bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteogenesis of osteogenic matrix cell sheets preserved in culture medium in a rat model
Authors: Kira Tsutomu , Akahane Manabu , Ouji-Sageshima Noriko , Shimizu Takamasa , Onishi Tadanobu , Omokawa Shohei , Ito Toshihiro , Tanaka Yasuhito
Published: July 2018

Osteogenic matrix cell sheets (OMCSs) are ideal for bone regeneration. Transportation of OMCSs may be necessary, during which their osteogenic ability must be maintained. Here, we evaluated different media and temperatures for OMCS preservation. Bone marrow stromal/stem cells (BMSCs) were obtained from Fischer rats and analyzed for stem cell markers by flow cytometry. OMCSs were prepared from BMSCs by treatment with dexamethasone and ascorbic acid phosphate. After OMCS collection, they were stored in minimum essential medium (MEM) or Hank’s balanced salt solution (HBSS) at 37, 22, or 4°C for 24 hours. Cell viability and cytotoxic effects in the preservation conditions were determined by adenosine triphosphate (ATP) contents and lactate dehydrogenase (LDH) release, respectively. Osteogenesis was assessed by subcutaneously implanting preserved OMCSs around β-tricalcium phosphate ceramic disks into syngeneic rats. Implants were evaluated by alkaline phosphatase (ALP) activities, osteocalcin contents, and histology. Mesenchymal stem cells comprised 51% of primary cultured BMSCs. ATP contents were significantly different in OMCSs stored in MEM or HBSS at 22°C and 4°C. LDH release was significantly different in OMCSs stored in HBSS at 22°C and 4°C. The highest LDH release was observed in OMCSs stored in HBSS at 37°C. ALP activities and osteocalcin contents were the lowest in implanted OMCSs stored in HBSS at 37°C at four weeks after subcutaneous implantation. There was a significant difference in the osteocalcin levels of implanted OMCSs stored in MEM at 37°C and HBSS at 4°C. Abundant bone tissue around and inside disks was found in histological sections of OMCSs stored in all preservation conditions except for MEM and HBSS at 37°C. Maintaining the osteogenic ability of OMCSs during transport is important, and preservation of OMCSs in MEM or HBSS at 4°C or 22°C is a simple and inexpensive method.
Discovering the Motives to Browse Internet among MBA Students: An Interpretivist Investigation
Authors: Naeem Usman , Kashif Muhammad
Published: July 2018

This study aims to discover motives to browse Internet among MBA students from Pakistan to understand its role to facilitate student leaning in business schools. The data is collected by means of focus groups and Facebook posts to discover motives to browse Internet. Thematic analysis is performed to analyse the data which includes recording, coding, and development of emergent themes. The four motives to browse Internet which are: Communication, Career Management, Information seeking, and Academic performance. The study is unique in two aspects. First, the data triangulation is achieved by methodological advancement to explore the motives behind Internet browsing. Secondly, the business students from a developing Asian country are selected to render some country specific strategies to make productive use of Internet.
Brokering Student Well-Being: Understanding the Work of School Health Administrators
Authors: Blackburn Samantha , Apesoa-Varano Ester Carolina
Published: July 2018

Despite a well-documented need for school health programs (SHPs) among schoolchildren, there is little school health funding in California and limited research on the role of those who manage SHPs. This qualitative study investigated the work of a selected group of school health administrators (SHAs) in California. Study aims were to explore SHA job pathways and responsibilities, the contextual factors influencing their work, and how they get their work done, given limited funding for SHPs. Thirty in-depth, semistructured interviews were conducted with SHAs and their staff, supervisors, and deputy SHAs. The main themes and subthemes are (1) district hierarchies marginalize SHAs and (2) in response to this marginalization, SHAs engage in brokering strategies to get their work done, including (a) raising awareness, (b) cultivating powerful allies, and (c) adjusting to working conditions. Despite structural disempowerment, SHAs have developed strategies to secure political support for SHPs and school nurses.
Assessment of Different Methods for Pediatric Meningitis Dosing Clinical Decision Support
Authors: Stultz Jeremy S. , Taylor Perry , McKenna Sean
Published: July 2018

Background: Indication-specific medication dosing support is needed to improve pediatric dosing support. Objective: To compare the sensitivity and positive predictive value (PPV) of different meningitis dosing alert triggers and dosing error rates between antimicrobials with and without meningitis order sentences. Methods: We retrospectively analyzed 4-months of pediatric orders for antimicrobials with meningitis-specific dosing. At the time of the order, it was determined if the antimicrobial was for meningitis management, if a cerebrospinal fluid (CSF) culture was ordered, and if a natural language processing (NLP) system could detect “meningitis” in clinical notes. Results: Of 1383 orders, 243 were for the management of meningitis. A CSF culture or NLP combination trigger searching the electronic health record since admission yielded the greatest sensitivity for detecting meningitis management (67.5%, P < 0.01 vs others), but dosing error detection was similar if the trigger only searched 48 hours preceding the order (68.8% vs 62.5%, P = 0.125). Using a CSF culture alone and a 48-hour time frame had a higher PPV versus a combination with a 48-hour time frame (97.1% vs 80.9%, P < 0.001), and both triggers had a higher PPV than others ( P < 0.001). Antimicrobials with meningitis order sentences had fewer dosing errors (19.8% vs 43.2%, P < 0.01). Conclusion and Relevance: A meningitis dosing alert triggered by a combination of a CSF culture or NLP system and a 48-hour triggering time frame could provide reasonable sensitivity and PPV for meningitis dosing errors. Order sentences with indication-specific recommendations may provide additional dosing support, but additional studies are needed.
Validation of the Work Family Conflict Scale for Sexual Minority Employees
Authors: Kim Shin Ye , Velez Brandon , Daheim Jacob , Lei Nina
Published: July 2018

The present study examined the factor structure, reliability, and validity of the Work–Family Conflict Scale (WFCS) in a sample of 295 sexual minority employees. Factor analyses supported a two-factor oblique model, with work–family conflict manifesting as worker role interfering with the family role (WIF) and family role interfering with the worker role (FIW). We also examined the relations of the latent WIF and FIW factors with conceptually related constructs. Both WIF and FIW were significantly negatively correlated with partner support; lesbian, gay, bisexual, and transgender–supportive climates; job satisfaction; and life satisfaction and were significantly positively correlated with turnover intentions, anxiety, and depression. Moreover, WIF (but not FIW) was significantly negatively associated with family support and family satisfaction, whereas FIW (but not WIF) was significantly negatively associated with outness at work. The findings of the present study suggest that the WFCS—and, possibly, the construct of work–family conflict more generally—holds promise for future vocational research focused on the interface of work and family in the lives of sexual minority employees. Implications of these findings for clinical work and research with sexual minority employees are discussed.
Physicochemical characterization of colored soluble protein fractions extracted from Spirulina (Spirulina platensis)
Authors: Barka Abakoura , Amira Amal B , Francis Frédéric , Blecker Christophe
Published: July 2018

The aim of this study was to evaluate the physicochemical properties of Spirulina colored soluble protein fractions extracted from spray-dried Spirulina powder. Three fractions, including the blue soluble Spirulina protein, the green soluble Spirulina protein, and the total soluble Spirulina protein fractions were obtained. Investigations on their behavior at air/water interface were carried out using dynamic methods of drop volume and bubble pressure surface tension measurements. Evaluation of their monolayer films’ mechanical behavior was done via compression isotherms using Langmuir film balance. The protein contents of the fractions were 82.76, 82.29, and 74.53% for the blue, the green, and the total fractions, respectively. Surface tension decay increased with increasing concentration for all the fractions. No significant difference in surface tension decay was observed between the samples at 0.3% (w/w). Surface tension decay was less important at pH 3 for all the fractions. The total fraction and the blue fraction appeared to form more elastic films than the green fraction. The blue soluble fraction also presented the highest collapse pressure and initial expansion area.
Memory System Neurons Represent Gaze Position and the Visual World
Authors: Meister Miriam
Published: July 2018

The entorhinal cortex, a brain area critical for memory, contains neurons that fire when a rodent is in a certain location (eg, grid cells), or when a monkey looks at certain locations. In rodents, these spatial representations align to visual objects in the environment by firing when the animal is in a preferred location defined by relative position of visual environmental features. Recently, our laboratory found that simultaneously recorded entorhinal neurons in monkeys can exhibit different spatial reference frames for gaze position, including a reference frame of visual environmental features. We also discovered that most of the neurons represent gaze position. These results suggest that gaze information in multiple spatial reference frames is a potent signal used in the primate memory system. Here, I describe how these findings support three underappreciated views of the hippocampal memory system.
Monitoring the impact of doing nothing: New trends in immigrant integration policy
Authors: Westerveen Laura , Adam Ilke
Published: July 2018

‘Mainstreaming’ has recently been considered as a possible new strategy for advancing immigrant integration in Europe. However, policy documents and current academic literature have hardly conceptualized what we label as ‘ethnic equality mainstreaming’. In this article, we lean on the widely available research on gender mainstreaming, to provide such a conceptualization of ethnic equality mainstreaming. Once conceptualized, we verify whether there is indeed a trend towards mainstreaming in Western Europe's old immigration countries. Our results show that there is no straightforward trend towards ethnic equality mainstreaming in these countries. However, the indicators that served to detect the existence of ethnic equality mainstreaming allowed us to uncover a new double and paradoxical trend in immigrant integration policies. This ‘new style’ immigrant integration policy can be depicted as follows: increasing ‘colourblindization’, in combination with ‘ethnic monitoring’. In other words, states increasingly monitor the impact of ‘doing nothing’.
Novel contribution to the simultaneous monitoring of pramipexole dihydrochloride monohydrate and levodopa as co-administered drugs in human plasma utilizing UPLC–MS/MS
Authors: Mohamed Dalia , Hegazy Maha A , Elshahed Mona S , Toubar Safaa S , Helmy Marwa I
Published: July 2018

An efficient, selective, sensitive, and rapid ultra-performance liquid chromatography tandem mass spectrometry method was established and validated for the quantification of pramipexole dihydrochloride monohydrate and levodopa simultaneously in human plasma with the aid of diphenhydramine as an internal standard. A simple protein precipitation technique with HPLC grade acetonitrile was efficiently utilized for the cleanup of plasma. The analysis was performed using a Hypersil gold 50 mm × 2.1 mm (1.9 µm) column and a mobile phase of 0.2% formic acid and methanol (90: 10 v/v). The triple-quadrupole mass spectrometer equipped with an electrospray source operated in the positive mode was set up in the selective reaction monitoring mode (SRM) to detect the ion transitions m/z 212.15 →153.01, m/z 198.10→ 135.16, and m/z 255.75 → 166.16 for pramipexole dihydrochloride monohydrate, levodopa, and diphenhydramine, respectively. The method was thoroughly validated according to FDA guidelines and proved to be linear, accurate, and precise over the range 100–4000 pg/mL for pramipexole dihydrochloride monohydrate and 60–4000 ng/mL for levodopa. The proposed method was effectively applied for monitoring both drugs in plasma samples of healthy volunteers.
How education standards gain hegemonic power and become international: The case of higher education and the Bologna Process
Authors: Brøgger Katja
Published: July 2018

Through an ethnographic exploration of policy documents, this paper aims to expose how outcome-oriented education standards gained international hegemonic status in the Bologna Process. Taking inspiration in the concept of hegemony and by connecting the invisible power of hegemony to soft governance, the paper shows how the outcome-based modular curriculum gained hegemonic power by means of the infrastructure of the reform. Centring on the movement from political agendas within the Bologna Process to the implementation in a national context using Denmark as a case, the paper tracks the transformation from an input- and content-driven curriculum to an outcome- and objectives-driven curriculum and the transition from a semestrial timeframe structure to a modular block structure. The paper shows how consent and legitimisation is manufactured through the infrastructure of the Bologna Process consisting of communication paths, standardisation and follow-up mechanisms such as benchmarking through graphs and frameworks for reporting.
Health-related quality of life, treatment adherence and psychosocial support in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension
Authors: Ivarsson Bodil , Hesselstrand Roger , Rådegran Göran , Kjellström Barbro
Published: July 2018

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) share similar quality of life impairment. The aim of the present study was to investigate health-related quality of life (HRQoL) and its relation to the perception of treatment and psychosocial support among PAH and CTEPH patients. All adult PAH or CTEPH patients in the Swedish Pulmonary Arterial Hypertension Register were invited to participate in a national cohort survey. The survey included the EuroQol 5-dimensions (EQ-5D) instrument that measures an individual’s HRQoL; the Beliefs about Medicines Questionnaire-Specific Scale that assesses the perception of PAH-specific treatment; the Mastery scale that evaluates the feeling of control and ability to cope with the disease; and the Social Network and Support Scale that maps the social support network. Of the 440 invited patients, 74% responded. Mean age was 66 ± 14 years, 58% were female and 69% diagnosed with PAH. Patients with PAH were younger, more often female and had a lower EQ-5D index (0.67 ± 0.29 vs. 0.73 ± 0.25, p = 0.050) than patients with CTEPH. Patients with a low EQ-5D index had more concerns about treatment ( p = 0.004), lower coping ability ( p < 0.001), less emotional support ( p = 0.003) and less accessible social network ( p = 0.002). In conclusion, patients with an impaired HRQoL also reported negative effects on their social support network, ability to handle stressors and concerns about treatment.
Challenges for Migrant and Cross-Border Populations With Diabetes Mellitus at Mae Tao Clinic in the Mae Sot–Myawaddy Border Region of Thailand and Myanmar
Authors: Naing Arkar Linn , Bakker Menno
Published: July 2018

The Mae Tao Clinic was established by Dr Cynthia Maung in 1989 in Mae Sot, Thailand, close to the border with Myanmar. The clinic provides primary health care, education, and protection to vulnerable and displaced people living in the Thailand-Myanmar border area. The leading vision of the organization is that all people from Burma (Myanmar) will have access to quality, equitable, and affordable health care, education, and protection in respect of all human rights. On yearly basis, the Mae Tao Clinic consults more than 100 000 outpatients and admits more than 10 000 patients to receive inpatient care. Many of the people served by the clinic cannot access affordable health care elsewhere principally due to lack of legal status, unaffordable costs, and language barriers.
Bioabsorbable Drug-Eluting Stent Versus Bare Metal Stent in Iliac Artery Evaluated by Optical Coherence Tomography: An In Vivo Study in Porcine
Authors: Zhao Yaping , Chen Zhong , Zhang Wayne W. , Wang Sheng , Yang Yaoguo , Yang Liao
Published: July 2018

Objective:

This study aimed to compare, using optical coherence tomography (OCT), the outcomes of bioabsorbable drug-eluting stent with those of bare metal stent (BMS) following implantation in porcine iliac artery.

Methods:

After the placement of BMS and bioabsorbable drug-eluting stents, we used OCT and digital subtraction angiography to investigate stent appositions, arterial neointima, evagination, and restenosis at 1 and 3 months.

Results:

At 1 and 3 months after stent implantation, OCT study was performed to investigate 32 stents and 21 788 struts. Thirty-three malapposed struts were found in the bioabsorbable drug-eluting stent groups and 2 were found in BMS groups. The average neointimal thickness, area, and in-stent stenosis were significantly lower in bioabsorbable drug-eluting stents than in BMS, while the frequency of malapposed struts was higher in the bioresorbable drug-eluting stent groups. Average neointimal thickness was lower in bioabsorbable drug-eluting stents than in BMS at 1 (0.19 ± 0.09 vs 0.67 ± 0.75 mm; P < .001) and 3 months (0.21 ± 0.08 vs 1.52 ± 0.28 mm; P < .001).

Conclusion:

Our study suggested that bioabsorbable drug-eluting stent is more effective in decreasing arterial restenosis than BMS in animal models.
Factores personales que afectan la calidad de vida de mujeres con cáncer de mama del noreste de México
Authors: Enríquez Reyna María Cristina , Vargas Flores María de los Ángeles
Published: July 2018

Introducción:

La terapia sistémica para el cáncer de mama afecta la calidad de vida de las mujeres y sus familias. Se analizó la influencia de los factores personales sobre la percepción de calidad de vida de mujeres en tratamiento para el cáncer mamario.

Métodos:

Participaron noventa y cinco asistentes a la consulta de un hospital público del noreste de México. Se aplicaron dos Cuestionarios de la Organización Europea para la Investigación y Tratamiento del Cáncer (EORTC QLQ-C30 y EORTC QLQ-BR23).

Resultados:

La edad promedio fue de 55 años ( DE = 9.24). Las participantes destacaron por presentar valores altos para el estado de salud global y niveles bajos en funcionamiento ( rango = 11.71 a 18.42). El insomnio y el impacto económico fueron las áreas más afectadas. Con el incremento de la edad, se observó menor afectación por síntomas mamarios, función y el disfrute sexual ( r = −.273, −.349 y −.304 respectivamente, p < .01).

Conclusión:

La situación laboral, estado civil, paridad y lugar de procedencia promovieron afectación diferencial en algunos síntomas incluyendo la imagen corporal. La aplicación de estos cuestionarios permitiría la identificación de necesidades de cuidado físico u emocional en la práctica clínica.
Proposal of a New Dynamic Distraction Device to Treat Complex Periarticular Fractures of the Metacarpophalangeal Joint of Long Finger
Authors: Kostoris Francesco , Addevico Francesco , Murena Luigi , Scaglione Michelangelo , Poggetti Andrea
Published: July 2018

Background: Complex periarticular fractures of the metacarpophalangeal joint (MCPJ) are often challenging to treat. Conservative and operative treatments are often burdened with stiffness, loss of function, and poor clinical outcome. These phenomena could be a direct consequence of long period of immobilization. To promote a short time of immobilization and a quick return to daily activities, it is mandatory to stabilize the fracture maintaining the active range of motion (AROM) of the ray. A simple solution is to reduce the fragments by means of dynamic ligamentotaxis. The authors propose a new dynamic distraction device (DDD) for the MCPJ. Methods: The DDD for the MCPJ was made of Kirschner wires bent and connected to counteract dislocation forces and to allow mobilization of the joint. The DDD was tested on a cadaver model under a simulated load in physiological conditions, and also in metacarpal and proximal phalanx (P1) fracture patterns. The effectiveness of the device was evaluated under fluoroscopy. Results: The data showed that DDD is able to achieve fracture reduction through ligamentotaxis and primary fragments stability and to avoid secondary dislocation during AROM of complex periarticular fractures of the MCPJ. Conclusions: The frame could be an alternative option to treat periarticular fractures of the MCPJ. The DDD implant has several advantages: It is time efficient because assembly and application take only few minutes. Furthermore, it is very versatile; indeed, it can be used in all metacarpal and phalanx bones, even in the central rays.
Comparison of the Short-Term and Long-Term Effects of Surgery and Nonsurgical Intervention in Treating Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis
Authors: Shi Qiyun , Bobos Pavlos , Lalone Emily A. , Warren Laura , MacDermid Joy C.
Published: July 2018

Background: The objective of the study is to examine the short-term and long-term efficacy of surgical treatment of carpal tunnel syndrome (CTS) compared with conservative treatment (ie, splint, steroid injection, or physical therapy). Methods: Two reviewers searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and PEDro up to September 2017. Quality appraisal and data extraction were performed in duplicate. Patient self-reported functional and symptom changes, as well as improvement of electrophysiological studies, were assessed as outcomes. Meta-analyses were performed in RevMan. Results: From 1438 studies identified after searching, 10 remained for analysis after exclusion criteria were applied. Moderate-quality evidence indicated that surgical interventions were superior to splint or steroid injection at 6 months with a weighted mean difference of 0.25 (95% confidence interval [CI], 0.07-0.44) for functional status and 0.64 (95% CI, 0.07-1.21) for symptom severity. The surgical group had better nerve conduction outcomes at 6 months (0.57 [95% CI, 0.05-0.50] ms). No significant differences were observed at 3 or 12 months. Conclusions: Both surgical and conservative interventions provide treatment benefits in CTS. Further studies on long-term outcome are needed.
Early Return to Play With Thumb Spica Gauntlet Casting for Ulnar Collateral Ligament Injuries Complicated by Adjacent Joint Dislocations in Collegiate Football Linemen
Authors: Bernstein Derek T. , McCulloch Patrick C. , Winston Leland A. , Liberman Shari R.
Published: July 2018

Background: Treatment of thumb ulnar collateral ligament (UCL) ruptures in elite athletes aims to restore thumb stability while minimizing lost playing time. Thus, surgical repair with early protected return to play in a thumb spica cast has been advocated. The purpose of this study was to document adjacent joint dislocations after primary surgical repair sustained during protected return to play with thumb spica casting in elite-level football players. Methods: Three Division I collegiate starting linemen sustaining adjacent joint dislocations in thumb spica casts following acute surgical repair of ipsilateral thumb UCL ruptures were retrospectively reviewed. Demographic data were recorded as well as the timeline for injury, treatment, and subsequent return to sport. Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were obtained at final follow-up. Results: The mean time from thumb UCL injury to surgical repair was 8.7 days, and the mean return to sport was 13.3 days from surgery. There were 4 simple dislocations including 3 proximal interphalangeal (PIP) joints and 1 elbow. Each PIP dislocation was close reduced and treated with buddy straps with immediate return to play. The elbow dislocation was close reduced and splinted with return to play 22 days after injury. The mean QuickDASH score was 2.3 at 12 month follow-up. Conclusions: This report highlights that while thumb spica casting protects the surgically repaired thumb UCL and allows for earlier return to play, it risks placing additional stress upon adjacent joints and therefore adjacent injury. Appropriate counseling of the risks and benefits of this treatment strategy is essential.
Improving care for acute in-hospital ischemic strokes—A narrative review
Authors: Chen Shuo , Singh Ravinder-Jeet , Kamal Noreen , Hill Michael D
Published: July 2018

In-hospital strokes, that is new strokes occurring among hospitalized patients, account for 6.5–15% of all strokes. Compared to community-onset stroke patients, in-hospital stroke patients tend to have worse functional and mortality outcomes. This review addresses the characteristics of acute in-hospital ischemic strokes, reasons these patients have worse outcomes compared to community-onset stroke patients, and future steps to improve outcomes.
Analysis of the separation angle between the thorax and pelvis, and its association with performance in the hammer throw
Authors: Brice Sara M , Ness Kevin F , Everingham Yvette L , Rosemond Doug , Judge Lawrence W
Published: July 2018

The hammer throw is perhaps one of the most misunderstood and difficult events to learn in track and field. Improvements in technique are focused on strategies designed to increase implement release velocity. The purpose of this cross-sectional investigative study was to examine the association between the angle of separation between the thorax and pelvis and performance in the hammer throw. Two male and four female throwers were used to assess positional data of the hammer, thorax, and pelvis. Hammer positional data were used to determine linear hammer speed at release, release angle, and release height. Thorax and pelvis positional data were used to determine thorax rotation relative to the pelvis (separation angle). The association between values of separation angle at key instances and performance was examined. Performance was determined by distance thrown (55.69 ± 3.42 m). Release speeds (24.32 ± 0.70 m/s) were also examined as a contributory factor towards performance and were included to account for instances where throwers released the hammer using sub-optimal release heights and angles which negatively affected distance thrown. The separation angle at its smallest within each turn was found to have a strong negative association with the performance indicators, especially in the first two turns (significant correlates ranged from −0.82 to −0.97). This finding indicates when throwers reduced the separation to a smaller value, performance was enhanced. Separation angle was at its smallest in double support. This suggests that throwers may improve performance by reducing the separation angle during double support phases.
Three-year recurrence of Dupuytren’s contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial
Authors: Scherman Peter , Jenmalm Per , Dahlin Lars B.
Published: July 2018

Collagenase injection and needle fasciotomy have similar short-term outcomes in the treatment of Dupuytren’s contracture. The purpose of this study was to compare the recurrence rate of these two procedures 3 years after index treatment of primary disease. We enrolled 93 patients (96 rays) from a previous two-centre randomized controlled trial. The rays that had been retreated or showed an increase in the total passive extension deficit of 30° or more compared with 3 months after treatment were regarded as recurrences. Seventeen of 40 needle fasciectomies and 12 of 36 of collagenase injections had recurred. This difference was not statistically significant. We conclude that collagenase injection and needle fasciotomy have similar 3-year recurrence rates in the treatment of Dupuytren’s contracture.

Level of evidence: I
Personality disorders
Authors: Camilleri Roberta
Published: July 2018

Personality disorders are complex to both identify and manage. All humans have a unique personality. Personality is what distinguishes us from each other and shapes our thoughts, emotions and behaviour. Personality disorders may be diagnosed when behaviour differs from expected norms, and abnormal traits in behaviour are persistent, pervasive and problematic. This article will provide an overview of the classification of personality disorders and the factors that contribute to their development. It will then consider dissocial personality disorder, the personality disorder encountered most often by GPs, in more detail. Finally, the benefits of countertransference are considered in an overview of the interaction between GPs and patients with a personality disorder.
Outcomes Following Posterior and Posterolateral Plating of Distal Fibula Fractures
Authors: Vance Danica D. , Swindell Hasani W. , Greisberg Justin K. , Vosseller James T.
Published: July 2018

Ankle fractures are common orthopaedic injuries often requiring open reduction and internal fixation. A variety of positions for plate placement exist for surgical fixation of distal fibula fractures, including direct lateral, posterior, or posterolateral. Direct lateral is more common, despite evidence that posterior and posterolateral placement is mechanically superior. However, concern for peroneal tendon injury from posterior plating remains. Our study investigates clinical and functional outcomes of patients who underwent operative fixation of distal fibula fractures with posterior or posterolateral plating over a 3-year period. Analyses were performed on 59 patients with at least 2 years of follow-up. Questionnaires were used to obtain demographic data, in addition to information regarding the presence of ankle pain, subsequent hardware removal, and Foot and Ankle Outcome Scores (FAOS). In patients with at least 2 years of follow-up (average 39.6 ± 10.6 months), 37.2% reported ongoing ankle pain; 11 patients underwent hardware removal (18.6%), with 8 patients undergoing removal because of hardware-related pain (13.6%). FAOS scores (n = 51) were as follows: pain (79.9 ± 22.3), activities of daily living (84.2 ± 22.6), symptoms (75.7 ± 23.5), sports (69.4 ± 31.6), and quality of life (58.3 ± 30.5). Posterior and posterolateral plating achieved good clinical and high functional outcomes across our study population. The percentage of hardware removal in our study was either equivalent to, or less than, historical controls for any type of fibular fixation, and removal may be helpful for those patients whose postoperative ankle pain is subjectively related to the hardware.

Levels of Evidence: Therapeutic, Level IV: Retrospective
Perceptions of mental illness etiology and treatment in Saudi Arabian healthcare students: A cross-sectional study
Authors: Alahmed Salman , Anjum Irfan , Masuadi Emad
Published: July 2018

Objectives:

Cultural beliefs often affect people’s attitude toward mental illness and their help-seeking behavior. Belief in superstitious causes of mental illness can lead to seeking help from non-medical practitioners, which might hinder treatment. This study aimed to explore the perception of mental illness and help-seeking behavior among healthcare students.

Methods:

A cross-sectional study carried out on a sample of 400 randomly selected undergraduate health professional students in Riyadh. Data collection involved two self-administered questionnaires: the causes and treatment routes for a female vignette with psychosis and the General Health Questionnaire-28.

Results:

The mean age of participants was 20.9 years, and 68.2% were male. Although participants reported a lack of personal history of mental illness (81.9%), female participants were more likely to disclose psychological distress as measured by General Health Questionnaire-28 (67.6%). Mental illness (47.2%) was chosen as the main reason for the problem depicted by the female vignette. General Health Questionnaire-28 scores for “caseness” did not affect perception about psychosis versus non-caseness. Factor analysis produced four dimensions for causes of psychosis: “social,” “psychobiological,” “superstitious,” and “socially undesirable”; and two treatment routes: “clinical” versus “social interventions.” Male participants leaned toward social factors for the cause of psychosis and were more likely to endorse social interventions for treatment.

Conclusion:

Healthcare students in Riyadh remained supportive of a biomedical approach toward the causation and treatment of mental illness. The use of religious practices as an adjunct was apparent. Students, especially females, were prone to experience more psychological distress.
Diabetes is an independent risk factor for delayed perforation after foreign bodies impacted in esophagus in adults
Authors: Zhang Shaowei , Wen Jiaxin , Du Mingmei , Liu Yunxi , Zhang Lianbin , Chu Xiangyang , Xue Zhiqiang
Published: July 2018

Background

Perforation is the most serious complication of esophageal foreign bodies. Studies examining the association between diabetes and esophageal foreign body‐induced perforation are largely non‐existent.

Objectives

The purpose of this study was to identify the risk factors for esophageal foreign body‐induced perforation.

Methods

A retrospective chart review of patients with esophageal foreign bodies between January 2012–January 2017 was performed at the Chinese People's Liberation Army General Hospital. The patients were divided into two groups: those complicated with perforation and those without perforation. Date on patient demographics, symptoms, foreign bodies, and diabetes were collected and analyzed. Study‐specific odds ratio and 95% confidence intervals (CI) were estimated using multivariable logistic regression models.

Results

Of 294 patients with esophageal foreign bodies (41.84% male, mean age, 56.73 years), 33 (11.22%) complicated by perforation. Diabetes (odds ratio = 6.00; 95% confidence interval = 1.72–20.23), duration (>24 h) of foreign bodies retention (odds ratio = 4.25; 95% confidence interval = 1.71–10.86), and preoperative fever (odds ratio = 8.19; 95% confidence interval = 3.17–21.74) were strongly associated with an increased risk of perforation, whereas the sensation of a foreign body (odds ratio = 0.32; 95% confidence interval = 0.09–0.92) was a protective factor of perforation. Glucose level was not observed to have an association among patients with or without perforation.

Conclusions

Diabetes and duration of foreign body retention increase risk for esophageal foreign bodies complicated by perforation, and cases with elevated armpit temperature may represented a more likely perforation compared with those without fever.
Bicyclic eremophilane-type petasite sesquiterpenes potentiate peroxisome proliferator–activated receptor γ activator–mediated inhibition of dendritic cells
Authors: Arizmendi Narcy , Hou Chenjie , Guo Fujiang , Li Yiming , Kulka Marianna
Published: July 2018

Dendritic cell (DC) activation induces expression of co-stimulatory surface molecules, as well as migration into secondary lymphoid organs, where they activate naïve T-cells. A family of plant derivatives, eremophilane-type petasite sesquiterpenes, can regulate the immune system through DC targeting due to their anti-inflammatory effects. Peroxisome proliferator–activated receptor gamma (PPARγ) is involved in inhibition of inflammatory responses and induction of DCs to acquire a mucosal phenotype. Since mucosal DCs are central in innate immune responses, we hypothesized that eremophilane-type petasite sesquiterpenes exerted their anti-inflammatory effects by inhibiting DC maturation and activation through PPARγ. This study assessed the bicyclic eremophilane-type petasite sesquiterpene compounds Fukinone and 10βH-8α,12-Epidioxyeremophil-7(11)-en-8β-ol (ZYFDC21 and ZYFDC22) in the maturation and activation of mouse DC. We measured surface expression of co-stimulatory molecules by flow cytometry and cell-free supernatant cytokine production upon lipopolysaccharide stimulation by enzyme-linked immunosorbent assays (ELISAs) in the presence or absence of PPARγ agonists. DCs were generated from C57BL/6 mice bone marrow cells and harvested. Cells were exposed to bicyclic eremophilane-type petasite sesquiterpenes ZYFDC21 or ZYFDC22 in the presence or absence of synthetic PPARγ agonists (GW1929 and TGZ) or the natural PPARγ ligand 15d-PGJ2, followed by overnight activation with LPS. We observed differences in the upregulation of surface expression of CD86, along with TNF, IL-6, and IL-12p70 released by DCs stimulated with LPS, when using combinations of bicyclic eremophilane-type petasite sesquiterpenes ZYFDC21 or ZYFDC22, and PPARγ agonists, in particular the PPARγ ligand 15d-PGJ2. Our results indicate that bicyclic eremophilane-type petasite sesquiterpenes ZYFDC21 or ZYFDC22 inhibit maturation and activation of DC, and this activity is augmented upon PPARγ activation.
Suicide: An Unrecognized Epidemic Among Farmers
Authors: Jones M. Susan , Reed Deborah B. , Hunt Matthew L.
Published: July 2018

Stress and depression are prevalent among farmers, and suicide has reached epidemic status. Occupational health nurses are in key positions to recognize these mental health issues and use strategies to control this epidemic.
Asymptomatic Participants With a Femoroacetabular Deformity Demonstrate Stronger Hip Extensors and Greater Pelvis Mobility During the Deep Squat Task
Authors: Catelli Danilo S. , Kowalski Erik , Beaulé Paul E. , Smit Kevin , Lamontagne Mario
Published: July 2018

Background:

Cam-type femoroacetabular impingement (FAI) is a femoral head-neck deformity that causes abnormal contact between the femoral head and acetabular rim, leading to pain. However, some individuals with the deformity do not experience pain and are referred to as having a femoroacetabular deformity (FAD). To date, only a few studies have examined muscle activity in patients with FAI, which were limited to gait, isometric and isokinetic hip flexion, and extension tasks.

Purpose:

To compare (1) hip muscle strength during isometric contraction and (2) lower limb kinematics and muscle activity of patients with FAI and FAD participants with body mass index–matched healthy controls during a deep squat task.

Study Design:

Controlled laboratory study.

Methods:

Three groups of participants were recruited: 16 patients with FAI (14 male, 2 female; mean age, 38.5 ± 8.0 years), 18 participants with FAD (15 male, 3 female; mean age, 32.5 ± 7.1 years), and 18 control participants (16 male, 2 female; mean age, 32.8 ± 7.0 years). Participants were outfitted with electromyography electrodes on 6 muscles and reflective markers for motion capture. The participants completed maximal strength tests and performed 5 deep squat trials. Muscle activity and biomechanical variables were extrapolated and compared between the 3 groups using 1-way analysis of variance.

Results:

The FAD group was significantly stronger than the FAI and control groups during hip extension, and the FAD group had greater sagittal pelvic range of motion and could squat to a greater depth than the FAI group. The FAI group activated their hip extensors to a greater extent and for a longer period of time compared with the FAD group to achieve the squat task.

Conclusion:

The stronger hip extensors of the FAD group are associated with greater pelvic range of motion, allowing for greater posterior pelvic tilt, possibly reducing the risk of impingement while performing the squat, and resulting in a greater squat depth compared with those with symptomatic FAI.

Clinical Relevance:

The increased strength of the hip extensors in the FAD group allowed these participants to achieve greater pelvic mobility and a greater squat depth by preventing the painful impingement position. Improving hip extensor strength and pelvic mobility may affect symptoms for patients with FAI.
Defining Successful Aging: Perceptions From Elderly Chinese in Hawai‘i
Authors: Zhang Wei , Liu Sizhe , Wu Bei
Published: July 2018

Background: This study aims to examine the lay perceptions of successful aging among elderly Chinese in Hawai‘i, the state has the highest life expectancy in the United States. Method: Principal components factor analysis and logistic regression models were used to analyze survey data collected among 136 respondents who were asked to evaluate the importance of 12 successful aging items developed in Asian societies involving the Chinese population. Results: Results from factor analysis reveal three distinct factors out of the 12 items of successful aging—(a) psychosocial and economic well-being, (b) physical well-being, and (c) social support from adult children. The former two factors were perceived as important dimensions of successful aging by most survey participants, and approximately 35%-41% respondents viewed items composing Factor 3 as important. Discussion: Results suggest that elderly Chinese in Hawai‘i have unique perceptions of successful aging that go beyond the Rowe and Kahn’s biomedical model to include more psychosocial components. In addition, their perceptions are similar to but slightly different from perceptions of elderly Chinese in China and Singapore in levels of familism. Our findings indicate cultural variation of successful aging.
Association Between Social Engagement and Cancer Screening Utilization in a Community-Dwelling Chinese American Older Population
Authors: Hei Ailian , Dong XinQi
Published: July 2018

Objectives: This study aims to examine the association between social engagement and cancer screening utilization among a Chinese American older population. Method: Data were drawn from the Population Study of Chinese Elderly (PINE). In total, 3,157 Chinese older adults enrolled in this study. Cancer screening utilization was assessed by asking whether participants had utilized cancer screenings. Social engagement was measured with 16 questions. Results: After controlling for potential confounders, a higher level of social engagement was associated with increased utilization in blood stool test (OR 1.03, [1.02, 1.05]), colonoscopy (OR 1.02, [1.01, 1.03]), mammography (OR 1.06, [1.05, 1.08]), Pap test (OR 1.04, [1.03, 1.06]), and prostate specific antigen (PSA) test (OR 1.03, [1.01, 1.05]). Compared with those with low levels of social engagement, older adults with high levels of social engagement were more likely to have utilized a blood stool test (OR 1.85, [1.46, 2.35]), a colonoscopy (OR 1.37, [1.09, 1.72]), a mammography (OR 3.05, [2.25, 4.14]), and a Pap test (OR 1.99, [1.49, 2.66]), but not more likely to have utilized a PSA test (OR 1.40, [0.97, 2.03]). Conclusion: This study underscores the association between active social engagement and increased utilization of cancer screening among a Chinese American older population. Improving social engagement could be helpful in promoting cancer screening utilization.
The Influence of Health Literacy and Acculturation on Cancer Screening Behaviors Among Older Chinese Americans
Authors: Li Chien-Ching , Matthews Alicia K. , Dong XinQi
Published: July 2018

Objective: Andersen’s Behavioral Model of Health Services Utilization was used as a framework to examine the influence of acculturation and health literacy on cancer screening behaviors among older Chinese Americans living in the greater Chicago area. Method: Data were obtained from the Population Study of Chinese Elderly in Chicago ( N = 3,157; mean age = 72.8 years). Logistic regression analyses were conducted to examine the impact of acculturation and health literacy on lifetime cancer screening utilizations and adherence to cancer screening guideline established by American Cancer Society (ACS) after controlling for predisposing, enabling, and need factors of Andersen’s behavioral model. Results: Lifetime rates of ever had cancer screening were low among older Chinese Americans living in the greater Chicago area. The majority of study participants were not adherent to ACS early detection cancer screening guidelines. Results from multivariate analyses showed that higher health literacy (odds ratio range = 1.39-1.72) and acculturation (odds ratio range = 1.28-2.06) levels were associated with an increased likelihood of lifetime and current cancer screening among older Chinese Americans. Discussion: The findings of this study highlight the importance of working to improve health literacy and developing effective interventions to increase cancer screening among older Chinese Americans.
What Matters Most at the End-of-Life for Chinese Americans?
Authors: Lee Mei Ching , Hinderer Katherine A. , Alexander Carla S.
Published: July 2018

Background: To provide optimal end-of-life (EOL) care in the Chinese American population, we need to have a better understanding of what matters most at EOL from their perspective. Experiencing a “good death” at the EOL is the optimal goal of palliative care. Studies show that the meaning and description of good death varies across cultures in different populations. In the United States, Chinese Americans comprise the largest Asian demographic. Aim: To describe EOL wishes, which define a good death for Chinese Americans. Method: Qualitative study using focus groups. A convenience sample of 60 Chinese Americans was recruited from a community organization in Maryland. Ten focus group discussion sessions were conducted. Results: Wishes at the EOL that defined a good death for the participants in this study included being pain-free, not being a burden to family, being with family, having a trusted physician, maintaining dignity, and prayer. Conclusion: A good death is a complex concept. What matters most to patients at the EOL differs depending on their cultural background. When caring for Chinese Americans, a comprehensive EOL care plan should include cultural considerations in addition to physical, psychosocial, and spiritual needs.
Loneliness, Depressive Symptoms, and Cognitive Functioning Among U.S. Chinese Older Adults
Authors: Kong Dexia , Davitt Joan , Dong XinQi
Published: July 2018

Objective: Loneliness has been associated with cognitive functioning in the general older adult population. Previous studies further indicate that loneliness has a strong association with depressive symptoms and the two constructs can reinforce each other to diminish well-being. However, such relationships have not been examined in U.S. Chinese older adults. This study attempts to bridge this knowledge gap. Method: Data were drawn from a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. Stepwise multivariate regression analyses were conducted to examine the relationship between loneliness, depressive symptoms, and global cognitive functioning. Results: Loneliness was associated with poor global cognitive functioning in U.S. Chinese older adults, though the relationship became nonsignificant after adjustment for depressive symptoms. The interaction term between loneliness and cognitive functioning was statistically significant ( p < .01). The findings further highlight the importance of age, education, number of children, number of people in household, and length of residence in the U.S. in cognitive functioning among U.S. Chinese older adults. Discussion: The study findings indicate that loneliness and depressive symptoms act together to influence cognitive functioning in U.S. Chinese older adults. Research and clinical implications of the findings are discussed.