bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Anxiety and Depression With Pain and Quality of Life in Patients With Chronic Foot and Ankle Diseases
Authors: Nakagawa Ryosuke , Yamaguchi Satoshi , Kimura Seiji , Sadamasu Aya , Yamamoto Yohei , Sato Yasunori , Akagi Ryuichiro , Sasho Takahisa , Ohtori Seiji
Published: August 2017

Background:

The purposes of this study were to clarify the incidence of anxiety and depression among patients with chronic foot and ankle diseases and to examine the independent association of anxiety and depression with pain and quality of life.

Methods:

Patients who visited the foot and ankle clinic from April 2015 to November 2016 were recruited. Anxiety and depression in patients were assessed using the Hospital Anxiety and Depression Scale. Pain and quality of life were evaluated using the visual analog scale (VAS) and Self-Administered Foot Evaluation Questionnaire (SAFE-Q), respectively. Furthermore, patient characteristics, including age, sex, body mass index, pain in other body areas, social support, employment, and household income, were surveyed. A multiple regression analysis was performed to examine the independent association of anxiety and depression with pain and quality of life. A total of 250 patients were included in the analysis.

Results:

The prevalence of anxiety and depression was 30% and 27%, respectively. The VAS and all SAFE-Q subscale scores were significantly worse in patients with anxiety or depression than in patients without the same (median VAS 63 vs 49 for anxiety, P = .005; 68 vs 47 for depression, P < .001). Furthermore, the multiple regression analyses showed that the presence of anxiety ( P = .02) and depression ( P < .001) was independently associated with increased pain, and it led to low scores on all SAFE-Q subscales ( P < .001 for all subscales).

Conclusion:

About 30% of patients with chronic foot and ankle disease had anxiety or depression. The presence of these psychological symptoms was independently associated with worse pain and impaired quality of life after controlling for patient characteristics. Clinicians need to recognize the possibility of concurrent anxiety and depression to provide a more holistic treatment for chronic foot and ankle disease.

Level of Evidence:

Level IV, case series.
The Spillover Effects of Political Scandals: The Moderating Role of Cynicism and Social Media Communications
Authors: Lee Francis L. F.
Published: August 2017

This study examines how political cynicism and social media communications moderate the spillover effects of political scandals, that is, the extent to which a scandal surrounding one political figure may influence people’s attitudes toward other political objects. Theoretically, spillover effects are understood as grounded in how people understand the interconnections among politicians and institutions. Analysis of a representative survey in Hong Kong documents the presence of spillover effects of scandals surrounding the Chief Executive of the government. The findings also illustrate the moderating role of political cynicism and, to a lesser extent, political communications via social media.
Sirolimus and mirabegron interaction in a hematopoietic cell transplant patient
Authors: Engle Jeff A , Fair Christina
Published: August 2017

Purpose

Hematopoietic cell transplant patients are exposed to numerous classes of medications. Transplant practitioners must vigilantly monitor for drug interactions especially involving immunosuppressants. We report a hematopoietic cell transplant patient receiving sirolimus who developed supratherapeutic serum concentrations after initiating mirabegron.

A 31-year-old, 98 kg female received a second umbilical cord blood transplant four years after the first transplant for relapsed acute myeloid leukemia. Mycophenolate mofetil and sirolimus were utilized for graft versus host disease prophylaxis. The patient was receiving sirolimus 2 mg daily and the serum concentration on day 26 post-transplant (day + 26) was within therapeutic range (6.7 μg/L, goal range 3–12 μg/L). Her post-transplant course was complicated by BK viruria-associated cystitis for which she was started on mirabegron. Six days after starting the new medication (day + 33), the sirolimus serum concentration increased to 19.2 μg/L. Thus mirabegron was discontinued and sirolimus was held. Sirolimus was restarted once the serum concentration was within goal and subsequently stabilized with a combination of 1 mg and 2 mg daily for a total weekly dose of 10 mg. The proposed mechanisms of interaction include: (1) sirolimus inhibition of organic anion transporting polypeptide leading to increased mirabegron in the intestinal lumen; (2) mirabegron inhibition of P-glycoprotein leading to increased absorption of sirolimus and; (3) increased sirolimus absorption leading to increased sirolimus serum concentrations.

Conclusion

To our knowledge, this is the first report of a potential drug interaction between sirolimus and mirabegron. Transplant specialists should be aware of this potential interaction when considering the concurrent use of these medications.
Use of whey as a culture medium for Bacillus clausii for the production of protein hydrolysates with antimicrobial and antioxidant activity
Authors: Rochín-Medina Jesús J , Ramírez-Medina Hilda K , Rangel-Peraza Jesús G , Pineda-Hidalgo Karen V , Iribe-Arellano Pablo
Published: August 2017

The use of whey as a natural culture medium to produce hydrolysates with antimicrobial from Bacillus clausii is the objective of this research. The fermentation process was carried out at 25 ℃ for five days, where proteolytic activity, soluble peptides quantification, and antimicrobial activity using the disc diffusion method were determined every day. The fermented whey reached values ​​of proteolytic activity between 90 and 260 U ml−1 and a production of soluble peptides between 100 and 2070 µg ml−1. The maximum values ​​were reached after three days of fermentation to all determinations. In addition, the inhibition zone of fermented whey against Salmonella Typhimurium, Escherichia coli, Shigella flexneri, Staphylococcus aureus, Listeria monocytogenes, and Enterococcus faecalis strains were 13.7, 13.2, 14.4, 14.6, 9.8, 15.7 mm, respectively. The hydrolysates inhibited the 2, 2’-azinobis (3-ethylbenzothiazoline- 6-sulfonic acid) (ABTS) and 2, 2-diphenyl-1-picrylhydrazyl (DPPH) radicals by 85 and 80%, respectively. The whey was used to allow the growth of B. clausii and to generate peptides with antioxidant and antimicrobial activity through the hydrolysis of proteins present in the natural culture medium. This process could be used for the development of new dairy products added with probiotics.
Survey of Diplomates of the American Board of Veterinary Toxicology Regarding Perceptions of the Value of This Certification
Authors: Dorman David C. , Kedrowicz April A.
Published: August 2017

An anonymous, online questionnaire was sent to active diplomates of the American Board of Veterinary Toxicology (DABVTs; n = 95) to determine the attitudes of veterinary toxicologists toward their ABVT certification and the adequacy of the training programs in this discipline. We gathered information related to demographics, educational and work history, and other specialty board membership. Ten questions sought the respondent’s opinion related to the economic value of the specialty, whether workforce shortages for DABVT exist, and whether DABVTs should complete a residency or graduate program. Fifty-one (54%) DABVTs responded. Their mean age was 58 and most (88%) held a graduate degree. When respondents were asked to rate their level of agreement (strongly disagree = 1; strongly agree = 5), most (73%) agreed or strongly agreed (median = 4) that there was a shortage of DABVTs. Fourteen (27%) participants strongly disagreed that the ABVT certification was required for their position, while 15 (29%) strongly agreed with this statement (median = 3). Most respondents agreed that the ABVT certification has been critical to their career (median = 4), in addition to a financial benefit to being a DABVT (median = 4). Most (67%) participants strongly or somewhat disagreed that current training programs are adequate to meet the shortage of DABVT (median = 2). Our findings indicate there is concern about the number of DABVTs and the adequacy of training programs to meet this perceived need. These findings improve our understanding of current attitudes of DABVTs toward their specialty.
Occupy, Black Lives Matter and Suspended Mediation
Authors: Campbell Perri
Published: August 2017

Following popular youth-led uprisings around the world a large body of literature has emerged focusing on how social media and digital spaces have reinvigorated young people’s engagements with political and social issues. In this article, I explore the ways in which young people’s expressive political practices are given shape through their movement in/between digital and non-digital spaces. Focusing, in particular, on the Occupy and Black Lives Matter movements, I suggest that a suspended self emerges from the interstices of digital and non-digital spaces, from young people’s movement in/between digital and non-digital spaces. This movement has consequences for self-shaping which young people involved in the Black Lives Matter movement and Occupy movement are not only aware of, but are utilizing in everyday ways to challenge the rules and regulations they encounter and to shift frames of recognition.
Condescension or Co-decisions
Authors: Boldt Georg
Published: August 2017

This article examines youth participation in public decision-making through an ethnographic case study analysing structural factors and agency of participants in a process of participatory budgeting. Deliberative democracy is increasingly offered as a policy solution for civic renewal. However, the legitimacy of these processes is commonly questioned. Therefore, procedural theorists have attempted to define ideal conditions for participation, highlighting how the possibility of participation is communicated, the selection of participants and their level of influence.

This study found that while some participants felt the process was meaningful, for others it offered sanctions and reinforcement of existing hierarchies. This article argues that ideal conditions of participation need to be understood in a wider sense, including how participation is made ‘youth friendly’, the opportunities and possibilities of participants in the core of the process versus those occupying marginal positions, and what kind of prior knowledge is necessary in order to participate.
Late presentation of NMOSD as rapidly progressive leukoencephalopathy with atypical clinical and radiological findings
Authors: Sechi Elia , Addis Alberto , Batzu Lucia , Mariotto Sara , Ferrari Sergio , Conti Maurizio , Sechi GianPietro
Published: August 2017

Brain abnormalities in neuromyelitis optica spectrum disorder (NMOSD) are highly heterogeneous and often non-specific. Extensive white matter involvement has been described and frequently manifests with encephalopathy requiring prompt intervention. Rarely, this may represent the only manifestation at onset without concurrent suggestive features of the disease, thus making diagnosis challenging. NMOSD may potentially occur at any age, but it seems that this disorder has distinctive clinical features in the elderly. We describe a case of NMOSD presenting as rapidly progressive leukoencephalopathy with atypical clinical and magnetic resonance imaging (MRI) findings in a 69-year-old woman.
Investigating consumers’ adoption of SSTs – a case study representing India’s hospitality industry
Authors: Kaushik Arun Kumar , Kumar Vikas
Published: August 2017

The present study develops and validates an extended model of tourists’ adoption intention towards self-service technologies (SSTs) to examine whether tourists prefer SSTs over employee-mediated services. Tourists’ need for interaction (NI) with hospitality employees has been proposed as an important variable influencing tourists’ propensity towards SST adoption in an offline hospitality context. The proposed model illustrates the reasons behind consumer choice between alternative service delivery processes – modern service delivery by SSTs and traditional service delivery through employees. It is based on primary responses collected from a sample ( n = 648) of domestic and foreign tourists in India. Findings show that NI and perceived usefulness perform vital roles in choosing SSTs over employees in trial and adoption stages of innovation adoption model, respectively. Results also suggest that a few non-technical concerns and motivations (perceived trust and perceived performance risk) might offset SST deployment. The proposed model assists service firms and managers in analysing tourists’ adaptability towards SSTs and deciding an appropriate combination of SSTs and employees for superior service delivery.
Are people incidentally exposed to news on social media? A comparative analysis
Authors: Fletcher Richard , Nielsen Rasmus Kleis
Published: August 2017

Scholars have questioned the potential for incidental exposure in high-choice media environments. We use online survey data to examine incidental exposure to news on social media (Facebook, YouTube, Twitter) in four countries (Italy, Australia, United Kingdom, United States). Leaving aside those who say they intentionally use social media for news, we compare the number of online news sources used by social media users who do not see it as a news platform, but may come across news while using it (the incidentally exposed), with people who do not use social media at all (non-users). We find that (a) the incidentally exposed users use significantly more online news sources than non-users, (b) the effect of incidental exposure is stronger for younger people and those with low interest in news and (c) stronger for users of YouTube and Twitter than for users of Facebook.
Planning by intentional communities: An understudied form of activist planning
Authors: Sager Tore
Published: August 2017

The article is about intentional communities choosing a lifestyle outside the mainstream. It is explained why their planning is a sort of activist planning and often a case of radical planning. Planning by intentional communities differs from most activist neighbourhood planning by closer relation to a deviating worldview or ideology. The permanent insistence on non-conformity makes planning processes involving both government and intentional community cases of agonist planning. Activist planning theory has not studied how the thousands of dedicated activists living in intentional communities plan the development of their area. The article starts such an investigation by studying Svartlamon in Trondheim, Norway. It is an urban intentional community for social change, housing some 240 individuals. The activists have used planning strategically to mobilize and build external support, to frame the cooperation with the municipality and to establish a legal underpinning of the intentional community. The following questions are answered: Are the goals of the activists clearly reflected in the plans? How are the activists involved in the planning? Are the planning ideas of the intentional community well received by the municipality?
Co-design and action learning in local public services
Authors: Laitinen Ilpo , Kinder Tony , Stenvall Jari
Published: August 2017

The paper argues that from a new public governance and service management perspective, local public services are best conceptualised as service systems in which users co-produce and co-design; this differentiates public from private services, which have lower of trust and shared values resulting in a goods-dominant logic and are an alternative to the new public management viewpoint. Referencing new case studies from Finland and Scotland, we further argue that for local public servicesŉ co-production as an action- learning environment supports and encourages co-design: this makes local public services a special case of codesign. Analysing the two cases of co-design, we argue that since public services are subject to public scrutiny, and since design is a social activity, there exists a wider democratic footprint. Finally, we argue that co-design of local public services is best analysed from the perspective of action learning, for which we suggest an analytical framework.
Geometrical modelling and thermal analysis of nonwoven fabrics
Authors: Siddiqui Muhammad Owais Raza , Sun Danmei , Butler Ian B
Published: August 2017

Nonwoven fabric can be produced for thermal insulation. It has low fibre volume fraction. Thermal insulation property of fibrous materials depends on not only the thermal conductivity of fibre but also the entrapped static air. If fibre volume fraction is low in fibrous assembly it means that more air in the volume, therefore, the insulation property of the fabric increases, or vice versa. In this research thermal bonded nonwoven fabrics were used to analyse the heat transfer phenomena and predict the effective thermal conductivity and thermal resistance by using finite element method. Finite element models of nonwoven fabrics were created by two techniques: 3D reconstruction and solid modelling. For validation purpose, the effective thermal conductivity results obtained from an in-house developed instrument were compared with predicted results from the developed finite element models. Furthermore, this research work also contains an investigation of the effect of fibre volume fraction and thermal conductivity of fibre on the overall heat transfer of nonwoven structures.
Common Core State Standards and Students with Severe Disabilities: An Introduction to the Special Issue
Authors: Dukes Charles , Darling Sharon M.
Published: August 2017

This paper introduces a special issue of Research and Practice for Persons with Severe Disabilities, entitled “Common Core State Standards and Students with Severe Disabilities.” The Common Core State Standards (CCSS) is a far-reaching policy intended to help all students be college and career ready. Yet, there seems to be quite a gap between interpretation of the standards and development of academic and social supports based on these standards for students with severe disabilities. In this introduction, some background is presented on the CCSS and why it is critical to examine the impact of standards adaptation and implementation for all students, including students with severe disabilities. Additionally, a rationale for the special issue is presented, along with a description of the special issue contents.
Considerations for Evaluation of Diabetes Prevention Programs in Hispanic Adults in the United States
Authors: Banna Jinan
Published: August 2017

Hispanics are at high risk for diabetes. While there have been a number of diabetes prevention programs targeting Hispanics in the United States, not all recent studies focused on evaluating such programs have made use of validated tools to examine behavior change or examined acceptability and feasibility of the intervention. Tools used to assess behavioral outcomes such as diet should be tested to ensure validity and reliability. Acceptability may be examined using qualitative and quantitative measures to obtain feedback on the content of the intervention. Feasibility of the intervention may be evidenced by the enrollment, attendance, and attrition rates, as well as barriers or facilitators to participating in the program. Appropriate and comprehensive evaluation of such programs will allow for continued improvement of prevention efforts to address high rates of diabetes in this at-risk population.
A Micropractice/Community Partnership Model for Lifestyle Medicine
Authors: Graff Kerry
Published: August 2017

Lifestyle medicine (LM) has been shown to be effective at preventing and reversing disease, while simultaneously reducing overall medical expenses. However, the current health care system is not designed to reimburse LM clinicians for the value that they provide. The micropractice model is an innovative approach to deliver LM in a financially viable manner. Costs are minimized by automating much of the practice through a website, limiting physical clinic space, and employing only essential staff. Described in this article is a unique micropractice family medicine/lifestyle medicine hybrid office that has partnered with a local health system and a culinary center to offer additional services.
Deterioration of heart rate recovery index in patients after carotid artery stenting
Authors: Aytac Emrah , Gonen Murat , Dogdu Orhan , Balin Mehmet
Published: August 2017

Objective

Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions long term after the procedure. Patients with CAS have been reported to have autonomic nervous system (ANS) dysfunction. This study aimed to evaluate heart rate recovery (HRR) indices and exercise test parameters after CAS.

Methods

Patients (10 male, 11 female) suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled in our study. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients pre- and post-procedure. The HRR index was defined as the reduction in the heart rate from the rate at peak exercise to the rate first minute (HRR1), second minute (HRR2), third minute (HRR3) and fifth minute (HRR5) after the cessation of exercise stress testing.

Results

The exercise time, maximal heart rate, maximal blood pressure and maximal metabolic equivalents values were significantly decreased after the procedure. The first- and second-minute HRR indices of patients before procedure were significantly lower than after procedure (23.5 ± 6.6 vs 25.8 ± 8.3; p < 0.001 and 41.8 ± 12.3 vs 50.2 ± 16.3; p < 0.001, respectively). Similarly, HRR indices after the third and fifth minutes of the recovery period were significantly lower in patients before procedure, when compared with those indices after procedure (52.9 ± 13.1 vs 60.7 ± 14.4; p < 0.001 and 62.4 ± 12.8 vs 71.9 ± 14.1; p < 0.001).

Conclusion

We have demonstrated that HRR indices increased in the first, second, third and fifth minutes of the recovery period after maximal exercise testing in patients after the CAS procedure, which may be a reflection of parasympathetic dominance after CAS.
Generation X leaders from London, New York and Toronto
Authors: Edge Karen , Descours Katherine , Oxley Laura
Published: August 2017

Inspired by scholarly calls to focus more intently on the influence of context on leaders’ construction and negotiation of identity, this paper draws on evidence from our Economic and Social Research Council (ESRC) project in London, New York City and Toronto. Throughout the paper, we strive to illuminate how the city-based context influences how race/ethnicity is experienced and described. We use social identity theory, organisational fit and in-group prototypes to frame school leaders’ explicit discuss race/ethnicity when reflecting on identity. We describe our data gathering process using our Professional Identity card-sort Tool, which guided leaders’ reflections on identity. The analysis details how we extracted and interpreted evidence from leaders who were explicit about the interrelationship between their own personal racial/ethnic identification and its alignment or misalignment with their school-level communities. We explore how different city contexts influence leader experience of in-groups and out-groups and the related leadership challenges and opportunities. In conclusion, we reflect on the influence that structures, policies and communities have on how leaders experience identity and the possible implications for their work. We also explore the value of attending to potential context-based identity-driven experiences for school leader development and support.
“It’s the Method, Stupid.” Interrelations between Methodological and Theoretical Advances: The Example of Comparing Higher Education Systems Internationally
Authors: Hoelscher Michael
Published: August 2017

This article argues that strong interrelations between methodological and theoretical advances exist. Progress in, especially comparative, methods may have important impacts on theory evaluation. By using the example of the “Varieties of Capitalism” approach and an international comparison of higher education systems, it can be shown that the use of improved data and of advanced analysis techniques changes the acceptance or rejection of the theoretical approach. As a conclusion, the article advocates data improvements, the use of advanced methods, more generally a methodologically reflexive interpretation of comparative research results as well as a closer cooperation between theory and method development.
1α,25-Dihydroxyvitamin D3 up-regulates IL-34 expression in SH-SY5Y neural cells
Authors: Zhang Dong , Li Miaomiao , Dong Yang , Zhang Xinhui , Liu Xingyun , Chen Zhangming , Zhu Yongji , Wang Huiming , Liu Xuwen , Zhu Jialiang , Shen Yujun , Korner Heinrich , Ying Songcheng , Fang Shengyun , Shen Yuxian
Published: August 2017

Vitamin D supplementation is regarded as a novel approach to treat Alzheimer’s disease, but the underlying mechanism remains elusive. The cytokine IL-34 provides strong neuroprotective and survival signals in brain injury and neurodegeneration and could be an immunological mediator for the vitamin D-induced protection. The aim of this study was to investigate whether human IL-34 is up-regulated in neuronal cells by the hormonally active form of vitamin D, 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3]. We found that IL-34 was detectable in a variety of cell lines and its expression was strongly induced in SH-SY5Y neural cells in a dose- and time-dependent manner by 1α,25(OH)2D3 through the vitamin D receptor (VDR). Furthermore, we identified the core promoter of IL-34 gene and a VDR binding site (CGCCCT) that was required for 1α,25(OH)2D3-induced IL-34 expression. These findings suggest that the induction of IL-34 expression by 1α,25(OH)2D3 may constitute a mechanism that explains the protective function of vitamin D in Alzheimer’s disease.
Assessment of chest pain
Authors: Schroeder Knut
Published: August 2017

Chest pain is an important presentation in primary care. Clinical assessment can be a challenge, as there are many potential causes of chest pain, ranging from benign to life-threatening. Since referring all patients to chest pain clinics is neither feasible nor appropriate, this article aims to help you differentiate between chest pain requiring urgent action, such as acute coronary syndrome or pulmonary embolism, and less serious non-cardiac chest pain that can (at least initially) be managed in the community.
Niraparib in ovarian cancer: results to date and clinical potential
Authors: Caruso Davide , Papa Anselmo , Tomao Silverio , Vici Patrizia , Panici Pierluigi Benedetti , Tomao Federica
Published: August 2017

Ovarian cancer is the first cause of death from gynaecological malignancy. Germline mutation in BRCA1 and 2, two genes involved in the mechanisms of reparation of DNA damage, are showed to be related with the incidence of breast and ovarian cancer, both sporadic and familiar. PARP is a family of enzymes involved in the base excision repair (BER) system. The introduction of inhibitors of PARP in patients with BRCA-mutated ovarian cancer is correlated with the concept of synthetic lethality. Among the PARP inhibitors introduced in clinical practice, niraparib showed interesting results in a phase III trial in the setting of maintenance treatment in ovarian cancer, after platinum-based chemotherapy. Interestingly, was niraparib showed to be efficacious not only in BRCA-mutated patients, but also in patients with other alterations of the homologous recombination (HR) system and in patients with unknown alterations. These results position niraparib as the first PARP-inhibitor with clinically and statistically significant results also in patients with no alterations in BRCA 1/2 and other genes involved in the DNA repair system. Even if the results are potentially practice-changing, the action of niraparib must be further studied and deepened.
An analytical model of linear density foam–protected structure under blast loading
Authors: Xia Ye , Wu Chengqing , Bennett Terry
Published: August 2017

Aluminium foam is widely known as an energy absorptive material which can be used as a protective cladding on structures to enhance blast resistance of the protected structures. Previous studies show that higher density provides larger energy absorption capacity of aluminium foam, but results in a larger transmitted pressure to the protected structure. To lower the transmitted pressure without sacrificing the maximum energy absorption, graded density foam has been examined in this study. An analytical model is developed in this article to investigate the protective effect of linear density foam on response of a structure under blast loading. The model is able to simulate structural deformation with reasonable accuracy compared with experimental data. The sensitivity of density gradient of foam cladding on reinforced concrete structure is tested in the article.
Editor’s Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function
Authors: Bonnefoy-Cudraz Eric , Bueno Hector , Casella Gianni , De Maria Elia , Fitzsimons Donna , Halvorsen Sigrun , Hassager Christian , Iakobishvili Zaza , Magdy Ahmed , Marandi Toomas , Mimoso Jorge , Parkhomenko Alexander , Price Susana , Rokyta Richard , Roubille Francois , Serpytis Pranas , Shimony Avi , Stepinska Janina , Tint Diana , Trendafilova Elina , Tubaro Marco , Vrints Christiaan , Walker David , Zahger Doron , Zima Endre , Zukermann Robert , Lettino Maddalena
Published: August 2017

Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit’s geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.
Making care organizations great again? A comparison of Care Pathways, Lean Thinking, Relational Coordination, and Modern Sociotechnical Design
Authors: Pless Sam , Van Hootegem Geert , Dessers Ezra
Published: August 2017

Introduction

Care organizations are often not well equipped to the increasing complexity and chronicity of diseases. Several organizational redesign models propose interventions that may help organizations adapt to this new reality. The objective of this study is to describe the redesign models in a uniform manner and to offer conceptual clarity.

Methods

This study presents a systematic comparison of the problem definition and proposed interventions of four redesign models: Care Pathways, Lean Thinking, Relational Coordination, and Modern Sociotechnical Design. Data were collected through a critical and thematic review of selected literature. Data were analyzed using a priori deducted coding derived from a theoretical framework based on Mintzberg. The COREQ checklist was used to minimize bias.

Results

Twenty conceptual documents and practical guidelines were included for data analysis. The problem definition of the four redesign models is largely similar and suggests that fragmented task division and centralized coordination hinder the delivery of complex and chronic care. The proposed interventions differ between the redesign models, but in general more attention is given to the coordination of tasks than to task division, and interventions are mainly situated at the micro (workplace) and meso (work unit) levels of the organization.

Discussion

The systematic comparison clarifies the similarities and differences between the analyzed redesign models, which can be useful for improving studies on redesign model effectiveness. Additionally, systematic comparison supports care organizations in selecting appropriate redesign models. Future studies may involve a larger selection of redesign models as well as the redesign of inter-organizational networks.
Assistive technology solutions for aiding travel of pedestrians with visual impairment
Authors: Chanana Piyush , Paul Rohan , Balakrishnan M , Rao PVM
Published: August 2017

This work systematically reviews the assistive technology solutions for pedestrians with visual impairment and reveals that most of the existing solutions address a specific part of the travel problem. Technology-centered approach with limited focus on the user needs is one of the major concerns in the design of most of the systems. State-of-the-art sensor technology and processing techniques are being used to capture details of the surrounding environment. The real challenge is in conveying this information in a simplified and understandable form especially when the alternate senses of hearing, touch, and smell have much lesser perception bandwidth than that of vision. A lot of systems are at prototyping stages and need to be evaluated and validated by the real users. Conveying the required information promptly through the preferred interface to ensure safety, orientation, and independent mobility is still an unresolved problem. Based on observations and detailed review of available literature, the authors proposed that holistic solutions need to be developed with the close involvement of users from the initial to the final validation stages. Analysis reveals that several factors need serious consideration in the design of such assistive technology solutions.
Never Gonna GIF You Up: Analyzing the Cultural Significance of the Animated GIF
Authors: Miltner Kate M. , Highfield Tim
Published: August 2017

The animated Graphics Interchange Format (GIF) is a digital file format with a long history within internet cultures and digital content. Emblematic of the early Web, the GIF fell from favor in the late 1990s before experiencing a resurgence that has seen the format become ubiquitous within digital communication. While the GIF has certain technical affordances that make it highly versatile, this is not the sole reason for its ubiquity. Instead, GIFs have become a key communication tool in contemporary digital cultures thanks to a combination of their features, constraints, and affordances. GIFs are polysemic, largely because they are isolated snippets of larger texts. This, combined with their endless, looping repetition, allows them to relay multiple levels of meaning in a single GIF. This symbolic complexity makes them an ideal tool for enhancing two core aspects of digital communication: the performance of affect and the demonstration of cultural knowledge. The combined impact of these capabilities imbues the GIF with resistant potential, but it has also made it ripe for commodification. In this article, we outline and articulate the GIF’s features and affordances, investigate their implications, and discuss their broader significance for digital culture and communication.
Trends, Costs, and Complications of Anterior Cervical Discectomy and Fusion With and Without Bone Morphogenetic Protein in the United States Medicare Population
Authors: Lord Elizabeth L. , Cohen Jeremiah R. , Buser Zorica , Meisel Hans-Joerg , Brodke Darrel S. , Yoon S. Tim , Youssef Jim A. , Wang Jeffrey C. , Park Jong-Beom
Published: August 2017

Study Design:

Retrospective database review.

Objectives:

After the Food and Drug Administration approved bone morphogenetic protein–2 (BMP) in 2002, BMP was used off-label in the cervical spine to increase bone growth and bony fusion. Since then, concerns have been raised regarding complication rates and safety. This study was conducted to examine the use of BMP in anterior cervical discectomy and fusion (ACDF) in the Medicare population and to determine risk of complications and associated costs within 90 days of surgery.

Methods:

Patients who underwent ACDF were identified using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision Procedure codes (ICD9-P). Complications were identified using ICD9 diagnostic codes. Charges were calculated as amount billed, and reimbursements were calculated as amounts paid by Medicare. Data for these analyses came from a nationwide claims database.

Results:

A total of 215 047 patients were identified who had ACDF from 2005 to 2011. For the majority of the procedures (89.0%), BMP was not used. BMP use rose from 11.84% in 2005 to a peak of 16.73% in 2007 before decreasing to 12.01% in 2011. BMP was used 16% more in women than men. BMP use was the highest in the West (13.6%) followed by Midwest (11.8%), South (10.6%), and Northeast (7.5%). There was a higher overall complication rate in the BMP group (2.1%) compared with the non-BMP group (1.9%) (odds ratio [OR] = 1.11, 95% CI = 1.01-1.22). The BMP group also had a higher rate of wound complications (0.98% vs 0.76%, OR = 1.29, 95% CI = 1.12-1.48). In this study population, there was no difference in dysphagia/hoarseness, neurologic, medical, or other complications. During the 90-day perioperative period, BMP surgeries were charged at 17.6% higher than non-BMP surgeries.

Conclusions:

The use of BMP in ACDF in the Medicare population has decreased since a peak in 2007. The rate of wound and overall complications for BMP use with ACDF was higher than without. Our results regarding dysphagia/hoarseness did not show a statistically meaningful difference, which is in contrast with many other studies. Charges associated with BMP use were higher during the 90-day perioperative period.
Investigating the 7-Year Cost-Effectiveness of Single-Level Cervical Disc Replacement Compared to Anterior Cervical Discectomy and Fusion
Authors: McAnany Steven J. , Merrill Robert K. , Overley Samuel C. , Kim Jun S. , Brochin Robert L. , Qureshi Sheeraz A.
Published: August 2017

Study Design:

Cost-effectiveness analysis.

Objectives:

To determine the 7-year cost-effectiveness of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF).

Methods:

We analyzed 7-year Short Form-36 Health Survey data collected from the Prestige Cervical Disc investigational device exemption study (IDE). The SF-6D algorithm was used to convert this data into health state utilities. Costs were calculated from the payer perspective, and quality adjusted life years (QALYs) were used to represent effectiveness. A Markov transition-state model was used to evaluate the cost-effectiveness of single-level CDR versus ACDF, and a Monte Carlo simulation was performed to assess the probabilistic sensitivity of the model.

Results:

CDR generated a 7-year cost of $172 989 compared to a 7-year cost of $143 714 for ACDF. CDR generated 4.53 QALYs compared to 3.85 QALYs generated by ACDF. The cost-effectiveness ratio of CDR was $38 247/QALY, while the cost-effectiveness ratio of ACDF was $37 325/QALY. The incremental cost-effectiveness ratio of CDR was $43 522/QALY, under the willingness to pay threshold of $50 000/QALY. Our probabilistic sensitivity analysis demonstrated CDR would be chosen 56% of the time based on 10 000 simulations.

Conclusions:

Single-level CDR and ACDF were both cost-effective strategies at 7 years for treating degenerative conditions of the cervical spine. Both the Markov simulation and the Monte Carlo simulation demonstrate CDR to be the more cost-effective strategy at 7 years. Continued analysis of IDE data should be performed to validate long-term cost-effectiveness of these treatment strategies.
Perceptions of Iranian Female Drug Users Toward HIV Testing: A Qualitative Content Analysis
Authors: Jamshidimanesh Mansoureh , Khoie Effat Merghati , Mousavi Seyed Abbas , Keramat Afsaneh , Emamian Mohammad Hassan
Published: August 2017

Background:

Drug-dependent women are the vulnerable population deprived of access to health services and also have particular relevance to public health perspective because they are important bridge population for driving HIV/AIDS epidemic. This qualitative study aimed to explore the perception of drug-dependent women regarding HIV testing.

Methods:

In this qualitative study, we approached 23 women with substance use disorders in 2 of the selected drop-in centers in the south Tehran. Focus group discussion, face-to-face semistructured interviews, and field notes were used to collect the data. Qualitative content analysis was used to extract the explanatory model of women’s perceptions about HIV testing.

Results:

Four main themes emerged from the data: forgotten health during use, having misconception, and sharing of sexual partner in secrecy and concerns. Seven subthemes were extracted, including not being sex worker, point of ruin, voluntary selection and concerns about fear of abandonment and fear of loss and death, double concern, and future of children.

Conclusion:

Beliefs and values of drug-dependent women can be positive points leading them to do an HIV test, and misconceptions of these women would be corrected by using safe behavioral skills training.
Structured Interviews: Developing Interviewing Skills in Human Resource Management Courses
Authors: Doll Jessica L.
Published: August 2017

Structured interviews are widely used in the employment process; however, students often have little experience asking and responding to structured interview questions. In a format similar to “speed dating,” this exercise actively engages students in the interview process. Students pair off to gain experience as an interviewer by asking and scoring structured behavioral interview questions and gain practice responding to questions as an interviewee. In both roles, students engage in building interview skills and applying course content. This activity is intended for instructors of human resource management and/or staffing/selection classes.
Thrombolysis management in thrombectomy patients: Real-life data from German stroke centres
Authors: Kellert Lars , Wollenweber Frank Arne , Thomalla Götz , Nolte Christian H , Fiehler Jens , Ringleb Peter Arthur , Dorn Franziska
Published: August 2017

Introduction

In randomised clinical trials (RCTs), endovascular thrombectomy (ET) was combined with intravenous thrombolysis (IVT) in the vast majority of patients. We aimed to analyse how German stroke centres manage IVT in patients receiving ET in daily routine.

Patients and Methods

We performed an online survey among neurologists and neurointerventionalists that included all German University hospitals and a selection of German community hospitals known to perform ET. The survey consisted of 20 questions and was open for reply from 20 December 2016 to 9 January 2017.

Findings

Overall, there were 110 replies, 76% (84/110) from neurologists and 20% (22/110) from neurointerventionalists. The majority of participants (75/99, 76%) reported to continue IVT after start of ET. Nine participants (9%) reported to stop IVT as a standard of care before ET and another 15 (15%) reported to stop IVT on a case-by-case basis. Thrombolysis is given intra-arterially in individual cases in 39% (37/99) and as a standard of care in 3% (3/99). Intra-arterial Heparin is given additionally as a standard procedure in 25% (24/96) and in individual cases in 11% (11/96). IVT is omitted even without contraindications before ET in 5% (5/95) as standard procedure and in 14% (13/95) in individual cases.

Discussion

We observed a wide heterogeneity with respect to the management of IVT in the context of ET. Evidence from RCTs is not implemented in a large number of cases.

Conclusion

These findings emphasise a requirement for further education and implementation of standards for the management of intravenous thrombolysis in endovascular treated stroke patients.
Can Economic Development Influence General Election Outcomes? Evidence from Consumption Expenditure Trends of Indian States
Authors: Mukherjee Sacchidananda , Chakraborty Debashis
Published: August 2017

India left aside the economic philosophy of the import-substitution-led growth model in 1991, and increasingly integrated itself with the world economy. 1 1 The views expressed by the authors are personal and in no way represent the same of their respective institutes. While the country’s GDP growth is commendable in global comparison, devolution of actual development at the state level is a relevant research question. It is argued that India’s poor growth prospect in recent times is a result of the counterproductive policies adopted over the last decade, particularly since 2009. The present analysis contributes to this debate by exploring two key questions. First, it enquires how the government’s social sector policies, measured by inflation-adjusted average per capita social sector expenditure (PCSSE) and per capita grants-in-aid disbursement (PCGAD), contribute to economic development, as reflected through inflation and inequality-adjusted monthly per capita consumption expenditure (MPCE), across various states over the last two decades. Second, the paper also attempts to explain the influence of development dynamics, as reflected through growth in MPCE, on general election outcomes. The analysis indicates that government policies in the social sector influence the development process, which in turn may affect general election outcomes. Given these findings, it is argued that there is room for introspection on recent restructuring of centre–state financial devolutions.