University of Tennessee at Chattanooga

BACKGROUND: Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation. METHODS: We randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group). Patients with a proximal intracranial occlusion in the anterior circulation were included up to 12 hours after symptom onset. Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. Workflow times were measured against predetermined targets. The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention would lead to lower scores on the modified Rankin scale than would control care (shift analysis). RESULTS: The trial was stopped early because of efficacy. At 22 centers worldwide, 316 participants were enrolled, of whom 238 received intravenous alteplase (120 in the intervention group and 118 in the control group). In the intervention group, the median time from study CT of the head to first reperfusion was 84 minutes. The rate of functional independence (90-day modified Rankin score of 0 to 2) was increased with the intervention (53.0%, vs. 29.3% in the control group; P<0.001). The primary outcome favored the intervention (common odds ratio, 2.6; 95% confidence interval, 1.7 to 3.8; P<0.001), and the intervention was associated with reduced mortality (10.4%, vs. 19.0% in the control group; P=0.04). Symptomatic intracerebral hemorrhage occurred in 3.6% of participants in intervention group and 2.7% of participants in control group (P=0.75). CONCLUSIONS: Among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality. (Funded by Covidien and others; ESCAPE ClinicalTrials.gov number, NCT01778335.).

SUMMARY: In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)].

Although the chloroplast genome contains many noncoding regions, relatively few have been exploited for interspecific phylogenetic and intraspecific phylogeographic studies. In our recent evaluation of the phylogenetic utility of 21 noncoding chloroplast regions, we found the most widely used noncoding regions are among the least variable, but the more variable regions have rarely been employed. That study led us to conclude that there may be unexplored regions of the chloroplast genome that have even higher relative levels of variability. To explore the potential variability of previously unexplored regions, we compared three pairs of single-copy chloroplast genome sequences in three disparate angiosperm lineages: Atropa vs. Nicotiana (asterids); Lotus vs. Medicago (rosids); and Saccharum vs. Oryza (monocots). These three separate sequence alignments highlighted 13 mutational hotspots that may be more variable than the best regions of our former study. These 13 regions were then selected for a more detailed analysis. Here we show that nine of these newly explored regions (rpl32-trnL((UAG)), trnQ((UUG))-5'rps16, 3'trnV((UAC))-ndhC, ndhF-rpl32, psbD-trnT((GGU)), psbJ-petA, 3'rps16-5'trnK((UUU)), atpI-atpH, and petL-psbE) offer levels of variation better than the best regions identified in our earlier study and are therefore likely to be the best choices for molecular studies at low taxonomic levels.

BACKGROUND: Bulky stage IB cervical cancers have a poorer prognosis than smaller stage I cervical cancers. For the Gynecologic Oncology Group, we conducted a trial to determine whether weekly infusions of cisplatin during radiotherapy improve progression-free and overall survival among patients with bulky stage IB cervical cancer. METHODS: Women with bulky stage IB cervical cancers (tumor, > or =4 cm in diameter) were randomly assigned to receive radiotherapy alone or in combination with cisplatin (40 mg per square meter of body-surface area once a week for up to six doses; maximal weekly dose, 70 mg), followed in all patients by adjuvant hysterectomy. Women with evidence of lymphadenopathy on computed tomographic scanning or lymphangiography were ineligible unless histologic analysis showed that there was no lymph-node involvement. The cumulative dose of external pelvic and intracavitary radiation was 75 Gy to point A (cervical parametrium) and 55 Gy to point B (pelvic wall). Cisplatin was given during external radiotherapy, and adjuvant hysterectomy was performed three to six weeks later. RESULTS: The relative risks of progression of disease and death among the 183 women assigned to receive radiotherapy and chemotherapy with cisplatin, as compared with the 186 women assigned to receive radiotherapy alone, were 0.51 (95 percent confidence interval, 0.34 to 0.75) and 0.54 (95 percent confidence interval, 0.34 to 0.86), respectively. The rates of both progression-free survival (P<0.001) and overall survival (P=0.008) were significantly higher in the combined-therapy group at four years. In the combined-therapy group there were higher frequencies of transient grade 3 (moderate) and grade 4 (severe) adverse hematologic effects (21 percent, vs. 2 percent in the radiotherapy group) and adverse gastrointestinal effects (14 percent vs. 5 percent). CONCLUSIONS: Adding weekly infusions of cisplatin to pelvic radiotherapy followed by hysterectomy significantly reduced the risk of disease recurrence and death in women with bulky stage IB cervical cancers.

J. Stewart Black, Mark Mendenhall, Gary Oddou, Toward a Comprehensive Model of International Adjustment: An Integration of Multiple Theoretical Perspectives, The Academy of Management Review, Vol. 16, No. 2 (Apr., 1991), pp. 291-317

Given the proliferation of training transfer studies in various disciplines, we provide an integrative and analytical review of factors impacting transfer of training. Relevant empirical research for transfer across the management, human resource development (HRD), training, adult learning, performance improvement, and psychology literatures is integrated into the review. We synthesize the developing knowledge regarding the primary factors influencing transfer—learner characteristics, intervention design and delivery, and work environment influences—to identify variables with substantive support and to discern the most pressing gaps. Ultimately, a critique of the state of the transfer literature is provided and targeted suggestions are outlined to guide future empirical and theoretical work in a meaningful direction.

To discover interordinal relationships of living and fossil placental mammals and the time of origin of placentals relative to the Cretaceous-Paleogene (K-Pg) boundary, we scored 4541 phenomic characters de novo for 86 fossil and living species. Combining these data with molecular sequences, we obtained a phylogenetic tree that, when calibrated with fossils, shows that crown clade Placentalia and placental orders originated after the K-Pg boundary. Many nodes discovered using molecular data are upheld, but phenomic signals overturn molecular signals to show Sundatheria (Dermoptera + Scandentia) as the sister taxon of Primates, a close link between Proboscidea (elephants) and Sirenia (sea cows), and the monophyly of echolocating Chiroptera (bats). Our tree suggests that Placentalia first split into Xenarthra and Epitheria; extinct New World species are the oldest members of Afrotheria.

J. Stewart Black, Mark Mendenhall, Cross-Cultural Training Effectiveness: A Review and a Theoretical Framework for Future Research, The Academy of Management Review, Vol. 15, No. 1 (Jan., 1990), pp. 113-136

A. Khosroshahi, Z. S. Wallace, J. L. Crowe, T. Akamizu, A. Azumi, M. N. Carruthers, S. T. Chari, E. Della-Torre, L. Frulloni, H. Goto, P. A. Hart, T. Kamisawa, S. Kawa, M. Kawano, M. H. Kim, Y. Kodama, K. Kubota, M. M. Lerch, M. L€ ohr, Y. Masaki, S. Matsui, T. Mimori, S. Nakamura, T. Nakazawa, H. Ohara, K. Okazaki, J. H. Ryu, T. Saeki, N. Schleinitz, A. Shimatsu, T. Shimosegawa, H. Takahashi, M. Takahira, A. Tanaka, M. Topazian, H. Umehara, G. J. Webster, T. E. Witzig, M. Yamamoto, W. Zhang, T. Chiba, and J. H. Stone

Purpose The purpose of this study is to examine the use of the strategic management tool, Strengths‐Weaknesses‐Opportunities‐Threats or SWOT analysis, and to assess how the methodology has been used as well as changes to the methodology. The findings both for and against SWOT analysis should lead to a balanced view of the technique as well as yield ideas for needed theory building. Design/methodology/approach Using the ABInform Global® database, academic peer‐reviewed articles were compiled indicating SWOT as one of the article's key index and search words. Findings The use of SWOT analysis continues to permeate the academic peer‐reviewed literature. Research supports SWOT analysis as a tool for planning purposes. Over the past decade, SWOT research has focused on analyzing organizations for recommended strategic actions. As a methodology for strategic positioning, SWOT analysis has been extended beyond companies to countries and industries and is used in virtually every published business case positioned for business student analysis. Additional use of SWOT is as teaching tools by consultants, trainers and educators. This paper provides a summary of the research studies and suggests paths for future research. Research limitations/implications This paper is limited to analyzing reports found in a selection of academic peer‐reviewed business journals. However, research implications for applying SWOT analysis provides a broad spectrum of industry analysis in North America, Europe, and Asia. Additional limitations are the need to link SWOT analysis to other strategic tools and methodologies for further theory building, since past research continues to lack quantifiable findings on the success of the SWOT analysis. Practical implications A fresh view of new directions and implementations for SWOT analysis, as well as other strategic planning tools that can be combined with SWOT, provides guidance for practitioners and policy makers alike. Originality/value The article adds value to the existing literature as the first summary of SWOT research indicating its uses and limitations. Support of its usage and place in the strategic literature is validated. The SWOT methodology is pervasive, in large part, due to its simplicity. In addition, the use of SWOT as a proven developmental, results‐oriented strategic planning tool is also extended, although further research leading to theory building is warranted and recommended.

BACKGROUND: Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated the effectiveness of angiotensin II for the treatment of patients with this condition. METHODS: We randomly assigned patients with vasodilatory shock who were receiving more than 0.2 μg of norepinephrine per kilogram of body weight per minute or the equivalent dose of another vasopressor to receive infusions of either angiotensin II or placebo. The primary end point was a response with respect to mean arterial pressure at hour 3 after the start of infusion, with response defined as an increase from baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, without an increase in the dose of background vasopressors. RESULTS: A total of 344 patients were assigned to one of the two regimens; 321 received a study intervention (163 received angiotensin II, and 158 received placebo) and were included in the analysis. The primary end point was reached by more patients in the angiotensin II group (114 of 163 patients, 69.9%) than in the placebo group (37 of 158 patients, 23.4%) (odds ratio, 7.95; 95% confidence interval [CI], 4.76 to 13.3; P<0.001). At 48 hours, the mean improvement in the cardiovascular Sequential Organ Failure Assessment (SOFA) score (scores range from 0 to 4, with higher scores indicating more severe dysfunction) was greater in the angiotensin II group than in the placebo group (-1.75 vs. -1.28, P=0.01). Serious adverse events were reported in 60.7% of the patients in the angiotensin II group and in 67.1% in the placebo group. Death by day 28 occurred in 75 of 163 patients (46%) in the angiotensin II group and in 85 of 158 patients (54%) in the placebo group (hazard ratio, 0.78; 95% CI, 0.57 to 1.07; P=0.12). CONCLUSIONS: Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors. (Funded by La Jolla Pharmaceutical Company; ATHOS-3 ClinicalTrials.gov number, NCT02338843 .).

Three daily diary studies were conducted to examine the incidence, nature, and impact of everyday sexism as reported by college women and men. Women experienced about one to two impactful sexist incidents per week, consisting of traditional gender role stereotypes and prejudice, demeaning and degrading comments and behaviors, and sexual objectification. These incidents affected women's psychological well‐being by decreasing their comfort, increasing their feelings of anger and depression, and decreasing their state self‐esteem. Although the experiences had similar effects on men's anger, depression, and state self‐esteem, men reported relatively fewer sexist incidents, suggesting less overall impact on men. The results provide evidence for the phenomena of everyday prejudice and enlighten our understanding of the experience of prejudice in interpersonal encounters from the perspective of the target.

Various forms of self-loss have been described as aspects of mental illness (e.g., depersonalization disorder), but might self-loss also be related to mental health? In this integrative review and proposed organizational framework, we focus on self-transcendent experiences (STEs)—transient mental states marked by decreased self-salience and increased feelings of connectedness. We first identify common psychological constructs that contain a self-transcendent aspect, including mindfulness, flow, peak experiences, mystical-type experiences, and certain positive emotions (e.g., love, awe). We then propose psychological and neurobiological mechanisms that may mediate the effects of STEs based on a review of the extant literature from social psychology, clinical psychology, and affective neuroscience. We conclude with future directions for further empirical research on these experiences.

The distinction between transaction‐specific satisfaction and overall satisfaction has received little empirical attention in the satisfaction and services literature. Furthermore, a review of the extant literature provides mixed conceptual evidence concerning the relationships among transaction‐specific satisfaction, overall satisfaction, and repurchase intentions. This study empirically investigates transaction‐specific satisfaction, overall satisfaction and repurchase intentions, and finds that the two types of satisfaction can be distinguished from one another. Furthermore, the findings from this study suggest that overall satisfaction has a direct influence on repurchase intentions as well as a moderating influence on the transaction‐specific satisfaction/repurchase intentions relationship. When overall satisfaction is high, transaction‐specific satisfaction has little impact on repurchase intentions, but when overall satisfaction is low, transaction‐specific satisfaction has a positive influence on repurchase intentions.

Previous research has found that interactional justice and distributive justice are critical factors influencing customer satisfaction after a service recovery. In addition, previous service recovery research has found that satisfaction is an important determinant of key outcome variables such as trust, commitment, and negative word‐of‐mouth. The current study extends previous research by investigating the role of service failure severity within the existing framework of service recovery research. The results indicate that service failure severity has a significant influence on satisfaction, trust, commitment, and negative word‐of‐mouth. The results also provide partial support for a moderating influence of service failure severity. Implications and areas for future research are discussed.

Firms operating in an international environment face a host of uncertainties that make it difficult to meet deadlines reliably. To be reliable in an uncertain and changing environment, firms must be able to quickly respond to changes. The ability to do this in a useful time frame is called agility. Unfortunately, measures taken to increase agility often lead to increases in complexity, which works against agility. We propose a theoretical construct linking elements of uncertainty with aspects of agility, pointing out the two‐edged nature of the requisite capabilities. We illustrate our points with examples from five case studies.

Approximately 1·5 billion people worldwide live with a physical, mental, sensory, or intellectual disability, about 80% of which are in low-income and middle-income countries. This Series paper provides a global overview of the prevalence, benefits, and promotion policies for physical activity for people living with disabilities (PLWD). PLWD are 16-62% less likely to meet physical activity guidelines and are at higher risk of serious health problems related to inactivity than people without disabilities. Meta-analyses have shown that physical activity has beneficial effects on cardiovascular fitness (average standardised mean difference [SMD] 0·69 [95% CI 0·31-1·01]), musculoskeletal fitness (0·59 [0·31-0·87]), cardiometabolic risk factors (0·39 [0·04-0·75]), and brain and mental health outcomes (0·47 [0·21-0·73]). These meta-analyses also show that health benefits can be achieved even with less than 150 min of physical activity per week, and suggest that some physical activity is better than none. Meta-analyses of interventions to increase physical activity for PLWD have reported effect sizes ranging from SMD 0·29 (95% CI 0·17-0·41, k=10) to 1·00 (0·46-1·53, k=10). There is increasing awareness among policy makers of the needs of PLWD for full participation in physical activity. Physical activity action plans worldwide must be adequately resourced, monitored, and enforced to truly advance the fundamental rights of PLWD to fully participate in physical activity.

BACKGROUND: Temporary abdominal wound closure after celiotomy for trauma is often desirable. The ideal method of temporary closure should allow rapid closure, easy maintenance, and allow reexploration and wound repair with minimal tissue damage. Over the past 7 years, we have successfully used a vacuum closure system (the vacuum pack) for temporary management of the open abdomen. METHODS: Medical records of trauma patients undergoing exploratory celiotomy from April of 1992 to February of 1999 were reviewed. Demographic data as well as indications for open-abdominal management and complications of open-abdominal management were collected. RESULTS: Two hundred sixteen vacuum packs were performed in 112 trauma patients. Of the 216 vacuum packs placed, 2.8% were placed for increased intra-abdominal pressure, 5.3% for inability to achieve tension-free fascial closure, 20% for damage control, 55% for reexploration, and 16.7% for a combination of factors. Sixty-two patients (55.4%) went on to primary closure and 25 patients (22.3%) underwent polyglactin mesh repair of the defect followed by wound granulation and eventual skin grafting. Twenty-two patients (19.6%) died before abdominal closure was attempted. Five patients (4.5%) developed enterocutaneous fistulae. Five patients (4.5%) developed intra-abdominal abscesses. There were no eviscerations. Three patients (2.7%) required further explorations after abdominal closure. Overall mortality rate was 25.9%, none related to the vacuum pack. CONCLUSIONS: The vacuum pack is the temporary abdominal wound closure of choice in patients undergoing open abdominal management at our institution. Primary closure is achieved in the majority of patients with a low rate of complication. The technique is simple and easily mastered. Technical complications are rare and easily repaired.

The phenomenon popularly referred to as helicopter parenting refers to an overinvolvement of parents in their children's lives. This concept has typically been used to describe parents of college-aged young adults. Despite much anecdotal evidence, little is known about its existence and consequences from an empirical perspective. Using a sample of college students at a university in the United States (N = 317), the exploration and measurement of this concept is examined. Results of factor analysis of helicopter parenting items constructed for this study support the use of the scale. Results suggest helicopter parenting is negatively related to psychological well-being and positively related to prescription medication use for anxiety/depression and the recreational consumption of pain pills.

Journal Article Varieties of Secularism in a Secular Age Get access Varieties of Secularism in a Secular Age. Edited by Michael Warner, Jonathan VanAntwerpen, and Craig Calhoun. Cambridge, MA: Harvard University Press, 2010. 352pp. $45.00. Wilfred M. McClay Wilfred M. McClay University of Tennessee at ChattanoogaChattanooga, Tennessee mcclayw@bellsouth.net Search for other works by this author on: Oxford Academic Google Scholar Journal of Church and State, Volume 54, Issue 1, Winter 2012, Pages 122–124, https://doi.org/10.1093/jcs/csr134 Published: 23 December 2011