bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural laminar flow airfoil shape design at transonic regimes with multi-objective evolutionary algorithms
Authors: Chen Yongbin , Tang Zhili
Published: December 2017

The natural laminar flow airfoil shape design at transonic regime is solved using multi-objective evolutionary algorithms in this paper. A shock wave control bump is used to reduce wave drag of natural laminar flow airfoil in transonic flow, and the eN transition prediction method based on the linear stability theory is used to predict the transition location. The multi-island parallel multi-objective evolutionary algorithms is implemented to optimize the airfoil shape equipped with shock wave control bump for obtaining a larger laminar flow region and a weaker wave drag simultaneously. Optimization experiment shows that it is easy to capture the Pareto front of wave drag minimization and laminar flow region maximization. Results demonstrate that both wave drag and friction drag performance of several chosen Pareto members are significantly improved via the optimal airfoil shape and shock wave control bump device compared to that of the baseline shape.
Family policy in high-income countries: Five decades of development
Authors: Daly Mary , Ferragina Emanuele
Published: December 2017

This article empirically traces trends in family policy in 23 high-income countries since the 1960s. A range of data on income supports for families with children, family-related leave and early childhood education and care are brought together and analysed. The results show that family policy has developed by layering, in terms of both content and time period. A ‘foundational phase’ is characterised by investment in cash and tax allowances for families and employment leave for mothers, while a ‘consolidation phase’ sees states adding to their family policy portfolio, especially through the diversification of family-related leave and augmentation of child-related care services, increasing their overall family policy expenditure and continuing to support families financially but with a preference to direct this through the tax system. There is no inexorable development path though, either within or across countries. A layering development pattern suggests that analysis of family policy over time needs to be oriented to examining both continuity and change and, as the conclusion makes clear, there are many fruitful lines of further research.
A case of fat embolism syndrome complicated by diffuse alveolar hemorrhage
Authors: Lee Jae Ha , Park Jin Han , Kim Yong Kyun , Kim Ji Wan , Kim Young Chang , Kim Hyun-kuk , Jang Hang Jea
Published: December 2017

Fat embolism syndrome is a life-threatening condition that may develop after orthopedic trauma and surgery. Fat embolism is caused by lipid droplets in the systemic circulation inducing mechanical or biochemical injury. Diagnosis is clinical and treatment is supportive. Clinical features including respiratory changes, neurological abnormalities, and petechial rashes generally present 12–72 h after the initial injury. However, respiratory failure accompanying diffuse alveolar hemorrhage in fat embolism syndrome is rare. This report describes a 44-year-old male patient suffering from fat embolism syndrome with diffuse alveolar hemorrhage caused by traumatic long bone fracture, in which mechanical ventilation was required to provide respiratory support.
Urban Regimes and Growth Machines toward a Cross-National Research Agenda
Authors: Harding Alan
Published: December 2017

The article begins with an appraisal of the concepts of urban regimes and growth machines and an assessment of their utility for cross-national urban political analysis, referring particularly to the United Kingdom. It then suggests that the formation of subnational development coalitions has become increasingly common across European liberal democracies but that political scientists, at least those in the United Kingdom, have yet to develop adequate conceptual tools with which to analyze this phenomenon. A final section suggests that the insights of the U.S. literature, suitably adapted, might be incorporated into a comparative research agenda based on the notion of urban governance.
Measuring Intent to Aid of Lay Responders: Survey Development and Validation
Authors: Miller Brian , Pellegrino Jeffrey L.
Published: December 2017

Background. Increasing lay responder cardiopulmonary resuscitation and automated external defibrillator use during sudden cardiac arrest depends on an individual’s choice. Investigators designed and piloted an instrument to measure the affective domain of helping behaviors by applying the theory of planned behavior (TPB) to better understand lay responders’ intent to use lifesaving skills. Method. Questionnaire items were compiled into 10 behavioral domains informed by the TPB constructs followed by refinement via piloting and expert review. Two samples from an American Red Cross–trained lay-responder population ( N = 4,979) provided data for an exploratory (EFA, n = 235) and confirmatory (CFA, n = 198) factor analyses. EFA derived interitem relationships into factors and affective subscales. CFA yielded statistical validation of factors and subscales. Results. The EFA identified four factors, aligned with the TPB constructs of attitudes, norms, confidence, and intention to act to explain 57% of interitem variance. The internal consistency of factor-derived subscales ranged between 0.71 and 0.91. Reduction of instrument items went from 47 to 32 (32%). The CFA yielded good model fit with the switching of the legal ramification item from the social norm to intention construct. Conclusion. The Intent to Aid (I2A) survey derived from this investigation aligned with the constructs of the TPB yielding four subscales. The I2A allows health education researchers to differentiate modalities and content impact on learner intention to act in a first aid (FA) emergency. I2A compliments cognitive and psychomotor measurements of learning outcomes. The experimental instrument aims to allow curricula developers and program evaluators a means of assessing the affective domain of human learning regarding intention-to-act in an FA emergency. In combination of with assessment of functional knowledge and essential skills, this instrument may provide curricula developers and health educators an avenue to better describe intention to act in an FA emergency.
Interpersonal Communication in Response to an Intervention and Its Impact on Smoking Cessation Within a Low-Income Population
Authors: Parks Michael J. , Kim Soyoon
Published: December 2017

Background. It is a priority to develop population-based strategies for reducing barriers to smoking cessation among low-income populations. Harnessing secondary transmission such as interpersonal communication (IC) has helped to reduce tobacco use, but there is a dearth of quasi-experimental research that examines IC and the full spectrum of smoking cessation behaviors, particularly in the context of population-level programs. Aims. Using quasi-experimental methods, we examined IC in response to a population-level intervention and its impact on the full spectrum of smoking cessation outcomes among low-income smokers. Method. We used propensity score matching; three different propensity score matching procedures were used to estimate and approximate experimental effects. We assessed four cessation outcomes: utilization of a free tobacco quitline (QL), making a quit attempt, and being smoke-free for 7 and 30 days at follow-up. We also examined predictors of IC. Results. IC was significantly related to QL utilization (effect sizes ranging from 0.135 to 0.166), making a quit attempt (effect sizes ranging from 0.115 to 0.147), being smoke-free for 7 days (effect sizes ranging from 0.080 to 0.121), and being smoke-free for 30 days at follow-up (effect sizes ranging from 0.058 to 0.082). Program-related and participant characteristics predicted IC, such as receiving emotional direct mail materials and living with a fellow smoker. Discussion. IC in response to a population-based program affected the cessation process, and IC had a marked impact on sustained cessation. Conclusion. Population-based programs should aim to harness psychosocial dynamics such as IC to promote sustained cessation among low-income populations.
The dividends of investing in computational software design: A case study
Authors: Dubey Anshu , Tzeferacos Petros , Lamb Don Q
Published: December 2017

A significant fraction of computational software for scientific research grows through accretion. In a common scenario, a small group develops a code for a specific purpose. Others find the software useful, so they add to it for their own use. The software grows to the point where its management becomes intractable and scientific results obtained from it become unreliable. This is in stark contrast with a small number of scientific codes that have undergone a design process, be it due to an upfront investment, or when haphazardly grown codes have reset and started again. At a minimum, these codes reduce the time to obtain research results for the communities they serve because individual researchers do not have to develop their own codes. They provide further benefits; the results they produce are more reproducible due to greater scrutiny, leading to better science. One of the more overlooked benefits, which is perhaps of greater significance, is that a well-designed code can expand to serve communities beyond the ones it was designed for. Thus, research communities with similar computational requirements can symbiotically improve computation-based research for each other. In this article, we present a case study of FLASH, a code that was designed and developed for simulating thermonuclear runaways such as novae and type Ia supernovae in astrophysics. Designed to be modular and extensible, users from several diverse research areas have added capabilities to it and adapted it for their own communities. Examples include cosmology, high-energy density physics, core-collapse supernovae, star formation, fluid–structure interactions, and chemical combustion. We give a summary of design features that facilitated the expansion and quantify the effort needed to expand into some of the above-mentioned fields. We also quantify the impact on different communities by mining the database of publications using FLASH, collected by its developers.
Applying Natural Language Processing Capabilities in Computerized Textual Analysis to Measure Organizational Culture
Authors: Pandey Sheela , Pandey Sanjay K.
Published: December 2017

We build on and extend methodological developments in computerized textual analysis and apply it for developing and validating a measure for the widely used concept of organizational culture. Although the organizational culture concept is widely used in a variety of domains of management scholarship, its measurement is primarily based on survey questionnaires. In this study, we extend computerized textual analysis by introducing the capabilities of natural language processing (NLP). NLP capabilities are artificial intelligence techniques for textual analysis that make it possible to conduct textual analysis at the multiple word level. We follow recommendations for establishing construct validity and demonstrate that the measure of organizational culture dimensions outlined in the study has content validity, external validity, dimensionality, and predictive validity.
Recent Police Killings in the United States: A Three-City Comparison
Authors: Lee Angela S. , Weitzer Ronald , Martínez Daniel E.
Published: December 2017

Recent police killings of citizens in the United States have attracted massive coverage in the media, large-scale public protests, and demands for reform of police departments throughout the country. This study is based on a content analysis of newspaper coverage of recent high-profile incidents that resulted in a citizen’s death in Ferguson, North Charleston, and Baltimore. We identify both incident-specific content as well as more general patterns that transcend the three cases. News media coverage of similar incidents in past decades tended to be episodic and favored the police perspective. Our findings point to some important departures from this paradigm. Reporting in our three cases was more likely to draw connections between discrete incidents, to attach blame to the police, and to raise questions about the systemic causes of police misconduct. These findings may be corroborated in future studies of news media representations of high-profile policing incidents elsewhere.
Candidate prognostic indicators in cats with histoplasmosis treated with antifungal therapy
Authors: Ludwig Hilary C , Hanzlicek Andrew S , KuKanich Kate S , Payton Mark E
Published: December 2017

Objectives

The aim of this study was to retrospectively identify candidate prognostic indicators in cats with histoplasmosis treated with antifungal therapy.

Methods

Medical records of cats diagnosed with histoplasmosis were reviewed. Candidate prognostic indicators were assessed for an association with survival to hospital discharge and survival to 1 and 6 months after diagnosis. Potential indicators included easily obtained data at the time of the initial hospital visit derived from cat signalment, historical information, physical examination, laboratory data, form of disease and initial treatment.

Results

Approximately 88% of cats survived to discharge, with 77% and 67% surviving to 1 and 6 months, respectively. Clinical variables significantly associated with death at more than one outcome time point included the presence of dyspnea, adventitial lung sounds, fungemia, neurologic disease, neutropenia, lymphopenia, multiple cytopenias (anemia, neutropenia, thrombocytopenia), hyperbilirubinemia and increased creatinine kinase activity. Cats that did not survive were more likely to have received corticosteroids, oxygen supplementation and required hospitalization. In addition, cats that did not survive required significantly longer hospitalization. There was no significant difference between initial antifungal drug and survival.

Conclusions and relevance

Potential prognostic indicators were associated with more severe respiratory, hepatic, hematologic or neurologic disease. Prospective investigation concerning clinical indicators of disease severity of these body systems is indicated.
Test–retest agreement and reliability of the Six Spot Step Test in persons with multiple sclerosis
Authors: Callesen Jacob , Richter Christina , Kristensen Cecilie , Sunesen Inger , Næsby Marie , Dalgas Ulrik , Skjerbæk Anders Guldhammer
Published: December 2017

Background:

The Six Spot Step Test (SSST) extends traditional walking outcomes in persons with multiple sclerosis (PwMS) by further challenging components of coordination and balance. Nonetheless, the test–retest agreement of the SSST has not been investigated.

Objective:

To determine the within-day, day-to-day, and inter-rater agreement and reliability of the SSST in PwMS. A secondary aim was to investigate the validity of handheld timing.

Methods:

A total of 38 PwMS with an Expanded Disability Status Scale (EDSS) <6.5 completed two SSSTs with a 5-minute break in-between. After 2 days, this procedure was repeated. Bland–Altman analysis was performed to determine the 95% Limits of Agreement (LOA) and Intraclass Correlation Coefficient (ICC) was calculated. In a subgroup of 18 PwMS, the SSSTs were video-recorded and timed by a second investigator.

Results:

The relative LOA within and between days were ±15% and ±19%, while ICC were 0.987 and 0.983, respectively. A minor learning effect was found over four tests. The handheld timing error was ±0.5 seconds when compared to video-based timing.

Conclusion:

The SSST has an acceptable within- and between-day agreement and reliability. For interventional purposes, a change of >19% can be regarded as a real change. Valid timing can be performed by a handheld stopwatch.
The impact of a special school placement on self-perceptions of confidence and competence among prospective PE teachers
Authors: Maher Anthony , Morley David , Fimusanmi Julie , Ogilvie Paul
Published: December 2017

School-based placements are often used as a way of preparing prospective teachers for the demands of their future role. However, little is known about the impact of such situated learning experiences on prospective physical education (PE) teachers’ confidence and competence. To the best of our knowledge, this article is the first of its kind to explore prospective teachers’ views of, and experiences within, special schools in order to identify the experiential mechanisms that shape self-perceptions of competence and confidence when teaching pupils with special educational needs and disabilities in PE. Thirty-two final year undergraduate students participated in focus group interviews and were selected on the basis that they: (1) were studying a Special Educational Needs and Disability in PE undergraduate module; (2) aspired to be a PE teacher; and (3) had attended six half-days of placement in a special school. All focus group transcripts were subjected to open, axial and selective coding in order to identify themes and sub-themes. The themes that were constructed from the analysis were: impact of placement role on confidence and competence; impact of knowing pupils’ needs and capabilities; conceptualising confidence and perceptions of its development; and conceptualising competence and perceptions of its development. We use these themes to discuss the usefulness of special school-based placements for preparing aspiring teachers for their role as inclusive educators.
Coping strategies and emotional well-being in children with disease-related pain
Authors: Failo Alessandro , Beals-Erickson Sarah E , Venuti Paola
Published: December 2017

Disease-related pain and the consequences of pain in children and families are important areas for further research inquiry. There are limited data on the relationship between children’s emotional well-being, their experience of pain, and the strategies they employ to cope with pain within the context of serious medical illnesses. Understanding what strategies chronically ill children use to cope with pain and stress is essential for clinical intervention. This observational study examined the ways that children and adolescents with chronic diseases cope with pain and adapt to illness. The data were collected by self-report measures and projective drawing techniques in a novel way to assess the emotional functioning in a mixed cohort of youth with disease-related pain (oncological, rheumatic, and cystic fibrosis). This protocol was administered to 47 children, aged 7–14, recruited from pediatric wards of hospitals of Trento and Rovereto (Italy). The results showed that coping strategies in youth with disease-related pain differed across diagnoses and with self-representations (as part of the self-concept adaptive mode). We also provide evidence of the applicability of using projective drawing methods in assessing coping in youth with chronic illness and associated pain.
Helping out, signing up and sitting down: The cultural production of “read-alouds” in three kindergarten classrooms
Authors: Moffatt Lyndsay , Heydon Rachel , Iannacci Luigi
Published: December 2017

Reading aloud to children is a ubiquitous practice in early childhood settings. While there are many recommendations for how educators should conduct these experiences, little research in the past decade has examined how read-alouds are actually accomplished. Using anthropological and sociological theories of learning, literacy and research, our analysis illustrates how read-alouds are enacted in three kindergarten classrooms. Our analysis highlights similarities and differences in how these phenomena are produced and raises questions about the consequences current ideologies of literacy learning may have for young children’s understandings of reading and of themselves as readers. Differences amongst the research sites are discussed in light of Cummins’ continuum of coercive and transformational curricula.
A Lupus Hepatitis Case and its Association with Igm Antibodies against Cytomegalovirus, Herpes Simplex and Herpes Zoster Viruses
Authors: Riccio A. , Morelli G. , Sangiolo M.G. , Morante R. , Esposito C. , Tarantino G.
Published: December 2017

The hypothesis for a role of viral infections on the pathogenesis of systemic lupus erythematosus has been discussed in many works, particularly that of cytomegalovirus and Epstein Barr virus infections as trigger of autoimmune processes. Here, we describe the case of a young woman affected by systemic lupus erythematosus with marked hepatic involvement presenting IgM antibodies against cytomegalovirus, herpesvirus and herpes zoster virus in the absence of virus. The meaning of these laboratory findings is discussed.
Serum Il-17 after one Course of Sublingual Immunotherapy in Allergic Rhinitis to Birch
Authors: Ciprandi G. , Fenoglio D. , De Amici M. , Marseglia G. , Murdaca G. , Di Gioacchino M.
Published: December 2017

Recently, it has been reported that IL-17 may be involved in allergic reaction. Sublingual immunotherapy (SLIT) is the unique curative treatment for allergic rhinitis. This study aims at investigating whether one course of birch SLIT could affect serum IL-17 levels. The findings provided show that some IL-17 producer patients had a reduction of serum IL-17 levels after one SLIT course. Therefore, this preliminary study shows that a single pre-seasonal SLIT course may induce a significant decreasing trend in serum IL-17 levels; further study should be carried out to define the role exerted by IL-17 in allergic rhinitis.
Epidemiology of Herpes Simplex Virus Infection in Pregnancy: A Pilot Study
Authors: Bellizzi A. , Fioriti D. , Marcone V. , Anzivino E. , Mischitelli M. , Barucca V. , Parisi A. , Moreira E. , Osborn J. , Chiarini F. , Calzolari E. , Pietropaolo V.
Published: December 2017

Herpes simplex virus (HSV) infection is one of the most common sexually transmitted viral diseases worldwide. HSV type 2 causes most genital herpes and HSV type 1 is usually transmitted via non-sexual contacts. We studied 109 pregnant women between January 2007 and December 2008, in relation to their age, condom use, number of sexual partners, age at first intercourse, parity and smoking habits. The aim of this study is to evaluate the prevalence of HSV cervical infection and HSV co-infection with other genital microorganisms associated with poor neonatal outcome. Our results show that of the 109 outpatients enrolled, 30% were HSV1 and/or HSV2 positive, of whom 30% were infected with both HSV1 and HSV2, 18% were infected with HSV1 alone and 52% with HSV2 alone. A significant association between HSV1 and HSV2 infection was found, and the prevalence of HSV2 infection in women infected with HSV1 was 63%. The prevalence of HSV1/2 varied in the presence of other vaginal microorganisms but a statistical significant association was not found. This pilot study is probably too small to obtain statistically significant results. Nevertheless, using these observed results, we calculated that about 530 patients with comparable features should be enrolled to detect an increase of 50% in HSV infection due to the presence of other genital infections and potential risk factors.
Urogenital tuberculosis, the cause of ineffective antibacterial therapy for urinary tract infections
Authors: Kulchavenya Ekaterina , Cherednichenko Andrey
Published: December 2017

Background:

Urogenital tuberculosis (UGTB) is one of the great imitators; it is commonly masked by urinary tract infections (UTIs). We aimed to estimate how many UGTB patients were among patients with a long history of UTIs.

Material and Methods:

A total of 244 patients with recurrent UTIs and suspected UGTB were enrolled in an open, noncomparative prospective study. Their urine and expressed prostate secretion or ejaculate were cultured (a total of 1446 samples), and 421 isolates with growth of ⩾104 colony-forming units (CFU)/ml were investigated for drug resistance. Typically, UGTB diagnosis is made by individual case.

Results:

All 244 patients had a long history of recurrent UTIs (on average, 7.9 ± 3.4 years); all received at least five courses of antibacterial therapy without good result. UGTB was diagnosed in 63 (25.8%), and in 41 of these (65.1%), there was comorbidity of UTI and UGTB. Of 1446 samples investigated, 421 (29.1%) were positive, and 1025 were negative. Escherichia coli was found in 57.3% of gram-negative microflora and in 29.0% only among all uropathogens. E. coli was resistant to amoxicillin/clavulanate in 51.5–57.1%, to cefotaxime in 50.0–52.0%, to gentamycin in 33.3–59.5%, to ciprofloxacin in 63.2–66.7%, to levofloxacin in 54.8–45.2%, and to nitrofurantoin in 23.5–20.8% in 2015 and 2016, respectively. If, in 2015, all isolates of E. coli were susceptible to imipenem, in 2016, 7.1% of strains were resistant to this antibiotic. Level of drug-resistance was higher in 2016, excluding only levofloxacin and nitrofurantoin.

Conclusions:

Total prevalence of UGTB among UTI patients with poor results of antibacterial therapy was 25.8%. Comorbidity of UTI and UGTB was diagnosed in 65.1%.
Investigating the use of an electronic hand hygiene monitoring and prompt device: influence and acceptability
Authors: Dyson Judith , Madeo Maurice
Published: December 2017

Introduction:

Hand hygiene (HH) prevents the transmission of healthcare-associated infections. Electronic HH monitoring and prompt devices have been developed to overcome problems with monitoring HH and to improve compliance. Devices monitor room entry and exit and soap use through communication between ceiling sensors and badges worn by practitioners and the badges sense alcohol rub.

Objectives:

To investigate (1) the impact of devices on HH compliance, (2) how devices influence behaviour and (3) the experience and opinions of practitioners on the use devices.

Methods:

HH compliance was monitored (before, during and after system installation) by observations and alcohol rub usage. Compliance during installation was also monitored by the device. Healthcare practitioner interviews (n = 12) explored how the device influenced behaviour and experiences and opinions of wearing the device.

Results:

HH compliance improved during the period the device was installed. Practitioners reported the device increased their awareness, enhancing their empathy for patients and encouraged patients and colleagues to prompt when HH was needed. Practitioners’ reported better HH, gaming the system and feelings of irritation.

Conclusion:

HH prompt and monitoring systems seem to improve compliance but improvements may be undermined by practitioner irritation and system gaming.
Healthcare-associated Legionnaires’ disease: Limitations of surveillance definitions and importance of epidemiologic investigation
Authors: Castellino Laila M , Gamage Shantini D , Hoffman Patti V , Kralovic Stephen M , Holodniy Mark , Bernstein Jack M , Roselle Gary A
Published: December 2017

Healthcare-associated Legionnaires’ disease (HCA LD) causes significant morbidity and mortality, with varying guidance on prevention. We describe the evaluation of a case of possible HCA LD and note the pitfalls of relying solely on an epidemiologic definition for association of a case with a facility. Our detailed investigation led to the identification of a new Legionella pneumophila serogroup 1 sequence type, confirmed a healthcare association and helped build the framework for our ongoing preventive efforts. Our experience highlights the role of routine environmental cultures in the assessment of risk for a given facility. As clinicians increasingly rely on urinary antigen testing for the detection of L. pneumophila, our investigation emphasises the importance of clinical cultures in an epidemiologic investigation.
Multi-centre prospective internal and external evaluation of the Brompton Harefield Infection Score (BHIS)
Authors: Rochon Melissa , Jarman Julian WE , Gabriel Joseph , Butcher Lisa , Morais Carlos , Still Martin , Ahmed Ishtiaq , Petrou Mario , Trimlett Richard , DeSouza Anthony , Yadav Rashmi , Raja Shahzad G
Published: December 2017

Background:

Previously, we reported that the Brompton Harefield Infection Score (BHIS) accurately predicts surgical site infection (SSI) after coronary artery bypass grafting (CABG). The BHIS was developed using two-centre data and stratifies SSI risk into three groups based on female gender, diabetes or HbA1c > 7.5%, body mass index ≥ 35, left ventricular ejection fraction < 45% and emergency surgery. The purpose of this study was to prospectively evaluate BHIS internally as well as externally.

Methods:

Multi-centre prospective evaluation involving three tertiary centres took place between October 2012 and November 2015. SSI was classified using the Public Health England protocol. Receiver operating characteristic (ROC) curves assessed predictive accuracy.

Results:

Across the four hospital sites, 168 of 4308 (3.9%) CABG patients had a SSI. Categorising the hospitals by BHIS score revealed that 65% of all patients were low risk (BHIS 0–1), 26% were medium risk (BHIS 2–3) and 8% were high risk (BHIS ≥ 4). The area under the ROC curve was in the range of 0.702–0.785. Overall area under the ROC curve was 0.709.

Conclusions:

BHIS provides a novel, internally and externally evaluated score for a patient’s risk of SSI after CABG. It enables clinicians to focus on strategies to prospectively identify high-risk patients and improve outcomes.
Likelihood of reporting medication errors in hospitalized children: a survey of nurses and physicians
Authors: Rishoej Rikke Mie , Hallas Jesper , Juel Kjeldsen Lene , Thybo Christesen Henrik , Almarsdóttir Anna Birna
Published: December 2017

Background:

Hospitalized children are at risk of medication errors (MEs) due to complex dosage calculations and preparations. Incident reporting systems may facilitate prevention of MEs but underreporting potentially undermines this system. We aimed to examine whether scenarios involving medications should be reported to a national mandatory incident reporting system and the likelihood of self- and peer-reporting these scenarios among paediatric nurses and physicians.

Methods:

Participants’ reporting of MEs was explored through a questionnaire involving 20 medication scenarios. The scenarios represented different steps in the medication process, types of error, patient outcomes and medications. Reporting rates and odds ratios with 95% confidence interval [OR, (95% CI)] were calculated. Barriers to and enablers of reporting were identified through content analysis of participants’ comments.

Results

The response rate was 42% (291/689). Overall, 61% of participants reported that scenarios should be reported. The likelihood of reporting was 60% for self-reporting and 37% for peer-reporting. Nurses versus physicians, and healthcare professionals with versus without patient safety responsibilities assessed to a larger extent that the scenarios should be reported [OR = 1.34 (1.05–1.70) and OR = 1.41 (1.12–1.78), respectively]; were more likely to self-report, [OR = 2.81 (1.71–4.62) and OR = 2.93 (1.47–5.84), respectively]; and were more likely to peer-report [OR = 1.89 (1.36–2.63) and OR = 3.61 (2.57–5.06), respectively]. Healthcare professionals with versus without management responsibilities were more likely to peer-report [OR = 5.16 (3.44–7.72)]. Participants reported that scenarios resulting in actual injury or incidents considered to have a learning potential should be reported.

Conclusion:

The likelihood of underreporting scenarios was high among paediatric nurses and physicians. Nurses and staff with patient safety responsibilities were more likely to assess that scenarios should be reported and to report. Incidents with actual injury or learning potential were more likely to be reported. The potential for improving reporting rates involving MEs seems high.
‘Investing’ in early childhood education and care in Aotearoa New Zealand: Noddings’ ethics of care and the politics of care within the Social Investment approach to governance
Authors: Delaune Andrea
Published: December 2017

This article draws from Nel Noddings’ ethics of care as a basis for analysing the political effects of the burgeoning Social Investment approach to governance in Aotearoa New Zealand. To assess the effects of the Social Investment paradigm of governance in relation to early childhood care and education, this article commences with an historical analysis of the relationships between the concepts of ‘care’ and ‘education’ through the history of Aotearoa New Zealand in relation to early childhood education and care. Following this, the burgeoning Social Investment paradigm will be charted. Then, the major principles of Noddings’ ethics of care are outlined and utilised to scrutinise current and potential effects the Social Investment paradigm will have on early childhood education and care and the discourses of ‘care’ and ‘education’. Foucauldian theories augment Noddings’ theories to highlight the bio-politics of care.
Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway
Authors: Mannsverk Jan , Steigen Terje , Wang Harald , Tande Pål Morten , Dahle Birgitte Mannsverk , Nedrejord Maret Lajla , Hokland Ida Olsen , Gilbert Mads
Published: December 2017

Background:

Prehospital thrombolytic therapy given by ambulance emergency medical services to patients with acute ST-segment elevation myocardial infarction (STEMI) may produce earlier reperfusion than percutaneous coronary intervention. Clinical results from prehospital thrombolytic therapy in rural areas are scarce.

Methods:

We studied outcomes during 11 years of a prehospital thrombolytic therapy system in rural sub-arctic Norway. Ambulance personnel gave protocol basic treatment and transmitted electrocardiograms to hospital physicians who made the decision for prehospital thrombolytic therapy. The study was divided into three time periods; 2000–2003, 2004–2007 and 2008–2011.

Results:

A total of 385 STEMI patients received prehospital thrombolytic therapy, median patient age was 61.2 years, and 77% were men. Time saved by prehospital reperfusion therapy was 131 minutes. The proportion who got prehospital thrombolytic therapy within 2 hours of symptom onset increased from 21% in 2000–2003 to 39% in 2008–2011 ( P=0.003). The proportion who underwent coronary angiography or percutaneous coronary intervention within 24 hours of first medical contact increased from 56.4% to 95.4% ( P<0.001). Post-STEMI systolic heart failure decreased from 19.4% to 8.1% ( P=0.02), while 1-year mortality fell, non-significantly, by 50% over time to reach 5.6%. Thirteen patients suffered acute out-of-hospital cardiac arrest; all were successfully defibrillated. Ten patients had major bleeding events (2.6%).

Conclusion:

A decentralised prehospital thrombolytic therapy system based on ambulance personnel, telemetry and centralised 7/24 invasive diagnosis and treatment service, combined with system maturation over time, was associated with earlier reperfusion, improved clinical outcomes and better survival. Prehospital thrombolytic therapy is a feasible and safe intervention used in rural settings with long evacuation lines to percutaneous coronary intervention facilities.
Clostridium difficile fecal toxin level is associated with disease severity and prognosis
Authors: Cohen Nathaniel A , Miller Tamar , Na’aminh Wasef , Hod Keren , Adler Amos , Cohen Daniel , Guzner-Gur Hanan , Santo Erwin , Halpern Zamir , Carmeli Yehuda , Maharshak Nitsan
Published: December 2017

Background

Antibiotic‐associated colitis caused by Clostridium difficile (C. difficile) is the most common cause of hospital‐acquired diarrhea. The pathogenesis of C. difficile colitis is mediated by bacterial toxins. C. difficile infection (CDI) severity may be determined by the fecal level of these toxins.

Objective

The objective of this article is to determine whether fecal C. difficile toxin (CDT) levels are associated with disease severity and prognosis.

Methods

A cross‐sectional study of patients admitted with CDI in a tertiary center between 2011 and 2015 was conducted. Fecal CDT levels were determined by quantitative ELISA. Severe CDI was defined as a leukocyte count of > 15 × 103 cells/μl, creatinine levels that deteriorated by > 1.5 times the baseline level, or albumin levels < 3 g/dl.

Results

Seventy‐three patients were recruited for this study. Patients with severe CDI (n = 47) had significantly higher toxin levels compared to patients with mild to moderate CDI (n = 26) (651 ng/ml (IQR 138–3200) versus 164 ng/ml (IQR 55.2–400.1), respectively; p = 0.001). A high toxin level (>2500 ng/ml) was associated with an increased mortality rate (odds ratio 11.8; 95% confidence interval 2.5–56).

Conclusions

The fecal CDT level is associated with disease severity and mortality rate. Measuring CDT levels may be an objective and accurate way to define the severity of CDI.
The accuracy and promise of personal breathalysers for research: Steps toward a cost-effective reliable measure of alcohol intoxication?
Authors: Riordan Benjamin C , Scarf Damian , Moradi Saleh , Flett Jayde A M , Carey Kate B , Conner Tamlin S
Published: December 2017

Objective

Technology is continuing to shape the way we collect health data, including data on alcohol use. A number of technologies are being developed to objectively measure intoxication ‘in the wild’ without relying on self-report; the most immediate solution may be the use of personal breathalysers. In this study, we aimed to determine whether a cost-effective personal breathalyser would perform in a similar manner to a device used for roadside breath testing.

Method

We intercepted young adults ( n = 337; 45% men) outside three concerts, administered 5-min interviews, and asked for breath samples on two devices (a personal breathalyser and a police-grade breathalyser).

Results

Participants reported having consumed an average of 7.3 standard drinks before the interview and had a mean Blood Alcohol Content of 0.077 g/dl on the police-grade device and 0.085 g/dl on the personal device. Difference scores suggested the personal breathalyser was more likely to over report Blood Alcohol Content (bias = 0.008 g/dl).

Conclusion

Although the personal device was more likely to over report Blood Alcohol Content compared with the police-grade device, the results suggest that personal devices could be used as a measure of Blood Alcohol Content when collecting data outside of the lab.
α7-Nicotinic Acetylcholine Receptor Agonist Ameliorates Nicotine Plus High-Fat Diet–Induced Hepatic Steatosis in Male Mice by Inhibiting Oxidative Stress and Stimulating AMPK Signaling
Authors: Hasan Mohammad Kamrul , Friedman Theodore C , Sims Carl , Lee Desean L , Espinoza-Derout Jorge , Ume Adaku , Chalfant Victor , Lee Martin L , Sinha-Hikim Indrani , Lutfy Kabirullah , Liu Yanjun , Mahata Sushil K , Sinha-Hikim Amiya P
Published: December 2017

α7-Nicotinic acetylcholine receptor (α7nAChR) agonists confer protection against a wide variety of cytotoxic insults and suppress oxidative stress and apoptosis in various cell systems, including hepatocytes. We recently demonstrated that nicotine, when combined with a high-fat diet (HFD), triggers oxidative stress, activates hepatocyte apoptosis, and exacerbates HFD-induced hepatic steatosis in male mice. This study evaluates whether PNU-282987 (PNU), a specific α7nAChR agonist, is effective in preventing nicotine plus HFD–induced hepatic steatosis. Adult C57BL6 male mice were fed a normal chow diet or HFD with 60% of calories derived from fat and received twice-daily intraperitoneal injections of 0.75 mg/kg body weight (BW) of nicotine, PNU (0.26 mg/kg BW), PNU plus nicotine, or saline for 10 weeks. PNU treatment was effective in attenuating nicotine plus HFD–induced increase in hepatic triglyceride levels, hepatocyte apoptosis, and hepatic steatosis. The preventive effects of PNU on nicotine plus HFD–induced hepatic steatosis were mediated by suppression of oxidative stress and activation of adenosine 5′-monophosphate-activated protein kinase (AMPK) together with inhibition of its downstream target sterol regulatory element binding protein 1c (SREBP1c), fatty acid synthase (FAS), and acetyl-coenzyme A-carboxylase (ACC). We conclude that the α7nAChR agonist PNU protects against nicotine plus HFD–induced hepatic steatosis in obese mice. PNU appears to work at various steps of signaling pathways involving suppression of oxidative stress, activation of AMPK, and inhibition of SREBP1c, FAS, and ACC. α7nAChR agonists may be an effective therapeutic strategy for ameliorating fatty liver disease, especially in obese smokers.
Rap1 acts via multiple mechanisms to position Canoe and adherens junctions and mediate apical-basal polarity establishment
Authors: Bonello Teresa T. , Perez-Vale Kia Z. , Sumigray Kaelyn D. , Peifer Mark
Published: December 2017

Epithelial apical-basal polarity drives assembly and function of most animal tissues. Polarity initiation requires cell-cell adherens junction assembly at the apical-basolateral boundary. Defining the mechanisms underlying polarity establishment remains a key issue. Drosophila embryos provide an ideal model, as 6000 polarized cells assemble simultaneously. Current data place the actin-junctional linker Canoe (fly homolog of Afadin) at the top of the polarity hierarchy, where it directs Bazooka/Par3 and adherens junction positioning. Here we define mechanisms regulating Canoe localization/function. Spatial organization of Canoe is multifaceted, involving membrane localization, recruitment to nascent junctions and macromolecular assembly at tricellular junctions. Our data suggest apical activation of the small GTPase Rap1 regulates all three events, but support multiple modes of regulation. The Rap1GEF Dizzy (PDZ-GEF) is crucial for Canoe tricellular junction enrichment but not apical retention. The Rap1-interacting RA domains of Canoe mediate adherens junction and tricellular junction recruitment but are dispensable for membrane localization. Our data also support a role for Canoe multimerization. These multifactorial inputs shape Canoe localization, correct Bazooka and adherens junction positioning, and thus apical-basal polarity. We integrate the existing data into a new polarity establishment model.
nkxgenes establish SHF cardiomyocyte progenitors at the arterial pole and pattern the venous pole through Isl1 repression
Authors: Colombo Sophie , de Sena-Tomás Carmen , George Vanessa , Werdich Andreas A. , Kapur Sunil , MacRae Calum A. , Targoff Kimara L.
Published: December 2017

NKX2-5 is the most commonly mutated gene associated with human congenital heart defects (CHDs) with a predilection for cardiac pole abnormalities. This homeodomain transcription factor is a central regulator of cardiac development and is expressed in both the first and second heart fields (FHF and SHF). We have previously revealed essential functions of nkx2.5 and nkx2.7, two Nkx2-5 homologues expressed in zebrafish cardiomyocytes, in maintaining ventricular identity. However, the differential roles of these genes in the specific subpopulations of the anterior (aSHF) and posterior (pSHF) SHFs have yet to be fully defined. Here, we show that nkx genes regulate aSHF and pSHF progenitors through independent mechanisms. We demonstrate that nkx genes restrict proliferation of aSHF progenitors in the outflow tract, delimit the number of pSHF progenitors at the venous pole, and pattern the sinoatrial node acting through Isl1 repression. Moreover, optical mapping highlights the requirement for nkx gene dosage in establishing electrophysiological chamber identity and integrating FHF and SHF cardiomyocyte physiologic connectivity. Ultimately, our results may shed light on the discrete errors responsible for NKX2-5-dependent human CHD of the cardiac outflow and inflow tracts.
Histogram analysis of apparent diffusion coefficient maps for assessing thymic epithelial tumours: correlation with world health organization classification and clinical staging
Authors: Kong Ling-Yan , Zhang Wei , Zhou Yue , Xu Hai , Shi Hai-Bin , Feng Qing , Xu Xiao-Quan , Yu Tong-fu
Published: December 2017

Objective:

To investigate the value of apparent diffusion coefficients (ADCs) histogram analysis for assessing World Health Organization (WHO) pathological classification and Masaoka clinical stages of thymic epithelial tumours.

Methods:

37 patients with histologically confirmed thymic epithelial tumours were enrolled. ADC measurements were performed using hot-spot ROI (ADCHS-ROI) and histogram-based approach. ADC histogram parameters included mean ADC (ADCmean), median ADC (ADCmedian), 10 and 90 percentile of ADC (ADC10 and ADC90), kurtosis and skewness. One-way ANOVA, independent-sample t-test, and receiver operating characteristic were used for statistical analyses.

Results:

There were significant differences in ADCmean, ADCmedian, ADC10, ADC90 and ADCHS-ROI among low-risk thymoma (type A, AB, B1; n = 14), high-risk thymoma (type B2, B3; n = 9) and thymic carcinoma (type C, n = 14) groups (all p-values <0.05), while no significant difference in skewness (p = 0.181) and kurtosis (p = 0.088). ADC10 showed best differentiating ability (cut-off value, ≤0.689 × 10−3 mm2 s–1; AUC, 0.957; sensitivity, 95.65%; specificity, 92.86%) for discriminating low-risk thymoma from high-risk thymoma and thymic carcinoma. Advanced Masaoka stages (Stage III and IV; n = 24) tumours showed significant lower ADC parameters and higher kurtosis than early Masaoka stage (Stage I and II; n = 13) tumours (all p-values <0.05), while no significant difference on skewness (p = 0.063). ADC10 showed best differentiating ability (cut-off value, ≤0.689 × 10−3 mm2 s–1; AUC, 0.913; sensitivity, 91.30%; specificity, 85.71%) for discriminating advanced and early Masaoka stage epithelial tumours.

Conclusion:

ADC histogram analysis may assist in assessing the WHO pathological classification and Masaoka clinical stages of thymic epithelial tumours.

Advances in knowledge:

1. ADC histogram analysis could help to assess WHO pathological classification of thymic epithelial tumours. 2. ADC histogram analysis could help to evaluate Masaoka clinical stages of thymic epithelial tumours. 3. ADC10 might be a promising imaging biomarker for assessing and characterizing thymic epithelial tumours.