bluuebunny/crossref_metadata_2025 huggingface dataset:
BK Virus-Associated Hemorrhagic Cystitis After Allogeneic Hematopoietic Stem Cell Transplantation in the Pediatric Population
Authors: Pérez-Huertas Pablo , Cueto-Sola Margarita , Escobar-Cava Paloma , Fernández-Navarro José María , Borrell-García Carmela , Albert-Marí Asunción , López-Briz Eduardo , Poveda-Andrés José Luis
Published: February 2016

Objective: To study the incidence, risk factors, and treatment of hemorrhagic cystitis secondary to BK-virus reactivation (HC-BKV) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the pediatric population. Methods: Case-control study in which all pediatric patients (0-18 years) who underwent allo-HSCT from September 2009 to January 2014 were followed. Results: Twenty-nine patients underwent an allo-HSCT. The median age was 9 years (range = 6 months to 15 years), 61% male. The primary diagnosis was acute lymphoblastic leukemia (72.4%). Six (20.7%) developed HC-BKV. In a multivariate analysis of risk factors, it was observed that the reactivation of BK virus was associated with age more than 10 years ( P = .098) and those with positive serology for Epstein-Barr virus ( P = .06). Five of the 6 patients with HC-BKV received cidofovir (CDV) at doses of 3 to 5 mg/kg/week. The treatment lasted a median of 3 cycles (range = 2-5). One of the patients (20%) developed nephrotoxicity. Of the 5 patients treated with CDV, 3 (60%) had a complete response, 1 (20%) partial response, and 1 (20%) no response. Conclusion: We conclude that HC-BKV is a frequent complication after allo-HSCT. CDV therapy can be effective but controlled clinical trials are needed.
Characteristics of Oral Problems and Effects of Oral Care in Terminally Ill Patients With Cancer
Authors: Nakajima Nobuhisa
Published: February 2016

Purpose:

Various distresses appear in the terminal stage of cancer. Oral problems including dry mouth, stomatitis and candidiasis are one of the important problems which should be resolved. The purpose of this study was to investigate oral problems in this stage and improvement of dry mouth by oral care.

Methods:

The study subjects were consecutive terminally ill cancer patients admitted over the past 2 years. Patients were divided based on the status of oral food intake into good oral food intake group (≥30%) and poor oral food intake group. The following 3 items were retrospectively investigated: 1) The incidences of these oral problems, 2) Severity of dry mouth and complication with other oral problems, 3) Improvement of dry mouth using standard oral care by nursing staff and specialist oral care including dentists as needed.

Results:

There were 115 and 158 patients in good and poor oral intake groups, respectively. 1) The incidences of dry mouth, stomatitis, and candidiasis were significantly higher in poor oral intake group ( p < 0.001). 2) Severe cases of dry mouth (Grade-2&3) were noted in 20.0% and 64.8% in good and poor oral intake groups, respectively ( p < 0.0001). Candidiasis complication rate was significantly higher in poor oral intake group ( p = 0.0002). 3) The rate of dry mouth improvement by oral care was 100% in Grade-1, 86% in Grade-2 and 81% in Grade-3.

Conclusion:

Oral problems occur in many of terminally ill cancer patients. Accurate diagnosis of oral problems and corresponding appropriate interventions are important for improving quality of end-of-life care.
Collaboration in the Cockpit
Authors: Marstall Jerry , Miller Michael E. , Poisson Robert J.
Published: February 2016

“Lead, where are you going?” Considering this life-saving radio call from my wingman many nights ago, one may wonder how technology could provide every pilot with as vigilant a wingman within his or her own aircraft. Questions regarding this artificial wingman reach beyond its design to include “Is it appropriate or necessary to develop standard communication procedures for human–computer interaction?” and “Should the artificial wingman assume control?” As context-aware computing and automation appear in people’s lives, their ability to answer these and related questions will shape the impact of technology on safety and well-being.
Domestic Violence and Abortion Among Rural Women in Four Indian States
Authors: Stephenson Rob , Jadhav Apoorva , Winter Amy , Hindin Michelle
Published: February 2016

The prevalence of domestic violence and abortion in India is high, yet little is known about the relationship between these experiences. Data from two linked data sets, India’s 1998-1999 National Family Health Survey (NFHS-2) and a follow-up survey in 2002-2003, were analyzed. The analysis examines how the experience of physical violence affects the subsequent uptake of abortion, and how the experience of abortion affects subsequent experience of physical, sexual, and verbal violence. Women who experienced physical violence have significantly higher odds of reporting a subsequent induced abortion, whereas women who had an induced abortion have significantly higher odds of reporting subsequent sexual and verbal violence. There was no significant relationship between domestic violence and spontaneous abortion.
Employee Rhetoric in the Acceptance or Rejection of Corporate Environmentalism
Authors: Onkila Tiina
Published: February 2016

This study explores how employees in a Finnish financial company use rhetorical strategies to accept or reject corporate environmentalism. It is based on a qualitative study in which face-to-face interviews were conducted among 30 employees. The study shows how employees rejected corporate environmentalism by dissociating their employer from polluters or by dissociating environmental values from other values in the financial business. It also shows how they accepted corporate environmentalism by associating it with other business virtues and by associating the employer with polluters. The study identifies rhetorical strategies as a means for employees to construct an understanding of corporate environmentalism, and of whether or not it is a part of their organization’s responsibilities. The results highlight a need to manage corporate environmentalism processes so that the focus is on finding diverse meanings instead of on promoting a single, organization-wide meaning for corporate environmentalism in a top-down manner.
When Frontline Employee Behavior Backfires
Authors: Bock Dora E. , Folse Judith Anne Garretson , Black William C.
Published: February 2016

Frontline employee behaviors can elicit gratitude, allowing service providers to reap benefits including positive word of mouth. However, research has begun to suggest some behaviors might instead elicit indebtedness, a different emotion not always associated with positive outcomes. Using a qualitative study, we construct a model grounded in the threat to self-esteem theory that delineates differences in employee behaviors that generate these two emotions and the consequences of their elicitation. The model is empirically tested in two studies. Consistent with the threat to self-esteem theory, the findings indicate that customer gratitude arises in supportive employee-customer encounters and drives positive relational behaviors. Conversely, customer indebtedness occurs in threatening employee-customer encounters and possesses the potential to deter positive relational behaviors. As a result, we encourage scholars to appreciate the differences between these two emotions and managers to promote employee behavior designed to generate gratitude and not indebtedness.
Accurate analytical solutions for shear-deformable web-core sandwich plates
Authors: Pydah Anup , Bhaskar K
Published: February 2016

An accurate discrete model and analytical solutions thereof are presented for shear-deformable web-core sandwich plates. The face-plates are analyzed using the equations of three-dimensional elasticity, while the webs are accurately modelled using the classical plate theory with a plane stress solution for transverse bending and a Levy-type methodology for lateral bending. It is shown that this obviates the need for a complete three-dimensional analysis of the sandwich plate. Results obtained by this approach are used to highlight the effect of shear deformation of the face-plates.
Peripartum depression in parents with multiple sclerosis and psychiatric disorders in children
Authors: Razaz Neda , Tremlett Helen , Marrie Ruth Ann , Joseph K.S.
Published: February 2016

Background:

Although many individuals with multiple sclerosis (MS) experience depression, there are no studies on the frequency and effect of peripartum depression among parents with MS.

Objective:

To examine the frequency of peripartum depression in individuals with MS and its potential association with children’s psychiatric disorders.

Methods:

We conducted a cohort study in British Columbia, Canada, using linked health databases, of parents with MS and their children, and age-matched unaffected parent–child dyads. The diagnosis of peripartum depression, MS and psychiatric disorders in children was based on information from hospital admission, physician visit and drug prescription claims.

Results:

Peripartum depression was significantly more common among MS parents ( n = 360) versus unaffected ( n = 1207) parents (25.8% vs 18.5%, p value 0.02), especially among MS affected fathers versus unaffected fathers (25.7% vs 10.2%, p value < 0.001). The incidence of psychiatric disorders in children was 3.3 and 2.7 per 100 child-years among children with and without an MS parent, respectively. The rate of psychiatric disorders was significantly higher in children with an MS parent (vs without, hazard ratio (HR): 1.34; 95% confidence interval (CI): 1.03–1.74) and among children with parents who had peripartum depression (HR: 1.87; 95% CI: 1.36–2.55).

Conclusion:

Parental MS is associated with a higher risk of peripartum depression and increases the risk of psychiatric disorders in children.
Hospitality and religious diversity, or, when is home not a home?
Authors: Conway Kyle
Published: February 2016

Recent debates about hospitality and religious diversity frequently hinge on unspoken notions of home. This is especially true in the Canadian province of Quebec, where citizens have worked to establish a secular state after a history of domination by the Catholic Church. In the last two decades, as religious minorities have grown, controversy has arisen about requests for accommodations made on religious grounds. Here I examine responses to those requests and ask what notions of home underpin them. One is grounded in history: its adherents contend that immigrants are guests and should conform to the norms of their new home. It expands the geography of home by linking secularism to collective identity. A second is grounded in political-legal thought: its adherents contend citizens are at home even if their views differ from the majority’s. It recognizes that long-time residents and newcomers mutually influence each other and, over time, people’s identities change.
PISA lends legitimacy: A study of education policy changes in Germany and Sweden after 2000
Authors: Ringarp Johanna
Published: February 2016

School issues have become increasingly important in public elections and political debates, leading to increased focus on the results students achieve in international large-scale assessments and in the rankings of the involved countries. One of the most important studies of scholastic performance is the Programme for International Student Assessment (PISA), which has gained a good deal of attention since the first study was published in 2000. This article analyses to what extent examples from international assessments and other countries’ results have been used as arguments for school policy change in Germany and Sweden. The conclusion is that both countries, after undergoing a “PISA shock”, found justification for changes in their education policy by referring to other countries. Their views of how to solve the problem (i.e., the drop in results) were also similar: increased management and control of parts of the education system, albeit by different means.
Rural and remote care
Authors: Goodridge Donna , Marciniuk Darcy
Published: February 2016

The challenges of providing quality respiratory care to persons living in rural or remote communities can be daunting. These populations are often vulnerable in terms of both health status and access to care, highlighting the need for innovation in service delivery. The rapidly expanding options available using telehealthcare technologies have the capacity to allow patients in rural and remote communities to connect with providers at distant sites and to facilitate the provision of diagnostic, monitoring, and therapeutic services. Successful implementation of telehealthcare programs in rural and remote settings is, however, contingent upon accounting for key technical, organizational, social, and legal considerations at the individual, community, and system levels. This review article discusses five types of telehealthcare delivery that can facilitate respiratory care for residents of rural or remote communities: remote monitoring (including wearable and ambient systems; remote consultations (between providers and between patients and providers), remote pulmonary rehabilitation, telepharmacy, and remote sleep monitoring. Current and future challenges related to telehealthcare are discussed.
Persistence to Graduation for Students With Disabilities: Implications for Performance-Based Outcomes
Authors: Knight William , Wessel Roger D. , Markle Larry
Published: February 2016

The study sought to determine whether students with disabilities are disadvantaged because of state and institutional performance-based policies providing incentives for 4-year graduation. In a longitudinal study of 32,187 students at a Midwestern Research University, the retention and graduation rates, and mean years to graduation, of students with disabilities were compared with students without disabilities. This study demonstrated that the presence of a disability does not negatively influence eventual graduation, but that it does influence the amount of time to degree completion. However, as the transition to college for students with disabilities can be more difficult, it is important that the institution has interventions in place to assist students with disabilities to assimilate into college. The discussion focuses on policy and practice implications linked to performance-based outcomes related to students with disabilities.
Freedom to Connect
Authors: Sohn Brian K. , Plaas Kristina , Franklin Karen , Dellard Tiffany , Murphy Brenda , Greenberg Katherine H. , Greenberg Neil B. , Pollio Howard R. , Thomas Sandra P.
Published: February 2016

Previous analyses of transformational learning (TL) focused on rational or nonrational processes such as critical reflection on an uncomfortable personal situation or emotional learning. In this phenomenological study, researchers examined existential dimensions of TL. Individual interviews were analyzed to identify the lived experiences of eight participants in a graduate seminar. Participants described their experience to be “different” from other courses and “relevant and applicable” to their lives. They found the “atmosphere” of the course to be “free” from institutional obligations and “open” to ideas. They were “collaborative” in exploring course content and “connected” with other students, “safe” to share perspectives and understandings, and “comfortable” to explore content in their own way. Study findings suggest that discomfort is not necessary for TL to occur when students build relationships and learn in a safe and open classroom climate and that such an environment supported spontaneous application of course content to student lives.
Integrated chassis control for vehicle rollover prevention with neural network time-to-rollover warning metrics
Authors: Zhu Bing , Piao Qi , Zhao Jian , Guo Litong
Published: February 2016

The rollover of road vehicles is one of the most serious problems related to transportation safety. In this article, a novel rollover prevention control system composed of rollover warning and integrated chassis control algorithm is proposed. First, a conventional time-to-rollover warning algorithm was presented based on the 3-degree of freedom vehicle model. In order to improve the precision of vehicle rollover prediction, a back-propagation neural network was adopted to regulate time to rollover online by considering multi-state parameters of the vehicle. Second, a rollover prevention algorithm based on integrated chassis control was investigated, where the active front steering and the active yaw moment control were coordinated by model predictive control methodology. Finally, the algorithms were evaluated under several typical maneuvers utilizing MATLAB/Simulink and Carsim co-simulation. The results show that the proposed neural network time-to-rollover metrics can be a good measure of the danger of rollover, and the roll stability of the simulated vehicle is improved significantly with reduced side slip angle and yaw rate by the proposed integrated chassis control rollover prevention system.
Multi-objective optimization of an on-road bicycle frame by uniform design and compromise programming
Authors: Cheng Yung-Chang , Lee Cheng-Kang , Tsai Ming-Tsang
Published: February 2016

With the rapid changes in manufacturing technology of bicycle, the safety and performance of a bicycle are important and remarkable research subjects. In this study, an innovative and integrated optimization procedure for multi-objective optimization of an on-road bicycle frame is presented. The multiple objectives are to reduce the bicycle frame’s permanent deformations and to decrease the bicycle frame’s mass. First, uniform design of experiments is applied to create a set of sampling points in the design space of control factors. Second, three-dimensional solid models of bicycle frames are constructed and permanent deformations of bicycle frames under dropping-mass and dropping-frame impact test simulations are measured by ANSYS and ANSYS/LS-DYNA. Third, Kriging interpolation is used to transform the discrete relations between input control factors and output measures to continuous surrogate models. Fourth, compromise programming and mixture uniform design of experiments are used to integrate the multiple-objective functions into one compromise objective function. Finally, generalized reduced gradient algorithm is employed to solve the optimization problem. After executing the innovative optimization procedure, an optimized on-road bicycle frame is obtained. Comparing with the original design, the frame’s permanent deformations and mass are reduced. Therefore, both consolidation and lightweight of on-road bicycle frame are achieved.
Model predictive control–based cooperative lane change strategy for improving traffic flow
Authors: Wang Di , Hu Manjiang , Wang Yunpeng , Wang Jianqiang , Qin Hongmao , Bian Yougang
Published: February 2016

Lane change has attracted more and more attention in recent years for its negative impact on traffic safety and efficiency. However, few researches addressed the multi-vehicle cooperation during lane change process. In this article, feasibility criteria of lane change are designed, which considers the acceptable acceleration/deceleration of neighboring vehicles; meanwhile, a cooperative lane change strategy based on model predictive control is proposed in order to attenuate the adverse impacts of lane change on traffic flow. The proposed strategy implements the centralized decision making and active cooperation among the subject vehicle performing lane change in the subject lane and the preceding vehicle and the following vehicle in the target lane during lane change. Using model predictive control, safety, comfort, and traffic efficiency are integrated as the objectives, and lane change process is optimized. Numerical simulation results of the cooperative lane change strategy suggest that the deceleration of following vehicle can be weakened and further the shock wave propagated in traffic flow can be alleviated to some degree compared with traditional lane change.
Assessing survival benefit when treatment delays disease progression
Authors: Schoenfeld David A , Finkelstein Dianne M
Published: February 2016

Background:

For a potentially lethal chronic disease like cancer, it is often infeasible to compare treatments on the basis of overall survival, so a combined outcome such as progression-free survival (which is the time from randomization to progression or death) has become an acceptable primary endpoint. The rationale of using an efficacy measure that is dominated by the time to progression is that an effective treatment will delay progression and when treatment is stopped at progression, the effect of treatment after this time is small. However, often trials that show a significant benefit for delaying progression but not on overall survival are not universally viewed as providing convincing evidence that the drug should become the standard of care.

Methods:

We propose that when there is a significant treatment effect of delaying progression, a Bayesian analysis of overall survival should be undertaken. We suggest using a joint piecewise exponential model, where the treatment effect on the hazard for progression and for death after progression is captured through two distinct parameters. We develop a plot of the overall survival advantage of the new therapy versus the prior distribution of the relative hazard for death after progression. This plot can augment the discussion about whether the new treatment is beneficial on survival.

Results:

In the example of an early breast cancer trial for which a new treatment significantly delayed disease recurrence, our Bayesian analysis showed that with very reasonable assumptions on the effects of treatment after recurrence, there is a high probability that the new treatment improves overall survival.

Conclusion:

For a clinical trial for which treatment delays progression, the proposed method can improve the interpretability of the survival comparison using data from the study.
Prohibition, privilege and the drug apartheid: The failure of drug policy reform to address the underlying fallacies of drug prohibition
Authors: Taylor Stuart , Buchanan Julian , Ayres Tammy
Published: February 2016

It appears to be a time of turbulence within the global drug policy landscape. The historically dominant model of drug prohibition endures, yet a number of alternative models of legalization, decriminalization and regulation are emerging across the world. While critics have asserted that prohibition and the ensuing ‘war on drugs’ lack both an evidence base and legitimacy, reformers are embracing these alternatives as indicators of progressive change. This article, however, argues that such reforms adhere to the same arbitrary notions, moral dogma and fallacious evidence base as their predecessor. As such they represent the ‘metamorphosis of prohibition’, whereby the structure of drug policy changes, yet the underpinning principles remain unchanged. Consequentially, these reforms should not be considered ‘progressive’ as they risk further consolidating the underlying inconsistencies and contradictions that have formed the basis of drug prohibition.
Pulse oximetry in primary care
Authors: Silverston Paul
Published: February 2016

Most acutely unwell patients entering the hospital through either the emergency department or through an emergency assessment unit will have pulse oximetry performed as part of their initial clinical assessment. Although many GPs now have access to a pulse oximeter, pulse oximetry tends to be used much less frequently in primary care, and mainly to assess patients with respiratory conditions or symptoms. This article shows how pulse oximetry can be used as a screening tool during the initial assessment of acutely unwell patients to detect unanticipated hypoxia, as well as to identify those patients with respiratory symptoms who are beginning to decompensate.
How Good Is the Samaritan, and Why?
Authors: Everett Jim A. C. , Haque Omar Sultan , Rand David G.
Published: February 2016

What is the extent and nature of religious prosociality? If religious prosociality exists, is it parochial and extended selectively to coreligionists or is it generalized regardless of the recipient? Further, is it driven by preferences to help others or by expectations of reciprocity? We examined how much of a US$0.30 bonus Mechanical Turk workers would share with the other player whose religion was prominently displayed during two online resource allocation games. In one game (but not the other), the recipient could choose to reciprocate. Results from both games showed that the more central religion was in participants’ lives, the more of the bonus they shared, regardless of whether they were giving to atheists or Christians. Furthermore, this effect was most clearly related to self-reported frequency of “thinking about religious ideas” rather than belief in God or religious practice/experience. Our findings provide evidence of generalized religious prosociality and illuminate its basis.
The Trickster in the Anthropocene
Authors: Thornton Thomas F , Malhi Yadvinder
Published: February 2016

A mischievous figure from traditional cultures around the world can contribute an alternative narrative for humanity in the Anthropocene.
The Anthropocene as rupture
Authors: Hamilton Clive
Published: February 2016

I argue that Earth System science – a recent paradigm shift in the earth and life sciences (Hamilton C and Grinevald J (2015) Was the Anthropocene anticipated? The Anthropocene Review 2(1): 59–72) – named the Anthropocene as the very recent rupture in Earth history arising from the impact of human activity on the Earth System as a whole. Many have mistakenly treated the new concept of the Earth System as if it were equivalent to ‘the landscape’, ‘ecosystems’ or ‘the environment’. The new paradigm of Earth System science is erroneously understood as no more than a variation or development of established ecological sciences. Various attempts to invent new starting dates for the new epoch are based on these misconceptions, as are a number of arguments deployed to reject the Anthropocene altogether. In this context I consider the early Anthropocene hypothesis, three readings of the Anthropocene as instances of ecosystem change, and the notion of the ‘good Anthropocene’. Using this frame I also assess the arguments of those who do not accept the idea of the new epoch. I defend the view that disciplines other than Earth System science distort the idea of the Anthropocene when they read it through their own lenses.
Are coups good for democracy?
Authors: Derpanopoulos George , Frantz Erica , Geddes Barbara , Wright Joseph
Published: February 2016

A number of recent studies argue that coups can help usher in democracy. We examine this relationship empirically by looking at the political regimes that follow coups in autocracies, as well as the level of repression against citizens. We find that, though democracies are occasionally established in the wake of coups, more often new authoritarian regimes emerge, along with higher levels of state-sanctioned violence.
Partisanship and political accountability in new democracies: Explaining compliance with formal rules and procedures in Ghana
Authors: Asunka Joseph
Published: February 2016

Standard political agency models generally predict an inverse relationship between the degree of partisan allegiance among citizens and political accountability. Does variation in voter attachments to political parties influence the behavior of public officials in new democracies? I take advantage of data from a unique audit of local governments in Ghana—the Functional Organizational Assessment Tool (FOAT)—to examine the impact of partisanship on public officials’ compliance with formal rules and procedures. Because unattached or weakly attached voters are more responsive to the performance of incumbent officials, they are more likely to deter rent seeking, corruption, and other administrative malpractices. Analysis of the baseline FOAT results provides strong support for this idea: compliance with formal rules and procedures is significantly higher in districts where voters evince weak attachments to political parties. This result is robust to controls for alternate explanations and sheds light on the conditions under which politicians would abjure rent seeking and corruption, even in the context of a new democracy where they have so much opportunity to do so.
A Prospective Study of Adolescents’ Sexual Partnerships on Emerging Adults’ Relationship Satisfaction and Intimate Partner Aggression
Authors: Longmore Monica A. , Manning Wendy D. , Copp Jennifer E. , Giordano Peggy C.
Published: February 2016

We examined whether the influence of adolescents’ sexual partnerships, both dating and casual, carried over to affect emerging adults’ relationship satisfaction and experiences of intimate partner aggression. Analyses of longitudinal data from the Toledo Adolescent Relationships Study ( n = 294) showed that net of control variables (delinquency, depression, family violence, relational and sociodemographic characteristics), adolescents’ number of dating, but not casual, sexual partners led to greater odds of intimate partner aggression during emerging adulthood. Further, relationship churning (breaking-up and getting back together) and sexual nonexclusivity during emerging adulthood mediated the influence of adolescents’ number of dating sexual partnerships on intimate partner aggression. The positive effect of dating sexual partnerships on intimate partner aggression was stronger for women compared with men. These findings confirm the long reach of adolescent experiences into emerging adulthood.
Comparison of Current Echocardiographic Modalities Used to Assess Left Ventricle Diastolic Function in Pediatric Patients
Authors: Cordell Lisa L.
Published: February 2016

Tissue Doppler imaging, left ventricular color M-mode velocity propagation, and deformation imaging techniques from the medical literature were critically reviewed. The review was undertaken to evaluate the accuracy, reproducibility, and clinical efficiency of echocardiographic technologies for image acquisition and data analysis in assessing pediatric diastolic function. Tissue Doppler imaging, velocity propagation, and deformation imaging all show low variability and high reproducibility and specificity. Age, growth, heart rate, morphology, and sonographic technique affect some pediatric echocardiographic indices more than others; therefore, each should not be solely relied on. Their complementary diagnostic information should be evaluated collectively as a complete echocardiographic examination by expertly trained medical professionals.
Diagnosis of Atypical Chest Pain Using Ultrasound
Authors: Olivieri Patrick , Berkowitz Rachel , Eaglstein Emily , Rose Gabriel , Siadecki Sebastian , Saul Turandot
Published: February 2016

While the common organs assessed in chest pain are the heart, lungs, and inferior vena cava, one must also consider other diagnoses. Splenic rupture can be either traumatic or atraumatic, and splenomegaly can make this vulnerable organ even more susceptible to injury. A case is reported of a patient who presented to the emergency department with a complaint of left-sided chest pain; a focused assessment with sonography for trauma (FAST) examination showed significant intraperitoneal free fluid consistent with splenic injury. The role of bedside sonography in acquiring a rapid and accurate diagnosis is discussed.
Prevalence and risk factors of hypotension associated with preload-dependence during intermittent hemodialysis in critically ill patients
Authors: Bitker Laurent , Bayle Frédérique , Yonis Hodane , Gobert Florent , Leray Véronique , Taponnier Romain , Debord Sophie , Stoian-Cividjian Alina , Guérin Claude , Richard Jean-Christophe
Published: February 2016

Background

Hypotension is a frequent complication of intermittent hemodialysis (IHD) performed in intensive care units (ICUs). Passive leg raising (PLR) combined with continuous measurement of cardiac output is highly reliable to identify preload dependence, and may provide new insights into the mechanisms involved in IHD-related hypotension. The aim of this study was to assess prevalence and risk factors of preload dependence-related hypotension during IHD in the ICU.

Methods

A single-center prospective observational study performed on ICU patients undergoing IHD for acute kidney injury and monitored with a PiCCO® device. Primary end points were the prevalence of hypotension (defined as a mean arterial pressure below 65 mm Hg) and hypotension associated with preload dependence. Preload dependence was assessed by the passive leg raising test, and considered present if the systolic ejection volume increased by at least 10 % during the test, as assessed continuously by the PiCCO® device.

Results

Forty-seven patients totaling 107 IHD sessions were included. Hypotension was observed in 61 IHD sessions (57 %, CI95%: 47–66 %) and was independently associated with inotrope administration, higher SOFA score, lower time lag between ICU admission and IHD session, and lower MAP at IHD session onset. Hypotension associated with preload dependence was observed in 19 % (CI95%: 10–31 %) of sessions with hypotension, and was associated with mechanical ventilation, lower SAPS II, higher pulmonary vascular permeability index (PVPI) and dialysate sodium concentration at IHD session onset. ROC curve analysis identified PVPI and mechanical ventilation as the only variables with significant diagnostic performance to predict hypotension associated with preload dependence (respective AUC: 0.68 (CI95%: 0.53–0.83) and 0.69 (CI95%: 0.54–0.85). A PVPI ≥ 1.6 at IHD session onset predicted occurrence of hypotension associated with preload dependence during IHD with a sensitivity of 91 % (CI95%: 59–100 %), and a specificity of 53 % (CI95%: 42–63 %).

Conclusions

The majority of hypotensive episodes occurring during intermittent hemodialysis are unrelated to preload dependence and should not necessarily lead to reduction of fluid removal by hemodialysis. However, high PVPI at IHD session onset and mechanical ventilation are risk factors of preload dependence-related hypotension, and should prompt reduction of planned fluid removal during the session, and/or an increase in session duration.
Investigation of an enameled glass mosque lamp: a 13th–14th-century Mamluk example or 19th-century European version?
Authors: Salvant Johanna , Schussler Victoria , McKenna Caitlin , Bruno Lisa , Ganio Monica , Walton Marc
Published: February 2016

Background

In this study, an enameled glass mosque lamp in the Brooklyn Museum collection is investigated to elucidate the origin and date of production of each of its components—the body, handles, wick-holder, and foot—to establish whether the lamp was produced during the Mamluk period (13th–14th century) or is a 19th-century European creation.

Results

Using X-ray fluorescence spectrometry and scanning electron microscopy with energy dispersive X-ray spectrometry (SEM–EDS), the body, handles, and wick-holder were found to exhibit identical composition. The lamp’s foot, however, presents a dissimilar composition, one significantly richer in sodium, magnesium, and potassium. The matrix compositions, colorants, and opacifiers of the body’s enamel decorations were characterized by SEM–EDS and Raman spectroscopy analyses and compared with Mamluk and 19th-century production.

Conclusions

The lamp’s body, handles, and wick-holder were produced using the same type of glass, one likely incorporating a plant ash flux typical of medieval Islamic glass. Materials composing the body’s enamel decorations are consistent with Mamluk production. The foot’s distinct composition indicates that it is a later addition to the object. Combining the analytical, stylistic, and historical evidences, this glass lamp can now be identified as a Mamluk example, one of few comprising an integral wick-holder. The presence of a wick-holder is discussed and connected to the small size of the lamp. Details informing understanding of the lamp’s manufacture are also included. The implications of these new findings on the object’s conservation treatment and display are discussed in the context of the upcoming reinstallation of the Arts of the Islamic World gallery at the Brooklyn Museum.
Beyond the Central Dogma: Model-Based Learning of How Genes Determine Phenotypes
Authors: Reinagel Adam , Bray Speth Elena
Published: February 2016

In an introductory biology course, we implemented a learner-centered, model-based pedagogy that frequently engaged students in building conceptual models to explain how genes determine phenotypes. Model-building tasks were incorporated within case studies and aimed at eliciting students’ understanding of 1) the origin of variation in a population and 2) how genes/alleles determine phenotypes. Guided by theory on hierarchical development of systems-thinking skills, we scaffolded instruction and assessment so that students would first focus on articulating isolated relationships between pairs of molecular genetics structures and then integrate these relationships into an explanatory network. We analyzed models students generated on two exams to assess whether students’ learning of molecular genetics progressed along the theoretical hierarchical sequence of systems-thinking skills acquisition. With repeated practice, peer discussion, and instructor feedback over the course of the semester, students’ models became more accurate, better contextualized, and more meaningful. At the end of the semester, however, more than 25% of students still struggled to describe phenotype as an output of protein function. We therefore recommend that 1) practices like modeling, which require connecting genes to phenotypes; and 2) well-developed case studies highlighting proteins and their functions, take center stage in molecular genetics instruction.
EFN-4/Ephrin functions in LAD-2/L1CAM-mediated axon guidance in Caenorhabditis elegans
Authors: Dong Bingyun , Moseley-Alldredge Melinda , Schwieterman Alicia A. , Donelson Cory J. , McMurry Jonathan , Hudson Martin L. , Chen Lihsia
Published: February 2016

During nervous system development, growing axons rely on guidance molecules to direct axon pathfinding. A well-characterized family of guidance molecules is the membrane-associated ephrins, which together with their cognate Eph receptors, direct axon navigation in a contact-mediated fashion. In C. elegans, the ephrin-Eph signaling system is conserved and is best characterized for their roles in neuroblast migration during early embryogenesis. This study demonstrates a role for the C. elegans ephrin, EFN-4 in axon guidance. We provide both genetic and biochemical evidence that is consistent with the C. elegans divergent L1 cell adhesion molecule, LAD-2, acting as a non-canonical ephrin receptor to EFN-4 to promote axon guidance. Lastly, we show that EFN-4 likely functions as a diffusible factor as EFN-4 engineered to be soluble can promote LAD-2-mediated axon guidance. This study thus reveals a potential additional mechanism for ephrins in regulating axon guidance and expands the repertoire of receptors by which ephrins can signal.
Grainyhead-like 2 downstream targets act to suppress EMT during neural tube closure
Authors: Ray Heather J. , Niswander Lee A.
Published: February 2016

The transcription factor Grainyhead-like 2 (GRHL2) is expressed in non-neural ectoderm (NNE) and Grhl2 loss results in fully penetrant cranial neural tube defects (NTDs) in mice. GRHL2 activates expression of several epithelial genes, however additional molecular targets and functional processes regulated by GRHL2 in the NNE remain to be determined, as well as the underlying cause of the NTDs in Grhl2 mutants. Here, we find that Grhl2 loss results in abnormal mesenchymal phenotypes in the NNE, including aberrant Vimentin expression and increased cellular dynamics that affects the NNE and neural crest cells. The resulting loss of NNE integrity contributes to an inability of the cranial neural folds to move toward the midline and results in NTD. Further, we identified Esrp1, Sostdc1, Fermt1, Tmprss2 and Lamc2, novel NNE-expressed genes that are downregulated in Grhl2 mutants. Our in vitro assays show they act as suppressors of the epithelial-to-mesenchymal transition (EMT). Thus, GRHL2 promotes the epithelial nature of the NNE during the dynamic events of neural tube formation by both activating key epithelial genes and actively suppressing EMT through novel downstream EMT suppressors.
Tumor protein Tctp regulates axon development in the embryonic visual system
Authors: Roque Cláudio Gouveia , Wong Hovy Ho-Wai , Lin Julie Qiaojin , Holt Christine E.
Published: February 2016

The transcript encoding translationally controlled tumor protein (Tctp), a molecule correlated with aggressive breast cancers, was identified among the most abundant in genome-wide screens of axons, suggesting that Tctp is important in neurons. Here, we tested the role of Tctp in retinal axon development in Xenopus laevis. We report that Tctp deficiency results in stunted and splayed retinotectal projections that fail to innervate the optic tectum at the normal developmental time due to impaired axon extension. Tctp-deficient axons exhibit defects associated with mitochondrial dysfunction and we show that Tctp interacts in the axonal compartment with myeloid cell leukemia 1 (Mcl1), a pro-survival member of the Bcl-2 family. Mcl1 knockdown gives rise to similar axon misprojection phenotypes, and we provide evidence that Tctp's anti-apoptotic activity is necessary for the normal development of the retinotectal projection. The findings suggest that Tctp supports the development of the retinotectal projection via its regulation of pro-survival signalling and axonal mitochondrial homeostasis, and establish a novel and fundamental role for Tctp in vertebrate neural circuitry assembly.
Management of children with prolonged diarrhea
Authors: Giannattasio Antonietta , Guarino Alfredo , Lo Vecchio Andrea
Published: February 2016

Prolonged diarrhea is usually defined as acute-onset diarrhea lasting 7 days or more, but less than 14 days. Its trend has been declining in recent years because of improvement in the management of acute diarrhea, which represents the ideal strategy to prevent prolonged diarrhea. The pathogenesis of prolonged diarrhea is multifactorial and essentially based on persistent mucosal damage due to specific infections or sequential infections with different pathogens, host-related factors including micronutrient and/or vitamin deficiency, undernutrition and immunodeficiency, high mucosal permeability due to previous infectious processes and nutrient deficiency with consequential malabsorption, and microbiota disruption. Infections seem to play a major role in causing prolonged diarrhea in both developing and developed areas. However, single etiologic pathogens have not been identified, and the pattern of agents varies according to settings, host risk factors, and previous use of antibiotics and other drugs. The management of prolonged diarrhea is complex. Because of the wide etiologic spectrum, diagnostic algorithms should take into consideration the age of the patient, clinical and epidemiological factors, and the nutritional status and should always include a search for enteric pathogens. Often, expensive laboratory evaluations are of little benefit in guiding therapy, and an empirical approach may be effective in the majority of cases. The presence or absence of weight loss is crucial for driving the initial management of prolonged diarrhea. If there is no weight loss, generally there is no need for further evaluation. If weight loss is present, empiric anti-infectious therapy or elimination diet may be considered once specific etiologies have been excluded.
Engaging patients with moderate to severe acquired brain injury in goal setting
Authors: D’Cruz Kate , Unsworth Carolyn , Roberts Karen , Morarty Jacqui , Turner-Stokes Lynne , Wellington-Boyd Anna , Matchado Joanne , Lannin Natasha A
Published: February 2016

Background/Aims:

An exploratory study of a novel approach to using the Goal Engagement Scale to examine patients', families' and health professionals' perceptions of patient engagement in goal setting.

Methods:

This mixed methods study was conducted from September 2013 to April 2014 in both inpatient trauma and rehabilitation units at an Australian health care service. Participants were 22 triads (patients with moderate to severe traumatic brain injury or stroke, their family member(s) and a treating health professional) participating in routine goal setting interviews. Goal setting interviews were audio recorded, transcribed and thematically analysed, drawing upon an iterative process of qualitative data analysis, while the Goal Engagement Scale scores were analysed descriptively, drawing comparison between triad participant findings.

Findings:

Perception of patient's level of engagement in goal setting differed between health professionals, patients and families. Health professionals' views dominated the goal setting process. Goal setting interview data revealed four main themes, highlighting the importance of reflective listening skills to build a trusting relationship with patients and families to support engagement in goal setting.

Conclusions:

The findings of this exploratory study both affirm the suitability of future research into goal setting engagement and provide clinically useful strategies to support engagement of patients and families in goal setting.
Using Writing as Therapy: Finding identity—an evaluation of its effects upon clinical outcomes and service
Authors: Cooper Pauline R , Davis Darryl Anthony
Published: February 2016

Introduction

‘Using Writing as Therapy (UWaT): finding identity’ is a six-session, manualised writing intervention exploring identity and self-esteem, and developed by an occupational therapist. UWaT was evaluated across three boroughs of a South London NHS trust.

Background/Aims:

The original research (Cooper, 2008), which was given approval by an NHS Research Ethics Committee, yielded positive results that inspired the hosting NHS trust to further evaluate UWaT, with respect to its effects upon clinical outcomes and service utilisation levels. It was evaluated within specific services in the acute adult, mental health directorate from September 2012 to June 2014. The project had several stages, including training-experienced clinicians to deliver the intervention.

Method:

A pilot group was facilitated by the lead author to check the manual's ease of use for facilitators. The Hopelessness Scale and Quality of Life (QoL) Scale are standardised assessments providing viewpoints of mood and life perspectives, and were used before (t1), immediately after (t2), and 6 months post-course (t3). T3 assessments were sent by post, and 18 were returned. A qualitative questionnaire was completed at t2. Retrospective service costs were gathered 6 months pre- and post-UWaT. Forty clients with varying diagnoses participated, 36 of whom completed the course.

Findings:

One-hundred per cent of clients reported partial or full benefit from attending. The Hopelessness Scale and QoL assessments demonstrated a change of perspective.