bluuebunny/crossref_metadata_2025 huggingface dataset:
Credit, Debt, and Inequality
Authors: Dwyer Rachel E.
Published: May 2018

Increasing access to diverse types of credit and spreading indebtedness across many social groups were significant economic developments of the twentieth century and into the twenty-first, with implications for social inequality and insecurity. This review evaluates the role of credit and debt in social inequality in the United States. Credit and debt shape inequalities along multiple pathways, in defining social inclusion and exclusion, directing life chances, and facilitating oppression. On the basis of this review, I conclude that building on the progress made in prior research calls for a relational approach to understanding credit, debt, and inequality that includes a focus on the powerful actors that benefit from a political economy increasingly dependent on credit and debt to distribute, regulate, and control social resources. I close by identifying outstanding questions that need to be answered in order to move forward our understanding of economic inequality and insecurity, as well as for social policy and the prospects for collective action.
Political (Mis)behavior: Attention and Lacunae in the Study of Latino Politics
Authors: Jones-Correa Michael , Al-Faham Hajer , Cortez David
Published: May 2018

The field of Latino politics has developed rapidly over the past decade, but some areas within the field have received more attention than others, with some topics remaining relatively overlooked. This article begins by reviewing three primary strands of the recent literature on Latino civic engagement, identity politics, and institutions. It then pivots off the 2016 election to highlight three additional lines of inquiry that are either understudied or where the findings in the literature remain conflicted: the effects of threat on Latino mobilization, the entry of new Latino voters into American politics, and Latino conservatism. Assessing the field, the article concludes by arguing for greater attention to understudied questions and against facile assumptions about Latinos in American politics.
Neratinib: Inching Up on the Cure Rate of HER2+ Breast Cancer?
Authors: Unni Nisha , Sudhan Dhivya R. , Arteaga Carlos L.
Published: May 2018

Neratinib was recently approved by the FDA for extended adjuvant treatment of HER2+ breast cancer. The ExteNET trial showed improvement in invasive disease-free survival (iDFS) in the neratinib arm compared with placebo. The benefit was more pronounced in patients with estrogen receptor–positive (ER+)/HER2+ tumors, suggesting bidirectional cross-talk between the ER and HER pathways. Clin Cancer Res; 24(15); 3483–5. ©2018 AACR.

See related article by Singh et al., p. 3486
Permanent Decompensated Congenital Hypothyroidism in Newborns with Whole-Blood Thyroid-Stimulating Hormone Concentrations between 8 and 10 mU/L: The Case for Lowering the Threshold
Authors: McGrath Niamh , Hawkes Colin P. , Mayne Philip , Murphy Nuala P.
Published: May 2018

Background: Congenital hypothyroidism (CHT) has a reported incidence of approximately 1 in 2,000–4,000 births. There is no consensus on the optimal cut-off whole-blood thyroid-stimulating hormone (TSH) concentration that should be used for newborn screening (NBS). The NBS programme in the Republic of Ireland has used a cut-off of 8 mU/L since 1979. The aim of this study was to determine if raising the cut-off to 10 mU/L would have resulted in undetected cases of permanent or decompensated CHT. Methods: All cases of CHT with a screening whole-blood TSH concentration between 8.0 and 9.9 mU/L were identified from the Republic of Ireland’s NBS programme. Baseline demographics and imaging results were recorded. All cases over 3 years of age were evaluated to determine if CHT was permanent or transient. Results: Of 2,361,174 infants screened in the Republic of Ireland between July 1979 and December 2016, a total of 1,063 babies were diagnosed with CHT and treated with levothyroxine. This included 33 (3.5%) infants with a whole-blood TSH concentration between 8 and 9.9 mU/L. Thirteen of these 33 infants had decompensated hypothyroidism with low plasma free thyroxine level at diagnosis and 9 (41%) of the 21 evaluable cases have confirmed permanent CHT. Conclusion: Although lowering screening TSH cut-offs can increase the cost of NBS, as well as anxiety for families, many infants with borderline increases in whole-blood TSH concentrations on NBS have persistent CHT and low thyroxine concentrations in infancy. We recommend that this is considered when developing and reviewing NBS protocols for identifying infants with CHT.
Primary Spinal Intradural Extraosseous Ewing Sarcoma in a Pediatric Patient: Case Report and Review of the Literature
Authors: Scantland Joshua T. , Gondim Mercia J. , Koivuniemi Andrew S. , Fulkerson Daniel H. , Shih Chie-Schin
Published: May 2018

Ewing sarcoma (ES) is an aggressive, primary bone malignancy with occasional soft tissue extension. Purely extra­osseous ES is rare. A primary intraspinal, intradural ES without bone involvement is exceedingly rare. ES may be differentiated from other primitive neuroectodermal tumors by molecular analysis. The authors report the case of a 14-year-old female who suffered an acute neurologic decline from a hemorrhagic, intraspinal, intradural ES. The patient has been tumor free for 2 years after the initial emergency surgery. Our management of the patient and a review of the literature are provided. Considering only those cases with molecular or genetic confirmation of ES, our patient is the fifth pediatric case reported in the English literature.
Clitoromegaly in Childhood and Adolescence: Behind One Clinical Sign, a Clinical Sea
Authors: Iezzi Maria L. , Lasorella Stefania , Varriale Gaia , Zagaroli Luca , Ambrosi Michela , Verrotti Alberto
Published: May 2018

The clitoris is a highly complex organ whose structure has only been clarified in recent years through the use of modern imaging techniques. Clitoromegaly is an abnormal enlargement of this organ. It may be congenital or acquired and is usually due to an excess of androgens in fetal life, infancy, or adolescence. Obvious clitoromegaly in individuals with ambiguous genitalia is easily identifiable, whereas borderline conditions can pass unnoticed. Case reports of clitoromegaly with or without clinical or biochemical hyperandrogenism are quite numerous. In these subjects, a comprehensive physical examination and an accurate personal and family history are needed to investigate the enlargement. We reviewed the literature on the conditions that may be involved in the development of clitoromegaly in childhood and adolescence.
Enhanced Cardiomyocyte NLRP3 Inflammasome Signaling Promotes Atrial Fibrillation
Authors: Yao Chunxia , Veleva Tina , Scott Larry , Cao Shuyi , Li Luge , Chen Gong , Jeyabal Prince , Pan Xiaolu , Alsina Katherina M. , Abu-Taha Issam , Ghezelbash Shokoufeh , Reynolds Corey L. , Shen Ying H. , LeMaire Scott A. , Schmitz Wilhelm , Müller Frank U. , El-Armouche Ali , Tony Eissa N. , Beeton Christine , Nattel Stanley , Wehrens Xander H.T. , Dobrev Dobromir , Li Na
Published: May 2018

Background:

Atrial fibrillation (AF) is frequently associated with enhanced inflammatory response. The NLRP3 (NACHT, LRR, and PYD domain containing protein 3) inflammasome mediates caspase-1 activation and interleukin-1β release in immune cells but is not known to play a role in cardiomyocytes (CMs). Here, we assessed the role of CM NLRP3 inflammasome in AF.

Methods:

NLRP3 inflammasome activation was assessed by immunoblot in atrial whole-tissue lysates and CMs from patients with paroxysmal AF or long-standing persistent (chronic) AF. To determine whether CM-specific activation of NLPR3 is sufficient to promote AF, a CM-specific knockin mouse model expressing constitutively active NLRP3 (CM-KI) was established. In vivo electrophysiology was used to assess atrial arrhythmia vulnerability. To evaluate the mechanism of AF, electric activation pattern, Ca
2+
spark frequency, atrial effective refractory period, and morphology of atria were evaluated in CM-KI mice and wild-type littermates.

Results:

NLRP3 inflammasome activity was increased in the atrial CMs of patients with paroxysmal AF and chronic AF. CM-KI mice developed spontaneous premature atrial contractions and inducible AF, which was attenuated by a specific NLRP3 inflammasome inhibitor, MCC950. CM-KI mice exhibited ectopic activity, abnormal sarcoplasmic reticulum Ca
2+
release, atrial effective refractory period shortening, and atrial hypertrophy. Adeno-associated virus subtype-9–mediated CM-specific knockdown of
Nlrp3
suppressed AF development in CM-KI mice. Finally, genetic inhibition of
Nlrp3
prevented AF development in CREM transgenic mice, a well-characterized mouse model of spontaneous AF.

Conclusions:

Our study establishes a novel pathophysiological role for CM NLRP3 inflammasome signaling, with a mechanistic link to the pathogenesis of AF, and establishes the inhibition of NLRP3 as a potential novel AF therapy approach.
Aspirin Effect on Adverse Pregnancy Outcomes Associated With Stage 1 Hypertension in a High-Risk Cohort
Authors: Hauspurg Alisse , Sutton Elizabeth F. , Catov Janet M. , Caritis Steve N.
Published: May 2018

Recently, the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines revised the recommendations for diagnosis of chronic hypertension. The new classification system includes a diagnosis of stage 1 hypertension in adults with blood pressures 130 to 139/80 to 89 mm Hg. We sought to compare outcomes among women at high risk for preeclampsia with stage 1 hypertension and assessed whether women with stage 1 hypertension had benefit from aspirin treatment compared with high-risk normotensive women. We performed a secondary analysis of the high-risk aspirin trial and included women with prior preeclampsia or diabetes mellitus. Among these women, 827 (81%) were classified as normotensive, whereas 193 (19%) were classified as stage 1 hypertensive. Among women receiving placebo, preeclampsia occurred significantly more often in women with stage 1 hypertension compared with normotensive high-risk women after adjustment for maternal age and body mass index (39.1% versus 15.1%; risk ratio, 2.49; 95% confidence interval, 1.74–3.55). Further, women with stage 1 hypertension had a significant risk reduction related to aspirin prophylaxis (risk ratio, 0.61; 95% confidence interval, 0.39–0.94) that was not seen in normotensive high-risk women (risk ratio, 0.97; 95% confidence interval, 0.70–1.34). Application of the American College of Cardiology/American Heart Association guidelines in a high-risk population demonstrates that in the setting of other risk factors, the presence of stage 1 hypertension is associated with a significantly increased risk of preeclampsia when compared with high-risk normotensive women. These findings emphasize the importance of recognition of stage 1 hypertension as an additive risk factor in women at high risk for preeclampsia and the benefit of aspirin.
Single‐ Versus 2‐Stent Strategies for Coronary Bifurcation Lesions: A Systematic Review and Meta‐Analysis of Randomized Trials With Long‐Term Follow‐up
Authors: Ford Thomas J. , McCartney Peter , Corcoran David , Collison Damien , Hennigan Barry , McEntegart Margaret , Hildick‐Smith David , Oldroyd Keith G. , Berry Colin
Published: May 2018

Background

The majority of coronary bifurcation lesions are treated with a provisional single‐stent strategy rather than an up‐front 2‐stent strategy. This approach is supported by multiple randomized controlled clinical trials with short‐ to medium‐term follow‐up; however, long‐term follow‐up data is evolving from many data sets.

Methods and Results

Meta‐analysis of randomized controlled trials evaluating long‐term outcomes (≥1 year) according to treatment strategy for coronary bifurcation lesions. Nine randomized controlled trials with 3265 patients reported long‐term clinical outcomes at mean weighted follow‐up of 3.1±1.8 years. Provisional single stenting was associated with lower all‐cause mortality (2.94% versus 4.23%; risk ratio: 0.69; 95% confidence interval, 0.48–1.00;
P
=0.049; I
2
=0). There was no difference in major adverse cardiac events (15.8% versus 15.4%;
P
=0.79), myocardial infarction (4.8% versus 5.5%;
P
=0.51), target lesion revascularization (9.3% versus 7.6%;
P
=0.19), or stent thrombosis (1.8% versus 1.6%;
P
=0.28) between the groups. Prespecified sensitivity analysis of long‐term mortality at a mean of 4.7 years of follow‐up showed that the provisional single‐stent strategy was associated with reduced all‐cause mortality (3.9% versus 6.2%; risk ratio: 0.63; 95% confidence interval, 0.42–0.97;
P
=0.036; I
2
=0).

Conclusions

Coronary bifurcation percutaneous coronary intervention using a provisional single‐stent strategy is associated with a reduction in all‐cause mortality at long‐term follow‐up.
Metapragmatic stereotypes about geographical diversity in Greece
Authors: Papazachariou Dimitris , Fterniati Anna , Archakis Argiris , Tsami Vasia
Published: May 2018

Over the past decades, contemporary sociolinguistics has challenged the existence of fixed and rigid linguistic boundaries, thus focusing on how the speakers themselves define language varieties and how specific linguistic choices end up being perceived as language varieties. In this light, the present paper explores the influence of metapragmatic stereotypes on elementary school pupils’ attitudes towards geographical varieties. Specifically, we investigate children’s beliefs as to the acceptability of geographical varieties and their perception of the overt and covert prestige of geographical varieties and dialectal speakers. Furthermore, we explore the relationship between the children’s specific beliefs and factors such as gender, the social stratification of the school location and the pupils’ performance in language subjects. The data of the study was collected via questionnaires with closed questions. The research findings indicate that the children of our sample associate geographical varieties with rural settings and informal communicative contexts. Moreover, children recognize a lack of overt prestige in geographical variation; at the same time, they evaluate positively the social attractiveness and the personal reliability of the geographical varieties and their speakers. Our research showed that pupils’ beliefs are in line with the dominant metapragmatic stereotypes which promote language homogeneity.
The Legal Enforceability of Articles 8.2 and 5.3 of the WHO Framework Convention on Tobacco Control: The Case of the Netherlands
Authors: Karapetian Gohar , Toebes Brigit
Published: May 2018

Since 2005, the WHO FCTC is binding on the Netherlands. Since that time, the Dutch courts have addressed Articles 8.2 and 5.3 FCTC on three occasions. In this article, we review these three cases in order to analyze the legal enforceability of Articles 8.2 and 5.3 FCTC in the Netherlands. Special attention is paid to the role the guidelines and recommendations adopted by the Conference of the Parties played in these cases. We observe that the legal enforceability of both articles depends on the specific circumstances of the case. We argue that the Dutch courts should have given more careful consideration to the FCTC guidelines and recommendations.
Reformed Protestantism and the Origins of Modern Environmentalism
Authors: Northcott Michael S.
Published: May 2018

The question I investigate in this essay is why it was individuals and regions with a Reformed Protestant religious background—rather than, say, Roman Catholic, Eastern Orthodox, Buddhist, or Taoist—which pioneered environmental campaigns and efforts to set aside national parks and rare species for conservation. Subsidiary questions discussed are two: (1) What might be the roots of an affinity between Protestantism and an ecological orientation to the world? (2) If there was this affinity in the nineteenth-century origins of ecological conservation, why is it not more widely acknowledged in contemporary scholarship and in the public mind?
In Search of a Sustainable Society in Africa: Christianity, Justice, and Sustainable Peace in a Changing Climate
Authors: Golo Ben-Willie Kwaku
Published: May 2018

The violence which humankind has visited not only on the natural world but also on human populations has resulted in negative environmental change which in turn induces diverse forms of violence in Africa. This has been threatening a sustainable society and human flourishing in Africa. Invited as Christ’s witnesses, Christians need to offer qualitative resources to forestall the violence that threatens human flourishing. What opportunities do these challenges offer Christian theologians and ethicists to provide life-transforming alternatives that enhance a sustainable African society? In this paper, I argue that considering the linkage between climate change and violence, a crucial transforming alternative towards a sustainable society in Africa is the quest for sustainable peace, realisable only within the context of justice (a just society)—specifically, climate and/or environmental justice. I intend to explore the Christian virtue of justice and its promise for a sustainable society, peace, and human flourishing in Africa.
Beyond Modernization: Development Cooperation as Normative Practice
Authors: Rademaker Corné J. , Jochemsen Henk
Published: May 2018

In 2010, the Dutch Scientific Council for Governmental Policy called for an explicit and adequate intervention ethics for policy on international development cooperation. Yet, as appears from a careful reading of their report, the council’s own overall commitment to a modernist worldview hinders the fruitful development of such an intervention ethics. There is, however, a strand in their thinking that draws attention to the importance of practical knowledge. We argue specifically that an intervention ethics for development cooperation in agriculture should start from this practical knowledge, which points to the inherent normativity of agricultural development cooperation. That is, agricultural development cooperation is a normative practice of which the inherent normativity consists in facilitating other practices in the agricultural domain. As such, agricultural development cooperation should respect the normativity inherent in those other practices.
A new species of Petalobrissus Lambert 1916 (Echinoidea: Faujasiidae) from the Jandaíra Formation, Potiguar Basin (Brazil)
Authors: ALVES JESSIKA , MONTEIRO FELIPE A. C. , MATTHEWS-CASCON HELENA , JOHNSSON RODRIGO , NEVES ELIZABETH G.
Published: May 2018

A new Late Cretaceous species of Petalobrissus, Petalobrissus lehugueurae sp. nov., is described from the Jandaíra Formation, Potiguar Basin, state of Rio Grande do Norte. To date, this genus comprises a total of 20 species, only two of which, Petalobrissus setifensis and Petalobrissus cubensis have so far been recorded from the Jandaíra Formation. Petalobrissus lehugeurae sp. nov. is distinguished from its congeners in that gonopores occupy only a small portion of the genital plates, in having a slit-like periproct and a unique abrupt depression of the test that forms a pronounced keel below the periproct. In addition, an identification key to species of Petalobrissus is presented.
How different reflective learning activities introduced into a postgraduate teacher training programme in England promote reflection and increase the capacity to learn
Authors: Mantle Melissa Jane Hannah
Published: May 2018

Student teachers in England are expected to learn from experience in order to become reflective practitioners and to achieve Qualified Teacher Status. This study is a qualitative project studying whether and how different reflective learning activities introduced into a postgraduate teacher training programme promote reflection and increase the capacity to learn. It takes an interpretative approach, generating qualitative data on the reflection of students and the most effective learning methods. The study took place over a one-year period in one teacher training institution. The data arose from Post Graduate Certificate of Education student teacher responses to different reflective learning activities and subsequent interviews followed by an evaluation of the effectiveness of the overall learning strategy. Of the four activities used to promote reflective learning (discussion groups, action learning sets, journals and interviews), the action learning sets had the most impact on the student teachers’ ability to reflect. The implication for initial teacher training programmes is that providers need to recognise the importance of oral reflection within a communal setting.
New Migrants’ Social Integration, Embedding and Emplacement in Superdiverse Contexts
Authors: Wessendorf Susanne , Phillimore Jenny
Published: May 2018

This article focuses on how newcomers form social relations when settling in the UK, and the role of these relations in regards to their sense of belonging as well as access to resources that support integration. By bringing together the concept of social integration with scholarship on embedding and sociabilities of emplacement, the article demonstrates how a combination of serendipitous encounters, ‘crucial acquaintances’ and more enduring friendships with other migrants, co-ethnics and members of the majority population support migrants’ settlement. Drawing on two qualitative studies on migrant settlement, it shows the importance of social relations with other migrants during settlement, and subsequently critically reflects on how the notion of ‘bridging social capital’ has been used in policy discourse. By doing so, the article contends that the notion of ‘integration’ needs to reflect the social ‘unit’ into which migrants are supposed to integrate.
Numerical analysis of the tension and twist of staple strands in embeddable and locatable spinning
Authors: Liu Keshuai , Zhou Yi , Xu Weilin
Published: May 2018

This study reports a numerical analysis on embeddable and locatable spinning systems. The finite element method is used to quantify the relationship between the tension and twist of staple strands and the spinning parameters. The model was constructed using the three-dimensional beam element, which is capable of simulating the stretching, bending and torsion behavior of the filament and the staple strand. It was found that the staple strand shares far less load (around 13.8%) than the filament during the spinning process. The twist is mainly distributed on the composite yarns and less on other zones. The pretension of the filament, the filament–strand distance ratio, the twist of the composite yarn and the material fed-in velocity were investigated for their influence on the tension and twist of the staple strand. Numerical predictions showed that higher filament tension and filament–strand ratio lead to less load and more twist on the staple strand. This is beneficial in producing stronger and smoother yarns and avoiding end breakages. It was also determined that strand tension and twist increase with an increase in composite yarn twist and a decrease in material fed-in velocity.
Statistical cut response of high-performance single fibers
Authors: Slusarski Kyle A , Taggart-Scarff Joshua K , Wetzel Eric D
Published: May 2018

Single high-performance fibers (Kevlar® K129, Twaron® 2040, Technora® T200, Dyneema® SK76, Zylon® AS, Vectran® HT, and S-glass) are subject to lateral cutting action by an industrial blade. Due to the inherent variability of such testing, 40–60 replicate experiments were performed for each fiber type, at each of three different loading orientations, and the data were fit with a generalized extreme value distribution to summarize likelihood of failure under each condition. The results show that when organic fibers are cut at an angle that introduces shear loads, cut resistance drops by 60–90% compared to normal-incidence cut loading. This trend is driven by the highly oriented and fibrillar nature of organic fibers, in contrast to the isotropic S-glass fibers which show comparatively little change in cut resistance with blade orientation. Overall, the Vectran fibers provide the best resistance to normal loading, while the S-glass fibers are most resistant to non-normal loading. Micrographs show that, for organic fibers, shear loads lead to more localized failure compared to normally loaded fibers.
Redefining the boundaries of Public Administration
Authors: Slagle Derek R , Williams Adam
Published: May 2018

The scope of the article is reinterpretation of the question posed by Rodgers and Rodgers, namely, are Public Administration scholarship produced by “disciplined purists” – Public Administration scholars producing Public Administration research – or “undisciplined mongrels”? The methodology diverges from previous analysis through examination of doctoral dissertation research classification, rather than faculty output in publications. Concomitantly, Biglan classification of disciplines was used as a framework to determine disciplinary classifications of “undisciplined” or interdisciplinary scholarship. Findings indicate that from 2000 to 2015, there were shifts toward Public Administration as a “purist” discipline. Not only are there changes toward a distinct discipline but also steady declines in outside discipline production of Public Administration doctoral research. The analysis demonstrated a statistically significant increase in categorization of Public Administration scholarship for subjects generally accepted as core issues. Another noted change was dramatic decline for the Doctor of Public Administration degree as the field redefined boundaries.
Reducing costs at the end of life through provider incentives for hospice care: A retrospective cohort study
Authors: Chen Bradley , Kuo Chin-Chi , Huang Nicole , Fan Victoria Y
Published: May 2018

Background:

Costs of medical care have been found to be highest at the end of life.

Aim:

To evaluate the effect of provider reimbursement for hospice care on end-of-life costs.

Design:

The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30 days of life.

Setting/participants:

A cohort of 151,509 patients with chronic kidney disease or cancer, aged 65 years or older, who died between 2005 and 2012 in the National Health Insurance Research Database, which contains all enrollment and inpatient claims data for Taiwan.

Results:

Even as end-of-life costs for cancer are declining over time, expanding hospice care benefits to end-stage renal disease patients is associated with an additional reduction of 7.3% in end-of-life costs per decedent, holding constant patient and provider characteristics. On average, end-of-life costs are also high for end-stage renal disease (1.88 times higher than those for cancer). The cost savings were larger among older patients—among those who died at 80 years of age or higher, the cost reduction was 9.8%.

Conclusion:

By expanding hospice care benefits through a provider reimbursement policy, significant costs at the end of life were saved.
Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives
Authors: Kuruvilla Lisha , Weeks Greg , Eastman Peter , George Johnson
Published: May 2018

Background:

Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised.

Aim:

To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps.

Design:

Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness.

Setting/Participants:

Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists.

Results:

Five major themes emerged from the focus groups: access to resources, medicines and information; shared care; challenges of polypharmacy; informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care.

Conclusion:

While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.
Altered folate binding protein expression and folate delivery are associated with congenital hydrocephalus in the hydrocephalic Texas rat
Authors: Jimenez Alicia Requena , Naz Naila , Miyan Jaleel A
Published: May 2018

Hydrocephalus (HC) is an imbalance in cerebrospinal fluid (CSF) secretion/absorption resulting in fluid accumulation within the brain with consequential pathophysiology. Our research has identified a unique cerebral folate system in which depletion of CSF 10-formyl-tetrahydrofolate-dehydrogenase (FDH) is associated with cortical progenitor cell-cycle arrest in hydrocephalic Texas (H-Tx) rats. We used tissue culture, immunohistochemistry, in-situ PCR and RT-PCR and found that the in-vitro proliferation of arachnoid cells is highly folate-dependent with exacerbated proliferation occurring in hydrocephalic CSF that has low FDH but high folate-receptor-alpha (FRα) and folate. Adding FDH to this CSF prevented aberrant proliferation indicating a regulatory function of FDH on CSF folate concentration. Arachnoid cells have no detectable mRNA for FRα or FDH, but FDH mRNA is found in the choroid plexus (CP) and CSF microvesicles. Co-localization of FDH, FRα and folate suggests important functions of FDH in cerebral folate transport, buffering and function. In conclusion, abnormal CSF levels of FDH, FRα and folate inhibit cortical cell proliferation but allow uncontrolled arachnoid cell division that should increase fluid absorption by increasing the arachnoid although this fails in the hydrocephalic brain. FDH appears to buffer available folate to control arachnoid proliferation and function.
Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps
Authors: Osendarp Saskia J. M. , Martinez Homero , Garrett Greg S. , Neufeld Lynnette M. , De-Regil Luz Maria , Vossenaar Marieke , Darnton-Hill Ian
Published: May 2018

Background:

Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance.

Objective:

To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC).

Methods:

A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a “snowball” process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact.

Results:

The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry.

Conclusions:

In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.
Framing terror: A content analysis of media frames used in covering ISIS
Authors: Boyle Kris , Mower Jordan
Published: May 2018

Media organizations all over the world spent a large amount of 2014 covering the influence and activities of the Islamic State in Iraq and Syria (ISIS). This study compares ISIS-related coverage among American, British and Middle Eastern media organizations, identifying the media frames used by these organizations. The findings reveal differences both in the amount of coverage and in the ways that each organization chose to frame its coverage.
Evaluating Screening Tests for Depression in Post-Stroke Older Adults
Authors: Wang Elizabeth Y. , Meyer Craig , Graham Glenn D. , Whooley Mary A.
Published: May 2018

Background:

Uncertainty surrounds which screening test to use in older patients with poststroke depression, in whom symptoms of depression are more complex and often occur in conjunction with other comorbidities. We evaluated screening tests for depression among a cohort of older ambulatory individuals with comorbid ischemic heart disease and prior stroke.

Methods:

We administered 4 depression screening instruments to 148 participants with ischemic heart disease and self-reported stroke from The Heart and Soul Study. Instruments included the 10-item Center for Epidemiologic Studies Depression Scale (CES-D), 9-item and 2-item versions of the Patient Health Questionnaire (PHQ-9 and PHQ-2), and the Whooley questions, a 2-item yes/no questionnaire. We administered the computerized version of the National Institute of Mental Health Diagnostic Interview Schedule as a gold standard.

Results:

Of the 148 participants, 35 (24%) had major depression. The Whooley questions demonstrated the highest sensitivity for detection (89%), followed by the CES-D (80%), PHQ-2 with cut point ≥2 (79%), PHQ-9 (51%), and PHQ-2 with cut point ≥3 (32%). The Whooley questions had a specificity of 0.66, a positive likelihood ratio of 2.61, and a negative likelihood ratio of 0.82. We observed no significant difference in the area under the receiver operating characteristic curve across the 4 instruments.

Conclusion:

In a cohort of ambulatory older adults with coronary heart disease and prior stroke, depression occurred in a fourth of the participants. The simple Whooley questions screening instrument can efficiently detect depression with a high sensitivity in this population, one representative of older patients commonly encountered within a primary care setting.
Good, Bad and Very Bad Part-time Jobs for Women? Re-examining the Importance of Occupational Class for Job Quality since the ‘Great Recession’ in Britain
Authors: Warren Tracey , Lyonette Clare
Published: May 2018

Britain has long stood out in Europe for its extensive but poor-quality part-time labour market dominated by women workers, who are concentrated in lower-level jobs demanding few skills and low levels of education, offering weak wage rates and restricted advancement opportunities. This article explores trends in part-time job quality for women up to and beyond the recession of 2008/9, and asks whether post-recessionary job quality remains differentiated by occupational class. A pre-recessionary narrowing of the part-time/full-time gap in job quality appears to have been maintained for the women in higher-level part-time jobs, while part- and full-timers in lower-level jobs suffered the worst effects of the recession, signalling deepening occupational class inequalities among working women.
Moving policy implementation theory forward: A multiple streams/critical juncture approach
Authors: Howlett Michael
Published: May 2018

Meta-reviews of the implementation literature have constantly bemoaned a lack of theory in this area. This is partially a function of the policy sciences having inherited a tradition of descriptive work in public administration, a historical phenomenon exacerbated by the more recent addition to this corpus of an equally atheoretical set of works in public management. As a result, the study of policy implementation within the policy sciences remains fractured and largely anecdotal, with a set of proto-theories competing for attention – from network management to principal–agent theory, game theory and others – while very loose frameworks like the ‘bottom-up vs. top-down’ debate continue to attract attention, but with little progress to show for more than 30 years of work on this subject. This article argues the way out of this conundrum is to revisit the subject and object of policy implementation through the lens of policy process theory, rather than appropriating somewhat ill-fitting concepts from other disciplines to this area of fields of study. In particular, it looks at the recent synthesis of several competing frameworks in the policy sciences – advocacy coalition, multiple streams and policy cycle models – developed by Howlett, McConnell and Perl and argues this approach, hitherto applied only to the ‘front end’ activities of agenda setting and policy formulation, helps better situate implementation activities in public policy studies, drawing attention to the different streams of actors and events active at this phase of public policy-making and helping to pull implementation studies back into the policy science mainstream.
Tolerance specification of the plane feature based on the axiomatic design
Authors: Zhao Qijian , Cao Yanlong , Liu Ting , Ren Lifei , Yang Jiangxin
Published: May 2018

Tolerance specification involves selecting tolerance types for functional or assembly features to control the variation of features. General methods tend to formulate a frame to specify all the features of part, while the specification methods or reasoning rules for specific feature (point, line, plane, cylinder, etc.) are less studied. This paper focuses on the tolerance-type selection of the plane feature. The theory of axiomatic design is introduced to select the tolerance type for the plane feature, and the problem is interpreted as a redundant decoupled design. To achieve the functional requirements, design parameters and constraints of physics domain are determined. The mapping rules, which are between design parameters and functional requirements, are generated based on the independent axiom. Considering the large number of solutions of the design, the constraints such as cost and inspection methods are introduced to reduce the number of solutions. The minimum information axiom is introduced for the optimum mapping rules and the tolerance types are selected by the optimum mapping rules for the plane feature. Finally, the specification process is concluded and demonstrated by means of an example.
Integrated guidance and control design considering system uncertainty
Authors: Chao Tao , Zhang Denghui , Wang Songyan , Ma Ping
Published: May 2018

The hypersonic vehicle has the characteristics of strong coupling, high uncertainty and complex nonlinearity, leading to an unsatisfactory control performance with the traditional design method. In this paper, an integrated guidance and control design approach is proposed to cope with this problem. A time-varying longitudinal integrated guidance and control model is first formulated, and then the overall uncertainty consisting of the un-modeled dynamic, parameter uncertainty and external disturbance is taken into account. A novel finite-time extended state observer is developed to estimate and compensate it in real time. Furthermore, an integrated guidance and control algorithm utilizing back-stepping method and the dynamic inverse is put forward. It has been theoretically proved that the finite-time extended state observer system and the cascade system are globally finite-time stable. Numerical simulation results under different kinds of uncertainty with different amplitude and frequency are presented to illustrate the effectiveness and feasibility of the proposed approach. The proposed integrated guidance and control possesses a better convergence performance and stronger disturbance rejection property in existence of the mismatched uncertainty and parameter uncertainty.
Lightweight and reliable metal–composite joints based on harmonization of strength properties of joined parts
Authors: Chernov Andrey , Fomin Danil , Kondakov Ivan , Mareskin Ivan , Shanygin Alexander
Published: May 2018

One of the key problems of designing composite primary aircraft structures is the problem of development of lightweight and reliable joints for such structures. For conventional bolted joints used for connection of laminated composite primary structure elements, the loads are transferred via the contact of metallic and composite parts having considerably different strength and stiffness parameters. As the local strength properties of composites are defined by polymer resins, having several times less strength as compared to the metallic alloys, the maximal load that can be transferred via the joint is limited by the properties of resins. As a consequence, the metallic parts of such joints are loaded to a very low extent, that causes low weight efficiency. In the presented paper, the approach to development of metal–composite joints based on the principle of harmonization is proposed. The harmonization principle is to minimize the disbalance of strength properties of metallic and composite parts in the local zones of contact. This principle can be realized by two ways: either by removing the resin from the zone of contact to increase local stiffness of composite part (“stiff” joint concept) or by creation of metallic part with porous structure to decrease local stiffness of the metallic part (“soft” joint concept). In this paper, the evaluation of both concepts is given, based on numerical and experimental investigations carried out in this work.
Feasibility of Patient-Reported Outcomes Measurement Information System (PROMIS®) computerized adaptive tests in systemic lupus erythematosus outpatients
Authors: Kasturi S , Burket J C , Berman J R , Kirou K A , Levine A B , Sammaritano L R , Mandl L A
Published: May 2018

Objective

The aims of this study were to assess the feasibility of administering Patient-Reported Outcomes Measurement Information System (PROMIS®) computerized adaptive tests (CATs) to outpatients with systemic lupus erythematosus (SLE).

Methods

Adults with SLE were recruited during routine outpatient visits at an SLE Center of Excellence. Participants completed 14 PROMIS CATs and provided feedback on their experience. Differences in socio-demographic and clinical characteristics between participants and non-participants were evaluated.

Results

A total of 204 (86%) of 238 socioeconomically and racially diverse SLE patients completed PROMIS CATs. There were no significant differences between participants and non-participants. Time constraints were cited most frequently as reasons for non-participation. More than 75% of individuals submitted positive comments, including approval of the content and format of questions, and the survey’s promotion of self-reflection. A minority of participants cited challenges, most often related to question phrasing (8%) and technical difficulties (6%).

Conclusions

The administration of PROMIS CATs was feasible and positively received in a diverse cohort of SLE outpatients. Neither socio-demographic nor disease characteristics were significant barriers to successful completion of PROMIS CATs. PROMIS CATs have great potential for efficiently measuring important patient-centered outcomes in routine clinical care of a wide range of SLE patients.
Dignity Impact as a Primary Outcome Measure for Dignity Therapy
Authors: Scarton Lisa , Oh Sungho , Sylvera Ashley , Lamonge Ralph , Yao Yingwei , Chochinov Harvey , Fitchett George , Handzo George , Emanuel Linda , Wilkie Diana
Published: May 2018

Background:

Feasibility of dignity therapy (DT) is well established in palliative care. Evidence of its efficacy, however, has been inconsistent and may stem from DT’s primary effects differing from the outcomes measured in previous studies. We proposed that DT effects were in the spiritual domain and created a new outcome measure, Dignity Impact Scale (DIS), from items previously used in a large randomized controlled trial (RCT).

Objective:

The purpose of this secondary analysis study was to examine properties of a new measure of dignity impact.

Design:

Using the DIS, we conducted reanalysis of posttest data from a large 3-arm, multi-site RCT study.

Setting/Participants:

Participants were receiving hospice/palliative care (n = 326, 50.6% female, mean age = 65.1 years, 89.3% white, all with a terminal illness with 6 months or less life expectancy). They had been randomized to standard palliative care (n = 111), client-centered care (n = 107), or DT (n = 108).

Measurement:

The 7-item DIS was derived from selected items in a posttest DT Patient Feedback Questionnaire. The DIS had strong internal consistency (α = 0.85).

Results:

The DT group mean DIS score (21.4 ± 5.0) was significantly higher than the usual care group mean score (17.7 ± 5.5; t = 5.2, df = 216, P < .001) and a client-centered intervention group mean score (17.9 ± 4.9; t = 5.2, df = 213, P < .001).

Conclusion:

We found that, compared to both other groups, patients who received DT reported significantly higher DIS ratings, which is consistent with the DT focus on meaning-making, preparation for death, and life completion tasks. We propose that the DIS be used as the primary outcome measure in evaluating the effects of DT.
Effect of β-blocker Therapy on Hospital Readmission and Mortality in Heart Failure Patients With Concurrent Cocaine Use
Authors: Egbuche Obiora , Ekechukwu Ifunanya , Effoe Valery , Maduabum Nnamdi , Millard Heather R. , Maihemuti Axiyan , Cross Jo Ann , Adedinsewo Demilade , Onwuanyi Anekwe E.
Published: May 2018

Background:

β-Blockers are first-line agents for reduction in symptoms, hospitalization, and mortality in patients with heart failure having reduced ejection fraction (HFrEF). However, the safety and efficacy of continuous β-blocker therapy (BBT) in patients who actively use cocaine remain controversial, and available literature is limited. We aimed to evaluate the effect of BBT on hospital readmission and mortality in patients having HFrEF with concurrent cocaine use.

Methods:

We conducted a retrospective study of patients with a diagnosis of HFrEF between 2011 and 2014 based on International Classification of Diseases 9-Clinical Modification codes. We included patients aged 18 and older who tested positive for cocaine on a urine toxicology test obtained at the time of index admission. Patients were followed for 1 year. Multivariate logistic regression was used to assess the effect of BBT on the 30-day, all-cause and heart failure–related readmissions.

Results:

The 30-day readmission rates for BBT versus no BBT groups were 20% versus 41% (odds ratio [OR]: 0.17, 95% confidence interval [CI] = 0.05-0.56, P = .004) for heart failure-related readmissions and 25% versus 46% (OR: 0.19, 95% CI = 0.06-0.64, P = .007) for all-cause readmissions.

Conclusion:

The BBT reduced 30-day, all-cause and heart failure–related readmission rate but not 1-year mortality in patients having HFrEF with concurrent cocaine use.