bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Dual Task Walking Improve in Parkinson’s Disease After External Focus of Attention Exercise? A Single Blind Randomized Controlled Trial
Authors: Beck Eric N. , Intzandt Brittany N. , Almeida Quincy J.
Published: December 2017

Background. It may be possible to use attention-based exercise to decrease demands associated with walking in Parkinson’s disease (PD), and thus improve dual task walking ability. For example, an external focus of attention (focusing on the effect of an action on the environment) may recruit automatic control processes degenerated in PD, whereas an internal focus (limb movement) may recruit conscious (nonautomatic) control processes. Thus, we aimed to investigate how externally and internally focused exercise influences dual task walking and symptom severity in PD. Methods. Forty-seven participants with PD were randomized to either an Externally (n = 24) or Internally (n = 23) focused group and completed 33 one-hour attention-based exercise sessions over 11 weeks. In addition, 16 participants were part of a control group. Before, after, and 8 weeks following the program (pre/post/washout), gait patterns were measured during single and dual task walking (digit-monitoring task, ie, walking while counting numbers announced by an audio-track), and symptom severity (UPDRS-III) was assessed ON and OFF dopamine replacement. Pairwise comparisons (95% confidence intervals [CIs]) and repeated-measures analyses of variance were conducted. Results. Pre to post: Dual task step time decreased in the external group (Δ = 0.02 seconds, CI 0.01-0.04). Dual task step length (Δ = 2.3 cm, CI 0.86-3.75) and velocity (Δ = 4.5 cm/s, CI 0.59-8.48) decreased (became worse) in the internal group. UPDRS-III scores (ON and OFF) decreased (improved) in only the External group. Pre to washout: Dual task step time ( P = .005) and percentage in double support ( P = .014) significantly decreased (improved) in both exercise groups, although only the internal group increased error on the secondary counting task (ie, more errors monitoring numbers). UPDRS-III scores in both exercise groups significantly decreased ( P = .001). Conclusions. Since dual task walking improvements were found immediately, and 8 weeks after the cessation of an externally focused exercise program, we conclude that externally focused exercise may improve on functioning of automatic control networks in PD. Internally focused exercise hindered dual tasking ability. Overall, externally focused exercise led to greater rehabilitation benefits in dual tasking and motor symptoms compared with internally focused exercise.
Digital engineering transformation across the Department of Defense
Authors: Zimmerman Phil , Gilbert Tracee , Salvatore Frank
Published: December 2017

A digital transformation has been implemented across a range of industries to drive affordability, agility, quality, and efficiency. Advancements in digital technologies are unleashing innovations that provide an opportunity to transform the engineering practice. Digital engineering is the Department of Defense’s (DoD’s) initiative to transform the way it designs, develops, delivers, operates, and sustains complex systems in a formidable and changing threat environment. It is defined as “an integrated digital approach that uses authoritative sources of systems’ data and models as a continuum across disciplines to support lifecycle activities from concept through disposal.” This paper sets the strategic direction for the digital engineering vision, in which five strategic goals are presented to guide DoD’s transformation efforts. This paper also describes the digital engineering initiatives that are in progress across the Office of the Secretary of Defense, Air Force, Army, and Navy. While these efforts have begun to realize initial benefits, challenges and next steps are also presented in order to realize the vision.
Clinical and Biochemical Outcomes Following EEG Neurofeedback Training in Traumatic Brain Injury in the Context of Spontaneous Recovery
Authors: Bennett Cathlyn N. , Gupta Rajnish K. , Prabhakar Puttachandra , Christopher Rita , Sampath Somanna , Thennarasu K. , Rajeswaran Jamuna
Published: December 2017

It has been found that reduction of posttraumatic stress symptoms is positively associated with the reduction of postconcussive symptoms. Cortisol is commonly used as a biomarker of stress. Understanding the role of posttraumatic stress and cortisol in symptom reduction has implication for neuropsychological rehabilitation particularly in the context of spontaneous recovery. Objective. The aim of the research was to study the effectiveness of EEG neurofeedback training on clinical symptoms, perceived stress, and cortisol in traumatic brain injury (TBI) patients in the context of spontaneous recovery. Methods. The design was an experimental longitudinal design with the pre-post comparison. The sample comprised 60 patients with the diagnosis of TBI—30 patients in the neurofeedback training (NFT) group and 30 patients in the treatment as usual group (TAU) group. Half of the patients were recruited within 6 months of injury to study the role of spontaneous recovery and the other half were recruited in the 12 to 18 months postinjury phase. Alpha-theta training was given to the NFT group over 20 sessions. Pre and post comparisons were made on clinical symptom rating, perceived stress, and serum cortisol levels. Results. The results indicate significant differences in symptom reporting and perceived stress between the NFT and TAU groups. Significant differences were also seen in cortisol levels with implications for the acute recovery phase. Conclusion. Alpha-theta NFT has a beneficial effect on symptom reduction as well as perceived stress. It also has a beneficial effect on levels of serum cortisol, corroborating these findings.
Subacute Encephalopathy With Seizures in Alcoholics (SESA) Presenting as Focal Nonconvulsive Status Epilepticus
Authors: Kaplan Peter W. , Billnitzer Andrew , Fernández-Torre José Luis
Published: December 2017

Purpose. To acquaint readers with the underrecognized subacute encephalopathy with seizures in chronic alcoholics (SESA) that has more recently been associated with different types of status epilepticus. Methods. Case reports and review of the literature on SESA and nonconvulsive status epilepticus (NCSE). Results. Two cases: one with alternating bifrontoparietal NCSE, and one with focal, confusional NCSE, with imaging and EEG correlates. Conclusion. Underrecognized SESA may present as NCSE with focal clinical, EEG and reversible diffusion-weighted MRI abnormalities, warranting expedited diagnosis and antiseizure treatment to minimize morbidity.
Novel Mutation Detection of Regulatory Molecule Dopamine Gene Receptors (D1–D5) Encoding Analysis on Human Peripheral Blood Lymphocytes in Schizophrenia Patients
Authors: Ahangari G. , Shariati G.H. , Asadi M.R. , Ostadali M.R. , Ahmadkhaniha H.R.
Published: December 2017

There is much evidence which highlights the involvement of the dopamine system in the pathophysiology of schizophrenia. Recently, there have been reports of detected mutations in dopamine gene receptors in genomic DNA of schizophrenia. In this study, we attempt to determine whether there is mutation in encoding dopamine receptor. The PBMC was separated from whole blood by Ficoll-hypaque; the total cellular RNA was extracted and the cDNA was synthesized. This process followed by real-time PCR using primer pairs specific for five dopamine receptor mRNAs and β-actin as internal control. The results show the presence of all types of dopamine receptor types in lymphocytes. The mutational analysis of the obtained PCR products for the respective dopamine receptor fragments were analyzed by sequenced capillary system. The results presented in this study confirm the high frequency of mutations in dopamine gene receptor DRD5 in schizophrenia patients. Mutational amino acid changes in dopamine gene receptors of DR2, DR3, DR4 but not DR1 are also shown. In conclusion, this is the first report of such complete mutational analyses in all dopamine gene receptors. Moreover, we found new mutations and 80% frequency of mutations in DRD5. These data further strengthen the argument for the role of dopamine gene receptor mutations in the pathogenesis of schizophrenia.
Understanding the gendered coaching workforce in Spanish sport
Authors: Hinojosa-Alcalde Ingrid , Andrés Ana , Serra Pedrona , Vilanova Anna , Soler Susanna , Norman Leanne
Published: December 2017

The present study focuses on the demographic and labor characteristics of coaches in Spain. Kanter’s theory on occupational sex segregation will be used as a guiding framework. The study was conducted with 1685 coaches (82.3% men and 17.7% women) from different sports and performance domains. The results show that there is an underrepresentation of women as coaches in Spain and data highlight that coaches’ gender is related to three structural factors: opportunity, power, and proportion. The present data reveal that women are younger, less likely to be in a marriage-like relationship, less likely to have children, and more likely to have competed at a high level as an athlete when compared to their male counterparts. However, fewer women than men access and participate in coach education in Catalonia and the working status of women was different to that of men. To expand, women worked less hours, were more likely to be assistant coaches, and had less years of coaching experience. Understanding of how gender influences women’s access, progression, and retention in coaching in Spain illustrates the need for gender sport policies and practices in sport organizations. This approach can benefit not only women, but the diversity and enrichment of the coaching system.
‘Time to clean’: A systematic review and observational study on the time required to clean items of reusable communal patient care equipment
Authors: Scott David , Kane Hayley , Rankin Annette
Published: December 2017

Background:

Concerns have been raised over poor standards of hospital cleanliness and insufficient time for staff to clean reusable communal patient care equipment. These items may then act as vectors for the transmission of nosocomial pathogens between hospital patients.

Aim:

To evaluate the impact of cleaning duration on nosocomial infection rates and estimate the time required to clean care equipment in accordance with national specifications (i.e. a ‘time to clean’).

Methods:

A systematic review of the published literature on cleaning times and an observational study in which nine healthcare workers cleaned seven items of care equipment while the duration of time taken to clean each item was measured.

Results:

A limited volume of low-quality evidence indicates that increased cleaning times in hospitals can reduce the incidence of healthcare-associated infections (HCAIs). The mean ‘time to clean’ for care equipment ranged from 166.3 s (95% confidence interval [CI] = 117.8–214.7) for a bed frame to 29.0 s (95% CI = 13.4–44.6) for a blood pressure cuff.

Discussion:

‘Time to clean’ estimates for care equipment provide an indication of how much protected time is necessary to ensure acceptable standards of cleanliness. Clinical trials are needed to further evaluate the impact of increased cleaning times on nosocomial infection rates.
Knowledge, perceptions and practices of healthcare workers regarding the use of respiratory protection equipment at Iran hospitals
Authors: Honarbakhsh Marzieh , Jahangiri Mehdi , Ghaem Haleh
Published: December 2017

Background:

Using appropriate respiratory protection equipment (RPE) is very important to protect healthcare workers (HCWs) against respiratory hazards. The aim of this study was to identify the level of knowledge, perceptions and practices of HCWs on using RPE.

Methods:

This cross-sectional study was conducted with 284 employees of educational hospitals affiliated to Shiraz University of Medical Sciences. The study’s instrument was a self-made questionnaire that comprised four components: demographic inquiries and questions designed to assess the knowledge, perceptions and practice of HCWs regarding RPE. Collected data were analysed using SPSS software version 21.

Results:

Average scores of knowledge, perceptions and practice of HCWs on using RPE were 66.50% ± 11.93%, 80.32% ± 10.05% and 70.12% ± 20.51%, respectively. A significant association was observed between knowledge and age, job experience, history of using respirator, marital status and risk of respiratory hazards in the workplace and perceptions with age and education and practice with education.

Conclusion:

Studied HCWs had positive perceptions and moderate level of knowledge and practice about the use of RPE. Full implementation of respiratory protection program in the hospitals would be helpful to improve the knowledge, perceptions and practices of HCWs regarding RPE.
A high impact intervention for a high impact intervention: Improving documentation of peripheral venous access insertion in theatre
Authors: Upadhyaya Kavita , Hendra Heidy , Wilson Nick
Published: December 2017

The Department of Health’s ‘High Impact Intervention (HII) – Peripheral intravenous cannula care bundle’ lists six actions to be performed at the time of peripheral intravenous cannulation. Audit of compliance to these requires documentation. We assessed documentation on the anaesthetic charts of 50 surgical patients. Purpose-made stickers were then placed on all anaesthetic charts. Re-assessment of a further 50 patients’ charts demonstrated a significant improvement in documentation of the bundle post intervention (Fisher’s exact test P < 0.0001). This is an example of how a low-tech intervention can produce a high impact improvement in documentation.
Quality improvement collaborative: A novel approach to improve infection prevention and control. Perceptions of lead infection prevention nurses who participated
Authors: Adams Debra , Hine Victoria , Bucior Helen , Foster Wendy , Mukombe Nyarayi , Ryan Jane , Smirthwaite Sandra , Winfield Jodie
Published: December 2017

Background:

In response to the ongoing infection prevention (IP) challenges in England, a 90-day quality improvement (QI) collaborative programme was developed. The paper discusses the approach, benefits, challenges and evaluation of the programme.

Objective:

The objective of the collaborative was to develop new approaches to enable sustainable and effective IP.

Methodology:

Six trusts in the region participated in the collaborative. Each defined their bespoke IP focus. There was no expectation that statistically significant measurable improvements would be identified during the short time frame. The experiences of the participants were sought both during the programme to facilitate its constant review and at the end of the programme to evaluate its effectiveness. The feedback focused on achievements, barriers to change and benefits of participating in a QI collaborative. To measure the potential success of the projects, participants completed the Model for Understanding Success in Quality framework. (MUSIQ; Kaplan et al., 2012).

Results:

Since each trusts IP focus was bespoke commonalities of success were not evaluated. Participants identified a positive outcome from their QI interventions. The MUSIQ score identified the projects had the potential for success.

Discussion:

The feedback from the participants demonstrated that it is worthy of further development.
Vessel Health and Preservation Framework: Use of the outcome logic model for evaluation
Authors: Burnett Emma , Hallam Carole , Curran Evonne T , Weston Valya
Published: December 2017

Background:

Vascular access is an important part of many patient care management plans, but has unwanted risks. A working group led by the Infection Prevention Society (IPS) produced a Vessel Health and Preservation (VHP) Framework. Based on current evidence, a framework was developed for frontline staff to assess and select the best vascular access device to meet the individual patient’s needs and to preserve veins for future use.

Methods:

Using the Outcome Logic Model, we conducted an evaluation of the short- and medium-term outcomes with regards to the impact and success of the VHP Framework.

Results:

This evaluation found that many respondents were aware of the framework and were using it in a range of different ways. Participants saw the framework as being most beneficial to help decisions on device choice and peripheral vein assessment. However, the framework has not fully reached its intended audience.

Discussion:

Many positive outcomes were reported as a result of using the VHP Framework including improving clinical practice as it relates to the VHP elements. However, further work is required to find the tools to extend the reach of the framework and assist healthcare teams to be able to fully implement it within their clinical settings.
An IoT-based cargo monitoring system for enhancing operational effectiveness under a cold chain environment
Authors: Tsang YP , Choy KL , Wu CH , Ho GTS , Lam HY , Koo PS
Published: December 2017

Differing from managing a general supply chain, handling environmentally sensitive products (ESPs) requires the use of specific refrigeration systems to control the designated range of storage conditions, such as temperature, humidity, and lighting level in a cold chain environment. In general, third-party logistics (3PL) companies are authorized to handle ESPs, who therefore need to have a good cargo monitoring system in the cold chain environment, without which the functional quality is difficult to control and manage. This may result in product deterioration and even inventory obsolescence of the ESPs due to the lack of such systems, so there is a need to develop an effective cargo monitoring system to prevent such situations. This article proposes an Internet of Things-based cargo monitoring system (IoT-CMS) to monitor any environmental changes of ESPs in order to ensure their functional quality throughout the entire cold chain operational environment. Operational efficiency, maintenance strategy, environmental change, and electricity consumption are considered in real-life cold chain operations. Through applying (i) a wireless sensor network to collect real-time product information, together with (ii) fuzzy logic and case-based reasoning techniques to suggest appropriate storage conditions for various ESPs, effective storage guidance can be established. Through conducting the case study in a 3PL company in Hong Kong, the performance in customer satisfaction, obsolescence rate, and inventory visibility after adoption of IoT-CMS is evaluated. It is found that the functional quality of ESPs can be effectively assured, and the overall customer satisfaction is increased.
Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study
Authors: Paterno Mark V. , Flynn Kaitlyn , Thomas Staci , Schmitt Laura C.
Published: December 2017

Background:

Outcomes after anterior cruciate ligament reconstruction (ACLR) are highly variable. Previous studies have failed to report the relationship between fear, objective measures of function, and reinjury rates. The purpose of this study was to determine whether fear was related to functional performance measures and risk of second ACL injury after ACLR and return to sport (RTS).

Hypothesis:

Fear will be associated with performance on functional testing and second ACL injury rate.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 2.

Methods:

A total of 40 patients cleared to RTS after ACLR completed the Tampa Scale of Kinesiophobia (TSK-11), hop testing, and quadriceps strength testing, bilaterally. Patients were tracked for 12 months after RTS to identify the incidence of second ACL injury. Chi-square analyses determined whether patients with high fear (TSK-11, ≥17) were more likely to have lower levels of activity, greater asymmetry on functional testing, and higher reinjury rates.

Results:

Patients with greater fear on the TSK-11 (≥17) at RTS were 4 times (odds ratio [OR], 3.73; 95% CI, 0.98-14.23) more likely to report lower levels of activity, 7 times (OR, 7.1; 95% CI, 1.5-33.0) more likely to have a hop limb symmetry lower than 95%, and 6 times (OR, 6.0; 95% CI, 1.3-27.8) more likely to have quadriceps strength symmetry lower than 90%. Patients who went on to suffer an ipsilateral second ACL injury had a greater TSK-11 score at the time of RTS (mean, 19.8 ± 4.0) than those who did not suffer a second ACL injury (mean, 16.4 ± 3.6) ( P = 0.03). Patients with a TSK-11 score of 19 or greater at the time of RTS were 13 times (relative risk, 13.0; 95% CI, 2.1-81.0) more likely to suffer a second ACL tear within 24 months after RTS.

Conclusion:

Patients with greater self-reported fear were less active, presented with lower single-leg hop performance and isometric quadriceps strength, and had an increased risk of suffering a second ACL injury in the 24 months after RTS.

Clinical Relevance:

Self-reported fear of movement/reinjury after ACLR at the time of RTS may be an important measure to incorporate into discharge criteria prior to release to return to pivoting and cutting sports after ACLR.
The Molitor Model of Change
Authors: Molitor Graham T. T.
Published: December 2017

The Molitor Model of Change was developed over a period of forty years by American futurist, Graham T. T. Molitor (1934–2017). It encompassed his lifelong work to reveal how public policy issues emerge, how they are advanced and how they are resolved. This article offers a 2009 summary of his model that was fully presented in his 2003 book, The Power to Change the World.
Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties
Authors: Neuprez Audrey , Neuprez Arnaud H. , Kaux Jean-François , Kurth William , Daniel Christophe , Thirion Thierry , Huskin Jean-Pierre , Gillet Philippe , Bruyère Olivier , Reginster Jean-Yves
Published: December 2017

Objective

To measure and identify the determinants of the outcomes after hip/knee arthroplasty (HA/KA) in patients with osteoarthritis during the first postsurgical year.

Design

In this prospective observational study, we evaluated the preoperative and postoperative (3, 6, and 12 months) outcomes of 626 patients who underwent HA (346 with median age 65 years, 59% female) or KA (280 with median age 66.5 years, 54% female) between 2008 and 2013. Generic and specific tools were used to measure health-related quality of life (HRQoL) and utility. Good outcome was defined as an improvement in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) greater than or equal to the minimal important difference (MID). Regressions were performed to evaluate the relationship between preoperative and postoperative measures and evolution of WOMAC/good outcome.

Results

We observed an almost systematic improvement of all parameters for up to 12 months, but especially at the 3-month follow-up. The low number of comorbidities and the absence of postoperative complications were the common determinants of improvement of WOMAC total score after 12 months. Other parameters (background of the joint, preoperative function and length of hospital stay in KA group; place of discharge in HA group) affected the evolution of WOMAC scores. 87.09% of HA and 73.06% of KA patients experienced a good outcome. A small number of comorbidities, a worse preoperative function, a shortened hospital stay (KA only), and an absence of early postoperative complications (HA only) significantly predicted a good outcome.

Conclusions

Intermediate HRQoL following HA or KA improved quickly from preoperative levels for all instruments. More than 70% of patients achieved a good outcome defined as improved pain, stiffness and disability and the predictors are slightly close.
Optimization of Extracellular Matrix Synthesis and Accumulation by Human Articular Chondrocytes in 3-Dimensional Construct with Repetitive Hydrostatic Pressure
Authors: Ogura Takahiro , Tsuchiya Akihiro , Minas Tom , Mizuno Shuichi
Published: December 2017

Objective

The effects of hydrostatic pressure (HP) on the matrix synthesis by human articular chondrocytes have been reported elsewhere. In order to optimize the production of extracellular matrix, we aimed to clarify the effects of repetitive HP on metabolic function by human articular chondrocytes.

Design

The human articular chondrocytes were expanded and embedded within a collagen gel/sponge scaffold. We incubated these constructs with and without HP followed by atmospheric pressure (AP) and repeated the second HP followed by AP over 14 days. Genomic, biochemical, and histological evaluation were performed to compare the effects of each regimen on the constructs.

Results

The gene expressions of collagen type II and aggrecan core protein were significantly upregulated with repetitive HP regimens compared with a single HP or AP by 14 days ( P < 0.01 or 0.05). Matrix metalloptoteinase-13 (MMP-13) in AP was upregulated significantly compared to other HP regimens at day 14 ( P < 0.01). No significant difference was observed in tissue inhibitor of metalloproteinases-II. Immunohistology demonstrated that application of HP (both repetitive and single) promoted the accumulation of specific extracellular matrix and reduced a MMP-13. A single regimen of HP followed by AP significantly increased the amount of sulfated glycosaminoglycan than that of the AP, whereas repetitive HP remained similar level of that of the AP.

Conclusions

Repetitive HP had a greater effect on anabolic activity by chondrocytes than a single HP regimen, which will be advantageous for producing a matrix-rich cell construct.
Is the Lone Scientist an American Dream? Perceived Communal Opportunities in STEM Offer a Pathway to Closing U.S.–Asia Gaps in Interest and Positivity
Authors: Brown Elizabeth R. , Steinberg Mia , Lu Yun , Diekman Amanda B.
Published: December 2017

The United States lags behind many Asian countries in engagement in science, technology, engineering, and mathematics (STEM). An unexplored factor in these country-level differences may be U.S.–Asia gaps in perceptions of the goal opportunities provided by STEM. Across four studies, U.S. students perceived fewer communal opportunities (working with/helping/relationships with others) in STEM than Asian students; this differential perception contributed to U.S.–Asia gaps in STEM interest. Perceptions of communal opportunities in STEM did not follow from a general orientation to perceive that all careers provided communal opportunities but from communal engagement in STEM. Perceptions about communal opportunities in STEM predicted STEM interest, and communal experience in STEM predicted STEM interest beyond quantity of STEM exposure. Experimentally highlighting the perceived communal opportunities in science closed the cultural gap in positivity toward a scientist career (Study 5). Perceptions of communal opportunities in STEM provide a new vantage point to improve U.S. engagement in STEM.
Psychological Entitlement Predicts Failure to Follow Instructions
Authors: Zitek Emily M. , Jordan Alexander H.
Published: December 2017

Six studies examined the relationship between psychological entitlement and not following instructions. In Study 1, more entitled individuals were more likely to ignore instructions about how to format their responses. Studies 2–4 investigated possible boundaries on the association between entitlement and ignoring instructions; however, entitled people were more likely to ignore instructions even when following instructions was low cost for the self, instructions were given in a less controlling way, or punishment was highly likely to result from a failure to follow instructions. To explore another possible explanation for the relationship between entitlement and ignoring instructions, Study 5 examined whether entitled people were more sensitive to situations potentially unfair to them; indeed, they were more likely to reject offers in an ultimatum game. Building on this finding, in Study 6, more entitled individuals’ greater likelihood of ignoring instructions was predicted by their viewing instructions as an unfair demand on them.
Action Recognition in a Crowded Environment
Authors: Fademrecht Laura , Nieuwenhuis Judith , Bülthoff Isabelle , Barraclough Nick , de la Rosa Stephan
Published: December 2017

So far, action recognition has been mainly examined with small point-light human stimuli presented alone within a narrow central area of the observer’s visual field. Yet, we need to recognize the actions of life-size humans viewed alone or surrounded by bystanders, whether they are seen in central or peripheral vision. Here, we examined the mechanisms in central vision and far periphery (40° eccentricity) involved in the recognition of the actions of a life-size actor (target) and their sensitivity to the presence of a crowd surrounding the target. In Experiment 1, we used an action adaptation paradigm to probe whether static or idly moving crowds might interfere with the recognition of a target’s action (hug or clap). We found that this type of crowds whose movements were dissimilar to the target action hardly affected action recognition in central and peripheral vision. In Experiment 2, we examined whether crowd actions that were more similar to the target actions affected action recognition. Indeed, the presence of that crowd diminished adaptation aftereffects in central vision as wells as in the periphery. We replicated Experiment 2 using a recognition task instead of an adaptation paradigm. With this task, we found evidence of decreased action recognition accuracy, but this was significant in peripheral vision only. Our results suggest that the presence of a crowd carrying out actions similar to that of the target affects its recognition. We outline how these results can be understood in terms of high-level crowding effects that operate on action-sensitive perceptual channels.
“What does it mean to care?” Collaborative images of care within an early years center
Authors: Myers Casey Y , Hostler Rochelle L , Hughes Joseph
Published: December 2017

Posing the question, “What does it mean to care?” this visual work came about through a collaboration between teachers, children, and a local artist to render experiences of care from children’s daily lives within an early years laboratory school. Working from a perspective of material-discursive intra-activity (Barad, 2003, 2007), this inquiry explored the ways in which children’s and adults’ engagement with materials, such as paint, paper, and ink, for the purpose of collaboratively constructing images might challenge ideas about what care is in an early years setting. The resulting image-stories were displayed at a community event as a provocation for others to (re)consider how young children come to know care/caring as enmeshed within experiences of love, loss, and longing of responsibility for their classmates, of stewardship for the environment, of deep investment in daily work, and of coming to trust adults and children outside of their immediate families. While we have long recognized “care” as a fundamental curricular touchstone for teachers and young children (Noddings, 1988) and we continue to value moral orientations, such as kindness and respect, in our everyday enactments of practice, through this particular entanglement of children-adults-materials discourses, we have come to understand that “caring” emerges through multiple pathways and to multiple effects and can be articulated through multiple modalities. By presenting these images as the primary “text,” our intention is to provoke readers of this Special Issue to (re)consider both the specificity and multiplicity of care in young children’s school lives.
Protective role of FKBP51 in calcium entry‐induced endothelial barrier disruption
Authors: Hamilton Caleb L. , Kadeba Pierre I. , Vasauskas Audrey A. , Solodushko Viktoriya , McClinton Anna K. , Alexeyev Mikhail , Scammell Jonathan G. , Cioffi Donna L.
Published: December 2017

Pulmonary artery endothelial cells (PAECs) express a cation current, ISOC (store‐operated calcium entry current), which when activated permits calcium entry leading to inter‐endothelial cell gap formation. The large molecular weight immunophilin FKBP51 inhibits ISOC but not other calcium entry pathways in PAECs. However, it is unknown whether FKBP51‐mediated inhibition of ISOC is sufficient to protect the endothelial barrier from calcium entry‐induced disruption. The major objective of this study was to determine whether FKBP51‐mediated inhibition of ISOC leads to decreased calcium entry‐induced inter‐endothelial gap formation and thus preservation of the endothelial barrier. Here, we measured the effects of thapsigargin‐induced ISOC on the endothelial barrier in control and FKBP51 overexpressing PAECs. FKBP51 overexpression decreased actin stress fiber and inter‐endothelial cell gap formation in addition to attenuating the decrease in resistance observed with control cells using electric cell‐substrate impedance sensing. Finally, the thapsigargin‐induced increase in dextran flux was abolished in FKBP51 overexpressing PAECs. We then measured endothelial permeability in perfused lungs of FKBP51 knockout (FKBP51–/–) mice and observed increased calcium entry‐induced permeability compared to wild‐type mice. To begin to dissect the mechanism underlying the FKBP51‐mediated inhibition of ISOC, a second goal of this study was to determine the role of the microtubule network. We observed that FKBP51 overexpressing PAECs exhibited increased microtubule polymerization that is critical for inhibition of ISOC by FKBP51. Overall, we have identified FKBP51 as a novel regulator of endothelial barrier integrity, and these findings are significant as they reveal a protective mechanism for endothelium against calcium entry‐induced disruption.
Exposure reporting disparity in Gulf War Registry–related clinical assessments
Authors: Metzger-Smith Valerie , Lei Karen , Javors Jennifer , Golshan Shahrokh , Leung Albert
Published: December 2017

Objectives:

The Gulf War Registry monitors related health conditions of veterans returning from the Persian Gulf Region. Enrollment consists of two phases: Phase I—veterans meet with their local VA Environmental Health Coordinator and complete the self-reported Gulf War Phase I Worksheet (VA Form 10-9009A). Phase II involves a physical exam, medical history review, and laboratory test analysis conducted by a licensed physician. The providers’ documentations are frequently referred for exposure assessment and benefit claim. We conducted an initial comparison assessment to ascertain any potential disparity in exposure reporting between the applicants in Phase I and the providers in Phase II.

Methods:

With institutional human subject committee approval, a list of veterans with a Gulf War Registry electronic medical note from the VA San Diego Healthcare System (2013–2015) was obtained. Comparing Phase I with Phase II reports allows three distinct reporting group combinations for each of the 21 exposure categories. Group I: both the patients and the healthcare personnel provided the same report for the respective exposure. Group II: healthcare personnel but not the patients reported the exposure. Group III: only the patients but not the healthcare personnel reported the exposure.

Results:

A total of 178 (of 367) subjects had both the medical note from the healthcare provider and a physical copy of their Phase I Worksheet available, and therefore were eligible to be included in the overall one-way and subsequent pair-wise chi-square analyses. The results indicate that Group I reporting pattern had a significantly (p < 0.01) lower prevalence in nine exposure categories compared to Group III.

Conclusion:

The findings suggest that the medical documentation from the healthcare providers does not consistently and accurately reflect the patients’ report in near 50% (9/21) of assessed exposure categories. Potential remedies addressing this exposure reporting disparity, such as a standardized template or electronic upload, are further discussed.
Transoral incisionless fundoplication for Jehovah’s Witnesses: A case report discussing safety and durability
Authors: Fanous Medhat Y , Lorenson David , Williams Sarah , Jaehne Anja K
Published: December 2017

Jehovah’s Witness patients pose a unique surgical challenge due to their refusal of transfusion of whole blood or major blood products. One of the surgical strategies is to offer the least invasive approach with the least likelihood of losing blood. In the context of surgical treatment of gastroesophageal reflux disease, endoluminal approaches such as transoral incisionless fundoplication represent an appropriate approach for Jehovah’s Witness patients. This patient is a devout Jehovah’s Witness who was troubled with gastroesophageal reflux disease for many years which was refractory to proton pump inhibitor therapy. Her standard preoperative workup showed that she was a candidate for transoral incisionless fundoplication. Surgery was performed by a transoral incisionless fundoplication certified surgeon and this patient was his second case. Patient had no immediate or long-term complications. She was successfully weaned off proton pump inhibitors. Transoral incisionless fundoplication is an appropriate option for Jehovah’s Witness patients with refractory gastroesophageal reflux disease. This case report shows that the procedure is safe and durable, even in the early stage of the physician’s learning curve.
Routine preoperative group and save for TURP and TURBT – need and cost effectiveness
Authors: Smith Hazel , Falconer Rachel , Szczachor Justyna , Ahmad Sarfraz
Published: December 2017

Introduction:

Standard practice in our unit is to take a group and save (G+S) blood sample for all patients undergoing a transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT). Modern studies show the transfusion rates for TURP are 2%–7% and for TURBT 2%.

Aims:

We will determine how many patients undergoing TURP and TURBT required blood transfusion, analyse the indication, timing and risk factors. Additionally we will assess the cost effectiveness of routine G+S.

Methods:

A retrospective analysis was conducted between 1 March 2015 and 29 February 2016 (one year). Patients were identified from OPERA database and cross-referenced with blood transfusion records. Electronic case notes for patients receiving transfusions were reviewed.

Results:

A total of 167 patients underwent TURP. Of these, 0.6% (1/167) received transfusion on day 4 post-op. A total of 160 patients underwent TURBT. Overall 3.8% (6/160) received transfusion: three patients on days 0–1 and three patients on days 2–30. All patients had pre-op Hb <100 g/l. All had large muscle-invasive tumours. Cost in our lab of a G+S sample is £23.52. Two samples are now required before blood can be issued.

Discussion:

Our study shows that risk factors for transfusion are large prostates, likely muscle-invasive bladder tumours and pre-op Hb <100 g/l. Other risks include coagulopathy. These will usually be identified by the surgeon or pre-assessment clinic prior to the procedure. Change in policy would save money and time of phlebotomists and junior doctors.

Conclusions:

Routine G+S is not necessary for all patients. Patients with risk factors can be identified preoperatively. This would give a potential saving of over £15,000 per year. This can be implemented without adversely affecting patient safety.
Creating spaces for change: Engaging civil society to harness change in criminal justice practice
Authors: McCulloch Trish , Smith Mark
Published: December 2017

In a context of neoliberal penality, crime is falling yet prison populations continue to rise. Governments profess to recognise the problem yet have had little impact on underlying trends in criminal justice practice. This article reports on a Scottish initiative to try and disrupt this cycle through broadening the base for deliberation upon justice matters to include civil society. In so doing, we sought to build upon an emerging civic engagement evident in the wake of the 2014 Independence Referendum. Our premise was that to effect change requires that we look beyond policy fixes to the values and the socio-cultural drivers that take practice in particular directions. We conclude with a reflection on the obstacles to change.
Propranolol-Induced Circulatory Collapse in a Patient With Thyroid Crisis and Underlying Thyrocardiac Disease: A Word of Caution
Authors: Abubakar Hossam , Singh Vijendra , Arora Anandita , Alsunaid Sammar
Published: December 2017

Thyrotoxic crisis or thyroid storm is a severe form of hyperthyroidism and a rare endocrinological emergency. The cornerstones of medical therapy in thyroid storm include decreasing the levels of circulating T3 in the blood as well as inhibiting the hormone’s peripheral effects through β-adrenergic blockade. Propranolol is the preferred agent for β-blockade in hyperthyroidism and thyroid storm due to its additional effect of blocking the peripheral conversion of inactive T4 to active form T3. We report a typical clinical scenario where propranolol was administered in treatment of thyroid storm but an uncommon adverse outcome: circulatory failure from cardiogenic shock warranting vasopressor and inotropic support. Caution with regard to the use long-acting β-blocking agents in patients with underling thyrocardiac disease may prevent this life-threatening adverse effect. Ultra–short-acting β-blockers that are easy to titrate maybe a suitable alternative in this subset of patients.
Mixed Adenoneuroendocrine Carcinoma of the Gastroesophageal Junction: A Rare Find
Authors: Ambesh Paurush , Weissbrot Joseph , Ratner Sabina , Sinha Ankur , Patti Ravikaran , Balderacchi Jasminka , Marcelin Michael , Wolf Lawrence , Kamholz Stephan
Published: December 2017

Neoplastic lesions that demonstrate neuroendocrine features are rare. However, esophageal tumors containing both adenocarcinomatous and neuroendocrine components are exceedingly rare. Mixed adenoneuroendocrine carcinomas (MANECs) are gastrointestinal tumors with both adenocarcinomatous and neuroendocrine differentiation. They have a tendency for early metastases but clinically manifest relatively late. Imaging studies are often nonspecific with regard to tumor type, and a histopathologic study of biopsy material is required for definitive diagnosis. The overall prognosis is poor. The current report describes a rare case of gastroesophageal MANEC tumor, with approximately 60% neuroendocrine and 40% adenocarcinomatous components. Since there is a dearth of concrete management guidelines for MANECs, we present possible management options to add to the existing literature.
A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint
Authors: Etier Brian E. , Norte Grant E. , Gleason Megan M. , Richter Dustin L. , Pugh Kelli F. , Thomson Keith B. , Slater Lindsay V. , Hart Joe M. , Brockmeier Stephen F. , Diduch David R.
Published: December 2017

Background:

The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility.

Purpose:

To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion.

Study Design:

Controlled laboratory study.

Methods:

Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest.

Results:

Subjective ratings of comfort and security did not differ between immobilization types ( P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane ( P = .027) and sagittal plane ( P = .030) during the tilt condition and transfer condition, respectively.

Conclusion:

The current study confirms similar motion in the vacuum-mattress splint compared with the rigid backboard in varying sized equipped or nonequipped athletes. Cervical spine motion occurs when removing a football helmet and shoulder pads, at an unknown risk to the injured athlete. In athletes who weighed more than 250 lb, immobilization with the rigid board helped to reduce cervical spine motion.

Clinical Relevance:

Athletic trainers and team physicians should consider immobilization of athletes who weigh more than 250 lb with a rigid board.
Reasons for Retirement Following Ulnar Collateral Ligament Reconstruction Among Major League Baseball Pitchers
Authors: Erickson Brandon J. , Ahn Junyoung , Chalmers Peter N. , Ahmad Christopher S. , Bach Bernard R. , Verma Nikhil N. , Romeo Anthony A.
Published: December 2017

Background:

Ulnar collateral ligament reconstruction (UCLR) has become an increasingly common procedure among Major League Baseball (MLB) pitchers. The long-term effects of this procedure on the career of an MLB pitcher are largely unknown.

Purpose/Hypothesis:

The purpose of this study was to determine why and when MLB pitchers who underwent UCLR during their careers retired from baseball as compared with controls. We hypothesized that pitchers who underwent UCLR are no more likely than control pitchers to retire from elbow or shoulder problems.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

All MLB pitchers who underwent UCLR were identified through publicly available data. A cohort of pitchers who did not undergo UCLR were matched to pitchers with a history of UCLR, based on sex, age, draft year, and draft round. Of those who were no longer pitching in the MLB, the reason for retirement was determined. Reason for retirement and length of career following UCLR (surgical group) and index year (control group) were determined and compared through prior studies via the MLB HITS database, MLB team websites, and publicly available internet-based injury reports.

Results:

Overall, 153 MLB pitchers who underwent UCLR between 1974 and 2015 are currently retired. Mean ± SD time to retirement was 4.4 ± 4.7 years (range, 0-26 years) after the index year in the control group and 4.4 ± 3.5 years (range, 0-15 years) after surgery in the UCLR group ( P = .388). Patients who were status post-UCLR were significantly more likely to be released during the season (34 of 144, 23.6%) than were players who were not status post-UCLR (14 of 144, 9.7%) ( P = .002). Shoulder injury as a reason for retirement was more common in the control group than the UCLR group ( P = .011). Elbow injury as a reason for retirement was not more common in either group ( P = .379). Leg injury as a reason for retirement was more common in the control group ( P = .013). Performance as a reason for retirement was more common in the UCLR group than the control group ( P < .001).

Conclusion:

MLB pitchers who have undergone UCLR are no more likely to retire from shoulder or elbow injuries than are those who have not undergone UCLR. MLB career length was similar between pitchers with and without a history of UCLR.