bluuebunny/crossref_metadata_2025 huggingface dataset:
Consumer-based brand equity of a destination for sport tourists versus non-sport tourists
Authors: Tasci Asli DA , Hahm Jeeyeon (Jeannie) , Breiter-Terry Deborah
Published: December 2016

Destination authorities invest in sport venues and related infrastructure to attract sport events due to their influence on destination image and visitation. Several studies have revealed a significant influence of image on behavioral intentions of sport or event tourists; however, a comprehensive assessment of consumer-based brand equity (CBBE) inclusive of image, consumer value, brand value, quality, and loyalty by comparing sport and non-sport tourists is lacking. The current study conducted an online survey with a sample of the US population and compared Orlando’s CBBE from the perspectives of sport and non-sport tourists in general and those sport and non-sport tourists who have visited Orlando in the past. Results revealed some differences between sport and non-sport tourists, both in the general sample and in the past visitor group. Although both groups revealed a strong CBBE in general, sport tourists have a better perception of Orlando in some image and loyalty dimensions. General sport tourists’ overall quality, image, and consumer value influence their loyalty, while only image and quality influence loyalty for those sport tourists who visited Orlando before.
Test of a social cognitive model of well-being among breast cancer survivors
Authors: Raque-Bogdan Trisha L , Lent Robert W , Lamphere Brooke
Published: December 2016

Given the potentially long-standing emotional impact of breast cancer, theoretical models are needed to identify critical resources and coping strategies that optimize survivors’ long-term adjustment. This study tested a model of well-being recovery with breast cancer survivors at 4 years post-treatment. Structural equation modeling was used to examine relationships between affect, loneliness, self-compassion, self-efficacy for coping with cancer, well-being, and life satisfaction. Two model variations offered good fit to the data, accounting for large portions of the variance in well-being and life satisfaction. Coping efficacy mediated paths from affect and loneliness to emotional well-being and life satisfaction.
Effect of live load on simply supported bridges under a random traffic flow based on weigh-in-motion data
Authors: Liu Yang , Zhang Haiping , Deng Yang , Jiang Nan
Published: December 2016

Weight, speed, axle space, and following distance of the vehicles are important factors that determine the live load for simply supported beam bridges. In this study, the effect of live load on simply supported bridges was investigated by considering these parameters. The parameters namely weight, speed, longitudinal following space, and vehicle occupancy ratio on different driving lanes are considered using different numerical models. Then, the random traffic flow is simulated using Monte Carlo method based on Nan-xi Yangzi River Bridge’s weigh-in-motion system data. Finite element models are established for six types of simply supported beam bridges with the span ranging from 6 to 40 m and transient analysis is simulated under the traffic loading. Subsequently, the maximum value distribution of live load for lifetime is obtained for the collected data by the method of extrapolation. This study shows that the mean value of the live load for the simply supported beam bridges under a random traffic flow is lower than the permissible design load as per American Association of State Highway and Transportation Officials; however, it is higher than the permissible design load as per BS5400, and it is 0.82 times the Highway-I standard load.
Application of acoustic emission monitoring for assessment of bond performance of corroded reinforced concrete beams
Authors: Abouhussien Ahmed A , Hassan Assem AA
Published: December 2016

This article presents the results of an experimental investigation on the application of acoustic emission monitoring for the evaluation of bond behaviour of deteriorated reinforced concrete beams. Five reinforced concrete beam–anchorage specimens designed to undergo bond failure were exposed to corrosion at one of the anchorage zones by accelerated corrosion. Two additional beams without exposure to corrosion were included as reference specimens. The corroded beams were subjected to four variable periods of corrosion, leading to four levels of steel mass loss (5%, 10%, 20% and 30%). After these corrosion periods, all seven beams were tested to assess their bond performance using a four-point load setup. The beams were continuously monitored by attached acoustic emission sensors throughout the four-point load test until bond failure. The analysis of acquired acoustic emission signals from bond testing was performed to detect early stages of bond damage. Further analysis was executed on signal strength of acoustic emission signals, which used cumulative signal strength, historic index ( H( t)) and severity ( Sr) to characterize the bond degradation in all beams. This analysis allowed early identification of three stages of damage, namely, first crack, initial slip and anchorage cracking, before their visual observation, irrespective of corrosion level or sensor location. Higher corrosion levels yielded significant reduction in both bond strength and corresponding acoustic emission parameters. The results of acoustic emission parameters ( H( t) and Sr) enabled the development of a damage classification chart to identify different stages of bond deterioration.
Civil Society and Party Politics in Bulgaria after 2013: A Gramscian Look
Authors: Stoyanova Veronika
Published: December 2016

In 2013, Bulgaria was shaken by two waves of mass protests, which seemed to mobilise distinct social groups and put different, and often conflicting, demands on the table. In the midst of the turbulence of the protests, new political formations emerged which aimed to capitalise on the mobilisations. The mushrooming of new political projects in the wake of the mass protests seems to mark an apparent re-politicisation following the post-political turn after 1989. Yet the language and identities of these new civic and party formations point to a more complicated dynamic between civic movements, political parties and the state. Drawing on Gramsci’s theory of hegemony, this article scrutinises the links between the newly emerged political projects and the civic mobilisations of 2013 to unravel the new social cleavages underpinning them and consider how these are played out in a context of a changed relationship between civil society and party politics 25 years after the fall of the socialist regime in Bulgaria.
The Role of Constituency, Party, and Industry in Pennsylvania's Act 13
Authors: Bishop Bradford H. , Dudley Mark R.
Published: December 2016

While a large body of research exists regarding the role of industry money on roll-call voting in the U.S. Congress, there is surprisingly little scholarship pertaining to industry influence on state politics. This study fills this void in an analysis of campaign donations and voting during passage of Act 13 in Pennsylvania during 2011 and 2012. After collecting information about natural gas production in state legislative districts, we estimate a series of multivariate models aimed at uncovering whether campaign donations contributed to a more favorable policy outcome for industry. Our findings indicate that campaign donations played a small but systematic role in consideration of the controversial legislation, which represented one of the first and most important state-level regulatory reforms for the hydraulic fracturing industry.
Below-Knee Amputation Failure and Poor Functional Outcomes Are Higher Than Predicted in Contemporary Practice
Authors: Columbo Jesse A. , Nolan Brian W. , Stucke Ryland S. , Rzucidlo Eva M. , Walker Karen L. , Powell Richard J. , Suckow Bjoern D. , Stone David H.
Published: December 2016

Objective:

The perceived functional benefit of below-knee amputation (BKA) must be carefully weighed against the need for potential reinterventions. This study sought to examine the contemporary clinical and functional outcomes of patients undergoing BKA in the endovascular era.

Methods:

All patients who underwent BKA from January 2008 to December 2014 at a single tertiary medical center were retrospectively reviewed. Demographics, comorbidities, ambulation status, and transcutaneous oximetry (TcPO2) values were recorded. Study end points included freedom from conversion to above-knee amputation (AKA), freedom from conversion to AKA or death, BKA healing, and ambulation. Statistical modeling was performed to determine associations with BKA failure.

Results:

Over the study interval, 130 limbs underwent BKA in 120 patients. Transcutaneous oximetry studies were obtained in 65% (n = 85). Thirty-eight percent (n = 46) of all BKA patients went on to heal and ambulate. Twenty-five percent (n = 33) required reintervention, 24 with conversion to AKA, and 9 with BKA revision. One-year freedom from conversion to AKA was 76% and was decreased among those with lower TcPO2 levels (60% TcPO2 <40 vs 81% TcPO2 ≥40; P = .04). One-year composite freedom from conversion to AKA/death was 60% and was decreased among those with lower TcPO2 readings (39% TcPO2 <40 vs 69% TcPO2 ≥40; P = .01).

Conclusion:

Despite a perceived functional bias toward knee salvage at the time of major amputation, most patients failed to postoperatively ambulate. Those with decreased TcPO2 levels (<40 mm Hg) have a 2-fold higher risk of AKA conversion or death, while nearly one-fourth of all BKA patients will succumb to the same fate irrespective of TcPO2. This suggests that many BKA patients in the endovascular era fail to derive the perceived benefit of knee salvage at the time of their index amputation. These findings highlight the need for careful patient selection and for a shared decision-making model in this frail population.
Exploring the Chronic Illness Experience of Rural-Dwelling Latinos of Mexican Origin
Authors: Guzman Anissa
Published: December 2016

Introduction:

Chronic illness is a complex and ever-growing phenomenon that is affecting millions of Americans every day, and it is disproportionately experienced by Latinos of Mexican origin.

Method:

In this quantitative study, the specific aims were to evaluate perceptions of chronic illness(es), locus of control (health and God), health status, and cultural orientation of rural-dwelling Latinos of Mexican origin in Colorado who have one or more chronic illnesses and to explore the relationships existing between these concepts.

Results:

A sample of 102 varied from overall national statistics for this population in the United States by gender, mean annual income, and education completed.

Conclusion:

As Latinos of Mexican origin move toward becoming the largest minority population in the United States, it is important to improve the body of nursing science that targets this population.
The Mirror Illusion Increases Motor Cortex Excitability in Children With and Without Hemiparesis
Authors: Grunt Sebastian , Newman Christopher J. , Saxer Stefanie , Steinlin Maja , Weisstanner Christian , Kaelin-Lang Alain
Published: December 2016

Background. Mirror therapy provides a visual illusion of a normal moving limb by using the mirror reflection of the unaffected arm instead of viewing the paretic limb and is used in rehabilitation to improve hand function. Little is known about the mechanism underlying its effect in children with hemiparesis. Objective. To investigate the effect of the mirror illusion (MI) on the excitability of the primary motor cortex (M1) in children and adolescents. Methods. Twelve patients with hemiparesis (10-20 years) and 8 typically developing subjects (8-17 years) participated. Corticospinal reorganization was classified as contralateral (projection from contralateral hemisphere to affected hand) or ipsilateral (projection from ipsilateral hemisphere to affected hand). M1 excitability of the hemisphere projecting to the affected (nondominant in typically developing subjects) hand was obtained during 2 different conditions using single-pulse transcranial magnetic stimulation (TMS). Each condition (without/with mirror) consisted of a unimanual and a bimanual task. Motor-evoked potentials (MEPs) were recorded from the abductor pollicis brevis and flexor digitorum superficialis muscles. Results. MEP amplitudes were significantly increased during the mirror condition ( P = .005) in typically developing subjects and in patients with contralateral reorganization. No significant effect of MI was found in subjects with ipsilateral reorganization. MI increased M1 excitability during active movements only. This increase was not correlated to hand function. Conclusion. MI increases the excitability of M1 in hemiparetic patients with contralateral corticospinal organization and in typically developing subjects. This finding provides neurophysiological evidence supporting the application of mirror therapy in selected children and adolescents with hemiparesis.
Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke?
Authors: Waddell Kimberly J. , Strube Michael J , Bailey Ryan R. , Klaesner Joseph W. , Birkenmeier Rebecca L. , Dromerick Alexander W. , Lang Catherine E.
Published: December 2016

Background. A common assumption is that changes in upper limb (UL) capacity, or what an individual is capable of doing, translates to improved UL performance in daily life, or what an individual actually does. This assumption should be explicitly tested for individuals with UL paresis poststroke. Objective. To examine changes in UL performance after an intensive, individualized, progressive, task-specific UL intervention for individuals at least 6 months poststroke. Methods. Secondary analysis on 78 individuals with UL paresis who participated in a phase II, single-blind, randomized parallel dose-response trial. Participants were enrolled in a task-specific intervention for 8 weeks. Participants were randomized into 1 of 4 treatment groups with each group completing different amounts of UL movement practice. UL performance was assessed with bilateral, wrist-worn accelerometers once a week for 24 hours throughout the duration of the study. The 6 accelerometer variables were tested for change and the influence of potential modifiers using hierarchical linear modeling. Results. No changes in UL performance were found on any of the 6 accelerometer variables used to quantify UL performance. Neither changes in UL capacity nor the overall amount of movement practice influenced changes in UL performance. Stroke chronicity, baseline UL capacity, concordance, and ADL status significantly increased the baseline starting points but did not influence the rate of change (slopes) for participants. Conclusions. Improved motor capacity resulting from an intensive outpatient UL intervention does not appear to translate to increased UL performance outside the clinic.
The role of the clerk to the corporation in promoting the legitimate governance of further education and sixth form colleges in England
Authors: Forrest Colin , Goodall Janet , Hill Ron , James Chris
Published: December 2016

In England, further education college and sixth form college governing bodies are required to appoint a clerk to administer and advise on governing procedure and practice. In this article we report research which aimed to understand and theorise about the role and the associated responsibilities. We analysed the relevant literatures, carried out a national survey of clerks and held seven regional focus group meetings. The role in relation to board matters is significant in institutionalising the governing body and thereby promoting legitimate governance. The clerk’s practices entail communicating the requirements of second-order governance which frame the everyday actions of first-order governance. The context for the role is potentially highly dynamic and clerks’ accountabilities to their boards can be complex. Clerks may have within-college governance responsibilities where their work may be similar to that of a company secretary. These responsibilities can expose clerks to role conflict and complicate accountability relationships, but can also bring benefits to their work with the board. The role, as experienced by clerks, is accorded insufficient status and under-valued, which can affect their authority. We conclude that a role promoting legitimate governance in the English further education sector and in other educational settings is crucial.
Professional identity, adaptation and the self
Authors: Notman Ross
Published: December 2016

There is developing interest in how professional identity can support educational leaders’ management of change. This article explores the conceptualisation and interplay of identity formation with adaptive and contingent forms of educational leadership. The article draws on qualitative data obtained from two New Zealand school principals and significant others, as each principal negotiated their way through the beginnings of a second principalship and associated change processes. Findings from this first year of a three-year study identified influential factors within each principal’s personal, and professional identities. A comparison of findings with the respective literatures revealed a potential fusion between identity formation and concepts within the broad fields of adaptive and values-based contingency leadership.
Accuracy of outpatient service data for activity-based funding in New South Wales, Australia
Authors: Munyisia Esther N , Reid David , Yu Ping
Published: December 2016

Background:

Despite increasing research on activity-based funding (ABF), there is no empirical evidence on the accuracy of outpatient service data for payment.

Objective:

This study aimed to identify data entry errors affecting ABF in two drug and alcohol outpatient clinic services in Australia.

Methods:

An audit was carried out on healthcare workers’ (doctors, nurses, psychologists, social workers, counsellors, and aboriginal health education officers) data entry errors in an outpatient electronic documentation system.

Results:

Of the 6919 data entries in the electronic documentation system, 7.5% (518) had errors, 68.7% of the errors were related to a wrong primary activity, 14.5% were due to a wrong activity category, 14.5% were as a result of a wrong combination of primary activity and modality of care, 1.9% were due to inaccurate information on a client’s presence during service delivery and 0.4% were related to a wrong modality of care.

Conclusion:

Data entry errors may affect the amount of funding received by a healthcare organisation, which in turn may affect the quality of treatment provided to clients due to the possibility of underfunding the organisation. To reduce errors or achieve an error-free environment, there is a need to improve the naming convention of data elements, their descriptions and alignment with the national standard classification of outpatient services. It is also important to support healthcare workers in their data entry by embedding safeguards in the electronic documentation system such as flags for inaccurate data elements.
Hackathons, data and discourse: Convolutions of the data (logical)
Authors: Thornham Helen , Gómez Cruz Edgar
Published: December 2016

This paper draws together empirical findings from our study of hackathons in the UK with literature on big data through three interconnected frameworks: data as discourse, data as datalogical and data as materiality. We suggest not only that hackathons resonate the wider socio-technical and political constructions of (big) data that are currently enacted in policy, education and the corporate sector (to name a few), but also that an investigation of hackathons reveals the extent to which ‘data’ operates as a powerful discursive tool; how the discourses (and politics) of data mask and reveal a series of tropes pertaining to data; that the politics of data are routinely and simultaneously obscured and claimed with serious implications for expertise and knowledge; and that ultimately, and for the vast majority of hackathons we have attended, the discursive and material constructions of data serve to underpin rather than challenge existing power relations and politics.
Just good enough data: Figuring data citizenships through air pollution sensing and data stories
Authors: Gabrys Jennifer , Pritchard Helen , Barratt Benjamin
Published: December 2016

Citizen sensing, or the use of low-cost and accessible digital technologies to monitor environments, has contributed to new types of environmental data and data practices. Through a discussion of participatory research into air pollution sensing with residents of northeastern Pennsylvania concerned about the effects of hydraulic fracturing, we examine how new technologies for generating environmental data also give rise to new problems for analysing and making sense of citizen-gathered data. After first outlining the citizen data practices we collaboratively developed with residents for monitoring air quality, we then describe the data stories that we created along with citizens as a method and technique for composing data. We further mobilise the concept of ‘just good enough data’ to discuss the ways in which citizen data gives rise to alternative ways of creating, valuing and interpreting datasets. We specifically consider how environmental data raises different concerns and possibilities in relation to Big Data, which can be distinct from security or social media studies. We then suggest ways in which citizen datasets could generate different practices and interpretive insights that go beyond the usual uses of environmental data for regulation, compliance and modelling to generate expanded data citizenships.
Dental considerations in anaesthesia
Authors: Sahni Vaibhav
Published: December 2016

Dental trauma as a result of anaesthesia practice is a relevant issue concerning morbidity and litigation. The investigator aimed to consolidate pertinent information on this issue to aid in the redressal of such an occurrence. A review of this relevant literature alongwith the author’s suggestions towards the management of the various kinds of dental trauma sustained as a result of anaesthesia practice is presented.
A cross-sectional study to assess the patient safety culture in the Palestinian hospitals: a baseline assessment for quality improvement
Authors: Elsous Aymen , Akbari Sari Ali , Rashidian Arash , Aljeesh Yousef , Radwan Mahmoud , AbuZaydeh Hatem
Published: December 2016

Objectives

To measure and establish a baseline assessment of the patient safety culture in the Palestinian hospitals.

Design

A cross-sectional descriptive study using the Arabic version of the Safety Attitude Questionnaire (Short Form 2006).

Participants

A total of 339 nurses and physicians returned the questionnaire out of 370 achieving a response rate of 91.6%.

Setting

Four public general hospitals in the Gaza Strip, Palestine.

Methods

Nurses and physicians were randomly selected using a proportionate random sampling. Data analysis performed using Statistical Package for the Social Sciences software version 20, and p value less than 0.05 was statistically significant.

Main outcomes measures

Current status of patient safety culture among healthcare providers and percentage of positive attitudes.

Results

Male to female ratio was 2.16:1, and mean age was 36.5 ± 9.4 years. The mean score of Arabic Safety Attitude Questionnaire across the six dimensions on 100-point scale ranged between 68.5 for Job Satisfaction and 48.5 for Working Condition. The percentage of respondents holding a positive attitude was 34.5% for Teamwork Climate, 28.4% for Safety Climate, 40.7% for Stress Recognition, 48.8% for Job Satisfaction, 11.3% for Working Conditions and 42.8% for Perception of Management. Healthcare workers holding positive attitudes had better collaboration with co-workers than those without positive attitudes.

Conclusion

Findings are useful to formulate a policy on patient safety culture and targeted a specific safety culture dimension to improve the safety of patients and improve the clinical outcomes within healthcare organisations.
Social Networking Site Behaviors Across the Relational Lifespan: Measurement and Association With Relationship Escalation and De-escalation
Authors: Brody Nicholas , LeFebvre Leah E. , Blackburn Kate G.
Published: December 2016

This study examines (1) the factor structure of social networking site relational behaviors (SNSRB), (2) the association between the behaviors and relational quality and breakup adjustment, and (3) whether behaviors vary as a function of relational status. Participants’ responses ( N = 363) indicated that the majority of variance in SNSRB was accounted for by 10 factors—surveillance, managing impressions through photographs, regulating usage, maintaining shared networks/contacts, oversharing, communicating directly via private messages, posting about offline activity, relationship broadcasting, status management, and privacy. Additionally, each factor was associated with the participants’ romantic relationships such as quality of current relationships, adjustment to dissolved relationships, or relational status. This study extends understanding of how technology reflects the way people interact throughout the romantic relationship lifespan.
A Comparison of Iranian High School Teachers’ and Students’ Perceptions of Effective English Teachers
Authors: Alimorad Zahra , Tajgozari Mostafa
Published: December 2016

As potential mismatches between teachers’ and students’ perceptions can have negative effects on students’ satisfaction with the language class and even on their ultimate achievement, many researchers have attempted to identify and examine possible sources of such mismatches. In line with those investigations, the present study intended to compare the perceptions held by Iranian English as a Foreign Language (EFL) public school teachers with those of their students. To this aim, a convenient sample of teachers ( N = 75) and students ( N = 202) from different cities of Iran was recruited to participate in the study. Using a 50-item Likert-type questionnaire and running between-groups independent-samples t tests and a two-way ANOVA, the researchers found that students’ perceptions were completely different from those of their teachers. Contrary to expectations, while students preferred a communicative approach to learning English, their teachers tended to favor a more traditional approach. Also, although high- and low-achieving students’ perceptions were not statistically different, they were significantly different from those of their teachers. Moreover, male teachers held different perceptions from their female students, and female teachers’ perceptions were also different from those of their male students. Findings of the study along with their implications for the practice of English teaching are also discussed.
Heterogeneous Credit Impacts on Health Care Spending of the Poor in Peri-Urban Areas, Vietnam
Authors: Doan Tinh Thanh , John Gibson , Tran Tuyen Quang
Published: December 2016

Quantile treatment effects are estimated to study the impacts of household credit access on health spending by poor households in one District of Ho Chi Minh City, Vietnam. There are significant positive effects of credit on the health budget shares of households with low health care spending. In contrast, when an average treatment effect is estimated, there is no discernible impact of credit access on health spending. Hence, typical approaches to studying heterogeneous credit impacts that only consider between-group differences and not differences over the distribution of outcomes may miss some heterogeneity of interest to policymakers.
Parallel Paradoxes and Useful Uselessness
Authors: Draus Paul , Roddy Juliette , Asabigi Kanzoni
Published: December 2016

This article explores potentially productive parallels between ethnographic interviewing, mindfulness-based practices, and recovery processes. First, we consider ethnographic interviews as dialogic and affective encounters that reflect and complement the recovery process, paradoxically enhancing agency by illuminating one’s lack of control. For individuals in recovery from substance abuse and associated trauma, the ethnographic interview may provide an opportunity to examine past events and gain insight into factors that contributed to risky situations and behaviors. We propose that the dialogic space created by the ethnographic interview resembles the moment-to-moment awareness cultivated by mindfulness practices and may have individual-level benefits for similar reasons. We briefly explore the relevance of recent research on epigenetic and neural plasticity. Finally, the potential for greater awareness of these mindfulness mechanisms to enhance ethnographic interviews is discussed.
Creating and Sustaining an Experiential Learning Component on Aging in a BSW Course
Authors: Young Jimmy A. , Lee Justin S. , Kovacs Pamela J.
Published: December 2016

Regardless of their particular field of practice, social workers increasingly serve the growing population of older adults in the United States. This article describes the process of integrating an experiential component into a Baccalaureate Social Work (BSW) course involving 75 BSW students. Reflections on the strengths and challenges during 3 years of the course and a successful sustainability strategy are discussed. Three methods of curriculum infusion were added to a required course: (a) guest speakers, (b) required volunteer hours, and (c) written reflections and class presentations. We discovered that students’ attitudes toward working with older adults were changed following their experience in this course. Cognizant of the difficulty introducing additional hours and content to a full course agenda, we advocate for curriculum change that includes an experiential component together with classroom discussion and activities. We provide details of our process of implementation and sustainability that might help guide similar course adaptations to increase BSW student exposure to working with older adults.
Research Insights About Risk Governance
Authors: Viscelli Therese R. , Beasley Mark S. , Hermanson Dana R.
Published: December 2016

In recent years, expectations for increased risk governance have been placed explicitly on boards of directors. In response, boards are being held responsible for not only understanding and approving management’s risk management processes, but they are also being held responsible for assessing the risks identified by those processes as part of overseeing management’s pursuit of value. These increasing responsibilities have led a number of organizations to adopt enterprise risk management (ERM) as a holistic approach to risk management that extends beyond traditional silo-based risk management techniques. As boards, often through their audit committee, consider management’s implementation of ERM as part of the board’s risk oversight, a number of questions emerge that can be informed by academic research related to ERM. This article summarizes findings from ERM research to provide insights related to the board’s risk governance responsibilities. We also identify a number of research questions that warrant further analysis by governance scholars. It is our hope that this article will spawn varying types of research about ERM and corporate governance.
A Weberian Study of Small, Prosperous Democracies
Authors: Ahonen Pertti
Published: December 2016

Max Weber constructed ideal types highlighting economic, social, political, or other values in objects of inquiry to utilize these ideal types in empirical studies. In this article, Weber’s ideal type, the ideal type of Herrschaft—“domination”—is adapted first to examine New Zealand, and using New Zealand as baseline to next examine Finland. The asymmetric comparative design is applied along three dimensions of domination. In an economic dimension, New Zealand highlights ways of countering threats of volatility and stagnation by means of retrenchment and fiscal austerity—characteristics also found in Finland. In a continuum from residual welfare for the worst-off to universal welfare for all in the social dimension, New Zealand is situated closer to the former and Finland the latter end. In the political dimension, dismantling concentrations of political power but retaining capacity at the “center of government” receives emphasis in New Zealand, and counterparts can be also found in Finland.
Using Universal Design for Learning to Design Standards-Based Lessons
Authors: Rao Kavita , Meo Grace
Published: December 2016

The Universal Design for Learning (UDL) framework can be used to proactively design lessons that address learner variability. Using UDL guidelines, teachers can integrate flexible options and supports that ensure that standards-based lessons are accessible to a range of learners in their classrooms. This article presents a process that teachers can use as they develop standards-based lesson plans. By “unwrapping” academic standards and applying UDL during the lesson planning process, teachers can identify clear goals aligned with an academic standard and develop flexible methods, assessments, and materials that address the needs and preferences of varied learners. General educators and special educators can use this process to develop inclusive lesson plans that address all learners, with and without disabilities.
Towards Sociology of Indian Elites: Marriage Alliances, Vulnerabilities and Resistance in Bollywood
Authors: Bhandari Parul
Published: December 2016

This brief essay explains the nuances and complexities of Indian elites’ subjectivities, which need to be understood beyond the simplistic frameworks of access to capital. This is done through the analysis of two recent Bollywood movies— Dil Dhadakne Do and Shaandaar—that depict the myriad struggles, vulnerabilities and strategies of the elites in forming marriage alliances.
Inherited thrombophilia: a double-edged sword
Authors: Middeldorp Saskia
Published: December 2016

Inherited thrombophilia is a blood coagulation disorder that increases the risk for venous thromboembolism (VTE). During the last decades, the practice of testing has evolved from testing selected populations, leading to high perceived risks, to broad testing for various conditions that included VTE, arterial thrombosis, and pregnancy complications. Because results of such tests usually do not guide treatment decisions, not testing patients with VTE for inherited thrombophilia is on the “Choosing Wisely” list endorsed by multiple specialty societies, including ASH. Inherited thrombophilia can be regarded a double-edged sword, as despite the rationale not to test, it is still being performed frequently. Another way of seeing inherited thrombophilia as a double-edged sword lies in its 2-sided association with reproduction, both in men and in women. Current areas of research are whether women with inherited thrombophilia and pregnancy complications benefit from anticoagulant therapy with regard to improving the chance of a successful pregnancy. Potential effects of inherited thrombophilia, most notably factor V Leiden, on improved embryo implantation in women and sperm counts in men are intriguing, but are currently poorly understood.
Thrombosis and anticoagulation in the setting of renal or liver disease
Authors: Ribic Christine , Crowther Mark
Published: December 2016

Thrombosis and bleeding are among the most common causes of morbidity and mortality in patients with renal disease or liver disease. The pathophysiology underlying the increased risk for venous thromboembolism and bleeding in these 2 populations is distinct, as are considerations for anticoagulation. Anticoagulation in patients with kidney or liver disease increases the risk of bleeding; this risk is correlated with the degree of impairment of anticoagulant elimination by the kidneys and/or liver. Despite being in the same pharmacologic category, anticoagulant agents may have varied degrees of renal and liver metabolism. Therefore, specific anticoagulants may require dose reductions or be contraindicated in renal impairment and liver disease, whereas other drugs in the same class may not be subject to such restrictions. To minimize the risk of bleeding, while ensuring an adequate therapeutic effect, both appropriate anticoagulant drug choices and dose reductions are necessary. Renal and hepatic function may fluctuate, further complicating anticoagulation in these high-risk patient groups.
Venous thromboembolism and stroke in pregnancy
Authors: McLean Kelley , Cushman Mary
Published: December 2016

Pregnancy and the postpartum period substantially increase the risk for thrombotic events. Although the absolute risk for thrombosis is low, these events comprise a significant portion of maternal morbidity and mortality. The vast majority of such events are venous, although the risk for ischemic stroke also appears to be increased in pregnancy. This review will explore the overlapping and unique risk factors for venous and arterial thrombosis in pregnancy. Diagnosis and prevention will be discussed, and treatment will be briefly touched on. The benefit of using a multidisciplinary model in caring for pregnant women who have had a thrombotic event or who are at increased risk for thrombosis is a major focus of the review. Using the experience of our own Hematology and Obstetrics/Maternal Fetal Medicine shared care model, we discuss specific examples of when the use of such an approach is particularly valuable.
Introduction to cancer genetic susceptibility syndromes
Authors: McGee Rose B. , Nichols Kim E.
Published: December 2016

The last 30 years have witnessed tremendous advances in our understanding of the cancer genetic susceptibility syndromes, including those that predispose to hematopoietic malignancies. The identification and characterization of families affected by these syndromes is enhancing our knowledge of the oncologic and nononcologic manifestations associated with predisposing germ line mutations and providing insights into the underlying disease mechanisms. Here, we provide an overview of the cancer genetic susceptibility syndromes, focusing on aspects relevant to the evaluation of patients with leukemia and lymphoma. Guidance is provided to facilitate recognition of these syndromes by hematologists/oncologists, including descriptions of the family history features, tumor genotype, and physical or developmental findings that should raise concern for an underlying cancer genetic syndrome. The clinical implications and management challenges associated with cancer susceptibility syndromes are also discussed.
Novel agents and strategies in transplant-eligible patients with relapsed and refractory Hodgkin lymphoma
Authors: Moskowitz Craig
Published: December 2016

The majority of patients with Hodgkin lymphoma are cured with frontline therapy; however, 10% to 15% with early-stage disease and 20% to 30% with advanced stage require second-line therapy that includes a potentially curative transplant, of which an additional 50% to 55% are cured. Those with multiply relapsed disease traditionally would receive novel agents on a clinical trial or combination chemotherapy as a potential bridge to an allogeneic stem cell transplant. This treatment paradigm has changed with the availability of brentuximab vedotin, an antibody drug conjugate used pre- and post-ASCT, as well as for palliation. With the availability of the checkpoint inhibitors, nivolumab and pembrolizumab, there will be another shift in treatment, with these agents being used for palliation and potentially replacing allogeneic stem cell transplantation in certain patient populations. Finally, up-front management is also changing and this will have an impact on how patients in the relapsed and refractory setting will be treated.
Management of primary central nervous system lymphoma in children
Authors: Giulino-Roth Lisa , Abla Oussama , Batchelor Tracy T.
Published: December 2016

A 14-year-old boy with no significant past medical history presents with headaches and vomiting and is found to have a 2 × 3-cm left parietal lobe mass. A stereotactic biopsy reveals diffuse large B-cell lymphoma (DLBCL). Cerebrospinal fluid cytology, as well as bone marrow biopsies are negative, and a whole-body positron emission tomography/computed tomography scan does not demonstrate other areas of disease. The primary medical team asks how you would treat this patient.
Diagnosis of suspected venous thromboembolism
Authors: Kearon Clive
Published: December 2016

The primary goal of diagnostic testing for venous thromboembolism (VTE) is to identify all patients who could benefit from anticoagulant therapy. Test results that identify patients as having a ≤2% risk of VTE in the next 3 months are judged to exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Clinical evaluation, with assessment of: (1) clinical pretest probability (CPTP) for VTE; (2) likelihood of important alternative diagnoses; and (3) the probable yield of D-dimer and various imaging tests, guide which tests should be performed. The combination of nonhigh CPTP and negative D-dimer testing excludes DVT or PE in one-third to a half of outpatients. Venous ultrasound of the proximal veins, with or without examination of the distal veins, is the primary imaging test for leg and upper-extremity DVT. If a previous test is not available for comparison, the positive predictive value of ultrasound is low in patients with previous DVT. Computed tomography pulmonary angiography (CTPA) is the primary imaging test for PE and often yields an alternative diagnosis when there is no PE. Ventilation-perfusion scanning is associated with less radiation exposure than CTPA and is preferred in younger patients, particularly during pregnancy. If DVT or PE cannot be “ruled-in” or “ruled-out” by initial diagnostic testing, patients can usually be managed safely by: (1) withholding anticoagulant therapy; and (2) doing serial ultrasound examinations to detect new or extending DVT.
Risk stratification and management of acute pulmonary embolism
Authors: Becattini Cecilia , Agnelli Giancarlo
Published: December 2016

The clinical management of patients with acute pulmonary embolism is rapidly changing over the years. The widening spectrum of clinical management strategies for these patients requires effective tools for risk stratification. Patients at low risk for death could be candidates for home treatment or early discharge. Clinical models with high negative predictive value have been validated that could be used to select patients at low risk for death. In a major study and in several meta-analyses, thrombolysis in hemodynamically stable patients was associated with unacceptably high risk for major bleeding complications or intracranial hemorrhage. Thus, the presence of shock or sustained hypotension continues to be the criterion for the selection of candidates for thrombolytic treatment. Interventional procedures for early revascularization should be reserved to selected patients until further evidence is available. No clinical advantage is expected with the insertion of a vena cava filter in the acute-phase management of patients with acute pulmonary embolism. Direct oral anticoagulants used in fixed doses without laboratory monitoring showed similar efficacy (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.70-1.12) and safety (OR, 0.89; 95% CI, 0.77-1.03) in comparison with conventional anticoagulation in patients with acute pulmonary embolism. Based on these results and on their practicality, direct oral anticoagulants are the agents of choice for the treatment of the majority of patients with acute pulmonary embolism.
Treatment of the elderly patient with mantle cell lymphoma
Authors: Soubeyran Pierre , Gressin Rémy
Published: December 2016

Treatment options for mantle cell lymphomas have expanded considerably over recent years, offering hematologists solutions for older patients with an appropriate risk-to-benefit ratio. Indeed, unfit older patients are exposed to a higher risk of toxicity with a standard treatment. Although new treatments have generally good safety profiles, they may lead to unexpected consequences in unfit older patients. Involving geriatricians and a comprehensive geriatric assessment in patient care could help hematologists address these vulnerabilities. The geriatric evaluation process is time-consuming but can be simplified, and its potential to help hematologists foresee unexpected consequences of treatment has now been demonstrated.
Primary immune deficiencies with defects in neutrophil function
Authors: Dinauer Mary C.
Published: December 2016

Immune deficiencies resulting from inherited defects in neutrophil function have revealed important features of the innate immune response. Although sharing an increased susceptibility to bacterial and fungal infections, these disorders each have distinctive features in their clinical manifestations and characteristic microbial pathogens. This review provides an update on several genetic disorders with impaired neutrophil function, their pathogenesis, and treatment strategies. These include chronic granulomatous disease, which results from inactivating mutations in the superoxide-generating nicotinamide dinucleotide phosphate oxidase. Superoxide-derived oxidants play an important role in the control of certain bacterial and fungal species, and also contribute to the regulation of inflammation. Also briefly summarized are updates on leukocyte adhesion deficiency, including the severe periodontal disease characteristic of this disorder, and a new immune deficiency associated with defects in caspase recruitment domain–containing protein 9, an adaptor protein that regulates signaling in neutrophils and other myeloid cells, leading to invasive fungal disease.
Immunoregulatory networks in sickle cell alloimmunization
Authors: Yazdanbakhsh Karina
Published: December 2016

Red blood cell (RBC) transfusions are critical for treatment and prevention of complications of sickle cell disease (SCD), and most SCD patients will receive 1 or more transfusions by age 20. However, SCD alloimmunization remains a serious complication of transfusions that can lead to life-threatening acute and delayed transfusion reactions. Alloimmunization rates are higher in SCD patients most likely due to RBC antigenic differences between largely white donors vs mainly African-American recipients and frequency of transfusions. However, it remains unclear why some but not all SCD patients develop alloantibodies. Cellular immune responses that differ between alloimmunized and nonalloimmunized SCD patients are beginning to be characterized. Altered CD4+ T helper cell responses, known to control immunoglobulin G production, have been identified in alloimmunized SCD patients, including abnormalities in regulatory T cells, as well as helper type 1 (TH1), TH17, and follicular helper T cells. Furthermore, heightened innate immune cell responses to cell free heme with cell polarization toward proinflammatory T cell profiles were recently reported in SCD antibody responders, suggesting that the ongoing hemolytic state in SCD may impair the ability of innate immune cells in these already alloimmunized patients to counter alloimmunization. Identification of molecular pathways in key cellular components that differ between alloimmunized and nonalloimmunized SCD patients is likely to lead to identification of biomarkers of alloimmunization and future design of targeted therapies to prevent or even dampen alloantibody responses in these highly susceptible patients.