bluuebunny/crossref_metadata_2025 huggingface dataset:
Implications of extrinsic cognitive load on three levels of adult woodwind players
Authors: Stambaugh Laura A.
Published: February 2016

The purpose of this study was to examine the effects of two levels of extrinsic cognitive load when three levels of adult woodwind musicians practiced. Extrinsic load was manipulated through repetitive and random practice orders. Participants ( N = 43) were novice, intermediate, and advanced university woodwind players who completed a three-day, repeated measures design. At the end of two days of practice, novices who had practiced in a blocked (repetitive) practice order played significantly faster than those who had practiced in a random order. However, this difference was eliminated at 24-hour retention testing. Intermediate players experienced no differential effects of extrinsic cognitive load at the end of practice or at retention. For the advanced players, a trend was found for speed increasing from the end of practice to 24-hour retention ( p = .06). While the constructs of cognitive load theory are relevant to woodwind learning, further research is needed to determine effective paradigms for their implementation.
How much are people willing to pay for efficient waste management schemes? A benefit transfer application
Authors: Damigos Dimitris , Kaliampakos Dimitris , Menegaki Maria
Published: February 2016

To socially justify the need for better municipal solid waste management services, especially in the light of the limited availability of public funds, it is important to quantify the monetary value of the potential social and environmental benefits offered by them. This article aims at estimating society’s willingness to pay improved municipal solid waste management and establishing suitable reference values using the ‘benefit transfer’ method. To this direction, relevant studies from the global scientific and grey literature in the field of municipal solid waste management valuation are analysed and two different transfer approaches are implemented. According to the analysis, the mean annual willingness to pay per household is 88.4 USD2014 (5%-trimmed mean: 78.7 USD2014; 95% confidence interval lower bound: 64.8 USD2014 and upper bound: 112.0 USD2014). The analysis yields estimates with a high standard deviation and notably broad confidence intervals, owing to design issues of the primary studies, the different socioeconomic profiles of the populations surveyed and the existing level of municipal solid waste management services. Thus, a meta-regression model is estimated to explore the sources of heterogeneity and facilitate more accurate transfer values. Nevertheless, the limited number of observations and some methodological issues in the design and conduct of the original surveys set certain challenges and increase the level of uncertainty of the transfer values.
Design, fabrication and characterization of oxidized alginate–gelatin hydrogels for muscle tissue engineering applications
Authors: Baniasadi Hossein , Mashayekhan Shohreh , Fadaoddini Samira , Haghirsharifzamini Yasamin
Published: February 2016

In this study, we reported the preparation of self cross-linked oxidized alginate–gelatin hydrogels for muscle tissue engineering. The effect of oxidation degree (OD) and oxidized alginate/gelatin (OA/GEL) weight ratio were examined and the results showed that in the constant OA/GEL weight ratio, both cross-linking density and Young’s modulus enhanced by increasing OD due to increment of aldehyde groups. Furthermore, the degradation rate was increased with increasing OD probably due to decrement in alginate molecular weight during oxidation reaction facilitated degradation of alginate chains. MTT cytotoxicity assays performed on Wharton's Jelly-derived umbilical cord mesenchymal stem cells cultured on hydrogels with OD of 30% showed that the highest rate of cell proliferation belong to hydrogel with OA/GEL weight ratio of 30/70. Overall, it can be concluded from all obtained results that the prepared hydrogel with OA/GEL weight ratio and OD of 30/70 and 30%, respectively, could be proper candidate for use in muscle tissue engineering.
Comorbidity of Cognitive Impairment and Late-Life Depression Increase Mortality
Authors: Georgakis Marios K. , Papadopoulos Fotios C. , Protogerou Athanasios D. , Pagonari Ioanna , Sarigianni Fani , Biniaris-Georgallis Stylianos-Iason , Kalogirou Eleni Ι. , Thomopoulos Thomas P. , Kapaki Elisabeth , Papageorgiou Charalampos , Papageorgiou Socratis G. , Tousoulis Dimitrios , Petridou Eleni Th.
Published: February 2016

Objective:

To investigate the association of cognitive impairment (COGI) and depression with all-cause mortality and cardiovascular-specific mortality among community-dwelling elderly individuals in rural Greece.

Methods:

Cognition and depressive symptomatology of 676 Velestino town residents aged ≥60 years were assessed using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Eight-year all-cause mortality and cardiovascular mortality were explored by multivariate Cox regression models controlling for major confounders.

Results:

Two hundred and one patients died during follow-up. Cognitive impairment (MMSE ≤ 23) was independently associated with all-cause mortality (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.13-2.18) and cardiovascular mortality (HR: 1.57, 95%CI: 1.03-2.41). Moderate to severe depression (GDS > 10) was significantly associated only with a 51% increase in all-cause mortality. A male-specific association was noted for moderate to severe depression, whereas the effect of COGI was limited to females. Noteworthy, COGI and depression comorbidity, rather than their sole presence, increased all-cause mortality and cardiovascular mortality by 66% and 72%, respectively. The mortality effect of COGI was augmented among patients with depression and of depression among patients with COGI.

Conclusion:

COGI and depression, 2 entities often coexisting among elderly individuals, appear to increase all-cause mortality and cardiovascular mortality. Gender-specific modes may prevail but their comorbidity should be carefully assessed, as it seems to represent an independent index of increased frailty, which eventually shortens life expectancy.
Supportive Family Environments Ameliorate the Link Between Racial Discrimination and Epigenetic Aging
Authors: Brody Gene H. , Miller Gregory E. , Yu Tianyi , Beach Steven R. H. , Chen Edith
Published: February 2016

This study tested the hypothesis that supportive family environments during adolescence buffer exposure to racial discrimination, reducing its impact on biological weathering and its manifestation in cellular aging. Perceived racial discrimination, support in the family environment, and confounder variables were assessed for 3 consecutive years across adolescence in two independent cohorts of African American youth from rural Georgia. DNA was extracted from peripheral blood mononuclear cells collected during young adulthood. Patterns of methylation were used to index the epigenetic ages of these cells and the extent to which they differed from participants’ chronological ages. Among youth in supportive family environments, exposure to higher levels of racial discrimination did not forecast greater epigenetic aging. Among youth in less supportive family environments, exposure to higher levels of racial discrimination did forecast greater epigenetic aging. The associations emerged independently of confounder variables, and the results were replicated across the two cohorts.
Using a Hierarchy of Supportive Consequences to Address Problem Behaviors in the Classroom
Authors: Leach Debra , Helf Shawnna
Published: February 2016

Many educators across the country are implementing positive behavioral interventions and supports (PBIS) in their schools and classrooms. While PBIS primarily focuses on proactive and preventative approaches to improve behavior, one of the essential elements of PBIS is the consistent use of consequences when students do not meet behavioral expectations. Most teachers view consequences as punitive reactions to misbehavior. However, there are ways to deliver consequences that are supportive in nature and result in positively redirecting students to engaging in desirable behavior, thereby eliminating the necessity of punitive responses. This column discusses the problems associated with commonly used punitive consequences to address challenging behaviors in classrooms and provides an alternative approach that is more in line with PBIS frameworks. This entails the use of a hierarchy of supportive consequences, which is explained in detail.
Fatigue damage propagation models for ductile fracture of ultrahigh toughness cementitious composites
Authors: Liu Wen , Xu Shilang , Feng Peng
Published: February 2016

Ultrahigh toughness cementitious composites are a kind of high-performance cementitious material with a characteristic of ductile fracture. Based on the continuum damage mechanics theory and flexural fatigue damage model, two damage propagation models of ultrahigh toughness cementitious composites are built. One is a linear bilogarithmic model with J-integral range as its independent variable, while the other one is a linear model on a semilogarithmic scale with fatigue stress level as its independent variable. However, according to former research, the J-integral depends strongly on specimens’ geometry, so the first damage propagation model is deeply influenced by material dimension. As a result, the second damage propagation model is more convenient in application, shows the material fatigue property in comparison with the first model. In order to prove these two models and obtain the parameters, a three-point flexural fatigue experiment on single-edge-notched fracture specimens is carried out. The results shows that the two models fit better with the experimental results, rather than the crack propagation law of ultrahigh toughness cementitious composites.
Role of Ivabradine in the Treatment of Patients With Cardiovascular Disease
Authors: Weeda Erin R. , Nguyen Elaine , White C. Michael
Published: February 2016

Objective: To review the role of heart rate in myocardial ischemia and heart failure with reduced ejection fraction (HFrEF) as well as ivabradine’s pharmacology and pharmacokinetics, clinical trials, and place in therapy. Data Sources: We conducted MEDLINE searches from 1980 to October 2015 using the terms heart failure, HFrEF, angina, f-channel inhibitor, and ivabradine, with forward and backward citation tracking. Study Selection and Data Extraction: English-language trials assessing ivabradine were obtained. Studies and narrative reviews of the topic areas were incorporated if they provided relevant data to inform the practicing clinician. Data Synthesis: In the SIGNIFY (Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients with Coronary Artery Disease) trial, there was no difference in the primary composite end point of cardiovascular (CV) mortality or nonfatal myocardial infarction with ivabradine use in patients with stable coronary artery disease (CAD) versus placebo ( P = 0.20). In the subgroup with Canadian Cardiovascular Society angina class ≥II, there was an 18% increase in the primary end point with ivabradine versus placebo ( P = 0.02). In HFrEF patients, ivabradine reduced CV mortality or heart failure hospitalizations versus placebo, as seen in the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial; P < 0.05). Conclusions: The SIGNIFY trial negated much of the enthusiasm for using ivabradine in CAD. Ivabradine is a promising therapy in HFrEF based on the results of the SHIFT, but it is an adjunctive therapy, not a substitute for drugs with proven mortality benefits.
The Burden of Burnout
Authors: Elmariah Hany , Thomas Samantha , Boggan Joel C. , Zaas Aimee , Bae Jonathan
Published: February 2016

This study sought to determine burnout prevalence and factors associated with burnout in internal medicine residents after introduction of the 2011 ACGME duty hour rules. Burnout was evaluated using an anonymized, abbreviated version of the Maslach Burnout Inventory. Surveys were collected biweekly for 48 weeks during the 2013-2014 academic year. Burnout severity was compared across subgroups and time. A score of 3 or higher signified burnout. Overall, 944 of 3936 (24%) surveys were completed. The mean burnout score across all surveys was 2.8. Categorical residents had higher burnout severity than noncategorical residents (2.9 vs 2.7, P = .005). Postgraduate year 2 residents had the highest burnout severity by year (3.1, P < .001). Residents on inpatient rotations had higher burnout severity than residents on outpatient or consultation rotations (3.1 vs 2.2 vs 2.2, P < .001). Night float rotations had the highest severity (3.8). Burnout remains a significant problem even with recent duty hour modifications.
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Authors: Haynes Jacob , Cherney Steven , Spraggs-Hughes Amanda , McAndrew Christopher M. , Ricci William M. , Gardner Michael J.
Published: February 2016

Background:

The distal tibiofibular syndesmosis is disrupted in up to 45% of operatively treated ankle fractures, and syndesmotic malreduction has historically been correlated with poor outcome. The purpose of this study was to quantify the clamp force used during syndesmotic reduction and to evaluate the effect of clamp force on fibular overmedialization (overcompression) at the level of the distal tibiofibular syndesmosis.

Methods:

A prospectively recruited cohort of 21 patients underwent operative syndesmotic reduction and fixation. A ball point periarticular reduction forceps that was modified to include a load cell in one tine was used for the reduction, and the clamp force required for reduction was measured. Patients underwent postoperative bilateral computed tomographic scans of the ankle and hindfoot to assess syndesmotic reduction. The uninjured extremity was used as a control. Side-to-side differences in fibular medialization, translation, and rotation within the tibial incisura were measured. These findings were correlated with the reduction clamp force utilized to obtain the reduction.

Results:

Syndesmotic overcompression (fibular medialization greater than 1.0 mm when compared with noninjured ankle) was seen in 11 of 21 patients (52%). Increased clamp force significantly correlated with syndesmotic overcompression. The mean reduction clamp forces were 88 N for the undercompressed group, 130 N for the adequately compressed group, and 163 N for the overcompressed group.

Conclusion:

This study demonstrated a significant correlation between increased clamp forces and syndesmotic overcompression, and determined objective forces that lead to overcompression. Our results indicate that surgeons should be cognizant of the clamp force used for syndesmotic reduction.

Level of Evidence:

Level III, case-control series, in accordance with STROBE guidelines.
Response to Lidstrom, Lewis, and Barnes on Fragmented Regionalism
Authors: Savitch H. V. , Adhikari Sarin
Published: February 2016

Critics often take their subjects on worthy journeys. Lidstrom has done this through a comparative approach. He draws parallels between American public authorities and European “inter-municipal cooperation”. While comparisons can be useful the parallels have limitations, and we point out that public authorities, “transcend local interests” whereas “inter-local agreements” reflect local interests. Lewis opens a new vista on the American landscape by demonstrating how numerous institutions work across jurisdictions. He shows there are functional equivalents to public authorites that work as “kludges” to patch together fragmented metropolises. Barnes takes us down a rockier road. He attributes much to our article that was neither written nor intended. Barnes’ critique is lodged in an assertion that we envisioned regionalism as an “ideal” of “one big metro government”. We take issue with this premise and its conclusions.
The effect of the mating gear surface over the durability of injection-molded polypropylene spur gears
Authors: Johnney Mertens A , Kumar Prateek , Senthilvelan S
Published: February 2016

Extensive investigations have been carried out to understand the effect of gear material, gear parameters and service conditions over polymer gear durability. However, the effect of the mating gear surface condition over test gear performance has not been completely understood. In this study, injection-molded polypropylene gears were paired with stainless steel gears and evaluated in the power absorption gear test rig. This study considered steel gears manufactured through the wire-cut electric discharge machining with different surface roughness (3.8–4.1 µm, 2.5–2.8 µm and 1.9–2.2 µm). The bearing ratio curves of the steel gear surfaces were obtained with the aid of non-contact profiler. During testing, the surface temperature of polymer gear increases due to the gear material hysteresis and surface interaction. The surface temperature of the gear increased by 5–15℃ due to the increase of surface roughness of the mating steel gear tooth (1.9–4.1 µm). The worn-out gear tooth surface also confirmed the significance of the mating gear surface condition. Further, stainless steel discs with different surface roughness (4.7–5.4 µm, 2.6–3.2 µm) were manufactured through the wire-cut electric discharge machining process. Injection-molded polypropylene pins were slid against these discs. Due to the increase in surface roughness, coefficient of friction was found to increase from 0.38 to 0.45 for the chosen test condition. The measured net surface temperature of the test specimen also increased from 52 to 59℃ due to the increase in surface roughness.
Social inclusion in the post-conflict state of Nepal: Donor practice and the political settlement
Authors: Drucza Kristie
Published: February 2016

Fragile states constitute a challenging operating environment. Yet, the role of development partner engagement on issues of social inclusion, identity politics, or horizontal inequalities in such fragile environments has not received the attention these complex issues warrant. The attitudes of development actors, their level of commitment, bias, risk management, and understanding of the political settlement can have a real bearing on the effectiveness of such efforts to promote inclusion. In Nepal, certain development partners have faced elite backlash for their engagement on social inclusion, while others have been more successful. This article asks what lessons can be learned from these experiences for those interested in promoting social inclusion in fragile states through development assistance.
Sludge
Authors: Olden Ruth
Published: February 2016

This article narrates a journey taken with wastewater at Shieldhall Wastewater Treatment Works in Glasgow as it courses through a number of treatment areas engineered to separate out solids and clear water. The journey is taken by two water scientists and a cultural geographer who follow the slowing and settling, filtering and dredging, bubbling and churning, as the wastewater system seeks to order material chaos – ‘turbidity’ as it is known here. But between the water sampling and testing undertaken on the journey, these attempts to categorise and make meaning of the stuff at Shieldhall, waste continues to resist determination. Its meanings leak, and its pathways through space and time spill out in unpredictable ways. This article considers what Hird has referred to as the ‘fully inhuman’ exuberance of waste to explore how life at this wastewater facility opens on to an uncertain future, and urges us to remember it.
The effect of upstream edge geometry on the acoustic resonance excitation in shallow rectangular cavities
Authors: Omer Ahmed , Arafa Nadim , Mohany Atef , Hassan Marwan
Published: February 2016

The flow-excited acoustic resonance phenomenon is created when the flow instability oscillations are coupled with one of the acoustic modes of a confined duct, which in turn generates acute noise problems and/or excessive vibrations. In this study, the effect of the upstream edge geometry on attenuating these undesirable effects is investigated experimentally for flows over shallow rectangular cavities with two different aspect ratios of L/D = 1 and 1.67, where L is the cavity length and D is the cavity depth, for Mach number up to 0.45. The acoustic resonance modes of the cavity are self-excited due to the development of free shear layers over the cavity mouth. Twenty four different upstream cavity edges are investigated in this study, including round edges, chamfered edges, vortex generators, and spoilers with different sizes and configurations. The results for each upstream cavity edge are compared with the base case where sharp edge is used. Most of the spoiler edges are found to be effective in suppressing the pressure amplitude of the excited acoustic resonance. Hot-wire measurements that were taken along the lateral direction downstream of the spoilers reveal the existence of secondary vortices generated by the spoilers, orthogonal to the cavity shear layer, which results in suppressing the resonance. The performance of each spoiler depends on its specific geometry (i.e. thickness, height, and angle) and the size and strength of the orthogonal vortices that can be generated. A summary of the results is presented in this paper.
Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia: a multicenter validation study
Authors: Wang Wen-Lun , Chang I-Wei , Chen Chien-Chuan , Chang Wei-Lun , Chu Yin-Yi , Wu Ping-Hsiu , Tai Wei-Chen , Chen Po-Yueh , Hsieh Ping-Hsin , Chung Chen-Shuan , Chang Chi-Yang , Lin Jaw-Town , Wang Hsiu-Po , Lee Ching-Tai
Published: February 2016

Background:

Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis.

Methods:

We consecutively enrolled patients with flat-type ‘large’ (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm2–clean–12 J/cm2 regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen.

Results:

A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93%, and the rates of perforation and postoperative stenosis were 0% and 17%, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95% confidence interval, 1.18–136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876).

Conclusions:

The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment (⩾9 cm) ESCNs.
Ensuring Culture Does Not Eat Strategy for Breakfast
Authors: Inayatullah Sohail
Published: February 2016

For foresight to be useful to organizations, it must have seven dimensions. The first is that the journey is learning focused and not about particular forecasts or strategic targets. The journey is continuous, adaptive, and narrative-based. Second, for organizations to transform, they must challenge their used future: practices they continue that do not match their desired vision. Third, as the rate of technological change is dramatic, often exponential, it is necessary for organizations to search for emerging issues—novel disruptors that can challenge standard operating procedures. Fourth, they need alternative futures or scenarios, as they best capture uncertainty and allow for novel possibilities. The fifth is inclusion, or the question of “who is not in the room?” Sixth, for a new future to successfully emerge, it must have a supportive worldview and underlying narrative or metaphor. And, seventh, they need a vision, neither too far nor too near, one that enables and ennobles.
Perinatal MRI diffusivity is related to early assessment of motor performance in preterm neonates
Authors: Navarra Riccardo , Sestieri Carlo , Conte Emanuela , Salomone Rita , Mattei Peter A , Romani Gian L , Domizio Sergio , Caulo Massimo
Published: February 2016

Preterm neonates represent a high-risk population for abnormal neuropsychological development. But presently, an accurate method for identifying those at risk is not available. This study evaluated the association between the microstructural organization measured with Diffusion Tensor Imaging (DTI) in term-corrected preterm neonates and subsequent motor performance. Fractional anisotropy (FA), axial diffusion (AD), mean diffusivity (MD) and radial diffusivity (RD) were determined in two regions of interest (ROIs) corresponding to the posterior limb of the internal capsule (PLIC) and cortico-spinal tract (CST). The Griffiths Mental Developmental Scales (GMDS) were longitudinally administered at 3, 6 and 15 months; and correlations between the metrics of diffusivity and the motor subscale of the GMDS were assessed using the Spearman correlation. A statistically significant negative correlation was observed between the AD of PLIC of the left hemisphere and the 3-month GMDS Locomotor Subscale. These results suggested that AD is a valid indicator of the stage of maturation of the motor pathway in preterm neonates, but not of later motor outcome.
Morphine-induced pruritus after epidural administration followed by treatment with naloxone in a cat
Authors: Evangelista Marina C , Steagall Paulo , Garofalo Natache A , Rodrigues Jessica C , Teixeira-Neto Francisco
Published: February 2016

Case summary

A young male domestic shorthair cat weighing 1.6 kg was admitted to a veterinary teaching hospital for elective orchiectomy. A lumbosacral epidural injection of preservative-free morphine (0.1 mg/kg) and lidocaine (0.25 ml/kg) was performed under general anesthesia. One hour after extubation, the cat became agitated. Severe licking and biting of the hindlimbs, tail and lumbar area were observed. Pruritus was suspected and likely to be caused by epidural morphine. Acepromazine (0.02 mg/kg IM) was administered but clinical signs did not cease. Naloxone (2 µg/kg IV) was administered and clinical signs resolved within 20 mins.

Relevance and novel information

Different therapeutic approaches are available for the treatment of morphine-induced pruritus. This case describes an additional treatment option using opioid antagonism with naloxone.
Managerial Imagination
Authors: Savvas Michael
Published: February 2016

This article analyzes the links between imagination and human resource management. The concept imagination has received little scholarly attention within the field of management, despite its potential to inform a number of lines of inquiry. At the present time, much of the research literature on imagination is confined to the visual arts, literature, and education. Human resource (HR) professionals could play a part in aligning employees with organizational goals and bring about organizational change if they developed their thinking in a more imaginative way. Developing managerial imagination can help solve the dilemmas and contradictions they face. A diagram is developed, which maps the development of the personnel function and offers four possibilities within a framework. They are biography, personal framing, history, and social structure. The outcome of this analysis provides a development of the personnel function one of which is a globally imaginative HR management. Within such a framework, the concept of “the imaginative performer” is discussed. The implications of combining imagination with management may provide a theoretical and practical way to understanding HR management.
Assessment of Motor Competence Across the Life Span
Authors: Sigmundsson Hermundur , Lorås Håvard , Haga Monika
Published: February 2016

In this article, the psychometric properties of a new test battery aimed at quantifying motor competence across the life span are explored. The battery was designed to be quantitative, simple to administer, applicable for large-group testing, and reliably to monitor life span motor development. A total of 638 participants between 5 and 83 years of age completed assessment of four different motor tasks (two fine and two gross motor tasks), enabling us to investigate its feasibility, internal consistency, construct validity, and test–retest reliability. Feasibility: Overall pattern of results suggest that the test battery for motor competence presented here is applicable for the age-span studied (5-83). Important consideration in this regard is that the same tasks are applied for all ages. A u-shaped curve between age and total test score indicate the adequate sensitivity of the test battery for the age range examined. Internal consistency: All individual test item scores correlated positively with the total test score with correlations ranging from .48 to .64. Correlations between scores on individual test items were moderate to high (.31-.69). The Cronbach’s alpha value for the standardized items was .79. Construct validity: Pearson correlation coefficient between total score Test of Motor Competence (TMC) and Movement Assessment Battery for Children (MABC) were .47 for 7- to 8-years-old children ( n = 70) and .45 for 15- to 16-years-old ( n = 101). Test-retest reliability: Intraclass correlation coefficients (ICCs) between test and retest scores ranged from .75 to .94, and test–retest coefficient for the total score was .87.
Guiding Students’ Learning With LibGuides as an Interactive Teaching Tool in Health Promotion
Authors: Berić-Stojšić Bojana , Dubicki Eleonora
Published: February 2016

The purpose of this article is to provide guidance to university faculty and librarians in developing LibGuides as effective pedagogical tools in teaching/learning in undergraduate- and graduate-level health promotion classes. This article presents the steps for developing and using LibGuides in course instruction as well as the evidence for their effectiveness.
Lung microbiome dynamics in COPD exacerbations
Authors: Wang Zhang , Bafadhel Mona , Haldar Koirobi , Spivak Aaron , Mayhew David , Miller Bruce E. , Tal-Singer Ruth , Johnston Sebastian L. , Ramsheh Mohammadali Yavari , Barer Michael R. , Brightling Christopher E. , Brown James R.
Published: February 2016

Increasing evidence suggests that the lung microbiome plays an important role in chronic obstructive pulmonary disease (COPD) severity. However, the dynamics of the lung microbiome during COPD exacerbations and its potential role in disease aetiology remain poorly understood.

We completed a longitudinal 16S ribosomal RNA survey of the lung microbiome on 476 sputum samples collected from 87 subjects with COPD at four visits defined as stable state, exacerbation, 2 weeks post-therapy and 6 weeks recovery.

Our analysis revealed a dynamic lung microbiota where changes appeared to be associated with exacerbation events and indicative of specific exacerbation phenotypes. Antibiotic and steroid treatments appear to have differential effects on the lung microbiome. We depict a microbial interaction network for the lung microbiome and suggest that perturbation of a few bacterial operational taxonomic units, in particularHaemophilusspp., could greatly impact the overall microbial community structure. Furthermore, several serum and sputum biomarkers, in particular sputum interleukin-8, appear to be highly correlated with the structure and diversity of the microbiome.

Our study furthers the understanding of lung microbiome dynamics in COPD patients and highlights its potential as a biomarker, and possibly a target, for future respiratory therapeutics.
Retrospective review of a tertiary adult burn centre’s experience with modified Meek grafting
Authors: Munasinghe Namal , Wasiak Jason , Ives Andrew , Cleland Heather , Lo Cheng Hean
Published: February 2016

Background

Autologous split skin grafting is the gold standard in treating patients with massive burns. However, the limited availability of donor sites remains a problem. The aim of this study is to present our experience with the modified Meek technique of grafting, outcomes achieved and recommendations for optimized outcomes.

Methods

We retrospectively reviewed patient records from our tertiary referral burn centre and the Bi-National Burns Registry to identify all patients who had modified Meek grafting between 2010 and 2013. Patient records were reviewed individually and information regarding patient demographics, mechanism of injury and surgical management was recorded. Outcome measures including graft take rate, requirement for further surgery and complications were also recorded.

Results

Eleven patients had modified Meek grafting procedures. The average age of patients was 46 years old (range 23 – 64). The average total body surface area (TBSA) burnt was 56.75 % (range 20–80 %). On average, 87 % of the grafted areas healed well and did not require regrafting. In the regrafted areas, infection was the leading cause of graft failure.

Conclusions

Modified Meek grafting is a useful method of skin expansion. Similar to any other grafting technique, infection needs to be sought and treated promptly. It is recommended for larger burns where donor sites are not adequate or where it is desirable to limit their extent.
Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus
Authors: Prasad N. , Ali A. , Stanley D.
Published: February 2016

Aims

We review our experience of Coonrad-Morrey total elbow arthroplasty (TEA) for fractures of the distal humerus in non-rheumatoid patients with a minimum of ten years follow-up.

Patients and Methods

TEA through a triceps splitting approach was peformed in 37 non-rheumatoid patients for a fracture of the distal humerus between 1996 and 2004. One patient could not be traced and 17 had died before the tenth anniversary of their surgery. This left 19 patients with a minimum follow-up of ten years to form the study group. Of these, 13 patients were alive at the time of final review. The other six had died, but after the tenth anniversary of their elbow arthroplasty. Their clinical and radiological data were included in the study.

Results

The mean follow-up of the 19 patients was 156 months (120 to 210). Two patients in the study group had undergone revision. One further patient had undergone a two-stage revision for infection but died before ten-year follow-up. Six other patients in the study group had evidence of loosening or wear of their bushings. Two were clinically symptomatic and were offered revision surgery. Male patients showed higher incidence of loosening and wear. Survivorship, with revision and definite loosening as end-points, was 89.5% at ten years in those patients followed for a minimum of ten years and 86% in the whole group of 36 patients.

Conclusion

This study shows that only 53% of non-rheumatoid patients who undergo TEA for a fracture of the distal humerus survive to the tenth anniversary of their index procedure. For those that survive, TEA provides acceptable outcomes in terms of function and implant survival. Take home message: The surgeons undertaking these procedures should be aware of the long-term revision rates and also the gender difference in the rates of loosening. Cite this article: Bone Joint J 2016;98-B:381–6.
Improving the care of patients with severe open fractures of the tibia
Authors: Wordsworth M. , Lawton G. , Nathwani D. , Pearse M. , Naique S. , Dodds A. , Donaldson H. , Bhattacharya R. , Jain A. , Simmons J. , Hettiaratchy S.
Published: February 2016

Aims

The management of open lower limb fractures in the United Kingdom has evolved over the last ten years with the introduction of major trauma networks (MTNs), the publication of standards of care and the wide acceptance of a combined orthopaedic and plastic surgical approach to management. The aims of this study were to report recent changes in outcome of open tibial fractures following the implementation of these changes.

Patients and Methods

Data on all patients with an open tibial fracture presenting to a major trauma centre between 2011 and 2012 were collected prospectively. The treatment and outcomes of the 65 Gustilo Anderson Grade III B tibial fractures were compared with historical data from the same unit.

Results

The volume of cases, the proportion of patients directly admitted and undergoing first debridement in a major trauma centre all increased. The rate of limb salvage was maintained at 94% and a successful limb reconstruction rate of 98.5% was achieved. The rate of deep bone infection improved to 1.6% (one patient) in the follow-up period.

Conclusion

The reasons for these improvements are multifactorial, but the major trauma network facilitating early presentation to the major trauma centre, senior orthopaedic and plastic surgical involvement at every stage and proactive microbiological management, may be important factors. Take home message: This study demonstrates that a systemised trauma network combined with evidence based practice can lead to improvements in patient care. Cite this article: Bone Joint J 2016;98-B:420–4.
Standing radiological analysis with a low-dose biplanar imaging system (EOS system) of the position of the components in total hip arthroplasty using an anterior approach
Authors: Morvan A. , Moreau S. , Combourieu B. , Pansard E. , Marmorat J. L. , Carlier R. , Judet T. , Lonjon G.
Published: February 2016

Aims

The primary aim of this study was to analyse the position of the acetabular and femoral components in total hip arthroplasty undertaken using an anterior surgical approach.

Patients and Methods

In a prospective, single centre study, we used the EOS imaging system to analyse the position of components following THA performed via the anterior approach in 102 patients (103 hips) with a mean age of 64.7 years (sd 12.6). Images were taken with patients in the standing position, allowing measurement of both anatomical and functional anteversion of the acetabular component.

Results

The mean inclination of the acetabular component was 39° (standard deviation (sd) 6), the mean anatomical anteversion was 30° (sd 10), and the mean functional anteversion was 31° (sd 8) five days after surgery. The mean anteversion of the femoral component was 20° (sd 11). Anatomical and functional anteversion of the acetabular component differed by >  10° in 23 (22%) cases. Pelvic tilt was the only pre-operative predictive factor of this difference.

Conclusion

Our study showed that anteversion of the acetabular component following THA using the anterior approach was greater than the recommended target value, and that substantial differences were observed in some patients when measured using two different measurement planes. If these results are confirmed by further studies, and considering that the anterior approach is intended to limit the incidence of dislocation, a new correlation study for each reference plane (anatomical and functional) will be necessary to define a ‘safe zone’ for use with the anterior approach. Take home message: EOS imaging system is helpful in the pre-operative and post-operative radiological analysis of total hip arthroplasty. Cite this article: Bone Joint J 2016;98-B:326–333.
Aspirin for thromboprophylaxis after primary lower limb arthroplasty
Authors: Ogonda L. , Hill J. , Doran E. , Dennison J. , Stevenson M. , Beverland D.
Published: February 2016

Aims

The aim of this study was to present data on 11 459 patients who underwent total hip (THA), total knee (TKA) or unicompartmental knee arthroplasty (UKA) between November 2002 and April 2014 with aspirin as the primary agent for pharmacological thromboprophylaxis.

Patients and Methods

We analysed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) then compared the 90-day all-cause mortality with the corresponding data in the National Joint Registry for England and Wales (NJR).

Results

The incidence of PE was 0.6% after THA, 1.47% after TKA and 1.2% after UKA. The 90-day mortality was 0.39% after THA and 0.44% after TKA. No deaths occurred after UKA. The main causes of death were ischaemic heart disease and respiratory failure. PE was responsible for only 18% of deaths. There was a decline in 90-day mortality, from 0.64% between 2002 and 2007, to 0.21% between 2008 and 2013 after THA, and from 0.47% to 0.39% after TKA for the corresponding period. The standardised mortality ratio (SMR) declined from 86.5 (confidence interval (CI) 63.0 to 137.7) to 39.7 (CI 31.2 to 54.3) p = 0.024. The incidence of proximal DVT was 0.3%. Take home message: With individualised risk assessment and as part of a multimodal approach, Aspirin is safe to use as the main thromboprophylactic agent in primary arthroplasty. It is not associated with an increased incidence of symptomatic DVT, PE or death. Cite this article: Bone Joint J 2016;98-B:341-8.
A new classification of glenoid bone loss to help plan the implantation of a glenoid component before revision arthroplasty of the shoulder
Authors: Kocsis G. , Thyagarajan D. S. , Fairbairn K. J. , Wallace W. A.
Published: February 2016

Aims

Glenoid bone loss can be a challenging problem when revising a shoulder arthroplasty. Precise pre-operative planning based on plain radiographs or CT scans is essential. We have investigated a new radiological classification system to describe the degree of medialisation of the bony glenoid and that will indicate the amount of bone potentially available for supporting a glenoid component. It depends on the relationship between the most medial part of the articular surface of the glenoid with the base of the coracoid process and the spinoglenoid notch: it classifies the degree of bone loss into three types. It also attempts to predict the type of glenoid reconstruction that may be possible (impaction bone grafting, structural grafting or simple non-augmented arthroplasty) and gives guidance about whether a pre-operative CT scan is indicated.

Patients and Methods

Inter-method reliability between plain radiographs and CT scans was assessed retrospectively by three independent observers using data from 39 randomly selected patients. Inter-observer reliability and test-retest reliability was tested on the same cohort using Cohen's kappa statistics. Correlation of the type of glenoid with the Constant score and its pain component was analysed using the Kruskal-Wallis method on data from 128 patients. Anatomical studies of the scapula were reviewed to explain the findings.

Results

Excellent inter-method reliability, inter-observer and test-retest reliability were seen. The system did not correlate with the Constant score, but correlated well with its pain component. Take home message: Our system of classification is a helpful guide to the degree of glenoid bone loss when embarking on revision shoulder arthroplasty. Cite this article: Bone Joint J 2016;98-B:374–80.
Do large pragmatic randomised trials change clinical practice?
Authors: Costa M. L. , Jameson S. S. , Reed M. R.
Published: February 2016

Aims

Our aim, using English Hospital Episode Statistics data before during and after the Distal Radius Acute Fracture Fixation Trial (DRAFFT), was to assess whether the results of the trial affected clinical practice.

Patients and Methods

Data were grouped into six month intervals from July 2005 to December 2014. All patient episodes in the National Health Service involving emergency surgery for an isolated distal radial fracture were included.

Results

Clinical practice in England had not changed in the five years before DRAFFT: 75% of patients were treated with plate fixation versus 12% with Kirschner (K)-wires. After the publication of the trial, the proportion of patients having K-wire fixation rose to 42% with a concurrent fall in the proportion having fixation with a plate to 48%. The proportion of ‘other’ procedures stayed the same. Take home message. It appears that surgeons in the United Kingdom do change their practice in response to large, pragmatic, multicentre clinical trials in musculoskeletal trauma. Cite this article: Bone Joint J 2016;98-B:410–13.
Quality of care for patients with a fracture of the hip in major trauma centres
Authors: Metcalfe D. , Gabbe B. J. , Perry D. C. , Harris M. B. , Ekegren C. L. , Zogg C. K. , Salim A. , Costa M. L.
Published: February 2016

Aims

In this study, we aimed to determine whether designation as a major trauma centre (MTC) affects the quality of care for patients with a fracture of the hip.

Patients and Methods

All patients in the United Kingdom National Hip Fracture Database, between April 2010 and December 2013, were included. The indicators of quality that were recorded included the time to arrival on an orthopaedic ward, to review by a geriatrician, and to operation. The clinical outcomes were the development of a pressure sore, discharge home, length of stay, in-hospital mortality, and re-operation within 30 days.

Results

There were 289 466 patients, 49 350 (17%) of whom were treated in hospitals that are now MTCs. Using multivariable logistic and generalised linear regression models, there were no significant differences in any of the indicators of the quality of care or clinical outcomes between MTCs, hospitals awaiting MTC designation and non-MTC hospitals.

Conclusion

These findings suggest that the regionalisation of major trauma in England did not improve or compromise the overall care of elderly patients with a fracture of the hip. Take home message: There is no evidence that reconfiguring major trauma services in England disrupted the treatment of older adults with a fracture of the hip. Cite this article: Bone Joint J 2016;98-B:414–19.
Measuring the Layer Charge of Dioctahedral Smectite by O—D Vibrational Spectroscopy
Authors: Kuligiewicz Artur , Derkowski Arkadiusz , Emmerich Katja , Christidis George E. , Tsiantos Constantinos , Gionis Vassilis , Chryssikos Georgios D.
Published: February 2016

Layer charge (LC) is a fundamental property of smectite but its measurement remains challenging and tedious to apply on a high-throughput basis. The present study demonstrates that the position of a sharp, high-energy O—D stretching band of adsorbed D2O (νO—D, at ~2686–2700 cm−1), determined by infrared spectroscopy, correlates with LC and provides a simple method for its measurement. Twenty nine natural dioctahedral smectites and 14 reduced-charge montmorillonites with LC determined previously by different methodologies were saturated with D2O and examined by attenuated total reflectance infrared spectroscopy (ATR-IR). The samples included smectites in Mg, Ca, Na, Li, K, and Cs forms and covered the full range of the smectite LC (0.2 to 0.6 e per formula unit). Statistically significant correlations were found between νO—D and LC values determined with each of the two main methods of LC determination: the structural formula method (R2 = 0.96, σ = 0.02, ~0.2 < LC < 0.6) and the alkylammonium method (R2 = 0.92, σ = 0.01, 0.27 < LC < 0.37). These correlations were based on Li- and Na-saturated smectites, respectively, but other cationic forms can be employed provided that the exchangeable cations are of sufficiently high hydration enthalpy (e.g. Mg2+ or Ca2+, but not K+ or Cs+). The new method is fast, low-cost, implemented easily in laboratories equipped with ATR-FTIR, and applicable to samples as small as ~5 mg.