bluuebunny/crossref_metadata_2025 huggingface dataset:
Imparting high flame retardancy to epoxy resin with ultra-low loading of 5,10-dihydro-phenophosphazine-10-oxide functioned triazine
Authors: Wu Xiaoli , Dong Chunlei , Wirasaputra Alvianto , Huang Haohao , Liu Shumei , Zhao Jianqing , Fu Yi
Published: August 2017

High mechanical properties and flame retardancy of epoxy are important for its applications. A novel star-shaped flame-retardant 5,10-dihydro-phenohphosphazine-10-oxide functioned triazine (TRIDPPA) with high efficiency is synthesized, and its structure is characterized. TRIDPPA is used as the co-curing agent for diglycidyl ether of the bisphenol A/4,4-diaminodiphenyl methane system. The introduction of TRIDPPA greatly improves the flame retardancy of the cured epoxy resins. The epoxy resin (ER)/TRIDDPA1.0 resin acquires a limiting oxygen index value of 30.7% and UL-94 V-0 rating when the mass fraction of TRIDDPA is 1.0 wt% with only 0.086 wt% of phosphorus content. The cross-link density of ER/TRIDDPA1.0 is increased, and the glass transition temperature is improved by 5°C. Besides, tensile strength and toughness of ER/TRIDDPA1.0 are also enhanced.
Effects of potassium titanate whisker and glass fiber on tribological and mechanical properties of PTFE/PEEK blend
Authors: Teng Xue , Wen Lefei , Lv Yunxia , Tang Wenge , Zhao Xiaogang , Chen Chunhai
Published: August 2017

Two series of 10% polytetrafluoroethylene (PTFE)/polyether ether ketone (PEEK) composites reinforced with potassium titanate whisker (PTW/PTFE/PEEK) and chopped glass fiber (GF/PTFE/PEEK) were prepared and characterized. We investigated the effects of the additives on thermal stability, tribological properties, mechanical properties, and rheological behavior. The results illustrated that the mechanical properties of 10% PTFE/PEEK blend can be dramatically improved by incorporating either PTW or GF; however, the reinforcing effect of GF was found to be superior. It was found that 1% additive resulted in blends with the best tribological properties. Compared to the unmodified blend, the friction coefficient and wear rate of the 1% PTW blend decreased by 7.2% and 21%, respectively, while the corresponding values of 1% GF blend decreased by 0.66% and 51%, respectively.
Universal logic assessment for complex product design with respect to smart energy efficient manufacturing characteristics
Authors: Wei Zhe , Gao Yicong , Qu Rongxia , Hong Zhaoxi , Zheng Bing
Published: August 2017

This paper proposes an assessment method of complex product design associated with smart energy efficient manufacturing characteristics based on the universal logic. Semantic expression of complex product solution is accomplished by the function tree of AND/OR and matches proposition set. Evaluation index of product solutions is divided into functional index and smart energy efficient manufacturing index in unit of each individual match proposition. Then, assessment is implemented by a fuzzy synthesis algorithm. Universal logic of proposition autocorrelation and cross-correlation combined influence model of assessment for complex product design effectively deals with smart energy efficient manufacturing characteristics, and considers integration characteristics among each individual solution. The logic inference of compositional proposition realizes the overall scheme evaluation. Finally, a case study involving design scheme evaluation of high-precision gear cutting machine tool is described to illustrate the proposed method and the method is proven to be effective.
A collaborative digital oral history collection
Authors: Thompson Beth J , Baugnon Rebecca A
Published: August 2017

A collaborative oral history project was recently completed at the University of North Carolina Wilmington (UNCW) by students enrolled in a Spanish seminar course and library faculty and staff members at the University. The course, ‘Hispanics in N.C.: Service Learning and Research,’ was created and offered as one component of a public programming grant awarded to UNCW by the National Endowment for the Humanities and the American Library Association through these institutions’ initiative called ‘Latino Americans: 500 Years of History.’ The course provided students with an opportunity to interview individuals in the southeastern North Carolina Latino community about their experiences in the United States. Students captured an audio recording of the interview which they later transcribed and provided a photograph of the interviewee. Library faculty and staff members were tasked with creating a digital collection to highlight the oral histories. Working within a limited time frame and with no funding for the project, the planning and implementation for the digital collection was completed by librarians in the library’s Information Technology and Systems, Special Collections, and Technical Services departments. Utilizing technology, systems, and skill sets that were already in place at Randall Library, a final product titled, ‘Somos NC: Voices from North Carolina’s Latino Community,’ was created. This article seeks to provide a practical discussion of the oral history project, outlining the Library’s processes and project workflows as well as assessment and reflections. Synthesizing knowledge gained through the experience, the intent is to provide an example of how, through collaboration and innovation, small to midsized libraries can accomplish similar projects.
The changing face of women living with HIV in western Ukraine
Authors: Dethier Divya , Rybak Natasha , Hirway Priya , Bachmaha Mariya , Carroll Jennifer , Sorokolit Andriy , Flanigan Timothy , Sluzhynska Maryana
Published: August 2017

Ukraine has the second largest HIV epidemic in Eastern Europe/Central Asia. This study characterizes the demographics of HIV-infected women in the Lviv region of western Ukraine, patterns in their clinical presentation, and factors associated with delays in seeking care. A retrospective chart review was conducted of 622 HIV-infected women who registered for HIV treatment at the Lviv AIDS Center between 2008 and 2013. A total of 81.6% of women were infected through heterosexual transmission and the remaining 18.4% through intravenous drug use. Slightly less than half (45.4%) was between 26 and 35 years old. Slightly more than half (56.7%) listed their residence in a city, 22.6% in villages. One-third (30.0%) of all women presented with AIDS, and 37.7% presented with symptomatic conditions. Women diagnosed with HIV during antenatal care experienced a median delay of 34 days between diagnosis and registration, compared to 87.5 days for nonpregnant women tested in the context of intravenous drug use. Overall, HIV-infected women in western Ukraine experience time delays in care, and often present with advanced HIV disease and secondary complications. Linkage to care in a timely manner is a high priority and substantial challenge for women, particularly for intravenous drug users who may face stigma and other additional barriers.
Misleading 18FDG-PET/CT finding caused by chronic HIV infection in a patient with gastric carcinoma: a case report
Authors: Bulut Nilufer , Yılmaz Burcak
Published: August 2017

The aim of this study was to describe the influence of HIV infection on the staging of gastric cancer by using positron emission tomography/computed tomography (PET/CT) imaging. We treated a patient with local advanced gastric cancer. PET/CT showed an unusual hypermetabolic activity of lymph nodes, and the patient was later found to be HIV-positive. PET/CT scans in cancer staging of patients with chronic HIV infection may show advanced stage disease. Spread of primary tumor to unusual sites should be a warning sign for the possible concurrent diseases.
Environmental controls for underground coal gasification
Authors: Mallett CW
Published: August 2017

Effective environmental management of an underground coal gasification pilot has been demonstrated at Kogan in Queensland, Australia. It commenced with selection of a suitable site with a coal seam surrounded by impervious rocks that provided a gas seal for the gasifier and sufficient groundwater pressure to constrain lateral loss of gas and chemicals through coal fractures. Project infrastructure was specified to withstand the temperatures and pressures experienced during gasification and gas processing. During syngas production in the second gasifier, Panel 2, it was shown that all pyrolysis products of environmental concern were retained within the gasifier. This was achieved by maintaining continuous groundwater inflow into the gasifier cavity through control of the relative pressures of the gasifier and surrounding groundwater. In Panel 1, it was shown that when pyrolysis products migrated out of the cavity, they were quickly detected and by modifying relative pressures to increase groundwater inflow the original groundwater conditions were restored. Following production, the cavities were decommissioned and in Panel 2 steam cleaning of the cavity removed 92% of the chemical load from the cavity. As a result, relatively low concentrations of pyrolysis products remained in the cavity. Fate and transport modelling predicted that these products will not migrate into the regional groundwater and will naturally degrade within three decades.
Effect of casing aspiration on the tip leakage flow in the axial flow compressor cascade
Authors: Mao Xiaochen , Liu Bo , Tang Tianquan
Published: August 2017

Tip leakage flow is usually responsible for the deterioration of compressor performance and stability. The current paper conducts numerical simulations on the impact of casing aspiration on the axial compressor cascade performance. Three aspiration schemes with different chordwise coverage are studied and analyzed. It is found that the cascade performance can be effectively improved by the appropriate casing aspiration, and the optimum aspiration scheme should cover the area including the onset point of tip leakage vortex and its vicinity. The control mechanisms are different for the aspiration schemes located at different blade chord ranges. For the aspiration scheme covering the onset point of tip leakage vortex, the improvement of the cascade performance is mainly due to that the starting point of the tip leakage vortex is shifted downstream. The original tip leakage vortex structure is divided into two parts if the aspiration scheme is located behind the onset point of tip leakage vortex and the final control effect is the combination of the influence from the two different parts of tip leakage vortex. Additionally, the casing aspiration redistributes the blade loading along the chord near blade tip. The results of these investigations may offer guidance for the appropriate design of aspiration scheme in the future updated compressors and the overall total pressure loss coefficient caused by aspiration slot should be considered in the design process.
Late-Holocene pollen-based paleoenvironmental reconstruction of the El Triunfo wetland, Los Nevados National Park (Central Cordillera of Colombia)
Authors: Giraldo-Giraldo María J , Velásquez-Ruiz Cesar A , Pardo-Trujillo Andrés
Published: August 2017

We present a palynologic study of El Triunfo wetland (4°58′54.5″N and 75°19′55.8″W), located at 3834 m a.s.l. in the Central Cordillera of Colombia. Pollen and spores record, which spans for the past ~1930 yr BP, shows that Páramo vegetation has been dominated by Poaceae, Asteraceae, Lycopodiaceae, and Ericaceae. The sub-Andean forest is characterized by Urticaceae and Acalypha (Euphorbiaceae), while the Andean forest by Quercus (Fagaceae), Hedyosmum (Chloranthaceae), and Weinmannia (Cunoniaceae). We observed that aquatic vegetation pollen such as Cyperaceae were abundant, indicating marsh conditions in most of the record. Cold and warm periods, inferred from Páramo and Andean forest elements, respectively, reveal that the warmest periods were registered at ~1000 cal. yr BP (~AD 1016) (‘Medieval Climatic Optimum’) and in the last century, whereas the coldest ones around 1200 cal. yr BP (AD 831) and 650–150 cal. yr BP (AD 1368–1750) (‘Little Ice Age’). The pollen signal suggests that warm periods were dry and cold periods were wet. A comparison of these results with some localities of northwestern Colombia, the Caribbean, and South America was made, displaying variations that reflect regional and/or global climatic phenomena such as Intertropical Convergence Zone and the El Niño Southern Oscillation. In the past 50 years, the decrease in Quercus, Weinmannia and Clusia recovery and the increase in Rumex, Plantago, and Gunnera may reflect human impact derived from livestock, agriculture, and/or firewood. Volcanic events of variable magnitude have been identified with an apparent minimal effect on vegetation, reaching a maximum variation of about 10–15% between the beginning and the end of a volcanic event.
A Survey Study Among Cancer Patients in Turkey
Authors: Ahmadi Fereshteh , Cetrez Önver A. , Erbil Pelin , Ortak Asil , Ahmadi Nader
Published: August 2017

To understand the role of culture on the use of the meaning-making coping among people who have been struck by cancer, qualitative and quantitative studies have been conducted in several countries like Sweden, China, Japan, South Korea, Malaysia, Philippines, and Turkey. This article reports on a quantitative study carried out in Turkey. The aim of the study has been to answer the following question: “Which meaning-making coping method (even nonreligious or spiritual coping methods) is used by informants?” The sample consists of 95 persons, 18+ who had been struck by cancer. The questionnaire was distributed to former/current cancer patients via a web address as an electronic survey through the media page of Cancer Survivors Association. The results of the study show that the most important coping methods used by cancer patients in Turkey are the religious coping (RCOPE) methods, particularly spiritual connection, active religious surrender, passive religious deferral, and pleading for direct intercession. Several RCOPE methods such as spiritual discontent, seeking support from clergy or members, punishing God reappraisal, and demonic reappraisal or self-directing religious coping are not used by the Turkish informants. Nor are non-RCOPE methods highly prevalent among informants.
Persistent Metronidazole-Induced Peripheral Neuropathy
Authors: Boyce Eric G. , Cookson Eileen T. , Bond William S.
Published: August 2017

We report the case of a young woman with Crohn's disease who developed a debilitating peripheral neuropathy when treated with metronidazole 2000 mg/d for 50 days. The patient's neuropathy improved considerably after the discontinuation of metronidazole, but still persists two years later. The current literature on this topic is reviewed. Reports such as this one underscore the need to closely monitor the neurologic status of patients undergoing chronic treatment with metronidazole.
Accuracy of Pharmacokinetic Dose Determination of Gentamicin in Geriatric Patients
Authors: Robinson J. Daniel , Lackner Thomas E. , Birge Stanley
Published: August 2017

Gentamicin pharmacokinetics and the predictive performance of the Sawchuk-Zaske dosing method for gentamicin were compared in elderly and young patients with stable normal serum creatinine concentrations. The predicted peak gentamicin concentrations in both young and elderly patients were not significantly different from the actual measured concentrations. The predicted trough concentrations for both the young and elderly were significantly different from the measured trough concentrations. However, the magnitude of this difference (0.2 μg/mL) is not considered to be clinically significant. A trend toward greater underprediction of trough gentamicin concentrations in elderly patients was evident. The mean increase of 15 percent in the gentamicin half-life at steady-state compared with the initial pharmacokinetics analysis in elderly patients was significantly larger than the increase in half-life in the young patients. The Sawchuk-Zaske method was equally accurate in determining the gentamicin dosing regimen in young and elderly patients with normal serum creatinine concentrations.
Drug Interactions Involving Immunologic Agents Part I. Vaccine–Vaccine, Vaccine–Immunoglobulin, and Vaccine–Drug Interactions
Authors: Hartshorn Edward A. , Grabenstein John D.
Published: August 2017

Information about immunologic drug interactions is needed by pharmacists to make rational drug-use decisions. Previously, reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents were widely dispersed. In this two-part review article, over 50 individual and categorical interactions are described, as are dozens of vaccine–vaccine and vaccine–immunoglobulin combinations for which interactions have been demonstrated not to occur. Vaccine–vaccine, vaccine–immunoglobulin, and vaccine–drug interactions are reviewed in this first part. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and to further assess known interactions.
Calling as a Predictor of Life Satisfaction
Authors: Choi Ye Eun , Cho Eunae , Jung Ha Jin , Sohn Young Woo
Published: August 2017

The current study examined the mediating role of psychological capital and work–family enrichment in the relation between calling and life satisfaction. Moreover, the moderating role of boundary management strategy, the tactics individuals utilize to manage role boundaries, in the relation between calling and work–family enrichment was investigated. Cross-sectional survey data were collected from members of the South Korean navy ( N = 195). As hypothesized, people who have a calling obtained more psychological capital (hope, self-efficacy, resilience, and optimism) from their work experience, which in turn positively related to work-to-family enrichment and life satisfaction. Although a statistically significant moderating effect of boundary management strategy was found, the pattern of the interaction was different from our original prediction; the positive relation between calling and work-to-family enrichment was stronger among those who strive to separate the work and family domains (i.e., separators) than among those who aim to integrate the two domains (i.e., integrators). The theoretical and practical implications are discussed.
The Lock-In
Authors: Delisle James R.
Published: August 2017

Six months ago, it sounded like a good idea: 70 gifted seventh and eighth graders spending an overnight at our school, with me as the lead chaperone. Here's how it all began.
Cultural Identity: A Glimpse down Under
Authors: Riley Tracy L.
Published: August 2017

As I begin my fifth academic year as an “ex-pat” lecturing in gifted education at a New Zealand university, I've been pondering the culture in which I find myself. I recall arriving in New Zealand, expecting some exotic differences between the southern United States from which I came and this lush, green island in the Pacific.
Book Bait III: Using Books to Lure Bright Students
Authors: Schlichter Carol L.
Published: August 2017

Book Bait consists of a series of articles designed to help parents and teachers provide appropriate books for their young readers. The books recommended here represent the wide variety of interests of today's youth. These articles will be compiled and published as a forthcoming GCT Inc. book.
Book Bait V: Using Books to Lure Bright Students
Authors: Schlichter Carol L.
Published: August 2017

Book Bait consists of a series of articles designed to help parents and teachers provide appropriate books for their young gifted readers. The books recommended here represent the wide variety of interests for today's youth. These articles will be published as a forthcoming GCT Inc. book.
Individualizing Instruction with Computer Applications
Authors: Strot Melody
Published: August 2017

Although computers can be a terrific resource for all children, gifted children particularly benefit from the individualization provided by-different computer applications. For the gifted child who finishes written class exercises quickly, computer programs may extend subject matter. From my observations, however, teachers use computers primarily for drill and practice exercises and word processing.
Taking a Big Step into the Wild Bondi Blue Yonder
Authors: Benno Mark
Published: August 2017

Now is the time for all good students to have computers in their homes. For many years, an entry-level home computer would set a family back about $2,000. Today, an entry-level machine from a variety of manufacturers are priced close to $1,000. Fortunately, half-price does not mean half the performance or capabilities.
Two Thumbs Up, Five Stars, and an Oscar?
Authors: Riley Tracy
Published: August 2017

As an American living in New Zealand, I followed last year's Academy Awards with fascination. The glitz and glamour of Hollywood crosses oceans and seems to saturate the movie industry. American movies mean big names and even bigger dollars. Seeing the stars in their dazzling attire may make one dream.
Compression properties of metal beetle elytron plates and the elementary unit of the trabecular-honeycomb core structure
Authors: Zhang Xiaoming , Chen Jinxiang , Okabe Yoji , Xie Juan , Zhang Zhijie
Published: August 2017

This paper investigates the mechanical properties of metal beetle elytron plates (a type of biomimetic sandwich structure) and the elementary unit of the trabecular-honeycomb core structure by compression experiments. The following conclusions are drawn: (1) after reaching the compressive strength, the stress–strain curve of the beetle elytron plate contains a yield plateau that advantageously exploits the material strength of metal and its plastic deformation capacity; (2) the elementary unit of the core structure in beetle elytron plates is proposed explicitly based on the trabecular characteristic; and (3) this elementary unit remains relatively unchanged on the constraint condition of the trabecular structure and has high independence and stability when placed under out-of-plane compression. Thus, the yield plateau and variation tendency of the compressive strength after buckling of this elementary unit are highly consistent with that of the entire structure, which provides the basis for further research on the equivalent parameters and equivalent model of the beetle elytron plate and its trabecular-honeycomb core structure.
Hippotherapy for patients with multiple sclerosis: A multicenter randomized controlled trial (MS-HIPPO)
Authors: Vermöhlen Vanessa , Schiller Petra , Schickendantz Sabine , Drache Marion , Hussack Sabine , Gerber-Grote Andreas , Pöhlau Dieter
Published: August 2017

Background:

Evidence-based complementary treatment options for multiple sclerosis (MS) are limited.

Objective:

To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients.

Methods:

A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity.

Results:

Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03–4.63, p = 0.047) between intervention ( n = 32) and control ( n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (−6.8, p = 0.02) and spasticity (−0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 ( p < 0.001) in physical health score and 14.4 ( p < 0.001) in mental health score of Multiple Sclerosis Quality of Life-54 (MSQoL-54).

Conclusion:

Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.
Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial
Authors: Azma Kamran , RezaSoltani Zahra , Rezaeimoghaddam Farid , Dadarkhah Afsaneh , Mohsenolhosseini Sarasadat
Published: August 2017

Introduction

Knee osteoarthritis is a major cause of disability among the middle to senior age groups. Despite being effective, office-based physical therapy (OBPT) needs professional human resources and is both costly and time-consuming. We aimed to compare the efficacy of tele-rehabilitation (tele-rehab) compared with OBPT in patients with knee osteoarthritis.

Methods

In this randomized clinical trial, patients with symptomatic osteoarthritis of the knee were assigned to participate in either a 6-week home-based tele-rehab or an OBPT program between 2015 and 2016. Our primary outcome was the mean change from the baseline until 1 and 6 month's post-intervention in scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used analysis of variance for the repeated measure statistical test.

Results

A total of 54 patients entered the final analysis, with 27 in each group. The mean age of the patients was 58.2 ± 7.41 years and 60.2% were female. In the tele-rehab and OBPT group, KOOS scores increased from baseline to 6 months post-intervention (50.6 to 83.1 and 49.8 to 81.8) respectively. There was no significant difference between tele-rehab and OBPT groups in any of the studied scales.

Discussion

The tele-rehab program is as effective as OBPT in improving the function of patients with knee osteoarthritis. Considering the much lower time and cost consumed by tele-rehab, it is the recommended program for the older population living in remote sites.
Understanding each other in the medical encounter: Exploring therapists’ and patients’ understanding of each other’s experiential knowledge through the Imitation Game
Authors: Wehrens Rik , Walters Bethany Hipple
Published: August 2017

The ability of health-care professionals to understand the lived experiences of their patients has become increasingly important but has been a difficult topic to investigate empirically because it involves two distinctive research strands: interpretative phenomenological analysis and patient–provider communication. While interpretative phenomenological analysis focuses on experiences and illness narratives of patients, but not on therapist’s understanding of those, patient–provider communication surveys focus primarily on effective forms of communication without addressing the actual illness experiences of patients. There is a need for empirical research that combines both strands to investigate not only the experiences of patients but also whether professionals are able to understand these. This study combined both strands by means of a novel research method called the Imitation Game (combined with other qualitative methods). This sociological method was developed to investigate what different social groups know of each other’s lifeworld. It focused on the important domain of eating disorder treatment to investigate whether therapists were able to understand the experiences of their patients and vice versa. This study provides insights into the domains in which therapists and patients were able to develop insights into each other’s experiential knowledge (and where they had difficulties in doing so). The findings also implicate the high potential of the Imitation Game as an interdisciplinary research method. We propose that the Imitation Game may be particularly valuable as a ‘can opener’ that enables the development of in-depth, qualitative insights into the substantive themes that matter in the lifeworlds of patients and therapists.
The cultural tragedy of production and the expropriation of the brickolariat: The Lego Movie as consumer-capitalist myth
Authors: Varul Matthias Zick
Published: August 2017

The Lego Movie is analysed as a consumer-capitalist myth reworking audience expectations and frustrations under contemporary capitalism into a comforting and consumable story. It does so by summoning two heterogeneous mythical topoi which are available as slates in the Western cultural repertoire, namely that of Plato’s demiurgic cosmogony and Erotic anthropology to represent a producerist engineering ethos, and the Native American Coyote stories to represent a consumerist ethos of bricolage. Posing as a narrative of empowerment, it promotes the activation of consumer inventiveness in ‘prosumption’ as a solution to the Simmelian tragedy of culture while containing the subversive potential in the recognition of extra-organisational creativity. The ideological ‘function’ of the Lego myth is a contribution to the legitimacy of a system whose modus of existence is that of permanent crisis against a nostalgic yearning for bygone certainties. For its audiences, it provides a therapeutic narrative that facilitates the interpretation of their experience of continuously contradictory role expectations as meaningful.
Distal radius fractures – A volar plate is not just a volar plate
Authors: Knight Richard , Elliott Lucy , Brewster Mark , Spiteri Michelle , Power Dominic
Published: August 2017

Introduction

Increasingly complex distal radius plate designs are available for treating distal radius fractures. As a result, many fractures are being ‘over-treated’ with more complex volar plate designs than necessary. We hypothesise that significant cost savings could be made by rationalising the use of complex locking plate designs.

Methods

Over a two-year period, radiographs of 250 consecutive distal radius fractures fixed with volar locking plates were reviewed and the type of plate, and type and number of screws used for fixation were noted. Preoperative radiographs were independently reviewed to ascertain if it would have been possible to stabilise the fracture with a simpler, extra-articular plate design. Potential cost savings were then calculated.

Results

It was deemed that 89 (36.5%) of the 250 cases originally treated with a more complex 2 column variable angle plate could have been treated with an extra-articular construct, leading to potential savings of £19,224.

Conclusion

It is clear from our data that many distal radius fracture patterns are being ‘over-treated’ with complex locking plate designs with multiple rows of screws and that substantial cost savings could be made by selecting an appropriate construct to suit the fracture pattern.
The state–consumer relationship and the instituting of consumer protection in East Asian societies
Authors: Wahn I-Liang
Published: August 2017

This article compares consumer protection policy and consumer activism in Japan, China, and Taiwan to understand state–consumer relationships in East Asia. It employs Maclachlan’s case study of Japan to develop an explanatory model of how political change and state–business relationships influence interaction between state and consumers, and how state–consumer relationships institute consumer protection. The article then compares the three countries, all of which have experienced rapid growth and consumerism, by utilizing their different political developments in the exploration of the interaction between state policy and consumer activism. This comparison highlights the different dynamics that institute consumer protection in the political, economic, and social spheres. The argument is made that transformations in the state–consumer relationship are required to allow civil society to take part in the instituting of consumer markets as East Asian capitalism turns to domestic consumption for growth.
Domestic architecture and the materiality of public-making in pre-Columbian Eastern Peru
Authors: Guengerich Anna
Published: August 2017

Understanding how publics were constituted in specific socio-historical settings is critical to understanding political practice in past societies. Yet the persistent use of terms such as “public space” and “public architecture” belies the influence of binary models of public and private life that still impact understandings of domestic life and residential architecture. I argue that the continued influence of these models results from the notion that publics in pre-industrial societies were produced primarily through large gatherings associated with standardized kinds of places such as plazas and monuments. This paper, in contrast, takes advantage of the exceptionally well-preserved site complex of Tambillo in Eastern Peru in order to explore how the material qualities of architecture, rather than its spatial layout, mediate the production of publics. I consider how three different modes of engagement with domestic architecture in particular—construction, discourse, and affiliation—generated multiple, diverse publics among the communities of Tambillo. This example demonstrates the variety of ways in which built environments create publics and underscores the need to acknowledge the role of domestic architecture within a broader ecology of the built environment as a whole.
Clinicians' perspectives on the duty of candour: Implications for medical ethics education
Authors: Fowler George E , Vivekananda-Schmidt Pirashanthie
Published: August 2017

Content

Truth-telling is an integral part of medical practice in many parts of the world. However, recent public inquiries, including the Francis Inquiry reveal that a duty of candour in practise, are at times compromised. Consequently, the duty of candour became a statutory requirement in England. This study aimed to explore clinicians’ perspectives of the implications of the legislation for medical ethics education, as raising standards to improve patient safety remains an international concern.

Methods

One-to-one interviews with clinical educators from various specialties who contribute to the MBChB programme at the authors’ university. Once data saturation had been assessed, transcripts were analysed using a thematic approach by the following concurrent activities: data reduction and coding into themes. Example quotations are used to illustrate that key themes are grounded in the data.

Results

Eleven clinical educators were interviewed; three general practitioners, six physicians and two surgeons. Thematic analysis identified three key themes; reaction to legislation, barriers to implementation and areas of the medical curriculum that can be further developed to better prepare future doctors.

Conclusions

Currently, the legislation is not reaching all frontline staff; there remains a lack of appropriate training and teaching on the legislation that responds to the perceived challenges to implementing candour. These challenges include tensions in the clinical workplace and concerns about the patient’s best interests conflicting with requirements of the legislation. Both undergraduate and postgraduate curricula need to integrate teaching on the implications of the legislation and take a practice based approach in doing so.
Practical Considerations in Donation After Circulatory Determination of Death in Switzerland
Authors: Dalle Ave Anne L. , Shaw David M. , Elger Bernice
Published: August 2017

Faced with similar issues of organ scarcity to its neighbors, Switzerland has developed donation after circulatory determination of death (DCDD) as a way to expand the organ pool since 1985. Here, we analyze the history, practical considerations, and ethical issues relating to the Swiss donation after circulatory death programs. In Switzerland, determination of death for DCDD requires a stand-off period of 10 minutes. This time between cardiac arrest and the declaration of death is mandated in the guidelines of the Swiss Academy of Medical Sciences. As in other DCDD programs, safeguards are put to avoid physicians denying lifesaving treatment to savable patients because of being influenced by receivers’ interest. An additional recommendation could be made: Recipients should be transparently informed of the worse graft outcomes with DCDD programs and given the possibility to refuse such organs.
European Vignettes in Donation After Circulatory Death
Authors: Gardiner Dale , Wind Tineke , Cole Ben , van Mook Walter , Del Río Francisco , Domínguez-Gil Beatriz ,   the ELPAT Deceased Donation Working Group
Published: August 2017

Donation after circulatory death (DCD) is increasing in Europe, yet there is widespread variability in practice. Insight into actual practice is difficult to acquire simply by analyzing protocols and laws from each individual country. For this reason, the 3 DCD vignettes in this article have been constructed to outline routine and standard DCD practice in the United Kingdom, the Netherlands, and Spain. These imagined vignettes reflect a “typical” case, based on the authors’ extensive experience with DCD but are not real patient cases. They are a resource aimed at stimulating discussion regarding European organ donation practice and provide a knowledge bank for those wanting to establish a DCD program in their country. It is our hope that by providing these vignettes, the wider organ donation and transplant community, as well as philosophers and the public, will have a better understanding of what DCD really is and what it really isn’t.
Organ Donation Registration and Decision-Making Among Current Blood Donors in the Netherlands
Authors: Merz Eva-Maria , van den Hurk Katja , de Kort Wim L.A.M.
Published: August 2017

Introduction:

In the Netherlands, there is a constant shortage in donor organs, resulting in long waiting lists. The decision to register as organ donor is associated with several demographic, cultural, and personal factors. Previous research on attitudes and motivations toward blood and organ donations provided similar results.

Research Question:

The current study investigated demographic, cultural, and personal determinants of organ donation registration among current Dutch blood donors.

Design:

We used data from Donor InSight (2012; N = 20 063), a cohort study among Dutch blood donors, to test whether age, gender, religious and political preferences, donor attitude, and altruism predicted organ donor registration among current blood donors.

Results:

Organ donors were more often represented in the blood donor population compared to the general Dutch population. Women showed a higher propensity to be registered as organ donor. Higher education as well as higher prosocial value orientation, prosocial behavior, that is, doing volunteer work, and awareness of need significantly associated with being registered as organ donor. Religious denomination negatively predicted organ donation registration across all faiths.

Discussion:

Results are discussed in light of cultural context, and possible implications for improving information provision and recruitment are mentioned.
A Department of Motor Vehicle–Based Intervention to Promote Organ Donor Registrations in New York State
Authors: Feeley Thomas Hugh , Anker Ashley E. , Evans Melanie , Reynolds-Tylus Tobias
Published: August 2017

Context:

Examination of efficacy of motor vehicle representative educational training and dissemination of promotional materials as a means to promote organ donation enrollments in New York State.

Objective:

To increase the number of New York State residents who consent to donation through the department of motor vehicle transactions during project period.

Setting:

County-run motor vehicle offices across New York State.

Participants:

Customers who present to New York Department of Motor Vehicle offices and the representative who work at designated bureaus.

Interventions:

point-of-decision materials including promotional posters, brochures, website, and the motor vehicle representative training sessions.

Main Outcome Measures:

Reasons for enrollment decision, knowledge/experience with donation, monthly consent rates, enrollment in state organ, and tissue registry.

Results:

Customers who elected not to register reported no reason or uncertainty surrounding enrollment. The representatives reported experience with donation, discussion with customers, and need for additional education on organ donation. Enrollment cards were mailed to 799 project staff; counties where offices participated in intervention did not indicate significantly higher monthly enrollments when comparing pre- to postenrollment rates.

Conclusions:

Use of point-of-decision materials and enrollment cards proved inexpensive method to register customers with a 3.6% return rate. Customers report low (27%) enrollment rate and reticence to consent to donation. Educational training sessions with representatives did not yield significant enrollment increases when evaluating data at county-level enrollment.
A sonographic Doppler study of the hepatic vein, portal vein and hepatic artery in liver cirrhosis: Correlation of hepatic hemodynamics with clinical Child Pugh score in Singapore
Authors: Afif Azizah M , Chang Jason Pik-Eu , Wang Yan Y , Lau Simin D , Deng Fuzhen , Goh Shy Y , Pwint Mar K , Ooi Chin C , Venkatanarasimha Nanda , Lo Richard HG
Published: August 2017

Objective

Liver cirrhosis has been a rising complication of chronic liver disease in Singapore. Ultrasound has been widely accepted as a non-invasive imaging modality for the evaluation of hepatic haemodynamics. This study aims to correlate the Doppler ultrasound values with the progression of liver cirrhosis to allow further understanding and possible prediction of clinical events for timely intervention.

Methods

Study sample of 56 eligible patients with liver cirrhosis was divided according to their Child-Pugh clinical score into Child’s A (n = 29 patients), B (n = 19 patients) and C (n = 8 patients). The maximum portal vein velocity, maximum hepatic vein velocity, maximum hepatic artery velocity and hepatic artery resistive index were assessed by Doppler ultrasound.

Results

The incidence of ascites increases with the severity of cirrhosis. Flattening of the hepatic vein waveforms was dependant on degree of liver cirrhosis. Maximum hepatic vein velocity was higher in cirrhotic patients (where p = 0.05). Maximum portal vein velocity was found to be lower in cirrhosis (where p < 0.001) and mean maximum portal vein velocity decreases as severity of cirrhosis worsens. Hepatic artery resistive index was significantly higher in cirrhosis (where p < 0.001). Significant association was found between maximum hepatic vein velocity and maximum hepatic artery velocity and significant negative correlation was observed with the maximum portal vein velocity and hepatic artery resistive index.

Conclusion

The study demonstrated that these parameters can supplement the evaluation of liver cirrhosis and will be able to distinguish the different grades of liver cirrhosis using Doppler ultrasound.
Review of recombinant anti-haemophilic porcine sequence factor VIII in adults with acquired haemophilia A
Authors: Fosbury Emma , Drebes Anja , Riddell Anne , Chowdary Pratima
Published: August 2017

Acquired haemophilia A (AHA) is a rare, serious bleeding disorder most often encountered in elderly patients. The mainstay of haemostatic management is with bypassing agents (BPAs) including recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrates (aPCCs). Their major limitation is incomplete efficacy, potential risk for thrombosis and the lack of routine laboratory assays for monitoring treatment response. Plasma-derived porcine FVIII (pd-pFVIII, Hyate C®), first used in the 1950s for the management of congenital haemophilia, has sufficient sequence homology to be haemostatic in humans, but the lack of complete homology facilitates efficacy even in the presence of human allo- and autoantibodies against human FVIII (hFVIII). In a small phase II/III study, recombinant porcine FVIII (rpFVIII, Obizur®, OBI-1, susoctocog alfa) was shown to be safe and effective for the management of bleeding episodes in patients with AHA with anti-porcine FVIII (anti-pFVIII) antibody levels of 20 BU/ml or less. Treatment outcome was judged on clinical response and FVIII levels after an initial fixed dose of 200 IU/kg. The rise in FVIII levels showed considerable inter-individual variability and was significantly influenced by the presence of anti-pFVIII antibodies. Based on the baseline levels of anti-pFVIII antibodies and response to treatment, three potential patient groups were identifiable. In the first group, the absence of cross-reacting antibodies was associated with supra-therapeutic FVIII levels, fewer infusions and lower rpFVIII utilization per treatment episode. The second group had patients with low levels of cross-reacting anti-pFVIII antibodies (0.8–5 BU/ml) with near-normal response to rpFVIII. The last group had higher titres of anti-pFVIII antibody (10–30 BU/ml) associated with lower FVIII levels, more infusions and higher consumption of rpFVIII. We propose a new treatment algorithm for the haemostatic management of AHA that includes the potential first-line clinical use of rpFVIII that takes into account availability of anti-pFVIII antibody results, titre of anti-pFVIII antibodies and severity of bleeding episode.
How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions
Authors: Myklebust Lars Henrik , Sørgaard Knut , Wynn Rolf
Published: August 2017

Objectives:

Studies on the dynamics between service organization and acute admissions to psychiatric specialized care have given ambiguous results. We studied the effect of several variables, including service organization, coercion, and patient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study in Norway, we compared a “deinstitutionalized” and a “locally institutionalized” model of mental health services. One had only community outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the local District Psychiatric Centre.

Methods:

From the case registries, we identified a total of 5338 admissions, which represented all the admissions to the psychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order to control for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regression model.

Results:

The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377, 95% confidence interval = 4.131–13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582–4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds available at small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions.

Conclusion:

While it is likely that the seriousness of the patients’ condition is the most important factor in doctors’ decisions to refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization of mental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds at local District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems with local community outpatient services and beds at Central Mental Hospitals.