bluuebunny/crossref_metadata_2025 huggingface dataset:
Otolaryngology Resident Well-Being and Perceptions of the Clinical Learning Environment
Authors: Dodson Kelley M. , Appelbaum Nital P. , Lee Nathaniel , Amendola Michael , Kaplan Brian
Published: April 2019

Objective:

To measure the current state of organizational and well-being factors in otolaryngology residency programs and associate these perceptions with demographics, pursuit of subspecialty fellowships, and performance on the Otolaryngology Training Examination (OTE).

Materials and Methods:

Anonymous mail and online survey study of otolaryngology residents from the Southern, Mid-Atlantic, and East South-Central Regions of the United States.

Summary of Results:

A total of 46 otolaryngology residents across 14 residency training programs (22% resident response rate) completed our survey. Residents who scored above the 80th percentile on the OTE perceived greater organizational support (median = 3.84) than residents who scored below the 40th percentile (median = 3.31), U = 48.00, P = .047, η2 = 0.14. Residents interested in fellowship reported less burnout (median = 2.44) compared to those who did not plan to pursue fellowship (median = 3.56), U = 105.00, P = .010, η2 = 0.05. Residents pursuing fellowship also reported less work–life strain (median = 2.56) than those forgoing fellowship (median = 2.89), U = 126.00, P = .044, η2 = 0.10. Residents with children reported greater work–life strain (median = 3.11) compared to those without (median = 2.56), U = 60.50, P = .008, η2 = 0.15.

Conclusion:

For otolaryngology residents in this survey sample, the perception of organizational support and well-being may influence resident performance (on OTE examinations) and ultimate career goals (fellowship applications). Program directors and coordinators can use this information to strengthen the perceptions of organizational support as well as improve the clinical learning environment to optimize training conditions for their residents. Residency program directors can also use the identified study measures to assess resident perceptions of the clinical learning environment and well-being for annual evaluation and improvement purposes.
Choosing to Regulate Emotions: Pursuing Emotion Goals in Autonomy-Supportive and Controlling Contexts
Authors: Benita Moti , Kehat Raz , Zaba Rotem , Blumenkranz Yael , Kessler Gittit , Bar-Sella Avigail , Tamir Maya
Published: April 2019

We applied self-determination theory to emotion regulation and tested the potential effects of autonomy-supportive and controlling contexts on the pursuit of emotion goals. In four experimental studies ( N = 242), participants viewed a fear-eliciting film clip or emotion-eliciting pictures and were prompted to pursue emotion goals with either autonomy-supportive or controlling instructions. Participants in both conditions were equally likely to engage in emotion regulation when directly instructed to do so. However, when they were allowed to spontaneously choose whether to regulate emotions or not, participants in the autonomy-supportive contexts were more likely than those in the controlling ones to independently pursue emotion goals. The latter also engaged in more defensive processing of emotion-eliciting stimuli than the former. These results indicate that people are more likely to pursue emotion goals of their own accord when the context in which they pursue them is autonomy supportive, rather than controlling.
Migration and Lived Experiences of Racism: The Case of High-Skilled Migrants in Wrocław, Poland
Authors: Jaskulowski Krzysztof , Pawlak Marek
Published: April 2019

This article examines migrants’ lived experiences with racism in Wrocław, Poland. Drawing on qualitative research conducted among high-skilled migrants, it analyzes various ways migrants encounter, understand, and cope with racism. Our case study broadens discussion about migration and racism by analyzing an Eastern European, post-socialist, predominantly “white” receiving society seldom researched in terms of racism. The article problematizes the assumption that high-skilled migrants experience only minor problems with incorporation. Furthermore, it suggests the importance of racial boundaries in a non-Western society that lacks a colonial background and long-standing relations with migrants. Therefore, our article contributes to a better understanding of how local settings inform the experiences of high-skilled migrants, which are often lost in abstract concepts of global flows and spaces.
Form-first approach in foreign language word learning
Authors: Chen Aleck Shih-wei
Published: April 2019

This article reports a study examining whether foreign language (FL) word learning can be improved with reduction in cognitive load. Cognitive load theory has received substantial supports in various fields of learning but never in FL word learning. Due to the defined poverty in exposure to the FL, hence deprived cognitive pre-requisites for natural FL development, cognitive load could be critical to FL learning success. Thus while word learning may be a simple attempt of associating word forms with their meanings for L1 children, for FL learners, the cognitive load is multiplied by the additional task of taming the often intractable phonological forms (both perceptive and productive) at the same time they are making the association. In light of cognitive burden reduction, FL learners could thus benefit from learning phonological forms first as their L1 counterparts do. The present study examined whether beginning learners of English as a foreign language (EFL) learn English novel names better if first familiarized with the phonological rimes of target names whose referents are taught only later. Chinese-speaking first graders were assigned to one of three teaching conditions: rime familiarization, which familiarized children with rimes through rhyming activities without any meanings involved; spoken vocabulary, which taught words in rhyming groups together with their referents; and semantic control, which focused on word use. As the results showed, the rime familiarization group outperformed the other two by an improvement score several times greater, suggesting the critical role of cognitive load in FL word learning success.
Disruption as worldview change: A Kuhnian analysis of the digital music revolution
Authors: Riemer Kai , Johnston Robert B
Published: April 2019

Why is it that technology-enabled industry disruptions appear entirely inevitable with hindsight, yet practitioners in disrupted businesses typically struggle to detect and respond appropriately to disruption while it is unfolding? We term this surprising contradiction ‘interpretive discontinuity’ and use it to problematize the established understanding of disruption in the literature. We suggest that the contradiction at the heart of interpretive discontinuity holds an important key to what exactly changes during disruption and why. By juxtaposing an empirical case of disruption in the music industry with theoretical resources sensitive to the nature of radical change – Thomas Kuhn’s work in the unrelated field of scientific practice – we demonstrate that it is productive to understand disruption as a Kuhnian paradigm shift. We are then able to trace interpretive discontinuity to the gestalt switch in worldview that accompanies such a paradigm shift. This insight sheds new light on both what is actually ‘disruptive’ about disruption and also on the limitations of prior work theorizing disruption. Our work is important because it adds to the literature on disruptive innovation important yet overlooked conceptual tools in Kuhn’s work – the role of exemplars, the worldview aspect of a paradigm, and paradigm incommensurability.
Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis
Authors: Peng Tzu-Hsuan , Zhu Jun-Ding , Chen Chih-Chi , Tai Ruei-Yi , Lee Chia-Yi , Hsieh Yu-Wei
Published: April 2019

Objective:

This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients.

Design:

Systematic review and meta-analysis of randomized controlled trials.

Data sources:

Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker.

Review methods:

Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy.

Results:

Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge’s g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge’s g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge’s g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge’s g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge’s g = 0.661 and 0.783).

Conclusion:

This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.
Effects of interval training on risk markers for arrhythmic death: a randomized controlled trial
Authors: Boidin Maxime , Gayda Mathieu , Henri Christine , Hayami Doug , Trachsel Lukas D , Besnier Florent , Lalongé Julie , Juneau Martin , Nigam Anil
Published: April 2019

Objective:

To compare the effects of high-intensity interval training versus moderate-intensity continuous training on risk markers of arrhythmic death in patients who recently suffered from an acute coronary syndrome.

Design:

Double-blind (patient and evaluator) randomized controlled trial.

Setting:

Cardiovascular Prevention and Rehabilitation Centre (EPIC Centre) of the Montreal Heart Institute, Montreal, Canada.

Subjects:

A total of 43 patients were randomized following an acute coronary syndrome.

Interventions:

Patients were assigned to either high-intensity interval training (n = 18) or isocaloric moderate-intensity continuous training (n = 19), three times a week for a total of 36 sessions.

Main measures:

Heart rate recovery for 5 minutes, heart rate variability for 24 hours, occurrence of ventricular arrhythmias, and QT dispersion were measured before and after the 36 sessions of training.

Results:

Among the 43 patients randomized, 6 participants in the high-intensity interval training group stopped training for reasons unrelated to exercise training and were excluded from the analyses. Heart rate recovery improved solely in the high-intensity interval training group, particularly at the end of recovery period ( p < 0.05). There were no differences in heart rate variability, occurrence of ventricular arrhythmias, or QT dispersion parameters between the groups at study end.

Conclusion:

Despite the lack of power to detect any large difference between the two interventions with respect to risk markers of arrhythmic death, high-intensity interval training appears safe and may be more effective at improving heart rate recovery relative to moderate-intensity continuous training in our patients following acute coronary syndrome.
Poverty, Neighbourhood Antisocial Behaviour, and Children’s Mental Health Problems: Findings from the 2014 Ontario Child Health Study
Authors: Boyle Michael H. , Georgiades Katholiki , Duncan Laura , Wang Li , Comeau Jinette ,   2014 Ontario Child Health Study Team
Published: April 2019

Objectives:

To determine if levels of neighbourhood poverty and neighbourhood antisocial behaviour modify associations between household poverty and child and youth mental health problems.

Methods:

Data come from the 2014 Ontario Child Health Study—a provincially representative survey of 6537 families with 10,802 four- to 17-year-olds. Multivariate multilevel modelling was used to test if neighbourhood poverty and antisocial behaviour interact with household poverty to modify associations with children’s externalizing and internalizing problems based on parent assessments of children (4- to 17-year-olds) and self-assessments of youth (12- to 17-year-olds).

Results:

Based on parent assessments, neighbourhood poverty, and antisocial behaviour modified associations between household poverty and children’s mental health problems. Among children living in households below the poverty line, levels of mental health problems were 1) lower when living in neighbourhoods with higher concentrations of poverty and 2) higher when living in neighbourhoods with more antisocial behaviour. These associations were stronger for externalizing versus internalizing problems when conditional on antisocial behaviour and generalized only to youth-assessed externalizing problems.

Conclusion:

The lower levels of externalizing problems reported among children living in poor households in low-income neighbourhoods identify potential challenges with integrating poorer households into more affluent neighbourhoods. More important, children living in poor households located in neighbourhoods exhibiting more antisocial behaviour are at dramatically higher risk for mental health problems. Reducing levels of neighbourhood antisocial behaviour could have large mental health benefits, particularly among poor children.
Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study
Authors: Georgiades Katholiki , Boylan Khrista , Duncan Laura , Wang Li , Colman Ian , Rhodes Anne E. , Bennett Kathryn , Comeau Jinette , Manion Ian , Boyle Michael H. ,   2014 Ontario Child Health Study Team
Published: April 2019

Objectives:

To present the 12-month prevalence and correlates of suicidal ideation and attempts in a sample of youth in Ontario.

Methods:

Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 y ( n = 2,396) completed a computer-assisted, self-administered questionnaire in their home to assess the occurrence of suicidal ideation, suicidal attempts, and associated correlates, including non-suicidal self-injury, mental disorders, substance use, peer victimization and exposure to child maltreatment. Socio-demographic information was collected from the parent. Logistic regression models were used to identify correlates that distinguished between youth reporting: 1) no suicidal ideation or attempts, 2) suicidal ideation but no attempts, and 3) suicidal ideation and attempts.

Results:

The 12-month prevalence of suicidal ideation and attempts was 8.1% and 4.3%, respectively. All clinical and behavioural correlates were significantly higher among youth reporting suicidal ideation or attempts, as compared with non-suicidal youth. In adjusted models, depression and non-suicidal self-injury were each independently associated with elevated odds of suicidal ideation (OR = 4.84 and 4.19, respectively) and suicidal attempt (OR = 7.84 and 22.72, respectively). Among youth who reported suicidal ideation, the only variable that differentiated youth who attempted suicide v. those who did not, in adjusted models, was non-suicidal self-injury (OR = 3.89).

Conclusions:

Suicidal ideation and attempts are common among youth in Ontario, often co-occurring with mental disorders and high-risk behaviours. These findings underscore the need for effective prevention and intervention strategies, particularly for youth depression and non-suicidal self-injury.
Changes in the Prevalence of Child and Youth Mental Disorders and Perceived Need for Professional Help between 1983 and 2014: Evidence from the Ontario Child Health Study
Authors: Comeau Jinette , Georgiades Katholiki , Duncan Laura , Wang Li , Boyle Michael H. ,   2014 Ontario Child Health Study Team
Published: April 2019

Objectives:

To examine: 1) changes in the prevalence of mental disorders and perceived need for professional help among children (ages 4 to 11) and youth (ages 12 to 16) between 1983 and 2014 in Ontario and 2) whether these changes vary by age and sex, urban-rural residency, poverty, lone-parent status, and immigrant background.

Methods:

The 1983 ( n = 2836) and 2014 ( n = 5785) Ontario Child Health Studies are provincially representative cross-sectional surveys with identical self-report checklist measures of conduct disorder, hyperactivity, and emotional disorder, as well as perceived need for professional help, assessed by integrating parent and teacher responses (ages 4 to 11) and parent and youth responses (ages 12 to 16).

Results:

The overall prevalence of perceived need for professional help increased from 6.8% to 18.9% among 4- to 16-year-olds. An increase in any disorder among children (15.4% to 19.6%) was attributable to increases in hyperactivity among males (8.9% to 15.7%). Although the prevalence of any disorder did not change among youth, conduct disorder decreased (7.2% to 2.5%) while emotional disorder increased (9.2% to 13.2%). The prevalence of any disorder increased more in rural and small to medium urban areas versus large urban areas. The prevalence of any disorder decreased for children and youth in immigrant but not nonimmigrant families.

Conclusions:

Although there have been decreases in the prevalence of conduct disorder, increases in other mental disorders and perceived need for professional help underscore the continued need for effective prevention and intervention programs.
Children’s Mental Health Need and Expenditures in Ontario: Findings from the 2014 Ontario Child Health Study
Authors: Duncan Laura , Georgiades Katholiki , Birch Stephen , Comeau Jinette , Wang Li , Boyle Michael H. ,   2014 Ontario Child Health Study Team
Published: April 2019

Objective:

To estimate the alignment between the Ontario Ministry of Children and Youth Services (MCYS) expenditures for children’s mental health services and population need, and to quantify the value of adjusting for need in addition to population size in formula-based expenditure allocations. Two need definitions are used: “assessed need,” as the presence of a mental disorder, and “perceived need,” as the subjective perception of a mental health problem.

Methods:

Children’s mental health need and service contact estimates (from the 2014 Ontario Child Health Study), expenditure data (from government administrative data), and population counts (from the 2011 Canadian Census) were combined to generate formula-based expenditure allocations based on 1) population size and 2) need (population size adjusted for levels of need). Allocations were compared at the service area and region level and for the 2 need definitions (assessed and perceived).

Results:

Comparisons were made for 13 of 33 MCYS service areas and all 5 regions. The percentage of MCYS expenditure reallocation needed to achieve an allocation based on assessed need was 25.5% at the service area level and 25.6% at the region level. Based on perceived need, these amounts were 19.4% and 27.2%, respectively. The value of needs-adjustment ranged from 8.0% to 22.7% of total expenditures, depending on the definition of need.

Conclusion:

Making needs adjustments to population counts using population estimates of children’s mental health need (assessed or perceived) provides additional value for informing and evaluating allocation decisions. This study provides much-needed and current information about the match between expenditures and children’s mental health need.
Prediction of peen forming stress and plate deformation with a combined method
Authors: Xiao Xudong , Sun Yao , Tong Xin , Li Yan , Gao Guoqiang
Published: April 2019

To simulate the deformations of the strip peen formed plate more realistic, and using low computational resources, a strategy combining analytical and finite element methods is proposed in this article. First, the internal stresses in the target induced by single shot impact are calculated with expanding cavity model. Second, the stress field of single shot impact is used to derive the stress field of multiple shot impacts by considering the overlaps of adjacent shot impacts. Third, the calculated stress field is introduced to the finite element model to obtain the resultant shape of the plate. The shot dimple distribution in reality is detected and fitted with normal distribution function. The random distribution of the positions of shot impacts is involved in the simulation to make the simulation more realistic. In the finite element model, the plate is modeled with shell element to reduce the demand of the computational resources. The simulated shapes of the plate under different peen forming parameters are compared with the scanned three-dimensional experimental shapes with the same forming parameters. The comparison shows that the simulated shapes are in good agreement with the experiments.
Ritonavir- or cobicistat-boosted antiretroviral therapy and direct oral anticoagulants: A case for apixaban
Authors: Nisly Sarah A , Stevens Brooke N
Published: April 2019

Summary

The potential for drug–drug interactions (DDIs) between direct oral anticoagulants and antiretroviral therapy (ART) is vast. Ritonavir and cobicistat are used as pharmacokinetic enhancers with either concurrent protease inhibitors or the integrase strand transfer inhibitor, elvitegravir, to optimize therapeutic concentrations by cytochrome P450 (CYP) inhibition. To date, only rivaroxaban and dabigatran have reported cases of use with ritonavir-boosted ART. Apixaban is metabolized similarly to rivaroxaban, but offers a dose reduction in the case of major DDIs. We report the successful use of reduced-dose apixaban to treat and prevent thromboembolic complications in six persons living with human immunodeficiency virus (HIV) on ritonavir- or cobicistat-boosted ART. This case series and available literature support the use of apixaban or dabigatran, depending on the boosted ART regimen.
Nurses experiences of ethical dilemmas: A review
Authors: Haahr Anita , Norlyk Annelise , Martinsen Bente , Dreyer Pia
Published: April 2019

Background:

Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and moral grounds in the individual care situation.

Aim:

The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today.

Method:

The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas.

Ethical consideration:

We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources.

Results:

The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses.

Conclusion:

Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values.
Regulatory justice following gross negligence manslaughter verdicts: Nurse/doctor differences
Authors: Hodson Nathan
Published: April 2019

Two professionals who treated Jack Adcock before his death were convicted of gross negligence manslaughter, receiving 24-month suspended sentences. His nurse, Isabel Amaro, was erased from the nursing register; but after reviews in the High Court and Court of Appeal, his doctor, Hadiza Bawa-Garba, was merely suspended. This article explores the proposition that nurses are at greater risk of erasure than doctors after gross negligence manslaughter through a close reading of the guidance for medical and nursing tribunals informed by analysis from the High Court and Court of Appeal in the Bawa-Garba cases. Examination of the relevant sections of the guidance for medical and nursing tribunals reveals no significant differences. An outline of the conduct that amounted to breach of duty of care by Amaro and Bawa-Garba shows that their conduct could satisfy the thresholds for erasure given in their professions’ respective guidelines for tribunals. Both presented similar mitigating evidence, although this cannot be weighed heavily in a professional tribunal setting. Thus, Amaro was treated more harshly than Bawa-Garba without a simple explanation. However, I suggest that the Nursing and Midwifery Council’s Conduct and Competence Committee made a mistaken ‘presumption of erasure’ for gross negligence manslaughter and misinterpreted the sway that sentencing remarks should hold over tribunals. Both of these types of error were criticised by the Court of Appeal in Bawa-Garba. Furthermore, the Conduct and Competence Committee did not flesh out its analysis of ‘public confidence’ or acknowledge Lord Hoffmann’s caution against ending ‘useful’ careers for the sake of public confidence, but Bawa-Garba’s legal team ensured these arguments were taken into account by the Medical Professional Tribunal. The Conduct and Competence Committee’s failures are not inherent to Nursing and Midwifery Council procedure or policy. Rather Amaro’s self-representation appears to have impaired her access to justice. Tribunals must accept their right, and responsibility, to reach their own conclusions.
Understanding the Spatial Patterns of Police Activity and Mental Health in a Canadian City
Authors: Hodgkinson Tarah , Andresen Martin A.
Published: April 2019

Mental health–related calls for service are increasing across Canadian communities. However, the spatial dynamics of these calls for service and their potential relationship with concentrations of crime has not been fully investigated in the Canadian context. The current study examines mental health and other calls for service in a medium-sized (approximate population of 250,000), midwestern Canadian city in the year 2014. Using kernel density analysis and a spatial point pattern test, the study explores the concentration and spatial patterns of mental health calls for service across the city. Findings indicate that mental health calls for service differ from other crime-related calls for service, except for violent crime. Possible explanations for this pattern and considerations for policy and policing are discussed.
Expansion of pharmacist clinical services to optimize the management of immune checkpoint inhibitor toxicities
Authors: Renna Catherine E , Dow Elizabeth N , Bergsbaken Jason J , Leal Ticiana A
Published: April 2019

Introduction

The development of immune checkpoint inhibitors has revolutionized cancer treatment and is now a part of the treatment paradigm for several malignancies. Although immune checkpoint inhibitors are generally well tolerated, treatment is associated with immune-related adverse events, some serious and potentially life threatening. Early identification and prompt appropriate management of immune-related adverse events are crucial to prevent morbidity and mortality. The complexity and severity of immune-related adverse events require interdisciplinary collaboration to optimize care. Patient and caregiver education and continued communication between patients and members of the oncology care team are vital for timely recognition and successful management of immune-related adverse events. The objective of this program is to provide a proof of concept; a pharmacist-led immune checkpoint inhibitor management program will increase early recognition and management of immune-related adverse events through patient and caregiver education and proactively assessing patients for toxicities.

Methods

At the University of Wisconsin Carbone Cancer Center, we developed and implemented a pharmacist-driven program, referred to as the immune checkpoint inhibitor program, which aimed to ensure patient and caregiver education and continuous monitoring of immune-related adverse events. This program utilized pharmacist–patient encounters to improve patient and caregiver education and follow-up monitoring. The design and implementation are detailed. Pharmacist interventions and patient outcomes were evaluated.

Results

At interim analysis, 47 patients were enrolled in the program and pharmacists completed 34 interventions on 26 patients. Pharmacists are well positioned to educate patients and caregivers on immune checkpoint inhibitor therapy and provide proactive monitoring to detect immune-related adverse events. We hypothesize that the interventions made by pharmacist may lead to earlier recognition and treatment of immune-related adverse events.
INSM1 Expression in Peripheral Neuroblastic Tumors and Other Embryonal Neoplasms
Authors: Wang Hannah , Krishnan Chandra , Charville Gregory W
Published: April 2019

Insulinoma-associated protein 1 (INSM1) is a transcription factor that functions in neuroepithelial tissue development and shows expression in neuroendocrine neoplasms. Given the role of INSM1 in controlling differentiation of the sympatho-adrenal lineage, we hypothesized that INSM1 expression would define a subset of neuroblastic tumors. This study aimed to characterize the immunohistochemical profile of INSM1 in a cohort of peripheral neuroblastic tumors and compare INSM1 expression in these tumors to that seen in other embryonal neoplasms, using both tissue microarrays and whole-slide histologic sections. INSM1 showed nuclear expression in 39/50 (78%) peripheral neuroblastic tumors, including 27/32 (84%) neuroblastomas, 9/9 (100%) ganglioneuroblastomas, and 3/9 (33%) ganglioneuromas. Altogether, 70% of peripheral neuroblastic tumors showed anti-INSM1 immunoreactivity in more than 20% of tumor nuclei. Although no non-neuroblastic tumors in this study exhibited INSM1 expression in more than 20% of nuclei, focal or patchy staining was identified in 7/14 (50%) rhabdomyosarcomas, 7/22 (32%) nephroblastomas, and 4/20 (20%) Ewing sarcomas. The absence of INSM1 expression in peripheral neuroblastic tumors was restricted to undifferentiated and poorly differentiated neuroblastomas, as well as mature ganglioneuromas, mimicking the transient INSM1 expression seen in sympatho-adrenal differentiation during normal development. No significant association between MYCN amplification status and INSM1 expression was observed. We found that all 3 INSM1-negative neuroblastoma patients with available follow-up were alive at a median of 15 years, in comparison to 9 of 13 INSM1-positive neuroblastoma patients living at a median of 5 years. Additional studies are needed to determine whether INSM1 expression is indicative of a clinically significant differentiation state in neuroblastoma.
Parameter analysis of damaged region for laminates with matrix defects
Authors: Huang ZQ , Yi SH , Chen HX , He XQ
Published: April 2019

Considering the influence of bridge fibers, a representative volume element (RVE) with damaged regions of vanishing thickness is developed to study for estimation of laminates with transverse matrix cracks. For the open and closed cracks, the tensile force, the compressive force and the shear force are mainly studied by the stress-based variational approach with the pending partition loads at the statically indeterminate boundary, with considering not only three cases of the ideal transverse cracks, the smooth plane-surface open crack, the smooth plane-surface closed crack and the perfect meshing open crack, but also two cases of the non-ideal transverse cracks, the open cracks and closed cracks with the resistance resisting the relative sliding of crack surfaces. The expressions of the stress components in the RVE are obtained by means of assumption of the function of inter-laminar shear stresses. The governing equations are derived from the variational analysis based on the principle of minimum complementary energy. Both the effective mechanical properties and the distributions stresses of the damaged laminates with the ideal transverse cracks and those of the laminates with the non-ideal transverse cracks are estimated on the basis of the analysis of deformation on surface of the RVE.
Options for end stage vascular access: Translumbar catheter, arterial-arterial access or right atrial graft?
Authors: Inston Nicholas , Khawaja Aurangzaib , Mistry Hiren , Jones Robert , Valenti Domenico
Published: April 2019

Background:

Running out of vascular access for dialysis is thankfully rare, but despite this, most units will have a number of patients with few options and in a precarious state. The increasing longevity of dialysis patients portends more patients will reach minimal access options. End stage vascular access is poorly defined but classification may enable assessment and comparison of treatment options. Three options for patients with end stage access are a central venous catheter through a translumbar or transhepatic route, arterial-arterial prosthetic loop or a right atrial graft.

Aims:

The aims of this study are to provide a structured review of evidence for these procedures to allow application and guide practice for patients with end stage vascular access.

Methods:

A standardised search of published literature was performed of relevant studies. In addition, the references cited in those papers were assessed for any further available articles. All study types were included and reviewed by two authors independently. Primary outcomes were patient survival and secondary patency rate at 3 and 12 months. Secondary outcomes were long-term patency rates, mean time to cannulation and complications such as access dysfunction, thrombosis and infection.

Based on the available evidence, it would appear that arterial-arterial prosthetic loop is a definitive option for maintaining dialysis access in patients with no more arteriovenous access options. Translumbar and transhepatic dialysis catheters may offer short- and medium-term options and right atrial grafts may also be suitable as an option where arterial-arterial prosthetic loop is unsuitable.
Aztreonam Lysine Inhalation Solution in Cystic Fibrosis
Authors: Elson Elizabeth Claire , Mermis Joel , Polineni Deepika , Oermann Christopher M
Published: April 2019

Patients with cystic fibrosis (CF) develop pulmonary disease secondary to airway infection and dysregulated inflammation. Therapeutic innovations such as nebulized antimicrobial therapy targeting specific pathogens have resulted in improvements in quality of life and life expectancy. Aztreonam lysine for inhalation (AZLI) solution was initially approved to improve respiratory symptoms in CF patients with Pseudomonas aeruginosa (PA) in 2010 by the Food and Drug Administration. Since then, research broadening labeling and clinical application has been developed. In this review, we analyze published and ongoing research regarding AZLI therapy in CF. A search of the Cochrane Database of Systematic Reviews and the PubMed and ClinicalTrials.gov databases was conducted to identify publications about AZLI. Three pre-approval studies were identified and assessed. Two are Phase 3, placebo-controlled trials, assessing a variety of safety and efficacy endpoints, leading to FDA approval. The third is an open-label extension of the two previous trials. An additional seven post-approval, completed trials were identified and are included in this review. They represent a variety of study designs including safety and efficacy in patients with mild lung disease and young patients, an active comparator trial vs inhaled tobramycin, an eradication study, a study among patients with Burkholderia cepacia, and a study assessing continuous alternating antibiotic therapy. Finally, five ongoing clinical trials are discussed. Overall, studies demonstrated that inhaled aztreonam is a safe and effective antimicrobial treatment for the eradication of newly acquired P. aeruginosa and long-term suppressive therapy of chronic endobronchial infection among people with cystic fibrosis.
Tweeting the cosmos: On the bot poetry of The Ephemerides
Authors: Carter Richard A
Published: April 2019

This article discusses Twitter bots that generate textual outputs for aesthetic effect. It considers in-detail a specific instance, The Ephemerides ( @the_ephemerides ) by Allison Parrish, and presents a critical assessment of how its functional and thematic attributes meditate self-reflexively upon their operational contexts within digital infrastructure. This mode of reading is then presented as having value for analysing generative Twitter bots more widely. The initial balance of this article will concern the broader question of how generative digital writing can be assessed critically, debating key claims made by Simanowski (2011), before presenting a model in which the salient quality of this art form is the distinctly machinic modes of expression it makes available, revealing the software itself to be an active agent in the reading encounter. The remainder of this article will then apply this perspective to a reading of The Ephemerides, considering its meditation on the functional and aesthetic relationship between technical systems that are unobtrusively efficient versus those that are vividly breaking down – with the latter making manifest the contingency that is inherent to the processes of coming to know and act on the world through technology. The goal of this discussion is to consider not only how the generative operations of Twitter bots might be approached fruitfully, but to demonstrate also that such analyses constitute a worthwhile pursuit in the first instance – that even these tightly constrained instances of digital creativity can offer forms expression that reward extended academic criticism.
Do travel images affect international students’ on-site academic value? New evidence from the Malaysia’s ‘higher edutourism’ destination
Authors: Lam Jason MS , Ariffin Ahmad Azmi M
Published: April 2019

While previous studies have merely focused on travel destination image (TDI) with respect to influencing international students’ decision-making for academic destinations (i.e. the pre-experience stage), research on TDI relating to students’ on-site educational experiences and future behavioural intentions remain scant. This study introduces the ‘higher edutourism’ concept as a key enabler from the higher education market in attracting international students for the tourism industry. This study attempts to extend the TDI paradigm by empirically examining cognitive, affective and conative TDIs from a multidimensional perspective and its effects on overall perceived value, while also testing the indirect effects of TDIs. A total of 515 questionnaires were analysed using structural equation modelling. The results confirmed that cognitive TDI would positively impact affective TDI, perceived value and subsequently, conative TDI. Theoretical and practical implications for policymakers, higher education administrators and tourism marketers are also discussed.
Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches
Authors: Valentine Lisa M , Donofry Shannon D , Broman Rachel B , Smith Erin R , Rauch Sheila AM , Sexton Minden B
Published: April 2019

Introduction

Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care.

Methods

Data were drawn from veterans ( N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions.

Results

FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan–Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment.

Discussion

Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.
Changes in the gender segregation of occupations in Sweden between 2003 and 2011
Authors: Gonäs Lena , Wikman Anders , Vaez Marjan , Alexanderson Kristina , Gustafsson Klas
Published: April 2019

Aim: The aim of this study was to analyze possible changes in the gender composition of occupations in Sweden, using register data covering the whole working population. Methods: Cross tabulations on gender by occupation were computed and comparisons made of numbers and proportions of women and men aged 20–64 years to illustrate occupational gender-segregation categories in 2003 and 2011, respectively. All of those in working ages, employed in 2003 and 2011 (4.2 resp 4.7 millions individuals), were included. Differences in the distribution of women and men in all occupations were summarized using two gender-segregation indexes from 2003 and 2011, separately. Results: The proportion of women increased in the gender-integrated (⩾40–<60% women) occupations. Also, the proportion of women in high-skilled professional occupations in the male-dominated category increased, as well as the proportion of men in mostly low-skilled female-dominated occupations, mainly in the service sector. The gender-segregation of occupations measured by the Index of Dissimilarly and the Karmel and MacLachlan Index was lower in 2011 than in 2003. Conclusions: The process of de-segregation has continued during our study period, from 2003 to 2011. The proportion of women increased in occupations that demand higher education, both in gender-integrated and in male-dominated occupations, which can contribute to a decrease in the level of sickness absence for women. Men increased their proportion in low-skilled, female-dominated occupations – a group with high levels of sickness absence or disability pension.
An early-stage design optimization for office buildings’ façade providing high-energy performance and daylight
Authors: Shahbazi Yaser , Heydari Mahdieh , Haghparast Farzin
Published: April 2019

The amount of received sunlight and radiant energy could affect the energy consumption in heating, cooling and lighting systems. Utilization of natural daylight in architecture, in addition to fulfilling the inhabitants’ mental and physical needs, could greatly reduce fossil fuel consumption. Although higher levels of daylight can be obtained by increasing light transmission, this increased transmission could negatively affect the building’s sustainability and thus result in higher energy consumption in turn. So, designers must seek an acceptable balance, in which not only optimal daylight comfort and usage are met but also the best possible thermal performance is achieved. The use of a parametric design model can facilitate the simulation of lighting and annual thermal performance of a building in the early stages of the design or restoration process. In this paper, the daylight and thermal performances of an office building are optimized using a simulated parametric-based design model and the Octopus plug-in which is an optimizing tool based on genetic algorithms developed for Grasshopper. By applying the developed workflow, the enhanced results for (useful daylight illuminance) is up by 20.56% and for energy use intensity by 141 kWh/m2/yr.
In Vitro Evaluation of the Gore Viabahn Balloon-Expandable Stent-Graft for Fenestrated Endovascular Aortic Repair
Authors: Torsello Giovanni Federico , Herten Monika , Müller Markus , Frank André- , Torsello Giovanni B. , Austermann Martin
Published: April 2019

Purpose: To evaluate the safety and integrity of a new stent-graft as a potential bridging device in fenestrated stent-grafts using an in vitro fenestrated model. Materials and Methods: Polyester test sheets with ten 6-mm- or 8-mm-diameter fenestrations were used to simulate a fenestrated main body endoprosthesis. In total, 50 Viabahn balloon-expandable (VBX) stent-grafts of varying lengths (29 and 39 mm) and diameters (6, 7, and 8 mm) were implanted in the fitting fenestrations. After release, the 6- and 7-mm-diameter stent-grafts were flared with a 10×20-mm angioplasty balloon; a 12×20-mm balloon was used in the 8-mm-diameter devices. Safety of the devices was defined as absence of fractures detected on radiography or computed tomography (CT), as well as material failure detected by microscopy and water permeability testing. The forces (in Newtons, N) needed for perpendicular dislocation (pullout force) and axial dislocation (shear stress force) were also evaluated. Results: Forty VBX stent-grafts were subjected to digital radiographic imaging and multiplanar CT. None showed any stent fracture. Subsequent microscopy indicated no damage to the fabric or separation of the graft after flaring. Ten VBX stent-grafts underwent water permeability testing after flaring; no water passed through the graft wall during a 10-minute period under an intraluminal pressure at 120 mm Hg. Testing of 25 VBX stent-grafts revealed initial pullout forces between 11.3 and 31 N. Shear stress tests showed that the average force needed to dislocate the stent-grafts by 50% of their diameter ranged between 5.75 and 6.91 N (mean 6.1±0.5 N) for the 6-mm stents and between 3.31 and 5.4 N (mean 4.4±0.8) for the 8-mm stents. Conclusion: This preliminary study demonstrated the applicability of the VBX as a bridging stent-graft in a simulated fenestration model. A comparison with other stent-grafts and clinical assessment are required.