bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Exhaustion More Sensitive Than Disengagement to Burnout in Academic Anesthesia? A Study Using the Oldenburg Burnout Inventory
Authors: Block Robert I. , Bair Heather L. , Carillo James F.
Published: June 2019

Reportedly, clinicians of all kinds are experiencing alarming rates of burnout, and its prevalence among anesthesia providers is high. We examined burnout in a large academic anesthesia department with a commonly used questionnaire, the Oldenburg Burnout Inventory, which provides scores on two scales, “exhaustion” and “disengagement.” We examined differences in scores between exhaustion and disengagement and their prevalences. All N = 415 staff members of the department were requested to complete the Oldenburg Burnout Inventory and N = 130 (31%) did so. The mean ± standard deviation was 2.52 ± 0.51 (range, 1.13 to 3.75) for exhaustion and 2.27 ± 0.52 (range, 1.13 to 3.63) for disengagement. The mean for exhaustion exceeded that for disengagement by 0.25 ± 0.42 (range, −1.25 to 1.25), t(129)=6.68, p < 0.0001 by paired t test. Mean ratings exceeded the midpoint (2.5) between the “burned out” and “not burned out” ends of the rating scale for 49% of respondents for exhaustion, but only 30% for disengagement. More respondents (N = 87, 67%) had a higher mean for exhaustion than disengagement than the opposite pattern (N = 28, 22%), M = 29.5, p < 0.0001 by sign test. Thus, burnout symptoms were common but reflected more in exhaustion than disengagement. Literature review suggested that the difference between the exhaustion and disengagement means that we found was larger than typical, but not unusual, for health-care-related groups, and typical for other groups. Future studies should clarify circumstances under which exhaustion exceeds disengagement and vice versa, both in anesthesia and other fields.
Food Insecurity Among Formerly Incarcerated Adults
Authors: Testa Alexander , Jackson Dylan B.
Published: June 2019

The purpose of this study is to further the understanding of the hardships faced by formerly incarcerated individuals by investigating the association between prior incarceration and postrelease food insecurity. Drawing on data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), our findings demonstrate that a history of incarceration is associated with an increased likelihood of experiencing food insecurity. This association is found to partially operate through household income, depressive symptoms, marital status, and social isolation. Given the importance of food insecurity in predicting future health outcomes and nutritional behavior, food insecurity may be an important factor in driving health disparities among formerly incarcerated persons.
Mental Health, Substance Abuse, Co-occurring Disorders, and 3-Year Recidivism of Felony Parolees
Authors: Houser Kimberly A. , Saum Christine A. , Hiller Matthew L.
Published: June 2019

Having a mental health, substance use, or co-occurring disorder (COD) can make successful reintegration a difficult process for returning offenders. However, our understanding of how these disorders varies as far as their impact on recidivism during the reentry stage is lacking. Using a sample of 4,381 parolees released to the City of Philadelphia, this study assessed how disorder type may influence repeat criminal offending by examining the independent effects of mental illness, substance abuse/dependence, and CODs on recidivism controlling for individual and neighborhood contextual factors and nonresidential land uses. In addition, we separated our measure of recidivism into two categories, re-incarceration for a new offense and re-incarceration for a parole violation to see whether different predictors emerged. Our findings showed that there were indeed differences according to disorder type, as well as between neighborhood variables and these findings also varied according to reason for incarceration. Moreover, we found evidence contrary to the assumption that COD offenders would have the worst outcomes due to the comorbid nature of their disorders.
Hybrid sliding mode observer for uncertain linear switching system with actuator faults
Authors: Islem Labidi , Asma Takrouni , Nadia Zanzouri
Published: June 2019

This paper investigates the problem of designing a hybrid sliding mode observer for mode identification and actuator fault reconstruction, applicable for a class of linear switching systems. For each operating mode constituting the whole system, only one observer is doomed to accomplish the two aforementioned tasks in the presence of exogenous disturbances. The method uses [Formula: see text] concept in the design of the sliding motion so that the effect of uncertainties on the residuals generation for mode recognition and on the reconstruction of the actuator faults will be minimized. Simulation results highlight the efficiency and the effectiveness of the proposed method.
A Cross-Sectional Examination of the Writing of Students with Visual Impairments
Authors: Savaiano Mackenzie E. , Hebert Michael
Published: June 2019

Introduction:

Not much is known about the writing skills of students with visual impairments, and this research is often limited to subgroups of the population or subskills. A more comprehensive approach to research on the writing skills of students with visual impairments is needed.

Methods:

Researchers used a cross-sectional design to examine the writing of students with visual impairments in Nebraska, attempting to include as many students as possible aged from 4 to 21 years. Fifty students participated. All students were given the Essay Composition subtest of the Wechsler Individualized Achievement Test (third edition), with modified instructions. Essays were scored on number of words, essay elements, and mechanics. Descriptive statistics and statistical comparisons of groups are provided.

Results:

Mean scores of the overall sample and subgroups fell within the average range when compared to normative samples. There were no statistical differences between students who were blind and students with low vision and no statistical differences between writing modality. There were statistical differences between students with multiple disabilities and others. Results suggest substantial heterogeneity in the sample.

Discussion:

Results suggest some students with visual impairments write as well as do their sighted peers. These results are complicated by heterogeneity and do not imply anything about the writing ability of individual students.

Implications for practitioners:

Teachers should avoid making assumptions about the writing potential of specific students. Students with visual impairments in this study scored comparably to a normative sample, and students with multiple disabilities may be able to participate in writing activities in a variety of ways.
Disciplinary Exclusions in Special Education: A 4-Year Analysis
Authors: Zhang Dalun , Katsiyannis Antonis , Herbst Maria
Published: June 2019

Current discipline policies have led to an increase in the use of exclusion with students with disabilities, thereby preventing some from receiving a free and appropriate public education. Students from ethnically and racially diverse groups and students with emotional or behavioral disorders are reported to have disproportionately higher rates of suspensions than others. The authors of this study analyzed disciplinary exclusion data in the last 4 years published by the U.S. Department of Education. Results indicated that (a) there was an increasing trend in exclusion of special education students; (b) African American and American Indian/Alaskan Native students were excluded more often than students from other racial groups; (c) some states excluded students with disabilities more often than the rest of the states; (d) students in the West were removed by school personnel more often than students in the other regions; (e) students in the South were more likely to receive short-term suspensions; and (f) interaction effects existed between certain variables. The authors discuss these results and make recommendations for future research.
First Step to Success: An Early Intervention for Elementary Children at Risk for Antisocial Behavior
Authors: Beard Kelli Y. , Sugai George
Published: June 2019

The increased prevalence and seriousness of antisocial behavior displayed by today's youths have become serious concerns for parents, educators, and community members. Antisocial behavior has a developmental course that starts with minor offenses in preschool (e.g., whining, teasing, noncompliance) and develops into major offenses (e.g., vandalism, stealing, assault, homicide) in older children and adolescents. Research results suggest that if interventions are implemented in the early elementary years, the likelihood of preventing future antisocial behavior is improved. Furthermore, interventions are said to be more successful if family members and teachers are involved. The purpose of this study was to examine the effects of an early intervention strategy, First Step to Success, involving (a) teacher-directed and (b) a combination of teacher- and parent-directed strategies on the behaviors of elementary school children at risk for antisocial behavior. The results suggest that interventions involving teachers and parents were associated with decreases in problem behavior in the classroom that maintained over 1 academic school year after intervention. Implications and recommendations are presented based on the outcomes and limitations of this study.
Use of Text Maps to Improve the Reading Comprehension Skills among Students in High School with Emotional and Behavioral Disorders
Authors: Stone Rebecca H. , Boon Richard T. , Fore Cecil , Bender William N. , Spencer Vicky G.
Published: June 2019

The purpose of this study was to examine the efficacy of text mapping as a strategy for improving the reading comprehension skills, of four high school students with emotional and behavioral disorders (EBD) in a self-contained freshman technical language arts classroom. Using a multiple baseline design across participants, each student received individualized training in the purpose, use, and completion of both the teacher and student-generated text maps. During the first intervention phase, students read a passage and completed a teacher-generated text map, whereas in the second intervention phase, the students created their own text maps for the passages. The study consisted of 20 text passages and was completed over a period of 28 days. Dependent measures included a 10- to 20-item production fill-in-the-blank comprehension test to assess the effectiveness of the intervention. Results indicated that both the teacher and student-generated text maps were effective in improving comprehension scores for all four students with EBD. Limitations of the study; implications for secondary classroom teachers, both general and special education; and future research questions are discussed.
Prevalence Rates of Psychotropic Medications for Students Placed in Residential Facilities
Authors: Ryan Joseph B. , Reid Robert , Gallagher Ken , Ellis Cynthia
Published: June 2019

The use of psychotropic interventions to manage the inappropriate behaviors displayed by students who are emotionally disturbed (ED) has continued to increase over the past several decades. To date, few studies have investigated the use of psychotropic medications among students with ED placed in the most restrictive educational settings (i.e., residential facilities). For this study, medication records from 137 students placed in three nonpublic residential schools were reviewed. This survey found that medication rates varied from 65% to 94%, with an overall medication rate of 76% among students placed in residential care. Other findings of interest included (a) Caucasian students were more likely to receive medication therapy than their African American or Hispanic peers, and (b) students placed in a residential center specializing in treating students with a history of substance abuse were less likely to receive medication therapy.
Self-Determination Interventions for Students with and at Risk for Emotional and Behavioral Disorders: Mapping the Knowledge Base
Authors: Carter Erik W. , Lane Kathleen Lynne , Crnobori Mary , Bruhn Allison L. , Oakes Wendy P.
Published: June 2019

Recognizing the association between self-determination and improved educational and postschool outcomes for children and youth with or at risk for emotional and behavioral disorders (EBD), increased attention has focused on efforts to promote the skills and attitudes that enhance self-determination. We conducted a comprehensive, systematic review of school-based intervention studies addressing nine component elements of self-determination for students with and at risk for EBD. These 81 studies primarily addressed a narrow range of self-determination elements as intervention components (i.e., self-management and self-regulation, problem solving, goal setting and attainment) or outcome measures (i.e., self-efficacy, problem solving), with relatively few studies addressing students from culturally diverse backgrounds. Additional research is needed to address key gaps related to the school contexts within which these interventions have been delivered. We offer recommendations for future research aimed at expanding this knowledge base to address the full spectrum of students and school contexts in which they are served.
The predictive effects of fear of being single on physical attractiveness and less selective partner selection strategies
Authors: Spielmann Stephanie S. , Maxwell Jessica A. , MacDonald Geoff , Peragine Diana , Impett Emily A.
Published: June 2019

Fear of being single (FOBS) tends to predict settling for less when seeking a romantic partner. The present research sought to examine whether this is due, at least in part, to lower physical attractiveness among those who fear being single. In a photo-rating study (Study 1, N = 122) and a speed-dating study (Study 2, N = 171), participants completed the FOBS Scale, rated perceptions of their own physical attractiveness, and were then rated on physical attractiveness by a team of raters. In Studies 1 and 2, FOBS was not significantly associated with judge-rated physical attractiveness as a bivariate association or in hierarchical regressions accounting for anxious and avoidant attachments, gender, and smiling. There were mixed findings in both studies regarding the association between FOBS and self-rated physical attractiveness in bivariate versus multivariate analyses. However, the tendency of those with stronger FOBS to be less selective during speed dating was not explained by either their judge-rated or their self-rated physical attractiveness.
An urgent open surgical approach for left ventricle venting during peripheral veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: case report
Authors: Beyls Christophe , Huette Pierre , Guilbart Mathieu , Nzonzuma Alphonse , Abou Arab Osama , Mahjoub Yazine
Published: June 2019

The objective of the study is to describe an emergency procedure for left ventricle venting during veno-arterial extracorporeal life support for refractory cardiac arrest. Veno-arterial extracorporeal membrane oxygenation is widely used in refractory cardiac arrest but is characterized by an increase in left ventricle afterload, which may impair cardiac contractility improvement. Different left ventricle venting techniques are available. We report the use of a surgical approach with sternotomy for left ventricle venting in a 21-year-old patient who was placed under veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest with severe pulmonary edema, respiratory failure, and left ventricle stasis. A 21-year-old woman was admitted for laparoscopic sleeve gastrectomy. In the recovery room, she developed a refractory circulatory shock. Transthoracic echocardiography revealed a dilated cardiomyopathy with severe left ventricle systolic dysfunction (left ventricle ejection fraction at 20%). Coronary angiogram was normal. On day 2, she underwent laparotomy for sepsis and she presented cardiac arrest secondary to ventricular tachycardia. We proceeded to peripheral veno-arterial extracorporeal membrane oxygenation as the cardiac arrest was refractory. A miniaturized veno-arterial extracorporeal membrane oxygenation system was implanted into the right femoral vessels onsite .The low flow duration was 40 minutes. Veno-arterial extracorporeal membrane oxygenation blood flow was set to 3 L min−1, resulting in a closed aortic valve and a massive pulmonary edema. Transesophageal echocardiography showed left ventricular ejection fraction at 5% without aortic valve opening. We first implanted an intra-aortic balloon pump without clinical improvement. Transesophageal echocardiography revealed massive thrombus formation into the aortic root. We decided to perform an open surgical approach for left ventricle unload using a transmitral cannula (22 Fr) via the right superior pulmonary vein connected to the inflow tube of the veno-arterial extracorporeal membrane oxygenation with Y connection. Transesophageal echocardiography showed a full opening of aortic valve and elimination of valve aortic thrombus. Chest radiography showed a significant decrease of pulmonary congestion. We were able to withdraw extracorporeal life support organization on day 10 and discharged on day 54. Clinical explorations reveal a fulminant rocuronium-related hypersensitivity myocarditis. This salvage surgical technique using a modified central veno-arterial extracorporeal membrane oxygenation cannulation technique has efficiently decreased blood stasis and permitted rapid recovery.
Extracellular ASC exacerbated the recurrent ischemic stroke in an NLRP3-dependent manner
Authors: He Xiao-fei , Zeng Yi-xuan , Li Ge , Feng Yu-kun , Wu Cheng , Liang Feng-yin , Zhang Yu , Lan Yue , Xu Guang-qing , Pei Zhong
Published: June 2019

Using a photothrombotic mouse model of single stroke, we show that a single stroke onset increases the nuclear factor-κB (NF-κB), NLR family CARD domain containing protein 4 (NLRC4), and absent in melanoma 2 (AIM2) inflammasomes, as well as the mRNA levels of NLRP3. Next, using a photothrombotic mouse model of recurrent stroke, we found that recurrent strokes increased the activation of NLRP3, exacerbated the brain damage and the pro-inflammatory response in wild type (WT) mice, but not in NLRP3 knockout ( NLRP3 KO) mice. Additionally, we found that apoptosis-associated speck-like protein containing a CARD (ASC) protein level surrounding the infarct area was comparatively increased, but that ASC specks outside of microglia in both the ipsilateral and contralateral of stroke site were decreased in NLRP3 KO mice relative to wild-type (WT) controls, and the number of ASC specks surrounding the second infarct area was positively correlated to the damage scores. Mechanistically, we found that recombinant ASC (RecASC) activated NLRP3 and induced pro-inflammatory responses, exacerbating the outcome of ischemic stroke, in WT mice, but not in NLRP3 KO mice. We therefore conclude that the NLRP3 inflammasome is activated by two attacks of stroke, which act together with ASC to exacerbate recurrent strokes.
Evaluation of lumbar multifidus muscle in patients with lumbar disc herniation: are complex quantitative MRI measurements needed?
Authors: Colakoglu Bulent , Alis Deniz
Published: June 2019

Objective

To assess the composition of lumbar multifidus muscle, in patients with unilateral lumbar disc herniation causing nerve compression, using quantitative and qualitative magnetic resonance imaging (MRI) measurement methods.

Methods

Two radiologists retrospectively measured MRI signal intensity of the multifidus muscle, as high intensity represents more fat, and visually graded the fat content using a 5-point grading system in patients with unilateral subarticular lumbar disc herniation. Findings from the herniated and contralateral sides were compared. The association between fat content and severity of nerve compression and symptom duration were also evaluated.

Results

Ninety patients (aged 24–70 years) were included. Signal intensity of the affected multifidus muscle was significantly higher versus the contralateral muscle for quantitative measurements and qualitative scoring for both investigators. Significant correlations were observed between the severity of nerve compression and symptom duration and the degree of fat content in the affected multifidus muscle.

Conclusions

Higher fat composition was observed in the multifidus muscle ipsilateral to the lumbar disc herniation versus the contralateral side. Straightforward visual grading of muscle composition regarding fat infiltration appeared to be as useful as quantitative measurement.
Role of interleukin-33 in the clinical pathogenesis of chronic apical periodontitis
Authors: Gegen Tana , Zhu Yanxia , Sun Qinnuan , Hou Benxiang
Published: June 2019

Objective

This study investigated interleukin (IL)-33 expression in chronic apical periodontitis (CAP) lesions and possible relationships with receptor activator of nuclear factor κ-Β ligand (RANKL) and osteoprotegerin (OPG).

Methods

Inflammatory cell infiltration in CAP lesions and samples of healthy periapical tissue (n = 30 each) was evaluated by hematoxylin and eosin staining. IL-33, RANKL, and OPG expression levels were assessed by immunohistochemistry and real-time PCR. In CAP lesions alone, relationships between mRNA level of IL-33 and mRNA levels of both RANKL and OPG were analyzed by Spearman rank correlation.

Results

Histological analysis revealed a large number of inflammatory cells in CAP lesions, and immunohistochemistry revealed IL-33-positive cells. There were more IL-33- and RANKL-positive cells in CAP lesions than in healthy periapical tissue, whereas there were fewer OPG-positive cells in CAP lesions than in healthy periapical tissue. In CAP lesions alone, IL-33 mRNA level was negatively correlated with mRNA level of RANKL and positively correlated with mRNA level of OPG.

Conclusions

IL-33 is highly expressed in CAP lesions, where it is negatively correlated with RANKL and positively correlated with OPG expression. IL-33 may protect against bone resorption via RANKL suppression and OPG induction, and constitutes a potential target for CAP treatment.
The role of solid waste composting in mitigating climate change in Jordan
Authors: Abu Qdais Hani , Wuensch Christoph , Dornack Christina , Nassour Abdallah
Published: June 2019

Solid waste composting has never been practised on a full scale in Jordan. However, the National Solid Waste Management Strategy recommended five major composting facilities to be put into operation starting from 2025. According to the Ministry of Environment, the waste sector is contributing to 10.6% of the total greenhouse gas emissions of the country. The main objective of this study was to assess the potential of solid waste composting in mitigating greenhouse gas emissions in Jordan. Applying the upstream-operating-downstream account framework and developing a model that estimates the greenhouse gas emissions, it was possible to estimate the emissions associated with composting of source-segregated bio-waste, which was compared with three other scenarios, including business as usual (dumping and landfilling), sanitary landfilling, and anaerobic digestion. The assessment revealed that composting and anaerobic digestion of the total generated source-segregated bio-waste (Scenarios 3 and 4) have the least net greenhouse gas emissions with 1.1 million Mg CO2-eq y-1, while engineered sanitary landfilling and dumping have net emissions of 2.6 and 3.75 million Mg CO2-eq y-1, respectively. The findings of this research are paving the way to make informed and responsible decisions in the Jordanian solid waste sector to adopt sustainable and integrated management options.
Main Barriers to Optimal Breastfeeding Practices in Armenia: A Qualitative Study
Authors: Demirchyan Anahit , Melkom Melkomian Dzovinar
Published: June 2019

Background

In 2015, the median duration of exclusive breastfeeding was 2.2 months in Armenia, and only 15% of 4–5-month-old children were exclusively breastfed, indicating an issue with breastfeeding knowledge and practices.

Research aim

To identify the main barriers to optimal breastfeeding practices in Armenia.

Methods

We used qualitative research methods via focus group discussions and in-depth interviews with four groups of providers from different levels of care, and mothers of young children, from Yerevan city and two provinces, Lori and Shirak. Overall, eight in-depth interviews and 13 focus group discussions were conducted with a total of 99 participants. Qualitative content analysis was applied, with elements of both inductive and deductive approaches.

Results

We identified two main categories of barriers to optimal breastfeeding—systemic barriers and knowledge deficiencies. The main themes within systemic barriers were lack of skilled breastfeeding support services and low motivation of providers—mainly related to inadequate recognition of their role in breastfeeding counseling and low remuneration. The main knowledge-related barriers were insufficient counseling of mothers, lack of reliable information sources about infant feeding, and misconceptions among both mothers and providers.

Conclusion

Optimal breastfeeding is crucial for the best start to an infant’s life; however, there were a number of barriers to optimal breastfeeding practices in Armenia. Our findings and recommendations could help policymakers apply effective strategies for improving breastfeeding rates in Armenia. Considering the similar historical backgrounds of the post-Soviet countries, our findings could also be applicable to other Commonwealth of Independent States countries.
Interrupting the Human Rights Expansion Narrative
Authors: López José Julián
Published: June 2019

In the growing field of the sociology of human rights, the notion that human rights might best be understood as the expansion and/or supersession of citizenship rights has taken root, as has the more generalized taken for granted “backstories” to the effect that human rights are the product of a unique postwar consensus. In this article, I argue that these assumptions are more encumbrance than assistance when it comes time to sociologically grasping what human rights are, how they emerged, and, more importantly, what they might be able to achieve. In the first half of the article, I demonstrate that the tropes of expansion and supersession of citizenship rights are central to two seminal sociological analyses of human rights—those of Bryan S. Turner (1993, 2006) and Yasemin N. Soysal (1994, 2012) —and that they fail to provide a social-relational and historical account of the emergence of human rights. In the second part, I pull together new historical and sociolegal scholarship that is recalibrating our understanding of human rights. Drawing attention to the 1970s as the more persuasive social-relational origin of contemporary human rights, I argue, allows a more nuanced appraisal of human rights’ (in)efficacy.
Improved numerical analysis of structures reinforced by composite FRP: Hygrothermal and prestressing loads with taper effect
Authors: Hebbaz Mohammed Amine , Kerboua Bachir , Tarfaoui Mostapha
Published: June 2019

Fiber-reinforced polymer (FRP) composites are becoming suitable and substantial materials in repairing and replacing conventional metallic materials because of their high strength and stiffness. Steel beams can be strengthened in flexure using bonded FRP or using steel plates. In such plated beams, shear forces develop in the bonded beam and these will be transferred to the FRP plate via the adhesion technique. Thus, the interfacial shear stress and normal stress will develop consequently, and debonding may occur at the FRP plate ends due to high interfacial stress values in this area. This original research aims to study the debonding phenomenon using an analytical and a numerical finite element models, in order to identify the interfacial stresses of a steel beam strengthened by the FRP plate with taper model, taking into account a new coupled approach of prestressing force and hygrothermal effect. This article explores the effects of various parameters, such as geometrical and physical properties, on the stress behavior of FRP composites.
Culturally Responsive Data-Based Decision Making in High School Settings
Authors: Kressler Benikia , Chapman Lindsey A. , Kunkel Amy , Hovey Katrina A.
Published: June 2019

Engaging in culturally responsive practices is considered best practice in classroom instruction, particularly within diverse schools, however, when making data-based decisions, there is little guidance for culturally responsive practitioners on how to engage in this work. This article introduces a model of culturally responsive data-based decision making (CR-DBDM) by outlining culturally responsive practices and combining them with Deno’s IDEAL (Identify, Define, Explore, Apply, and Look) problem solving model. The article provides members of high school-based problem-solving teams (PSTs), working within a response to intervention (RTI) framework, suggestions for decision making in ways that do not contribute to the disproportionate representation of culturally and linguistically diverse students in special education and empowers students and families by valuing their voices throughout the RTI process.
A Low-Grade Myxoid Liposarcoma Arising in a Deep-Seated Conventional Lipoma
Authors: Tsagkozis Panagiotis , Haglund Felix
Published: June 2019

Myxoid liposarcomas (MLS) are known to arise de novo and have not been shown to derive from previous benign lesions (lipomas), whereas lipomas occasionally harbor areas of other benign mesenchymal tissue. Rarely, tumors presenting with MLS or round cell liposarcomas together with conventional liposarcoma have been classified as mixed liposarcomas. However, no case of MLS arising in a conventional lipoma has been described. In this article, we report a case of a young male presenting with a deep-seated soft tissue tumor of the posterior part of the thigh. The tumor was removed en bloc. Grossing revealed a small encapsulated myxoid lesion (2.5 cm) within the larger lipomatous tumor (14 cm). Histological examination and cytogenetic analysis revealed a FUS-CHOP positive low-grade MLS arising in a conventional lipoma without histological atypia, FUS-CHOP fusion, or CDK4/MDM2 amplification. While we cannot conclude whether these were collision tumors or an MLS progression from a lipoma, this case highlights the value of careful grossing in the soft tissue setting.
TKI-Related Platelet Dysfunction Does Not Correlate With Bleeding in Patients With Chronic Phase-Chronic Myeloid Leukemia With Complete Hematological Response
Authors: Sener Yigit , Okay Mufide , Aydin Seda , Buyukasik Yahya , Akbiyik Filiz , Dikmen Zeliha Gunnur
Published: June 2019

Bleeding has been reported in patients with chronic myeloid leukemia (CML) using tyrosine kinase inhibitors (TKIs). In this study, we aimed to evaluate platelet functions and associated bleeding symptoms in patients with CML using TKIs. A standardized questionnaire that was developed for inherited bleeding disorders (ISTH/SSC Bleeding Assessment Tool) was used to score bleeding symptoms in 68 chronic phase patients with CML receiving imatinib (n = 47), dasatinib (n = 15), or nilotinib (n = 6). Light transmission aggregometry was used for platelet function testing. None of the patients had major bleeding (score > 3). Minor bleeding was observed in 25.6% and 20% of the patients in imatinib and dasatinib treatment groups. Impaired/decreased platelet aggregation was observed in 29.8% of imatinib treatment group, 50% of nilotinib group, and 40% of dasatinib group. A secondary aggregation abnormality compatible with the release defect was observed in 26% of patients with CML; 25.5%, 33.3%, and 16.7% of patients receiving imatinib, dasatinib, and nilotinib, respectively. No correlation was found between bleeding symptoms and the impaired platelet function. We can conclude that TKIs may impair in vitro platelet aggregation but this impairment is not associated with bleeding diathesis.
Prices for Medical Services Vary Within Hospitals, but Vary More Across Them
Authors: Panhans Matthew , Rosenbaum Ted , Wilson Nathan E.
Published: June 2019

Using commercial claims for 2012-2013 from the Colorado All Payer Claims Database, we examine how medical service prices vary for five hospital-based procedures and the complexity-adjusted inpatient price. We find that prices vary substantially in multiple dimensions. Our analysis indicates that there is significant price variation across payers for the same service in the same hospital. If prices converged to the lowest rate each hospital receives, commercial expenditures would fall by 10% to 20%. Differences across hospitals account for an even more substantial amount of the overall variation. For five out of six prices, we find that differences associated just with hospitals’ metropolitan areas account for over 35% of the total variation. We observe substantial residual variation (18%-32%) after accounting for factors specific to a given payer or provider.
An International Perspective on Health Information Exchange: Adoption in OECD Countries With Different Health Care System Configurations
Authors: Guerrazzi Claudia
Published: June 2019

The sharing of information among various care providers is becoming an essential feature of health care systems, and many countries are now adopting policies to foster health information exchange, defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. Given the increasing adoption of this type of policy in several Organization for Economic Cooperation and Development countries, it is important to compare experiences from different countries, because policy adoption in one country can be explained more comprehensively and coherently through comparison with similar policies adopted in other nations. To make a more meaningful cross-country comparison, this article identifies a taxonomy of health systems, and it analyzes institutional and resource-based factors related to health information exchange adoption and how they differ in three main types of health systems: the National Health Service, social health insurance, and private health insurance.
An Examination of Failed Grocery Store Interventions in Former Food Deserts
Authors: Engler-Stringer Rachel , Fuller Daniel , Abeykoon A. M. Hasanthi , Olauson Caitlin , Muhajarine Nazeem
Published: June 2019

Background. Implementing food stores in deprived neighborhoods to improve access to healthy food is a debated topic. Aims. To uncover important contributors to the closure of grocery store interventions in urban food deserts. Method. We systematically reviewed both peer-reviewed and gray literature for publications on the failure of grocery store interventions. Results. We found nine articles on six different failed food stores. The reasons stated for closure included low sales, a lack of food retail experience, poor marketing, and difficulty in attracting and retaining a high volume of consumers from the local market. Discussion. Current literature on the topic of the closure of inner-city grocery stores does not have a concise rationale to explain why inner-city grocery store interventions were not successful. Conclusion. We must consider the most appropriate interventions to improve food environments in food deserts using local and national policies to address the social determinants of health.
A Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men: Results From the Animo Pilot Randomized Controlled Trial
Authors: Garcia David O. , Valdez Luis A. , Aceves Benjamin , Bell Melanie L. , Humphrey Kyle , Hingle Melanie , McEwen Marylyn , Hooker Steven P.
Published: June 2019

Background. Hispanic males have the highest rates of overweight and obesity compared with men of all other racial/ethnic groups. While weight loss can significantly reduce obesity-related health risks, there is limited research examining effective gender- and culturally tailored behavioral weight loss programs for Hispanic men. Objective. To assess the feasibility and preliminary efficacy of a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) as compared with a waist-list control (WLC) in sedentary, Hispanic males with overweight/obesity. Method. Fifty Hispanic males (age: 43 years [ SD = 11]; BMI: 34 ± 5 kg/m2; 58% Spanish monolingual) were randomized to one of two groups: GCSWLI ( n = 25) or WLC ( n = 25). GCSWLI participants attended weekly in-person individual sessions with a bilingual, bicultural Hispanic male lifestyle coach, and were prescribed a daily reduced calorie goal and 225 minutes of moderate-intensity physical activity per week. The WLC were asked to maintain their usual diet and physical activity habits for 12 weeks. GCSWLI participants continued with 12 additional weeks of follow-up including biweekly phone calls with lifestyle coaches. Results. At Week 12, the mean weight loss in the GCSWLI was −6.3 kg (95% confidence interval [CI; −8.1, −4.4]) compared with −0.8 kg (95% CI [−2.5, 0.9]) for the WLC (difference = −5.5 kg, 95% CI [−8.0, −2.9], p < .01). At Week 24, weight loss in the GCSWLI was maintained. Conclusions. The GCSWLI appears to be a feasible strategy to engage Hispanic males in short-term weight loss. Our pilot study indicates preliminary evidence of efficacy, though confirmation of these findings is needed in a larger study.
The Easier the Better? Comparing the Readability and Engagement of Online Pro- and Anti-Vaccination Articles
Authors: Xu Zhan , Ellis Lauren , Umphrey Laura R.
Published: June 2019

Online anti-vaccine articles contribute to the anti-vaccine movement, which leads to recent outbreaks of vaccine-preventable diseases. Previous studies indicate that anti-vaccine articles are easy to read and understand, which may increase their abilities to engage viewers. The present study aims to examine if readability levels are related to engagement. Using combination of terms to search for vaccine articles in Google in May 2017, this study examined 541 pro-vaccine online articles with a total of 508,571 words and 382 anti-vaccine articles with a total of 843,805 words. Almost all vaccine articles exceeded the American average reading comprehension level. No significant difference in readability was found between pro- and anti-vaccine articles. Pro-vaccine articles that could only be understood by college graduates were less engaging than those with lower readability levels. No significant relationship between anti-vaccine articles’ readability and engagement was discovered. Different vaccine topics had different readability and engagement levels, which implied that certain combinations of themes and readability levels could enhance the health messages’ persuasion effect. Recommendations for designing effective health messages are provided.
Complex facial emotion recognition and atypical gaze patterns in autistic adults
Authors: Black Melissa H , Chen Nigel TM , Lipp Ottmar V , Bölte Sven , Girdler Sonya
Published: June 2019

While altered gaze behaviour during facial emotion recognition has been observed in autistic individuals, there remains marked inconsistency in findings, with the majority of previous research focused towards the processing of basic emotional expressions. There is a need to examine whether atypical gaze during facial emotion recognition extends to more complex emotional expressions, which are experienced as part of everyday social functioning. The eye gaze of 20 autistic and 20 IQ-matched neurotypical adults was examined during a facial emotion recognition task of complex, dynamic emotion displays. Autistic adults fixated longer on the mouth region when viewing complex emotions compared to neurotypical adults, indicating that altered prioritization of visual information may contribute to facial emotion recognition impairment. Results confirm the need for more ecologically valid stimuli for the elucidation of the mechanisms underlying facial emotion recognition difficulty in autistic individuals.
“Everyone thinks I am just lazy”: Legitimacy narratives of Americans suffering from fibromyalgia
Authors: Paxman Christina G
Published: June 2019

This qualitative study reflects an analysis of 50 stories told by Americans living with fibromyalgia, a chronic condition marked by widespread physical pain. Stories were randomly collected from The Experience Project, an online public forum, and analyzed using the communication theory of identity as a guiding framework. Thematic analysis was used to examine how the legitimacy narratives of people with fibromyalgia respond to the American discourse of hard work. Three narrative themes emerged from the data: The Personal Experience of Living With Fibromyalgia (personal layer of identity), the Struggle to Complete Everyday and Professional Tasks (enacted layer of identity), and a Limited Ability to Perform Gender Roles (relational layer of identity). Throughout their stories, individuals with FM strive to legitimate their condition and contest the notion that they are lazy. Stories reveal that people suffering from fibromyalgia experience significant personal (e.g. cleaning the house) and professional (e.g. extended sick leave) challenges, as well as serious relational challenges that are often tied to gender roles (e.g. being a good mother). Results provide a variety of implications and directions for future research.
Development and testing of precast concrete beam-to-column connections with high-strength hooked bars under cyclic loading
Authors: Yang Hui , Guo Zhengxing , Yin Hang , Guan Dongzhi , Yang Sen
Published: June 2019

A traditional reinforcing detail—hooked bars anchored in the joint core—for the bottom bars in precast beams was improved by using small-diameter high-strength bars to reduce the steel congestion in the cast-in-place connection zone. Five full-scale beam-to-column connections, including a monolithic specimen, were tested under reversed cyclic loading. The primary test variables were the type of beam longitudinal bars, manner of roughening the inner surface of the precast U-shell, presence or absence of the small-diameter stirrups inside the U-shell, and height of the precast columns. An analysis of the strength, ductility, stiffness, and energy dissipation showed that the proposed connection exhibited a comparable, although slightly inferior, seismic performance relative to the monolithic connection. Among the precast specimens, the existence of additional stirrups slightly improved the total performance. The use of high-strength steel bars as beam top longitudinal bars further decreased the loading capacity and energy dissipation. The air bubble film technique used to roughen the interfaces ensured the structural integrity.
You need ‘help for the journey’: Freedom and regulation in a ‘market-friendly’ megachurch
Authors: Yip Jeaney , Ainsworth Susan
Published: June 2019

One of the dominant trends in contemporary religion is a focus on individual freedom, choice and autonomy, all central tenets of mainstream consumer society. Rather than indicating a lack of religious regulation, we show how they can be the means through which regulation operates. Drawing on the theory of governmentality, which focuses on how power operates in discourse, we present a case study of a highly successful megachurch and global leader in Christian music – Hillsong – and show how this religious producer constructs a subject position for the consumer that promotes freedom and choice but nevertheless has regulatory implications by limiting what is thinkable and possible. Our findings show how Hillsong uses music and offers a worship experience that encourages continued reliance on the Church supported by its selective interpretation of the Pentecostal tradition. We trace how Hillsong claims knowledge of the religious consumer, identifying its central logic and contradictions. In doing so we show how religious regulation is taking new forms in contexts that may appear to be unregulated. We highlight the potential of this Foucauldian theory to not only enhance the understanding of current trends in religion but also to widen the repertoire used by critical marketing scholars to analyse how marketing discourse and practices are mobilized in specific contexts and with what effects.
Histopathology of Iliocaval Venous In-Stent Restenosis Treated With Directional Atherectomy
Authors: Robertson Cameron , Varcoe Ramon L. , Black Stephen , Thomas Shannon D.
Published: June 2019

Purpose: To report the use of directional atherectomy to treat venous in-stent restenosis (ISR) and subsequent histopathological analysis of retrieved intrastent tissue. Case Report: A 55-year-old man presented with recurrent symptoms of venous congestion following iliofemoral stenting. The stents were found to be occluded on imaging. Directional atherectomy was used to recanalize the iliofemoral venous stents, which provided significant symptom relief. Tissue retrieved from within the stent demonstrated patterns of cellular components similar to arterial ISR. At 6-month follow-up, the stents remain patent, with no evidence of further ISR. Conclusion: Directional atherectomy is a potential treatment option for iliofemoral venous ISR. The pathological process of venous ISR demonstrates cellular changes similar to arterial ISR.
Insights From a Short-Term Protein–Calorie Restriction Exploratory Trial in Elective Carotid Endarterectomy Patients
Authors: Kip Peter , Trocha Kaspar M. , Tao Ming , O’leary James J. , Ruske Jack , Giulietti Jennifer M. , Trevino-Villareal Jose H. , MacArthur Michael R. , Bolze Andrew , Burak M. Furkan , Patterson Suzannah , Ho Karen J. , Carmody Rachel N. , Guzman Raul J. , Mitchell James R. , Ozaki C. Keith
Published: June 2019

Background:

Open vascular surgery interventions are not infrequently hampered by complication rates and durability. Preclinical surgical models show promising beneficial effects in modulating the host response to surgical injury via short-term dietary preconditioning. Here, we explore short-term protein–calorie restriction preconditioning in patients undergoing elective carotid endarterectomy to understand patient participation dynamics and practicalities of robust research approaches around nutritional/surgical interventions.

Methods:

We designed a pilot prospective, multicenter, randomized controlled study in patients undergoing carotid endarterectomy. After a 3:2 randomization to a 3-day preoperative protein–calorie restriction regimen (30% calorie/70% protein restriction) or ad libitum group, blood, clinical parameters, and stool samples were collected at baseline, pre-op, and post-op days 1 and 30. Subcutaneous and perivascular adipose tissues were harvested periprocedurally. Samples were analyzed for standard chemistries and cell counts, adipokines. Bacterial DNA isolation and 16S rRNA sequencing were performed on stool samples and the relative abundance of bacterial species was measured.

Results:

Fifty-one patients were screened, 9 patients consented to the study, 5 were randomized, and 4 completed the trial. The main reason for non-consent was a 3-day in-hospital stay. All 4 participants were randomized to the protein–calorie restriction group, underwent successful endarterectomy, reported no compliance difficulties, nor were there adverse events. Stool analysis trended toward increased abundance of the sulfide-producing bacterial species Bilophila wadsworthia after dietary intervention ( P = .08).

Conclusions:

Although carotid endarterectomy patients held low enthusiasm for a 3-day preoperative inpatient stay, there were no adverse effects in this small cohort. Multidisciplinary longitudinal research processes were successfully executed throughout the nutritional/surgical intervention. Future translational endeavors into dietary preconditioning of vascular surgery patients should focus on outpatient approaches.