bluuebunny/crossref_metadata_2025 huggingface dataset:
Technology to support relational care for people who use drugs at home: Literature review and key informant content
Authors: Szelest Izabela , Motluk Lori , Jennens Helen , Lagassé Jeannine , Tailleur Martin , Salvalaggio Ginetta
Published: May 2019

Canada’s opioid crisis is a public health emergency that disproportionately affects people who use drugs alone at home, requiring the mobilization of health systems to implement timely, effective, and innovative programs. The purpose of this review is to provide a synthesis of recent literature relating to technology-enabled harm reduction strategies. The results of the literature review are corroborated with key informants, including family members of people who use drugs and policy-makers in the area of opioid use. Based on this, it is recommended that technology-enabled support programs for people who use drugs at home must deliver support at whatever point the person is along their drug use continuum, must transfer frontline relational skills, must be co-developed with community members and service providers, and must deliver predictable and reliable services that are safe from stigma.
Organizational implications of implementing a new adverse drug event reporting system for care providers and integrating it with provincial health information systems
Authors: Small Serena S. , Hohl Corinne M. , Balka Ellen
Published: May 2019

Cross-sector collaborations between academia, government, and private industry, known as Triple Helix configurations, are increasingly common. In the health Information Technology (IT) sector, such configurations often also include health delivery organizations where technology is implemented and used. The complexity of collaborating within and between multiple organizations can present hurdles for innovators that are seldom discussed in the literature. We outline challenges we encountered in cross-sector collaboration and offer some guiding principles for decision-makers, academics, industry partners, and health delivery organizations to successfully negotiate divergent approaches to innovation and implementation. We discuss an innovative project that aims to implement a researcher-designed adverse drug event reporting system into clinical care and integrate it with provincial and health authority IT systems. Based on our experience, implementing an interoperable health IT system must extend beyond technical integration to encompass meaningful stakeholder engagement to ensure utility for end-users and beneficial impact for participating organizations.
A Collaborative Initiative for Reducing Operating Room Waste of Unused Refrigerated Medication
Authors: Tsang Dawn K. , Deng Jin , Enten Garrett , Coleman Debra , Dansby Mary , Pease Sonya , Camporesi Enrico M.
Published: May 2019

Background:

Inappropriate management of anesthetic medications requiring refrigeration creates waste and increases costs of intraoperative care. At Tampa General Hospital, pharmacy personnel refill medications in cardiovascular operating rooms (CVOR) nightly and noticed large amounts of unattended medications at room temperature for unknown periods of time. Per protocol, these medications were disposed.

Objective:

To effectively decrease pharmaceutical waste in the CVOR.

Methods:

A pharmacy-led anesthesia committee identified the most used intraoperative medications requiring refrigeration and implemented changes to decrease waste. As a result, norepinephrine intravenous piggyback (IVPB), norepinephrine vials, nitroglycerin vials, and epinephrine IVPB were physically relocated into preexisting mini-refrigerators inside each CVOR. Vasopressin vials and phenylephrine syringes/vials were relocated into automated anesthesia cabinets. Amounts and cost of wasted medication were analyzed before and after protocol implementation.

Results:

Average weekly cost of wasted medication was significantly reduced (preintervention: US$1188.59 vs postintervention: US$322.96; P < .001), despite a consistent caseload.

Conclusion:

Recorded weekly savings of US$865.63 (∼annual savings of >US$45 000) reflect only the explicit cost of waste. True savings are higher when including opportunity costs such as salary of pharmacy personnel and supplies needed to replace wasted medications. We demonstrate the benefits of a collaborative approach to improving inefficiencies in health care.
Compliant assembly analysis including initial deviations and geometric nonlinearity, part II: Plate structure
Authors: Liu Tao , Li Zhi-min , Jin Sun , Chen Wei
Published: May 2019

Part I of this paper (Liu et al., “Compliant assembly analysis including initial deviations and geometric nonlinearity, part I: Beam structure”) has studied the variation propagation of beam structures with consideration of initial deviations and geometric nonlinearity. In practices, plate structures are more commonly used in manufacturing fields, and the attempt of this paper is to expand previous methodology for the assembly process of orthotropic composite plate structures. Similarly, initial deviations and von Kármán-type geometric nonlinearity are introduced into variation analysis model, with Mindlin plate theory accounting for shear effect. The analyzed plates are set as orthotropic composite materials, which also preserve the compatibility with isotropic metal materials. Governing equations and corresponding finite element expressions can be obtained by applying the principle of virtual work. Also, a linearized model or noninitial model can be regarded as a degradation of origin governing equations. A variation analysis approach for plate structures is proposed to make more refined assembly variation predictions with consideration of initial deviations, fixture errors, and matching deviations. The verification of the developed method is implemented with case studies on springback prediction of two composite plates assembly.
Effect of blade tip grooving on the performance of an axial fan at different tip clearances in the absence and presence of inlet guide vanes
Authors: Kharati-Koopaee Masoud , Moallemi Hossein
Published: May 2019

This research aims at the numerical study of the blade tip grooving effect on the performance of a ducted axial fan at different tip clearances in the absence and presence of inlet guide vanes. To do this, significant parameters of the fan (i.e. pressure and torque coefficients as well as fan efficiency) comprising single- and double-grooved tips are evaluated and compared with those of the original fan. Validation of the considered numerical model is performed through comparison of the numerical findings with experimental results of a single-stage ducted fan, which comprises a set of 37 guide vane and 24-blade rotor rotating at the speed of 3600 r/min. Results reveal that grooving the blade tip causes the fan parameters to increase and higher fan parameters could be attained adopting single-grooved tip. It is shown that employing grooved blades causes the sensitivity of fan parameters to the change in the tip clearance to diminish. Results exhibit that the impact of grooving the blade on the reduction of sensitivity of fan parameters to the change in the tip clearance for the single-grooved tip in the absence of guide vanes is more remarkable than the other cases and in this case, as the tip clearance increases from the lower to the upper considered value, the decreased percentages in pressure coefficient, torque coefficient, and fan efficiency are 29.8%, 8.9%, and 22.8%, respectively. Numerical findings show that the influence of grooving the blade on the fan parameters in the presence of guide vanes is lower than that without guide vanes and in the presence of guide vanes, the highest average increase percentages in pressure coefficient, torque coefficient, and fan efficiency relative to those of the original fan, which is observed in the single grooved tip, are 3.1%, 1.4%, and 1.7%, respectively.
Pomalidomide Reduces Ischemic Brain Injury in Rodents
Authors: Tsai Yan-Rou , Tweedie David , Navas-Enamorado Ignacio , Scerba Michael T. , Chang Cheng-Fu , Lai Jing-Huei , Wu John Chung-Che , Chen Yen-Hua , Kang Shuo-Jhen , Hoffer Barry J. , de Cabo Rafael , Greig Nigel H. , Chiang Yung-Hsiao , Chen Kai-Yun
Published: May 2019

Stroke is a leading cause of death and severe disability worldwide. After cerebral ischemia, inflammation plays a central role in the development of permanent neurological damage. Reactive oxygen species (ROS) are involved in the mechanism of post-ischemic inflammation. The activation of several inflammatory enzymes produces ROS, which subsequently suppress mitochondrial activity, leading to further tissue damage. Pomalidomide (POM) is a clinically available immunomodulatory and anti-inflammatory agent. Prior cellular studies demonstrate that POM can mitigate oxidative stress and lower levels of pro-inflammatory cytokines, particularly TNF-α, which plays a prominent role in ischemic stroke-induced brain damage and functional deficits. To evaluate the potential value of POM in cerebral ischemia, POM was initially administered to transgenic mice chronically over-expressing TNF-α surfactant protein (SP)-C promoter (SP-C/TNF-α mice) to assess whether systemically administered drug could lower systemic TNF-α level. POM significantly lowered serum levels of TNF-α and IL-5. Pharmacokinetic studies were then undertaken in mice to evaluate brain POM levels following systemic drug administration. POM possessed a brain/plasma concentration ratio of 0.71. Finally, rats were subjected to transient middle cerebral artery occlusion (MCAo) for 60 min, and subsequently treated with POM 30 min thereafter to evaluate action on cerebral ischemia. POM reduced the cerebral infarct volume in MCAo-challenged rats and improved motor activity, as evaluated by the elevated body swing test. POM’s neuroprotective actions on ischemic injury represent a potential therapeutic approach for ischemic brain damage and related disorders, and warrant further evaluation.
Impact of co-mixing technique and surface modification of ZnO nanoparticles using stearic acid on their dispersion into HDPE to produce HDPE/ZnO nanocomposites
Authors: Benabid FZ , Kharchi N , Zouai F , Mourad Abdel-Hamid I , Benachour D
Published: May 2019

In this article, the effectiveness of the co-mixing processing technique and surface modification of zinc oxide (ZnO) filler on the characteristics of the developed high-density polyethylene (HDPE)/ZnO was investigated. ZnO was treated and co-mixed with stearic acid (SA) at a ratio of 50/50 wt% using kitchen coffee grinder and the mixture was then added to the HDPE matrix in a Brabender plastograph with various ZnO contents of 0.5, 1 and 2 wt%. The morphology of the nanocomposites was characterized using scanning electron microscopy (SEM). The micrographs showed well and uniform dispersion of both treated and untreated ZnO nanofiller; however, the treated ZnO particles showed better dispersion. The nanocomposite containing 1 wt% ZnO nanoparticles was found to have the optimal properties. The results of the SEM were supported by the atomic force microscopic technique. The uniform dispersion of ZnO was further investigated through X-ray diffraction spectra. The minor peaks of ZnO in the HDPE/treated and untreated ZnO nanocomposites are considered as an evidence for the presence of uniform and well-dispersed ZnO. The electrical conductivity of the nanocomposite samples is higher than that of neat HDPE due to the semiconducting nature of ZnO and increases with ZnO content. The results of this work proved that dispersibility can be achieved through the addition of SA and conductivity of the nanocomposite depends on the ZnO content. Moreover, co-mixing technique and the surface modification of the nanofillers are very effective in producing the HDPE/ZnO nanocomposites that have many potential industrial applications such as food packaging, drug and pharmaceutical bottles.
Women’s Labour, Patriarchy and Feminism in Twenty-first Century Kerala: Reflections on the Glocal Present
Authors: Devika J.
Published: May 2019

This article focuses on two sites in late 20th to early 21st century Malayali society to examine the transformative effects of global flows on the gender dynamics of each—labour and feminist interventions—to reflect on the shape of, and resistance to, post-liberalisation patriarchy in Kerala. As is well known, labour migration to the Persian Gulf from Kerala from the 1970s has been a decisive flow that has impacted all aspects of life in the state. Its impact on the family as a procreative unit has, however, been only probed superficially. I argue that the opening of the global job market, combined with other features of contemporary Malayali society, has transformed the very functioning of the nuclear family unit. In feminist politics, global flows have led to the surfacing of several ‘regulative universals’, and these flows take place through a variety of channels. The clash now is no longer between the indigenous and the foreign, but between ‘glocally generated’ hybrids.
Long-Term Outcomes for Transition-Age Youth With Mental Health Conditions Who Receive Postsecondary Education Support
Authors: Anand Priyanka , Honeycutt Todd C.
Published: May 2019

This article examines the relationship between receiving support for postsecondary education (college or vocational training) from state vocational rehabilitation (VR) agencies and long-term outcomes for youth with mental health conditions (MHCs). We use longitudinal data to follow three cohorts of youth VR applicants for 9 years after they applied for VR services. The results show a strong relationship between receipt of postsecondary education support and long-term employment, earnings, and federal disability benefit receipt. For some outcomes, such as being employed in the 9 years after VR application, the number of years employed, and benefit receipt in the 9 years after VR application for those who did not receive benefits at the time of application, the association is larger for youth with MHCs than for those with other disabilities. These findings provide valuable descriptive estimates of the benefits of providing postsecondary education support for VR youth with MHCs and how these benefits compare with youth with other types of disabilities.
A combined analytical–numerical analysis on multidirectional finite bending of functionally graded temperature-sensitive hydrogels
Authors: Shojaeifard Mohammad , Rouhani Fatemeh , Baghani Mostafa
Published: May 2019

Recently, temperature-sensitive hydrogels have been employed widely in various applications such as switches and actuators. Considering the discontinuity in the stresses and deformation fields of multilayers, in this article, we developed a new analytical method to study the swelling-induced finite bending of temperature-sensitive functionally graded hydrogels under plane-strain condition. The cross-linked density distribution along strip thickness varies linearly or exponentially which causes the switch to bend in response to temperature variation. To clarify the actuation mechanism and probe the various effects of parameters on switches’ thermomechanical response, a semi-analytical approach is developed. Finite element method is employed to validate the deformation of functionally graded temperature-sensitive hydrogel layer results. The stresses and deformation fields, bending curvature, and semi-angle are investigated using semi-analytical and numerical methods for several cases in one-directional and bidirectional bending switches. The continuous stresses and deformation fields and multiple neutral axes are illustrated which have crucial role in designing switches.
A piezoelectric-based three-direction normal stress sensor for concrete structures
Authors: Hou Shuang , Cui Liuliang , Xu Xibing
Published: May 2019

Piezoelectric-based sensors are low cost, highly stable, responsive, and changeable in shapes, allowing them to be easily embedded within concrete structures to perform various monitoring tasks. In this research, an in-built piezoelectric-based three-direction stress sensor is proposed, which could monitor the internal normal stresses in three mutually orthogonal directions. The sensor has a cubic shape with edges of about 25 mm. It consists of three PZT (lead zirconate titanate) patches, each of which is sandwiched between a steel base and a square steel plate with epoxy. To test the sensors’ characteristics, a finite element analysis was carried out to investigate stress transfer inside the sensor. Besides, a servo-hydraulic machine was used to conduct a cyclic loading test, delivering compressive stress up to 30 MPa on the three sensors. Both the numerical simulation and experiment results have shown that the cross-interference effect between different directions is negligible. Also observed was a high level of consistency in the sensitivity of measurements, regardless of the monitoring direction and sensor. With the advantages of a simple structure, low cross interference, and consistent sensitivity, the proposed three-direction normal stress sensor has a great potential to be mass produced and used in monitoring the health state of structural concrete.
Masculinity and Suicidal Desire in a Community Sample of Homeless Men: Bringing Together Masculinity and the Interpersonal Theory of Suicide
Authors: Genuchi Matthew C.
Published: May 2019

Men’s high suicide death rates are likely associated with a range of factors, notably men’s conformity to predominant masculine gender role norms and men’s gender-related attitudes toward suicide death based on those norms. The purpose of this study was to investigate how two models integrating men’s conformity to hegemonic masculine gender role norms, perceived burdensomeness, and thwarted belongingness predict the existence and severity of suicidal ideation in a sample of men at high risk for suicide, homeless men. The study results indicated that multiple norms were predictive of the existence or severity of suicidal ideation while perceived burdensomeness predicted both suicide ideation and the severity of ideation.
Using the K-SADS psychosis screen to identify people with early psychosis or psychosis risk syndromes
Authors: Tsuji Thomas , Phalen Peter , Rakhshan Rouhakhtar Pamela , Millman Zachary , Bussell Kristin , Thompson Elizabeth , Demro Caroline , Roemer Caroline , Reeves Gloria , Schiffman Jason
Published: May 2019

Background:

Current methods to identify people with psychosis risk involve administration of specialized tools such as the Structured Interview for Psychosis-Risk Syndromes (SIPS), but these methods have not been widely adopted. Validation of a more multipurpose assessment tool—such as the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)—may increase the scope of identification efforts.

Methods:

We assessed the correspondence between SIPS-determined clinical high risk/early psychosis (CHR/early psychosis) status and K-SADS psychosis screen (child and parent reports and their combination) in a sample of 147 help-seeking individuals aged 12–25. Detailed classification results are reported.

Results:

Both the child and parent interviews on the K-SADS psychosis screen were strongly predictive of CHR/early psychosis status, although parent reports contributed no significant additional information beyond child reports. Across informants, the presence of either subthreshold hallucinations or subthreshold delusions was highly suggestive of CHR/early psychosis status as determined by SIPS interview (78% (child) and 74% (parent) accuracy).

Conclusions:

Subthreshold scores on the two-item K-SADS psychosis screen may be good indicators of the presence or absence of early signs of psychosis. The option of using a non-specialized assessment such as the K-SADS as a staged approach to assess for CHR/early psychosis status could increase rates of early psychosis screening and treatment.
Arabic as a heritage language: A scoping review
Authors: Visonà Mark Winston , Plonsky Luke
Published: May 2019

Aims and Objectives/Purpose/Research Questions:

Second language researchers have focused increasingly in recent years on “heritage language learners,” or adult learners who wish to learn, relearn, or improve their linguistic proficiency in a family language they spoke while growing up. The present study examines this domain with a particular focus on Arabic.

Design/Methodology/Approach:

We present in this paper a “scoping review” that systematically examines the theoretical approaches, methods, contexts, instruments, and linguistic foci found in empirical research on Arabic heritage language learning and learners. Following a comprehensive search, 34 empirical studies (27 journal articles and seven dissertations/theses) were identified that met our criteria.

Data and Analysis:

Each study was coded for the samples, designs, theoretical approaches, data collection instruments, and a number of other substantive and methodological features and practices. Frequencies and percentages of study features were then calculated.

Findings/Conclusions:

Among other results, the study revealed a variety of approaches to defining heritage learners/learning. Although studies in this domain most often employed cross-sectional designs and interviews to collect data, a variety of theoretical approaches both socially and cognitively oriented can be found.

Originality:

This study presents the first attempt to apply synthetic research techniques to the growing body of research on heritage language learning/learners.

Significance/Implications:

Our results describe this growing domain, identifying current trends and potentially fruitful directions for future research.
Conviviality and parallax in David Olusoga’s Black and British: A Forgotten History
Authors: Black Jack
Published: May 2019

Through examining the BBC television series, Black and British: A Forgotten History, written and presented by the historian David Olusoga, and in extending Paul Gilroy’s assertion that the everyday banality of living with difference is now an ordinary part of British life, this article considers how Olusoga’s historicization of the Black British experience reflects a convivial rendering of UK multiculture. In particular, when used alongside Žižek’s notion of parallax, it is argued that understandings of convivial culture can be supported by a historical importance that deliberately ‘shocks’, and subsequently dislodges, popular interpretations of the UK’s ‘white past’. Notably, it is parallax which puts antagonism, strangeness and ambivalence at the heart of contemporary depictions of convivial Britain, with the UK’s cultural differences located in the ‘gaps’ and tensions which characterize both its past and present. These differences should not be feared but, as a characteristic part of our convivial culture, should be supplemented with historical analyses that highlight but, also, undermine, the significance of cultural differences in the present. Consequently, it is suggested that if the spontaneity of conviviality is to encourage openness, then understandings of multiculturalism need to go beyond reification in order to challenge our understandings of the past. Here, examples of ‘alterity’ are neither ‘new’ nor ‘contemporary’, but instead, constitute a fundamental part of the nation’s history: of the ‘gap’ made visible in transiting past and present.
Integrated longitudinal and lateral guidance of vehicles in critical high speed manoeuvres
Authors: Sazgar Hadi , Azadi Shahram , Kazemi Reza , Khalaji Ali Keymasi
Published: May 2019

One of the most important and conventional manoeuvres, that is not easy to even skilled drivers, is the high-speed critical lane change on the highways. The main contribution of this study is the development of an integrated longitudinal and lateral guidance algorithm for these manoeuvres. This algorithm consists of two parts: the trajectory planning and the integrated control. In the first part, taking into account the position of the target vehicle for different accelerations, several trajectories are produced. Next, considering the dynamic capabilities of the vehicle, the most appropriate trajectory is selected. Since the proposed trajectory planning approach works algebraically, its computational cost is negligible, which is very valuable for practical implementations. In the second step, using a robust-integrated longitudinal–lateral controller, the control inputs are calculated and transmitted to the brakes, throttle and steering actuators. It should be noted that the trajectory planning and the integrated controller are based on the seven degrees of freedom model of the vehicle, and the nonlinear dynamics of the tyre and the dynamics of the brakes/throttle actuators are also taken into account. To assess the efficiency of the integrated longitudinal–lateral guidance algorithm, the full vehicle model is used in the CarSim–Simulink software. In order to have conditions closer to real applications, it is assumed that the yaw rate and the longitudinal and lateral accelerations of the vehicle are noisy, and the longitudinal and lateral velocities are predicted using the same signals. Obtained results for the critical collision avoidance manoeuvres confirm the effectiveness of the proposed planned trajectory and the good performance of the combined control method. In addition, the results indicate that the integrated control is robust against the variation of friction coefficient and unmodelled dynamics while maintaining the vehicle stability.
Organisational perspectives on the digital transformation of adult and continuing education: A literature review from a German-speaking perspective
Authors: Bernhard-Skala Christian
Published: May 2019

The digitalisation of adult and continuing education involves both a societal challenge and a policy demand to harness digital media for effective adult and continuing education provision. Therefore, this article adopts an organisational perspective on adult and continuing education, raising the question of what management knowledge is needed to support the introduction of digital learning formats in public and community-based adult and continuing education organisations. An international literature review is then performed. As a result, the author draws a picture of the current state of adult and continuing education digitalisation in Switzerland and Germany. Based on this ‘state of the German-speaking landscape’, he identifies that information technology-infrastructure, staff development and management/leadership are the most relevant challenges for implementing digital media in adult and continuing education organisations. These are taken as a structure for reviewing international studies and developing a research agenda. The proposed research agenda frames these three fields of investigation by the state of research. The conclusion outlines questions of strategy development and strategy implementation within an organisational theory framework as relevant fields for future research.
Meeting in the middle: Hybrid clay three-dimensional fabrication processes for bio-reef structures
Authors: Trilsbeck Matthew , Gardner Nicole , Fabbri Alessandra , Haeusler Matthias Hank , Zavoleas Yannis , Page Mitchell
Published: May 2019

Despite the relative accessibility of clay, its low cost and reputation as a robust and sustainable building material, clay three-dimensional printing remains an under-utilized digital fabrication technique in the production of architectural artefacts. Given this, numerous research projects have sought to extend the viability of clay three-dimensional digital fabrication by streamlining and automating workflows through computational methods and robotic technologies in ways that afford agency to the digital and machinic processes over human bodily skill. Three-dimensional printed clay has also gained prominence as a resilient material well suited to the design and fabrication of artificial reef and habitat-enhancing seawall structures for coastal marine environments depleted and disrupted by human activity, climate change and pollution. Still, these projects face similar challenges when three-dimensional printing complex forms from the highly plastic and somewhat unpredictable feed material of clay. In response, this article outlines a research project that seeks to improve the translation of complex geometries into physical clay artefacts through additive three-dimensional printing processes by drawing on the notion of digital craft and giving focus to human–machine interaction as a collaborative practice. Through the case study of the 1:1 scale fabrication of a computationally generated bio-reef structure using clay as a feed material and a readily available Delta Potterbot XLS-2 ceramic printer, the research project documents how, by exploiting the human ability to intuitively handle clay and adapt, and the machine’s ability to work efficiently and with precision, humans and machines can fabricate together. With the urgent need to develop more sustainable building practices and materials, this research contributes valuable knowledge of hybrid fabrication processes towards extending the accessibility and viability of clay three-dimensional printing as a resilient material and fabrication system.
Improvement of Urinary Incontinence, Life Impact, and Depression and Anxiety With Modified Pelvic Floor Muscle Training After Radical Prostatectomy
Authors: Pan Li-Hui , Lin Mei-Hsiu , Pang See-Tong , Wang Jeng , Shih Whei-Mei
Published: May 2019

Prostate cancer ranks second among male cancers in the United States in terms of death rate. Robot-assisted surgery (RAS) is now offered as the standard surgical procedure performed for radical prostatectomy. Urinary incontinence and erectile dysfunction were common complications after RAS prostatectomy. Patients felt ill-prepared after surgery, resulting in negative impacts on their quality of life. Pelvic floor muscle exercise is prioritized for patients with mild-to-moderate incontinence. The purpose of this study was to examine the effects of using resistance band pelvic floor muscle exercise for patients after RAS prostatectomy. A preexperimental single-group study was conducted for this study. A total of 43 patients completed the program. Urinary incontinence scale, Incontinence Impact Questionnaire, and Hospital Anxiety and Depression Scale were assessed at 0.5 months, 1 month, 2 months, and 3 months after urinary catheter removal. The results revealed that urinary incontinence, life impact, and depression and anxiety improved significantly as time went on. This study suggests that using simple and easy-to-learn resistance band pelvic floor muscle exercise program at home can benefit patients financially and reduce travel time.
Pharmacists’ lack of profession-hood: Professional identity formation and its implications for practice
Authors: Gregory Paul , Austin Zubin
Published: May 2019

Background:

Understanding the internalized, psychological sense of being a professional may provide important insight into understanding pharmacists’ behaviours and attitudes in practice.

Methods:

It is difficult to directly or quantitatively measure an internalized psychological state such as profession-hood. An indirect method was selected in which pharmacists who were themselves patients or caregivers were identified and invited to discuss their experiences, as a vehicle for better understanding how they relied upon personal and professional identities during high-stress, impactful times.

Results:

A total of 17 community pharmacists from southern Ontario participated in this study. Regardless of demographic background, participants reported little reliance on professional identity, knowledge or role as a pharmacist when advocating for themselves or a loved one.

Interpretation:

These findings suggest that community pharmacists have incomplete, separated or functional (rather than existential) professional identities. This lack of professional identity may influence behaviours in practice such as interactions with other health care professionals or patients or self-confidence in clinical decision-making.

Conclusions:

Further work is necessary to better understand the socialization and professional identity formation of pharmacists to help support them through the current evolution of pharmacy towards more interdependent and complex clinical roles and decision-making.
Estimated treatment effect of ticagrelor versus aspirin by investigator-assessed events compared with judgement by an independent event adjudication committee in the SOCRATES trial
Authors: Easton J Donald , Denison Hans , Evans Scott R , Knutsson Mikael , Amarenco Pierre , Albers Gregory W , Ladenvall Per , Minematsu Kazuo , Molina Carlos A , Wang Yongjun , Wong KS Lawrence , Johnston S Claiborne ,   for the SOCRATES Steering Committee and Investigators
Published: May 2019

Background

Adjudication of endpoints is a standard procedure in cardiovascular clinical trials. However, several studies indicate that the benefit of adjudication in estimating treatment effect may be limited.

Aims

This post hoc analysis of SOCRATES (NCT01994720) compared the treatment effects and investigated the agreement of clinical event assessment by site investigators and independent adjudicators.

Methods

SOCRATES compared ticagrelor and aspirin in 13,199 patients with acute minor stroke or high-risk transient ischemic attack. The primary endpoint was stroke, myocardial infarction, or death. Stroke was the major component of the primary endpoint and a secondary endpoint. The endpoints were adjudicated by a blinded independent committee. We compared the treatment effect on the primary endpoint and stroke alone based on the investigators' and adjudicators' assessments, and investigated the agreement rate on the stroke endpoint and major hemorrhages.

Results

The hazard ratios (95% confidence interval) for ticagrelor versus aspirin therapy for the primary endpoint were 0.89 (0.78–1.01) when calculated on adjudicator-assessed events and 0.88 (0.78–1.00) for investigator-assessed events. The hazard ratios (95% confidence intervals) for stroke were 0.86 (0.75–0.99) based on the adjudicators' diagnoses and 0.85 (0.75–0.97) based on the investigators' diagnoses. The overall agreement between adjudicator- and investigator-diagnosed stroke was 91%, and for major hemorrhages was 88%.

Conclusions

In SOCRATES, there was no clinically meaningful difference in the estimated treatment effect, on either the primary endpoint or stroke, by using investigator- or adjudicator-assessed events. Double-blind treatment outcome studies with stroke endpoints may not benefit from adjudication.

Trial Registration

ClinicalTrials.gov Identifier: NCT01994720.
Acute ischemic myelopathy treated with intravenous thrombolysis: Four new cases and literature review
Authors: Jankovic Jeremy , Rey Bataillard Vincianne , Mercier Noëlle , Bonvin Christophe , Michel Patrik
Published: May 2019

Background

Intravenous thrombolysis is a well-established treatment of ischemic stroke within 4.5 h. However, its effectiveness in acute ischemic myelopathy is unknown.

Purpose

We describe a series of four acute ischemic myelopathy patients treated with intravenous thrombolysis within 4.5 h and review the current literature to explore this treatment feasibility, potential safety, and efficacy.

Methods

We reviewed all routinely collected clinical, radiological, and follow-up data of patients with a final acute ischemic myelopathy diagnosis who received acute intravenous thrombolysis in our stroke network. We also reviewed thrombolyzed acute ischemic myelopathy patients in the literature.

Results

Four patients (three women) aged 57 to 83 years presented with acute uni- or bilateral extremity paresis, considered initially as cerebral strokes in two of them. After excluding contraindications by brain imaging in three, spinal computed tomography in one and confirmation of acute ischemic myelopathy on spinal magnetic resonance imaging in one patient, intravenous thrombolysis was administered at 135, 190, 240, and 245 min accordingly. Subacute diffusion-weighted imaging-magnetic resonance imaging confirmed acute ischemic myelopathy in all but one patient. Favorable outcome was achieved in two patients rapidly and in three patients at three-month follow-up. We identified seven other thrombolyzed acute ischemic myelopathy patients in the literature, who showed variable recovery and no hemorrhagic complications.

Conclusions

With appropriate acute imaging, intravenous thrombolysis after acute ischemic myelopathy is feasible and potentially safe within 4.5 h. Given the potential of benefit of thrombolysis in acute ischemic myelopathy, this treatment warrants further efficacy and safety studies.
A comprehensive review of chronic heart failure pharmacotherapy treatment approaches in African Americans
Authors: Tillman Frank , Kim Jennifer , Makhlouf Tanya , Osae Leah
Published: May 2019

Background:

Our aim was to review the published literature evaluating treatment approaches for chronic heart failure (HF), notably as it relates to African American patients.

Method:

We undertook a comprehensive database search (1986–2017) of PubMed, EMBASE, and Ovid/MEDLINE utilizing terms ‘African American’, ‘black’, ‘chronic heart failure’, ‘heart failure’, ‘medication’, ‘chronic therapy’, and ‘clinical trials’. Additional notable studies were obtained from ClinicalTrials.gov . Studies published in English that examine treatment modalities of chronic HF in African American and non-African American patients were included.

Results:

Examples of current gaps worthy of investigation include whether to maximize thiazides and calcium-channel blockers prior to adding renin–angiotensin system (RAS) inhibitors or beta blockers in HF with preserved ejection fraction; whether hydralazine/isosorbide dinitrate (ISDN) should be initiated during earlier HF stages; whether to prioritize hydralazine/ISDN over other agents such as RAS inhibitors; varying response of African Americans to different agents within drug classes; and the role of mineralocorticoid receptor antagonists.

Conclusion:

Further studies are needed in order for consensus guidelines to clarify how best to treat this population.
Distal biceps hook test – Sensitivity in acute and chronic tears and ability to predict the need for graft reconstruction
Authors: Luokkala Toni , Siddharthan Sijin K , Karjalainen Teemu V , Watts Adam C
Published: May 2019

Background

The aim of this study was to assess the sensitivity of distal biceps hook test – O’Driscoll hook test – in a retrospective series of acute and chronic distal biceps tendon tears and investigate the ability of the test to predict the need for graft reconstruction.

Methods

We retrospectively evaluated 234 consecutive distal biceps tendon tears operated in a single centre. The result of O’Driscoll hook test and perioperative findings of distal biceps were documented in standard fashion.

Results

The perioperative and O’Driscoll hook test data were available in 202 cases. The sensitivity for the distal biceps hook test was 78% in all tears and 83% in complete tears. The sensitivity was significantly lower in partial tears (30%) and in cases where lacertus fibrosus was found to be intact (45 %). When O’Driscoll hook test was positive and the delay from initial injury to operative intervention was eight weeks or more, there was over 75% probability of achilles tendon allograft reconstruction. When O’Driscoll hook test was negative, the probability of reconstruction even after 12 weeks’ delay was only 20%.

Discussion

O’Driscoll hook test is useful when establishing distal biceps tendon tear diagnosis, but a negative test does not exclude rupture. In delayed cases, a positive test may predict the need for reconstruction.
Physical Exams: Legal Liability (Versus Professional Norms)
Authors: Zirkel Perry A.
Published: May 2019

This article summarizes the facts and rulings of a relatively recent and representative federal appellate court decision concerning a parent’s civil rights lawsuit in response to a school nurse’s visual examination of a child’s “private parts.” The discussion of the court’s rulings extends to a sampling of related case law and, as in a previous NASN School Nurse Zirkel article, the difference between legal and professional boundaries.
Cobimetinib- and vemurafenib-induced granulomatous dermatitis and erythema induratum: A case report
Authors: Iafolla Marco AJ , Ramsay Jennifer , Wismer Judy , McWhirter Elaine
Published: May 2019

Metastatic melanoma is an aggressive malignancy. Survival can be increased with the combination of BRAF and MEK inhibition. BRAF inhibitor-induced cutaneous toxicities can be attenuated with MEK inhibition. Here, we describe the first reported case of a patient with metastatic melanoma who developed granulomatous dermatitis and erythema induratum when treated with combination BRAF (vemurafenib) and MEK inhibitor (cobimetinib) therapy and discuss the clinical features and management of dermatologic side-effects secondary to BRAF +/– MEK inhibition.
Incidental urological findings in patients undergoing computed tomography colonography for investigation of suspected colorectal cancer
Authors: Ahmad Adnan , Nettleton Jeremy , Hotston Matthew , Bradley Alison , Maskell Giles
Published: May 2019

Objective:

To determine the rate of incidental urological findings in patients undergoing computed tomography (CT) colonography/CT colonoscopy (CTC) for investigation of suspected colorectal cancer.

Methods:

Retrospective analysis of patients undergoing CTC between January 2011 and December 2013. All patients with new incidental urological findings were included with their type and number of urological findings. These were stratified as per the colonography reporting and data system (C-RADS) criteria, and a note made of any further imaging, intervention and histology where appropriate.

Results:

Within the time period, n = 1891 CTCs were undertaken. Of these, n = 333 (17.6%) had an incidental urological finding and n = 41 of these patients had dual incidental urological pathologies. In total, n = 49 had significant pathology which required monitoring, further imaging, and medical or surgical intervention; n = 12 required further imaging. In n = 1, the imaging result led to a decision to operate and in n = 9 the results excluded the need for surgical intervention; n = 24 underwent operative intervention. The rates of incidental urological findings were similar to those quoted in literature.

Conclusion:

Our study demonstrates a 17.6% rate of incidental urological findings. Of all findings, 13.1% were deemed significant to warrant further investigation or intervention, and 7.2% of patients with urological findings required intervention. CTCs can adequately image renal masses and further imaging of renal masses did not change management. Level of evidence: 4
Prosthetic Conduit Endocarditis With Nontuberculous Mycobacteria in a Child: Associated With the Water Mattress and Heater Chiller Unit
Authors: Sargent Helen M. , Crouch Gareth C. , Roberts Sally , Finucane A. Kirsten
Published: May 2019

There is a growing body of literature on infection with nontuberculous mycobacteria (NTM) associated with heater chiller units in the cardiac surgery population. We report a pediatric case undergoing reoperation for early right ventricle-to-pulmonary artery conduit stenosis. A successful outcome was achieved following excision of the infected conduit and six-week antibiotic treatment. To our knowledge, there is only one other pediatric cardiac case reported in the literature. Similar to the recently reported cases of infection associated with Mycobacterium chimaera in predominately adult patients after cardiac bypass surgery, we hypothesize that water-containing devices such as the heater chiller unit and water blanket acted as a reservoir for other NTM. With increasing awareness of NTM, we analyzed the 2015-2016 culture data on our fleet of eight heater chiller units. We identified an association between persistent positive cultures and the connection of a water mattress to the heater chiller unit circuit. This led us to abandoning the use of the mattress in pediatric cardiac surgery.
The Effects of English Learner Classification on High School Graduation and College Attendance
Authors: Johnson Angela
Published: May 2019

Descriptive evidence shows that English learners (ELs) have lower high school graduation and 4-year-college attendance rates than monolingual and fluent English users. Applying the regression discontinuity design to rich administrative data from a large district in California, this study identifies the first causal effects of initial EL classification on high school graduation and college enrollment. I also report the effects of maintaining EL status, or not reclassifying, after testing in each grade between third and eighth grades. I find no statistically significant impact of initial EL classification on high school graduation or college enrollment. Reclassification just before school transition (fifth and eighth grades) significantly affected the probabilities of on-time graduation and, conditional on college attendance, starting at a 4-year university and starting full-time.
The rise and fall of the kāvya project
Authors: Veluthat Kesavan
Published: May 2019

The Rāmāyana of Vālmīki is said to be the ‘first kāvya’ (poem) in Sanskrit, but the age of its compilation is uncertain. The Junagarh inscription of the Śaka ruler Rudradāman, ad 150, is the first datable Sanskrit poem belonging to the category of praśastis. Praśastis became increasingly common subsequently as a tool of flattery and means of monarchical legitimisation. In time it became normal for every sovereign to have a praśasti composed for himself, so that inscriptions carrying praśastis tended to become more and more numerous. The Harṣacarita of Bāṇa shows how long texts could carry this form of literature, which, in turn, would influence the style and similes of subsequently inscribed praśastis. The Palam Baoli inscription (1,276) shows how a praśasti could now be compiled without the court of the ruler (in this case Sultan Balban) being aware of it. Obviously, praśastis lost their political utility. Although subsequently too praśastis were composed, their legitimising role seems to have been over now. This boded ill for the kāvya form as well.
Nationalist representations of the Mughal state: The views of Tilak and Gandhi
Authors: Hasan Farhat
Published: May 2019

The Mughal Empire as the major polity in India preceding the colonial regime was seen by British historians as a Muslim regime, imposed over a Hindu majority, and this fitted into their picture of two irreconcilable religious camps, existing within India, whose mutual conflict was kept at bay only because of the intervention of the colonial power. Tilak accepted this picture and saw Shivaji as the leader of Hindu resistance against foreign, Muslim domination. His early views were, however, modified in later years when he realised that overtures should be made to Muslims in order to strengthen the national struggle. The tag of ‘foreign’ was removed from the Mughals. It was argued that because Akbar’s successors no longer followed his enlightened policy, Shivaji rose against the Mughals and so must be treated as a national hero. On the other hand, Gandhi from his South Africa days was not prepared to denounce Muslim rulers, including the Mughals, as foreigners or as evil. While not prepared to concede to any religion’s superiority over another, he was critical of what he thought to be Akbar’s attempt to unite all religions into one. On the other hand, he praised Mughal rulers for their tolerance and even defended Aurangzeb though on the basis only of what Mohammad Ali, for long his political associate, told him! Unlike Jawaharlal Nehru, Gandhi did not explicitly extol composite culture possibly because while he wished that all religions tolerate each other, he did not want them to get mixed up.