bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined spinal and general anaesthesia in 58 cats undergoing various surgical procedures: description of technique and retrospective perioperative evaluation
Authors: Sarotti Diego , Cattai Andrea , Franci Paolo
Published: December 2018

Objectives

The aim of this retrospective study was to describe the spinal anaesthesia (SA) technique and evaluate the incidence of perioperative complications in cats.

Methods

The anaesthetic records of cats of American Society of Anaesthesiologists physical status I, II and III, which received general and SA for different surgeries between 2012 and 2016, were examined. SA was administered through a 25 G Quincke needle, using an isobaric solution of bupivacaine and morphine at the level of either the L7–S1 interspaces (sternal recumbency) or the L5–6/L6–7 interspaces (lateral recumbency). Procedural failure rate (PFR), drugs and dose used, heart rate (HR), arterial blood pressure, incidence of bradycardia (HR <100 bpm) and hypotension (mean arterial pressure [MAP] <60 mmHg for at least 5 mins), intraoperative rescue analgesia (iRA) and any other detrimental events and their treatment until discharge were recorded. Abdominal surgery cases were excluded from the intraoperative evaluation.

Results

A total of 58 anaesthetic records met the inclusion criteria and were analysed. PFR related to the space of injection (L7–S1 vs L5–6/L6–7) was 3/11 (27%) and 1/47 (2%), respectively ( P = 0.017). The total median dose of intrathecal bupivacaine and morphine was 0.8 (range 0.5–1.6 mg/kg) and 0.10 (0.05–0.18 mg/kg), respectively. Nine of 46 (20%) cats received iRA, and no iRA cases were reported with a dose of bupivacaine higher than 0.8 mg/kg. Median HR and MAP before intrathecal injection (T0) and 10 mins after (T1) were, respectively, 118 bpm (range 74–190 bpm) and 106 bpm (67–160 bpm) ( P = 0.005), and 65 mmHg (range 50–94 mmHg) and 52 mmHg (range 35–85 mmHg) ( P = 0.003). Bradycardia was reported in 18/46 (39%) cats and hypotension in 23/46 (50%) cats. No complications were recorded during the observation period.

Conclusions and relevance

SA was characterised by a low PFR when performed at the L5–6/L6–7 interspaces and low postoperative complications. Hypotension and bradycardia were the most common side effects.
Rotatory Dislocation of the Spine in Dystrophic Kyphoscoliosis Secondary to Neurofibromatosis Type 1
Authors: Tsirikos Athanasios I , Dhokia Rakesh , Wordie Sarah
Published: December 2018

Aim of the study:

Neurofibromatosis type 1 (NF-1) is associated with the development of scoliosis or kyphoscoliosis. The deformity is rapidly progressive in the presence of dystrophic changes producing bone erosion. Vertebral subluxation or dislocation can occur in children with highly dystrophic kyphoscoliosis and carries an increased risk of paralysis. There is no standardised treatment for this extreme deformity with very few patients currently reported in the literature.

Methods:

Retrospective review of a patient with NF-1 who developed a dystrophic upper thoracic kyphoscoliosis with segmental displacement of T2 on T3.

Results:

We report a patient with NF-1 who presented at 8.9 years with a progressive upper thoracic kyphoscoliosis. At 18.8 years, the deformity had deteriorated to scoliosis 65° and kyphosis 78° with fixed segmental rotatory dislocation at T2-T3. He underwent posterior cervico-thoracic fusion with concave pedicle screw/hook/rod instrumentation and iliac crest bone. Minimum correction was achieved due to curve rigidity and inability to reduce the T2/T3 displacement by halo-femoral traction. At 7 months, an elective posterior re-grafting procedure was performed followed by anterior fusion with rib strut grafts between T2-T6 through a midline sternotomy. The patient is now 3.5 years after anterior surgery and remains neurologically intact with stable residual deformity and computed tomographic evidence of circumferential fusion. He has no back pain and resumed non-contact physical activities.

Conclusions:

Patients with NF-1 can develop dystrophic kyphoscoliosis with segmental spinal subluxation/dislocation. Circumferential fusion is a technically challenging procedure which often requires a multi-disciplinary surgical team but produces satisfactory clinical outcome preventing paraplegia.
Dalfampridine benefits ambulation but not cognition in multiple sclerosis
Authors: Satchidanand Nikhil , Drake Allison , Smerbeck A , Hojnacki David , Kolb Channa , Patrick Kara , Weinstock-Guttman Bianca , Motl Robert , Benedict Ralph HB
Published: December 2018

Background:

Impaired cognition and ambulation are common in multiple sclerosis (MS). Dalfampridine is the first Food and Drug Administration (FDA)–approved medication to treat impaired ambulation in MS. Dalfampridine may benefit patients with cognitive impairment, given its effects on saltatory conduction and the association between cognitive and motor function.

Objective:

To examine the effects of dalfampridine on cognition in MS. To determine if the anticipated improved cognition is grounded in dalfampridine’s effects on ambulation.

Methods:

Adults with MS were randomized to dalfampridine ( n = 45) or placebo ( n = 16) for 12 weeks. Cognition and motor function were assessed at baseline and end-point.

Results:

T25FW and 6-minute walk (6MW) performance improved at end-point in the treatment group but not in the placebo group ( p < 0.05). Our primary outcome, performance on the Symbol Digit Modalities Test, did not improve. About 30% ( n = 12) of the dalfampridine group demonstrated ⩾20% improved ambulation and were categorized “responders.” Among “responders”, Symbol Digit Modalities test performance did not improve. However, performance on the Paced Auditory Serial Addition Test improved among “responders” ( p < 0.05).

Conclusion:

Dalfampridine benefits timed ambulation but not cognition. Some improvement among ambulation “responders” is consistent with prior reports of cognition-motor coupling in MS ( ClinicalTrials.gov #: NCT02006160).
‘ASMR’ autobiographies and the (life-)writing of digital subjectivity
Authors: Gallagher Rob
Published: December 2018

For years now, a growing online subculture has been exchanging videos designed to induce ‘autonomous sensory meridian response’ (ASMR), a mysterious, blissfully relaxing tingling sensation held to alleviate anxiety, pain, insomnia and depression. Emerging from online health forums, ASMR culture today centres on YouTube, where ‘ASMRtists’ have used the feedback mechanisms built into social media platforms to refine a repertoire of ‘trigger’ techniques. Exemplifying a wider trend for using ‘ambient media’ as mood modulators and task facilitators (Roquet, 2016 Ambient Media: Japanese Atmospheres of Self. London: University of Minnesota Press.), ASMR culture’s use of the word ‘trigger’ is telling, gesturing towards what Halberstam ((2014) You Are Triggering Me! The Neo-Liberal Rhetoric of Harm, Danger and Trauma. Bully Bloggers. Available at: https://bullybloggers.wordpress.com/2014/07/05/you-are-triggering-me-the-neo-liberal-rhetoric-of-harm-danger-and-trauma/ (accessed 8 August 2018)) sees as a shift away from the Freudian notion of ‘memory as a palimpsest’ towards one of memory as ‘a live wire sitting in the psyche waiting for a spark’, whereby digital subjects become black-boxed nodes in a cybernetic circuit. This shift has serious implications for the humanities and is particularly resonant for scholars of life-writing. As McNeill ((2012) There is no “I” in network: Social networks sites and posthuman auto/biography. Biography 35(1): 65–82.) argues, digital technologies ‘complicate[] definitions of the self and its boundaries, both dismantling and sustaining the humanist subject in practices of personal narrative’ (p. 65). The resulting friction is highlighted in ‘ASMR autobiographies’: texts narrating the author’s experiences of ASMR and their discovery of online ASMR communities. Echoing familiar auto/biographical forms, from medical case histories and coming out narratives to tales of religious conversion, these texts show that the models of subjectivity we have inherited from Enlightenment philosophy, religion, psychology and Romantic literature retain some cultural purchase. But they also suggest digital media are fostering new understandings of personhood informed by cybernetics, evolutionary psychology, behaviourism and neuroscience. Focusing on works by Andrew MacMuiris, Andrea Seigel and Jon Kersey while also addressing a range of other texts, this article asks what ASMR autobiographies can tell us about digital subjectivity.
Anxiety from the perspective of modernity: An empirical study based on the Chinese General Social Survey of 2005–2013
Authors: Jiang Junfeng
Published: December 2018

Based on the Chinese General Social Survey of 2005–2013, with a sample of 41,242 people, this study carried out a hierarchical age–period–cohort cross-classified random-effects model on anxiety scores. The results indicated a U-shaped relationship between age and anxiety with increased anxiety from young to the middle age and a decline in the old. Population disparities showed cumulative advantage/disadvantage and age-as-leveler effects in different groups. Anxiety declined in earlier cohorts but emerged as a rising trend in more recent cohorts born in peaceful social contexts. Anxiety resulting from modernity is distinct in different social and historical environments.
Hydrodynamic characteristics of the multi-level overtopping wave power device
Authors: Wan Zhanhong , Yao Zhongzhi , Song Tianyu , Chen Jiawang
Published: December 2018

The geometrical model was built by the computer-aided design software and imported into STAR-CCM+. Typical wave conditions in the East China Sea were used in computational fluid dynamics simulation. By observing overtopping process and recording water discharge, the relationship between wave conditions and overtopping process was obtained. Finally, the simulation was validated by comparing the theoretical and experimental results. Furthermore, an empirical model was developed to predict the water discharge.
Influence of flexoelectric, small-scale, surface and residual stress on the nonlinear vibration of sigmoid, exponential and power-law FG Timoshenko nano-beams
Authors: Arefi Mohammad , Pourjamshidian Mahmoud , Ghorbanpour Arani Ali , Rabczuk Timon
Published: December 2018

This research deals with the nonlinear vibration of the functionally graded nano-beams based on the nonlocal elasticity theory considering surface and flexoelectric effects. The flexoelectric functionally graded nano-beam is resting on nonlinear Pasternak foundation. Cubic nonlinearity is assumed for foundation. It is assumed that the material properties of the nano-beam change continuously along the thickness direction according to different patterns of material distribution. In order to include coupling of strain gradients and electrical polarizations in equation of motion, the nonlocal, nonclassical nano-beam model containing flexoelectric effect is employed. In addition, the effects of surface elasticity, di-electricity, and piezoelectricity as well as bulk flexoelectricity are accounted in constitutive relations. The governing equations of motion are derived using Hamilton principle based on first shear deformation beam theory and the nonlocal strain gradient elasticity theory considering residual surface stresses. The differential quadrature method is used to calculate nonlinear natural frequency of flexoelectric functionally graded nano-beam as well as nonlinear vibrational mode shape. After validation of the present numerical results with those results available in literature, full numerical results are presented to investigate the influence of important parameters such as flexoelectric coefficients of the surface and bulk, residual surface stresses, nonlocal parameter, length scale effects (strain gradient parameter), cubic nonlinear Winkler and shear coefficients, power gradient index of functionally graded material, and geometric dimensions on the nonlinear vibration behaviors of flexoelectric functionally graded nano-beam. The numerical results indicate that, considering the flexoelectricity leads to the decrease of the bending stiffness of the flexoelectric functionally graded nano-beams.
The spring load adjustment method for six-axle high-power locomotives
Authors: Xiao Yu-Qi , Pan Di-Fu
Published: December 2018

The stability and comfort of locomotives need to be guaranteed by load adjustment technology. Considering the defects of the traditional two-step adjustment method for locomotive load distribution, including its lack of efficiency and error accumulation, a new technical approach is developed here under entire locomotive conditions, simulating the load adjustment test via the application of shimming under the treads. In the case of high-power locomotives, a complete theoretical model is established based on the classical two-suspension model. According to the difference between shimming on the treads and on primary suspension positions, a transformation matrix is established with which to describe the conversion relationship between the shim quantity on the primary supporting positions and on the treads. Considering that locomotive load regulation is a nonlinear problem characterised by nonlinearity, parametric uncertainty and multiple optimisation objectives, this paper proposes QAGA, an optimisation algorithm for entire locomotive load adjustment based on an adaptive genetic algorithm and a quantum-behaved particle swarm optimisation algorithm, to carry out simulations using data from an HXD1D-type electric locomotive. Analysis of the simulation results proves that the proposed approach can significantly improve the efficiency, accuracy and feasibility of the entire locomotive load adjustment process.
Development of a new visualization technique using photochromism for transport process of lubricating oil around the engine piston
Authors: Azetsu Akihiko , Kitajima Ikkei , Kuratsuji Kazaki
Published: December 2018

This study proposes and experimentally validates a new method for the visualization of oil film flow. A photochromic dye is dissolved in the oil and an arbitrary spot of an oil film is illuminated with ultraviolet light, which makes a marker in the oil film via a photochromic reaction. The basic principle of the photochromic reaction and its application to flow visualization are described. The color density of the colored solution is quantified based on the absorbance calculated from images taken before and after coloring. The results confirm that the color density is proportional to the oil film thickness. The color density changes sufficiently slowly at room temperature to make it suitable as a marker for flow visualization. The characteristics of the coloring and fading reactions are examined. The results confirm that increase in the energy density of the ultraviolet light effectively increases the color density and that the optimal energy density of the ultraviolet light can be determined from a model formula for the coloring reaction. The color fading reaction at different temperatures is measured, and the temperature dependence of a solution of spiropyran and ester oil is quantified using an Arrhenius plot. Flow visualization is conducted in a 10- μm-thick flow channel with a complex shape. The test oil flowing through this channel is colored by the focused third harmonic of an Nd:YAG laser, and the flow velocity distribution is visualized using the proposed method. Finally, for experimental validation, the proposed method is used to visualize the movement of an oil film on the piston land of an optical engine. The proposed technique can be applied to investigate the dominant route of oil consumption and the physics involved.
Large eddy simulations of diesel-fuel injection and auto-ignition at transcritical conditions
Authors: Ihme Matthias , Ma Peter C , Bravo Luis
Published: December 2018

Large eddy simulations of transcritical injection and auto-ignition of n-dodecane in a combustion chamber are performed. To this end, a diffuse-interface method is employed that solves the compressible multi-species conservation equations, and a cubic state equation together with real-fluid transport properties is employed to describe the transcritical fluid state. The reaction chemistry is represented by a finite-rate chemistry model involving a 33-species reduced mechanism for n-dodecane. Compared to commonly employed two-phase approaches, the method presented in this work does not introduce tunable parameters for spray-breakup. Large eddy simulation calculations are performed by considering the Spray A single-hole injector at non-reacting and reacting conditions at a pressure of 60 bar and temperatures between 800 and 1200 K. Quantitative comparisons with measurements for liquid and vapor penetration lengths are performed for non-reacting conditions, and sensitivity to threshold values on mixture fraction are examined. The analysis of reacting flow simulations focuses on comparisons of the instantaneous temperature and species fields for OH and CH2O at 800 and 900 K, respectively. Quantitative comparisons with measurements for ignition delay and lift-off heights as a function of ambient temperature are performed. To examine the transient ignition phase, comparisons of radially integrated OH profiles obtained from the simulations with reported measurements for OH* are performed, showing good agreement. These results show that the large eddy simulation modeling framework adequately reproduces the corresponding ignition processes, which are relevant to realistic diesel-fuel injection systems.
Degenerative aortic valve disease and diabetes: Implications for a link between proteoglycans and diabetic disorders in the aortic valve
Authors: Barth Mareike , Selig Jessica I , Klose Svenja , Schomakers Antje , Kiene Lena S , Raschke Silja , Boeken Udo , Akhyari Payam , Fischer Jens W , Lichtenberg Artur
Published: December 2018

Degenerative aortic valve disease in combination with diabetes is an increasing burden worldwide. There is growing evidence that particularly small leucine-rich proteoglycans are involved in the development of degenerative aortic valve disease. Nevertheless, the role of these molecules in this disease in the course of diabetes has not been elucidated in detail and previous studies remain controversial. Therefore, the aim of this study is to broaden the knowledge about small leucine-rich proteoglycans in degenerative aortic valve disease and the influence of diabetes and hyperglycaemia on aortic valves and valvular interstitial cells is examined. Analyses were performed using reverse-transcription polymerase chain reaction, Western blot, enzyme-linked immunosorbent assay, (immuno)histology and colorimetric assays. We could show that biglycan, but not decorin and lumican, is upregulated in degenerated human aortic valve cusps. Subgroup analysis reveals that upregulation of biglycan is stage-dependent. In vivo, loss of biglycan leads to stage-dependent calcification and also to migratory effects on interstitial cells within the extracellular matrix. In late stages of degenerative aortic valve disease, diabetes increases the expression of biglycan in aortic valves. In vitro, the combinations of hyperglycaemic with pro-degenerative conditions lead to an upregulation of biglycan. In conclusion, biglycan represents a potential link between degenerative aortic valve disease and diabetes.
Correct use and ease of use of a placebo dry powder inhaler in subjects with asthma and chronic obstructive pulmonary disease
Authors: Feldman Gregory J , Galkin Dmitry V , Patel Pinal , Collison Kathryn A , Sharma Raj
Published: December 2018

Correct use and ease of use of a placebo dry powder inhaler was evaluated in two single-arm, United States-multicenter, phase-IV studies in adults with asthma ( n = 259) or chronic obstructive pulmonary disease (COPD; n = 278) who were receiving maintenance inhaler therapy. Subjects demonstrating correct placebo inhaler use within three attempts at screening were instructed to take once-daily inhalations from the inhaler for 28 ± 2 days (continuing usual maintenance), followed by randomization to complete one of two versions of an ease-of-use questionnaire and reassessment for correct inhaler use. At study end, 96% asthma/93% COPD subjects rated the placebo inhaler as “easy” or “very easy” to use while demonstrating correct use. Furthermore, 99% asthma/99% COPD subjects indicated it was “easy” or “very easy” to determine number of doses remaining, and 81%/84%, respectively, indicated they would be “likely” or “very likely” to request their current medication in the inhaler, if available. Adverse event (AE) rates were 12% asthma/15% COPD, most frequently headache (3%/3%). Treatment-related AEs were reported in one subject with asthma (cough) and four subjects with COPD (cough, n = 3; back pain, n = 1). At study end, most subjects with asthma or COPD operated the placebo inhaler correctly and found it easy to use.
Disability Studies and Inclusive Teacher Preparation: A Socially Just Path for Teacher Education
Authors: Ashby Christine
Published: December 2018

This article explores the benefits and challenges of operating an inclusive elementary and special education teacher preparation program within a disability studies framework. How does such a program balance issues of theory and practice? How does it provide students with a critical approach that essentially views disability as a social and cultural category much like race and gender, with a practical approach that attempts to address, remediate or eliminate those conditions that are considered disabling? How is it possible to become a successful professional with a disability studies perspective within a field such as special education that is traditionally based around a deficit model? The article provides recommendations for how such questions might be addressed in teacher education.
A National Study of Community Living: Impact of Type of Residence and Hours of In-Home Support
Authors: Kim Rah Kyung , Dymond Stacy K.
Published: December 2018

This study investigated the frequency of community participation and level of assistance needed to perform domestic and safety skills for individuals with severe disabilities who live successfully in the community, based on type of residence and hours of in-home support provided. Participants included residential specialists from small community residences (i.e., eight or less residents) in 26 states who had experience delivering residential services to adults with intellectual and developmental disabilities. Surveys were mailed to 1,000 residential specialists using a random proportional stratified sampling procedure; 280 completed surveys were used for data analysis. Residential specialists who work at supported apartments indicated that individuals with severe disabilities needed less assistance performing domestic and safety skills and participated more frequently in community activities than residential specialists who worked at group homes Residential specialists who provided less than 20 hours of in-home support per week also indicated individuals with severe disabilities needed less assistance performing domestic and safety skills and participated more frequently in community activities than residential specialists who provided 20 hours or more of in-home support. The findings suggest that the philosophy of supported living has not been fully realized. Flexible systems must be developed for individuals with severe disabilities that respond to their changing needs and preferences
Factors affecting the concordance of radiologic and pathologic tumor size in breast carcinoma
Authors: Hamza Ameer , Khawar Sidrah , Sakhi Ramen , Alrajjal Ahmed , Miller Shelby , Ibrar Warda , Edens Jacob , Salehi Sajad , Ockner Daniel
Published: December 2018

Background

Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/clinical staging is.

Materials and methods

The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within ±2 mm.

Results

The difference between radiologic and pathologic tumor size was within ±2 mm in 40.4% cases. The mean radiologic size was 1.73 ± 1.06 cm. The mean pathologic size was 1.84 ± 1.24 cm. A paired t-test showed a significant mean difference between radiologic and pathologic measurements (0.12 ± 1.03 cm, p = 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors ≤2 cm (pT1) (51.1%) as compared to those greater than 2 cm (≥pT2) (19.7%) ( p < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) ( p < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors ( p = 0.02).

Conclusion

Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate.
Sex/gender bias in the management of chest pain in ambulatory care
Authors: Clerc Liaudat Christelle , Vaucher Paul , De Francesco Tommaso , Jaunin-Stalder Nicole , Herzig Lilli , Verdon François , Favrat Bernard , Locatelli Isabella , Clair Carole
Published: December 2018

Objective:

Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care.

Setting:

We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland.

Participants:

In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women.

Main outcome measures:

The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months.

Results:

The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs 14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women (16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52–4.09). After adjustment for the patients’ age and cardiovascular disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30–3.78).

Conclusion:

Although the same proportion of women and men present with a chest pain of cardiovascular origin in ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure equity between men and women in medical care.
The power of the pen: Prisoners’ letters to explore extreme imprisonment
Authors: Vannier Marion
Published: December 2018

This article examines how we might best examine the most extreme and inaccessible corners of imprisonment. Drawing on a study of life imprisonment without parole (LWOP) in California, this article argues that prisoners’ letters can shed exceptional light on the hidden and unspoken experiences of imprisonment. It provides an in-depth methodological and reflective outline of how to use prisoners’ letters, a familiar tactic in prison researchers’ and advocates’ toolkits, but a research implement that is rarely discussed explicitly. By better understanding how to do prison research with letters and the emotions these might provoke in the process, this article demonstrates the very specific and distinct value of the method, in particular how letters can contribute to knowledge about extreme penal severity.
Optimisation of perioperative investigations among elective orthopaedic patients in a Dublin-based teaching hospital
Authors: O’Sullivan Jane , Collins Jack , Cooper David , Magdalina Ana , Meehan Frances , Kumar Lachmann , Quinlan John , O’Connor Donal , Fitzpatrick Gerry
Published: December 2018

Background

The current National Institute for Health and Care Excellence guidelines, in accordance with the Association of Anaesthetists of Great Britain and Ireland guidelines, recommend the following haematological investigations for all patients undergoing major elective surgery: full blood count, renal profile and coagulation screen if clinically indicated. However, the guidelines fail to specify a time-interval for which normal blood results remain valid. Currently all patients in Ireland undergoing substantial elective surgery requiring general or regional anaesthetic have a preoperative assessment prior to the surgery. Patients have phlebotomy performed as part of this assessment. Patients admitted for elective surgery often have these bloods repeated on the morning of surgery.

Objectives

To determine if blood investigations taken over a one-year period prior to surgery can be used as a baseline for clinically stable patients undergoing elective surgery.

Study design and methods

All consecutive day of surgery admission patients >18 years of age undergoing elective orthopaedic surgery in Tallaght Hospital between 1 December 2014 and 1 December 2015 were identified using hospital records. Their blood results in the one-year period prior to surgery were compared to the blood results on the morning of surgery, using a McNemar’s test. A further clinical analysis was performed.

Results

There was no statistically significant change between blood results from three months prior to the surgery and the morning of surgery (P < 0.05). Furthermore, the blood results remained largely unchanged in the one year prior to surgery. No patient had the operation deferred due to aberrant blood results, following previously normal results prior to surgery. The potential cost-saving of omitting bloods is enormous.

Conclusions

There appears to be neither a statistical nor clinical benefit to repeating blood tests on the morning of surgery, following normal bloods <3 months in a clinically stable individual.
The introduction of play specialists as operating department escorts for children
Authors: Horton Smith Lorraine
Published: December 2018

Attending theatre for a surgical procedure can be a very stressful time for both children and their parents and guardians, with ward staff accompanying patients to the operating department to provide support. A local Trust proposed a change from the deployment of registered nurses to the utilisation of play specialists as escorts for children on their journey to theatre and during the induction of anaesthesia to improve patient experience, levels of registered staff remaining on the children’s ward and theatre efficiency. It was found that in children who had not received premedication, this substitution can be completed successfully, providing that the play specialists receive sufficient training to carry out this role effectively.
Ulnar nerve transposition in the hand: a cadaveric study
Authors: Beldner Steven , Rabinovich Remy V. , Polatsch Daniel B. , Gonzalez Derek M.
Published: December 2018

Primary repair of a nerve is preferable over nerve grafting when a tension-free environment can be achieved. The purpose of this cadaveric study was to evaluate the facility of nerve-gap closure gained by removing the hamate hook, eliminating the circuitous path of the motor branch of the ulnar nerve in the hand. Six cadaveric specimens were dissected and the length of the motor branch coursing through Guyon’s canal before and after hamate hook excision and nerve transposition was recorded. Average length was significantly shorter in specimens after transposition, with a mean 21% reduction relative to the nerve’s original course. This knowledge may help guide surgeons on whether excision of the hamate hook will allow for primary repair of the nerve when a segmental defect or retraction and scarring of the nerve stumps is encountered.
Gambling addiction
Authors: Moran Laura , Bradbury Emma , Mills Jonathan
Published: December 2018

Addictive behavioural problems bear resemblance to alcohol and substance misuse, although no drug is consumed. Compulsive gambling can leave an individual and their friends and family in serious debt, along with significant detriment to their health and emotional wellbeing, and there is an increased risk of suicide. Gambling problems are more common in younger adult males and those with insecure finances and employment. It is also associated with violence and recognising it can lead to improved treatment and support for those affected.
“Was the Infant Born Alive?” A Review of Postmortem Techniques Used to Determine Live Birth In Cases of Suspected Neonaticide
Authors: Phillips Bianca , Ong Beng Beng
Published: December 2018

The question of whether an infant was born alive has received much attention in the forensic literature. The volume of literature reflects the degree of controversy surrounding the techniques employed and their varied interpretation and utility. The majority of the investigation has been focused on the question “Has the infant breathed?” to determine if an infant was born alive by utilizing techniques that assess aeration of the lungs. However, caution must be employed when interpreting these techniques due to the well-recognized limitations in their interpretation, particularly in the presence of gaseous decomposition and/or resuscitation efforts. Although in some instances there may be irrefutable evidence that the infant was born alive, there is no single finding that can reliably be utilized to answer the question “Was the infant born alive?” in every case. Hence, the approach to postmortem investigation continues to include a wide range of observations, dissections, special techniques, and ancillary tests to assist the pathologist to form a considered opinion. There are a number of more recently described techniques which show great promise in assisting to answer this question including advanced imaging and immunohistochemical studies of the umbilical cord. It remains, though, that in many cases it is not possible to definitively answer this question and stillbirth should be assumed due to the potential legal implications of determining that an infant was born alive.
Accidental Finding of Atherosclerosis with 90% Stenosis of the Coronary Artery In a 17-Year-Old White Male
Authors: Bao Connie , Dilks Lindsay C. , Flessner Richard , Bao Shiping
Published: December 2018

Atherosclerotic cardiovascular disease is the leading cause of death in the United States, though no case reports of teenage deaths due to the disease were found after extensive literary research. A case is presented of a 17-year-old male driver involved in a motor vehicle collision.

Autopsy examination revealed multiple blunt force injuries. Approximately 3 mm of the middle portion of the left anterior descending coronary artery displayed about 90% atherosclerotic stenosis. It was determined that the cause of death was ventricular fibrillation due to atherosclerotic cardiovascular disease. The consultation with the parents and possible finding of hypercholesterolemia are discussed in the report.
Interdependence and Reciprocity: Partnership Ethos at the University of Denver
Authors: Korach Susan , Anderson Erin , Hesbol Kristina , Tabron Lolita , Candelarie Doris , Kipp Patty , Miller-Brown Ellen
Published: December 2018

Research indicates that preparation programs featuring partnerships between universities and districts have a greater impact on career advancement of graduates than more conventional university-based programs. The University of Denver’s (DU) Ritchie Program for School Leaders has been identified as a “model” of university–district collaboration. This partnership program between DU and Denver Public Schools to develop transformative and courageous leaders launched a partnership ethos that defines the Educational Leadership and Policy Studies (ELPS) department. Since that time, ELPS partnerships have expanded and evolved. In this article, we share the complex and dynamic nature of ELPS’ partnership ethos.
Hematological profiling of tuberculosis-infected and co-morbid patients: A study carried out in central Punjab, Pakistan
Authors: Javed Irum , Javed Muhammad Tariq , Mahmood Zahed , Riaz Muhammad , Iqbal Riffat , Rasul Akhtar
Published: December 2018

Tuberculosis (TB) caused by Mycobacterium tuberculosis (MTB) is a chronic bacterial infection affecting many organs of the body particularly the lungs. Another organ seriously affected by TB is the hematopoietic system. TB patients co-infected with other disorders are more prone to death than TB alone. This study was aimed to investigate the variations in hematological profile of pulmonary tuberculosis (PTB) patients co-infected with chronic infectious and metabolic disorders. The study population (n = 366) include PTB patients (positive control) and PTB patients co-infected with hepatitis C virus (HCV) infection, human immunodeficiency virus (HIV) infection, diabetes, and myocardial infarction (MI). Healthy individuals (n = 95) were also included as normal control. All the study subjects were screened for PTB, diabetes, HCV infection, MI, and HIV infection. Polymerase chain reaction (PCR) was performed to confirm MTB infection at molecular level. Among 366 Ziehl–Neelsen positive cases, 258 (70.5%) were confirmed PTB positive by PCR. Among them, 36.8% were infected with PTB only, while 24% were co-morbid with diabetes, 17.8% co-infected with HCV, 11.2% with diabetes and HCV, 4.2% with HIV, 2.3% with both HCV and HIV, and 3.4% co-morbid with MI. Significant ( P < 0.01) variations were observed in hematological profile of different study groups. The study concluded that significant increase in PTB patients co-infected with HCV, HIV, diabetes, and MI suggests the investigation of co-morbidities to rule out PTB co-infection with infectious and metabolic disorders before the start of anti-TB drug therapy.
Effect of antihypertensive agents ACEI/ARB and CCB on hypertensive intracerebral hemorrhage and inflammatory cytokines, serum ferritin, and serum P
Authors: Li Peiyu , Yang Hui , Bi Sheng , Wu Chengji
Published: December 2018

The aim of this study was to investigate the effect of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and calcium channel blocker (CCB) antihypertensive drugs on the treatment of hypertensive intracerebral hemorrhage (ICH) and on the expression level of inflammatory factors, serum ferritin (SF), and serum substance P (SP). A total of 160 patients with hypertensive ICH were divided into three groups according to the type of antihypertensive drugs taken before cerebral hemorrhage: group A (40 cases, taking ACEI/ARB antihypertensive drugs before cerebral hemorrhage), group B (40 cases, CCB antihypertensive drugs were regularly taken before the onset of cerebral hemorrhage), and C group (80 cases, nor any antihypertensive drugs were regularly taken before the onset of cerebral hemorrhage). Patients in group C were further divided into two groups: group D (40 cases, ARB antihypertensive drugs were regularly taken after cerebral hemorrhage) and group E (40 cases, CCB antihypertensive drugs were regularly taken after cerebral hemorrhage). On the third day, after the onset of disease, the level of serum interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, SF, and SP in all the patients was detected. At the same time, the brain computed tomography (CT) was used to evaluate the cerebral edema. On the first day and the thirty day after the onset of disease, the patient’s neurological deficit status was assessed according to the National Institutes of Health Stroke Scale (NIHSS) score. On the third day after onset, the levels of IL-1β, IL-6, TNF-α, SF, and the volume of cerebral edema in group A and group B were significantly lower than those in group C ( P < 0.05). The level of serum SP in group A and group B was significantly higher than that in group C ( P < 0.05). However, there was no significant difference between group A and group B ( P > 0.05). On the third day after onset, the mortality of each group is of no significant difference ( P > 0.05). However, NIHSS scores in group A and group B were significantly lower than those in group C ( P < 0.05). There was no statistical difference in NIHSS scores between group A and group B ( P > 0.05). In conclusion, in the early stage of hypertensive ICH, early normative use of ACEI/ARB or CCB antihypertensive drugs can improve the prognosis of patients, whose mechanism may be related to the improvement of level of serum inflammatory factors and SP and SF.
A multimodal approach to the treatment of extensive burn scars: a modified subcision technique for intralesional delivery of corticosteroid and 5-fluorouracil in combination with several procedural laser therapies; a case report
Authors: Erickson Taylor , Gray Jayla , Tayebi Bailey , Tung Rebecca
Published: December 2018

Introduction:

Hypertrophic scars and keloids are challenging to manage due to recurrence and often sub-optimal response to treatment. There is a lack of both definitive treatment standards and randomised controlled trials comparing therapeutic options. While a wide array of procedures has been utilised to improve traumatic burn scars, such interventions have been used with varying degrees of success. Some reported methods include intralesional injections of anti-inflammatory and anti-mitotic medications, laser-based therapy, topical therapies, cryotherapy, silicone gel sheeting, pressure therapy, radiotherapy and reconstructive surgery.

Case:

We report a case of extensive traumatic burn scarring on the head and neck successfully treated with a multimodal approach comprised of an infrequently used modified subcision technique to deliver alternating intralesional injections of anti-inflammatory (high-dose steroid) and anti-metabolite (5-flurouracil) concurrently with a series of laser (epilatory, vascular and fractional) treatments.

Methods:

Our treatment modality utilised a subcisional technique to deliver intralesional steroid and anti-metabolite medications directly into scar tissue to downregulate inflammation and inhibit collagen synthesis. Alexandrite, fractional and pulsed dye laser therapy was employed to improve skin texture, reduce dyschromia and reduce tissue burden of hypertrophic scar and keloid tissue, resulting in improved mobility and skin elasticity.

Conclusion:

Our case supports a combined medical and procedural, subcisional, approach to successfully treat a patient with extensive hypertrophic scarring and keloid formation with associated hair entrapment after a head and neck burn.
Analysis of the Effect of Working Capital Management on Profitability of the Firm: Evidence from Indian Steel Industry
Authors: Paul Pinku , Mitra Paroma
Published: December 2018

Working capital is one of the important measures of a firm’s efficiency and represents the total liquid assets available with a firm. It reflects a firms’ ability to meet day-to-day operating expenses and also acts as an indicator of a firm’s short-term financial health. So a firm has to plan the effective utilisation of its working capital in order to maintain equilibrium between liquidity and profitability of the business. Therefore, the present article tries to examine the impact of working capital management on profitability of the firms of Indian steel industry. The study has taken into consideration four independent variables, that is, Current ratio, Quick ratio, Debtors turnover ratio and Finished goods turnover ratio which act as the indicators of working capital use in the industry. Return on total assets represents the profitability of the industry and acts as a dependent variable to develop an empirical model in order to establish relationship between working capital management and profitability of the steel industry in India by using panel data regression. The period of study is 17 years, that is, 2000–2016. The result of the study indicates that the impact of working capital management on profitability of the firms of Indian steel industry has been significant.
Student-Teacher Race Congruence: New Evidence and Insight From Tennessee
Authors: Joshi Ela , Doan Sy , Springer Matthew G.
Published: December 2018

Our work aims to substantiate and extend earlier findings on the effects of student-teacher race matching on academic achievement using longitudinal data for students in Grades 3 through 8 in Tennessee. We examine heterogenous effects not only by racial subgroup and student preparedness, as explored in prior literature, but also by levels of teacher effectiveness, drawing on data from the state’s teacher evaluation system. We find that student-teacher race congruence does not have a significant overall effect on test scores. However, subgroup analyses reveal a positive, significant race-match effect in elementary school math. We observe meaningful effects for Black students in both reading and math, race-matched students in the bottom-most preparedness quartile in math, and race-matched students assigned to teachers in the middle two teacher performance quartiles in math. Our results align with prior findings, emphasizing that race-match effects transcend state borders. Findings support policy efforts to diversify the educator labor force.
Signs of a Future Transformation in Mission
Authors: Motte Mary
Published: December 2018

In his gestures, choices, and words Pope Francis offers a new path for missionary transformation. This new path is rooted in his recognition that he is a sinner and in need of the mercy of God. From this space of lowliness he invites all Christians to recognize their calling as missionary disciples in a time of ongoing missionary conversion. He recognizes the necessity of ecumenical and interreligious collaboration in discovering a way to communicate the Gospel, which is rooted in the culture of encounter, is based upon the experience of authentic contemplation, and always has a place for others.
Poverty and Economic Justice in Pope Francis
Authors: Ilo Stan Chu
Published: December 2018

This article discusses Pope Francis’s teaching on poverty and economic justice with reference to his Evangelii gaudium and Laudato si’. This teaching is developed through three emphases of the pope: (1) a compassionate church, moved by the suffering and injustice in the world; (2) a church whose mission is to accompany humanity with the leaven of the Gospel in order to bring about a radical conversion of hearts and worldly systems and institutions; and (3) a transformative missional praxis that brings about integral salvation through solidarity with the poor and marginalized, and a prophetic commitment to human and cosmic flourishing.