bluuebunny/crossref_metadata_2025 huggingface dataset:
Forty years of the American Society of Missiology: retrospect and prospect
Authors: Robert Dana L.
Published: October 2013

This essay was delivered as a plenary address at the ASM meeting in Chicago, June 21, 2013. It demonstrates how over the past 40 years, the Association has established the academic legitimacy of missiology across Catholic, mainline Protestant, and evangelical divides. It suggests a tripartite periodization of ASM history. The founding era was marked by crisis over the identity of missions and mission studies. In the second era, beginning around 1989–91, mission studies moved beyond its captivity to a colonialist paradigm and influenced other academic disciplines, including theology, ecclesiology, and church history. The 21st century brought a new era of world Christianity, in which awareness of Christianity as a global religion reframed mission studies. The article raises several challenges for the ASM moving forward in a global era, such as asking what is uniquely North American about the American Society of Missiology.
Emergent Identity Work and Institutional Change: The ‘Quiet’ Revolution of Japanese Middle-Class Housewives
Authors: Leung Aegean , Zietsma Charlene , Peredo Ana Maria
Published: October 2013

How do relatively low-power, role-constrained actors break through their constraints in a highly institutionalized environment? Examining the experience of Japanese middle-class housewives involved in a social enterprise, we developed a model of emergent identity work which outlines how actors who enacted their role values in new domains triggered a process of learning and sensemaking which led to spiralling cycles of role boundary expansion. In this process, facilitated by an enabling collective, actors not only changed their own self-concept (internal identity work) but also, through external identity work, changed others’ conceptions of their institutionally prescribed roles.
African American Paternal Grandmothers’ Satisfaction With the Fathering Practices of Their Teenage Sons
Authors: Reddock Ebony , Caldwell Cleopatra Howard , Antonucci Toni C.
Published: October 2013

African American paternal grandmothers serve an important role in influencing teenage fathers’ involvement with their children in that grandmothers’ support of their sons’ fathering practices is associated with increased father involvement. We used qualitative data from 53 paternal grandmothers to compare satisfaction with teenage sons’ fathering practices with their expectations for ideal fathering and identify reasons for inconsistencies between the two. Paternal grandmothers characterized three practices (providing financial support, being attentive, and performing day-to-day care) that were key to their satisfaction with their sons’ fathering practices. These characterizations mostly overlapped with their expectations for ideal practice. When inconsistencies between expectations and satisfaction were noted, we identified three ways grandmothers interpreted satisfaction with fathering practices. These results have implications for research on teenage fatherhood and interventions meant to enhance teenage fathers’ involvement in rearing their children.
Witness and Unity in 21st-Century World Christianity
Authors: Robert Dana L
Published: October 2013

Christianity has recently undergone historic demographic and cultural shifts: it has expanded significantly in the global south while declining in the west. In an age of World Christianity, these changes bring diversity and competition, and renewed Christian witness. The global context for the faith reveals unavoidable tensions between missional expansion and the call to be one in Christ Jesus. Amid plurality and rapid changes in identity, Christians are challenged to re-appropriate the classic marks of the church – one, holy, catholic, and apostolic. Engagement with all four marks, reframed for the contemporary situation, will help to maintain the creative tension between mission and unity, to connect Christians across geography and generations, and to forge a common vision of salvation in an interconnected world.
The Movement of the Spirit Around the World in Pentecostalism
Authors: Onyinah Opoku
Published: October 2013

The article makes a brief survey of the movement of the Holy Spirit in various church traditions across the world. It begins by highlighting the various revivals in Christianity, including Pietism among Lutheranism and the Holiness movement. It shows these as the precursors to the emergence of Pentecostalism in the 20th century. The Latter Rain movement, which came out of the Pentecostal movement, is analysed as a contributing factor to the Charismatic renewal within world Christianity. The empowerment of the Holy Spirit, which is one of the distinctive emphases of the Charismatic renewal, is shown as providing the opportunity to build the kingdom of the Lord, by various denominations, in love and unity.
Authenticity
Authors: Kadirov Djavlonbek , Varey Richard J. , Wooliscroft Ben
Published: October 2013

This investigation argues that authenticity is inherently a macromarketing concept that is linked to how marketers and consumers view themselves and their own status in society. We show that authenticity refers to the marketer’s marketplace condition (mindset) that can be best described as sincere concern for another. We argue that micromarketing as a general phenomenon is rooted in inauthenticity due to the fact that micromarketing practices represent (distressed, decomposed) overreaction to the marketers’ self-embraced narrow view of their own social status (as maximiser of self-interest, profit, growth) that is largely irrelevant – even contradictory – to the crucial goals of society.
Three-dimensional object reconstruction of symmetric objects by fusing visual and tactile sensing
Authors: Ilonen Jarmo , Bohg Jeannette , Kyrki Ville
Published: October 2013

In this work, we propose to reconstruct a complete three-dimensional (3-D) model of an unknown object by fusion of visual and tactile information while the object is grasped. Assuming the object is symmetric, a first hypothesis of its complete 3-D shape is generated. A grasp is executed on the object with a robotic manipulator equipped with tactile sensors. Given the detected contacts between the fingers and the object, the initial full object model including the symmetry parameters can be refined. This refined model will then allow the planning of more complex manipulation tasks. The main contribution of this work is an optimal estimation approach for the fusion of visual and tactile data applying the constraint of object symmetry. The fusion is formulated as a state estimation problem and solved with an iterated extended Kalman filter. The approach is validated experimentally using both artificial and real data from two different robotic platforms.
The effects of scoop sampling on the creep behaviour of power plant straight pipes
Authors: Rouse James P , Sun Wei , Hyde Thomas H
Published: October 2013

Small specimen testing techniques are potentially highly useful procedures which could be used to determine many fundamental material properties from relatively small amounts of sample material. Small specimens can be manufactured from scoop samples taken from the surface of a component, allowing for continued operation after sampling. In the past, it has been assumed that, provided the wall thickness dimension around the specimen sample site is greater than the minimum design requirement, the action of scoop sampling will not greatly compromise the future operation of the component. Little study has been completed, however, to verify this assumption or to evaluate the likely reduction in remnant life due to scoop sampling. In the present study, a finite element investigation is made into the effects of scoop sampling on the stress states and failure lives of power plant straight pipes under steady-state creep conditions. Loading conditions considered include an internal pressure load only (assuming closed-end conditions), as well as system loading (in the form of additional axial and in-plane bending moment loading). Typically, the application of system loading increases the likelihood of failure being controlled by the stress states in the vicinity of a scoop excavation. This leads to potentially significant reductions (up to approximately 90%) in creep life of straight piping components. Parametric equations (valid for a range of pipe geometries and scoop cut depths) have been proposed, which can estimate the stress riser effect in the vicinity of an excavation sample under closed-end and additional axial loading conditions.
Seeing the Light
Authors: Smith Robert
Published: October 2013

The purpose of this research note is to illustrate the usefulness of the qualitative method of visual ethnography in producing new insights into family business research by investigating the “lived narrative” of a family business in Scotland. The overarching objective is to provide clarity on the use of the method and its potential value for family business researchers as well as to provide an account of the benefits of the approach.
Developing Positivity in Family Business Leaders
Authors: Caspersz Donella , Thomas Jill
Published: October 2013

This article describes a qualitative study exploring how a leadership intervention in a group context developed positivity in leaders of family businesses. Ideas are drawn from positivity in organizational scholarship and group social capital. The article makes two contributions: the first is in conceptualizing positivity in family business studies while the second is to contribute to management thought by describing how the leadership intervention developed positivity to lead and manage in leaders of family business. To the best of our knowledge, there is little research that applies these ideas in family business studies.
Turning modeling and simulation of an aerospace grade aluminum alloy using two-dimensional and three-dimensional finite element method
Authors: Asad Muhammad , Ijaz Hassan , Khan Muhammad A , Mabrouki Tarek , Saleem Waqas
Published: October 2013

This article presents the development of two-dimensional and three-dimensional finite element–based turning models, for better prediction of chip morphology and machined surface topology. Capabilities of a commercial finite element code Abaqus®/Explicit have been exploited to perform coupled temperature–displacement simulations of an aerospace grade aluminum alloy A2024-T351 machining. The findings show that two-dimensional cutting models predict chip morphologies and machined surface textures on a plane section (with unit thickness) passing through the center of workpiece width, and not at the edges. The contribution highlights the importance of three-dimensional machining models for a close corroboration of experimental and numerical results. Three-dimensional cutting simulations show that a small percentage of material volume flows toward workpiece edges (out of plane deformation), augmenting the contact pressures at the edges of tool rake face–workpiece interface. This enhances the burr formation process. Computational results concerning chip morphologies and cutting forces were found in good correlation with experimental ones. In the final part of the article, numerical simulation results with a modified version of a particular turning tool have been discussed. It has been found that the proposed geometry of the tool is helpful in reducing burr formation as well as cutting force amplitude during initial contact of cutting tool with the workpiece material.
Dry gas sealing solutions for high-pressure compressor applications
Authors: Tacon Ken , Twiss Colin , Mammadov Vugar , Aslan-Zada Farhad
Published: October 2013

Although the use of dry gas seals (DGSs) in process centrifugal compressors has become an industry standard since the 1980s end users are still facing operational issues related to premature failures which incur significant maintenance and operational costs. It has been recognized that the majority of the failures are due to a lack of properly conditioned seal gas and this has driven more recent development of Gas Conditioning Units (GCUs) to deliver appropriate quantities of clean, superheated gas to the seal at the required pressure. However, there are a large number of operating units where retrofit of a GCU represents significant cost and engineering challenge. The aim of this paper is to share some recent experience of a DGS reliability improvement program that does not involve retrofitting a GCU. A basic introduction to DGS operating principles and an overview of DGS design and control issues is also included with a focus on tandem seals in high-pressure natural gas compression applications.
The use of acoustic emission for the condition assessment of gas turbines: Acoustic emission generation from normal running
Authors: Nashed Mohammad S , Steel John A , Reuben Robert L
Published: October 2013

Many approaches have been taken to the condition monitoring of gas turbines including performance analysis, vibration monitoring and lubricant debris monitoring. Acoustic emission monitoring has the potential to provide information about turbine operation and faults as they occur and has two possible advantages over other techniques. Firstly, because acoustic emission is sensitive to minor changes which do not necessarily involve whole-body motion, it is potentially able to reveal faults at an early stage. Secondly, because acoustic emission propagates over the structure from the source(s) to the sensor(s), it has the capacity to locate the source of any fault signal without intrusion. This paper explores the nature of the acoustic emission signals generated in a laboratory-scale gas turbine in order to extract and select features of the signal under normal running conditions and to establish the physical source(s) of this acoustic emission. A series of tests with the turbine running normally, either idling with the speed being controlled by fuel and air flow, or under load at fixed fuel and air flow with the speed being controlled by the amount of load applied, provided a range of conditions of gas flow through the turbine. An ancillary set of simplified tests with the free power turbine impeller jammed or absent was used to help distinguish between components of the acoustic emission associated with standing waves in various parts of the turbine and turbulence around the impeller. The results provide the first systematic study of fluid-induced acoustic emission in turbines and, as such, offer a baseline interpretation for acoustic emission generation in turbines and fluid machinery generally. Specifically, the findings will be compared with measurements made on the same turbine with simulated blade faults in a future publication.
Paying Attention to Attention in Recognition Memory
Authors: Dubé Chad , Payne Lisa , Sekuler Robert , Rotello Caren M.
Published: October 2013

Reliance on remembered facts or events requires memory for their sources, that is, the contexts in which those facts or events were embedded. Understanding of source retrieval has been stymied by the fact that uncontrolled fluctuations of attention during encoding can cloud results of key importance to theoretical development. To address this issue, we combined electrophysiology (high-density electroencephalogram, EEG, recordings) with computational modeling of behavioral results. We manipulated subjects’ attention to an auditory attribute, whether the source of individual study words was a male or female speaker. Posterior alpha-band (8–14 Hz) power in subjects’ EEG increased after a cue to ignore the voice of the person who was about to speak. Receiver-operating-characteristic analysis validated our interpretation of oscillatory dynamics as a marker of attention to source information. With attention under experimental control, computational modeling showed unequivocally that memory for source (male or female speaker) reflected a continuous signal detection process rather than a threshold recollection process.
Practices of Traditional Birth Attendants in Sierra Leone and Perceptions by Mothers and Health Professionals Familiar With Their Care
Authors: Dorwie Florence M. , Pacquiao Dula F.
Published: October 2013

Study Purpose: Describe practices of traditional birth attendants (TBAs) in assisting women in childbirth and the perceptions of TBAs by mothers and health professionals familiar with their work. Methodology: Qualitative design using focus groups conducted in urban and rural settings in Sierra Leone. Separate audiotaped focus groups conducted for each group of participants lasting between 45 and 90 minutes. Participants: Purposive sample of 20 TBAs, 20 mothers, and 10 health professionals who met the following criteria: (a) at least 18 years of age, (b) TBAs currently practicing, (c) mothers who delivered at least one child assisted by a TBA, and (d) health professionals currently practicing in the hospital and familiar with TBA practices. Findings: TBAs are valued by mothers, health professionals, and the community because they provide accessible and affordable care to mothers who may otherwise have no access to health services. TBAs need training, supervision, and resources for effective referral of mothers. Systemic problems in the health care system create enormous barriers to effective care for mothers and children independent of TBA practices that contribute to high maternal and infant mortality rates. The study findings have implications on broad public policy in improving maternal and child health in the country.
The Tangled Branches (Las Ramas Enredadas)
Authors: De Santis Joseph P. , Gonzalez-Guarda Rosa , Provencio-Vasquez Elias , Deleon Diego A.
Published: October 2013

Hispanic men who have sex with men (MSM) experience a number of health disparities including high rates of HIV infection from high-risk sex, substance abuse, and intimate partner violence. Although some research is available to document the relationships of these health disparities in the literature, few studies have explored the intersection of these disparities and the factors that influence them. The purpose of this study was to explore the experiences that Hispanic MSM residing in South Florida have with high-risk sex, substance abuse, and intimate partner violence. Focus groups were conducted and analyzed using grounded theory methodology until data saturation was reached ( n = 20). Two core categories with subcategories emerged from the data: The Roots of Risk ( Los raices del riesgo) and The Tangled Branches ( Las Ramas Enredadas). The results of the study provided some important clinical implications as well as directions for future research with Hispanic MSM.
Influence of Psychosocial Factors on Self-Care Behaviors and Glycemic Control in Turkish Patients With Type 2 Diabetes Mellitus
Authors: Cosansu Gulhan , Erdogan Semra
Published: October 2013

Purpose: The main purpose of this study was to investigate the direct and indirect effects of psychosocial factors on self-care behavior and glycemic control in Turkish patients with type 2 diabetes mellitus. Method: The study used a cross-sectional questionnaire survey design ( N = 350). Data were collected using the Summary of Diabetes Self-Care Activities Scale and the Multidimensional Diabetes Questionnaire. The relationship between the study variables was analyzed using Pearson’s correlation coefficient and structural equation modeling. Results: Self-efficacy was associated with social support, outcome expectancies, perceived interference, educational level, and self-care and A1C. According to the structural equation model, self-efficacy was the predictor variable that influenced both self-care and glycemic control. Conclusions: Self-efficacy in achieving desired health outcomes was found to play a central role in Turkish patients. Although interventions are planned and implemented to achieve and maintain self-management in individuals with diabetes, strengthening psychosocial factors, particularly self-efficacy, may contribute to adjustment to disease and good glycemic control in the long term.
Terrorism and Small Groups
Authors: Reedy Justin , Gastil John , Gabbay Michael
Published: October 2013

Terrorism scholarship has revealed the importance of small groups—both cells and leadership groups—in the proliferation of violence, yet this field remains only loosely connected to small group theory and research. There exists no systematic consideration of the role that group dynamics play in the disruption of terrorist activities. This article proposes an analytical framework for terrorist group disruption that shows how the goals and methods of counterterrorist intervention intersect with small group behavior. We use this framework to theorize how three intervention types—repression, manipulation, and persuasion—interact with group variables and processes, such as communication networks, social identities, group cohesion, and intragroup conflict. Seven theoretical propositions demonstrate how the framework can show how the direct and indirect effects of group behavior can augment or undermine counterterrorist strategies.
Fatigue in the core of aluminum honeycomb panels: Lifetime prediction compared with fatigue tests
Authors: Wahl Laurent , Maas Stefan , Waldmann Danièle , Zürbes Arno , Frères Patrick
Published: October 2013

In comparison to their weight, honeycomb composite structures have a high bending stiffness, which makes them very suited for every application such as airplanes, railway-cars and vehicles, where little weight is important. The sandwich panels consist of two thin and stiff aluminum face sheets, which are bonded to a thick and lightweight aluminum honeycomb core. These structures are subjected to dynamic loading. However, in the literature, there are hardly any fatigue properties of the honeycomb core described. The fatigue properties of the core are investigated using the finite element method and experiments. Depending on the load application, the honeycomb core fails either through core indentation or shear failure. For a fatigue prediction, both failure modes have to be investigated. Additionally, the physical behavior of the honeycomb core is depending on the orientation of the core. Hence, fatigue tests were conducted in three directions of the core: the stiffest direction, the most compliant direction and the direction with the highest stresses. A three-point bending test setup was built to study the fatigue properties of the honeycomb core. Several fatigue tests were carried out with a load ratio of R = 0.1 (maximum load 10 times bigger than minimum load) and the fatigue diagrams being illustrated. Additionally, food-cart roller tests (wheels of a cart rolling in a circle on a floor panel) were done to dynamically test the panels in every angle. The sandwich structures were modeled with the ANSYS finite element software. The simulations, which were used to determine the stress amplitudes in the specimens, are described later. In addition, buckling analyses were used to examine core indentation failure. Based on these simulations, failure predictions can be made. The fatigue life of the examined specimens is successfully approximated in this manuscript, with the lifetime analysis being based on the FKM guideline (error less than 14% in load amplitude).
A Two-Group Confirmatory Factor Analysis of The Arc’s Self-Determination Scale With Students With Emotional/Behavioral Disorders or Learning Disabilities
Authors: Seo Hyojeong , Wehmeyer Michael L. , Palmer Susan B. , Little Todd D.
Published: October 2013

Given the emphasis on promoting self-determination in the field of special education and the corresponding use of scales to measure self-determination in research and practice, it is important to examine whether widely used self-determination assessments measure the same constructs among and between students from different disability categories. This study examined the equivalence of measurement and structural parameters of The Arc’s Self-Determination Scale (SDS) across groups of students with emotional and behavioral disorders (EBD) or learning disabilities (LD), using a two-group confirmatory factor analysis (CFA). The results indicated that four essential elements of self-determined behavior that form the structure of the SDS (i.e., autonomy, self-regulation, psychological empowerment, and self-realization) are invariant across the two groups. In addition, students with EBD indicated lower levels of autonomy compared with those with LD. Implications and future directions for research and practice are discussed.
Improved active control of a functionally graded material beam with piezoelectric patches
Authors: Bruant I , Proslier L
Published: October 2013

In this paper, the active vibration control tools are implemented for the vibration control of functionally graded material (FGM) beam with piezoelectric actuators and sensors. The properties of FGM are functionally graded in the thickness direction according to the volume fraction power law distribution. An analytical formulation, based on an efficient trigonometric shear deformation theory, is used to obtain a state space equation. The main steps to set up active control of FGM vibrations are considered in this work. The actuators’ and sensors’ locations are defined from two optimization problems using controllability and observability gramians. The linear quadratic regulator (LQR) control law, including a state observer is computed. Numerical examples show the influence of the volume fraction index on the observability and controllability properties of the system. The LQR leads to efficient active damping for several kinds of excitations. The study of the uncertainty in the volume fraction index shows the robustness of the control method, and also the possible induced defects.
Perioperative Diastolic Dysfunction
Authors: Nicoara Alina , Whitener George , Swaminathan Madhav
Published: October 2013

Left ventricular diastolic dysfunction (LVDD) has only recently been recognized as an important determinant of perioperative morbidity. Intraoperative echocardiographers have been slow to adopt assessment of LVDD into clinical practice. This has been partly attributable to the complex measurements required to characterize LVDD, which are in turn related to how our understanding of diastole has evolved. Additionally, the lack of effective therapeutic options has left many wondering whether it is worthwhile to characterize this pathology in the first place. However, therapies are developed more rapidly once a problem can be identified reliably. The assessment of LVDD is centered on how effectively the left ventricle can fill. Diastolic dysfunction affects intraventricular pressures and stiffness, which in turn affect the pressure relationship between the left atrium and the left ventricle thereby affecting transmitral flow. Since echocardiography can enable the measurement of flow velocities, transmitral diastolic filling flow patterns provide robust information on diastolic function. The impact of abnormal diastolic function on left atrial pressure has consequences for pulmonary venous flow, which can also be measured with echocardiography. However, given the limitations of flow velocity, direct measurement of tissue velocity can significantly improve the characterization of diastolic dysfunction. The evolution of Doppler and speckle-based methods of assessing tissue motion have vastly improved our understanding of diastolic function. With the development of simpler algorithms for categorization, and their gradual adoption by perioperative echocardiographers, LVDD should be better diagnosed and treated to improve postoperative outcomes.
Impact detection and location for a plate structure using least squares support vector machines
Authors: Xu Qingsong
Published: October 2013

Impact force magnitude detection and site location for clamped plates have direct relevance to the maintenance of aircraft and spacecraft structures. This article presents the impact identification of an aluminum plate structure based on least squares support vector machines. The structure is equipped with an array of surface-bounded piezoelectric sensors, which receive strain response signals excited by hammer impacts on different sites with varying magnitudes. To identify the magnitude and location of the impact, two features are extracted from each sensor signal by Hilbert transform, and intelligent models are established using least squares support vector machines. The regression models are then validated through experimental studies, which reveal that the least squares support vector machine–based approach achieves more reliable identification result and better detection accuracy than conventional artificial neural networks. In addition, an empirical index is presented to compare the system efficiency in terms of detection accuracy as well as the numbers of sensors and data sets. Results show that the proposed least squares support vector machine–based impact identification system affords a higher efficiency than the existing ones because it accomplishes a moderate detection accuracy along with greatly reduced hardware cost and workload.
Probation skills between education and professional socialization
Authors: Durnescu Ioan
Published: October 2013

This paper presents the results of a study of probation staff skills and characteristics. It first explores the skills and attributes employed by Romanian probation counsellors in the process of one-to-one supervision. It then advances a theory of how these skills and characteristics might be developed in the organizational context. The concepts of ‘habitus’ and professional socialization play an important role in this process.
Semantic and Phonemic Listener Confusions in a Case of Isolated Congenital Aglossia
Authors: McMicken Betty , Vento-Wilson Margaret , Von Berg Shelley , Iskarous Khalil , Kim Namhee , Rogers Kelly , Young Sonja
Published: October 2013

This article is the second in a series that examines the intelligibility of a person with congenital aglossia (PWCA). Specific factors examined in this study included (a) intelligibility for meaningful words versus nonsense words, (b) intelligibility for consonant-vowel-consonant words (CVCs) as a function of phonemic segment types, and (c) whether there is a correlation between intelligibility for these factors and the acoustic properties of the speech samples. Results revealed greater intelligibility for meaningful versus nonsense CVCs, greater intelligibility for back, low, and high-back versus front vowels embedded in CVCs, and greater intelligibility for productions as a function of phonemic variables, which demonstrated the following hierarchy: initial consonant > consonant vowel > vowel consonant > final consonant. Further results suggest that consonant recognition was consistently affected by “vowel context.” This suggests that movement sequencing appeared to be of importance for speech perception in productions of a PWCA.
Candidates, Competition, and the Partisan Press
Authors: Carson Jamie L. , Hood M. V.
Published: October 2013

Congressional elections have occurred every 2 years since the nation’s founding, yet we know surprisingly little about these electoral contests outside of the modern era. This is unfortunate as our understanding of how Congress performs and has evolved over time is directly linked to how its elected representatives reach and maintain office. In an effort to better understand early U.S. House elections, we revisit the era of the “partisan press” where newspapers were the main source of news for American voters and were typically operated by one of the two major parties. Using a data set linking the geographic location of partisan newspapers with electoral data during the early 19th century, we examine district-specific factors impacting the competitiveness of House races. We uncover previously unidentified evidence of candidate-specific effects during this historical era along with confirmation of media influence in the context of early American elections.
What is Family-Centered Care for Nursing Home Residents With Advanced Dementia?
Authors: Lopez Ruth Palan , Mazor Kathleen M. , Mitchell Susan L. , Givens Jane L.
Published: October 2013

To understand family members’ perspectives on person- and family-centered end-of-life care provided to nursing home (NH) residents with advanced dementia, we conducted a qualitative follow-up interview with 16 respondents who had participated in an earlier prospective study, Choices, Attitudes, and Strategies for Care of Advance Dementia at End of Life (CASCADE). Family members of NH residents (N = 16) with advanced dementia participated in semistructured qualitative interviews that inquired about overall NH experience, communication, surrogate decision making, emotional reaction, and recommendations for improvement. Analysis identified 5 areas considered important by family members: (1) providing basic care; (2) ensuring safety and security; (3) creating a sense of belonging and attachment; (4) fostering self-esteem and self-efficacy; and (5) coming to terms with the experience. These themes can provide a framework for creating and testing strategies to meet the goal of person- and family-centered care.
Cerebrospinal Fluid Biomarkers of Alzheimer’s Disease in Chinese Patients
Authors: Shea Yat Fung , Chu Leung-Wing , Zhou Lin , Li Wing-Man , Lin Oi Yee , Chan May N. Y. , Xu Aimin , Wong Rachel , Ho Tip Yin , Liu Kin Wah , Ha Joyce , Daniel T.W. , Song You-Qiang , Lam Karen S.
Published: October 2013

In view of the paucity of data on cerebrospinal fluid (CSF) biomarkers in Chinese patients, we evaluated the validity of tau, phosphorylated tau 181 (p-tau-181), amyloid β 42 (Aβ42), and Aβ40 proteins in Chinese patients with Alzheimer’s disease (AD). We recruited 24 patients with AD, 12 nondemented controls, and 12 patients with non-AD dementia. We found the CSF levels of Aβ42, tau, p-tau, Aβ42–tau, and Aβ42–p-tau ratios, except the Aβ40 protein level, were significantly different among the 3 groups of patients. Patients with AD had higher levels of CSF tau and p-tau but lower levels of Aβ42 proteins, Aβ42–tau, and Aβ42–p-tau ratios than the nondemented controls. In the diagnosis of AD versus nondementia, the sensitivity and specificity of the ratios of Aβ42–tau and Aβ42–p-tau were 96% and 83% versus 92% and 83%, respectively. Only the Aβ42–p-tau ratio showed satisfactory sensitivity and specificity in the diagnosis of AD versus other dementia.
A Pilot of an Intervention Delivered to Chinese- and Spanish-Speaking Carers of People With Dementia in Australia
Authors: Leone Desiree , Carragher Natacha , Santalucia Yvonne , Draper Brian , Thompson Larry W. , Shanley Christopher , Mollina Angelica , Chen Langduo , Kyriazopoulos Helena , Thompson Dolores Gallagher
Published: October 2013

There are limited language- and culture-specific support programs for carers of people with dementia living in Australia. A group intervention for use with Chinese and Spanish speakers in the United States was adapted to the Australian context, and a pilot study was undertaken with these 2 communities. The intervention is based on a cognitive behavioral therapy approach and was delivered by bilingual health professionals. The adapted material comprised 7 sessions, spanning 2 hours in duration. All 22 participants completed the Depression Anxiety and Stress Scale—Short form (DASS-21) pre- and postintervention. A significant decrease in depression, anxiety, and stress was observed among Spanish speakers; a significant decrease in depression and anxiety was present among the Chinese speakers. The implications are considered in the context of Australia’s changing aged care service system.
Importance of Hypertension and Social Isolation in Causing Sleep Disruption in Dementia
Authors: Eshkoor Sima Ataollahi , Hamid Tengku Aizan , Nudin Siti Sa’adiah Hassan , Mun Chan Yoke
Published: October 2013

This study aimed to determine the effects of diabetes mellitus (DM), hypertension (HT), heart disease, social isolation, and sociodemographic factors on sleep in the elderly patients with dementia. Samples included 1210 noninstitutionalized, Malaysian elderly patients with dementia. The multiple logistic regression analysis was applied to estimate the risk of sleep disturbances among respondents. Approximately 41% of the patients experienced sleep problems. The results showed that age (odds ratio [OR] = 1.02), social isolation (OR = 1.33), and HT (OR = 1.53) significantly increased sleep disruption in respondents ( P <.05). Furthermore, education (OR =.63) and non-Malay ethnicity (OR = 0.63) significantly decreased sleep problems ( P <.05). It was found that DM, heart disease, sex differences, and marital status were not significant predictors of sleep disturbances ( P >.05). It was concluded that age, social isolation, and HT increased sleep disruption but education and ethnic non-Malay reduced the risk of sleep problems. Moreover, HT was the most important variable to increase sleep disturbances in the elderly patients with dementia.
Case Examples of Enhancing Pediatric OCD Treatment With a Smartphone Application
Authors: Whiteside Stephen P. H. , Ale Chelsea M. , Vickers Douglas Kristin , Tiede Michael S. , Dammann Julie E.
Published: October 2013

These case examples depict the use of a smartphone application, Mayo Clinic Anxiety Coach, to enhance the treatment of pediatric obsessive-compulsive disorder (OCD). The presented cases highlight the use of Anxiety Coach as a stand-alone intervention for mild OCD symptoms and as an adjunct to treatment for severe OCD complicated by geographical barriers. Each case includes a description of treatment, patient use of the application, objective assessment of clinical symptoms, and a qualitative interview with the families. Both patients responded well to treatment and had a positive experience with Anxiety Coach. The application encouraged the families to complete exposures between sessions and allowed a detailed examination of the patients’ engagement in homework assignments. Potential uses of smartphone applications to address challenges facing treatment of, and research on, OCD are discussed.
Impact of a Culturally Sensitive Health Self-Empowerment Workshop Series on Health Behaviors/Lifestyles, Body Mass Index, and Blood Pressure of Culturally Diverse Overweight/Obese Adults
Authors: Tucker Carolyn M. , Butler Ashley , Kaye Lillian B. , Nolan Sarah E. M. , Flenar Delphia J. , Marsiske Michael , Bragg Marie , Hoover Eddie , Daly Katherine
Published: October 2013

Objective. To examine the impact of the health self-empowerment theory–based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (body mass index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low-income households. Design. A total of 153 overweight/obese adults participated in an immediate treatment (IT) group (n = 100) or a waitlist control (WC) group (n = 53). Results. Post-intervention, the IT group compared with the WC group reported (a) significantly higher engagement in physical activity and healthy eating; (b) significantly less intake of calories, total fat, trans fat, saturated fat, sugar, and added sugar; (c) significantly higher motivators for engaging in 2 of 4 specific health-smart behaviors; (d) significantly lower barriers to engaging in 3 of 4 specific health-smart behaviors; and (e) significantly lower BMI and systolic blood pressure. Conclusion. The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults—individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.
Performance of two-stage continual reassessment method relative to an optimal benchmark
Authors: Wages Nolan A , Conaway Mark R , O’Quigley John
Published: October 2013

Background

The two-stage, likelihood-based continual reassessment method (CRM-L) entails the specification of a set of design parameters prior to the beginning of its use in a study. The impression of clinicians is that the success of model-based designs, such as CRM-L, depends upon some of the choices made with regard to these specifications, such as the choice of parametric dose–toxicity model and the initial guess of toxicity probabilities.

Purpose

In studying the efficiency and comparative performance of competing dose-finding designs for finite (typically small) samples, the nonparametric optimal benchmark is a useful tool. When comparing a dose-finding design to the optimal design, we are able to assess how much room there is for potential improvement.

Methods

The optimal method, based only on an assumption of monotonicity of the dose–toxicity function, is a valuable theoretical construct serving as a benchmark in theoretical studies, similar to that of a Cramér–Rao bound. We consider the performance of CRM-L under various design specifications and how it compares to the optimal design across a range of practical situations.

Results

Using simple recommendations for design specifications, the CRM-L will produce performances, in terms of identifying doses at and around the maximum tolerated dose (MTD), that are close to the optimal method on average over a broad group of dose–toxicity scenarios.

Limitations

Although the simulation settings vary in the number of doses considered, the target toxicity rate, and the sample size, the results here are presented for a small, though widely used, set of two-stage CRM designs.

Conclusions

Based on simulations here, and many others not shown, CRM-L is almost as accurate, in many scenarios, as the nonparametric optimal design. On average, there appears to be very little margin for improvement. Even if a finely tuned skeleton offers some improvement over a simple skeleton, the improvement is necessarily very small.
Marker Sequential Test (MaST) design
Authors: Freidlin Boris , Korn Edward L , Gray Robert
Published: October 2013

Background

New targeted anticancer therapies often benefit only a subset of patients with a given cancer. Definitive evaluation of these agents may require phase III randomized clinical trial designs that integrate evaluation of the new treatment and the predictive ability of the biomarker that putatively determines the sensitive subset.

Purpose

We propose a new integrated biomarker design, the Marker Sequential Test (MaST) design, that allows sequential testing of the treatment effect in the biomarker subgroups and overall population while controlling the relevant type I error rates.

Methods

After defining the testing and error framework for integrated biomarker designs, we review the commonly used approaches to integrated biomarker testing. We then present a general form of the MaST design and describe how it can be used to provide proper control of false-positive error rates for biomarker-positive and biomarker-negative subgroups. The operating characteristics of the MaST design are compared by analytical methods and simulations to the sequential subgroup-specific design that sequentially assesses the treatment effect in the biomarker subgroups. Practical aspects of MaST design implementation are discussed.

Results

The MaST design is shown to have higher power relative to the sequential subgroup-specific design in situations where the treatment effect is homogeneous across biomarker subgroups, while preserving the power for settings where treatment benefit is limited to biomarker-positive subgroup. For example, in the time-to-event setting considered with 30% biomarker-positive prevalence, the MaST design provides up to a 30% increase in power in the biomarker-positive and biomarker-negative subgroups when the treatment benefits all patients equally, while sustaining less than a 2% loss of power against alternatives where the benefit is limited to the biomarker-positive subgroup.

Limitations

The proposed design is appropriate for settings where it is reasonable to assume that the treatment will not be effective in the biomarker-negative patients unless it is effective in the biomarker-positive patients.

Conclusion

The MaST trial design is a useful alternative to the sequential subgroup-specific design when it is important to consider the treatment effect in the biomarker-positive and biomarker-negative subgroups.
Does recruitment for multicenter clinical trials improve dissemination and timely implementation of their results? A survey study from the Netherlands
Authors: Litjens Rogier JNTM , Oude Rengerink Katrien , Danhof Nora A , Kruitwagen Roy FPM , Mol Ben Willem J
Published: October 2013

Background

Results from clinical trials are often slowly implemented. We studied whether participation in multicenter clinical trials improves reported dissemination, convincement, and subsequent implementation of its results.

Methods

We sent a web-based questionnaire to gynecologists, residents, nurses, and midwives in all obstetrics and gynecology departments in the Netherlands. For nine trials in perinatology, reproductive medicine, and gynecologic oncology, we asked the respondents whether they had knowledge of the results, were convinced by the results, and what percentage of their patients were treated according to the results of these trials. We compared the level of knowledge, convincement, and reported implementation of results in practice for the nine trials for respondents who worked in hospitals that had recruited for a trial with respondents who worked in a hospital that had not recruited for that trial. The reported implementation was restricted to six trials that showed decisive results.

Results

We analyzed 202 questionnaires from 83 departments in obstetrics and gynecology in the Netherlands (93% of all departments). The percentage of respondents who had worked in a hospital that recruited for a specific study varied between 8% and 71% per study and was 28% on average. The relative risk (RR) for knowledge of the study result for respondents who had worked in a recruiting hospital was for all studies positive and varied between 1.1 and 3.3 (pooled RR: 1.8, 95% confidence interval (CI): 1.7–1.9). In general, health-care workers were convinced of trial results, independent of whether they had worked in a hospital that recruited for a trial or not (pooled RR: 1.02, 95% CI: 0.99–1.05). Reported implementation of trial’s results, that is, less than 20% were treated with unfavorable treatment according to study results, was better in hospitals that had recruited for those trials (pooled RR: 1.1, 95% CI: 1.02–1.19).

Conclusion

Participation in these multicenter clinical trials was associated with better knowledge about the trial’s results, with a minor improvement of the reported implementation of the study results.
The leadership styles of Hong Kong kindergarten principals in a context of managerial change
Authors: Chan Chi Wai
Published: October 2013

Since the implementation of the Pre-primary Education Voucher Scheme (PEVS) in 2007, its built-in quality assurance mechanism has brought about subtle changes in the work relationship between kindergarten (KG) principals and teachers. The increasing demand for accountability and the call for improvement in the quality of pre-school education are altering the conventional practice of school management, which had been strongly affected by Chinese cultural values. In the meantime, the collaboration and teachers’ participation in making decisions in KGs, which are emphasized in the quality assurance mechanism of the PEVS, are influencing the leadership styles of KG principals in managing their staff. This article presents the findings on Hong Kong KG teachers’ perceptions of their principals’ leadership practices in the context of such managerial changes.