bluuebunny/crossref_metadata_2025 huggingface dataset:
Pollution and Personal Injury: Problems and Prospects
Authors: Lee Maria
Published: January 2017

By comparison with the clear damage present in tort claims for traumatic injury, for example, following a road accident, the effect of pollution on the person is frequently resistant to immediate perception. This paper will examine some of the difficulties which the nature of harm can imply when looking to the common law to address environmental damage to the person. The generalised nature of environmental damage, together with its intangible or latent effects, can distort the operation of liability rules, which more commonly address traumatic injury. The notion of personal injury is, however, somewhat under-examined in English law. It will be argued here that although the nature of environmental damage will sometimes present overwhelming challenges in civil claims, the common law can accommodate certain of the less substantial personal harms which are characteristic of environmental damage to the person. This involves considering the margins of recognised personal injury and the possibility of recovery for psychiatric illness brought about by exposure to pollution.
The Environmental Integration Clause in Article 6 of the EU Treaty: Prioritising Environmental Protection
Authors: Schumacher T.
Published: January 2017

Traditionally, environmental protection legislation has taken the form of direct statutory intervention to protect certain habitats or require the reduction of pollution output. However, the only recently reworded ‘environmental integration clause’ in Article 6 of the EU Treaty has created a very different instrument to further the Treaty objective of environmental protection (stated in Article 2). It introduces the concept that environmental protection requirements must be taken into account whenever laws are passed and decisions are made. Rather than direct legislation on a specific field of environmental action, the environmental integration clause requires the indirect adaptation of all legal measures with environmental protection requirements. The author argues that this duty to ‘integrate’ environmental protection requirements has many practical implications and, above all, results in the priority of environmental protection when balanced against other Treaty objectives. The implications of such an interpretation are particularly striking in cases in which environmental protection clashes with well-established economic Treaty objectives, such as the free movement of goods.
Protecting the European Environment from the Community: The Case of Agriculture
Authors: Jack Brian
Published: January 2017

The Common Agricultural Policy (CAP) was one of the first common policies to be created by the then European Economic Community. The policy was created at a time when little or no thought had been given to the environmental effects of Community policies. Today, Article 6 of the EC Treaty places an obligation upon the Community to directly integrate environmental protection considerations into other policy areas. This article will examine the manner in which this commitment has been observed by the Community in respect of the CAP. In this context an examination will be conducted of the manner in which the CAP was created and of the environmental issues which have been attributed to agriculture. The article will then, in the light of subsequent reforms, examine the present CAP. In particular, the article focuses upon environmental measures which have been adopted by the Community and analyses these measures against the objective of integrating environmental protection considerations within the CAP.
Trading in Risk: The Biosafety Protocol, Genetically Modified Organisms and the World Trade Organisation
Authors: Street Paul
Published: January 2017

This article examines the negotiations and final adopted text of the Cartegena Protocol on Biosafetv to the Convention on Biological Diversity. In so doing it argues that the disputes that characterised the protracted process of negotiations, in particular the relationship of the Protocol to the World Trade Organisation (WTO), have not been resolved with the adoption of the final text. In seeking to achieve a compromise the text of the Protocol now firmly embodies a number of contradictory elements. This leaves open the possibility of a dispute in the WTO should a party to the Protocol seek to regulate the import of genetically modified organisms.
The Environmental Perspective in the 1999 Nigerian Constitution
Authors: Okon Emmanuel E.
Published: January 2017

Environmental degradation is bound to increase as long as human population increases and new technologies are invented. In order to arrest the problems of environmental degradation, a number of approaches have been adopted. Among such approaches are the integration of environmental protection policies into development programmes, enactment of comprehensive legislation on all segments of environment and the inclusion of environmental provisions in the constitutions of most countries. Unfortunately, while some countries make their constitutional provisions on environment enforceable, others do not. In Nigeria, indirect environmental provisions were first made part of the constitution in the 1979 Constitution. In 1999, direct environmental provision was entrenched in the 1999 Constitution. Unfortunately, Chapter II of the 1999 Constitution, which contains the environmental provisions, is unenforceable. While the Nigerian courts have done nothing tangible to enforce the provisions of the constitution on environment, on the other hand, the Indian courts have taken positive steps to enforce provisions of the Indian Constitution on environment. In conclusion, apart from other suggestions made, it is strongly recommended that Nigerian courts should emulate the efforts made by Indian courts to enforce provisions of the Indian Constitution on environment.

The world has moved far away from the era when it was believed that the only rights which a government is called upon to guarantee and protect are the natural rights of man. By living in nation-states and in organised communities, man has acquired new rights, which are now regarded by many civilised countries as just as inalienable as those rights with which nature endows him at birth. The right to education and work are among such rights. Increasingly important in some countries is the addition of the right to a decent and healthy environment to these newly acquired rights.1
The Regulation of Drinking Water Quality: Control by Cooperation Rather Than Enforcement
Authors: Atkinson Carl
Published: January 2017

This article discusses the system of regulation of the quality of drinking water in England and Wales. It reflects upon the role of the Drinking Water Inspectorate within the regulatory regime and the frequency with which the Drinking Water Inspectorate exercises their statutory powers of prosecution against water suppliers. Although there is evidence to suggest that water suppliers are subject to increasing prosecution, it is contended that the generally low level of prosecution is typical of a regulatory regime that is dependent upon the cooperation of the regulated industry. The few cases that have been prosecuted by the Drinking Water Inspectorate are examined and it is clear that all of the prosecutions of water companies that have been successful have involved a guilty plea by the defendant. The only case in which there was a not guilty plea failed for evidential reasons. It is suggested that this supports the view that water companies tolerate a level of regulation and thereby cooperate with the regulator. It is concluded that effective control of drinking water quality is not achieved by criminal enforcement, but by less formal control mechanisms.
Time to Discard the Concept of Waste?
Authors: Wilkinson David
Published: January 2017

The concept of waste is of the utmost importance in determining the regulatory and economic framework for much environmental protection. Its origins, however, reveal a history of considerable disagreement concerning the concretisation of that concept. Recent case law of the European Court of Justice has tended towards the creation of a non-substantive concept of waste. A non-substantive concept of waste carries certain disadvantages and difficulties, including possibly undesirable inclusion of materials subject to recycling/recovery processes. Other elements of the EC concept of waste show divergence between international and European formulations as well as potentially problematic national divergence. The author takes the view that the key environmental problem caused by waste (pollution) is more properly captured by a value concept of waste since this relates directly to the causal mechanisms of pollution. Value concepts of waste are not new and would not include materials undergoing recycling or re-use. Beyond value concepts of waste, there may be grounds for moving away entirely from classification of materials as waste and regulating all substances, waste and non-waste alike, on the basis of their environmental risk.
Animal Protection and the Red Fox: Could Licensing Provide an Answer?
Authors: Martin Bridget
Published: January 2017

Whereas most of the provisions protecting wild birds are located in the Wildlife and Countryside Act 1981, the legislation protecting animals is disparate. This article explores the fundamental difference between the protection offered to wild birds and to animals, in particular the red fox. It examines some of the many pieces of legislation relating to fox control and to associated welfare issues, as well as the impact these can have on other, vulnerable species. Finally, it is proposed that licensing provisions similar to those that currently apply to the control of birds, should be applied to the control of foxes. This would enable the same level of protection to be applied to wild animals as now applies to wild birds, both within the single structure of the Wildlife and Countryside Act 1981. It would also provide an alternative to an outright ban on foxhunting.
Challenging Environmental Tobacco Smoke in the Workplace
Authors: Spink Paul
Published: January 2017

This article examines the law relating to passive smoking and focuses on the issue of occupational health and safety. Recent litigation in the United Kingdom, the United States and Australia is discussed against the backdrop of newly published medical research. Various means of challenging employers who acquiesce in the face of workplace tobacco smoke are considered in the main body of the article.
Optimal duration of pulmonary rehabilitation for individuals with chronic obstructive pulmonary disease - a systematic review
Authors: Beauchamp Marla K , Janaudis-Ferreira Tania , Goldstein Roger S , Brooks Dina
Published: January 2017

The purpose of this review was to determine the impact of duration of pulmonary rehabilitation on measures of health-related quality of life and exercise tolerance in individuals with chronic obstructive pulmonary disease (COPD). Randomized controlled trials (RCTs) comparing different lengths of pulmonary rehabilitation in patients with COPD were identified after searches of six electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, Physiotherapy Evidence Database [PEDro] and the Cochrane Library of clinical trials) and reference lists of pertinent articles. Two reviewers performed the searches and assessed trial quality using PEDro and Jadad scales. Five RCTs met inclusion criteria. The mean PEDro score was 6 (range 3-8) and mean Jadad was 2 (range 1-3). Three trials reported a difference in health-related quality of life in favour of the longer duration program; two trials reported a benefit in exercise capacity in favour of longer programs. A meta-analysis of results was not possible due to considerable heterogeneity in program duration and outcomes. Longer duration pulmonary rehabilitation programs appear to have a more favourable effect on health-related quality of life in individuals with COPD; results for exercise capacity are less clear. The limited literature prevents a more definitive conclusion on optimal duration of rehabilitation.
Chronic obstructive pulmonary disease (COPD) and old age?
Authors: Jarad Nabil
Published: January 2017

Chronic obstructive pulmonary disease (COPD) in old age is an increasing problem. Understanding the features of COPD in older patients is important in order to introduce effective interventions and to inform efforts for health resource allocation. Features of importance to old age include increased prevalence of COPD in non-smokers and rise in the rate of systemic comorbidities. In addition, acute exacerbations in older patients have poorer outcome, manifesting by increase in the rate of hospitalisation, greater length of stay, increase of the rate of re-hospitalisation and in mortality rate. Impaired cognitive functions as well as problems affecting hand joints make using inhaled medications less reliable which leads to further deterioration of outcome of care. Even for those who are competent in using inhalers, the evidence for their efficacy in older patients is not certain.
Evidence on Spouse Responses to Illness as a Guide to Understanding and Studying Spouse Responses to Living Organ Donation
Authors: Taylor Laura , Nolan Marie , Dudley-Brown Sharon
Published: January 2017

Although living kidney donors receive praise from friends and coworkers for their selflessness, recent studies report that members of the immediate family may not be as supportive. Reports of conflict surrounding living organ donation include divorce between the donor and the donor's spouse. The purpose of this review of the literature is to (1) discuss the spousal role when confronted with a partner's illness, (2) explore the current research describing the spouses of patients with heart disease and cancer, various transplant recipients, and living organ donors, and (3) identify the need for future research to explore the experiences and needs of the spouses of living kidney donors. Because the attitudes of donor family members, especially spouses, may affect the decision to donate and the satisfaction with recovery from donation surgery, it is critical to know how the spouses of living kidney donors view kidney donation. This knowledge may be instrumental in promoting family harmony and donor recovery and wellness.
Reproduction and Pregnancy in Transplant Recipients: Current Practices
Authors: McKay Dianne B. , Adams Patricia L. , Bumgardner Ginny L. , Davis Connie L. , Fine Richard N. , Krams Sheri M. , Martinez Olivia M. , Murphy Barbara , Pavlakis Martha , Tolkoff-Rubin Nina , Sherman Michael S. , Josephson Michelle A.
Published: January 2017

Many transplant physicians are faced with questions from their patients about the safety and long-term consequences of pregnancy following transplantation. To better understand how pregnancies are managed and to clarify the outcome of pregnancy after transplantation, a survey questionnaire was developed and mailed to all medical and surgical directors of transplant centers throughout the United States; responses were obtained from 59.1% of the transplant centers. Although many opinions were collected, most respondents conceded that their opinions were based on personal experience rather than evidence-based. The underutilization of existing information was revealing and highlighted a need for an evidence-based approach to care of the pregnant transplant recipient and her offspring. The survey results, reported in this article, led to formation of a consensus conference to determine the optimal approach to pregnant transplant recipients and to define what is currently known and unknown about reproduction and transplantation.
BK Virus Infection in Kidney Transplantation: A Case for Early Intervention
Authors: Schwartz Susan E. , Twining Lisa M.
Published: January 2017

The prognosis for renal allograft survival in a patient with BK virus–associated nephropathy is distressing because nearly 50% of affected grafts are lost. With these statistics in mind, attempting clinical intervention before BK virus disease develops seems appropriate. Noninvasive screening tools such as tests to detect decoy cells in urine can enable diagnosis of BK viral infection in its early stages. Although it is not entirely clear which patients with BK infection will have BK disease develop, it may be possible to intervene in this early warning period to prevent the further development of BK virus–associated nephropathy. We present a case of a 50-year-old man in whom asymptomatic BK viruria developed 6 weeks after he received a non-HLA matched kidney from a deceased donor. This BK viruria was accompanied, subsequently, by an unexplained increase in serum creatinine level 2 months after transplantation. Following a change in his immunosuppressive regimen as therapy for presumed renal allograft dysfunction associated with BK viral infection, the decoy cells in his urine disappeared and his creatinine levels stabilized.
Family Responses to Donor Designation in Donation Cases: A Longitudinal Study
Authors: Dodd-McCue Diane , Cowherd Robin , Iveson Amy , Myer Kevin
Published: January 2017

Context

A 2001 state law reinforced donors' rights by mandating that donor consent be strictly honored. One concern was the potentially negative impact of donor designation notification on donor families.

Objectives

To examine donor families' responses to donor designation.

Design

Descriptive nonexperimental design spanning July 1999 to September 2004.

Setting

State served by organ procurement organization.

Data

Results from surveys completed by 569 donor families, including 162 surveys from designated donor families.

Main Outcome Measures

Previous discussions, designation awareness, information helpful, information stress, awareness of meaning of donation, and comfort with designation decision.

Results

The majority (79%) of designated donor families reported their loved ones had discussed donation with them; of these families, 86% were aware of donor designation, and 83% understood what donation entailed. The majority (75%) thought information about loved ones' donor designation was helpful, and only 8% found it stressful. In contrast, 18% of families of nondesignated donors said being approached about donation was stressful after the law was strengthened. However, over 80% of all donor families were comfortable with the donation decision.

Conclusions

The results fail to support the assumption that donor families perceive donor designation notification as negative and stressful. The majority of designated donor families report relief and reduced stress, compared to families approached for donation. The findings suggest that strengthening donor designation legislation can lead to positive results for donor families and donation recipients.
Role of Adolescent Development in the Transition Process
Authors: Kaufman Miriam
Published: January 2017

Adolescent development is the normal process of transition from childhood to adulthood. Adolescents with transplants make the transition from pediatric to adult care within the context of other transitions in cognition, emotional attachments, autonomy, self-identity, sexuality, physical changes, life philosophy, and education/vocation. Healthcare providers can reduce their frustrations with this age group and optimize their care by understanding the impact of adolescent development on the transition process. In a busy clinic, attention to developmental issues can take on a low priority, but this does not have to be time consuming and may involve more of a perspective change than anything else. Both the adult and pediatric teams should remember that development does not stop at the time of transfer of care.
Medication Adherence after Heart Transplantation: Adolescents and Their Issues
Authors: McAllister Sara , Buckner Ellen B. , White-Williams Connie
Published: January 2017

Context

Medication nonadherence among adolescent heart transplant recipients can have overwhelming negative consequences including rejection and mortality. Because of issues specific to adolescents such as peer pressure, risk taking, independence, self-image, and self-esteem, they are a population susceptible to nonadherence. Adherence may be associated with a supportive environment, fewer physical and cosmetic side effects, and a sufficient knowledge of therapies. Adherence also may be related to regimens with fewer medications, predominantly fewer immunosuppressive drugs.

Objective

To examine the differences in motivation between adolescents who are more adherent and those who are less adherent to their medication regimen following transplant surgery.

Design

A descriptive design and mixed methodology, including a modified written survey, the Frazier Noncompliance Inventory; a self-report measure of overall medication adherence; and an interview designed by the investigator. Interview questions were reviewed for content validity by nurse clinicians and researchers.

Setting

A heart transplant follow-up clinic in the southeastern United States.

Results

Findings for 2 participants revealed striking contrasts in adolescent issues and factors affecting adherence. These findings are presented in a case comparison. Data show that a supportive environment and knowledge of medications were significant in increasing self-responsibility and adherence in adolescent transplant recipients. Also, experiencing rejection early in treatment because of less adherence led to increased adherence for fear of further rejections or death.
Transition of Transplant Patients with Cystic Fibrosis to Adult Care: Today's Challenges
Authors: Taylor Louise , Tsang Anna , Drabble Alison
Published: January 2017

One of the most trying ordeals for patients with cystic fibrosis is moving from one care setting to another. When the patient is facing the crisis of failing health and the need for lung transplantation, the transition can seem even more overwhelming. In Toronto, patients are transferred from pediatric to adult care at age 18. Moving a teenager with cystic fibrosis to the adult system presents many challenges, and even greater challenges arise when the patient has received a lung transplant or is awaiting one. Two pediatric and adult cystic fibrosis teams have worked closely with the lung transplant teams to create a smooth transition system. This article outlines both programs and presents a case study to explore the challenges for the teams in deciding the best place to meet the needs of the patients and their families. These families offer us a look at coping with change at a time of great stress and at how we as healthcare providers can support them through the system.
Caregivers of Lung Transplant Candidates: Do They Benefit When the Patient is Receiving Psychological Services?
Authors: Rodrigue James R. , Widows Michelle R. , Baz Maher A.
Published: January 2017

Background

We recently demonstrated that a targeted psychological intervention has quality of life, mood, and social intimacy benefits for patients awaiting lung transplantation.

Objective

To evaluate the impact of the patient's participation in treatment on caregiver functioning.

Design and Intervention

Caregivers of patients participating in a randomized clinical trial designed to compare 2 telephone-based psychological interventions completed outcome measures at baseline and at 1 and 3 months after patients completed treatment. Patients were randomized to receive either supportive therapy (emotional and educational support) or quality-of-life therapy (a cognitive-behavioral intervention that provided specific intervention strategies to boost happiness and satisfaction in life domains that compromise overall quality of life). Caregivers did not participate directly in the interventions.

Setting and Participants

Participants were 28 caregivers from a large lung transplant center in the southeastern United States.

Main Outcome Measures

Quality of life (Quality of Life Inventory), mood disturbance (Profile of Mood States-Short Form), and social intimacy (Miller Social Intimacy Scale).

Results and Conclusions

Caregivers reported higher quality of life and lower mood disturbance scores, and comparable social intimacy scores relative to the patients for whom they were caring. Caregivers whose patients received quality-of-life therapy reported vicarious gains in quality of life, mood disturbance, and social intimacy, relative to those whose patients received support therapy. Finally, the degree of change in patients' quality of life, mood disturbance, and social intimacy contributed significantly to predicting caregivers' functioning at the 3-month follow-up assessment. These findings suggest that telephone-based quality-of-life therapy has beneficial effects that extend beyond patients to their caregivers.
Lung Transplantation in Adolescents and Young Adults with Cystic Fibrosis
Authors: Yorke Janelle , Parle Michael , James Melveta , Gay Tatiana , Harkess Michelle , Glanville Allan
Published: January 2017

Context

Little is known about adolescents' and young adults' experience with cystic fibrosis while waiting for or after receiving a lung transplant. The psychological and psychosocial factors that may influence these patients' transplant outcomes are yet to be fully explored.

Objective

To explore the psychosocial impact of the lung transplant journey on adolescents and young adults with cystic fibrosis.

Design

A questionnaire-based pilot study was used to enable descriptive, comparative, and correlational analyses between pretransplant and posttransplant groups. Setting—A major lung transplant unit in Australia.

Participants

Twenty-seven patients (9 before and 18 after transplantation) participated in the study. The mean ages were 18.7 years (SD 4.2) and 22.6 years (SD 3.9) in the pretransplant and posttransplant groups, respectively.

Results

In all domains of the Short Form 36 except Mental Health and Social Functioning, the posttransplant group had significantly higher scores ( P < .05) compared to the pretransplant group. The Hospital and Anxiety and Depression Scale total Distress score in the posttransplant group was related to the number of rejection episodes ( r = 0.47, P = .049) as well as hospital admissions ( r = 0.51, P = .012). The number of rejection episodes was significantly related to patients' perceived level of self-efficacy ( P = .025), importance to health ( P = .001), and ease ( P = .10) of monitoring their symptoms.

Conclusion

This study provides some insight into the needs of adolescents and young adults with cystic fibrosis and the differences between those who are awaiting a transplant and those who have received a transplant. Assessing the young person's perceptions in relation to activities such as exercising, monitoring symptoms, and taking medications can give helpful insights into the transition phase, but require further research.
The Effect of Donor Factors on Human Islet Yield and Their in Vivo Function
Authors: Sabek Omaima M. , Cowan Patricia , Fraga Daniel W. , Gaber A. Osama
Published: January 2017

Background

A major problem in the islet field is the high selectivity exercised in accepting cadaveric pancreas for islet isolation. This practice is based on experience that indicates that islet yield and posttransplant function are related to donor demographics and injury mechanisms.

Objective

To examine factors influencing islets recovery and in vivo function with emphasis on donor-related factors.

Methods

Islets were isolated from 99 human donor pancreata, and islet yield was reported as islet equivalent per gram pancreatic tissue. Donor, procurement, and isolation factors were collected for each isolation and correlation statistics were performed between these variables and islet yield.

Results

Results indicated a differential effect of enzyme mixes on yield with 2 Collagenase P digestion most suitable for increased ischemic time ( R2 = 0.1; P < .08), Liberase with small donor pancreas size and elevated preprocurement glucose ( R2 = 0.15; P < .02), and Serva with female donors ( R2 = 0.17; P < .06). Islets from 29 isolations were further tested by transplantation under the kidney capsule of immune-deficient NOD-SCID mice. Although all 29 preparations had acceptable in vitro perfusion parameters indicating viability, only 19 functioned in vivo with serum levels of insulin >5 U/mL and C peptide >1.5 ng/mL. No significant differences in donor, procurement, and isolation factors were evident between the islet preparations that functioned in vivo and those that were nonfunctional.

Conclusions

These data demonstrate that although yield is affected by a variety of donor factors and enzyme mixes, these factors do not affect islet in vivo function.
Advanced Practice Organ Procurement Techniques: Insertion of Arterial Catheters
Authors: Powner David J.
Published: January 2017

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.
The Role of Marketing in Transplantation
Authors: Thomson Art
Published: January 2017

Although marketing has a well-established role in healthcare, few publications on the role of marketing in transplantation exist. In addition, the field of organ transplantation presents some unique marketing challenges because of the limited availability of organs. Marketing is essential to the success of transplantation services. An effective market planning process includes several steps: an assessment of the current program; analysis of strengths, weaknesses, opportunities, and threats; a competitive analysis; the identification of target audiences; setting of marketing goals, strategies, and tactics; and developing methods for tracking and evaluation. Two often overlooked needs are to assess readiness for marketing and internal marketing.
Complexities in Transplant Revenue Management
Authors: Marshall Barry , Swearingen Justin P.
Published: January 2017

Numerous payment methodologies, contract types, and income reimbursement methods exist in the highly complex environment of transplantation. A fundamental understanding of the transplant environment and the various compensation schemes involved with transplant revenue management is necessary to stay viable in such a complicated system. Knowledge of resources such as Medicare, commercial insurance, Medicaid, and self-pay individuals will allow a program to fully optimize allowable revenue streams. This multiple payer mix can be challenging, with payment arrangements ranging from a single global case rate that must cover all transplant-related services to individual payment arrangements for each stage of the transplantation process. Transplant programs must track each agreement to ensure optimal payment, and must therefore become proficient with central fiscal operations such as Medicare cost reporting and managed care contract negotiations. Outlier protection and risk pool strategies can also be used to remain competitive and profitable. A transplant program must have a thorough understanding of all available payment schemes and reimbursement optimizing strategies to facilitate the realization of a strong financial outlook.
Unique Challenges for the Pediatric Transplant Administrator
Authors: Smith-Fields Cassandra
Published: January 2017

Pediatric transplant administrators face a variety of unique challenges that are generally not encountered by their adult program counterparts. Not only do the size of the patients differ in pediatric care compared with adult care but the size of the programs is dramatically different as well. These differences lead to distinctive challenges in administering a transplant program. This article highlights 3 of the essential areas in which pediatric transplant care differs from adult care: the environment of care, staffing, and reimbursement.
Incorporating Quality of Life and Patient Satisfaction Measures into a Transplant Outcomes Assessment Program: Technical and Practical Considerations
Authors: Feurer Irene D. , Russell Robert T. , Pinson C. Wright
Published: January 2017

Objective

To present an overview of methods for incorporating the measurement of health-related quality of life and patient satisfaction into a comprehensive outcomes assessment program in the organ transplantation setting. An introduction to basic psychometric concepts as they relate to survey instrument selection is presented, and the complementary nature of health status instruments and preference-based utility measures is discussed. The role of these concepts and measures in a transplant outcomes assessment and research program and the psychometric evidence for selected instruments are described.

Data Sources

Descriptions of specific survey instruments were abstracted from published reports or manuals. Data describing the Vanderbilt Transplant Center Patient Satisfaction Inventory were derived from a single institution transplant outcomes research database.

Study Selection and Data Extraction

Previously reported research was selected from the literature to provide brief examples of basic concepts, which are not intended to be a comprehensive review of these topics. Illustrative data from the Vanderbilt program were extracted from a longitudinal database.

Data Synthesis

Data and published reports were synthesized for descriptive and illustrative purposes.

Conclusions

This review describes various types of health-related quality of life and patient satisfaction outcomes assessment tools and measurement methods; introduces considerations relevant to survey instrument selection and development; and outlines the evolution of and psychometric support for a transplant center-wide outcomes assessment and research program.
Implementing Randomized Assignment in a Nursing Clinical Randomized Control Trial
Authors: Winsett Rebecca P. , Thompson Denise A. , Gower Gayle , Leimig Renata , Lloyd Melissa , Hathaway Donna K.
Published: January 2017

During the design phase of any research, an investigator addresses internal and external threats to validity and develops mechanisms to minimize these threats. Controlling for threats to study validity enhances the meaningfulness and generalizability of study outcomes. Representativeness of the study sample is one key design feature undertaken to ensure study validity; however, during clinical trials the investigator must stay attuned to ongoing situations that can alter sample representativeness. In the context of an ongoing nursing-led randomized control trial, threats to sample representativeness are discussed. These threats can occur in any study and may require modification of the study design to maintain validity of research outcomes. This article provides insight regarding threats to study validity encountered by one research team and the modifications undertaken to address them.
Progressive Multifocal Leukoencephalopathy: A Case Study
Authors: McCalmont Vicki , Bennett Kristi
Published: January 2017

Progressive multifocal leukoencephalopathy is a rare, highly fatal demyelinating brain infection caused by the JC virus. This infection is associated with immunosuppressive agents and is emerging in the transplant population. There has never been a documented case of progressive multifocal leukoencephalopathy in a transplant recipient receiving sirolimus. We present a study, in which the JC virus was found in a 68-year-old man who had received a postorthotopic heart transplant 3 years earlier and who was receiving sirolimus and prednisone for immunosuppression. We review the clinical presentation, diagnosis, current treatment options, and the outcomes of progressive multifocal leukoencephalopathy in transplant recipients.
A Comparison of Rehabilitation Outcome Measures for Traumatic Brain Injury
Authors: Shah Surya , Muncer Steven J.
Published: January 2017

This study evaluates the appropriateness, responsiveness, and predictive ability of the Modified Barthel Index (MBI), the Disability Rating Scale (DRS), the Barry Rehabilitation In-patient Screening of Cognition (BRISC), and the Glasgow Coma Scale (GCS) for 78 patients with traumatic brain injury referred for in-patient rehabilitation. Appropriateness was evaluated by examining means, standard deviations, coefficients of variation, and ceiling and floor effects. Responsiveness was determined by examining paired t-test results for admission and discharge scores, and on the basis of an effect size calculation. Predictive power was evaluated by performing two stepwise regressions with length of rehabilitation and total length of hospital stay. The results suggest that although the DRS and GCS have some advantages, notably in low ceiling and floor effects, overall the MBI is the most effective measure, particularly for prediction, with a moderate coefficient of determination (r2 = 0.42) and no significant differences between predicted and real length of hospital stay.
Assessing Children's Competence in Computer Interactions: Preliminary Reliability and Validity of the Test of Mouse Proficiency
Authors: Lane Alison , Ziviani Jenny
Published: January 2017

The Test of Mouse Proficiency (TOMP) was developed to assist occupational therapists and education professionals assess computer mouse competency skills in children from preschool to upper primary (elementary) school age. The preliminary reliability and validity of TOMP are reported in this paper. Methods used to examine the internal consistency, test-retest reliability, and criterion- and construct-related validity of the test are elaborated. In the continuing process of test refinement, these preliminary studies support to varying degrees the reliability and validity of TOMP. Recommendations for further validation of the assessment are discussed along with indications for potential clinical application.
Direct Puncture and Sclerotherapy with Sotradecol®
Authors: Svendsen P.A. , Wikholm G. , Rodriguez M. , Enoksson P. , Frisén L. , Strömland K. , Seregard S.
Published: January 2017

We evaluated sclerotherapy in the treatment of orbital lymphatic malformations.

Six consecutive patients with unilateral orbital cystic masses and recurrent episodes of orbital swelling were included in this retrospective study. All have been treated with percutaneous puncture and injection of Sotradecol (sodium tetredecyl sulphate) under radiographic guidance, on one or more occasions.

Reduction of orbital mass volume was documented clinically and radiologically within a few weeks in all cases. There was total regression of proptosis in three instances. There were no immediate complications. One subject suffered a presumably coincidental orbital hemorrhage two weeks after treatment. Follow-up times ranged between six months and four years.

Sotradecol sclerotherapy appears to be a useful adjunct to the therapeutic arsenal for orbital lymphatic malformations.
MR Quantification of Flow in Children with Vein of Galen Malformations
Authors: Poskitt K. J. , Marotta T. , Culham G. , Xiang S.
Published: January 2017

Vein of Galen vascular malformations are either Vein of Galen Aneurysmal malformations (VGAMs) or Vein of Galen Aneurysmal Dilatations (VGADs). VGAMs may be of the choroidal or mural type and are fistulas associated with the precursor of the vein of Galen.

The treatment of VGAMs is aimed at controlling the size of the vascular shunt since it is believed that the shunt is responsible for venous hypertension, cardiac stress, delayed development and may be so large as to damage the brain. In VGAMs as noted by Berenstein and Lasjaunias.

Absolute measures of flow may contribute to our understanding of CNS disease and permit objective measures of the success or failure of therapeutic interventions5. MR phase contrast cine angiographic techniques can be employed to measure bulk flow in intracranial vessels. Vein of Galen vascular malformations are an ideal model to measure venous flow as the draining vein is large and angiographic evaluation is limited. Thus our goal was to develop an objective non-invasive method of measuring vascular flow in VGAMs and VGADs6. Herein we report our experience using this technique in a group of patients with Vein of Galen vascular malformations. We also hypothesized that the degree of shunting would correlate to the degree of cardiac stress and be an indicator of optimal timing for intervention.

We believe that we have succeeded in our goal to develop an objective, non-invasive method of shunt quantification using velocity encoded MR sequences. This promises new insight into the hemodynamics, natural history and treatment response of vascular malformations.
Dural Sinus Malformation with Dural Arteriovenous Fistula
Authors: Yau C.K. , Alvarez H. , Lasjaunias P.
Published: January 2017

A rare case of dural sinus malformation with dural arteriovenous fistula in an infant is presented. Presenting symptom was progressive macrocrania without hydrocephalus. A high flow AVS of the sigmoid sinus associated with jugular bulb diaphragm was demonstrated. Reflux in the intracranial sinus was present. The shunt was successfully occluded by transarterial embolization. The natural history and treatment strategy are discussed.
Stenting of a Venous Stenosis in Vein of Galen Aneurysmal Malformation
Authors: Brew S. , Taylor W. , Reddington A.
Published: January 2017

The vein of Galen aneurysmal malformation (VGAM) is a high flow arteriovenous shunt at the choroidal level. In the neonatal period, it typically presents with cardiac failure. Venous stenoses, occlusions and anomalies are often present. In the absence of adequate venous outflow pathways, severe, irreversible cerebral parenchymal damage may occur due to intracranial venous hypertension, altered hydrodynamics and ischaemia. We present a case of deployment of a stent across a focal superior jugular bulb stenosis in an effort to avert this outcome.
Unilateral A1 and M1 Occlusions in a Child with Trisomy 21
Authors: Corr P. , Lasjaunias P.
Published: January 2017

We report a child with known trisomy 21 who presented with a stroke. Angiographic evaluation demonstrated unilateral intracerebral arterial occlusions of the A1 and M1 segments of the anterior and middle cerebral arteries. The hypothesis of segmental arterial vulnerability is reviewed in an attempt to explain these findings.
Spontaneous Occlusion of a Bilateral Post Traumatic Carotid Cavernous Fistula
Authors: Churojana A. , Chawalaparit O. , Chiewwit P. , Suthipongchai S.
Published: January 2017

This report describes a rare occurrence of spontaneous closure of direct bilateral carotid cavernous fistula in a 62-year-old woman who had head injury.

This was confirmed by clinical examination and subsequent angiogram. Partial thrombosis of bilateral superior ophthalmic veins was observed in the initial arteriography.

This finding may be useful in prediction of spontaneous cure of carotid cavernous fistulas.
A Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery
Authors: Taylor A.G. , Tymianski M. , terBrugge K.
Published: January 2017

Dissecting aneurysms occur when blood extrudes into the wall of a vessel. Posterior circulation dissections are recognised as an important cause of cerbral infarction and subarachnoid haemorrhage(SAH), however posterior inferior cerebellar artery (PICA) aneurysmal dissections are rare. A 49-year-old man who presented with SAH was found to have a left PICA dissection on cerebral angiography. The lesion was treated with surgical clipping proximal to the dissection and a distal PICA to PICA anastomosis. The pathology, diagnosis, presentation and treatment of these difficult lesions is discussed.
A Case of Multiple Intracranial Aneurysms with Unruptured Associated Aneurysms and Newly Developed Ruptured Aneurysm
Authors: Jayakrishnan V.K. , Rodesch G. , Alvarez H. , Lasjaunias P.
Published: January 2017

We report a case of mirror aneurysms at the middle cerebral artery bifurcation with rupture on the left side. After six years, the patient had subarachnoid haemorrhage from a de novo aneurysm which developed separate from but adjacent to the already present aneurysm on the right side. The mechanism of development of multiple aneurysms, especially of the mirror-image type cannot be explained based only on haemodynamic factors and congenital segmental arterial vulnerability which is generalised than focal is highly likely. The sequence of development of aneurysms in this patient along with existing knowledge regarding rupture of aneurysms in conditions like polycystic kidney disease raise questions about the current trend of treating all patients with coincidental, unruptured aneurysms as they may never bleed from such aneurysms but could still be at risk of SAH from newly developing aneurysms.
Complete Thrombosis of a Giant Distal Middle Cerebral Artery Aneurysm
Authors: Lenthall R. , Rodesch G.
Published: January 2017

Complete thrombosis of a giant cerebral aneurysm is rarely reported and peripheral giant middle cerebral artery (MCA) aneurysms are similarly rare. We present a case of complete spontaneous thrombosis of a giant sylvian artery aneurysm that had previously been wrapped at surgery.
Transarterial Embolization of a Cervical Dural Arteriovenous Fistula
Authors: Ansari S.A. , Lassig J.P. , Nicol E. , Thompson B.G. , Gemmete J.J. , Gandhi D.
Published: January 2017

We describe a case of a 75-year-old man who presented with acute onset of headache and subarachnoid hemorrhage and initial cerebral angiography was deemed “negative”. In retrospect, a faint contrast collection was present adjacent to the right vertebral artery at the C1 level suspicious for a small dural arteriovenous fistula (dAVF).

Follow-up angiography with selective micro-catheter injections of the right vertebral artery and C1 radicular artery confirmed a complex dAVF with characteristically specific venous drainage patterns associated with a subarachnoid hemorrhage presentation. Subsequently, the cervical dAVF was treated with superselective glue embolization resulting in complete occlusion.

Cervical dAVFs are extremely rare vascular causes of subarachnoid hemorrhage. Both diagnostic angiography and endovascular treatment of these lesions can be challenging, especially in an emergent setting, requiring selective evaluation of bilateral vertebral arteries and careful attention to their cervical segments. Although only a single prior case of a cervical dAVF presenting with subarachnoid hemorrhage has been successfully treated with embolization, modern selective transarterial techniques may allow easier detection and treatment of subtle pathologic arteriovenous connections.
Bilateral Persistent Pharyngo-Stapedial Arteries Revealed during Evaluation of a Carotid-Cavernous Fistula
Authors: Jehl J. , Jeunet L. , Berraiah M. , Bonneville J.-F.
Published: January 2017

A 33-year-old woman was evaluated for a right carotid-cavernous fistula revealed by a proptosis and chemosis of the right eye. The initial angiogram showed a left persistent pharyngo-stapedial artery (Ph-SA). A temporal bone CT suggested bilateral pharyngo-stapedial artery persistence. The right Ph-SA was not opacified in the first angiogram because of the high degree of shunting in the fistula. Four months later the patient was admitted for treatment of the carotid-cavernous fistula. In the meantime, the fistula had altered, with spontaneous thrombosis of the ophthalmic vein, and decrease of the vascular steal, explaining that the right Ph-SA was clearly visible on the angiogram performed during the procedure.

The carotid-cavernous fistula was completely occluded with five detachable coils. The follow-up included 3 Tesla MR angiography that showed complete closure of the fistula with preservation of the right ICA and bilateral persistent pharyngo-stapedial arteries.