bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use and Misuse of Logic Trees in Probabilistic Seismic Hazard Analysis
Authors: Bommer Julian J. , Scherbaum Frank
Published: December 2008

Logic trees have become a standard feature of probabilistic seismic hazard analyses (PSHA) for determining design ground motions. A logic tree's purpose is to capture and quantify the epistemic uncertainty associated with the inputs to PSHA and thus enable estimation of the resulting uncertainty in the hazard. There are many potential pitfalls in setting up a logic tree for PSHA, mainly related to the fact that in practice, it is questionable that the requirements that the logic-tree branches be both mutually exclusive and collectively exhaustive can actually be met. Careful consideration is also required for making use of the output; in particular, in view of how PSHA is employed in current engineering design practice, it may be more rational to determine the mean ground motion at the selected design return period rather than to find the ground motion at the mean value of this return period.
Dynamic Periods and Building Damage at Charleston, South Carolina during the 1886 Earthquake
Authors: Fairbanks Cedric D. , Andrus Ronald D. , Camp William M. , Wright William B.
Published: December 2008

Fundamental dynamic periods of Quaternary deposits beneath the peninsula of Charleston, South Carolina, are characterized spatially using an updated isopach map of Quaternary thickness, characteristic small-strain shear wave velocity information, a 1:24,000 geologic map, and a simple approximating equation. The updated isopach map is developed from subsurface information from 266 investigation sites. Estimates of fundamental periods for the Quaternary sediments primarily range between 0.3 and 0.7 s. These periods are lower end estimates of actual ground periods, based on a comparison with modeled response-spectra ratios. Estimates of fundamental periods range from 0.1 to 0.4 s for over 95% of the buildings present in 1886. Thus, the overlap between the range of building periods and the range in periods corresponding to high spectral ratios is not great. This finding agrees with the observation of Marciano and Elton that damage was independent (or only slightly dependent) of building height.
Modeling Triple Friction Pendulum Bearings for Response-History Analysis
Authors: Fenz Daniel M. , Constantinou Michael C.
Published: December 2008

There are currently no applicable hysteresis rules or nonlinear elements available in structural analysis software that can be used to exactly model triple Friction Pendulum bearings for response-history analysis. Series models composed of existing nonlinear elements are proposed since they can be immediately implemented in currently available analysis software. However, the behavior of the triple Friction Pendulum bearing is not exactly that of a series arrangement of single concave Friction Pendulum bearings—though it is similar. This paper describes how to modify the input parameters of the series model in order to precisely retrace the true force-displacement behavior exhibited by this device. Recommendations are made for modeling in SAP2000 and are illustrated through analysis of a simple seismically isolated structure. The results are confirmed by (a) verifying the force-displacement behavior through comparison with experimental data and (b) verifying the analysis through comparison to the results obtained by direct numerical integration of the equations of motion.
Rocking Stability of Masonry Arches in Seismic Regions
Authors: DeJong Matthew J. , De Lorenzis Laura , Adams Stuart , Ochsendorf John A.
Published: December 2008

This study evaluates the susceptibility of masonry arches to earthquake loading through experimental testing and progresses toward a specific criterion by which arches can be quickly assessed. Five different earthquake time histories, as well as harmonic base excitations of increasing amplitude, were applied to model arches, and the magnitude of the base motion resulting in collapse was determined repeatedly. Results are compared with failure predictions of an analytical model which describes the rocking motion of masonry arches under base excitation. The primary impulse of the base excitation is found to be of critical importance in causing collapse of the masonry arch. Accordingly, a suite of failure curves are presented which can be used to determine the rocking stability of masonry arches under a primary base acceleration impulse which has been extracted from an expected earthquake motion.
A Semi-Automated Procedure for Selecting and Scaling Recorded Earthquake Motions for Dynamic Analysis
Authors: Kottke Albert , Rathje Ellen M.
Published: December 2008

Suites of earthquake ground motions play an important role in the seismic design and analysis process. A semi-automated procedure is described that selects and scales ground motions to fit a target acceleration response spectrum, while at the same time the procedure controls the variability within the ground motion suite. The basic methodology selects motions based on matching the target spectral shape, and then fits the amplitude and standard deviation of the target by adjusting the individual scale factors for the motions. The selection of motions from a larger catalog of motions is performed through either a rigorous method that tries each possible suite of motions or an iterative approach that considers a smaller set of potential suites in an effort to find suites that provide an acceptable fit to the target spectrum. Guidelines are provided regarding the application of the developed procedures, and example applications are described.
Forced Vibration Testing of a Four-Story Reinforced Concrete Building Utilizing the nees@UCLA Mobile Field Laboratory
Authors: Yu Eunjong , Skolnik Derek , Whang Daniel H. , Wallace John W.
Published: December 2008

The nees@UCLA mobile field laboratory was utilized to collect forced and ambient vibration data from a four-story reinforced concrete (RC) building damaged in the 1994 Northridge earthquake. Both low amplitude broadband and moderate amplitude harmonic excitation were applied using a linear shaker and two eccentric mass shakers, respectively. Floor accelerations, interstory displacements, and column and slab curvature distributions were monitored during the tests using accelerometers, linear variable differential transformers (LVDTs) and concrete strain gauges. The use of dense instrumentation enabled verification of common modeling assumptions related to rigid diaphragms and soil-structure-interaction. The first six or seven natural frequencies, mode shapes, and damping ratios were identified. Significant decreases in frequency corresponded to increases in shaking amplitude, most notably in the N-S direction of the building, most likely due to preexisting diagonal joint cracks that formed during the Northridge earthquake.
Predictors of Referral for Specialized Psychosocial Oncology Care in Patients With Metastatic Cancer: The Contributions of Age, Distress, and Marital Status
Authors: Ellis Janet , Lin Judy , Walsh Andrew , Lo Christopher , Shepherd Frances A. , Moore Malcolm , Li Madeline , Gagliese Lucia , Zimmermann Camilla , Rodin Gary
Published: December 2008

Purpose

This study examines the rate and prediction of referral for specialized psychosocial oncology care in 326 patients with metastatic GI or lung cancer.

Patients and Methods

Referral information was abstracted from medical records and hospital databases. Patients completed measures of psychosocial and physical distress and functioning.

Results

Routine referral occurred in 33% of patients, and in 42% and 44%, respectively, of those scoring high on measures of depression (Beck Depression Inventory [BDI]-II ≥ 15) and hopelessness (Beck Hopelessness Scale ≥ 8). Univariate analyses indicated that referral was associated with younger age, unmarried status, living alone, presence of more depressive symptoms, hopelessness, and attachment anxiety, and with less social support, self-esteem, and spiritual well-being (all P < .05). Among the significantly depressed (BDI-II ≥ 15), 100% of those less than 40 years of age, but only 22% of those age 70 years or older were referred. Multivariate analyses indicated that referral was associated with younger age, unmarried status, and presence of more depressive symptoms. Moreover, increasing age was associated with a progressively lower likelihood of referral independent of the level of distress.

Conclusion

Routine referral of patients with metastatic cancer for psychosocial oncology care was predicted by presence of more severe depressive symptoms, younger age, and unmarried status. The rate of referral progressively declined with each decade of age, even among those with significant distress. These findings are consistent with some aspects of Andersen's model of health care utilization. The extent to which referred patients represent those who are most likely to benefit deserves further investigation.
Behavioral Health Services for Women Who Have Breast Cancer
Authors: Azzone Vanessa , Frank Richard G. , Pakes Juliana R. , Earle Craig C. , Hassett Michael J.
Published: December 2008

Purpose

To explore whether the use of behavioral health services (BHS) among women with breast cancer is influenced by how insurance plans administer these services, we compared utilization of psychotherapy and psychotherapeutic medications among women with breast cancer who received BHS coverage through a carve-out versus integrated arrangement.

Patients and Methods

We analyzed insurance claims, enrollment data, and benefit design data from the MarketScan Commercial Claims & Encounters Research Database for the years 1998 to 2002 for women ≤ 63 years old with newly diagnosed breast cancer. We compared the probability of receiving psychotherapy, the likelihood of receiving antidepressant/antianxiety/hypnotic medications, and the number of psychotherapy sessions used during the year after a breast cancer diagnosis among women whose behavioral health services were provided through carve-out versus integrated arrangements.

Results

Women enrolled in carve-outs were significantly less likely to receive any psychotherapy visits compared with women in integrated arrangements (odds ratio, 0.68; P < .01). Conditional on having received psychotherapy, however, women in carve-out arrangements used more psychotherapy visits than women in integrated arrangements. The use of antianxiety/hypnotic drugs was significantly higher for women in carve-out arrangements versus women in integrated arrangements (36.1% v 32.6%, P < .05). Moreover, women who received psychotherapy were significantly more likely to received antidepressants and antianxiety/hypnotic medications (five and three times more likely, respectively).

Conclusion

The type of BHS arrangement was associated with the utilization of psychotherapy and psychotherapeutic medications among women with breast cancer.
Can Women With Early-Stage Breast Cancer Make an Informed Decision for Mastectomy?
Authors: Collins E. Dale , Moore Caroline P. , Clay Kate F. , Kearing Stephen A. , O'Connor Annette M. , Llewellyn-Thomas Hilary A. , Barth Richard J. , Sepucha Karen R.
Published: December 2008

Purpose

The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice.

Patients and Methods

This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment.

Results

Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes (“remove breast for peace of mind,” “avoid radiation,” and “keep breast”) clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation.

Conclusion

Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict.
Immunoglobulin Prophylaxis in Hematopoietic Stem Cell Transplantation: Systematic Review and Meta-Analysis
Authors: Raanani Pia , Gafter-Gvili Anat , Paul Mical , Ben-Bassat Isaac , Leibovici Leonard , Shpilberg Ofer
Published: December 2008

Purpose

Because the role of immunoglobulins (IVIG) prophylaxis in patients undergoing hematopoietic stem-cell transplantation (HSCT) has not been established in terms of survival and infection prevention, we conducted a meta-analysis evaluating these issues.

Methods

Systematic review and meta-analysis of randomized-controlled trials comparing prophylaxis with polyvalent IVIG or cytomegalovirus (CMV)-IVIG and control or another preparation or dose. PUBMED, Cochrane Library, LILACS, and conference proceedings were searched. Two reviewers appraised the quality of trials and extracted data. Relative risks (RRs) with 95% CIs were estimated and pooled.

Results

Thirty trials including 4,223 patients undergoing bone marrow transplantation (BMT) were included. There was no difference in all-cause mortality when polyvalent IVIG or CMV-IVIG was compared to control (RR, 0.99; 95% CI, 0.88 to 1.12; and RR, 0.86; 95% CI, 0.63 to 1.16, respectively). There was no difference in clinically documented infections when polyvalent IVIG was compared with control (RR, 1.00; 95% CI, 0.90 to 1.10; five trials). CMV infections were not significantly reduced with either polyvalent IVIG or CMV-IVIG. Interstitial pneumonitis was reduced with polyvalent IVIG in older studies but not in the more recent ones, nor in studies assessing CMV-IVIG. Polyvalent IVIG increased the risk for veno-occlusive disease (RR, 2.73; (95% CI, 1.11 to 6.71). Graft-versus-host disease was not affected.

Conclusion

Because there is no advantage in terms of survival or infection prevention, IVIG does not have a role in HSCT.
Colorectal Cancer Risk Prediction Tool for White Men and Women Without Known Susceptibility
Authors: Freedman Andrew N. , Slattery Martha L. , Ballard-Barbash Rachel , Willis Gordon , Cann Bette J. , Pee David , Gail Mitchell H. , Pfeiffer Ruth M.
Published: December 2008

Purpose

Given the high incidence of colorectal cancer (CRC), and the availability of procedures that can detect disease and remove precancerous lesions, there is a need for a model that estimates the probability of developing CRC across various age intervals and risk factor profiles.

Methods

The development of separate CRC absolute risk models for men and women included estimating relative risks and attributable risk parameters from population-based case-control data separately for proximal, distal, and rectal cancer and combining these estimates with baseline age-specific cancer hazard rates based on Surveillance, Epidemiology, and End Results (SEER) incidence rates and competing mortality risks.

Results

For men, the model included a cancer-negative sigmoidoscopy/colonoscopy in the last 10 years, polyp history in the last 10 years, history of CRC in first-degree relatives, aspirin and nonsteroidal anti-inflammatory drug (NSAID) use, cigarette smoking, body mass index (BMI), current leisure-time vigorous activity, and vegetable consumption. For women, the model included sigmoidoscopy/colonoscopy, polyp history, history of CRC in first-degree relatives, aspirin and NSAID use, BMI, leisure-time vigorous activity, vegetable consumption, hormone-replacement therapy (HRT), and estrogen exposure on the basis of menopausal status. For men and women, relative risks differed slightly by tumor site. A validation study in independent data indicates that the models for men and women are well calibrated.

Conclusion

We developed absolute risk prediction models for CRC from population-based data, and a simple questionnaire suitable for self-administration. This model is potentially useful for counseling, for designing research intervention studies, and for other applications.
The Terrible Choice: Re-Evaluating Hospice Eligibility Criteria for Cancer
Authors: Casarett David J. , Fishman Jessica M. , Lu Hien L. , O'Dwyer Peter J. , Barg Frances K. , Naylor Mary D. , Asch David A.
Published: December 2008

Purpose

To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services.

Patients and Methods

Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death.

Results

Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status.

Conclusion

The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice.
Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy for Advanced Breast Cancer: Results of Ganglion Sentinelle et Chimiothérapie Neoadjuvante, a French Prospective Multicentric Study
Authors: Classe Jean-Marc , Bordes Virginie , Campion Loic , Mignotte Herve , Dravet François , Leveque Jean , Sagan Christine , Dupre Pierre François , Body Gilles , Giard Sylvia
Published: December 2008

Purpose

To determine the detection rate, the false-negative rate, and the accuracy of sentinel lymph node (SLN) detection after neoadjuvant chemotherapy (NAC) for advanced breast cancer.

Patients and Methods

A prospective multicentric study was initiated to evaluate the results of SLN biopsy with the combined method after NAC for advanced large operable breast cancer.

Results

From September 2003 to March 2007, 195 patients enrolled from 12 institutions were found suitable for evaluation. The detection rate was 90% (176 of 195 patients), and the false-negative rate was 11.5% (six of 52 patients). Patients without axillary palpable nodes (N0) before NAC had a better detection rate compared with patients with axillary suspicious nodes (N1, 94.6% v 81.5%; P = .008). The false-negative rate was not correlated with clinical nodal status before NAC (9.4% v 15%; P = .66).

Conclusion

This study confirms the feasibility of SLN biopsy after NAC in the case of large operable breast cancer. The detection rate, false-negative rate, and accuracy do not differ from those obtained in the case of early breast cancer without NAC, thus demonstrating the feasibility of SLN biopsy after NAC.
Short Delay in Initiation of Radiotherapy May Not Affect Outcome of Patients With Glioblastoma: A Secondary Analysis From the Radiation Therapy Oncology Group Database
Authors: Blumenthal Deborah T. , Won Minhee , Mehta Minesh P. , Curran Walter J. , Souhami Luis , Michalski Jeff M. , Rogers C. Leland , Corn Benjamin W.
Published: December 2008

Purpose

To analyze the Radiation Therapy Oncology Group (RTOG) database of patients with glioblastoma and appraise whether outcome was influenced by time to initiation of radiation therapy (RT).

Patients and Methods

From 1974 through 2003, adult patients with histologically confirmed supratentorial glioblastoma were enrolled onto 16 RTOG studies. Of 3,052 enrolled patients, 197 patients (6%) were either initially rendered ineligible or had insufficient chronologic data, leaving a cohort of 2,855 patients for the present analysis. We selected four patient groups based on the interval from surgery to the start of RT: ≤ 2 weeks, 2 to 3 weeks, 3 to 4 weeks, more than 4 weeks to the protocol eligibility limit of 6 weeks. Survival times were estimated by the Kaplan-Meier method. Multivariate analysis incorporated variables of time interval, recursive partitioning analysis (RPA) class, and treatment regimen.

Results

No decrement in survival could be identified with increasing time to initiation of RT. Among our four temporal groupings, median survival time was unexpectedly and significantly greater in the group with the longest interval (> 4 weeks) than in those with the shortest delay (≤ 2 weeks): respectively, 12.5 months versus 9.2 months (P < .0001). On multivariate analysis, with overall survival as the end point, time interval more than 4 weeks and lower RPA class were both significant predictors of improved outcome. Treatment regimen was not a significant factor.

Conclusion

There is no evident reduction in survival by delaying initiation of RT within the relatively narrow constraint of 6 weeks. An unanticipated yet significantly superior outcome was identified for patients for whom RT was delayed beyond 4 weeks from surgery.
Phosphoinositide-Phospholipase C β1 Mono-Allelic Deletion Is Associated With Myelodysplastic Syndromes Evolution Into Acute Myeloid Leukemia
Authors: Follo Matilde Y. , Finelli Carlo , Clissa Cristina , Mongiorgi Sara , Bosi Costanza , Martinelli Giovanni , Baccarani Michele , Manzoli Lucia , Martelli Alberto M. , Cocco Lucio
Published: December 2008

Purpose

To evaluate the association between the presence of phosphoinositide-phospholipase C β1 (PI-PLCβ1) mono-allelic deletion with the clinical outcome of myelodysplastic syndromes (MDS) patients.

Methods

PI-PLCβ1, PI-PLCβ4, and PI-PLCγ1 cytogenetic investigations were performed on 80 newly diagnosed MDS patients (18 low risk, 26 intermediate 1, 18 intermediate 2, 18 high risk) comparing the results with the clinical outcome of the patients. Moreover, fluorescent in situ hybridization results were validated by real-time polymerase chain reaction (PCR). Finally, PI-PLCβ1 gene and protein expression were assessed by both real-time PCR and immunocytochemical experiments.

Results

Collectively, 35 (43.75%) of 80 of the MDS patients showed a specific mono-allelic deletion of PI-PLCβ1. Kaplan-Meier analysis revealed a significant association (P < .0001) between the PI-PLCβ1 mono-allelic deletion and a higher risk of evolution into acute myeloid leukemia (AML), since 23 of 35 MDS patients (65.7%) bearing the PI-PLCβ1 mono-allelic deletion evolved into AML. Even in multivariate analysis, the PI-PLCβ1 mono-allelic deletion retained a higher significance, with a P < .001, as a prognostic factor of evolution into AML (odds ratio [OR] 1.83; 95% CI, 2.26 to 17.24; P = .00045). Finally, PI-PLCβ1 deletion was related to an altered gene and protein expression.

Conclusion

PI-PLCβ1 mono-allelic deletion is associated with a worse clinical outcome in MDS patients, hinting at the identification of a new group at higher risk of AML evolution and representing a reliable prognostic tool. Moreover, targeting PI-PLCβ1 pathways might emerge as a new therapeutic strategy for MDS.
Radiotherapy After Segmental Resection of Breast Cancer With Favorable Prognostic Features: 12-Year Follow-Up Results of a Randomized Trial
Authors: Holli Kaija , Hietanen Päivi , Saaristo Rauni , Huhtala Heini , Hakama Matti , Joensuu Heikki
Published: December 2008

Purpose

Postoperative breast irradiation is considered standard after breast-preserving surgery for cancer. We evaluated the efficacy of radiation therapy in the prevention of local recurrence in a patient population that had small-size breast cancer with features that suggested low biologic aggressiveness.

Patients and Methods

Women (n = 264) older than 40 years who were treated by breast resection with ≥ 1 cm of tumor-free margin and axillary nodal dissection were randomly assigned to receive or not to receive breast irradiation (cumulative dose, 50 Gy) after surgery. The tumor was required to be ≤ 20 mm, node negative, progesterone receptor positive, well to moderately well differentiated and unifocal, and of low cell proliferation rate (ie, S phase fraction ≤ 7% or nuclear Ki-67 expression < 10%) and had to lack an extensive intraductal component. The median follow-up time was 12.1 years after random assignment.

Results

Sixteen (11.6%) and 34 (27.2%) cancers recurred locally in the radiotherapy and the control arms, respectively (P = .0013). Time to local recurrence was longer in the radiotherapy arm (hazard ratio [HR], 0.36; 95% CI, 0.20 to 0.65; P = .00071). Twenty-one patients assigned to radiotherapy and 26 assigned to control died during the follow-up. There were no differences in overall survival time (HR, 0.63; 95% CI, 0.35 to 1.12; P = .11), distant disease-free survival (P = .94), or breast cancer–specific survival (P = .56) between the radiation therapy and control groups.

Conclusion

Radiation therapy after breast resection reduces the frequency of ipsilateral breast recurrences, even among women with small-size breast cancers that have favorable histologic features and that are resected with at least a 1-cm margin. Postoperative radiotherapy did not significantly improve survival.
Mechanical vibration: R. E. D. Bishop's contribution to the Journal of Mechanical Engineering Science
Authors: Newland D E
Published: December 2008

R. E. D. Bishop was one of the founders of the Journal of Mechanical Engineering Science ( JMES). He was a member of the journal's Editorial Panel for 27 years. This is an appreciation of his contribution to the formation and success of the Journal.
The Perception of Support Received from Breast Care Nurses by Depressed Patients Following a Diagnosis of Breast Cancer
Authors: Clark Louise , Holcombe Christopher , Hill Jonathan , Downey Hilary , Fisher Jean , Krespi Margorit Rita , Salmon Peter
Published: December 2008

INTRODUCTION

Due to their specialist training, breast care nurses (BCNs) should be able to detect emotional distress and offer support to breast cancer patients. However, patients who are most distressed after diagnosis generally experience least support from care staff. To test whether BCNs overcome this potential barrier, we compared the support experienced by depressed and non-depressed patients from their BCNs and the other main professionals involved in their care: surgeons and ward nurses.

PATIENTS AND METHODS

Women with primary breast cancer (n = 355) 2–4 days after mastectomy or wide local excision, self-reported perceived professional support and current depression. Analysis of variance compared support ratings of depressed and non-depressed patients across staff types.

RESULTS

There was evidence of depression in 31 (9%) patients. Depressed patients recorded less surgeon and ward nurse support than those who were not depressed but the support received by patients from the BCN was high, whether or not patients were depressed.

CONCLUSIONS

BCNs were able to provide as much support to depressed patients as to non-depressed patients, whereas depressed patients felt less supported by surgeons and ward nurses than did non-depressed patients. Future research should examine the basis of BCNs' ability to overcome barriers to support in depressed patients. Our findings confirm the importance of maintaining the special role of the BCN.
A Simple Prophylaxis Regimen for MRSA: Its Impact on the Incidence of Infection in Patients Undergoing Liver Resection
Authors: Al-Mukhtar Ahmed , Wong Vincent KH , Malik Hassan Z , Abu-Hilal Mohammed , Denton Miles , Wilcox Mark , Lodge J Peter A , Toogood Giles J , Prasad K Rajendra
Published: December 2008

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) infection has increased at an alarming rate in the recent past and has major cost implications. The aim of this study is to assess the impact of a policy of pre-operative MRSA prophylaxis on the incidence of MRSA infection in patients undergoing liver resection.

PATIENTS AND METHODS

A total of 585 patients underwent hepatectomy in a tertiary referral centre between January 2000 and September 2005. In September 2003, a policy of MRSA prophylaxis (nasal mupirocin and triclosan wash for 5 days) was introduced within this unit. Demographic, pathological and outcome data were compared between the pre- and post-MRSA prophylaxis cohorts.

RESULTS

The prevalence of MRSA infection prior to initiating the prophylaxis protocol was 29 patients (8.3%) and this fell to 9 patients (3.8%; P= 0.029). Furthermore, patients who had MRSA-related infection had a higher incidence of additional complications compared to the rest of the cohort (P= 0.001). Total cost savings incurred as a result of this protocol over the past 2 years has been approximated at £28,893.

CONCLUSIONS

Introduction of a simple MRSA prophylaxis policy has had a significant reduction on the incidence MRSA-related infection within our patient population, leading to reduced morbidity and cost saving to the UK National Health Service.
Community-Based Orthopaedic Follow-Up. Is it What Doctors and Patients Want?
Authors: Harle Daniel , Ilyas Shazad , Darrah Clare , Tucker Keith , Donell Simon
Published: December 2008

INTRODUCTION

The objective of this study was to investigate how patients, general practitioners (GPs) and orthopaedic trainees, feel about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community.

SUBJECTS AND METHODS

The design was a cross-sectional questionnaire study including a teaching hospital and general practitioners in the Norfolk primary care trust. Participants were 73 orthopaedic postoperative patients who attended out-patients over a 1-week period in July 2007 who all responded. Of 250 GPs, 239 responded. Of 38 orthopaedic trainees at the level of senior house officer (post MRCS) and specialist registrar (Eastern Deanery Rotation and Pott Rotation), 30 responded

RESULTS

Of the 73 patients, 56 (77%) felt the surgeon was best suited to manage them postoperatively. Of these, 47 felt that it was very important that the surgical team saw them postoperatively. Also, 53 felt that their GP did not have sufficient knowledge and experience to deal with their current orthopaedic problem adequately. Only 12 GPs of 239 (5%) felt very confident assessing postoperative patients. Inadequate resources available to diagnose and treat postoperative complications was noted by 74% as the reason for not performing follow-up in primary care, and only 18% felt they should follow-up postoperative patients. All trainees felt that following up their own postoperative patients was important to their training.

Conclusions

Most patients, GPs, and orthopaedic trainees had serious doubts about the proposed governmental changes to reduce orthopaedic out-patient clinics by having GPs and specialist nurses follow-up postoperative orthopaedic patients in the community.
Anterior Shoulder Dislocation
Authors: Cutts Steven , Prempeh Mark , Drew Steven
Published: December 2008

INTRODUCTION

Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management.

MATERIALS AND METHODS

We have discussed this condition with our colleagues and performed a Medline search (‘anterior shoulder dislocation’) of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint.

RESULTS

Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition.

CONCLUSIONS

Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae.
The Incidence and Reporting Rates of Needle-Stick Injury Amongst UK Surgeons
Authors: Thomas WJC , Murray JRD
Published: December 2008

INTRODUCTION

Needle-stick injuries are common. Such accidents are associated with a small, but significant, risk to our career, health, families and not least our patients. National guidelines steer institution-specific strategies to provide a consistent and safe method of dealing with such incidents. Surgeon-specific guidelines are not currently available. We have observed that hospital sharps policy is often considered cumbersome to the surgeon, resulting in on-the-spot decision making with potential long-term implications. By their essence, these decisions are inconsistent, not reproducible and, thus, we believe them to be unsafe. The under-reporting to occupational health departments is well documented. Current surgical practice has the potential to expose the surgeon to unnecessary risk. The aims of this study were to establish the true incidence of contaminations caused by needle-stick injury in our hospital and to assess how well current protocols are really implemented.

SUBJECTS AND METHODS

We identified all surgeons of consultant, non-career staff grade (NCSG) and registrar grade working in a large 687-bed district general hospital serving a population of 550,000, in the UK. We designed a retrospective, anonymous 30-second survey. Surgeons' awareness and opinion of local policy was sought in a free-text section.

RESULTS

Of the 98 surgeons in the hospital, 77% responded to the questionnaire and 44% anonymously admitted to having a needle-stick injury. Only 3 of the 33 (9%) who sustained an needle-stick injury said that they followed the agreed local policy. Twenty-three surgeons (70%) performed first aid type procedures such as informing scrub nurse, changing needle and gloves. Seven surgeons (21%) simply ignored the incident and continued. Forty-three surgeons commented on the policy's nature with only 9 who regarded it as ‘user friendly’.

CONCLUSIONS

Needle-stick injury is still a common problem, particularly in the surgical cohort and remains significantly under-reported. The disparity between hospital sharps policy and actual surgical practice is considered and an explanation for the difference sought. Without this awareness of ‘real-life’ surgical practice, the occupational health figures for sharps injury will always tell a rosy story under-estimating a real problem. We strongly advocate universal precautions in the operating theatre. However, we acknowledge that sharps injuries will occur. We should remain vigilant and act upon contaminations without surgical bravado but with mater-of-fact professionalism. This includes regular review of policy and, particularly, promotion of surgical awareness.
Competence, safety, Quality: the path of the 21st century
Authors: Healy Gerald B
Published: December 2008

Allow me to take you on a journey through what in my opinion will form the legacy of the 21st-century surgeon. Many years from now the young surgeons of today will look back on their careers and examine their legacy. That legacy will be shaped during a career that will have embraced three distinct areas: competence, safety and quality.
An update on NICE and how to get more involved
Authors: Campbell Bruce
Published: December 2008

The regular news features on the National Institute for Health and Clinical Excellence (NICE) in the Annals give a digest of guidance likely to interest surgeons, together with insights into particular aspects of its work. In writing this short invited article my aim is to highlight a few important ways in which every surgeon might benefit from what NICE has (or will have) on offer and ways in which surgeons can contribute to the guidance NICE produces, which may influence their practice.
Working at the changing face of dentistry: a year in the FGDP(UK)
Authors: O'malley Dave
Published: December 2008

These are interesting times for dentistry, with many often conflicting political, ethical, financial and regulatory pressures. This year has seen a major landmark in dental teamworking in the UK: the compulsory registration of all dental care professionals (DCPs) with the General Dental Council (GDC). For the first time, dental nurses and technicians must now demonstrate that they are qualified or experienced, or both. This is a welcome move for the FGDP(UK), who have long supported professional development for DCPs and share the GDC's goal of improving the standard of care given to patients.
Using Polyalkylene Glycol Quenchants to Effectively Control Distortion and Residual Stresses in Heat Treated Aluminum Alloys
Authors: Croucher Tom
Published: December 2008

Polyalkylene glycol quenchants (also commonly called “glycol” quenchants throughout the industry) were introduced into the aluminum heat treating industry in the mid 1960s and immediately became the most important tool for reducing quenching distortion in sheet metal alloys. Later, the feasibility and benefit of glycol quenching thicker products, such as castings and forgings (which were normally quenched in hot or boiling water), was proven. Specifications were changed to permit glycol quenching of forgings and castings. However, because of a lack of understanding of the technology, the original benefits achieved in sheet metal distortion control and optimum distortion and residual stress control of thicker products has diminished. Currently, there is a significant lack of understanding regarding glycol quenching and, as a result, the full benefit of this technology is not currently being utilized. Distortion of sheet metal products and precision forgings has increased, resulting in increased check and straightening costs and higher residual stresses being imparted to parts. The realization of the benefits of glycols being able to reduce residual stress and ultimately machining costs is waning due to the reluctance of many engineers to recognize and understand the benefits of expanding the limits of the technology to achieve results not heretofore achievable. It is the purpose of this paper to review the basic concepts regarding glycol quenching of high strength aluminum alloys and to present recommendations for optimum control of distortion and residual stresses using the products. Specific illustrations showing that the proper use of glycol quenchants can provide the producer significant savings by (1) reducing quenching distortion and (2) minimizing residual stresses (which significantly improve machining practices and reduce the generation of scrap) are provided.
A Synthesis of the World Literature of Ice Hockey Injuries: Epidemiologic Principles and Future Directions
Authors: Stuart M. J. , Dajani K. A. , Crawford B. J. , Gill M. L. , Link A. A. , Smith A. M.
Published: December 2008

Ice hockey is a fast-paced, aggressive sport whose participants are subject to relatively high rates of injury. Although there is a growing emphasis on the epidemiology of ice hockey research and its application towards reducing injuries, the literature has never been organized into an accessible database. Ice hockey is played in North America, Europe, Scandinavia, the U.K., and several other non-English speaking countries, yet injury reports not written in English are often ignored in review articles. The purpose of this project was to synthesize the existing world literature on ice hockey injuries into a framework of epidemiologic criteria, accessible in an organized, retrievable library. An extensive search of the following databases was done: MEDLINE, BIOSIS, EMBASE, NTIS, CURRENT CONTENTS, DISSERTATION ABSTRACTS, SPORT DISCUS, CINAHL, and WEB OF SCIENCE. Key words used were “ice hockey” and “injuries,” and the search range was 1966 to July 2007. Endnote X (Thompson Corp., Stamford, CT) was used for reference compilation. Eight hundred sixty seven documents were catalogued, from 27 countries in 8 languages. Documents were first categorized by type, including injury (226), equipment (45), case reports (94), review articles (294), editorials (39), or as focusing on the physiological, psychological, or medical aspects of ice hockey (169). Documents were then subdivided by study type and whether they were prospective (117) or retrospective (109). Further subdivisions beyond these levels were based on the inclusion of certain critical epidemiological criteria, including exposure time, a clear definition of “injury,” and the level of play, among others. This comprehensive database should make future ice hockey research more efficient, as well as promote sound epidemiology and a more global perspective.
Experimental and Numerical Determination of Mixed Mode Crack Extension Angle
Authors: Merah Nesar , Albinmousa Jafar
Published: December 2008

Crack initiation angles for mixed mode fracture are measured and predicted using photoelastic and finite element techniques. Different crack inclination angles (0°, 10°, 20°, 30°, and 40°) are considered. The Schroedl and Smith method is used for estimating pure opening mode I stress intensity factor. On the other hand, the Sanford and Dally method is used to estimate stress intensity factors in mixed mode (I and II). The Smith and Smith method for estimating mixed mode SIF is also examined. In addition, the ANSYS finite element code is employed to estimate the pure and mixed mode SIF numerically. The estimated values of the SIF from both finite element analysis and photoelasticity are incorporated into six criteria for crack initiation angle prediction. The applicability of the crack initiation criteria such as maximum tangential stress (MTS), minimum strain energy density (S), maximum dilatational strain (T), maximum triaxial stress (M), modified MTS (MMTS), (R) criterion, and fringe symmetry axis method (FSAM) are investigated. An experimental setup is used to measure the initiation angles at different crack inclinations. The measured crack initiation angles are used to validate the predicted values. The results showed that the initiation angles estimated by different criteria using SIFs determined experimentally and numerically compared well with the measured ones, especially at higher inclination angles.
Sludge and Risk Assessment
Authors: Ehreth DJ , Jutro PR
Published: December 2008

Before the passage of the Federal Water Pollution Control Act (FWPCA) in 1972, sludge management was viewed primarily as a problem of dewatering and physical removal of sewage treatment plant residues. There was little concern with the broader implications of processing alternatives and disposal options. With the enactment of FWPCA, planning for sludge disposal became a required part of general wastewater treatment facility planning. In the ensuing years, planners have become increasingly aware that sludge management is a technically difficult and very costly element in controlling water pollution.
Sediment Reference Materials and the Canadian Marine Analytical Chemistry Standards Program
Authors: Greig Sim P , David Jamieson W , Berman SS , Boyko VJ
Published: December 2008

The Marine Analytical Chemistry Standards Program was established in 1976 by the National Research Council of Canada in support of analytical aspects of marine chemistry. Part of the mandate of the program has been the development of a series of reference materials for the determination of trace inorganic and organic constituents of marine samples. Among the samples prepared to date are a set of two sediment reference materials for the determination of trace elements and inorganic constituents and a set of three sediment reference materials for the determination of polychlorinated biphenyls (PCB).

The inorganic sediment reference materials have been freeze-dried, screened, homogenized, bottled, and sterilized. Reliable values are given for 13 trace elements and 12 other constituents.

The PCB reference materials have been given the same treatment, except for the radiation sterilization. The levels of PCB in these sediments are expressed as parts per million (ppm) of Arochlor 1254. Values for selected congeners have also been determined.

The development of these materials, as well as work underway on the development of a set of five sediment reference materials for polycyclic aromatic hydrocarbon (PAH) determination, is discussed.
The Variographic Experiment: An Essential Test for Optimizing Sampling Methodology in Monitoring Streams
Authors: Pitard FF
Published: December 2008

Systematic and random sampling (stratified or not) are widely applied to monitor toxic chemicals in streams, municipal wastes, sediments, dredge spoils, and so on. One advantage of systematic sampling is the simplicity of identifying exact sampling points; however, it can lead to biased results. The advantage of simple random and stratified random sampling is the expectation that results will be unbiased; however, it is difficult to identify exact sampling points. The primary attraction of systematic sampling is that, if no cyclic phenomenon is present, it can produce unbiased results with better precision than possible with simple random or stratified random sampling. The test described in this paper provides an answer to the difficult choice of selecting the most appropriate sampling methodology for a particular case. The distribution of toxic chemicals in a number of sites is an autocorrelated function of space or time most of time. The study of this function provides an effective means of deciding how many increments a sample should contain, how often an increment should be taken, and how the increment should be collected to keep its representativeness when cyclic phenomena occur. The test provides essential information on the sampling selection error by separating this error into three major components. The first component is a short-range quality fluctuation error, which includes errors introduced by small local composition and distribution heterogeneities. The second component is a long-range quality fluctuation error, which represents the continuous trend introduced by the waste producer. The third component is a periodic fluctuation error, which may render systematic sampling a difficult and risky operation. Systematically implementing a variographic experiment on sites where a long-term commitment for monitoring is essential is recommended. Not only does it effectively optimize the sampling methodology, but it also gives valuable information on the variability of the parameter of interest, which in turn gives valuable clues to the waste producer in solving his problem.