bluuebunny/crossref_metadata_2025 huggingface dataset:
A revision of the new world goblin spider genus Cinetomorpha Simon, 1892 revalidated from Gamasomorpha Karsch, 1881 (Araneae, Oonopidae, Oonopinae)
Authors: OTT RICARDO , UBICK DARRELL , BONALDO ALEXANDRE B. , BRESCOVIT ANTONIO D. , HARVEY MARK S.
Published: July 2019

The goblin spider genus Cinetomorpha Simon is removed from the synonymy of Gamasomorpha Karsch and treated as the senior synonym of Yumates Chamberlin and Lucetia Dumitresco & Georgesco. All 41 species occur only in the New World, and the genus is divided into four species groups: the simplex group, the puberula group, the patquiana group and the itabaiana group. The following species are transferred to Cinetomorpha: C. floridana (Banks), comb. nov., and C. sedata (Gertsch & Mulaik), comb. nov., from Opopaea; C. angela (Chamberlin), comb. nov., and C. nesophila (Chamberlin), comb. nov., from Yumates; and C. patquiana (Birabén) and C. platensis (Birabén), comb. nov., from Gamasomorpha. Gamasomorpha wasmanniae Mello-Leitão and Lucetia distincta Dumitresco & Georgesco are newly synonymized with C. simplex Simon. Two species currently in Gamasomorpha are transferred to Hexapopha Platnick & Berniker: H. brasiliana (Bristowe), comb. nov. and H. m-scripta (Birabén), comb. nov. The following 31 species are newly described: C. adaga Ott & Bonaldo (Brazil, Colombia, Ecuador and Peru); C. atlantica Ott & Brescovit (Brazil); C. baja Ott & Ubick (Mexico); C. bandolera Ott & Harvey (Mexico & USA); C. boraceia Ott & Brescovit (Argentina and Brazil); C. campana Ott & Harvey (Chile); C. central Ott & Brescovit (Brazil); C. chicote Ott & Bonaldo (Brazil, Colombia, Ecuador and Peru); C. concepcion Ott & Harvey (Chile); C. iguazu Ott & Brescovit (Argentina and Brazil); C. itabaiana Ott & Brescovit (Brazil); C. laguna Ott & Ubick (Mexico); C. lavras Ott & Brescovit (Brazil); C. longisetosa Ott & Harvey (Costa Rica and Brazil); C. lorenzo Ott & Harvey (Guatemala); C. loreto Ott & Bonaldo (Peru); C. nayarit Ott & Harvey (Mexico); C. orellana Ott & Bonaldo (Ecuador); C. pauferro Ott & Brescovit (Brazil); C. peluda Ott & Harvey (Chile); C. pinheiral Ott & Brescovit (Brazil); C. pocone Ott & Brescovit (Brazil); C. punctata Ott & Brescovit (Brazil); C. quillota Ott & Harvey (Chile); C. rinconada Ott & Harvey (Chile); C. santamaria Ott & Brescovit (Argentina); C. similis Ott & Brescovit (Brazil); C. sternalis Ott & Bonaldo (Brazil); C. sur Ott & Ubick (Mexico); C. waorani Ott & Bonaldo (Ecuador); and C. zero Ott & Harvey (Mexico to Venezuela).
Ectopic Thymus: An Unusual Case of Subglottic Mass
Authors: Paraboschi Irene , Fati Federica , Rizzo Francesca , Sacco Oliviero , Stagnaro Nicola , Mattioli Girolamo , Simonini Alessandro , Mazzei Oscar , Torre Michele
Published: July 2019

Objectives:

The aim of our study is to report a case of a child with subglottic thymus that was suspected during diagnostic work-up for severe airway obstruction, excised surgically and confirmed with final histopathological examination. Moreover, we performed a narrative literature review to outline clinical and diagnostic features of this rare condition and to report suggestions for the management of subglottic masses.

Methods:

We report the case of a 7-month-old boy who was admitted to our Pediatric Airway Team Unit due to a history of worsening biphasic stridor and recurrent episodes of upper airway obstruction. The successful diagnostic work-up and a narrative literature of analogous cases of subglottic thymus were reported.

Results:

Ectopic thymus is a very rare condition in which thymic tissue is found outside the normal pathway of its embryonic migration. It usually presents as a cystic or, more rarely, solid mass, showing an indolent course toward spontaneous involution. In some cases, however, it becomes symptomatic exerting compression on surrounding vital structures. Due to its rarity, the initial diagnosis is normally mistaken with inflammatory diseases or malignancies and the definitive diagnosis is only achieved after histological examination of the excised specimen. To our knowledge, only four other cases of subglottic ectopic thymic tissue have been reported in the English literature so far and the diagnosis has never been suspected preoperatively.

Conclusion:

It is mandatory to consider ectopic thymic tissue in the differential diagnosis in children presenting with airways obstruction in order to prevent unnecessary, extensive, and exploratory surgery.
Combined Gas, Oxygen, Ether and Warmed Ether Apparatus
Authors: Hirsch C. T. W.
Published: July 2019

[The demonstration of this apparatus is published in extenso in the Lancet, July 13, 1918, p. 48 (with illustration).]
Some Observations on Diphtheria Carriers
Authors: McCartney J. E. , Harvey William C.
Published: July 2019

The results of the clinical examination of 288 diphtheria carriers, 300 diphtheria patients, and 100 diphtheria convalescents ready for discharge are given. It is shown that the proportion of abnormal conditions in the nose and throat of the carriers (94·1 per cent.) is higher than in the diphtheria patient group (73 per cent.), and considerably higher than in the recovered convalescent cases (52 per cent.). This is particularly noticeable when the proportion of cases with nasal abnormalities is considered in the three groups, namely, in carriers 72·2 per cent.; in diphtheria patients 42·6 per cent.; while in negative convalescent cases the figure is only 7 per cent. Further, the departures from normal in the recovered convalescents are generally enlarged but healthy looking tonsils which do not appear to interfere with the natural elimination of diphtheria bacilli during convalescence.

The greatest proportion of carriers is in the age group 1 to 5 years, and owing to the small size and anatomical complexities of the nasal passages, the pathological conditions tend to persist and make examination and treatment difficult. The figures indicate that the presence of pathological conditions in the nose and throat of diphtheria patients is conducive to the establishment of the carrier state.

It has been shown during the investigation that the presence of diphtheria bacilli in carriers is intermittent, and that there may be failure to isolate the organisms over long periods of time although the patient may still be infective.

It is emphasized that even three negative culture results are not sufficient to establish that a carrier is completely free from infection.
Note on Idiosyncrasies and Abnormalities in Human Beings
Authors: Weber F. Parkes
Published: July 2019

Idiosyncrasies are the expression of abnormal mental or physical reaction towards “agents.” An attempt is made to indicate the position of idiosyncrasies in a classified scheme of all abnormalities; but bodily idiosyncrasies due to an “allergic” or hypersensitive response to agents are mainly considered in the present paper. Migraine and mucous colic (“colitis mucosa”) are discussed in connexion with Freeman's view of food idiosyncrasies, hay fever, asthma, urticaria, angioneurotic œdema, &c., as manifestations of an “immunological abnormality or defect.”

The hypothesis that idiosyncratic hypersensitiveness towards physical agents, such as light, heat, cold and mechanical trauma, may in reality be the expression of reaction towards a histamine-like body, or protein of some kind (virtually a “foreign protein”) liberated in the tissues by the physical agent in question, is referred to, according to the works of W. W. Duke and Sir Thomas Lewis and his co-workers, and the writings of Sir Humphry Rolleston on the subject. A somewhat analogous explanation is suggested for the following conditions: an abnormally hypersensitive (eczema-like) reaction towards formalin lotions; epidermolysis bullosa; constitutional factitious urticaria in otherwise healthy individuals not suffering from ordinary urticaria; excessive liability to chilblains; so-called “erythrocyanosis” of the lower parts of the legs in girls and young women, and some cases of Raynaud's disease.

The significance of eosinophilia in cases of dermatitis herpetiformis and pemphigus is also alluded to.
Electro-Therapy 1910–1935, Including Experiments in the Induction of Artificial Fever
Authors: Heald C. B.
Published: July 2019

Recent advances in direct-current technique, especially the advantages of ionization with such drugs as histamine.

Faradic-current improvements, especially in connexion with the grid-glow valve; oscillo-graphic tracings of various modifications of this current.

Heat and electro-pyrexia examined in particular reference to the type of apparatus producing the most comfortable form of pyrexia in a one-hour's treatment. Advantages of inductothermy in producing hyperpyrexia.

Scope of hyperpyrexia treatments, in particular reference to their beneficial effects in gonorrhœa, neurosyphilis, asthma, arthritis, &c. Necessity for hyperpyrexia treatment to be under the charge of a qualified practitioner.

Progress in ultra-violet-light therapy. A new apparatus for treatment of lupus. Improved clinical results in cases of burns, pruritus, varicose ulcers and diseases of the lymphatic system. A strong band (about 10,000A°) not clinically recognized is present in a water-cooled Kromayer Lamp. Emphasis is laid upon the penetrative power of this beam and its powerful selective effect upon lymphatic tissues.
Some Recent Work on Barbiturates
Authors: Cameron G. R.
Published: July 2019

Toxic effects are sometimes seen after the administration of quite small amounts of barbiturates. Factors concerned in their production are discussed under the following heads:—

Barbiturates can produce liver damage, even hepatitis. Barbiturates may become toxic in the presence of liver damage, as shown by:— Clinical and post-mortem experience. Experimental evidence—the work of Pratt and Koppanyi in America and our own experiments showing that certain barbiturates may exert toxic effects not only when there is severe liver damage but also in the early stages of liver injury. Other factors also seem to be concerned:— Cold. Hæmorrhage. Fasting. Sepsis. Tight bandage around upper abdomen. Castration.

The experimental evidence for this statement is given.
Radiation Therapy in Tumours of Bone
Authors: Fulton J. Struthers
Published: July 2019

Radiation can be shown to produce satisfactory results in the treatment of simple bone cyst, chondroma, angioma, and benign giant-cell tumour. It is of particular value in benign giant-cell tumour where there are grounds for the opinion that it should largely replace surgical methods.

Surgery remains the methods of choice in the treatment of osteogenic sarcoma but where the lesion is inaccessible growth restraint may be obtained by the use of X-ray therapy.

Radiation, as a palliative measure, is of definite value in the treatment of bone metastases.

Myelomata are uniformly responsive to X-ray therapy, which is capable of prolonging life and relieving pain in these cases.

It is probable that radiation therapy is superior to surgery in treatment of Ewing's tumour if the diagnosis be made at an early stage of the disease.

Direct invasion of the bone by tumour should not be considered a contra-indication to radiation therapy, particularly if the tumour is of a type known to be radio-sensitive.
Discussion on the Therapeutic Value of Transfusion of Derivatives of Blood
Authors: Whitby L. E. H.
Published: July 2019

Transfusion may be performed for a large number of reasons wvhich must be clearly defined because almost all derivatives of blood lack one or more of properties of fresh blood and have, therefore, only a limited therapeutic value. The convenience of blood derivatives must not lead to improper use. War has led to the development of durable blood derivatives suitable for the blood volume restoration essential for the treatment of secondary shock. Stored blood over a certain age must be included in this category.

Experimental evaluation has placed the order of preferment for blood derivatives used for blood volume restoration as citrated plasma, serum, hoemoglobin-Ringer, gum saline, red cells in saline suspension, isotonic saline and glucose. Clinical evaluation of the advantages of plasma over serum and vice versa has not yet been fully decided. Serum preparation, dry or fluid, is technically much easier than plasma. For blood volume restoration in secondary shock there is required an innocuous protein fluid which is retained in the circulation. The amount that needs to be transfused is often incredibly large and must be at least 5o% of the volume lost; the effect requires to be carefully controlled by blood-pressure observations and clinical judgment. Rate also is important. Extensive experience has shown that though citrated plasma is eminently satisfactory it is an advantage to use a proportion of blood when the volume restoration needs to be large.
The Nature of Herpes Zoster: A Long-Term Study and a New Hypothesis
Authors: Hope-Simpson R Edgar
Published: July 2019

Dr Hope-Simpson presents a study of all cases of herpes zoster occurring in his general practice during a sixteen-year period. The rate was 3·4 per thousand per annum, rising with age, and the distribution of lesions reflected that of the varicella rash.

It was found that severity increased with age, but that the condition did not occur in epidemics, and that there was no characteristic seasonal variation. A low prevalence of varicella was usually associated with a high incidence of zoster.

Dr Hope-Simpson suggests that herpes zoster is a spontaneous manifestation of varicella infection. Following the primary infection (chickenpox), virus becomes latent in the sensory ganglia, where it can be reactivated from time to time (herpes zoster). Herpes zoster then represents an adaptation enabling varicella virus to survive for long periods, even without a continuous supply of persons susceptible to chickenpox.
Psychotropic Drugs (1) Interaction between Centrally Acting Drugs in Man: Some General Considerations
Authors: Shepherd Michael
Published: July 2019

As a biological phenomenon the interaction between drugs may be viewed in ‘explanatory’ or ‘empirical’ terms. In clinical psychopharmacology the former is rarely possible: two examples are cited, one concerning amphetamine and reserpine, the other desmethyl-imipramine and tetrabenazine. Among centrally acting substances, empirical studies of the interaction between alcohol and the barbiturates have been pursued intensively by several methods in clinic and laboratory. Both general considerations and recent work on the effects of amphetamine-barbiturate combinations suggest caution in the medical use of mixtures of psychotropic drugs. Adverse reactions caused by interaction between psychotropic drugs and other substances have still to be studied systematically as a potential hazard.
Changes and Trends in Family Structure in Taiwan, 1990 to 2010
Authors: Wang Ying-Ting , Yang Wen-Shan
Published: July 2019

Taiwan has experienced significant demographic changes since the late 20th century, including decreasing fertility rate, increasing life expectancy, postponement of marriage and childbearing, reduced marriage rate, and rise in divorce. These demographic trends are likely to change the family structure. The objective of this article is to describe and summarize the changes in family structure between 1990 and 2010 in Taiwan using the Population and Housing Census data. During this period, the average household size decreased from 4.1 to 3.0 persons per household. Also, the share of couple households with unmarried children decreased by 15.1%, and the share of single-person households increased by 8.6%. Nuclear-family households, though they became less common, remained the dominant household type. Single-person households surpassed stem-family households as the second most common household type in 2000 and 2010. Households that are at greater risk of economic hardship, such as single-parent households and skipped-generation households, also increased their respective share during this period.
Environmental and health risks related to waste incineration
Authors: de Titto Ernesto , Savino Atilio
Published: July 2019

The article presents a mini review of the published research focused on understanding environmental and human health impacts nearby waste incineration plants. We found no studies indicating that modern-technology waste incineration plants, which comply with the legislation on emissions, are a cancer risk factor or have adverse effects on reproduction or development. There are several factors in favor of this affirmation: (a) the emission levels of the plants currently built in the developed countries are several orders of magnitude lower than those of the plants in whose environments epidemiological studies have been carried out and which have found some kind of negative association in terms of health; (b) risk assessment studies indicate that most of the exposure is produced through the diet and not by a direct route; and (c) monitoring dioxin level studies in the population resident in the environment of incineration plants did not reveal increases of these levels when compared with a population living in reference areas. A necessary condition for the development of a waste incineration plant is to generate the conditions to prevent any impact that activates or potentially carries damage or risks to the environment and, in particular, to health. This makes it imperative to use a preventive strategy through the implementation of a previous environmental impact assessment and the establishment of emissions standards and an emissions monitoring program in order to ensure the prevention of environmental damage.
An uncommon disease with an under-recognised finding
Authors: Cheung Jonathan Chun-Hei , Kitchell Abdul Karim Bin , Law Kam Leung
Published: July 2019

A 44-year-old healthy man presented to the emergency department with left hip pain for a week. The physical exam did not point to a specific disease and his serum inflammatory markers were all increased. Point-of-care ultrasound was performed to help guide the management. The patient was able to receive definitive operation in a day.
Psychosocial Impacts of Immigration on Nigerian Immigrants in the United States: A Phenomenological Study
Authors: Ekwemalor Chukwudi C. , Ezeobele Ifeoma E.
Published: July 2019

Introduction. Nigerian immigrants constitute a major proportion of the increasing immigration trend from sub-Saharan Africa to the United States. However, limited studies exist on the psychosocial impacts of their immigration experiences. This phenomenological study, based on Husserlian philosophy, explored the perceptions of Nigerian immigrants about the psychosocial impacts of immigration to the United States. Method. Twenty Nigerian immigrants in Houston, Texas, constituting a purposive sample were interviewed face-to-face using semistructured guided questions and probes. Results. A thematic analysis using Giorgi’s approach revealed both positive and negative themes but mostly negative psychosocial experiences of migration to the United States. Discussion. The participants associated the most negative experiences with the lack of adequate preparation prior to migration and the cultural differences between the two countries. Notwithstanding that the findings of this study have health and immigration policy implications and increased awareness for potential immigrants, further studies are needed.
Nonlinear vibration of magnetoelectroelastic nanoscale shells embedded in elastic media in thermoelectromagnetic fields
Authors: Wang Yan Qing , Liu Yun Fei , Zu Jean W
Published: July 2019

This study investigates the nonlinear vibration of magnetoelectroelastic composite cylindrical nanoshells embedded in elastic media for the first time. The small-size effect and thermoelectromagnetic loadings are considered. Based on the nonlocal elasticity theory and Donnell’s nonlinear shell theory, the nonlinear governing equations and the corresponding boundary conditions are derived using Hamilton’s principle. Then, the Galerkin method is utilized to transform the governing equations into a nonlinear ordinary differential equation and subsequently the method of multiple scales is employed to obtain an approximate analytical solution to nonlinear frequency response. The present results are verified by the comparison with the published ones in the literature. Finally, an extensive parametric study is conducted to examine the effects of the nonlocal parameter, the external magnetic potential, the external electric potential, the temperature change, and the elastic media on the nonlinear vibration characteristics of magnetoelectroelastic composite nanoshells.
Should Antibiotic-Impregnated Cement Be Used During Primary Total Ankle Arthroplasty (TAA)?
Authors: Richter Jens
Published: July 2019

Recommendation:

Unknown. There is insufficient evidence for the routine use of antibiotic-impregnated cement during primary total ankle arthroplasty (TAA).

Level of Evidence:

Consensus.

Delegate Vote:

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
Should Treatment of Diabetic Foot Osteomyelitis Be Based on Bone Biopsies?
Authors: Heidari Nima , Kwok Iris , Vris Alexandros , Charalambous Alexander
Published: July 2019

Recommendation:

Yes. Bone biopsies play both a crucial diagnostic and interventional role in the management of diabetic foot infection. Although bone biopsies are not required in every case of diabetic foot infection, their most important role is in guiding accurate antibiotic treatment, as they provide more accurate microbiological information than superficial soft tissue samples in patients with diabetic foot osteomyelitis.

Level of Evidence:

Moderate.

Delegate Vote:

Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)
Functional Capacity Evaluation for Injuries to the Foot and Ankle
Authors: Idarraga Alexander J. , Wright-Chisem Adam , Bohl Daniel D. , Lee Simon , Lin Johnny , Holmes George B. , Hamid Kamran S.
Published: July 2019

Background:

The functional capacity evaluation (FCE) is used to determine physical ability after treatment of a workplace-related injury. This evaluation is a determinant in the administration of benefits and the decision to return to work (RTW). The purpose of this study was to characterize FCE results and ability to RTW after treatment for workplace-related orthopedic injuries to the foot or ankle.

Methods:

A retrospective medical record review from the practices of 4 orthopedic foot and ankle surgeons was conducted. Inclusion criteria were a workplace-related injury to the foot or ankle, at least 2 years of follow-up, and an associated FCE. The FCE report and clinic notes were used to determine the patient’s preinjury job requirement, postinjury FCE-determined ability, specific FCE- or physician-imposed work restrictions, and clearance to RTW. A total of 188 patients met inclusion criteria.

Results:

In total, 74.4% of patients had FCE-determined work abilities at or above their preinjury job requirements, and 63.3% of patients were cleared to RTW. The mean time from injury to FCE was 1.9 ± 1.5 years, and the mean time to clearance for RTW was 2.0 ± 1.3 years. A less strenuous preinjury job requirement was positively associated with both the FCE-determined ability meeting the preinjury job requirement ( P < .001) and clearance to RTW ( P = .034).

Conclusion:

Two in 3 patients were cleared to RTW following workplace-related injuries to the foot or ankle culminating in an FCE. However, it took a mean of 2 years to achieve this clearance. Patients with more strenuous jobs were less likely to be able to RTW after injury.

Level of Evidence:

Level III, retrospective comparative study.
Imagining genocide heritage: Material modes of development and preservation in Rwanda
Authors: Bolin Annalisa
Published: July 2019

The Rwandan government has undertaken ambitious development projects resulting in major changes to the country’s built environment, including the materiality of genocide heritage. This article focuses on the genocide memorials of Nyamata and Ntarama, arguing that these sites demonstrate how globally-circulating discourses of development and preservation are vernacularized, instantiated, and transformed in their encounter with the national imaginary. The forces that affect the material choices of heritage management here include Rwanda’s state-led imperative toward a particular physical ideal of development, UNESCO World Heritage-driven concepts of authenticity, and the Rwandan government’s need for evidence of genocide. Differently affecting each site, these factors result in multiple modes of material intervention. The article argues that the physical form of heritage sites is shaped by engagements between global and local discourses and ideals of heritage and development; these engagements direct the processes of preservation and intervention that ultimately determine how heritage is materialized.
Determinants of voluntary early retirement for older workers with and without chronic diseases: A Danish prospective study
Authors: Sewdas Ranu , Thorsen Sannie Vester , Boot Cécile R.L. , Bjørner Jakob Bue , Van der Beek Allard J.
Published: July 2019

Aims: This study explored differences in determinants (i.e. health-related, work-related and social factors) of voluntary early retirement between older workers with and without chronic diseases in Denmark. Methods: Workers aged 56–64 years who were members of a voluntary early retirement scheme were selected from the Danish National Working Environment Survey (2008–2009) and were followed in a public register for four years. Cox regression analyses were performed separately for older workers with and without chronic disease to identify the associations between determinants and voluntary early retirement. To explore the differences between groups, an interaction term between the determinant and having a chronic disease was included in the analyses for the total population. Results: Among 1861 eligible older workers, determinants associated with a higher risk of voluntary early retirement included poorer self-rated health, more depressive symptoms, a higher physical workload, lower job satisfaction and lower influence at work. For older workers with a chronic disease ( n=1185), the presence of work–family conflict was also associated with a higher risk of voluntary early retirement, whereas for those with no chronic disease ( n=676), a poorer relationship with colleagues was an additional determinant. Higher emotional demands, a higher work pace and higher quantitative demands were not significantly associated with voluntary early retirement for either group. None of the interaction terms was found to be statistically significant ( p>0.05). Conclusions: Determinants associated with voluntary early retirement did not significantly differ between older workers with or without a chronic disease in Denmark. We conclude that several health-related, work-related and social factors are important for prolonged labour force participation of older workers (with and without a chronic disease).
A semi-empirical laminar-to-turbulent flame transition model coupled with G equation for early flame kernel development and combustion in spark-ignition engines
Authors: Keum Seunghwan , Zhu Guangfei , Grover Ronald , Zeng Wei , Rutland Christopher , Kuo Tang-Wei
Published: July 2019

It has been reported that early combustion in a spark-ignition engine determines the subsequent combustion. Also, the early combustion has a very strong correlation with cycle-to-cycle variability, which limits engine operating range. As such, accurate modeling of the early flame development is very important in accurate simulation of spark-ignition engine combustion. During the early flame development, the flame kernel, initiated by spark, grows initially at laminar flame speed. As the kernel grows, the flame surface wrinkles due to surface instability and interacts with the flow turbulence as the flame transitions from laminar to turbulent flame. In this study, a semi-empirical model is proposed to simulate the laminar-to-turbulent flame transition process during early spark-ignition combustion. A hyperbolic tangent function was used to emulate the laminar-to-turbulent flame speed transition process. The proposed transition function was evaluated during early flame kernel development for both Reynolds-averaged Navier–Stokes and large eddy simulation models against combustion analysis data from high-speed optical particle image velocimetry. Difference in Reynolds-averaged Navier–Stokes and large eddy simulation transition function was analyzed and discussed.
Determinants of caregiver burden in heart failure: does caregiver contribution to heart failure patient self-care increase caregiver burden?
Authors: Durante Angela , Greco Andrea , Annoni Anna Maria , Steca Patrizia , Alvaro Rosaria , Vellone Ercole
Published: July 2019

Background:

The burden is high in caregivers of heart failure patients, but the literature on patient and caregiver predictors of caregiver burden is inconsistent. Also, it is unknown if caregiver contribution to heart failure self-care maintenance (i.e. helping patients to maintain heart failure stable) and self-care management (i.e. helping patients to act in case of heart failure worsening) increases caregiver burden.

Aims:

To identify caregiver and patient predictors of caregiver burden in heart failure; and to evaluate if caregiver contribution to heart failure self-care maintenance and management increases caregiver burden.

Methods:

A cross-sectional study with the enrolment of 505 caregivers of heart failure patients. We used the caregiver burden inventory and the caregiver contribution to self-care of heart failure index. We analysed the data using hierarchical regression.

Results:

Heart failure caregivers, mostly women (52.5%), with a mean age 56.5 (±14.9) years, cared for heart failure patients, mostly men (55.2%), with a mean age of 75.9 (±10.4) years. Caregiver predictors of higher caregiver burden were older age, female gender, fewer caregiving hours and poor social support. Patient predictors of higher caregiver burden were older age, better education, taking fewer medications and higher quality of life. Caregiver contribution to self-care maintenance and management were not significant predictors of caregiver burden.

Conclusions:

Our results could help providers to identify heart failure caregivers who are more exposed to burden. As caregiver contribution to heart failure self-care improves patient outcomes and seems not burdensome for caregivers, providers may consider educating caregivers about self-care as a viable option for improving patient outcomes without increasing caregiver burden.
Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus
Authors: Liu Xian-Liang , Willis Karen , Fulbrook Paul , Wu Chiung-Jung (Jo) , Shi Yan , Johnson Maree
Published: July 2019

Background:

Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus.

Methods:

This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed.

Results:

Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects.

Conclusions:

Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.
Hydroelasticity of the barge near island affected by bathymetry based on THAFTS software
Authors: Lu Ye , Temarel Pandeli , Zhou Ye , Tian Chao
Published: July 2019

Floating structures are sometimes deployed in shallow water areas close to reefs and islands as facilities serving tourists. In contrast to the open sea, the marine environment, such as wave and current, in the nearshore shallow water area will be affected by the non-uniform complex seabed bottom, and the hydrodynamic interaction between the floating structure and the seabed bathymetry should be investigated, instead of being ignored as the case when a uniform seabed is assumed. A hydroelastic analysis method for slowly varying water depths is proposed to calculate the hydroelastic responses of the floating structures, considering the seabed as a fixed boundary condition. This method was integrated into the software THAFTS (Three Dimension Hydroelastic Analysis of Floating and Translating, developed by China Ship Scientific Research Center). Based on the THAFTS software, the three-dimensional hydroelastic motion response analysis of a barge is carried out, in which the effects of different water depths and the complex bathymetry are investigated by comparing the results of the motion and structural responses of the barge. The stress distribution of the barge with the effect of the bathymetry taken into account is presented in this article as well as the modal stresses. The strength evaluation of the barge indicates that the effect of the inhomogeneous seabed plays a large role in the dynamic responses of the barge when it is deployed near reefs.
Research on shore-based intelligent vessel support system based on multi-source navigation sensors simulation
Authors: Yang Xiao , Lian Jing-jing , Ren Hongxiang
Published: July 2019

Under the guidance of industry 4.0, peoples pay more attention to the intelligent equipment and system. Intelligent vessel without crew on board has acquired growing attention worldwide over the years. The navigation condition of intelligent vessel without crew at sea should be monitored and controlled by the shore-based intelligent vessel support system. The navigation-related data collected by the multi-source navigation sensors should be presented on the shore-based support system in an efficient and friendly way. This article presents a simulation model for multi-source navigation sensors such as echo sounder and electronic position-fixing system. Furthermore, this work proposes an efficient architecture for the shore-based support system by way of multi-source navigation sensors simulation. The results show that the simulation model of multi-source navigation sensors is efficient for the simulation of echo sounder and electronic position-fixing system. The shore-based intelligent vessel support system based on multi-source navigation sensors simulation can present navigation-related data and monitor the condition of intelligent vessel at sea.
Violence, emotion and place: The case of five murders involving sex workers
Authors: Wattis Louise
Published: July 2019

This article examines a series of murders involving young women linked to sex work, which occurred in the same Northern town between 1998 and 2003. It explores the case on a number of levels. First, it situates violence, and these murders specifically, in the localised spaces of advanced marginality, which follow in the wake of deindustrialisation and economic decline. Second, the article links these murders to sex workers’ disproportionate vulnerability to violence as a result of social stigma and situational risk. However, informed by auto-ethnography and the growing recognition that there is potential for academic analysis within criminology to include the criminologist’s own emotional engagement, the discussion moves on to explore the author’s personal reflection on this series of murders derived from vicarious connection and proximity to victims. In addition, the author draws on the concepts of spectrality and haunting, which have gained currency across the social sciences, to illuminate the irrevocable connections between place, violence and emotion at the level of the local. The concept of spectrality offers a means of envisaging how the past continues to occupy and disrupt the present. Studies of place deploy spectrality and the figure of the ghost to consider how acts of violence and atrocity transform the essence of physical and social space. For the purposes of this article, the concept of haunting is used to explore these young women’s lives and deaths, which retain a strong presence in the collective memory due to their powerful connections to place, as well as the cultural work of the media in keeping them alive in the local imagination. Finally, the political potential of haunting – as a means to confront past and ongoing injustices, is also considered, which draws attention to the combined structural conditions in which these young women were murdered.
Sociodemographic Factors and Stage of Cancer at Diagnosis: A Population-Based Study in South India
Authors: Mathew Aleyamma , George Preethi Sara , Ramadas Kunnambath , Mathew Beela Sarah , Kumar Aswin , Roshni Sivasevan , Jayakumar Krishnan Nair Lalithamma , Booth Christopher M.
Published: July 2019

PURPOSE

Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India.

METHODS

We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung).

RESULTS

The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350).

CONCLUSION

A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.
Microcosting Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi
Authors: Painschab Matthew S. , Kohler Racquel E. , Kasonkanji Edwards , Zuze Takondwa , Kaimila Bongani , Nyasosela Richard , Nyirenda Ruth , Krysiak Robert , Gopal Satish
Published: July 2019

PURPOSE

To describe the cost of treating diffuse large B-cell lymphoma (DLBCL) in Malawi under the following circumstances: (1) palliation only, (2) first-line cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), (3) salvage etoposide, ifosfamide, and cisplatin (EPIC), and (4) salvage gemcitabine and oxaliplatin (GEMOX).

METHODS

We conducted a microcosting analysis from the health system perspective in the context of a prospective cohort study at a national teaching hospital in Lilongwe, Malawi. Clinical outcomes data were derived from previously published literature from the cohort. Cost data were collected for treatment and 2-year follow-up, reflecting costs incurred by the research institution or referral hospital for goods and services. Costs were collected in Malawian kwacha, inflated and converted to 2017 US dollars.

RESULTS

On a per-patient basis, palliative care alone cost $728 per person. Total costs for first-line treatment with CHOP chemotherapy was $1,844, of which chemotherapy drugs made up 15%. Separate salvage EPIC and GEMOX cost $2,597 and $3,176, respectively. Chemotherapy drugs accounted for 30% of EPIC and 47% of GEMOX.

CONCLUSION

To our knowledge, this is among the first published efforts to characterize detailed costs of cancer treatment in sub-Saharan Africa. The per-patient cost of first-line treatment of DLBCL in Malawi is low relative to high-income countries, suggesting that investments in fixed-duration, curative-intent DLBCL treatment may be attractive in sub-Saharan Africa. Salvage treatment of relapsed/refractory DLBCL costs much more than first-line therapy. Formal cost-effectiveness modeling for CHOP and salvage treatment in the Malawian and other low-resource settings is needed to inform decision makers about optimal use of resources for cancer treatment.
Standardizing Febrile Neutropenia Management: Antimicrobial Stewardship in the Hematologic Malignancy Population
Authors: O’Horo John C. , Marcelin Jasmine R. , Abu Saleh Omar M. , Barwise Amelia K. , Odean Patricia M. , Rivera Christina G. , Tande Aaron J. , Wilson John W. , Osmon Douglas R. , Tosh Pritish K.
Published: July 2019

Patients with febrile neutropenia (FN) often are subject to antibiotic and diagnostic test overuse. We sought to improve appropriate use of antimicrobials and diagnostic tests for patients with FN. We used a blended quality approach with Lean Six Sigma tools and iterative improvement of a clinical decision aid to guide providers through empirical antimicrobial selection and diagnostic evaluation of patients with FN during a yearlong period. We evaluated the incidence of nonadherence to best practice before, during, and after rollout of a clinical decision aid in conjunction with an educational initiative. At baseline, 71% of patients with FN had at least one critical deviation from best practice. During the project, the percentage decreased to 27.3%; 4 months after the project was completed, the percentage was 33.3% ( P = .04). A clinical decision aid can improve adherence to best practices for the empirical management of FN.
Models of Pediatric Palliative Oncology Outpatient Care—Benefits, Challenges, and Opportunities
Authors: Brock Katharine E. , Snaman Jennifer M. , Kaye Erica C. , Bower Kimberly A. , Weaver Meaghann S. , Baker Justin N. , Wolfe Joanne , Ullrich Christina
Published: July 2019

PURPOSE:

Although the bulk of current pediatric palliative care (PPC) services are concentrated in inpatient settings, the vast majority of clinical care, symptom assessment and management, decision-making, and advance care planning occurs in the outpatient and home settings. As integrated PPC/pediatric oncology becomes the standard of care, novel pediatric palliative oncology (PPO) outpatient models are emerging. The optimal PPO model is unknown and likely varies on the basis of institutional culture, resources, space, and personnel.

METHODS:

We review five institutions’ unique outpatient PPO clinical models with their respective benefits and challenges. This review offers pragmatic guidance regarding PPO clinic development, implementation, and resource allocation.

RESULTS:

Specific examples include a floating clinic model, embedded disease-specific PPC experts, embedded consultative or trigger-based supportive care clinics, and telehealth clinics.

CONCLUSION:

Organizations that have overcome personnel, funding, and logistical challenges can serve as role models for centers developing PPO clinic models. In the absence of a one-size-fits-all model, pediatric oncology and PPC groups can select, tailor, and implement the model that best suits their respective personnel, needs, and capacities. Emerging PPO clinics must balance the challenges and opportunities unique to their organization, with the goal of providing high-quality PPC for children with cancer and their families.
Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups
Authors: White Andrew A , McIlraith Thomas , Chivu Anton M , Cyrus Rachel , Cockerham Christopher , Vora Hardik , Vulgamore Patrick
Published: July 2019

BACKGROUND

Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue.

OBJECTIVE

To describe current attitudes and beliefs of hospital executives regarding the value of contributions made by HMGs.

DESIGN

Thematic content analysis of key informant interviews.

PARTICIPANTS

Twenty‐four healthcare institutional leaders, including hospital presidents, chief medical officers, chief executive officers, and chief financial officers. Participants comprised a diverse sample from all regions in the United States, including rural, suburban, and urban locations, and academic and nonacademic institutions.

RESULTS

Executives highly valued hospitalist groups that demonstrate alignment with hospital priorities, and often used this concept to summarize the HMG's success across several value domains. Most executives evaluated only a few key HMG metrics, but almost no executives reported calculating the HMG return on investment by summing pertinent quantitative contributions. Respondents described an evolving concept of hospitalist value and believed that HMGs generate substantial value that is difficult to measure financially.

CONCLUSIONS

Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG's broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.