bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnesium sulfate reduces EEG activity but is not neuroprotective after asphyxia in preterm fetal sheep
Authors: Galinsky Robert , Draghi Vittoria , Wassink Guido , Davidson Joanne O , Drury Paul P , Lear Christopher A , Gunn Alistair J , Bennet Laura
Published: June 2016

Magnesium sulfate is now widely recommended for neuroprotection for preterm birth; however, this has been controversial because there is little evidence that magnesium sulfate is neuroprotective. Preterm fetal sheep (104 days gestation; term is 147 days) were randomly assigned to receive sham occlusion (n = 7), i.v. magnesium sulfate (n = 10) or saline (n = 8) starting 24 h before asphyxia until 24 h after asphyxia. Sheep were killed 72 h after asphyxia. Magnesium sulfate infusion reduced electroencephalograph power and fetal movements before asphyxia. Magnesium sulfate infusion did not affect electroencephalograph power during recovery, but was associated with marked reduction of the post-asphyxial seizure burden (mean ± SD: 34 ± 18 min vs. 107 ± 74 min, P < 0.05). Magnesium sulfate infusion did not affect subcortical neuronal loss. In the intragyral and periventricular white matter, magnesium sulfate was associated with reduced numbers of all (Olig−2+ve) oligodendrocytes in the intragyral (125 ± 23 vs. 163 ± 38 cells/field) and periventricular white matter (162 ± 39 vs. 209 ± 44 cells/field) compared to saline-treated controls ( P < 0.05), but no effect on microglial induction or astrogliosis. In conclusion, a clinically comparable dose of magnesium sulfate showed significant anticonvulsant effects after asphyxia in preterm fetal sheep, but did not reduce asphyxia-induced brain injury and exacerbated loss of oligodendrocytes.
Magnetic resonance imaging biomarkers for clinical routine assessment of microvascular architecture in glioma
Authors: Stadlbauer Andreas , Zimmermann Max , Heinz Gertraud , Oberndorfer Stefan , Doerfler Arnd , Buchfelder Michael , Rössler Karl
Published: June 2016

Knowledge about the topological and structural heterogeneity of the microvasculature is important for diagnosis and monitoring of glioma. A vessel caliber and type-dependent temporal shift in the magnetic resonance imaging signal forms the basis for vascular architecture mapping. This study introduced a clinically feasible approach for assessment of vascular pathologies in gliomas using vascular architecture mapping. Sixty consecutive patients with known or suspected gliomas were examined using vascular architecture mapping as part of the routine magnetic resonance imaging protocol. Maps of microvessel radius and density, which adapted to the vasculature-dependent temporal shift phenomenon, were calculated using a costume-made software tool. Microvessel radius and density were moderately to severely elevated in a heterogeneous, inversely correlated pattern within high-grade gliomas. Additionally, three new imaging biomarkers were introduced: Microvessel type indicator allowing differentiation between supplying arterial and draining venous microvasculature in high-grade gliomas. Vascular-induced bolus peak time shift may presumably be sensitive for early neovascularization in the infiltration zone. Surprisingly, curvature showed significant changes in peritumoral vasogenic edema which correlated with neovascularization in the tumor core of high-grade gliomas. These new magnetic resonance imaging biomarkers give insights into complexity and heterogeneity of vascular changes in glioma; however, histological validations in more well-defined patient populations are required.
How diverse can measures of segregation be? Results from Monte Carlo simulations of an agent-based model
Authors: Arribas-Bel Daniel , Nijkamp Peter , Poot Jacques
Published: June 2016

Cultural diversity is a complex and multi-faceted concept. Commonly used quantitative measures of the spatial distribution of culturally defined groups—such as segregation, isolation or concentration indexes—have been designed to capture just one feature of this distribution. The strengths and weaknesses of such measures under varying demographic, geographic and behavioral conditions can only be comprehensively assessed empirically. This has been rarely done in the case of multigroup cultural diversity. This paper aims to fill this gap and to provide evidence on the empirical properties of various segregation indexes by means of Monte Carlo replications of agent-based modelling simulations under widely varying assumptions. Schelling’s classical segregation model is used as the theoretical engine to generate patterns of spatial clustering. The data inputs include the initial population, the assumed geography, the number and shares of various cultural groups, and their preferences with respect to co-location. Our Monte Carlo replications of agent-based modelling data generating process produces output maps that enable us to assess the sensitivity of the various measures of segregation to parameter assumptions by means of response surface analysis. We find that, as our simulated city becomes more diverse, stable residential location equilibria require the preference for co-location with one’s own group to be not much more than the group share of the smallest demographic minority. When equilibria exist, the values of the various segregation measures are strongly dependent on the composition of the population across cultural groups, the assumed preferences and the assumed geography. Index values are generally non-decreasing in increasing preference for within-group co-location. More diverse populations yield—for given preferences and geography—a greater degree of spatial clustering. The sensitivity of segregation measures to underlying conditions suggests that meaningful analysis of the impact of segregation requires spatial panel data modelling.
Validity of Guatemalan Mother’s Self-Reported Breast-Feeding Practices of 3-Month-Old Infants
Authors: Mazariegos Monica , Slater Christine , Ramirez-Zea Manuel
Published: June 2016

Introduction:

Breast-feeding practices (BFPs) can be assessed by interviewing the mother about current feeding practices and with a 24-hour recall. It is crucial to establish the accuracy of these methods, which are commonly used by public health decision makers to design health policies aimed at increasing exclusive breast-feeding rates.

Objective:

We aimed to validate 2 self-report BFP instruments using the dose-to-mother deuterium oxide turnover technique (DMDOT) as the reference method.

Methods:

Breast-feeding practices were assessed by interviewing the mother about current feeding practices and with a 24-hour recall in 36 Guatemalan mother–infant pairs. The validity of these instruments was assessed using DMDOT as the reference method.

Results:

Both self-report instruments overestimated exclusively breast-fed (EBF) infants. Infants classified as EBF were 50% by the reported current feeding practice, 61% by the 24-hour recall, and only 36% using DMDOT. Sensitivity to detect EBF infants from the mother’s self-report was 92% (95% CI: 62%-99%) while from the 24-hour recall was 100% (95% CI: 72%-100%, P < .01). However, specificity for both instruments was low, at 74% (95% CI: 51%-89%) for reported current feeding practice and at 61% (95% CI: 39%-79%) for the 24-hour recall ( P < .01).

Conclusion:

Both reported current feeding practice and the 24-hour recall instruments overestimated exclusive breast-feeding. Nevertheless, the use of reported current feeding practice provided more accurate data to assess BFPs in a public health setting. Furthermore, population-based surveys should consider the overestimation of exclusive breast-feeding caused when using these BFP instruments.
Conscientization and Third Space
Authors: Boumlik Habiba , Schwartz Joni
Published: June 2016

This case study examines, Al Bawsala, a nongovernmental organization and a female cyber social activist, Amira Yahyaoui, in the aftermath of Tunisia’s Jasmine Revolution through the lens of adult education. The theoretical frameworks of conscientization and third space are employed to describe Yahyaoui’s development of the watchdog political organization, Al Bawsala, for the purpose of democratic learning and popular education in Tunisia. Through interviews with Yahyaoui as well as content analysis of social media platforms used by Al Bawsala, the findings suggest popular education praxis of conscientization and third space are operative and central to Tunisia’s relatively nonviolent path toward democratization after the Arab Spring. The authors further suggest that Al Bawsala’s work is one approach for moving forward in a postrevolution context, and that adult education is central to that process.
Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding
Authors: Boullata Joseph I. , Holcombe Beverly , Sacks Gordon , Gervasio Jane , Adams Stephen C. , Christensen Michael , Durfee Sharon , Ayers Phil , Marshall Neil , Guenter Peggi ,   for the Parenteral Nutrition Safety Committee, American Society for Parenteral and Enteral Nutrition
Published: June 2016

Parenteral nutrition (PN) is a high‐alert medication with a complex drug use process. Key steps in the process include the review of each PN prescription followed by the preparation of the formulation. The preparation step includes compounding the PN or activating a standardized commercially available PN product. The verification and review, as well as preparation of this complex therapy, require competency that may be determined by using a standardized process for pharmacists and for pharmacy technicians involved with PN. An American Society for Parenteral and Enteral Nutrition (ASPEN) standardized model for PN order review and PN preparation competencies is proposed based on a competency framework, the ASPEN‐published interdisciplinary core competencies, safe practice recommendations, and clinical guidelines, and is intended for institutions and agencies to use with their staff.
Hardship Politics
Authors: Gomberg-Muñoz Ruth
Published: June 2016

This article explores how undocumented people and their family members strategically narrate stories of hardship to build community, legitimize their experiences, cultivate political consciousness, and combat dehumanizing stereotypes of undocumented people. As they share stories, personal experiences of hardship become a critical source of information and validation, as well as a resource that undocumented organizers can draw upon to cultivate possibilities for social and political change. This article considers not only the political possibilities that strategic deployment of hardship narratives present but also their theoretical, methodological, and political implications for ethnographers.
Process monitoring of friction stir welding via the frequency of the spindle motor current
Authors: Longhurst William R , Wilbur Isaac C , Osborne Brandon E , Gaither Bryan W
Published: June 2016

Friction stir welding is a solid-state process that is gaining preference for the joining of metals with low melting points. Despite the clear advantages of friction stir welding over traditional fusion welding, voids within the weld seam arise when improper conditions are present. The work presented in this article examines the development of an automated process monitoring system for friction stir welding. The system indirectly monitors the welding torque through the supplied current to the spindle motor. To measure the current, a clamp-on current meter was used. Our results have shown that using a simple and inexpensive clamp-on current meter provides good insight into the welding torque. Examination focused on the frequency spectrum of the current. A Fourier transform decomposed the signal into various frequencies present. The results consistently showed that when no void was present, there was a component of the current’s frequency at 14 Hz. However, when the tool encountered a void, the frequency spectrum changed. The component at 14 Hz went away while content in the range of 1–4 Hz increased.
Rubber pad tube straining as a new severe plastic deformation method for thin-walled cylindrical tubes
Authors: Shapourgan Omid , Faraji Ghader
Published: June 2016

A novel severe plastic deformation technique entitled rubber pad tube straining is proposed suitable for manufacturing of high-strength ultrafine-grained and nanostructured thin-walled cylindrical tubes. A punch with a convex portion in the middle is pressed down into a tube constrained with a hollow cylindrical rubber supported by a rigid cylinder. Tube diameter increases and decreases incrementally when the punch is pressed down, and the rubber pressure pressed back the tube diameter to its initial size. This process was performed on a commercially pure aluminum tube. Finite element results revealed that the equivalent plastic strain of about 1 could be reached at the end of the first cycle of rubber pad tube straining while having a good strain homogeneity along the thickness and length. Experimental results showed that the yield and ultimate strengths were increased to about 172 and 182 MPa from the initial values of about 80 and 128 MPa, respectively. Also, the hardness was increased to ∼55 HV from ∼44 HV.
Tool strain–based wear estimation in micro turning using Bayesian networks
Authors: Mandal Soumen , Sharma Vimlesh Kumar , Pal Aniruddha , Nagahanumaiah
Published: June 2016

Estimation of tool wear in micro turning is important as it enhances the process fidelity and the surface quality of the job. In this work, a simple process is demonstrated that estimates the tool wear from strain data near the cutting edge of the tool tip for micro turning operations. The tool strain for tool with six different wear lengths, collected using fiber Bragg grating sensor, was preprocessed to generate a probability distribution. The strain and tool wear data were used as the training dataset. This training dataset was subjected to maximum likelihood estimation algorithm to obtain the conditional probability distribution table required for the functioning of a suitable Bayesian network. The Bayesian network was tested for estimation of tool wear using strain data as priors for three different experiments. The maximum error in tool wear estimation using this procedure was ∼6 µm.
Injection-moulded lens form error prediction using cavity pressure and temperature signals based on k-fold cross validation
Authors: Nam Jung Soo , Na Cho Rok , Jo Hyoung Han , Song Jun Yeob , Ha Tae Ho , Lee Sang Won
Published: June 2016

This article discusses the development of lens form error prediction models using in-process cavity pressure and temperature signals based on a k-fold cross-validation method. In a series of lens injection moulding experiments, the built-in-sensor mould is used, the in-process cavity pressure and temperature signals are captured and the lens form errors are measured. Then, three features including maximum pressure, holding pressure and maximum temperature are identified from the measured cavity pressure and temperature profiles, and the lens form error prediction models are formulated based on a response surface methodology. In particular, the k-fold cross-validation approach is adopted in order to improve the prediction accuracy. It is demonstrated that the lens form error prediction models can be practically used for diagnosing the quality of injection-moulded lenses in an industrial site.
Investigations on the edge-chipping reduction in rotary ultrasonic machining using a conical drill
Authors: Wang Jianjian , Feng Pingfa , Zhang Jianfu
Published: June 2016

The edge chipping of holes, which is induced by mechanical machining, restricts the applications of brittle materials. Rotary ultrasonic machining is considered a suitable approach to machine holes in brittle materials with a smaller edge-chipping size. However, obvious edge chipping at the hole exit in rotary ultrasonic machining remains observable. In this study, conical diamond core drills with various characteristic angles ( θ) were designed to further reduce the edge-chipping size for rotary ultrasonic machining. Machining tests on quartz glass were conducted to evaluate the effectiveness of this new type of drill. Experimental results show that the conical drill can obviously reduce the edge-chipping size only when certain conditions are satisfied. The mechanism of edge-chipping reduction using a conical drill was revealed by the theoretical analysis and detailed observation of the thrust force and obtained cylinder. To guarantee the feasibility of the conical drill, its characteristic angle should exceed a critical value at a certain feed rate. A higher feed rate requires a higher critical characteristic angle. The other advantage of the conical drill is its ability to suppress the bad effects of increasing the feed rate on the stability of ultrasonic vibration.
Preliminary design and multi-objective optimization of electro-hydrostatic actuator
Authors: Wu Shuai , Yu Bo , Jiao Zongxia , Shang Yaoxing , Luk PCK
Published: June 2016

Electro-hydrostatic actuator is generally regarded as the preferred solution for more electrical aircraft actuation systems. It is of importance to optimize the weight, efficiency and other key design parameters, during the preliminary design phase. This paper describes a multi-objective optimization preliminary design method of the electro-hydrostatic actuator with the objectives of optimizing the weight and efficiency. Models are developed to predict the weight and efficiency of the electro-hydrostatic actuator from the requirements of the control surface. The models of weight prediction are achieved by using scaling laws with collected data, and the efficiency is calculated by the static energy loss model. The multi-objective optimization approach is used to find the Pareto-front of objectives and relevant design parameters. The proposed approach is able to explore the influence of the level length of linkage, displacement of pump and torque constant of motor on the weight and efficiency of the electro-hydrostatic actuator, find the Pareto-front designs in the defined parameter space and satisfy all relevant constraints. Using an electro-hydrostatic actuator for control surface as a test case, the proposed methodology is demonstrated by comparing three different conditions. It is also envisaged that the proposed prediction models and multi-objective optimization preliminary design method can be applied to other components and systems.
Efficient lighting uptake among the urban poor: evidence from a Kenyan informal settlement
Authors: Figueroa Aurelia Rochelle
Published: June 2016

Based on an original dataset of 651 households in the informal settlement of Kibera in Nairobi, Kenya, this article examines household electricity use, drivers of uptake and willingness to pay (WTP) for efficient compact fluorescent lamp (CFL) lighting technology. Informal and illegal electricity consumption, euphemistically referred to by residents as “electricity borrowing”, is common. This removes the metered electricity price lever upon which to influence consumer behaviour and demand for energy-efficient technologies. However, as this study demonstrates, the comparative durability of efficient lighting technologies presents economic benefits for uptake even in a context of fixed-rate electricity payments. While bulb uptake and stated WTP are independent of demographic characteristics such as income activity, gender, education and other factors, they are significantly correlated with informal electricity consumption, beliefs related to bulb durability, knowledge of past energy efficiency outreach, and other contextual factors, underlining a need for tailored approaches to energy efficiency in informal settlements.
Eddy current damper for passive reaction force compensation of a linear motor motion stage
Authors: Ahn Hyeong-Joon , Hwang KangJo , Nguyen Duc Canh
Published: June 2016

This article presents an eddy current damper of a passive reaction force compensation mechanism for a linear motor motion stage. The reaction force compensation mechanism with a movable magnet track and eddy current damper resolves problems with the existing spring-based reaction force compensation mechanism such as resonance, design freedom, and difficulty of assembly and manufacturing. A simplified mathematical model of the eddy current damper is derived considering the sinusoidal magnetic flux density distribution and effective width of the eddy current damper, which shows important design factors of the eddy current damper–based reaction force compensation mechanism. Then, force of the eddy current damper according to the constant speed motion of the magnet track is investigated using multi-physical finite element analysis and is verified by experiments. Finally, the passive reaction force compensation with movable magnet track and eddy current damper is identified by experiments, and the finite element analysis of the eddy current damper is verified with free and forced vibration responses.
An ℒ1 fuzzy adaptive controller for a class of SISO nonaffine nonlinear systems: application to the control of an electropneumatic actuator
Authors: Boubakir Ahsene , Souanef Toufik , Labiod Salim , Plestan Franck , Boudjema Fares
Published: June 2016

This paper proposes an ℒ1 fuzzy adaptive controller for a class of uncertain continuous-time single-input single-output nonaffine nonlinear systems. The structure of this controller is derived based on ℒ1 adaptive control design methodology and integrates a fuzzy system. The latter is used to approximate as best as possible a function of an unknown ideal implicit controller, which provides good results and improves the performance significantly. The ℒ1 fuzzy adaptive controller consists of a predictor, a control law and its adaptive laws. The major advantage of the proposed control scheme is its ability to guarantee uniformly bounded transient and tracking performance for the controlled system. These performance bounds can be rendered arbitrarily small by the systematic choice of design parameters. The effectiveness and feasibility of the proposed ℒ1 fuzzy adaptive controller are examined experimentally in the position control of a pneumatic actuator system.
Arthur Ferguson MacCallan CBE, MD, FRCS (1872–1955), trachoma pioneer and the ophthalmic campaign in Egypt 1903–1923
Authors: MacCallan Michael
Published: June 2016

Arthur Ferguson MacCallan was an ophthalmic surgeon who undertook his pioneering work in Egypt between 1903 and 1923. He established the Egyptian ophthalmic infrastructure which, on his departure, consisted of 23 operational hospital units, treating 134,000 new patients, having trained some 100 ophthalmic surgeons. He also established the Memorial Ophthalmic Laboratory at Giza which is still operational today.

MacCallan became a world authority on trachoma. He pioneered the ‘MacCallan Classification’ which was the first grading system to standardise the stages of trachoma. He used this grading internally from 1905, continuing his research into trachoma over the ensuing years. In 1952, the WHO adopted the ‘MacCallan Classification’ as its standard.

There has recently been a revival of interest in MacCallan’s work. First, the International Coalition for Trachoma Control (ICTC) inaugurated the ‘ICTC MacCallan Medal’ in 2014 as a contribution towards achieving the WHO’s target date for the Global Elimination of Blinding Trachoma (‘GET 2020’). Second, MacCallan’s work with the military hospitals has been recognised by Moorfields Eye Hospital on their World War I Commemorative History Board. Thus, MacCallan’s pioneering spirit, his humanitarian campaign for the relief of suffering and his accomplishments of over a century ago continue to resonate with the profession today.
Psychometric evaluation of the Moral Distress Scale–Revised among Iranian Nurses
Authors: Soleimani Mohammad Ali , Sharif Saeed Pahlevan , Yaghoobzadeh Ameneh , Panarello Bianca
Published: June 2016

Background:

Experiencing moral distress is traumatic for nurses. Ignoring moral distress can lead to job dissatisfaction, improper handling in the care of patients, or even leaving the job. Thus, it is crucial to use valid and reliable instruments to measure moral distress.

Objective:

The purpose of this study was to determine the reliability and the validity of the Persian version of the Moral Distress Scale–Revised among a sample of Iranian nurses.

Research design:

In this methodological study, 310 nurses were recruited from all hospitals affiliated with the Qazvin University of Medical Sciences from February 2014 to April 2015. Data were collected using a demographic questionnaire and the Moral Distress Scale–Revised. The construct validity of the Moral Distress Scale–Revised was evaluated using principal component analysis and confirmatory factor analysis. Internal consistency reliability was assessed with Cronbach’s alpha.

Ethical considerations:

This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.

Findings:

The construct validity of the scale showed four factors with eigenvalues greater than one. The model had a good fit ( χ2(162) = 307.561, χ2/ df = 1.899, goodness-of-fit index = .904, comparative fit index = .927, incremental fit index = .929, and root mean square error of approximation (90% confidence interval) = .049 (.040–.057)) with all factor loadings greater than .5 and statistically significant. Cronbach’s alpha coefficients were .853, .686, .685, and .711for the four factors. Moreover, the model structure was invariant across different income groups.

Discussion and conclusion:

The Persian version of the Moral Distress Scale–Revised demonstrated suitable validity and reliability among nurses. The factor analysis also revealed that the Moral Distress Scale–Revised has a multidimensional structure. Regarding the proper psychometric characteristics, the validated scale can be used to further research about moral distress in this population.
Exploring Choice Overload, Internet Shopping Anxiety, Variety Seeking and Online Shopping Adoption Relationship: Evidence from Online Fashion Stores
Authors: Nagar Komal , Gandotra Payal
Published: June 2016

This study attempts to investigate the nature and impact of choice overload and Internet shopping anxiety on online shopping patronage in the context of fashion products by examining the extent to which consumers seeking variety while shopping online would experience an overload of the innumerable choices offered to them and whether the availability of large assortment of choices will have a significant effect on the patronage of e-stores providing choice in their product offerings. The study also hoped to examine the anxiety experienced by consumers while shopping online and the resultant effect of shopping anxiety on consumers’ intention to patronize web stores. Findings of the study based on a total of 189 responses reveal that online shoppers’ variety-seeking behaviour significantly affects choice overload, while too much shopping anxiety among online shoppers also significantly contributed to a decrease in the level of online patronage intentions among online shoppers. Based on the results of the study, suggestions are made to lower the anxiety among online shoppers to improve consumers’ patronage intentions as too much information is likely to influence their quality of decisions.
Brand Image Mapping: A Study on Bathing Soaps
Authors: Das Jitendra K. , Prakash Om , Khattri Varsha
Published: June 2016

This study discusses the fact that there are a host of possible associations that a firm can build in a brand. Not all associations need to be built but rather those that directly or indirectly affect consumers’ buying behaviour. The article identifies the associations in which the brands are positioned strongly and new associations for weaker or new brands to position themselves. The brand image has been studied using a technique called perceptual mapping, which can have any number of dimensions but the most common are two dimensions. Any more dimensions are a challenge to draw and confusing to interpret. Following that logic, the discriminant analysis of selected attributes that discriminate between objects is used. The brand Dettol is strongly positioned with the functional association of antiseptic nature and Lux with perfect fragrance. In the symbolic associations, Dove positioned itself as ‘Popular among friends’ and Cinthol for its ‘Attractive name’. For experience association, Dove and Dettol are positioned as brands for ‘more self-confidence’ and Lux for ‘Glowing skin’. The article helps in understanding the importance of brands and their features in evolving consumers’ world. It analyzes the significance of brand image building and the value it adds to consumer brand perception and association. The study highlights the effect of brand associations in brand positioning by identifying new associations for weaker brands (repositioning) or new brands to position themselves.
Book Review: Richard Koch, The 80/20 Manager: Ten Ways to Become a Great Leader
Authors: Jena Lalatendu Kesari
Published: June 2016

Richard Koch, The 80/20 Manager: Ten Ways to Become a Great Leader. Gurgaon: Hachette Publishers, 2015 ed., 268 pp. ₹ 399 (ISBN: 978-0-7499-5926-5) (Paperback)
‘It’s Complicated’: The Construction of Indian Middle-class Teens in Social Media
Authors: Diwakar Vaishali
Published: June 2016

After more than two decades as social media became regularized, domesticated and incorporated into our everyday life, we need to understand, both, how social media is shaped by and is shaping the practices humans use in interaction with, around and through it. With the advent of social media, everybody is affected, in one way or the other, by very ubiquity of new online expertise; children and young adults are usually among the first and keenest and passionate users of information and communication technologies. However, teens’ voices are rarely acknowledged and considered effective in shaping the public discourse. This article claims that the new social media opens up the possibility for the young (13–17-year olds), of being part of the global world and at the same time being true to their roots and middle-class moralities. This article emphasizes that social networking sites act as a democratizing element which balances the power somewhat in favour of teens and helps them negotiate between being world class citizens and the torch bearers of Indian middle-class morality. This article explores their sense making of these often contradictory, yet connected, intersecting/overlapping, yet distinct, worlds.
Reflections on using a postgraduate educational environment measure
Authors: Joiner Adam B , Dearman Samuel P
Published: June 2016

Objectives:

The aim was to use an educational environment measure to learn more about our postgraduate psychiatry education program, in order to gain further insights into areas for development. The educational environment includes such things as atmosphere and facilities. A secondary aim was to explore if different types of trainees experienced any aspects of the educational environment differently.

Conclusions:

The education environment measure used was able to reveal areas of the educational environment which trainees did not feel were adequate, as well as differences between how different trainees perceive some aspects of the educational environment. This allowed us to understand where improvements which we had not previously considered should be made to the educational environment.
Short-term Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation
Authors: Xu Buyun , Peng Fang , Tang Weiliang , Du Ye , Guo Hangyuan
Published: June 2016

Background: The incidence of recurrent arrhythmia after catheter ablation (CA) for atrial fibrillation (AF) is unacceptable. Short-term antiarrhythmic drug (AAD) treatment following CA was presumed to be effective in reducing recurrent arrhythmia. Objective: To fully evaluate the efficacy of short-term use of AADs following CA for AF in preventing recurrence of atrial tachyarrhythmias. Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched up until May 1, 2016. We enrolled randomized controlled trials (RCTs) that evaluated the efficacy of short-term use of AADs following CA for AF in preventing early and/or late recurrence of atrial tachyarrhythmias. The statistical analyses were performed using Review Manager Version 5.3. Results: Six RCTs were included in this analysis, involving a total of 2764 patients. The frequency of early recurrence of atrial tachyarrhythmias was 39.5% in the AAD group (556 of 1407) and 47.2% (640 of 1357) in the control group. The pooled risk ratio of the AAD group to the control group was 0.78 (95% CI = 0.62-0.98). Regarding late recurrence of AF (LRAF), the incidence in the AAD group and the control group was 32.5% (420 of 1293) and 34.6% (450 of 1300), respectively. No significant difference was identified between the 2 groups (relative risk = 0.94, 95% CI = 0.85-1.05). Conclusions: Short-term use of AADs following CA for AF reduced the incidence of early recurrent atrial tachyarrhythmias but did not prevent LRAF.
Impact of a Guideline for the Management of Antimicrobial/Warfarin Interactions in the Inpatient Setting and Across Transition of Care
Authors: Ha Nghi B. , Yang Katherine , Hanigan Sarah , Kurtz Brian , Dorsch Michael P. , Mak Hannah , Nagel Jerod
Published: June 2016

Background: Drug-drug interactions (DDIs) with warfarin and antimicrobial agents are a common cause of international normalized ratio (INR) instability, which can affect the risk for bleeding and thrombotic events. Objective: The purpose of this study was to assess the impact of a comprehensive guideline for the management of warfarin-antimicrobial DDIs across transitions of care. The guideline emphasizes improving identification of significant antimicrobial-warfarin DDIs during hospitalization, empirical warfarin dose modification based on DDI and baseline INR, patient education, documentation of the DDI, communication with outpatient providers regarding the DDI and anticipated antimicrobial stop date, and warfarin dose adjustment on discontinuation of antimicrobial. Methods: This retrospective, single-center, quasiexperimental, pre-post study compared end points 3 months before and after guideline implementation. The primary outcome was time within therapeutic range (TTR). Results: The study included 78 preguideline and 31 postguideline patients; baseline characteristics were similar between groups. Implementation of the guideline resulted in greater in-hospital TTR (72% vs 50%, P = 0.04) and improved TTR across transition of care (70% vs 46%, P = 0.01). Documentation of DDI in the pharmacy anticoagulation discharge summary significantly improved in the postguideline group (40% vs 14%, P = 0.02) and numerically improved within the daily pharmacy progress notes (94% vs 82%, P = 0.13). The implementation of the guideline was associated with a nonsignificant, numerical reduction in bleeding events compared with the preguideline group (0 vs 4 events, P = 0.11). Conclusion: This single-center approach to optimize the comprehensive management of significant antimicrobial-warfarin DDIs resulted in improved communication with outpatient providers and improved INR TTR.
Psychosocial Risk Factors for Postoperative Pain in Ankle and Hindfoot Reconstruction
Authors: Mulligan Ryan P. , McCarthy Kevin J. , Grear Benjamin J. , Richardson David R. , Ishikawa Susan N. , Murphy G. Andrew
Published: June 2016

Background:

The purpose of this study was to examine factors associated with pain after elective ankle and hindfoot reconstruction.

Methods:

Patients who underwent major ankle or hindfoot reconstruction over a 3-year period were identified. Retrospective chart review determined patient demographics, comorbidities, surgeries, tobacco, alcohol, and narcotic use, chronic pain, and mood disorders. Primary outcomes were cumulative amount of narcotic prescribed (morphine milligram equivalent dose) in the initial 90-day postoperative period, beyond 90 days, and visual analog pain score (VAS) at a minimum of 1-year follow-up. One hundred thirty-two patients (139 operations) met the inclusion criteria.

Results:

The average narcotic amount prescribed in the initial 90 days after surgery was 1711 mg (morphine equivalent), and narcotic prescriptions were required after 52 surgeries (35%) past 90 days. Preoperative narcotic use ( P < .01), chronic pain disorder ( P = .02), and mood disorder ( P < .01) were significant risk factors for continued narcotic use past 90 days. Tobacco use ( P = .01) and chronic pain disorder ( P < .01) also were significant risk factors for increased initial postoperative narcotic use. The average VAS score in 91 patients at an average of 2.7-year follow-up was 2.1. Mood disorder was a risk factor for increased VAS ( P < .01). No other associations were noted.

Conclusion:

Patients being treated for chronic pain, diagnosed with a mood disorder, taking any amount of narcotics preoperatively, or using tobacco products had a statistically significant increased risk for pain postoperatively. The presence of risk factors should prompt physicians to discuss pain management strategies before surgery.

Level of Evidence:

Level III, comparative series.
Modeling Heterogeneity in Momentary Interpersonal and Affective Dynamic Processes in Borderline Personality Disorder
Authors: Wright Aidan G. C. , Hallquist Michael N. , Stepp Stephanie D. , Scott Lori N. , Beeney Joseph E. , Lazarus Sophie A. , Pilkonis Paul A.
Published: June 2016

Borderline personality disorder (BPD) is a diagnosis defined by impairments in several dynamic processes (e.g., interpersonal relating, affect regulation, behavioral control). Theories of BPD emphasize that these impairments appear in specific contexts, and emerging results confirm this view. At the same time, BPD is a complex construct that encompasses individuals with heterogeneous pathology. These features—dynamic processes, situational specificity, and individual heterogeneity—pose significant assessment challenges. In the current study, we demonstrate assessment and analytic methods that capture both between-person differences and within-person changes over time. Twenty-five participants diagnosed with BPD completed event-contingent, ambulatory assessment protocols over 21 days. We used p-technique factor analyses to identify person-specific psychological structures consistent with clinical theories of personality. Five exemplar cases are selected and presented in detail to showcase the potential utility of these methods. The presented cases’ factor structures reflect not only heterogeneity but also suggest points of convergence. The factors also demonstrated significant associations with important clinical targets (self-harm, interpersonal violence).
Association of the von Willebrand Factor–ADAMTS13 Ratio With Incident Cardiovascular Events in Patients With Peripheral Arterial Disease
Authors: Green David , Tian Lu , Greenland Philip , Liu Kiang , Kibbe Melina , Tracy Russell , Shah Sanjiv , Wilkins John T. , Huffman Mark D. , Liao Yihua , Lloyd Jones Donald , McDermott Mary M.
Published: June 2016

Background:

Platelet adhesion is mediated by von Willebrand factor (vWF), and disintegrin-like and metalloprotease domain with thrombospondin type-1 motif, number 13 (ADAMTS13) is a protease that cleaves vWF. A change in the balance between vWF and ADAMTS13 in favor of thrombosis might occur shortly before ischemic cardiovascular (CV) events.

Objective:

To determine whether vWF, ADAMTS13, and the ratio of vWF and ADAMTS13 change during the months preceding an acute CV event.

Design:

Prospective longitudinal observational study.

Setting:

Outpatient.

Patients:

A total of 595 participants with peripheral artery disease (PAD).

Measurements:

Blood samples were obtained every 2 months for up to 3 years and hemostatic factors examined at intervals preceding events.

Results:

Sixty-one participants (cases) experienced events and were matched to 122 PAD controls. During the 2-month interval prior to an event, cases (n = 48) had higher levels of the vWF and ADAMTS13 than controls (n = 95; P = .05), but significance was lost after adjusting for the baseline differences in myocardial infarction, unstable angina, and stroke. During the 10 months prior to an event, median values for vWF and the ratio of vWF and ADAMTS13 were higher in cases than in controls, but the differences were not statistically significant. However, in a subset of 20 patients with complete bimonthly data, there was a trend toward an increase in the ratio in the 10 months prior to a CV event ( P = .04).

Conclusion:

In patients with PAD experiencing an ischemic CV event, a significant increase in the ratio of vWF to ADAMTS13 prior to the event could not be confirmed, although there was a weak trend in this direction.
Multiparameter Predictor of Fluid Responsiveness in Cardiac Surgical Patients Receiving Tidal Volumes Less Than 10 mL/kg
Authors: Ikeda Keita , Smith Gregory , Renehan John , Isbell James , McMurry Timothy , Rosner Mitchell , Thiele Robert
Published: June 2016

Introduction. We hypothesize that respiratory variation in the pulmonary artery tracing predicts fluid responsiveness (primary hypothesis) and that inclusion of multiple physiologic waveforms as well as ventilator settings in a predictive model of fluid responsiveness would lead to improvements in the clinical utility of this class of metrics (secondary hypothesis). Methods. Blood pressure tracings were prospectively recorded in 35 patients immediately following cardiac surgery. Fluid bolus administration data, ventilator settings, and cardiac output were recorded prospectively before and after fluid boluses given at the discretion of the treating physician. Results. We observed statistically significant but limited relationships between pulmonic ( r2 = .26, P = .0052) and systemic ( r2 = .13, P = .011) pulse pressure variation and changes in cardiac index. A multiparameter estimate of fluid responsiveness, which included respiratory variation in central venous pressure and pulmonary artery pressure, indexed tidal volumes, positive end-expiratory pressure, and mean airway pressure, was also correlated with change in cardiac index ( r2 = .42, P = .0056). Using the area under the curve (AUC) technique to compare specificity and sensitivity, dynamic indicators (AUC = 0.74, 0.67, and 0.81 for systemic arterial respiratory [pulse pressure] variation, pulmonic arterial respiratory [pulse pressure] variation, and the multiparameter estimate, respectively) outperformed static estimates (0.49 and 0.48 for central venous pressure and pulmonary artery diastolic pressure, respectively). Conclusion. While integration of multiple physiologic waveforms as well as ventilator parameters improves the predictability of fluid responsive metrics in the setting of lung-protective ventilation, the composite index may still be of limited predictive value.
Possible use in psychology of threshold concept in order to study sensemaking processes
Authors: De Luca Picione Raffaele , Freda Maria F
Published: June 2016

Manifold forms of sensemaking processes and their simultaneity pose many questions about their integration and also on their development. Human beings mean their own experience and activity in the world by forms of symbolic meaning but also by several forms of embodied meaning, in an endo-semiotic and exo-semiotic key, such as the construction of artifacts, instruments, monuments, stories, myths. The culture in this perspective is not considered a repository of information and become an intersubjective process that develops over time and is rooted deeply in various embodied forms. Authors discuss the notion of threshold through two possible paths. The first one allows us to demarcate the boundaries of the domain of semiotic research and at the same time to reflect on the specificity of the different processes of sensemaking, from biological processes (vegetative and animal) to typically psychological processes, characteristic of human beings and of cultural dynamics. The second one deals with dynamics of transformation of the processes of sensemaking, claiming that the relationship between an organism and its environment has a gestaltic quality, whose form is constantly changing. The notion of threshold is developed in reference to the changes and transformations that mark discontinuous passages and developments within phases of stability.
Many faces of the concept of culture (and education)
Authors: Matusov Eugene , Marjanovic-Shane Ana
Published: June 2016

In this theoretical essay, we examine four conceptual gestalt approaches to culture and education: “culture as pattern,” “culture as boundary,” “culture as authorship,” and “culture as critical dialog.” In the “culture as pattern,” education aims at socializing people into a given cultural practice. Any decline from culturally valued patterns becomes a deficit for education to eliminate. In the “culture as boundary,” encounter with other cultures highlights their arbitrariness and equality. Education focuses on celebration of diversity, tolerance, pluralism, social justice, and equal rights. The “culture as authorship” is about authorial transcendence of the given recognized by others. Education promotes dialogic creativity and authorship. Student/author is the final authority of his/her own education. “Culture as critical dialog” promotes testing ideas, opinions, beliefs, desires, and values. Critical dialog is inherently deconstructive, promoting never-ending search for truth. Education aims at the critical examination of the self, life, world, and society. Student is welcomed as an ultimate spoilsport, a devil’s advocate. In conclusion, we discuss complex relationships among the four gestalt approaches to culture and education and the ontology of these gestalt approaches. As a by-product of our analysis, we critically deconstruct the concept of meaning making as deeply dialogic process, separating it from its many masks that are mistakenly identified with it.
Location, safety and (non) strangers in gay men’s narratives on ‘hook-up’ apps
Authors: Davis Mark , Flowers Paul , Lorimer Karen , Oakland Jane , Frankis Jamie
Published: June 2016

Hook-up websites and apps are said to be transforming the sexual lives of gay men and have been linked with the apparent erosion of gay publics as the basis for identity politics and social action. This article examines these dynamics in the interview and focus-group talk of gay men living on the economic and geographical margins of metropolitan gay culture. It offers perspectives on the importance of location – class, generation and space – for the experience of digital media, the negotiation of safety, and the new codifications and elaborations on sex with the (non) stranger; a figure who is not alien, yet not familiar, in sexual sociality. Reflecting on these situated perspectives in connection with debates on the erosion of gay publics, this article argues against monolithic framings of gay men’s sexual lives after digital media.