bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immigrant “Quality” in Canada: More Direct Evidence of Human Capital Content, 1956–1994
Authors: Akbari Ather H. 
Published: June 2018

This article provides direct evidence about educational attainments of new arrivals in Canada over the period 1956 to 1994. This evidence is based on immigrants’ educational attainment data obtained from two sources: different population censuses from 1961 to 1986, including those from 1961, 1971, 1981 and 1986; and landing documents of immigrants. Data from these two sources allow an analysis of educational attainment trends over a longer period than that conducted in some other studies and in more depth. Finally, immigrant data are also compared with the educational attainment of the Canadian-born population in corresponding periods. Individuals aged 25 years or older are considered. Results show that, in the total immigrant inflows of any subperiod since 1956, the percentages of those with high school education or less have been declining and have been lower than those for the Canadian-born population, while the percentages of those with university degrees have been rising and have been higher than those for the Canadian-born population. These results contradict the generally held view in Canada that in the post-1967 period, the immigration policy's increased focus on family and refugee classes has resulted in the admission of immigrants who are less educated than those who arrived before 1967. This result indicates that other factors such as discrimination and general economic conditions in the country should be investigated in depth to explain the recently cited decline in the economic performance of Canadian immigrants.
Discriminative stimulus effects of cocaine-levamisole combinations in Sprague-Dawley rats
Authors: Zimmermann Zachary J , Gauvin David V , Poling Alan 
Published: June 2018

Background: Levamisole (LVM) is a common adulterant in clandestinely manufactured cocaine (COC), with a range of well-documented deleterious health effects. Although the prevalence of LVM in COC has been widely noted, the subjective effects related to concomitant COC-LVM administration are poorly understood. Aims: The present study sought to compare the subjective effects of LVM alone and in combination with COC in male and female Sprague-Dawley rats trained to discriminate COC from vehicle injections. Methods: Male and female Sprague-Dawley rats were trained to discriminate COC from vehicle injections using a two-lever, food-reinforced drug discrimination procedure. Subsequent dose-effect curves were generated for COC, LVM, and a variety of COC-LVM combinations. Results: No significant difference in males and females was observed on any measure of responding. LVM alone dose-dependently decreased response rates and failed to produce substitution for COC. When LVM was administered with COC, previously ineffective doses of COC engendered COC-appropriate responding. Conclusions: LVM potentiates the subjective effects of COC when administered concomitantly. These findings are consistent with the popular notion that LVM is added as an adulterant to COC to amplify the subjective effects of COC administration.
Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures
Authors: Cui Xueliang , Chen Hui , Rui Yunfeng , Niu Yang , Li He 
Published: June 2018

Objectives Two-stage open reduction and internal fixation (ORIF) and limited internal fixation combined with external fixation (LIFEF) are two widely used methods to treat Pilon injury. However, which method is superior to the other remains controversial. This meta-analysis was performed to quantitatively compare two-stage ORIF and LIFEF and clarify which method is better with respect to postoperative complications in the treatment of tibial Pilon fractures. Methods We conducted a meta-analysis to quantitatively compare the postoperative complications between two-stage ORIF and LIFEF. Eight studies involving 360 fractures in 359 patients were included in the meta-analysis. Results The two-stage ORIF group had a significantly lower risk of superficial infection, nonunion, and bone healing problems than the LIFEF group. However, no significant differences in deep infection, delayed union, malunion, arthritis symptoms, or chronic osteomyelitis were found between the two groups. Conclusion Two-stage ORIF was associated with a lower risk of postoperative complications with respect to superficial infection, nonunion, and bone healing problems than LIFEF for tibial Pilon fractures. Level of evidence 2.
Characteristics of uterine rupture after laparoscopic surgery of the uterus: clinical analysis of 10 cases and literature review
Authors: Wu Xiaoyi , Jiang Wei , Xu Huan , Ye Xuping , Xu Congjian 
Published: June 2018

Objective An increasing trend of uterine rupture (UR) after laparoscopic surgery of the uterus (LSU) has been observed. Although the overall incidence is extremely low, UR may have catastrophic outcomes. Therefore, investigation of its potential risk factors is important. Methods We retrospectively reviewed the medical data of 10 women who developed UR after LSU performed at our hospital from October 2003 to October 2016 and conducted a literature review. Results All cases of UR occurred during the third trimester of pregnancy. The surgeries contributing to UR were laparoscopic myomectomy, adhesion decomposition, and salpingectomy, resulting in unfavorable outcomes especially for the fetus. Diathermy was routinely used for hemostasis, and multilayer suturing was not adequately performed in many cases. The posterior wall was the most common site of UR in most cases. Silent rupture with unremarkable symptoms was not rare. Similar risk factors were identified in the literature review. Conclusions Excessive use of energy equipment and the lack of multilayer suturing were the most common characteristics of UR after LSU. A history of LSU should always be considered a risk factor for UR.
On the Expanding Ludosphere
Authors: Stenros Jaakko , Kultima Annakaisa 
Published: June 2018

Background. Taking Klabbers’ call for a coherent game science as a starting point, we argue for an alternative way to approach the multidisciplinarity of research into games. Aim. Building on game studies and design research, this article reviews the history and forecasts the future of studying games. Application. All scholars of games could benefit from an awareness of the works of other game scholars in different traditions. The plurality of approaches towards games is an intellectual strength, even if it is difficult for a single scholar to maintain a holistic grasp on research relating to ‘games’. The multitude not only describes the disciplinary traditions reflecting the wider phenomenon of games and play, but also games as creative practice. Demonstration. While the article is theoretical in nature, we use real-world examples to illustrate and ground the argumentation. For example, a key challenge identified here is that the realm of games and their influence, the ludosphere, is expanding too rapidly for any single researcher to keep up with it. Conclusions. We invite game scholars to cultivate a stronger awareness of the multitude of research into games to better position their own work in a larger context.
Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon
Authors: Leal Claudia Resende , de Carvalho Roberta Martinelli , Ozawa Terumi Okada , de Almeida Araci Malagodi , da Silva Dalben Gisele , da Cunha Bastos José Carlos , Garib Daniela Gamba 
Published: June 2018

Objective: To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2. Design: Cross-sectional. Setting: Tertiary craniofacial center. Participants: Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition. Interventions: The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs. Main Outcome Measures: The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05). Results: All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001). Conclusion: The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.
New onset seizures as a sole clinical presentation of multiple sclerosis
Authors: Al Hussona Mariam , Kearney Hugh , Fisher Arie , Lynch John , Looby Seamus , Delanty Norman 
Published: June 2018

Background and objectives: Epileptic seizures frequently occur in people with multiple sclerosis (MS) and are thought to represent a manifestation of cortical pathology. However, at present, seizures are not considered to be a typical clinical presentation of demyelination. Methods and results: In this case series, we identified four people, who presented with seizures as a sole presenting feature, with demyelinating imaging abnormalities that satisfy current diagnostic criteria for a clinically isolated syndrome (CIS) or early MS. Conclusion: Based on this case series, we propose that people presenting with de novo seizures, with concurrent radiological abnormalities suggestive of demyelination could potentially be considered to have a CIS.
Engaging persons with disabilities as community teachers for experiential learning in occupational therapy education
Authors: Lim Sok Mui , Leet Tan Bhing , Lim Hua Beng , Goh Zi An Galvyn 
Published: June 2018

Background Cultivating empathy towards persons with disabilities has been highlighted as an essential graduate attribute in the occupational therapy profession. Purpose With the aim to developing a more holistic understanding of disability, this project seeks to translate an experiential learning activity developed in Canada to the local Singaporean context. Small groups of two to three students were paired with a person with physical disability, known as a community teacher, for a series of visits to observe and participate in their self-care, productivity and leisure activities. Method A sequential explanatory mixed methods design was adopted with the administration of an adapted version of the Multidimensional Attitudes Scale Towards Persons with Disabilities on 51 first year occupational therapy students. Seventeen students participated in three focus group discussions at the end of the learning activity. Findings: Comparison of pre- and post-scores using Wilcoxon signed-rank tests of all three subscales of the Multidimensional Attitudes Scale Towards Persons with Disabilities yielded significant improvements. The average score for Affect improved from 42.94 to 32.08, z = −5.43, P <  .001; for Cognition improved from 26.12 to 21.41, z = −4.20, P <  .001; for Behaviour improved from 23.78 to 20.65, z= −4.44, P <  .001. Effect sizes ranged from medium to large. Thematic analysis of focus groups led to the identification of four themes that explained these improvements. Implications: Experiential learning can be effective in cultivating empathy and improving attitudes of occupational therapy students towards persons with disabilities. There is potential to expand this pedagogical approach to other health sciences disciplines.
Experimental study of the characteristics of various types of filling coils for intracranial aneurysm embolisation
Authors: Ito Masashi , Matsubara Noriaki , Izumi Takashi , Miyachi Shigeru , Ota Keisuke , Imai Tasuku , Nishihori Masahiro , Wakabayashi Toshihiko 
Published: June 2018

Background In endovascular embolisation for an intracranial aneurysm, after framing coil deployment, soft coils (often called filling coils) are usually selected to fill inside the cage of previous coils. Various kinds of filling coils are available, although each coil has its own characteristics. Understanding their differences to ensure proper coil selection is important to achieve successful embolisation. The purpose of this study was to investigate the characteristics of various filling coils. Materials and methods The authors developed a radiolucent coil to evaluate the performance of coils under conditions simulating the course of embolisation. Experimental embolisation was performed by using a silicone aneurysm filled with radiolucent coils. Indices including area, circularity, centroid position and coefficient of variation were investigated by analysing the figures of the filling coils after being inserted into the radiolucent coil under fluoroscopy. Results The characteristics of each coil depended on the coil design. The helical coil had the highest circularity and centroid position scores and lowest area score. Therefore, it tended to develop a compacted mass. The low shape-memory coil had the lowest circularity, second-highest centroid position and highest coefficient of variation scores. Therefore, it tended to develop irregularly shaped distribution with low reproducibility. Complex coils generally had higher area and circularity scores. Therefore, they tended to provide a balanced distribution with relatively expanded mass and less small compartmentation. Conclusions The evaluated characteristics of various filling coils should be useful for appropriate selection of filling coils.
Onyx embolization of a pial AV fistula with a giant venous varix using a flow-directed Scepter balloon catheter: Technical note
Authors: Griffin Andrew S , Befera Nicholas , Hauck Erik 
Published: June 2018

Background and importance Pial arteriovenous fistulas (AVFs) of the brain are treacherous lesions that can be challenging to treat because of high risk of hemorrhage. We report on a rare case of a pial AVF with a giant venous varix as a draining vein treated successfully with flow-directed balloon-assisted Onyx embolization. Clinical presentation A 56-year-old female with headaches underwent brain magnetic resonance imaging, which demonstrated a 4 cm aneurysmal malformation in the right temporal lobe. A diagnostic cerebral angiogram demonstrated a right temporal pial AVF fed by an enlarged right posterior cerebral artery with drainage into a giant venous varix. Onyx embolization was curative using a flow-directed Scepter balloon catheter. Conclusion Flow-directed balloon-assisted Onyx embolization can be highly successful for the curative embolization of pial AVFs. Balloon application changes the nature of the lesion from high-flow–high risk to no-flow–low-risk. Using a flow-directed technique with balloon microcatheters may help minimize the risk of intracranial vascular injury.
Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose?
Authors: Lenters-Westra Erna , English Emma 
Published: June 2018

Background: Point-of-care (POC) testing is becoming increasingly valuable in health care delivery, and it is important that the devices used meet the same quality criteria as main laboratory analyzers. While external quality assessment (EQA) provides a great tool for assessing quality, many POC devices are not enrolled in these schemes and standard laboratory evaluations are needed to assess performance. Methods: The Clinical and Laboratory Standards Institute (CLSI) protocols EP-5 and EP-9 were applied to investigate imprecision, accuracy and bias. We assessed bias using the mean of 4 certified secondary reference measurement procedures (SRMPs). Results: The Afinion2™ and the Quo-Lab had CVs of ≤1.7 and ≤2.4% respectively in IFCC SI units (≤1.2 and ≤1.7% NGSP) and a bias ≤2 mmol/mol (≤0.2% NGSP) at 48 and 75 mmol/mol (6.5 and 9.0% NGSP). Sigma for the Afinion2 was 5.8 and for the Quo-Lab 4.0. Both methods passed the NGSP criteria with 2 instruments when compared with 4 individual SRMPs. The HbA1c 501 had a CV of 3.4% and 2.7% in IFCC SI units (2.1% and 1.7% NGSP) and a bias ≤2.4 mmol/mol (≤0.2% NGSP) and passed the NGSP criteria with 2 instruments compared with 4 individual SRMPs except for instrument 2 compared with the Tosoh G8. Sigma was 2.1. The A1Care had a sigma of 1.4 and failed all criteria mainly due to a high CV (6.2% and 4.1% in IFCC SI units [4.1% and 2.9% NGSP] at 48 and 75 mmol/mol [6.5 and 9.0% NGSP]). Conclusions: The analytical performance was excellent for the Afinion2 and the Quo-Lab, acceptable for the HbA1c 501 and unacceptable for the A1Care according to different used criteria, demonstrating that whilst performance is improving there are still areas for considerable improvement.
Nursing Unit Design, Nursing Staff Communication Networks, and Patient Falls: Are They Related?
Authors: Brewer Barbara B. , Carley Kathleen M. , Benham-Hutchins Marge , Effken Judith A. , Reminga Jeffrey 
Published: June 2018

Purpose: The purpose of this research is to (1) investigate the impact of nursing unit design on nursing staff communication patterns and, ultimately, on patient falls in acute care nursing units; and (2) evaluate whether differences in fall rates, if found, were associated with the nursing unit physical structure (shape) or size. Background: Nursing staff communication and nursing unit design are frequently linked to patient safety outcomes, yet little is known about the impact of specific nursing unit designs on nursing communication patterns that might affect patient falls. Method: An exploratory longitudinal correlational design was used to measure nursing unit communication structures using social network analysis techniques. Data were collected 4 times over a 7-month period. Floor plans were used to determine nursing unit design. Fall rates were provided by hospital coordinators. Results: An analysis of covariance controlling for hospitals resulted in a statistically significant interaction of unit shape and size (number of beds). The interaction occurred when medium- and large-sized racetrack-shaped units intersected with medium- and large-sized cross-shaped units. Conclusion: The results suggest that nursing unit design shape impacts nursing communication patterns, and the interaction of shape and size may impact patient falls. How those communication patterns affect patient falls should be considered when planning hospital construction of nursing care units.
Mobile health and the performance of maternal health care workers in low- and middle-income countries: A realist review
Authors: Abejirinde Ibukun-Oluwa Omolade , Ilozumba Onaedo , Marchal Bruno , Zweekhorst Marjolein , Dieleman Marjolein 
Published: June 2018

Introduction Maternal health and the performance of health workers is a key concern in low- and middle-income countries. Mobile health technologies are reportedly able to improve workers’ performance. However, how this has been achieved for maternal health workers in low-resource settings is not fully substantiated. To address this gap by building theoretical explanations, two questions were posed: How does mobile health influence the performance of maternal health care workers in low- and middle-income countries? What mechanisms and contextual factors are associated with mobile health use for maternal health service delivery in low- and middle-income countries? Methods Guided by established guidelines, a realist review was conducted. Five databases were searched for relevant English language articles published between 2009 and 2016. A three-stage framework was developed and populated with explanatory configurations of Intervention–Context–Actors–Mechanism–Outcome. Articles were analyzed retroductively, with identified factors grouped into meaningful clusters. Results Of 1254 records identified, 23 articles representing 16 studies were retained. Four main mechanisms were identified: usability and empowerment explaining mobile health adoption, third-party recognition explaining mobile health utilization, and empowerment of health workers explaining improved competence. Evidence was skewed toward the adoption and utilization stage of the framework, with weak explanations for performance outcomes. Conclusions Findings suggest that health workers can be empowered to adopt and utilize mobile health in contexts where it is aligned to their needs, workload, training, and skills. In turn, mobile health can empower health workers with skills and confidence when it is perceived as useful and easy to use, in contexts that foster recognition from clients, peers, or supervisors.
Lack of cross-cultural validity of the Endometriosis Health Profile-30
Authors: Verket Nina Julie , Andersen Marit Helen , Sandvik Leiv , Tanbo Tom Gunnar , Qvigstad Erik 
Published: June 2018

Introduction: The Endometriosis Health Profile-30 is a disease-specific patient-reported outcome measure of health-related quality of life. Cross-cultural validation of the Endometriosis Health Profile-30 has been performed for several translated versions. The aim of this study was to evaluate the measurement properties of a Norwegian version Endometriosis Health Profile-30. Methods: This study was designed as a cross-sectional anonymous postal questionnaire study. A total of 157 women with endometriosis were included during a period from 2012 to 2013. Women aged 18–45 years were recruited from the Norwegian Endometriosis Association. Principal components analysis with varimax rotation was used to assess construct validity. Short Form-36 was used to determine convergent validity. Cronbach’s alpha was used to measure internal consistency. Intraclass correlation coefficients and paired t-tests were used to evaluate test–retest reliability. Floor and ceiling effects were estimated. Results: Factor analysis resulted in a three and five-factor model for the core and modular questionnaire, respectively. Factor analysis could not support construct validity of the scales self-image and treatment. The Norwegian version Endometriosis Health Profile-30 demonstrated acceptable internal consistency and test–retest reliability, except for the scale relationship with children. Floor effects were observed for the scales self-image (20.1%), work life (33.9%), relationship with children (34.2%), and medical profession (20.5%). Conclusion: The construct self-image does not seem to be measured appropriately by the Norwegian version Endometriosis Health Profile-30, suggesting a lack of cross-cultural validity of the Endometriosis Health Profile-30. With multinational studies increasing, adequate translation, cross-cultural adaptation, and cross-cultural validation of instruments are essential to ensure equivalence in languages and cultures other than the original.