bluuebunny/crossref_metadata_2025 huggingface dataset:
Discrepancies Identified Through a Telephone-Based, Student-Led Initiative for Medication Reconciliation in Ambulatory Psychiatry
Authors: Albano Marie E. , Bostwick Jolene R. , Ward Kristen M. , Fluent Thomas , Choe Hae Mi
Published: June 2017

Purpose:

To identify the number of medication discrepancies following establishment of a telephone-based, introductory pharmacy practice experience student-driven, medication reconciliation service for new patients in an ambulatory psychiatry clinic. Secondarily, to identify factors impacting medication discrepancies to better target medication profiles to reconcile and to evaluate whether the implementation of a call schedule effected clinic no-show rates.

Methods:

This was a retrospective analysis of a telephone-based medication reconciliation service from June 2014 to January 2016.

Results:

At least 1 medication discrepancy was identified among 84.7% of medication profiles (N = 438), with a total of 1416 medication discrepancies reconciled (3.2 discrepancies per patient). Of the 1416 discrepancies, 38.6% were deletions, 38.9% were additions, and 22.5% were changes in dosage strength or frequency. Discrepancies pertaining to prescription medications totaled 57.8%. Student pharmacists were critical team members in the service. Patient’s age, number of medications on the patient’s list, and number of days since the last medication reconciliation were not clinically significant determinants for targeting medication profiles. There was a statistically significant reduction in the clinic no-show rates following implementation of a call schedule compared with no-show rates prior to call schedule implementation.

Conclusion:

This student pharmacist–led telephone medication reconciliation service demonstrated the importance of medication reconciliation in ambulatory psychiatry by identifying numerous discrepancies within this population. Further, we demonstrated pharmacy students across various levels of education can assist in this process under the supervision of a pharmacist.
Semilunar Coronally Advanced Periodontal Flap to Increase Soft Tissue Coverage of a Maxillary Fourth Premolar in a Dog
Authors: Skinner Allen , Niemiec Brook
Published: June 2017

A 7-year-old, 31.3 kg spayed female Golden Retriever dog was presented for the treatment of Miller Class I gingival recession at the right maxillary fourth premolar (108). A semilunar coronally advanced periodontal flap was performed at this tooth and created an increase of approximately 3 mm of soft tissue coverage of the tooth. This method may have benefits over traditional periodontal advancement flaps in that there is no need for suturing, can be done more quickly, maintains lateral blood supply to the flap, and likely has decreased risk of surgical site dehiscence. This case shows that the semilunar coronally advanced periodontal flap demonstrates an appropriate method to treat Miller Class I gingival recession in the maxilla.
Supercooled large droplet icing accretion and its unsteady aerodynamic characteristics on high-lift devices
Authors: Zhang Chen , Liu Hong , Wang Fuxin , Kong Weiliang
Published: June 2017

Given the importance of understanding new FAR25, Appendix O certification, supercooled large droplet icing characteristics and its damages should be specified because of its serious hazard to in-flight safety and aircraft engineering. This study compares the icing feature and aerodynamic degradation of high-lift devices under different diameter conditions using a verified numerical method SJTUICE (a ice accretion simulating code by Shanghai Jiao Tong Univeristy). With two different flow and freezing time-steps Tf and Ts, the accuracies on fluid dynamic and icing predictions over a long period of time can be both controlled within an acceptable range. The comparisons between supercooled large droplet and non-supercooled large droplet conditions reflect that larger diameters induce more intense icing characteristics on the suction-side of each airfoil, in which the leading edge of flap is the most sensitive one to drop size. The second-accelerated flow near the gap is adverse to smaller droplet collection but benefit for impact thermodynamic enhancement of those larger collected droplets. The ice-caused gap narrowing makes flow separation earlier, which finally leads to the degradation of global high-lift performance worsen. Lift coefficient comparison also indicates the performance of high-lift devices decays more quickly under supercooled large droplet conditions. Results of this paper highlight the supercooled large droplet icing effects with respect to smaller diameter conditions.
Bayesian analysis of longitudinal dyadic data with informative missing data using a dyadic shared-parameter model
Authors: Ahn Jaeil , Morita Satoshi , Wang Wenyi , Yuan Ying
Published: June 2017

Analyzing longitudinal dyadic data is a challenging task due to the complicated correlations from repeated measurements and within-dyad interdependence, as well as potentially informative (or non-ignorable) missing data. We propose a dyadic shared-parameter model to analyze longitudinal dyadic data with ordinal outcomes and informative intermittent missing data and dropouts. We model the longitudinal measurement process using a proportional odds model, which accommodates the within-dyad interdependence using the concept of the actor-partner interdependence effects, as well as dyad-specific random effects. We model informative dropouts and intermittent missing data using a transition model, which shares the same set of random effects as the longitudinal measurement model. We evaluate the performance of the proposed method through extensive simulation studies. As our approach relies on some untestable assumptions on the missing data mechanism, we perform sensitivity analyses to evaluate how the analysis results change when the missing data mechanism is misspecified. We demonstrate our method using a longitudinal dyadic study of metastatic breast cancer.
Interpreting ‘Filler Pause’ in Interpersonal Communication: A Study of Situational Comedy The Big Bang Theory
Authors: Chakravarty Urjani
Published: June 2017

Humour as represented vis-à-vis situational comedy in general forms an important aspect of interpersonal communication. Though the reception of humour is often ascribed to personal taste, the extent to which an audience will find something humorous depends upon a multitude of factors, including benchmarks of culture and context. Regardless of the factors, it is observed that situational comedies elicit laughter through non-linguistic strategies. ‘Fillers’ mark one of the non-linguistic strategies of interpersonal communication. These have varied functions in all possible socio-cultural environments as well as in discourse construction. In addition to being universal in nature, ‘Fillers’ also facilitate the interpretation process and understanding. Using Sperber and Wilson’s Relevance Theory (2002), the study examines the selective communication situations with their interpretation process and understanding (cognitive effects) between the characters of American sitcom The Big Bang Theory. The article contends that ‘filler pause’ (termed as such in this article) used in a situational comedy have a function to play, namely, they tend to break down the formal barrier in an interpersonal communication and act as a humour trigger.
Effects of miR-1236-3p and miR-370-5p on activation of p21 in various tumors and its inhibition on the growth of lung cancer cells
Authors: Li Chuanchang , Ge Qiangqiang , Liu Jiaxuan , Zhang Qingsong , Wang Chenghe , Cui Kai , Chen Zhong
Published: June 2017

The mechanism of dsRNA-induced gene activation (RNAa) is being gradually unveiled. The plentiful evidence that it existed in mammalian species other than human demonstrated that dsRNA-mediated RNAa is a conservative phenomenon. Simultaneously, accumulating evidence suggested that microRNAs could activate gene expression by targeting promoter. Nevertheless, it is ambiguous whether microRNA-induced gene activation in different human cells is a common phenomenon. The study we performed verified that miR-1236-3p (miR-1236) and miR-370-5p can activate p21 expression in bladder cancer (BCa) T24, EJ cells, and non-small-cell lung carcinoma A549 cells, while in hepatocellular HepG2 cells both microRNAs cannot effectively induce the expression of P21WAF1/CIP1 (p21). In pancreatic cancer PANC-1 cells, only miR-370-5p had the potent abilities to induce p21 expression rather than miR-1236-3p. Unlike microRNA-mediated RNA activation, we can observe that dsP21-322 significantly activated p21 in above cells. Besides, we demonstrated that miR-1236 and miR-370 inhibited cyclin D1-CDK4/CDK6 pathway while upregulated E-cadherin expression by upregulation of p21. Overexpression of these two microRNAs in A549 induced cell-cycle arrest and cell senescence, delayed cell proliferation and colony formation, and inhibited migration and invasion. In conclusion, microRNA-mediated RNAa depends on the cell context, and miR-1236 and miR-370 can inhibit non-small-cell lung carcinoma cell growth by upregulating p21 expression in vitro.
Patterns of Participation and Social Connections in Online Discussion Forums
Authors: Tirado-Morueta Ramón , Maraver-López Pablo , Hernando-Gómez Ángel
Published: June 2017

Social relations are an essential component of group learning online, because through them, the process is managed and controlled. In addition, learning cannot be understood in isolation from its situated nature. To identify patterns of participation and social connections in online group learning, this study analyzes the social network among university students who work in online discussion forums and are required to solve higher order learning tasks. Discussion forums were used, focusing on three types of tasks: analyzing case studies, evaluating websites, and creating WebQuest. The structures of social networks that arose out of 96 discussion forums over three academic years were analyzed. The results demonstrate that as the opening (lower level of structuration) of the learning task increases, so too does the need for social interaction in the group. The social structure of the groups is modulated by the type of learning task. Finally, the educational implications of the results are discussed.
Diffraction of elastic waves from object in layer with slightly corrugated surface
Authors: Elmorabie Khaled M , Yahya Rania R
Published: June 2017

This work is concerned with the influence of corrugated surfaces on waves diffracted from an object in an elastic layer. A boundary value problem is formulated to simulate an anti-plane problem for a harmonic load acting on the upper surface of the layer. By using the boundary integral equation method and the perturbation technique, the considered problem is reduced to a pair of integral equations. By constructing the Green’s function, the scattering problem in a one-mode frequency range is solved. To check the validity of the proposed technique, several numerical examples for different geometrical shapes of the corrugated bottom are presented.
Service Climate as a Moderator of the Effects of Customer-to-Customer Interactions on Customer Support and Service Quality
Authors: Jung Jin Ho , Yoo Jaewon Jay , Arnold Todd J.
Published: June 2017

This study introduces customer-perceived service climate, which captures an individual customer’s perception of the extent to which a service organization teaches, prioritizes, and recognizes outstanding customer service through organizational practices and procedures. Such a perception is found to significantly and positively influence the outcomes of a customer’s already positive interactions with other customers as well as temper outcomes associated with a customer’s negative experience of another customer’s dysfunctional behaviors. Longitudinal results demonstrate that customer-perceived service climate creates a potential “spillover” effect, where positive influences of a strong service climate benefit an organization in two ways—both through employee actions (as previous research shows) and through customer actions toward one another (i.e., supportive behaviors—as the current study demonstrates). The development of such supportive behaviors among customers is shown to be critical, as it is these support behaviors from other customers, and not positive or negative customer-to-customer (C2C) interactions themselves, that ultimately influence a customer’s judgment of organizational service quality. Service organizations should be aware of the importance of developing positive customer perceptions of service climate to help in positively influencing C2C interactions as well as focusing upon the development of a service environment that enables C2C support behaviors.
Experimental, analytical and numerical study of mechanical properties and fracture energy for composite sandwich beams
Authors: Toygar M Evren , Tee Kong Fah , Maleki Farshid Khosravi , Balaban A Cagla
Published: June 2017

In this study, the mechanical and fracture behaviour of marine sandwich-structured composite that is manufactured by vacuum-assisted resin infusion process with a PVC foam-web core, and different thicknesses of upper and lower glass fibre-reinforced polymer face sheets used as outer and inner side of the hull have been examined. The properties of PVC core, face sheet material, and composite sandwich structures are presented. Failure modes include sandwich flatwise tension, core flatwise compression, sandwich edgewise compression, and face sheet bending of manufactured composites have been investigated experimentally for marine application. The analytical solution is derived to calculate the flexural rigidity, shear stresses and maximum tensile, compression stresses in three-point bending specimens for marine sandwich composites. 3 End Notched Flexure test method has been applied to calculate the strain energy release rate. Moreover, the finite element study is carried out by using a 2D model to calculate the fracture energy (J) value numerically and virtual crack closure technique. Reasonably good results are obtained between analytical and numerical methods.
Farming versus tourism
Authors: Liu Jun , Zhu Jianghuan , Lin Chu , Li Yunyun , Wu Lijun
Published: June 2017

Participation in the tourism industry around World Heritage Sites is an important livelihood strategy for farmers. To enhance their sustainable livelihood ability, it is important to identify these strategies and determine the factors that affect their shift from low- to high-stability employment plans. We conducted face-to-face interviews with 150 farmer households on a World Heritage Site in China. Using the sustainable livelihood framework, proposed by the Department for International Development in the United Kingdom, a detailed inventory of farmers’ livelihood capital was created. A livelihood capital evaluation system was established adopting an entropy weight method. In addition, a multiple logistic regression model was used to analyze the impact of farmers’ livelihood capital on their choice of tourism schemes. The results show that the most stable tourism livelihood strategies in the area studied were store types, and the most unstable, stall types. The key factors that affected the farmers’ shift of livelihood strategy were physical, financial, and human capital. Farmers with a larger quantum of these types of capital were more likely to choose a high-level livelihood strategy than other farmers. Moreover, the distance from their residence to the main attractions and tourist routes was an important factor that affected their choice of livelihood strategies.
Brexit, Trump and the special relationship
Authors: Wilson Graham K
Published: June 2017

The unexpected victories of Donald Trump in the United States 2016 Presidential campaign and of the Leave campaign in the British referendum on membership in the European Union have important similarities in terms of campaign strategy, rhetoric and social bases of support. They are exemplars of a wave of right-wing populism that has swept across advanced democracies. The triumph of Brexit also raises questions about the future relationship between the United Kingdom and United States. While it is too early to be certain about either the impact of Brexit or the future direction of the Trump Administration, and despite ties between the Trump Administration and British politicians who campaigned for or subsequently supported Brexit, the United Kingdom could become much less useful as a diplomatic and economic partner to the United States after leaving the European Union.
The disjuncture between confidence and cooperation: Police contact amongst Polish migrants and established residents
Authors: Griffiths Clare E.
Published: June 2017

Trust and confidence in such criminal justice institutions as the police is considered crucial for the successful functioning of society and to allow for greater voluntary compliance and cooperation with institutions of control. There is a plethora of existing research, however, that shows the often strained relationships between the police and particular ethnic minority groups in the UK, Europe and the US, with such groups exhibiting a great deal of mistrust and lack of cooperation. This article aims to add to this body of literature by presenting the findings of a case study that used quantitative and qualitative methods to explore new Polish migrants’ and established local residents’ trust in and cooperation with the police following a period of mass migration in a small working-class town in the north-west of England. The key results show that, contrary to expectations, Polish migrants in fact have greater trust in the police than do the more established local residents in the area. Notwithstanding this high confidence, Polish migrants remain reluctant to contact the police. Adding greater complexity to Tyler’s ‘normative’ model of police contact (Tyler, 2006; Tyler and Fagan, 2008), the article presents the nuances of police relations with majority and minority groups in this working-class town.
Collaborative Autoethnography as a Pathway for Transformative Learning
Authors: Blalock A. Emiko , Akehi Meg
Published: June 2017

Through the exercise of collaborative autoethnography, we propose intentional and purposeful dialogue can act as a pathway for transformative learning. We seek to first deepen our understandings of transformative learning, particularly for underserved students in higher education and second to advance autoethnographic methods, a method that incorporates personal reflections on culture. Our own dialogue as biracial women in higher education represents the transformative power of talking out loud in a space created to honor and recognize our race, ethnicity, and gender. Topics that deal directly with identity development can have an enormous impact on fostering transformative learning. Moreover, when nondominant methods such as collaborative autoethnography are practiced, specifically with underserved students, deep relationships and soul work can occur.
Habitat Use of the Saola Pseudoryx nghetinhensis (Mammalia; Bovidae) Based on Local Sightings in the Northern Annamite Mountains of Lao PDR
Authors: Phommachanh Chanthasone , Ngoprasert Dusit , Steinmetz Robert , Savini Tommaso , Gale George A.
Published: June 2017

The Saola Pseudoryx nghetinhensis (Mammalia; Bovidae) is IUCN Critically Endangered, but its ecology remains almost entirely unknown. Here we present the first characterization of Saola habitat use. We assessed Saola macrohabitat and microhabitat characteristics using Saola sighting location data obtained from local people. The study focused on the Phou Sithon Endangered Species Conservation Area in the northern Annamites of Lao PDR. A geographical information system was used to characterize macrohabitat variables including elevation, abundance of streams, and distance to nearest village associated with each observation. Infinitely weighted logistic regression models were used to assess relationships between detection of Saola and these macro variables. Direct measurements for microhabitat variables for each Saola observation were also collected and compared with other available vegetation data. Twenty-two observations from 18 independent observation points were analyzed. Elevations of the points ranged from 592 to 1,112 m (Median = 747 m) matching previous studies (500–1,400 m). Our regression model indicated abundance of streams affected detection of Saola suggesting it was more likely detected in areas with higher abundances of streams; however, streams were also associated with human travel routes. Our analysis also suggested that Saola were more frequently encountered in primary forest with a high density of trees but were occasionally observed in secondary growth. Most encounters were on animal trails. This information represents an important baseline for future assessments of Saola priority areas, which may assist in searching for possible sites that might harbor this elusive species; however, additional studies of its ecology are urgently needed to guide future management.
Healing of Osteochondral Defects via Endochondral Ossification in an Ovine Model
Authors: Lydon Helen , Getgood Alan , Henson Frances M. D.
Published: June 2017

Objective

The objective of this study was to describe the mechanism of healing of osteochondral defects of the distal femur in the sheep, a commonly used translational model. Information on the healing mechanism be useful to inform the design of tissue engineering devices for joint surface defect repair.

Design

A retrospective study was conducted examining 7-mm diameter osteochondral defects made in the distal medial femoral condyle of 40 adult female sheep, comprising control animals from 3 separate structures. The healing of the defects was studied at post mortem at up to 26 weeks.

Results

Osteochondral defects of the distal femur of the sheep heal through endochondral ossification as evidenced by chondrocyte hypertrophy and type X collagen expression. Neocartilage is first formed adjacent to damaged cartilage and then streams over the damaged underlying bone before filling the defect from the base upward. No intramembranous ossification or isolated mesenchymal stem cell aggregates were detected in the healing tissue. No osseous hypertrophy was detected in the defects.

Conclusions

Osteochondral defects of the medial femoral condyle of the sheep heal via endochondral ossification, with neocartilage first appearing adjacent to damaged cartilage. Unlike the mechanism of healing in fracture repair, neocartilage is eventually formed directly onto damaged bone. There was most variability between animals between 8 and 12 weeks postsurgery. These results should be considered when designing devices to promote defect healing.
Carotid intraplaque hemorrhage on vessel wall MRI does not correlate with TCD emboli monitoring in patients with recently symptomatic carotid atherosclerosis
Authors: de Havenon Adam , Tirschwell David , Majersik Jennifer J , McNally Scott , Stoddard Gregory , Moore Anne , Mossa-Basha Mahmud
Published: June 2017

Background

Carotid intraplaque hemorrhage (IPH) seen on vessel wall MRI is associated with an increased risk of stroke or transient ischemic attack, as are microembolic signals (MES) detected by transcranial Doppler (TCD). We sought to examine the association between IPH and MES in acute stroke patients with symptomatic carotid atherosclerosis.

Methods

Through a retrospective chart review, we included patients from 2011 to 2013 with acute ischemic stroke due to carotid atherosclerosis of varying stenosis who had both 3D volumetric MRI of the neck and TCD emboli monitoring.

Results

Twenty-four patients met the inclusion criteria. Mean time from stroke to MRI was 1.4 ± 1.9 days and to TCD was 2.6 ± 2.4 days. MES was seen in 10 patients (42%) and IPH was present in seven patients (29%), but we did not find a relationship between MES and IPH ( p = 0.64).

Conclusion

In patients with recent acute ischemic stroke attributed to carotid atherosclerosis, we did not detect an association between the presence of IPH and MES. While this small study may be underpowered, an alternate explanation is that MES and IPH reflect vulnerable carotid atherosclerosis through different mechanisms. This untested concept warrants prospective study in a larger cohort.
The association among prematurity, cochlear hyperintensity, and hearing loss
Authors: Wien Michael A , Whitehead Matthew T
Published: June 2017

Background

Prematurity is a major risk factor for neonatal hearing loss. Recent advancements in magnetic resonance imaging (MRI) have made it possible to evaluate structural details of the membranous labyrinths in premature infants that have heretofore been inaccessible.

Objective

We compared the prevalence of abnormal cochlear signal intensity in premature and term neonates and evaluated for a potential link with hearing loss.

Materials and methods

We retrospectively reviewed 148 consecutive MR exams performed in premature (< 37 weeks’ gestation) and term neonates performed over a 30-month period. Cochlear signal alteration was evaluated on three-dimensional T1-weighted imaging (T1WI) sequences. Each patient’s electronic medical record was reviewed to document demographics, symptomatology, physical exam findings, and potential medical variables that could contribute to cochlear signal alteration.

Results

Cochlear hyperintensity on T1WI was present in 6.8% patients ( n = 10) overall, but was much more common in preterm than term patients (12.2% (9 of 74) vs. 1.4% (1 of 74), respectively; p value < 0.05; Fisher’s exact test). Overall, 14.9% ( n = 15) of the patients with hearing test results failed the screening Auditory Brainstem Response exam. However, failure was much more common among patients with cochlear hyperintensity on T1W1 than those with normal findings (56% (5 of 9) vs. 11% (10 of 92), respectively; p value < 0.01; Fisher’s exact test).

Conclusion

Cochlear hyperintensity on T1WI is more common in preterm than term neonates, and potentially associated with hearing loss. Cochleae should be closely scrutinized in all premature infants; signal alterations should prompt further diagnostic inquiry and possible early otolaryngology referral.
Management of prostacyclin side effects in adult patients with pulmonary arterial hypertension
Authors: Kingman Martha , Archer‐Chicko Christine , Bartlett Mary , Beckmann Joy , Hohsfield Robin , Lombardi Sandra
Published: June 2017

Therapies that target the prostacyclin pathway are considered effective, yet are complex to dose and may cause dose‐limiting side effects for patients with pulmonary arterial hypertension (PAH). Careful side effect management and the ability to discern side effects from worsening disease are essential in order for patients to continue, and benefit from, prostacyclin therapy. This manuscript was developed through a collaborative effort of allied health providers with extensive experience in managing patients with PAH who are treated with medications that target the prostacyclin pathway. This article provides an overview of individual prostacyclin pathway therapies approved in the United States, side effects most commonly associated with these therapies, and practical suggestions for side effect management. Most patients will experience significant side effects on prostacyclin therapy. Creating a proactive and careful side effect management program will increase the likelihood that patients are able to stay on therapy and receive the benefits afforded by prostacyclin therapy.
Managing menopause in women living with HIV: A survey of primary care practitioners
Authors: Chirwa Mimie , Ma Richard , Guallar Cristina , Tariq Shema
Published: June 2017

Objective

One in three women living with HIV (WLHIV) in the UK is aged 45–56, and therefore of potentially menopausal age. Little is known about the management of menopause in WLHIV in primary care. We aim to describe current knowledge and practice in the management of menopause in WLWH among primary care practitioners (PCPs).

Methods

A questionnaire-based study of 88 PCPs attending two sexual and reproductive health conferences.

Results

Almost all respondents (n = 87, 99%) routinely managed women with menopause-related symptoms; however, only 18 (20%) reported having managed menopause in WLHIV. Over 95% (n = 85) reported being confident in managing menopause in general, whereas less than half (n = 40) reported confidence in managing menopause in WLHIV ( p < 0.001). The majority of respondents (n = 84) felt that menopause should be routinely managed in primary care, whereas just over half thought that menopause in WLHIV should be managed in primary care (n = 50, p < 0.001). Almost all respondents (n = 85) reported concerns about managing menopause in WLHIV.

Conclusion

PCPs reported limited experience of and low levels of confidence in managing menopause-related symptoms in WLHIV. Nearly all PCPs had concerns about managing menopause-related symptoms in WLHIV, many stating that this should be managed outside primary care. Development of national guidance and specialised training, coupled with good liaison between HIV services and PCPs, may improve confidence in this area.
Primary fibrosarcoma of the urinary bladder in a cat: follow-up after incomplete surgical excision
Authors: Greci Valentina , Rocchi Paola M , Sontuoso Antonio F , Olivero Daniela , Capasso Angelo , Raiano Vera
Published: June 2017

Case summary

An 11-year-old female spayed domestic shorthair cat was presented with haematuria of 2 months’ duration followed by pollakiuria and stranguria. A firm, non-painful mass in the urinary bladder was palpated. Abdominal radiographs and ultrasound were suggestive of a urinary neoplasia. During explorative laparotomy, a partial cystectomy and surgical debulking were performed. Histopathology and immunostaining were consistent with a fibrosarcoma. The cat was discharged 10 days after surgery with a residual mass of about 1.8 cm on ultrasound re-examination. The cat was not given adjuvant therapy. The cat was euthanased 8 months after surgery because of tumour invasion of the urinary trigone and subsequent ureter dilation, hydronephrosis and severe azotaemia.

Relevance and novel information

Malignant urinary fibrosarcoma in this cat appeared to be only locally invasive. Palliative surgery without adjuvant postoperative chemotherapy in this cat resulted in an 8 month period of good quality of life.
Race, Emotional Reliance, and Mental Health
Authors: Erving Christy L. , Thomas Courtney S.
Published: June 2017

Prior research shows that emotional reliance, an indicator of interpersonal dependence, is an important psychosocial risk factor for mental health problems. However, few have considered black-white differences in emotional reliance or the role it may play in racial variations in mental health outcomes. Using a community epidemiologic sample of adults in Nashville, Tennessee, the current study builds on the small literature on emotional reliance by exploring three aims. First, we evaluate racial differences in emotional reliance. Second, we examine the association between emotional reliance and mental health. Last, we assess the relationships among race, emotional reliance, and mental health. Findings reveal that emotional reliance is generally associated with higher depressive symptoms, more anxiety symptoms, and lower levels of life satisfaction. However, the magnitude of these relationships is greater for blacks compared to whites. We discuss the implications of these findings and areas of promising future research.
Phase-Specific Ground Reaction Force Analyses of Bilateral and Unilateral Jumps in Patients With ACL Reconstruction
Authors: Baumgart Christian , Hoppe Matthias W. , Freiwald Jürgen
Published: June 2017

Background:

In patients who have undergone anterior cruciate ligament (ACL) reconstruction, there is a weak correlation between subjective evaluation of knee function on questionnaires and clinical or biomechanical test results.

Hypothesis:

Patients with lower subjective knee function will demonstrate lower ground-reaction forces (GRFs) in the operated leg and greater GRF asymmetries in both phase-specific and functional data analysis (FDA) approaches compared with patients with higher subjective knee function.

Study Design:

Descriptive laboratory study.

Methods:

The GRFs of the operated and nonoperated legs of 40 patients who previously underwent ACL reconstruction (patellar tendon) were analyzed during unilateral and bilateral countermovement jumps at a mean 2.5 years after surgery. The patients were separated into 2 groups depending on their International Knee Documentation Committee (IKDC) Subjective Form score: low IKDC and high IKDC.

Results:

Both phase-specific and FDA approaches showed lower GRF values in the operated compared with the nonoperated leg within the low-IKDC group during bilateral jumps. Moreover, lower GRF values were also present in the operated and nonoperated legs in the low-IKDC group compared with those of the high-IKDC group. Differences in GRFs were predominantly observed during the eccentric deceleration phase of jumping.

Conclusion:

Patients with previous ACL reconstruction who have limited subjective knee function have lower GRF values and greater GRF asymmetries, suggesting the use of interlimb compensation strategies.

Clinical Relevance:

The study results lead to a better understanding of the motor control needed during the eccentric and concentric movement phases of unilateral and bilateral jumps in patients who have undergone ACL reconstruction.
Return to Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Football League Linemen
Authors: Cinque Mark E. , Hannon Charles P. , Bohl Daniel D. , Erickson Brandon J. , Verma Nikhil N. , Cole Brian J. , Bach Bernard R.
Published: June 2017

Background:

Tears of the anterior cruciate ligament (ACL) are common in the National Football League (NFL). The impact of these injuries on the careers of NFL linemen is unknown.

Purpose:

To define the percentage of NFL linemen who return to sport (RTS) after ACL reconstruction, the mean time to RTS, and the impact on performance compared with matched controls.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data on NFL offensive and defensive linemen who sustained an ACL tear and underwent ACL reconstruction between 1980 and 2015 were analyzed. Players were identified through NFL team websites, publicly available injury reports, player profiles, and press releases. Demographics and mean in-game performance data preinjury and post–ACL reconstruction were recorded. A player was deemed to have returned to sport if he played in at least 1 NFL game after his ACL reconstruction. A healthy control group was selected to compare in-game performance data and was matched with the study group on several parameters.

Results:

Overall, 73 NFL linemen met the inclusion criteria; 47 (64.3%) returned to play after ACL reconstruction (62.5% of offensive linemen, 65.9% of defensive linemen). All offensive linemen successfully returned to play the season after injury. No difference existed in number of seasons, total number of games played, mean number of games played, or mean number of games started per season when offensive linemen who RTS after ACL reconstruction were compared with matched controls (all P > .05). Among defensive linemen who RTS, most returned the season after injury (88.9%). There was no difference between defensive linemen who RTS after ACL reconstruction and matched controls in any performance metrics as an average over the remainder of their career (all P > .05). However, NFL defensive linemen who tore their ACL played fewer total seasons than matched controls ( P = .020).

Conclusion:

Overall, 64.3% of NFL offensive and defensive linemen who undergo ACL reconstruction returned to play. Linemen who RTS do so at a high level, with no difference in in-game performance or career duration when compared with matched controls.
Critical elements in non-sulfide Zn deposits: a reanalysis of the Kabwe Zn-Pb ores (central Zambia)
Authors: Mondillo N. , Herrington R. , Boyce A. J. , Wilkinson C. , Santoro L. , Rumsey M.
Published: June 2017

The Kabwe Zn-Pb deposit (central Zambia) consists of a cluster of mixed sulfide and non-sulfide orebodies. The sulfide ores comprise sphalerite, galena, pyrite, chalcopyrite and accessory Ge-sulfides (±Ga and In). The non-sulfide ores comprise: (1) willemite-dominated zones encasing massive sulfide orebodies and (2) oxide-dominated alteration bands, overlying both the sulfide and Zn-silicate orebodies. This study focuses on the Ge, In and Ga distribution in the non-sulfide mineralization, and was carried out on a suite of Kabwe specimens, housed in the Natural History Museum Ore Collection (London). Petrography confirmed that the original sulfides were overprinted by at least two contrasting oxidation stages dominated by the formation of willemite (W1 and W2), and a further event characterized by weathering-related processes. Oxygen isotopic analyses have shown that W1 and W2 are unrelated genetically and furthermore not related to supergene Zn-Pb-carbonates in the oxide-dominated assemblage. The δ18O composition of 13.9–15.7‰ V-SMOW strongly supports a hydrothermal origin for W1. The δ18O composition of W2 (−3.5‰ to 0‰ V-SMOW) indicates that it precipitated from groundwaters of meteoric origin in either a supergene or a low-T hydrothermal environment. Gallium and Ge show a diversity of distribution among the range of Zn-bearing minerals. Gallium has been detected at the ppm level in W1, sphalerite, goethite and hematite. Germanium occurs at ppm levels in W1 and W2, and in scarcely detectable amounts in hemimorphite, goethite and hematite. Indium has low concentrations in goethite and hematite. These different deportments among the various phases are probably due to the different initial Ga, In and Ge abundances in the mineralization, to the different solubilities of the three elements at different temperatures and pH values, and finally to their variable affinities with the various minerals formed.
GATA2 haploinsufficiency accelerates EVI1-driven leukemogenesis
Authors: Katayama Saori , Suzuki Mikiko , Yamaoka Ayaka , Keleku-Lukwete Nadine , Katsuoka Fumiki , Otsuki Akihito , Kure Shigeo , Engel James Douglas , Yamamoto Masayuki
Published: June 2017

Key Points

Leukemic cells in an inv(3)(q21q26) EVI1 misexpression mouse model are able to differentiate toward myeloid lineage. Gata2 heterozygous deletion accelerates EVI1 misexpression leukemia by inducing a proliferation and differentiation defect in leukemia cells.
A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy
Authors: Kong Zhangyuan , Qin Ping , Xiao Shan , Zhou Hai , Li Hong , Yang Renchi , Liu Xiaofan , Luo Jianmin , Li Zhichun , Ji Guochao , Cui Zhongguang , Bai Yusheng , Wu Yuxia , Shao Linlin , Peng Jun , Ma Jun , Hou Ming
Published: June 2017

Key Points

rhTPO is a potentially effective and safe treatment option for ITP during pregnancy.
The impact of blood glucose on community-acquired pneumonia: a retrospective cohort study
Authors: Jensen Andreas Vestergaard , Egelund Gertrud Baunbæk , Andersen Stine Bang , Trier Petersen Pelle , Benfield Thomas , Faurholt-Jepsen Daniel , Rohde Gernot , Ravn Pernille
Published: June 2017

Hyperglycaemia is common in patients with community-acquired pneumonia (CAP) and is a predictor of severe outcomes. Data are scarce regarding whether this association is affected by diabetes mellitus (DM) and also regarding its importance for severe outcomes in hospital. We determined the impact of blood glucose on severe outcomes of CAP in hospital.

We studied 1318 adult CAP patients hospitalised at three Danish hospitals. The association between blood glucose and DM status and severe clinical outcome (admission to an intensive care unit (ICU) and/or in-hospital mortality) was assessed by logistic regression. Models were adjusted for CURB-65 score and comorbidities.

12% of patients had DM. In patients without DM an increase in admission blood glucose was associated with risk for ICU admittance (OR 1.25, 95% CI 1.13–1.39), but not significantly associated with in-hospital mortality (OR 1.10, 95% CI 0.99–1.23). In patients with DM an increase in admission blood glucose was not associated with ICU admittance (OR 1.05, 95% CI 1.00–1.12) or in-hospital mortality (OR 1.05, 95% CI 0.99–1.12).

An increase in admission blood glucose (only in patients without DM) was associated with a higher risk for ICU admittance and a trend towards higher in-hospital mortality. DM was not associated with a more severe outcome of CAP.
Corticosteroid-resistant inflammatory signalling inPseudomonas-infected bronchial cells
Authors: Mizutani Mirai , Bérubé Julie , Ahlgren Heather G. , Bernier Joanie , Matouk Elias , Nguyen Dao , Rousseau Simon
Published: June 2017

Decreasing the inflammatory response that leads to tissue damage during cystic fibrosis (CF) lung disease has been a long-standing goal of CF therapy. While corticosteroids are widely used anti-inflammatory drugs, their efficacy in CF lung disease remains debated. The complex interaction between the colonising bacteria and the host environment may impact corticosteroid responsiveness.

In this study, sputum samples from adult CF patients were collected at baseline and during pulmonary exacerbation episodes. Lung function measurements and sputum microbiological analyses were performed. In parallel, the inflammatory response and corticosteroid sensitivity of airway epithelial cells toPseudomonas-derived exoproducts was investigated.

We report that adult CF patients colonised with mucoidPseudomonas aeruginosahave higher levels of baseline inflammation, more frequent exacerbations and worse lung function compared with patients colonised with nonmucoidP. aeruginosa. Moreover, mucoidP. aeruginosaactivates NF-κBviaToll-like receptor (TLR) 2, which acts in an additive manner to TLR5 to drive inflammation in airway epithelial cells. Furthermore, TLR2-mediated intracellular signalling is more resistant to the anti-inflammatory effects of corticosteroid when compared with other TLR signalling pathways.

Overall, these results suggest that airway inflammation triggered by mucoidP. aeruginosais less responsive to the anti-inflammatory action of corticosteroids. Whether this translates into a diminished response of CF patients to corticosteroid therapy should be examined in future clinical studies.
Up-regulation of EP2 and EP3 receptors in human tolerogenic dendritic cells boosts the immunosuppressive activity of PGE2
Authors: Flórez-Grau Georgina , Cabezón Raquel , Borgman Kyra J E , España Carolina , Lozano Juan Jose , Garcia-Parajo Maria F , Benítez-Ribas Daniel
Published: June 2017

Dendritic cells (DCs) are APCs essential in regulating the immune response. PGE2, produced during inflammation, has a pivotal role in the maturation of DCs and, therefore, is vital for the immune response. The large variety of biologic functions governed by PGE2 is mediated by its signaling through 4 distinct E-type prostanoid (EP) receptors. Immunogenic DCs express EP2 and EP4, which mediate the PGE2 signaling. However, the expression and function of EP receptors in human tolerogenic DCs (tol-DCs), which present an inhibitory phenotype, have not yet, to our knowledge, been assessed. To clarify the role of EP receptors in tol-DCs, we examined the expression of different EP receptors and their effect using selective agonists in human cells. We find that EP2 and EP3 expression are up-regulated in in vitro–generated tol-DCs compared with mature DCs (mDCs). Activation of EP2–EP4 has a direct effect on the surface expression of costimulatory molecules and maturation receptors, such as CD80, CD83, and CD86 or MHCII and CCR7 in tol-DCs, the latter being exclusively modulated by PGE2–EP4 signaling. Importantly, we find that EP2 and EP3 receptors are involved in tolerance induction through IL-10 production by tol-DCs. These results are in sharp contrast with the inflammatory role of EP4. Moreover, we show that DCs generated in the presence of agonists for EP receptors, induce naive T cell differentiation toward polarized Th1/Th17 cells. Given the differential effects of EP receptors, our results suggest that EP receptor agonist/antagonists might become relevant novel drug templates to modulate immune response.
Supporting carers of people with dementia: What is effective?
Authors: Jackson Graham A. , Browne Debbie
Published: June 2017

Carer stress is well documented, especially in those caring for individuals with dementia. A recommendation of all national dementia strategies is to provide excellent support and information to informal carers of people with dementia. NICE guidance suggests that a range of tailored interventions, including psychological input, psychoeducation and training courses, should be offered to reduce caregiver burden and stress, although good-quality outcome-based evidence is lacking. On the basis of a narrative review of the literature, we describe individual and multicomponent carer support packages and discuss their evidence base, reflecting on outcomes for carers. Multicomponent interventions have the best evidence for effectiveness.

Learning Objectives

• Consider the risks of both physical and psychological harm experienced by carers of people with dementia (often referred to as carer burden or caregiver burden)

• Be aware of the interventions available for the support of carers of people with dementia

• Consider the evidence for the effectiveness of these interventions and be aware of the limitations of the evidence
Malingering mental disorders: Clinical assessment
Authors: Tracy Derek K. , Rix Keith J. B.
Published: June 2017

Malingering is the dishonest and intentional production of symptoms. It can cause considerable difficulty as assessment runs counter to normal practice, and it may expose clinicians to testing medicolegal situations. In this first part of a two-article review, we explore types of psychiatric malingering and their occurrence across a range of common and challenging scenarios, discussing presentations that may help delineate true from feigned illness. A framework is provided for undertaking an assessment where malingering is suspected, including recommendations on clinician approach, the use of collateral information, and self-evaluation of biases. The uses, and limitations, of psychometric tests are discussed, including ‘general’, malingering-specific and ‘symptom validity’ scales.

Learning Objectives

• Understand the challenges of determining ‘real’ from ‘malingered’ symptomatology across a range of psychiatric conditions

• Have a rational strategy for approaching a clinical assessment where malingering is suspected

• Appreciate the role and limitations of various psychometric tests that can be used in such assessments
Statutory wills: Doing the right thing under the Mental Capacity Act 2005
Authors: Milward Kathryn , Curtice Martin , Harding Rosie
Published: June 2017

Statutory wills are made under the Mental Capacity Act 2005 (MCA) for persons who lack testamentary capacity. Mental health practitioners are likely to be familiar with many of the provisions of the MCA and the test for testamentary capacity. However, they may not have encountered statutory wills. This article explains the procedure for applying for a statutory will, including the role of medical practitioners. Salient legal cases are summarised to highlight the difficulties in applying a best interests framework for decision-making in the context of statutory wills. Finally, this article considers how the United Nations Convention on the Rights of Persons with Disabilities (CRPD) might affect not only on statutory wills, but also the wider provisions of the MCA.

Learning Objectives

• Be able to explain statutory wills and the application procedure to a patient or carer

• Understand the differences between the test for testamentary capacity (as established inBanks v Goodfellow(1870)) and assessing capacity under the MCA

• Appreciate how the CRPD might affect the decision-making process, not only for statutory wills but for all decisions made under the MCA