bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality After Elective and Ruptured Abdominal Aortic Aneurysm Surgical Repair: 12-Year Single-Center Experience of Estonia
Authors: Lieberg J. , Pruks L.-L. , Kals M. , Paapstel K. , Aavik A. , Kals J.
Published: November 2017

Background and Aims:

Abdominal aortic aneurysm is a degenerative vascular pathology with high mortality due to its rupture, which is why timely treatment is crucial. The current single-center retrospective study was undertaken to analyze short- and long-term all-cause mortality after operative treatment of abdominal aortic aneurysm and to examine the factors that influence outcome.

Material and Methods:

The data of all abdominal aortic aneurysm patients treated with open repair or endovascular aneurysm repair in 2004–2015 were retrospectively retrieved from the clinical database of Tartu University Hospital. The primary endpoint was 30-day, 90-day, and 5-year all-cause mortality. The secondary endpoint was determination of the risk factors for mortality.

Results and Conclusion:

Elective abdominal aortic aneurysm repair was performed on 228 patients (mean age 71.8 years), of whom 178 (78%) were treated with open repair and 50 (22%) with endovascular aneurysm repair. A total of 48 patients with ruptured abdominal aortic aneurysm were treated with open repair (mean age 73.8 years) at the Department of Vascular Surgery, Tartu University Hospital, Estonia. Mean follow-up period was 4.2 ± 3.3 years. In patients with elective abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In multivariate analysis, the main predictors for 5-year mortality were preoperative creatinine value and age (p < 0.05). In patients with ruptured abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. In multivariate analysis, the risk factors for 30-day mortality in ruptured abdominal aortic aneurysm were perioperative hemoglobin and lactate levels (p < 0.05). According to this study, the all-cause mortality rates of elective abdominal aortic aneurysm and ruptured abdominal aortic aneurysm at our hospital were comparable to those at other centers worldwide. Even though some variables were identified as potential predictors of survival, the mortality rates after ruptured abdominal aortic aneurysm remain high. Early diagnosis, timely treatment, and detection of the risk factors for abdominal aortic aneurysm progression would improve survival in patients with abdominal aortic aneurysm.
Strategies of making and unmaking ethnic boundaries: Evidence on the Laz of Turkey
Authors: Serdar Ayşe
Published: November 2017

The main aim of this article is to explore different strategies of boundary making and unmaking by a minority ethnic group. I apply the theories of “boundary work” and constructivist understanding of ethnicity and nationhood to the case of the Laz, one of the autochthons of the Eastern Black Sea region of Turkey. I analyze two main strategies—boundary crossing and contraction—in the context of three sets of encounters and interactions, with Turks/Turkishness, people of Black Sea—Karadenizli—and Kurds/Kurdishness. First, I argue that assimilating into the official Turkish identity is one of the strategies adopted by the ethnic Laz. The Laz are incorporated into Turkishness both by their search for economic mobility, status, and by assimilationist policies of the state especially aimed at the spread of Turkish. To become a full-fledged true member of the nation and access to potential benefits, Turkishness through language shift has been realized that allowed boundary crossing of the Laz. Second, I state that despite the efforts of the top-down assimilationist policies, noncontentious ethnic identities can be reproduced by means of symbolic boundaries. The Laz contextually activate symbolic boundaries in informal settings by contracting from other people of Black Sea—Karadenizli—or ethnic Turkishness. The ethnic language is substituted by nonthreatening ethnic performances and rhetoric, less marked and more subjective traits of self-asserted differences. Such symbolic boundaries correspond to unofficial forms of hierarchies and competition over local belongings. Third, the analysis of the Laz–Kurd relationship unveils that ethnic boundaries can be redefined according to changing conditions. The impact of the Kurds on the Laz identity, either by means of personal acquaintances or the relationship between the state and the Kurdish national movement, is imperative. It triggers contradictions in the Laz identity by revealing new potential redefinitions and recasting of boundaries.
Accelerated generation of (protonated) imines and quinoxalines by formation of C=N bonds in the microdroplets of a nebuliser
Authors: Saidykhan Amie , Nazir Yasser , Martin William HC , Gallagher Richard T , Bowen Richard D
Published: November 2017

Ions corresponding to protonated imines appear in the positive ion electrospray mass spectra of mixtures of the parent aromatic aldehyde and arylamine. The formation of these imine products occurs readily in the electrospray source nebuliser, even without the application of a spray potential. This accelerated formation of C=N bonds in the nebuliser has been extended to encompass the preparation of quinoxalines from a range of substituted phenylenediamines and benzils. The condensation may be induced either under conventional positive ion electrospray conditions (to give the protonated quinoxalines) or when the nebuliser is disconnected from the mass spectrometer (to give the neutral quinoxaline). Ions corresponding to intermediate adducts formed by condensation of the phenylenediamine component with the protonated benzil are observed in many cases when the condensation occurs in the mass spectrometer. This finding supports an interpretation based on nucleophilic addition in droplets generated by the nebuliser.
Islamic principles of conflict management
Authors: Abdul Cader Akram
Published: November 2017

This article explores and analyzes Islamic principles that govern conflict management within the Islamic human resource management (HRM) context and provides new insight into the theoretical development of conflict management from an Islamic HRM perspective. Current models are analyzed through Islamic principles and integrated into a comprehensive Islamic framework that can function as a guide for HRM toward developing a proactive nonlinear conflict management strategy. This study shifts the dialogue of Islamic conflict management from intervention to organizational culture. The premise of this study is to develop a model for HRM practitioners among a Muslim workforce. The proposed model suggests that conflict is referred back to Quran and Sunnah, the two primary sources of Islam. Islam mandates selection of Shura (council) and appointment of a Muslih (mediator) whose function is (1) al-tathabbut (verification) and (2) nasīhah (advice). HRM must consider proactive organizational traits based on Islamic principles: (1) ta’awun (cooperation), (2) sabr (patience), (3) al-ta’akhi (brotherhood), and (4) husn al-dhann (good assumptions).
Reframing the discourse: Ethnography, Bernstein and the distribution of reading attainment by gender
Authors: Moss Gemma
Published: November 2017

This paper has two aims: to introduce readers to Bernstein’s concept of languages of description, interpreted through the lens of ethnography; and to demonstrate the value of this approach to theory-making by showing how a qualitative study conducted on these principles led to new explanations for gender differences in literacy attainment that can be tested using PISA data.
How are social bonds to a romantic partner related to criminal offending?
Authors: Nielsen Alva Albæk
Published: November 2017

This study uses a combination of Danish administrative register and survey data on a representative sample aged 18–64 ( N = 11,114) to investigate the importance of social bonds to a romantic partner. Results show that people with strong social bonds to their romantic partner offend significantly less than people with weak social bonds to their partner. The study finds no difference in offending between people with weak social bonds to their partner and people without a partner. Additionally, one result shows that strong social bonds matter less for the risk of offending if a person is aged over 30; however, this result is mainly suggestive.
Effects of varenicline therapy in combination with advanced behavioral support on smoking cessation and quality of life in inpatients with acute exacerbation of COPD, bronchial asthma, or community-acquired pneumonia: A prospective, open-label, preference-based, 52-week, follow-up trial
Authors: Politis Alexios , Ioannidis Vasileios , Gourgoulianis Konstantinos I , Daniil Zoe , Hatzoglou Chrissi
Published: November 2017

Quitting smoking is the most important element in the therapeutic management of chronic respiratory diseases. Combining pharmacotherapy with behavioral support increases smoking cessation success rates. In addition, hospitalized smokers have increased motivation to quit. We investigated the efficacy on smoking cessation, of varenicline in combination with behavioral support, in smokers hospitalized due to (a) acute exacerbation of chronic obstructive pulmonary disease (COPD), or (b) bronchial asthma attack, or (c) community-acquired pneumonia (CAP). The method used is prospective, open-label, preference-based, parallel group, 52-week trial. Patients chose the smoking cessation intervention they preferred: a standard regimen of varenicline combined with post-discharge advanced behavioral support (group A) or one private consultation session during hospitalization (group B). Follow-up phone calls were scheduled in weeks 1, 2, and 4 and months 3, 6, and 9. The final hospital visit was performed in week 52. Primary outcome was success rate defined as the percentage (%) of smoking abstinence at week 52 and secondary outcomes were (a) changes in quality of life (QoL) indicated by the scores on the Short Form 36 (SF36) questionnaire and (b) predictors of smoking abstinence investigated with multiple binary logistic regression. One hundred one patients were enrolled, 44 (43.6%) in group A and 57 (56.4%) in group B. Respective abstinence rates were 54.5% and 15.8% at week 12 and 52.3% and 14.0% at week 52. Scores on SF36 were statistically significantly increased in both groups. Predictors of smoking abstinence were varenicline (odds ratio (OR) 7.29; 95% confidence interval (CI) 2.15, 24.77; p = 0.001), age (OR 1.07; 95%CI 1.00, 1.15; p = 0.042), Fagerstrom score (OR 0.37; 95%CI 0.20, 0.68; p = 0.001), SF36 domains “vitality” (OR 1.12; 95%CI 1.04, 1.21; p = 0.003), and “social functioning” (OR 0.95; 95%CI 0.90, 1.00; p = 0.041). Varenicline in combination with behavioral support resulted in high abstinence rates inpatients hospitalized for exacerbation of COPD, asthma attack, or CAP, and improved QoL.
One-Year Outcomes Following Directional Atherectomy of Popliteal Artery Lesions: Subgroup Analysis of the Prospective, Multicenter DEFINITIVE LE Trial
Authors: Rastan Aljoscha , McKinsey James F. , Garcia Lawrence A. , Rocha-Singh Krishna J. , Jaff Michael R. , Harlin Stuart , Kamat Suraj , Janzer Sean , Zeller Thomas
Published: November 2017

Purpose: To report the effectiveness of directional atherectomy for the treatment of popliteal artery occlusive disease. Methods: This subset of the prospective, multicenter, single-arm DEFINITIVE LE trial included 158 patients (mean age 72.0±10.9 years; 82 men) who underwent directional atherectomy in 162 popliteal artery lesions between 2009 and 2011. Forty-eight (30.4%) patients were suffering from critical limb ischemia (CLI). The mean lesion length was 5.8±3.9 cm; 38 (23.5%) arteries were occluded. The primary outcome measure for patients with intermittent claudication (IC) was duplex ultrasound–defined primary patency at 1 year; the outcome for subjects with CLI was freedom from major amputation of the target limb at 1 year. Outcomes and adverse events were independently assessed. Results: Procedure success (≤30% residual stenosis) was achieved in 84.4% of treated lesions; adjunctive stenting was required in 6 (3.7%) of the 162 lesions. The 1-year primary patency rate was 75.0% (IC patients 78.2% and CLI patients 67.5%, p=0.118). The freedom from major amputation in both cohorts was 100%. In both IC and CLI patients, significant improvements were demonstrated at 1 year in the Rutherford category, walking distance, and quality of life in comparison to baseline. Conclusion: This study indicates that directional atherectomy in popliteal arteries leads to favorable technical and clinical results at 1 year for claudicant as well as CLI patients.
Simulation-Based Communication Skills Training for Experienced Clinicians to Improve Family Conversations About Organ and Tissue Donation
Authors: Potter Julie Elizabeth , Gatward Jonathan J. , Kelly Michelle A. , McKay Leigh , McCann Ellie , Elliott Rosalind M. , Perry Lin
Published: November 2017

Introduction:

The approach, communication skills, and confidence of clinicians responsible for raising deceased organ donation may influence families’ donation decisions. The aim of this study was to increase the preparedness and confidence of intensive care clinicians allocated to work in a “designated requester” role.

Design:

We conducted a posttest evaluation of an innovative simulation-based training program. Simulation-based training enabled clinicians to rehearse the “balanced approach” to family donation conversations (FDCs) in the designated requester role. Professional actors played family members in simulated clinical settings using authentic scenarios, with video-assisted reflective debriefing. Participants completed an evaluation after the workshop. Simple descriptive statistical analysis and content analysis were performed.

Results:

Between January 2013 and July 2015, 25 workshops were undertaken with 86 participants; 82 (95.3%) returned evaluations. Respondents were registered practicing clinicians; over half (44/82; 53.7%) were intensivists. Most attended a single workshop. Evaluations were overwhelmingly positive with the majority rating workshops as outstanding (64/80; 80%). Scenario fidelity, competence of the actors, opportunity to practice and receive feedback on performance, and feedback from actors, both in and out of character, were particularly valued. Most (76/78; 97.4%) reported feeling more confident about their designated requester role.

Discussion:

Simulation-based communication training for the designated requester role in FDCs increased the knowledge and confidence of clinicians to raise the topic of donation.
Correlation Between Renal Cortical Stiffness and Histological Determinants by Point Shear-Wave Elastography in Patients With Kidney Transplantation
Authors: Chiocchini A. L. Croci , Sportoletti C. , Comai G. , Brocchi S. , Capelli I. , Baraldi O. , Bruno P. , Conti F. , Serra C. , Meola M. , Zompatori M. , La Manna G.
Published: November 2017

Introduction:

Renal allograft biopsy is the gold standard for the detection of histological lesions of chronic allograft dysfunction. The identification of a noninvasive routine test would be desirable. Elastosonography is used to assess tissue stiffness according to viscosity, and no data are available on the use of point quantification shear-wave elastography (ElastPQ) for the evaluation of renal chronic lesions.

Research Question:

To evaluate the feasibility of ElastPQ to assess cortical allograft stiffness and to determine the correlation of clinical, biological, and pathological factors with the diagnostic accuracy of kidney stiffness values in patients with histological lesions.

Design:

Forty-two patients underwent kidney transplant biopsy and 10 valid measurements of ElastPQ, blindly performed by 2 operators. The interobserver reproducibility was assessed according to intraclass correlation coefficient. The ElastPQ measurements and the clinical data were compared using the Spearman correlation analysis.

Results:

97.6% reliable measurements were obtained using ElastPQ, with an excellent interobserver agreement. The kidney stiffness was significantly higher in the patients with a time since transplantation >12 months and was correlated with chronic lesions (interstitial fibrosis, tubular atrophy transplant glomerulopathy, and mesangial matrix), with the interstitial fibrosis/tubular atrophy, score and with the sum of the scores of the chronic lesions. Mesangial matrix increase is the only independent determinant of kidney stiffness.

Discussion:

ElastPQ is a noninvasive, reproducible, and sensitive diagnostic tool able to detect moderate/severe chronic lesions. Its routine use during follow-up can identify patients eligible for biopsy, which remains the gold standard exam for detecting chronic allograft dysfunction.
Distinguished Scholars Invited Essay: Becoming a Good Sport and a Better Performer: A Social Information Processing View of Authentic Leadership
Authors: Schriesheim Chester A. , Liu Yonghong
Published: November 2017

Drawing on social information processing theory, this study investigates the mechanisms by which authentic leadership affects subordinate task performance through subordinate attitudes and behavior. Sportsmanship, conceptualized as a behavioral indicator of employee positivity and persistence in pursuing high performance, is argued to be a potentially important outcome for authentic leadership. Data collected from 203 matched subordinate–supervisor dyads in six organizations from six diverse industries were subjected to contrast analysis with bootstrapping. The results suggest that the indirect effect of authentic leadership on subordinate sportsmanship is mainly via a cognitive process, as opposed to an affective one. Furthermore, it is the employee’s sportsmanship that transmits the effects of authentic leadership on employee task performance. Implications and future directions are discussed.
The technique of superselective ophthalmic artery chemotherapy for retinoblastoma: The Garrahan Hospital experience
Authors: Requejo Flavio , Marelli Juan , Ruiz Johnson Agustin , Sampor Claudia , Chantada Guillermo
Published: November 2017

Background

Superselective ophthalmic artery chemotherapy (SOAC) is a proven therapy for the treatment of retinoblastomas. We describe the technique, results and complications of SOAC performed in our hospital.

Objective

The aim of this article is to demonstrate that a seemingly complex technique can be carried out with a low morbidity rate.

Methods

A retrospective analysis of patients receiving SOAC in our department from November 2014 to April 2017 was performed. Data collected were age, gender, number of procedures, arteries approached, bilaterality of treatment, and complications. The procedure was performed using a 3F sheath and a flow-dependent 1.5F microcatheter that was navigated from the femoral artery to the ostium of the ophthalmic artery (OA). When the OA was too small or a stable position could not be achieved, the microcatheter was navigated in the external carotid artery to reach an anastomotic ramus (AR) of the middle meningeal artery (MMA) to the OA. The drugs were then injected through the microcatheter in a pulsatile way.

Results

Forty-one patients underwent SOAC. A total of 248 procedures were performed in 45 eyes, and 248 arteries were approached (205 OAs and 43 MMAs). Four patients underwent tandem therapy (both eyes treated in the same procedure). Complications were: hypotension and bradycardia during the procedure (five cases), transient thrombosis of the femoral artery (two cases), retinal hemorrhage (one case), alopecia (one case), and anaphylactic shock to carboplatin (one case). No patient showed adverse effects of radiation or ischemic stroke.

Conclusion

SOAC is a safe technique with a very low complication rate.
Endovascular treatment outcomes using the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program
Authors: Hassan Ameer E , Sanchez Christina , Johnson Angela N
Published: November 2017

Background

“Door to treatment” time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated.

Objective

The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes.

Methods

The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T. Demographics, clinical characteristics, and modified Rankin Score at three months were analyzed. Thrombolysis in Cerebral Infarction (TICI) scale was used to grade pre- and post-procedure angiographic recanalization. Using electronic hemodynamic recording, stepwise workflow times were collected for door time (TD), entering angiography suite (TA), groin puncture (TG), first DSA (TDSA), microcatheter placement (TM), and final recanalization (TR). Median intervention time (TA to TR) and recanalization time (TG to TR) were compared through Year 1 to Year 5.

Results

A total of 230 individuals (age 74 ± 12, between 30 to 95) were enrolled. Median intervention and recanalization times were significantly reduced, from 121 minutes to 52 minutes and from 83 minutes to 36 minutes respectively from Year 1 to Year 5, ( p < 0.001). Across the study period, annual recruitment went up from 12 to 66 patients, and modified Rankin Score between 0 and 2 increased from 36% to 59% ( p = 0.024).

Conclusions

STEPS-T improved time-to-treat in patients undergoing mechanical thrombectomy for AIS. During the observation period, clinical outcomes significantly improved.
A new endovascular technique for the treatment of dialysis-associated steal syndrome
Authors: Ascher Enrico , Mandel Jacob E. , Marks Natalie A. , Hingorani Anil P.
Published: November 2017

Background

Dialysis access-associated steal syndrome is a major complication of arteriovenous fistula creation whereby the low-resistance venous conduit shunts arterial inflow through the anastomosis, resulting in clinically significant distal artery insufficiency. Herein, we describe a case of severe steal phenomenon with gangrene of a digit following placement of an arteriovenous fistula that was treated with a novel, entirely endovascular technique. To our knowledge, this was the first totally endovascular approach to dialysis access-associated steal syndrome.

Methods

Catheterization of the right subclavian, axillary, and brachial arteries was performed. A short 5-Fr sheath was exchanged for a long destination 6-Fr sheath and placed in the proximal brachial artery. An arteriogram showed no stenosis of the arterial system, but did show substantial steal phenomenon with inflow to the arteriovenous fistula, instead of the forearm. We placed a stent graft in the brachial artery across the anastomosis such that the graft covered 3/4 of the length of the opening of the anastomosis.

Results

Immediately after placement of the stent graft the clinical picture improved dramatically. Patient was followed for 15 months after this procedure until her demise for unrelated causes without ever experiencing dialysis access-associated steal syndrome and with a patent and functional arteriovenous fistula.

Conclusion

We present a patient with severe dialysis access-associated steal syndrome complicated by third fingertip gangrene, which was successfully treated using a completely endovascular technique. This novel endovascular approach enabled a high-risk patient to avoid open surgery, preserve her limb, and maintain the function of her arteriovenous fistula.
Evaluating the impact of distributed culturally responsive leadership in a disadvantaged rural primary school in Ireland
Authors: Brown Martin , McNamara Gerry , O’Hara Joe , Hood Stafford , Burns Denise , Kurum Gül
Published: November 2017

This paper suggests that distributed leadership is a vital first step in making schools flexible enough to respond to new pressures. However, it is then argued that distributed leadership per se does not necessarily imply a commitment to a particular stance on issues of social justice, such as equality, but rather that this can only flow from leaders becoming culturally responsive to the diverse traditions and needs of the changing populations of their schools. We define this combination as ‘distributed culturally responsive leadership’. The second part of the paper attempts to illustrate this argument by closely examining the philosophy and actions of a particular principal who is regarded as an exemplar of good practice. The methodology used in the school case study is described and, finally, we provide a presentation and analysis of the data followed by a discussion of the research findings.
Beastly Humans: The Welfare Model Of Executions
Authors: Jones Imogen , Malkani Bharat
Published: November 2017

In determining whether executions are “humane,” authorities in the USA tend to balance the interest of the condemned person to be free from suffering with the interest of observers to be free from distress. This “welfare model” mirrors the approach to terminating the lives of companion non-human animals. We argue, therefore, that lethal injections are unconstitutional not because of the risk of pain that they present, but because, as a matter of principle they relegate human beings to the same moral space as non-human animals. This conflicts with the Eighth Amendment requirement that punishments respect the dignity of the person.
Oversight: Community vulnerabilities in the blind spot of research ethics
Authors: Cragoe Nicholas G
Published: November 2017

In spite of many and varied concerns that the processes of institutional ethical review are flawed, cumbersome, and in need of reform, these processes do provide effective protection in certain situations for individual research subjects, researchers, and the institutions from which the researchers venture to conduct their fieldwork. Many in the social sciences have argued that the ethical protocols that the researcher must observe are designed to protect against the potential dangers of much riskier biomedical research, and that social research is, by and large, harmless. Although there is some validity to that argument, in this paper, social research is assessed not in terms of its risks to the individual participant, but to communities. By examining the protocols of the Belmont Report, the Institutional Review Board, and the American Sociological Association’s “Code of Ethics” and ethical review, this paper discusses some of the major blind spots in the ethical review of social science research, applying the analysis in particular to the case of indigenous communities, who have historically sustained significant damage from academic researchers against which no standardized institutional review could have protected them. The paper covers the history and parameters of these three ethical review institutions, identifies shared blind spots, and discusses the consequences of these blind spots for indigenous communities, ending with some suggestions of ways to address the problems in the system.
Faking participant identity: Vested interests and purposeful interference
Authors: Fronek Patricia , Briggs Lynne
Published: November 2017

Misrepresentation and mischief in the research process can impact on ethical conduct, the validity of findings and deliberately change the outcome. This short report presents a scenario about deliberate interference in adoption research by one organisation seeking accreditation to deliver adoption services. Unbeknown to the researchers, fake participants completed an online survey designed to capture the post-adoption needs of adult international adoptees living in Australia. Interference was unexpected as it was naively assumed that all stakeholders involved in adoption would be concerned with meeting post-adoption needs. A definition of politically motivated fake participants, implications for the research process, predicting such interference and strategies to address the problem are discussed.
Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study
Authors: Luckraz Heyman , Manga Na’ngono , Senanayake Eshan L , Abdelaziz Mahmoud , Gopal Shameer , Charman Susan C , Giri Ramesh , Oppong Raymond , Andronis Lazaros
Published: November 2017

Background

Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom.

Methods

Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay.

Results

There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829.

Conclusion

Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.
Arthroscopically-assisted fixation of anteromedial coronoid facet fracture and lateral ulnar collateral ligament repair for acute posteromedial rotatory fracture dislocation of the elbow
Authors: Rashid Abbas , Copas David , Granville-Chapman Jeremy , Watts Adam
Published: November 2017

If left untreated, varus posteromedial rotatory injuries of the elbow result in poor functional outcomes. Surgical treatment allows restoration of elbow kinematics, minimizing the chances of chronic varus instability and early onset osteoarthritis. However, large exposures are associated with extensive soft tissue stripping, a high risk of infection, nerve injury, poor visualization of the articular surface and longer recovery. Consequently, there has been renewed interest in the use of elbow arthroscopy to circumvent these problems. Arthroscopic treatment offers the potential advantage of a swift recovery, with instant rehabilitation, less stiffness and swelling than might be expected after open repair. We present the first combined arthroscopic-assisted anteromedial facet coronoid fracture fixation and lateral ulna collateral ligament repair in a varus posteromedial rotatory injury of the elbow.
Sickness certification in Singapore’s public primary healthcare system: A cross-sectional analysis
Authors: Ng David Chee Chin , Lew Yii Jen , Koh Eileen Yi Ling , Nguyen Van Hai , Wong Hwee Bee , James Lyn , Tan Ngiap Chuan
Published: November 2017

Objectives:

Sickness absenteeism has been rising in Singapore with sickness certification commonly performed by primary care physicians. The Primary Care Survey 2014 reported increased primary care demand driven by a rapidly ageing population and the prevalence of chronic disease. This article aims to determine the magnitude of outpatient sickness certification in all the polyclinics in Singapore and identify the demographic characteristics and factors influencing the taking of sick leave by the local multi-ethnic Asian patients.

Design:

A one-week, cross-sectional survey using computer-assisted interviews with age-stratified, systematically sampled patients was conducted at all 18 polyclinics in 2014. Sick leave data was then extracted from each polyclinic’s administrative system. Data was analysed with logistic regression to determine statistically significant factors.

Results:

The sickness certification rate was 22.6% during the study period with a weighted average duration of 1.42 days. Sickness certification was most associated with the younger age group (17–20 years; adjusted odd ratio (AOR) = 9.51), an acute condition (AOR = 24.8) and those living in 1–2 room public housing (AOR = 4.72). Among employees, those working in manufacturing industries had the most association with sickness certification while the finance and insurance industry had the least. An acute upper respiratory tract infection was the most frequent diagnosis for those who obtained medical certificates (38.7%).

Conclusion:

A medical certificate was issued in almost one-quarter of consultations in Singapore polyclinics. Sickness certification was predominated by short-term absence for acute conditions. Characterisation of sickness absenteeism among employees serves as a benchmark for future studies. Mitigation measures were discussed while exclusion of private primary care clinics probably led to an underestimation of the magnitude of sickness certification.
Major adverse cardiovascular event reduction with GLP-1 and SGLT2 agents: evidence and clinical potential
Authors: Røder Michael E.
Published: November 2017

Treatment of patients with type 2 diabetes is directed against treating symptoms of hyperglycemia, minimizing the risk of hypoglycemia, and the risk of microvascular and macrovascular complications. The majority of patients with type 2 diabetes die from cardiovascular or cerebrovascular disease. Future therapies should therefore focus on reducing cardiovascular morbidity in this high-risk population. Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose co-transporter 2 inhibitors (SGLT2-i) are two drug classes with proven antihyperglycemic effect in type 2 diabetes. However, these drugs seem to have other effects such as weight reduction, low risk of hypoglycemia, and blood pressure reduction. Emerging evidence suggests pleiotropic effects, which potentially could be important in reducing cardiovascular risk. Prompted by regulatory authorities demanding cardiovascular outcome trials (CVOTs) assessing the cardiovascular safety of new antihyperglycemic drug candidates, many CVOTs are ongoing and a few of these are finalized. Somewhat surprising recent CVOTs in both drug classes have shown promising data on cardiovascular morbidity and mortality in patients with a very high risk of cardiovascular events. It is uncertain whether this is a class effect of the two drug classes, and it is yet unproven whether long-term cardiovascular benefits of these drugs can be extrapolated to populations at lower risk of cardiovascular disease. The aim of the present review is to give an overview of our current knowledge of the GLP-1RA and SGLT2-i classes, with specific focus on mechanisms of action, effects on cardiovascular risk factors and cardiovascular morbidity and mortality from the CVOTs presently available. The clinical potential of these data is discussed.
‘Listen, Anarchist!’ A personal response to Simon Springer’s ‘Why a radical geography must be anarchist’
Authors: Harvey David
Published: November 2017

This article offers a critical response to Simon Springer’s ‘Why a Radical Geography Must Be Anarchist’. From a Marxist perspective, the autonomist and anarchist tactics and sentiments that have animated a great deal of political activism over the last few years (in movements like ‘Occupy’) have to be appreciated, analyzed, and supported when appropriate. To the degree that anarchists of one sort or another have raised important issues that are all too frequently ignored or dismissed as irrelevant in mainstream Marxism, dialogue—let us call it mutual aid—rather than confrontation between the two traditions is a far more fruitful way to go. Conversely, Marxism, for all its past faults, has a great deal to offer to the anti-capitalist struggle in which many anarchists are also engaged. Judging from his piece, however, Springer would want no part in such a project. He seems mainly bent on polarizing the relation between anarchism and Marxism as if they are mutually exclusive if not hostile. There is, in my view, no point in that. Honest disagreements should not be a barrier to fertile collaborations in anti-capitalist struggles. So the conclusion I reach is this: let radical geography be just that: radical geography, free of any particular ‘ism’, nothing more, nothing less.
The limits to Marx
Authors: Springer Simon
Published: November 2017

Responding to David Harvey’s critique of my article, ‘Why a Radical Geography Must Be Anarchist’, I reiterate the importance of anarchist perspectives in contemporary politics and geographical praxis. In challenging Harvey on the limits to Marx, I urge him to think again about the hidden vanguardism, implied statism, and veiled hierarchy that continue to lurk within the Marxist project, and importantly how these specters constrain both our collective political imagination and the possibilities of radical geography. I am admittedly very critical of Harvey, but I nonetheless refuse to close the door on dialogue between the Black and Red, even in the face of ongoing Marxist ridicule of anarchist politics. Accordingly, I propose an agonistic embrace of a ‘postfraternal’ or ‘postsororal’ politics on the left, where we come to appreciate ongoing conflict as a sign of a healthy leftist milieu. In doing so, we can move beyond the misguided idea that all disagreements over strategies, tactics, and organizing methods will ever be resolved. Ultimately, what I have dubbed ‘the condition of postfraternity’ keeps us alert to the continually unfolding possibilities of a thoroughly politicized and forever protean space. By embracing this shifting horizon, not as a static limit to our politics but as a beautiful enabler of visionary possibilities, the rhizomes of emancipation grow stronger.
The disvalues of alienated capitalist natures
Authors: Sullivan Sian
Published: November 2017

This engagement highlights the antagonism between wealth and the commodity value form posed at the heart of Marx’s work. In doing so, it considers methodological possibilities for both understanding and intervening in the fabricating of new alienated capitalist values from beyond-human natures.
What’s beyond capitalist natures? The view from a camel’s back
Authors: Johnson Leigh
Published: November 2017

The authors’ formulation ‘capitalist natures’ may be too quick to imply that the formal and/or real subsumption of all natures is in the process of being accomplished. I point toward liminal and dynamic cases, such as camels in pastoral production systems, to trouble the mental model of a spatialized ‘outside’ that is either simply colonized by or subsidizing capitalist relations.
Does service timing matter for psychological outcomes in cardiac rehabilitation? Insights from the National Audit of Cardiac Rehabilitation
Authors: Sumner Jennifer , Böhnke Jan R , Doherty Patrick
Published: November 2017

Background

The presence of mental health conditions in cardiac rehabilitation (CR) patients such as anxiety and depression can lead to reduced programme adherence, increased mortality and increased re-occurrence of cardiovascular events undermining the aims and benefit of CR. Earlier research has identified a relationship between delayed commencement of CR and poorer physical activity outcomes. This study wished to explore whether a similar relationship between CR wait time and mental health outcomes can be found and to what degree participation in CR varies by mental health status.

Methods

Data from the UK National Audit of Cardiac Rehabilitation, a dataset that captures information on routine CR practice and patient outcomes, was extracted between 2012 and 2016. Logistic and multinomial regression models were used to explore the relationship between timing of CR and mental health outcomes measured on the hospital anxiety and depression scale.

Results

The results of this study showed participation in CR varied by mental health status, particularly in relation to completion of CR, with a higher proportion of non-completers with symptoms of anxiety (5% higher) and symptoms of depression (8% higher). Regression analyses also revealed that delays to CR commencement significantly impact mental health outcomes post-CR.

Conclusion

In these analyses CR wait time has been shown to predict the outcome of anxiety and depression status to the extent that delays in starting CR are detrimental. Programmes falling outside the 4-week window for commencement of CR following referral must strive to reduce wait times to avoid negative impacts to patient outcome.
Serum levels of Growth Arrest-Specific 6 protein and soluble AXL in patients with ST-segment elevation myocardial infarction
Authors: Caldentey Guillem , García De Frutos Pablo , Cristóbal Helena , Garabito Manel , Berruezo Antonio , Bosch Xavier , San Antonio Rodolfo , Flores-Umanzor Eduardo , Perea Rosario J , De Caralt Teresa M , Rodríguez Jany , Ortiz-Pérez José T
Published: November 2017

Background:

Serum soluble AXL (sAXL) and its ligand, Growth Arrest-Specific 6 protein (GAS6), intervene in tissue repair processes. AXL is increased in end-stage heart failure, but the role of GAS6 and sAXL in ST-segment elevation myocardial infarction (STEMI) is unknown.

Objectives:

To study the association of sAXL and GAS6 acutely and six months following STEMI with heart failure and left ventricular remodelling.

Methods:

GAS6 and sAXL were measured by enzyme-linked immunosorbent assay at one day, seven days and six months in 227 STEMI patients and 20 controls. Contrast-enhanced magnetic resonance was performed during admission and at six months to measure infarct size and left ventricular function.

Results:

GAS6, but not sAXL, levels during admission were significantly lower in STEMI than in controls. AXL increased progressively over time ( p<0.01), while GAS6 increased only from day 7. GAS6 or sAXL did not correlate with brain natriuretic peptide or infarct size. However, patients with heart failure (Killip >1) had higher values of sAXL at day 1 (48.9±11.9 vs. 44.0±10.7 ng/ml; p<0.05) and at six months (63.3±15.4 vs. 55.9±13.7 ng/ml; p<0.05). GAS6 levels were not different among subjects with heart failure or left ventricular remodelling. By multivariate analysis including infarct size, Killip class and sAXL at seven days, only the last two were independent predictors of left ventricular remodelling (odds ratio 2.24 (95% confidence interval: 1.08–4.63) and odds ratio 1.04 (95% confidence interval: 1.00–1.08) respectively).

Conclusion:

sAXL levels increased following STEMI. Patients with heart failure and left ventricular remodelling have higher sAXL levels acutely and at six month follow-up. These findings suggest a potential role of the GAS6–AXL system in the pathophysiology of left ventricular remodelling following STEMI.
New holosystolic murmur after acute myocardial infarction
Authors: Flores-Umanzor Eduardo , Caldentey Guillem , San Antonio Rodolfo
Published: November 2017

In the era of primary percutaneous coronary intervention, mechanical complications after acute myocardial infarction are extremely rare, with an incidence of less than 0.5%. Rupture of the ventricular septum is the least frequent occurrence. Nevertheless, current mortality remains high and a prompt diagnosis and treatment are imperative to increase survival. Despite early surgical repair, mortality still remains high.
Risk stratification of colorectal polyps for predicting residual or recurring adenoma using the Size/Morphology/Site/Access score
Authors: Barosa Rita , Mohammed Noor , Rembacken Bjorn
Published: November 2017

Background and Aims

Endoscopic mucosal resection is an effective and safe procedure to manage large non‐pedunculated colonic polyps for which residual/recurrent adenoma is the main drawback. Size/Morphology/Site/Access score determines polypectomy difficulty. We aimed to describe residual/recurrent adenoma rate according to Size/Morphology/Site/Access and to select the ize/Morphology/Site/Access cut‐off to predict low residual/recurrent adenoma.

Methods

This was a retrospective cohort study of endoscopic mucosal resection for large non‐pedunculated colonic polyps performed in a tertiary centre.

Results

Three hundred and sixteen procedures were included. The mean size of lesions was 34.5 ± 17.1 mm, 59.5% were sessile, 60.4% were in the right colon and in 17.7% (n = 56) the access was difficult. Of the lesions, 83.6% were Size/Morphology/Site/Access 3–4. Residual/recurrent adenoma at first and second follow‐up was significantly lower in Size/Morphology/Site/Access 2 (1.9% and 0.0%, respectively) when compared to Size/Morphology/Site/Access 3 (18.2%, p = 0.004 and 6.7%, p = 0.049) and Size/Morphology/Site/Access 4 (30.8%, p < 0.001 and 22.7%, p = 0.030). The negative predictive value of Size/Morphology/Site/Access 2 for residual/recurrent adenoma at second follow‐up was 86.1%. On multivariate analyses, Size/Morphology/Site/Access 3–4 predicted residual/recurrent adenoma at first (odds ratio 11.96, 95% confidence interval 1.57–91.13) and second follow‐up (odds ratio 2.47, 95% confidence interval 1.51–4.22) and had higher cumulative incidence of residual/recurrent adenoma compared to Size/Morphology/Site/Access 2 (p ≤ 0.003).

Conclusion

Use of the Size/Morphology/Site/Access score allows cases to be identified with a low risk of residual/recurrent adenoma.
Patient-centred outcomes research: perspectives of patient stakeholders
Authors: Chhatre Sumedha , Gallo Joseph J , Wittink Marsha , Schwartz J Sanford , Jayadevappa Ravishankar
Published: November 2017

Objective

To elicit patient stakeholders’ experience and perspectives about patient-centred care.

Design

Qualitative.

Setting

A large urban healthcare system.

Participants

Four patient stakeholders who are prostate cancer survivors.

Main outcome measures

Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions.

Results

Our patient stakeholders represented a diverse socio-demographic group. The patient stakeholders identified engagement and dialogue with physicians as crucial elements of patient-centred care model. The degree of patient-centred care was observed to be dependent on the situations. High severity conditions warranted a higher level of patient involvement, compared to mild conditions. They agreed that patient-centred care should not mean that patients can demand inappropriate treatments.

Conclusions

An important attribute of patient-centred outcomes research model is the involvement of stakeholders. However, we have limited knowledge about the experience of patient stakeholders in patient-centred outcomes research. Our study indicates that patient stakeholders offer a unique perspective as researchers and policy-makers aim to precisely define patient-centred research and care.