedance (BI) relies on the conduction of a low-voltage alternating current through the body. Lean tissue and fluids containing electrolytes conduct the current and cell membranes serve as capacitors and account for capacitive resistance. Fat and bone are poor conductors. Measurement of the voltage drop of the applied current yields resistance (R) and reactance (Xc). R and Xc are used with height, weight, age, and gender in a number of multiple regression relationships to predict body composition compartments such as fat-free mass, lean body mass, extracellular mass, and body cell mass. The technique has been compared with and validated against traditional measures of body composition analysis. In clinical practice, BI has been used to monitor fluid status in burn and dialysis patients, assess changes of body cell mass with nutritional repletion, and predict pharmacokinetic parameters and dose of theophylline and aminoglycoside antibiotics. BI is a noninvasive, safe, rapid, and reproducible technique with exciting potential in clinical practice.
Bacterial Resistance to Antibiotics: Mechanisms and Prevalence in Hospitals and Nursing Homes
Authors: Bosso John A.
Published: February 2017

Bacterial resistance to antibiotics has become an increasingly distressing problem over the last few decades. In this article, known resistance mechanisms are reviewed and the extent of the problem in both hospitals and nursing homes is addressed. Suggestions for preventing the further spread of this problem are presented.
Isoflurane for the Management of Status Epilepticus
Authors: Meeke Rodney I. , Soifer Betsy E. , Gelb Adrian W.
Published: February 2017

When conventional therapy fails in status epilepticus, general anesthesia is recommended. We present our experience with isoflurane, an inhalational anesthetic, in the management of a patient with refractory status epilepticus. The seizures were controlled with relatively small concentrations of isoflurane. Hypotension, the only adverse effect of isoflurane, was managed with fluid and dopamine infusions.
Changing Patterns of Psychotropic Drug use in the Elderly: A Five-Year Update
Authors: Stewart Ronald B. , May Franklin E. , Moore Mary T. , Hale William E.
Published: February 2017

Psychotropic drug use was evaluated in 2022 ambulatory elderly subjects in 1978-80 and again in 1984-86. Use of hypnotic drugs declined from 8.5 percent (n = 3234) in 1978-80 to 6.3 percent (n = 2681) in 1984-86 (p<0.01). Use of the long-acting hypnotic flurazepam decreased (p <0.01) and use of two short-acting drugs, triazolam and temazepam, increased. Prescribing of long half-life benzodiazepines, such as diazepam (p<0.01) and chlordiazepoxide, clorazepate, halazepam, and prazepam as a group (p <0.01) decreased as well as the use of nearly all products containing barbiturates (p<0.01).
The Application of Current Proposed Venous Thromboembolism Risk Assessment Model for Ambulatory Patients With Cancer
Authors: Abdel-Razeq Hikmat , Mansour Asem , Saadeh Salwa S. , Abu-Nasser Mahmoud , Makoseh Mohammad , Salam Murad , Abufara Alaa , Ismael Yousef , Ibrahim Alaa , Khirfan Ghaleb , Ibrahim Mohammad
Published: February 2017

Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice. Medical records and hospital electronic database were searched for patients with cancer having VTE. Known risk factors were collected, and risk assessment was done using the Khorana RAM. Over a 10-year period, 346 patients developed VTE in ambulatory settings. Median age was 57 and 59.0% were females. Lower extremities were involved in 196 (56.6%), while 96 (27.7%) had pulmonary embolism. Most (76.6%) patients had stage IV disease, only 9.0% had stage I or II disease. Only 156 (45.1%) patients were on active chemotherapy, for whom Khorana risk assessment score was calculated. In these patients, high risk was identified in 31 (19.9%) patients, while 81 (51.9%) had intermediate risk and 44 (28.2%) had low risk. No patients were on prophylaxis prior to VTE. Most ambulatory patients with cancer who developed VTE were not on chemotherapy, and many of those who were on active treatment had low Khorana risk scores. This illustrates the need to modify the model or develop a new one that takes into consideration this group of patients.
Potential cost savings by dose down-rounding of monoclonal antibodies in a community cancer center
Authors: Copur Mehmet S , Gnewuch Curtis , Schriner Megan , Tharnish Mark , Gonen Mithat , McDonald Monica , Kezeor Jami , Ramaekers Ryan C , Gauchan Dron , Clark Douglas , Greenwalt Lois , Mickey Mary , Norvell Max
Published: February 2017

Purpose

Increasing new cancer cases and approval of effective but expensive new drugs extending survival have led to unsustainable cancer care costs. Potential cost savings by a hypothetical dose down-rounding project of monoclonal antibodies at a community-based cancer center is presented.

Methods

From October 2014 through October 2015, metastatic cancer patients receiving monoclonal antibodies at CHI-Health St Francis Cancer Treatment Center in Grand Island, Nebraska, were identified through electronic health records. A total of 11 different types of monoclonal antibodies that were administered during the study period were identified. Trastuzumab, ofatumumab, and obinutuzumab did not require dose-rounding; thus, they were excluded from the analyses. Available vial size(s) and costs per milligram per average wholesale price for each monoclonal antibody were recorded. Costs of actual amounts prescribed were compared to the costs of theoretically reduced ≤5% and ≤10% doses rounded to the nearest vial sizes. Reduced doses resulting in a decreased number of opened vials qualified for meaningful dose down-rounding and were included in the analysis. Average actual dose reduction percentage resulting in cost savings for both groups was also calculated.

Results

A total of 728 doses of eight monoclonal antibodies suitable for dose down-rounding were identified. Vial sizes of pembrolizumab and ipilimumab did not allow for a meaningful dose down-rounding. At the ≤5% dose down-rounding, 255 of 728 doses (35%) qualified with a potential annual cost savings of $220,793.80. At the ≤10% dose down-rounding, 526 of 728 doses (72%) qualified with a potential annual cost savings of $454,461.00. The average actual dose reduction was 2.4% for the ≤5% dose reduction group and 4.9% for the ≤10% dose reduction group. Overall average cost savings per qualifying dose reduction was around $865.00. More doses qualified for cost savings in the ≤10% dose reduction group. Significant differences between different monoclonal antibodies for dose rounding at either ≤5% (p = 0.002) or ≤10% (p < 0.001) were observed.

Conclusion

A practical dose down-rounding procedure may allow significant cost reduction in metastatic cancer setting, where the cure is not the goal. Drug waste can be avoided by convenient vial sizes or can even be eliminated by lyophilized forms like in trastuzumab. Our data reflect the monoclonal antibody use and potential cost savings with the proposed dose down-rounding approach in a community-based cancer program.
Moral responsibility, personal regulation, and helping others: A cultural approach to moral reasoning in U.S. evangelical Christian cultures
Authors: Fasoli Allison DiBianca
Published: February 2017

The way that people think about moral responsibility and personal freedom in their moral judgments is a complex issue that has been extensively theorized and researched from the perspective of Social Domain Theory. In this study, I offer a cultural reinterpretation of the Social Domain Theory of moral reasoning to examine how judgments about helping others are linked to cultural visions of morality and personal freedom within U.S. evangelical Christian religious cultures. Sixteen parent–child dyads from an evangelical Christian church produced conversations in response to hypothetical vignettes about helping others in need. Mixed quantitative and qualitative analyses revealed conceptions of personal freedom that prioritized personal regulation of self in line with standards for helping actions and desires determined by God, rather than personal determination of correct action and desire. Findings are interpreted and discussed in light of local conceptions of morality, self, and helping. I conclude by using these findings to illuminate the role of culture in constituting domains of social knowledge.
Simulation modeling analysis of sequential relations among therapeutic alliance, symptoms, and adherence to child-centered play therapy between a child with autism spectrum disorder and two therapists
Authors: Goodman Geoff , Chung Hyewon , Fischel Leah , Athey-Lloyd Laura
Published: February 2017

This study examined the sequential relations among three pertinent variables in child psychotherapy: therapeutic alliance (TA) (including ruptures and repairs), autism symptoms, and adherence to child-centered play therapy (CCPT) process. A 2-year CCPT of a 6-year-old Caucasian boy diagnosed with autism spectrum disorder was conducted weekly with two doctoral-student therapists, working consecutively for 1 year each, in a university-based community mental-health clinic. Sessions were video-recorded and coded using the Child Psychotherapy Process Q-Set (CPQ), a measure of the TA, and an autism symptom measure. Sequential relations among these variables were examined using simulation modeling analysis (SMA). In Therapist 1’s treatment, unexpectedly, autism symptoms decreased three sessions after a rupture occurred in the therapeutic dyad. In Therapist 2’s treatment, adherence to CCPT process increased 2 weeks after a repair occurred in the therapeutic dyad. The TA decreased 1 week after autism symptoms increased. Finally, adherence to CCPT process decreased 1 week after autism symptoms increased. The authors concluded that (1) sequential relations differ by therapist even though the child remains constant, (2) therapeutic ruptures can have an unexpected effect on autism symptoms, and (3) changes in autism symptoms can precede as well as follow changes in process variables.
Screening for autism spectrum disorder in low- and middle-income countries: A systematic review
Authors: Stewart Lydia A , Lee Li-Ching
Published: February 2017

This review contributes to the growing body of global autism spectrum disorder literature by examining the use of screening instruments in low- and middle-income countries with respect to study design and methodology, instrument adaptation and performance, and collaboration with community stakeholders in research. A systematic review was conducted to understand the use of autism spectrum disorder screening instruments in low- and middle-income countries from studies published between 1992 and 2015. This review found that 18 different autism spectrum disorder screeners have been used in low- and middle-income settings with wide ranges of sensitivities and specificities. The significant variation in study design, screening methodology, and population characteristics limits the ability of this review to make robust recommendations about optimal screening tool selection. Clinical-based screening for autism spectrum disorder was the most widely reported method. However, community-based screening was shown to be an effective method for identifying autism spectrum disorder in communities with limited clinical resources. Only a few studies included in this review reported cultural adaptation of screening tools and collaboration with local stakeholders. Establishing guidelines for the reporting of cultural adaptation and community collaboration procedures as well as screening instrument psychometrics and screening methodology will enable the field to develop best practices for autism spectrum disorder screening in low-resource settings.
Optimising the illumination spectrum for tissue texture visibility
Authors: Wang H , Cuijpers RH , Vogels IMLC , Ronnier Luo M , Heynderickx I , Zheng Z
Published: February 2017

A light-emitting diode based spectrum optimisation is proposed to enhance the visibility of the texture of biological tissue. This optimisation method is based on maximising perceptual colour differences between pairs of colour patches using images of biological tissue. This approach has two advantages. First, by weighting the importance of colour differences, the impact of glint or specular reflection is reduced automatically. Second, this optimisation method puts the priority on small colour differences which could be more useful in enhancing the visibility of tissue texture. Furthermore, a psychophysical experiment has been conducted to evaluate the effectiveness of the proposed method. To be able to generalise our conclusions, different biological tissue types are used. The results show that illumination spectra that are optimised based on human perceptual colour differences significantly improve the visibility of tissue texture compared to illuminants such as CIE D65, and white LED light.
Cilostazol May Improve Maturation Rates and Durability of Vascular Access for Hemodialysis
Authors: Russell Todd E. , Kasper Gregory C. , Seiwert Andrew J. , Comerota Anthony J. , Lurie Fedor
Published: February 2017

Cilostazol is effective in controlling pathophysiological pathways similar or identical to those involved in nonmaturation and failure of the arteriovenous access. This case–control study examined whether cilostazol would improve maturation rates and durability of vascular access for hemodialysis. The treatment group included 33 patients who received cilostazol for ≥30 days prior to creation of a dialysis access and continued with cilostazol therapy for ≥60 days after surgery. The matched (gender, age, race, diabetes, and the year of surgery) control group included 116 patients who underwent the same procedure but did not receive cilostazol prior to and at least 3 months after surgery. Primary outcomes were maturation and, for those that matured, time of functioning access, defined as the time from the first use to irreparable failure of the access. Secondary outcomes were time to maturation, complications, and time to first complication. Study group patients were 3.8 times more likely to experience fistula maturation compared to the controls (88% vs 66%, RR = 3.8, 95% confidence interval: 1.3-11.6, P = .016). Fewer patients in the study group had complications (76% vs 92%, P = .025), and the time from construction of the fistula to the first complication was longer (345.6 ± 441 days vs 198.3 ± 185.0 days, P = .025). Time to maturation was similar in both groups (119.3 ± 62.9 days vs 100.2 ± 61.7 days, P = .2). However, once matured, time to failure was significantly longer in the treatment group (903.7 ± 543.6 vs 381.6 ± 317.2 days, P = .001). Multivariate analysis confirmed that the likelihood of maturation was significantly higher in the treatment group patients. These results suggest that dialysis access patients may benefit from preoperative and postoperative cilostazol therapy. If confirmed by a randomized trial, this treatment will have a major beneficial impact on patients dependent on a well-functioning access for their hemodialysis.
Training Performance of Laparoscopic Surgery in Two- and Three-Dimensional Displays
Authors: Lin Chiuhsiang Joe , Cheng Chih-Feng , Chen Hung-Jen , Wu Kuan-Ying
Published: February 2017

Introduction. This research investigated differences in the effects of a state-of-art stereoscopic 3-dimensional (3D) display and a traditional 2-dimensional (2D) display in simulated laparoscopic surgery over a longer duration than in previous publications and studied the learning effects of the 2 display systems on novices. Methods. A randomized experiment with 2 factors, image dimensions and image sequence, was conducted to investigate differences in the mean movement time, the mean error frequency, NASA-TLX cognitive workload, and visual fatigue in pegboard and circle-tracing tasks. Results. The stereoscopic 3D display had advantages in mean movement time ( P < .001 and P = .002) and mean error frequency ( P = .010 and P = .008) in both the tasks. There were no significant differences in the objective visual fatigue ( P = .729 and P = .422) and in the NASA-TLX ( P = .605 and P = .937) cognitive workload between the 3D and the 2D displays on both the tasks. For the learning effect, participants who used the stereoscopic 3D display first had shorter mean movement time in the 2D display environment on both the pegboard ( P = .011) and the circle-tracing ( P = .017) tasks. Conclusions. The results of this research suggest that a stereoscopic system would not result in higher objective visual fatigue and cognitive workload than a 2D system, and it might reduce the performance time and increase the precision of surgical operations. In addition, learning efficiency of the stereoscopic system on the novices in this study demonstrated its value for training and education in laparoscopic surgery.
Target tracking control and semi-physical simulation of Qball-X4 quad-rotor unmanned aerial vehicle
Authors: Liu Lu , Pan Feng , An Zhe , Xue Dingyu
Published: February 2017

In this article, a set of integrated ground target tracking flight system has been proposed based on the Qball-X4 quad-rotor unmanned aerial vehicle hardware platform and the QuaRC software platform. Both of the hardware and software platforms are developed by Quanser Company, Canada. The proposed tracking and positioning algorithm could be divided into several stages. First, a tracker is developed based on an optical flow method to track the target; and then, in order to improve the reliability of tracking algorithm and also help in retrieving the lost target, a cascade target detector is developed; meanwhile, a model updated scheme aiming at some possible errors in tracking and detecting process is presented based on Positive-Negative (P-N) learning system; at last, a monocular visual positioning system is designed based on the corresponding navigation message. In addition, the effectiveness of the proposed flight control system is verified by both simulation and hardware-in-loop system results in several tracking flight tests.
Apixaban, concomitant medicines and spontaneous reports of haemorrhagic events
Authors: Caughey Gillian E. , Kalisch Ellett Lisa M. , Barratt John D. , Shakib Sepehr
Published: February 2017

Introduction:

Little is known about the potential safety issues associated with apixaban in clinical practice and their reporting in spontaneous adverse event (SAE) databases.

Objective:

To describe SAE reports associated with the oral anticoagulant apixaban from Australia, Canada and USA and to examine associated concomitant medicine use.

Methods:

SAE report databases from Australia, Canada and the USA were examined for all reports of adverse events associated with apixaban and concomitant medicines from 1 January 2012 to 30 September 2014. Disproportionality analysis (proportional reporting ratio (PRR) and reporting odds ratio (ROR)) was conducted for the quantitative detection of signals using the USA database.

Results:

There were 97 SAE reports associated with apixaban from Australia, 77 from Canada and 2877 from the USA. Reporting of haemorrhage (any type) was common, ranging from 18% for USA to 31% for Australia. Gastrointestinal (GI) haemorrhage was the most commonly reported haemorrhage, accounting for approximately 10% of adverse event reports across all countries. Positive signals were confirmed in the USA data (haemorrhage (any type) PRR, 12.1; χ2, 5582.2 and ROR, 13.4; 95% CI: 12.13–14.6; GI haemorrhage PRR, 11.8; χ2, 2325.4 and ROR, 12.3; 95% CI, 10.8–14.0). Reporting of concomitant use of medicines with the potential to increase bleeding risk ranged from 47.6% in Canada to 65.5% in Australia.

Conclusion:

A large proportion of adverse event reports for apixaban were associated with use of concomitant medicines which may have increased the risk of haemorrhage.
Afterwards: Habitat III and the Sustainable Development Goals
Authors: Revi Aromar
Published: February 2017

Given the far-reaching impact of urbanisation across the globe, the Editor of Urbanisation, Aromar Revi, calls for a better understanding of cities as systems and of the challenges and opportunities of sustainable urbanisation. The article assesses this need in a moment of key international accords in Paris, New York and Quito. National governments displayed exceptional solidarity at the United Nations (UN) Sustainable Development Summit, when they adopted the Sustainable Development Goals (SDGs). Furthermore, the global discussion around the New Urban Agenda (NUA) of Habitat III has made it moderately clear that most of the other SDGs cannot be achieved without sustainable urbanisation, and vice versa. As the operational implications of the political commitment made by governments slowly sink in, the article offers a set of reflections on the role of cities in the implementation of the SDGs, NUA and the Paris climate accord. Moreover, it underlines the need for a comprehensive, multidimensional framework to facilitate the implementation of sustainable urbanisation in light of a new global urban agenda.
DPP-4 inhibition has no acute effect on BNP and its N-terminal pro-hormone measured by commercial immune-assays. A randomized cross-over trial in patients with type 2 diabetes
Authors: Fadini Gian Paolo , Bonora Benedetta Maria , Albiero Mattia , Zaninotto Martina , Plebani Mario , Avogaro Angelo
Published: February 2017

Background

Use of dipeptidyl peptidase-4 inhibitors (DPP4-i) for the treatment of type 2 diabetes (T2D) has been associated with a possible increase in the risk for heart failure (HF). B-type natriuretic peptide (BNP), which is both a biomarker of HF and a hemodynamically active hormone, is a substrate of DPP-4. We herein tested the acute effects of the DPP-4i linagliptin on BNP and NT-proBNP in a cross-over placebo-controlled trial in patients with T2D with and without chronic kidney disease (CKD).

Methods

B-type natriuretic peptide and NT-proBNP were measured using commercially available clinical-grade immune-assays at baseline and at the end of a 4-day treatment with placebo and linagliptin. Changes from baseline during each treatment arm, as well as placebo-subtracted effects of linagliptin on BNP and NT-proBNP were calculated.

Results

46 patients completed the study, 18 of whom were affected by CKD. Baseline BNP and NT-proBNP levels increased with age, were elevated in CKD patients, and inversely correlated with estimated glomerular filtration rate. No significant change was detected in BNP and NT-proBNP levels after treatment with linagliptin or placebo in patients with or without CKD. Only in CKD patients the placebo-subtracted effect of linagliptin indicated a significant reduction in NT-proBNP levels, but this finding was not statistically robust.

Conclusions

Acute treatment with a DPP-4i exerts no clinically-meaningful effects on BNP and NT-proBNP. As routinely used immunoassays do not discriminate between intact/active and cleaved BNP, these data cannot rule out an effect of DPP-4i on HF pathophysiology.

Trial registration NCT01617824
Caring for relatives with agitation at home: A qualitative study of positive coping strategies
Authors: Hoe Juanita , Jesnick Leah , Turner Rebecca , Leavey Gerard , Livingston Gill
Published: February 2017

Background

Trials of psychological interventions for reducing agitation in people with dementia living at home have been unsuccessful.

Aims

To inform future interventions by identifying successful strategies of family carers with relatives with dementia and agitation living at home.

Method

Qualitative in-depth individual interviews were performed with 18 family carers. We used thematic analysis to identify emerging themes.

Results

Carers described initial surprise and then acceptance that agitation is a dementia symptom and learned to respond flexibly. Their strategies encompassed: prevention of agitation by familiar routine; reduction of agitation by addressing underlying causes and using distraction; prevention of escalation by risk enablement, not arguing; and control of their emotional responses by ensuring their relative's safety then walking away, carving out some time for themselves and using family and services for emotional and practical help.

Conclusions

These strategies can be manualised and tested in future randomised controlled trials for clinical effectiveness in reducing agitation in people with dementia living at home.
Use of empathy in psychiatric practice: Constructivist grounded theory study
Authors: Ross James , Watling Chris
Published: February 2017

Background

Psychiatry has faced significant criticism for overreliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and medications with purported disregard for empathetic, humanistic interventions.

Aims

To develop an empirically based qualitative theory explaining how psychiatrists use empathy in day-to-day practice, to inform practice and teaching approaches.

Method

This study used constructivist grounded theory methodology to ask (a) ‘How do psychiatrists understand and use empathetic engagement in the day-to-day practice of psychiatry?’ and (b) ‘How do psychiatrists learn and teach the skills of empathetic engagement?’ The authors interviewed 17 academic psychiatrists and 4 residents and developed a theory by iterative coding of the collected data.

Results

This constructivist grounded theory of empathetic engagement in psychiatric practice considered three major elements: relational empathy, transactional empathy and instrumental empathy. As one moves from relational empathy through transactional empathy to instrumental empathy, the actions of the psychiatrist become more deliberate and interventional.

Conclusions

Participants were described by empathy-based interventions which are presented in a theory of ‘empathetic engagement’. This is in contrast to a paradigm that sees psychiatry as purely based on neurobiological interventions, with psychotherapy and interpersonal interventions as completely separate activities from day-to-day psychiatric practice.
Management of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations
Authors: Flemming Kelly D. , Lanzino Giuseppe
Published: February 2017

Purpose of Review: Unruptured intracranial aneurysms and vascular malformations are detected more frequently because of the increased use and availability of brain imaging. Management of these entities requires knowledge of which patients are at high risk for hemorrhage and what treatment options are available. This article summarizes the epidemiology, natural history, and management strategies for unruptured intracranial aneurysms, arteriovenous malformations, cavernous malformations, developmental venous anomalies, and capillary telangiectasias.

Recent Findings: Pooled cohort studies and meta-analyses have improved the ability to predict hemorrhage for each vascular abnormality. Scores and tools have been developed to aid the practitioner in predicting hemorrhage risk for unruptured intracranial aneurysms. Advances in endovascular techniques for unruptured intracranial aneurysms have improved the ability to treat difficult wide-necked aneurysms.

Summary: Unruptured intracranial aneurysms are a common incidental finding. The PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm) score and Unruptured Intracranial Aneurysm Treatment Score may be useful tools for predicting natural history and treatment recommendations. The overall risk of hemorrhage for both arteriovenous malformations and cavernous malformations is about 2% to 4% per year. With both of these entities, prior hemorrhage predicts future hemorrhage. In addition, other select patient and radiologic factors influence risk of hemorrhage. The risk of future hemorrhage should be compared to the risk of treatment. Developmental venous anomalies and capillary telangiectasias are largely benign entities and rarely symptomatic.
Cardioembolic Stroke
Authors: O’Carroll Cumara B. , Barrett Kevin M.
Published: February 2017

Purpose of Review: Cardioembolic stroke is common and disproportionately more disabling than nonembolic mechanisms of stroke. Its incidence is expected to rise because of the age-related incidence of atrial fibrillation and an aging population. This article summarizes the different causes of cardioembolism and outlines current management guidelines.

Recent Findings: Since cardioembolic stroke is not a single disease entity, its diagnosis requires initial clinical suspicion and a comprehensive evaluation, including ECG, echocardiography, brain imaging, and cardiac monitoring. Atrial fibrillation is the most common cause of cardioembolic stroke, and anticoagulation is usually recommended. This article reviews risk stratification models to assist in the decision-making process and highlights the increased use of novel oral anticoagulants for stroke prevention in atrial fibrillation. New data support the importance of prolonged cardiac monitoring for diagnosing occult atrial fibrillation. Current data on other mechanisms of cardioembolic stroke, such as prosthetic heart valves and aortic arch atherosclerosis, are also presented, and the available evidence regarding patent foramen ovale closure in cryptogenic stroke is summarized.

Summary: Cardioembolism is an important cause of ischemic stroke, with diverse underlying mechanisms requiring a tailored approach to diagnosis, management, and prevention.
Large Artery Atherosclerotic Occlusive Disease
Authors: Cole John W.
Published: February 2017

Purpose of Review: Extracranial or intracranial large artery atherosclerosis is often identified as a potential etiologic cause for ischemic stroke and transient ischemic attack. Given the high prevalence of large artery atherosclerosis in the general population, determining whether an identified atherosclerotic lesion is truly the cause of a patient’s symptomatology can be difficult. In all cases, optimally treating each patient to minimize future stroke risk is paramount. Extracranial or intracranial large artery atherosclerosis can be broadly compartmentalized into four distinct clinical scenarios based upon the individual patient’s history, examination, and anatomic imaging findings: asymptomatic and symptomatic extracranial carotid stenosis, intracranial atherosclerosis, and extracranial vertebral artery atherosclerotic disease. This review provides a framework for clinicians evaluating and treating such patients.

Recent Findings: Intensive medical therapy achieves low rates of stroke and death in asymptomatic carotid stenosis. Evidence indicates that patients with severe symptomatic carotid stenosis should undergo carotid revascularization sooner rather than later and that the risk of stroke or death is lower using carotid endarterectomy than with carotid stenting. Specific to stenting, the risk of stroke or death is greatest among older patients and women. Continuous vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy is the mainstay for stroke prevention in the setting of intracranial and vertebral artery origin atherosclerosis.

Summary: Lifelong vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy are the key elements to reduce future stroke risk in the setting of large artery atherosclerosis. When considering a revascularization procedure for carotid stenosis, patient demographics, comorbidities, and the periprocedural risks of stroke and death should be carefully considered.
Clinical Evaluation of the Patient With Acute Stroke
Authors: Southerland Andrew M.
Published: February 2017

Purpose of Review: This article reviews the clinical evaluation of the patient with acute stroke, including key questions in the focused stroke history, important aspects of the National Institutes of Health Stroke Scale and focused neurologic examination, and the significance of the basic head CT scan in informing a timely treatment decision.

Recent Findings: Advances in both stroke treatment and enhanced diagnostics support an evolving paradigm for acute stroke care, ranging from the prehospital setting to the rehabilitative setting. An international emphasis on best practice strategies promotes efficiency and standardization in stroke systems of care.

Summary: Despite continual changes and augmentations to the field of acute stroke, several fundamentals remain. Central among these is in-depth knowledge of neurovascular anatomy, clinical stroke syndromes, and common mimics, which are foundational to the bedside evaluation of the patient with acute stroke.
Visual acuity in ray-finned fishes correlates with eye size and habitat
Authors: Caves Eleanor M. , Sutton Tracey T. , Johnsen Sönke
Published: February 2017

Visual acuity (the ability to resolve spatial detail) is highly variable across fishes. However, little is known about the evolutionary pressures underlying this variation. We reviewed published literature to create an acuity database for 159 species of ray-finned fishes (Actinopterygii). Within a subset of those species for which we had phylogenetic information and anatomically-measured acuity data (n=81), we examined relationships between acuity and both morphological (eye size and body size) and ecological (light level, water turbidity, habitat spatial complexity, and diet) variables. Acuity was significantly correlated with eye size (p<0.05); a weaker correlation with body size occurred via a correlation between eye and body size (p<0.001). Acuity decreased as light level decreased and turbidity increased; however, these decreases resulted from fishes in dark or murky environments having smaller eyes and bodies than those in bright or clear environments. We also found significantly lower acuity in horizon-dominated habitats than in featureless or complex habitats. Higher acuity in featureless habitats is likely due to species having absolutely larger eyes and bodies in that environment, though eye size relative to body size is not significantly different from that in complex environments. Controlling for relative eye size, we found that species in complex environments have even higher acuity than predicted. We found no relationship between visual acuity and diet. Our results show that eye size is a primary factor underlying variation in fish acuity. We additionally show that habitat type is an important ecological factor that correlates with acuity in certain species.
Compass cues used by a nocturnal bull ant, Myrmecia midas
Authors: Freas Cody A. , Narendra Ajay , Cheng Ken
Published: February 2017

Ants use both terrestrial landmarks and cues derived from path integration to navigate to and from their nest location. These cues persist even as light levels drop during the twilight/night. Here we determined the compass cues used by a nocturnal bull ant, Myrmecia midas, in which the majority of the individuals begin foraging during the evening twilight period. Foragers of M. midas with vectors of≤5 m when displaced to unfamiliar locations did not follow the home vector, but instead showed random heading directions. Foragers with larger home vectors (≥ 10 m) oriented toward the fictive nest, indicating a possible increase in cue strength with vector length. When the ants were displaced locally to create a conflict between the home direction indicated by path integration and terrestrial landmarks, foragers oriented using landmark information exclusively and ignored any accumulated home vector regardless of vector length. When the visual landmarks at the local displacement site were blocked, foragers were unable to orient to the nest direction and their heading directions were randomly distributed. Ants of M. midas typically nest at the base of the tree and some individuals forage on the same tree. Foragers collected on the nest tree during evening twilight were unable to orient toward the nest after small lateral displacements away from the nest, suggesting the possibility of high tree fidelity and an inability to extrapolate landmark compass cues from information collected on the tree and at the nest site to close displacement sites.
Information Culture Development by Younger Schoolchildren in the Process of Education of the Work with Dictionaries
Authors: Зиновьева  , Zinoveva T.
Published: February 2017

The article considers the problem of information culture development by younger schoolchildren it the process of education of the use of linguistic dictionaries for the training tasks solutions. The author describes the features of linguistic dictionaries, characterizes the methodical conditions of their use in the primary school.
Formation of Calligraphic Correct Hand Writing As Pedagogical Problem
Authors: Пяткова  , Pyatkova V.
Published: February 2017

The article considers the problem of teaching first-grade pupil calligraphic correct letter as a basis of handwriting, which is a stable personality characteristic in the future is difficult to correcting. As the process of writing is extremely complex and covers various areas of mental activity, the teacher is recommended to take into account the hygiene, physiological and educational components that contribute to conscious mastery of technique first-grade pupil letters formation of skills of visual-motor development of self-control on the basis of geometric eye estimation. The

author offers the technique “Line-art formation of calligraphic writing”, characterizes its components, compares with the traditional method of teaching writing.
Purposes of Education Understanding in the Domestic Pedagogy in the End of XVIII – Middle of XIX Century
Authors: Никулина  , Nikulina E.
Published: February 2017

The article is addressed to the period of formation in the Russian pedagogical anthropology, when various aspects of philosophical and anthropological foundations of pedagogy, including - the question of the ultimate goal of teaching were actively discussed. Various interpretations

of the concept of “goal of education”, which are represented in the works of local authors and the secular clergy, and under the influence of any foreign pedagogy and teaching of the Orthodox tradition. Common and distinct features in the views of the authors of the period are revealed, as well as the inability to prove the formal separation of them secular and religious in determining the purpose of pedagogical activity.
Older people and health care: challenging assumptions
Authors: Scammell Janet
Published: February 2017

At a time of winter pressures, Janet Scammell, Associate Professor (Nursing), Bournemouth University, looks at how health professionals and society perceive older people, and how this might influence patient care
Our support processes
Authors: Martland Rebecca
Published: February 2017

Following on from last month's introduction, Rebecca Martland offers a variety of practical ideas for supporting young children with a wide range of sensory processing difficulties.
A way to solve problems
Authors: Webb Penny
Published: February 2017

Purpose-made toys and resources have a time and a place, but with their use limited and a shortage of storage space it can pay to look at the benefits of heuristic play materials.
The new Red 1 ambulance response time definition: evaluating clinical impact
Authors: Lynde Jessica , Trebilcock Hannah , Kirby Kim , Tuckett Susan , Perris Andy , South Adrian , Black Sarah
Published: February 2017

Rapid identification of patients with life-threatening conditions is the main priority for any ambulance telephone triage system. Historically there has been a focus on the identification of patients in cardiac arrest; however, the clinical benefits of early recognition of patients in peri-arrest could be considered equally important. An expanded definition of the highest priority response, Red 1, was introduced to identify patients who are critically unwell, at high risk of cardiac arrest, and who would benefit clinically from the fastest level of response from the ambulance service.

An evaluation of the impact of the new Red 1 definition was completed in South Western Ambulance Service NHS Foundation Trust during 2013. It demonstrated that the new Red 1 definition was more sensitive than the previous Red 1 definition in identifying patients in cardiac arrest and those at high risk of out-of-hospital cardiac arrest. The total number of patients who required resuscitation decreased by 11.7% under the new Red 1 definition, supporting the hypothesis that more patients are captured by the new Red 1 definition and a more rapid response diminishes their likelihood of experiencing a cardiac arrest.
Analisis Petrografi Fasa Molybdenum (Mo) dari Oksida Primer Fe2O3 Deposit Bontocani dengan Teknik X-Ray Mapping dan Difraksi Sinar-X
Authors: S Subaer , N Nurhayati , N Nurhasmi , N Nurfadillah
Published: February 2017

A researh related to petrogaphy analysis of molybdenum (Mo) has been conducted. The main objective of this study is to get quantitative information about the composotion of molybdenum (Mo) as a minor phase of primer mineral Fe2O3 deposited at Bontocani, District of Bone South Sulawesi. The petrography analysis was performed on 10 samples by means of Tescan Vega3SB Scanning Electron Microscopy (SEM) coupled with Bruker X-Ray Mapping and Energy Dispersive Spectroscopy (EDS). Crystallinity level and chemical composition
(phase) mineral constituent were performed by using MiniFlexII X-Ray Diifraction (XRD). The petrography analysis in the form of elemental mapping show the position of Mo along with Fe, S and other elements. The XRD analysis showed that that the Mo mineral of Bontocani deposit is found in the form of pure Mo element with a concentration of 0.2 – 8.0 wt%, compound of Fe17(Mo3)0.1 and Fe2(MoO4)3 with a concentration of 2.04 wt% and 14.0 wt%.
Kajian Gejala Penyearahan Optik pada Metamaterial Chiral
Authors: Partini Juliasih , Abraha Kamsul , Hermanto Arief , Tomita Satoshi , Takahiro Matsui
Published: February 2017

Chiral metamaterial is a new breakthrough in the fabrication of a metamaterial because of the capability of providing different refractive index values for each circular polarization angle. This provides opportunities to obtain negative refractive index values, without the necessity to have simultaneously negative values for both permittivity and permeability. This study investigated the optical rectification, which is the phenomenon of second order non-linear optics in the chiral metamaterial. This relates to the testing of the new designs of square structure chiral metamaterial. Optical rectification is often used to 'rectify' femtoseconds laser from the realm of visible light into the terahertz domain. Nonlinear response of metamaterial was observed by terahertz emission spectroscopy. The results showed that the obtained terahertz signal is proportional to the square of the laser power used. This suggests that in the
incoherent optical rectification, there is a mixture of optical rectification with the second harmonic wave generation. Development of square-structured chiral metamaterials is expected to be an alternative source of material due to the lack of non-linear material that can be used in the terahertz domain.
Estimasi Kedalaman Bitumen Batubara di Desa Banjaran Kecamatan Salem Kabupaten Brebes Berdasarkan Data Anomali Magnetik
Authors: S Sehah , Raharjo Sukmaji Anom , Chandra Adi
Published: February 2017

The Estimation of coal bituminous depth in Village of Banjaran, District of Salem, Regency of Brebes based on magnetic anomaly data has been done. The Village of Banjaran is located in the geology basin which called as Bentarsari Basin. The activities stages that carried out in this research include of magnetic data acquisition in the field, data processing, and interpretation. The interpretation of the anomalies data is done through the modeling using the Mag2DC for Window software on the local magnetic anomalies data. Based on this modeling results, then obtained six anomalous objects that can be interpreted as the subsurface rocks in the research area, which consists of sediments of gravel, sand, clay, and silt ( = 0.0020 cgs units); tuff and tuffaceous sandstone ( = 0.0069cgs units); andesite breccia, tuff, and tuffaceous sandstone ( = 0.0085cgs units); solid andesite breccia which not layered ( = 0.0115 cgs units); coarse sandstones, limestones, and sandy marl ( = 0.0109cgs units); andesite sandstone that layered with claystone and thin insertions of new coal bituminous alternately ( = 0.0008cgs units). Based on the modeling results and the geological information of this research area, it can be estimated that the coal bituminous found in the Kaliglagah formation, with its depths ranging between 104.48 m – 505.97m, and the value of the magnetic susceptibility is 0.0008 cgs units.