bluuebunny/crossref_metadata_2025 huggingface dataset:
How power states and others’ statuses influence status consumption: The role of signaling effectiveness
Authors: Jin Xiaotong , Xu Wei , Wang Yan
Published: January 2018

This research aims to examine how power states and others’ statuses interact to influence status consumption. Specifically, consumers in low-power states are more inclined to engage in status consumption than those in high-power states when others’ statuses are superior. However, consumers in high-power states are more inclined to engage in status consumption than those in low-power states when others’ statuses are inferior. Signaling effectiveness plays a mediating role in the interaction effect of power states and others’ statuses on status consumption. Two studies were conducted to test our hypotheses. Study 1 tested how others’ statuses moderate the effects of power states on status consumption and how signaling effectiveness mediates the moderating role of others’ statuses on the effects of power states on status consumption. Study 2 further tested the two hypotheses in a different scenario through the sense of the power scale used to measure the power state. This research confirms the effects of power states on status consumption depending on others’ statuses and the fundamental mechanism of status consumption. The theoretical contributions and practical implications are of value for both researchers and managers.
Love as a core value in veterinary and medical practice: Towards a humanimal clinical ethics?
Authors: Gallagher Ann , Watson Fraje , Fitzpatrick Noel
Published: January 2018

This article represents the outcome of a dialogue between a vet and a healthcare ethicist on the theme of ‘love’ in professional life. We focus on four types or varieties of love (eros, agape, philia and storge) in relation to the professional care of humans and animals. We discuss the relevance of Fromm’s core elements of love (care, responsibility, respect and knowledge) and consider the implications of these for human and animal health care practice. We present and respond to five arguments that might be waged against embracing love as a professional value in veterinary and medical practice. We argue that a moderated love can and should be reclaimed as a contemporary professional value. It is most helpfully contextualised within virtue ethics or care ethics. We suggest that love is a rich starting point from which to launch an exploration of an interprofessional humanimal clinical ethics.
Conscientious objection: a morally insupportable misuse of authority
Authors: Shahvisi Arianne
Published: January 2018

In this paper, I argue that the conscience clause around abortion provision in England, Scotland and Wales is inadequate for two reasons. First, the patient and doctor are differently situated with respect to social power. Doctors occupy a position of significant moral and epistemic authority with respect to their patients, who are vulnerable and relatively disempowered. Doctors are rightly required to disclose their conscientious objection, but given the positioning of the patient and doctor, the act of doing so exploits the authority of the medical establishment in asserting the legitimacy of a particular moral view. Second, the conscientious objector plays an unusual and self-defeating moral role. Since she must immediately refer the patient on to another doctor who does not hold a conscientious objection, she becomes complicit, via her necessary causal role, in the implementation of the procedure. This means that doctors are not able to prevent abortions, rather, they are required to ensure that they are carried out, albeit by others. Since removing the disclosure and referral requirements may prevent patients from accessing standard medical care, the conscience clause should instead be revoked, and those opposed to abortion should be encouraged to select other specialities or professions. This would protect patients from judgement, and doctors from complicity.
Error trawling and fringe decision competence: Ethical hazards in monitoring and address patient decision capacity in clinical practice
Authors: Hartvigsson Thomas , Munthe Christian , Forsander Gun
Published: January 2018

This article addresses how health professionals should monitor and safeguard their patients’ ability to participate in making clinical decisions and making subsequent decisions regarding the implementation of their treatment plan. Patient participation in clinical decision-making is essential, e.g. in self-care, where patients are responsible for most ongoing care. We argue that one common, fact-oriented patient education strategy may in practice easily tend to take a destructive form that we call error trawling. Illustrating with empirical findings from a video study of consultations between clinicians and adolescent patients with diabetes, we argue on independent grounds that this strategy not only risks to overlook significant weaknesses in patient decision competence, but also to undermine patient capacity for decision-making and implementing care. In effect, this strategy for clinically monitoring and addressing the problem of fragile decision-making capacity brings hazards in need of address. We close by suggesting complementary and alternative strategies, and comment on how these may call for broadened competency among clinical health professionals.
“Es como una Familia”: Bridging Emotional Support With Academic and Professional Development Through the Acquisition of Capital in Latinx Student Organizations
Authors: Luedke Courtney L.
Published: January 2018

This study explored the ways Latinx-based organizations assist students in navigating college and career preparation. Data consist of in-depth interviews with 17 first-generation Latinx students attending two predominantly White institutions in the Midwest. I employed Bourdieu’s social reproduction theory to examine the ways Latinx student organizations cultivate social and cultural capital among participants. Findings reveal that peers in Latinx-based organizations share capital relevant to navigating college, academics, and career development.
REHEARSAL Using Patient-Specific Simulation to Improve Endovascular Efficiency
Authors: Wooster Mathew , Doyle Adam , Hislop Sean , Glocker Roan , Armstrong Paul , Singh Michael , Illig Karl A.
Published: January 2018

Objective:

To determine whether rehearsal using patient-specific information loaded onto an endovascular simulator prior to carotid stenting improves procedural efficiency and outcomes.

Methods:

Patients scheduled for carotid artery stenting who had adequate preoperative computed tomography (CT) imaging were considered for enrollment. After obtaining informed consent, patients were randomized to control versus rehearsal groups. Those in the rehearsal group had their CT scans loaded into an endovascular simulator (Angio Mentor) followed by case rehearsal by the attending on the simulator within 24 hours prior to the procedure; control patients underwent routine carotid stenting without rehearsal. Contrast usage, fluoroscopy time, and timing of procedural steps were recorded by a blinded observer during the actual case to determine benefit.

Results:

Fifteen patients were enrolled, with 6 patients randomized to the rehearsal group and 9 to the control. All measures showed improvement in the rehearsal group: Mean contrast volume (59.2 vs 76.9 mL), fluoroscopy time (11.4 vs 19.4 minutes), overall operative time (31.9 vs 42.5 minutes), time to common carotid sheath placement (17.0 vs 23.3 minutes), and total carotid sheath dwell time (14.9 vs 19.2 minutes) were all lower (more favorable) in the rehearsal group. The study was terminated early due to the lack of simulator access, and all P values were thus greater than .05 due to the lack of power. No strokes or other adverse events occurred in either group.

Conclusion:

Case-specific simulator rehearsal using patient-specific imaging prior to carotid stenting is associated with numerically less contrast usage, operative time, and radiation exposure, although this study was underpowered.
Research Brief: Self-Reports of a Constellation of Persistent Antiandrogenic, Estrogenic, Physical, and Psychological Effects of Finasteride Usage Among Men
Authors: Walf Alicia A. , Kaurejo Shan , Frye Cheryl A.
Published: January 2018

Our research objective is to understand more, through subjective, self-reports on discussion boards/forums, persons’ experiences associated with the use of drugs that alter androgen metabolism, such as finasteride. Finasteride is an orally active, specific inhibitor of 5α-reductase, which is localized to many androgen-dependent tissues. Finasteride inhibits the conversion of testosterone (T) to dihydrotestosterone (DHT), and is commonly used to treat benign prostatic hypertrophy (BPH) and male pattern baldness (MPB), both disorders associated with elevated DHT levels and 5α-reductase activity in the prostate and hair follicles, respectively. It is now acknowledged that long-term use and discontinuation of finasteride has adverse effects (AEs); however, these claims have not been well documented. In this study, discussion board posts (forums) were analyzed as self-reports of what finasteride users indicate is problematic for them. Reports were categorized by the age of subjects as well as the types of AEs described: antiandrogenic, estrogenic, central, and nonspecific/severe. A total of 244 cases were recorded and analyzed on the discussion forum on propeciahelp.com . Among these, 74 (32%) cases reported antiandrogenic affects, 43 (19%) reported estrogenic effects, 70 (30%) reported central effects, 11 (5%) reported nonspecific/severe AEs, and 31 (14%) reported AEs in all categories. The categorization of AEs may prompt further investigation into the pathophysiology of post-finasteride syndrome (PFS). Also, subjective reports may engender greater understanding of the perceived lasting AEs of finasteride.
Amniotic Constriction Bands: Secondary Deformities and Their Treatments
Authors: Drury Benjamin T. , Rayan Ghazi M.
Published: January 2018

Background: The purpose of this study was to report the surgical treatment experience of patients with amniotic constriction bands (ACB) over a 35-year interval and detail consequential limb deformities with emphasis on hands and upper extremities, along with the nature and frequency of their surgical treatment methods. Methods: Fifty-one patients were identified; 26 were males and 25 females. The total number of deformities was listed. The total number of operations, individual procedures, and operations plus procedures that were done for each patient and their frequency were recorded. Results: The total number of operations was 117, and total number of procedures was 341. More procedures were performed on the upper extremity (85%) than the lower extremity (15%). Including the primary deformity ACB, 16 different hand deformities secondary to ACB were encountered. Sixteen different surgical methods for the upper extremity were utilized; a primary procedure for ACB and secondary reconstructions for all secondary deformities. Average age at the time of the first procedure was 9.3 months. The most common procedures performed, in order of frequency, were excision of ACB plus Z-plasty, release of partial syndactyly, release of fenestrated syndactyly, full-thickness skin grafts, resection of digital bony overgrowth from amputation stumps, and deepening of first and other digital web spaces. Conclusions: Many hand and upper extremity deformities secondary to ACB are encountered. Children with ACB may require more than one operation including multiple procedures. Numerous surgical methods of reconstruction for these children’s secondary deformities are necessary in addition to the customary primary procedure of excision of ACB and Z-plasty.
Perception of work-related empowerment of nurse managers
Authors: Trus Marija , Doran Diane , Martinkenas Arvydas , Asikainen Paula , Suominen Tarja
Published: January 2018

Purpose/Aim

The paper aims to analyse the perception of being empowered according to the self-evaluation of nurse managers, presenting it as structural and psychological empowerment.

Methods

A questionnaire-based study was conducted. The sample consisted of 193 nurse managers working in a total of seven university and general level hospitals in Lithuania. The Conditions of Work Effectiveness Questionnaire-II measuring structural empowerment and the Work Empowerment Questionnaire measuring psychological empowerment were used.

Results

The paper reveals that nurse managers experienced structural empowerment at a moderate level and were highly psychologically empowered.

Conclusions

These findings are in line with previous research. The results showed that particular background factors were related to aspects of empowerment. The findings of this research can be used to examine the structural and psychological aspects that function as barriers to feeling empowered. The results are also useful for chief nurses who are involved in the recruitment and retention of nurse managers. Further research is needed to look into the question of improving formal power issues, e.g. the rewards for innovation at work, and also outcome empowerment aspects that may affect changes in the way that nurse managers carry out their work.
The influence of personality and working memory capacity on implicit learning
Authors: Guzmán Muñoz Francisco Javier
Published: January 2018

The main objective of this study was to influence implicit learning through two different classical manipulations and to inspect whether working memory capacity (WMC) and personality were related to the different measures of learning. With that purpose, in Experiment 1 we asked 172 undergraduate students of psychology to perform a serial reaction time (SRT) task under single- or dual-task conditions and to complete a WMC task and a personality test. In Experiment 2, 164 students performed the SRT task under incidental or intentional conditions and also filled a WMC task and a personality test. In both experiments, WMC influenced learning, but this relation was found only when attention was not loaded (Experiment 1) or when intentional instructions were given (Experiment 2). The pattern of relations with personality, although more varied, also showed a commonality between both experiments: learning under the most implicit conditions correlated positively with extraversion.
‘Showing’ the Way
Authors: Fazey Cath , Jones Iolen , Morris Joanne , Smith Jan
Published: January 2018

This article arises from the involvement of two complete theatre teams in a project to develop quality teaching and assessment in technical and operative procedures in general surgery. It gives the personal accounts of three scrub nurses who through reflective practice explore their own contribution to the teaching of senior surgical house officers (SHOs) and junior doctors within their working environment.
Tanzania a Personal Reflection
Authors: Gilmour Diane
Published: January 2018

Looking out of the aeroplane window at the first glimpses of the East African coast the adventure became reality. Despite months of injections, applying for a visa and lesson planning, being in Tanzania was not fully grasped until that point. To be honest I was nervous and apprehensive. This was something so very different from anything I had ever done before. From the minute we arrived until the minute we left the activity was non-stop and it is only now with time that I am able to fully understand and reflect on the adventure and its impact.
The Kolff Artificial Kidney
Authors: Ellis Harold
Published: January 2018

Nowadays renal dialysis, with its sleek, compact machinery, is a routine, somewhat taken for granted procedure in our hospitals. The development of this life-saving apparatus, initiated by a young Dutch physician during the Nazi occupation of his country, is a fascinating story.
The Risks of Surgery in HIV-Infected Patients
Authors: Nelson Lisa , Fried Mike , Stewart Kenneth
Published: January 2018

There are increasing demands for surgical interventions in Human Immunodeficiency Virus (HIV)-infected patients as a consequence of antiretroviral therapy. This article will discuss various risk factors involved in the surgical management of patients with HIV infection including: anaesthetic and surgical risk to patients with HIV infection undergoing surgical procedures; risk to healthcare professionals involved in the treatment of HIV-infected patients; and measures taken to ensure a safe and optimal outcome from surgery.
Physician decision making in anticoagulating atrial fibrillation: a prospective survey of a physician notification system for atrial fibrillation detected on cardiac implantable electronic devices of patients at increased risk of stroke
Authors: Cloutier Justin M. , Khoo Clarence , Hiebert Brett , Wassef Anthony , Seifer Colette M.
Published: January 2018

Objectives:

The objectives of this study were to evaluate the effectiveness of a physician notification system for atrial fibrillation (AF) detected on cardiac devices, and to assess predictors of anticoagulation in patients with device-detected AF.

Methods:

In 2013, a physician notification system for AF detected on a patient’s CIED [including pacemakers, implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT) devices] was implemented, with a recommendation to consider oral anticoagulation in high-risk patients. We prospectively investigated the effectiveness of this system, and evaluated both patient and physician predictors of anticoagulation, as well as factors influencing physician decision making in prescribing anticoagulation. Both uni- and multivariable analysis as well as descriptive statistics were used in the analysis.

Results:

We identified 177 patients with device-detected AF, 126 with a CHADS2 ⩾2. Only 41% were prescribed anticoagulation at any point within 12 months. On multivariable analysis, stroke risk as predicted by CHADS2 was not a predictor of anticoagulation. ASA use predicted a lower rate of anticoagulation (OR 0.39, 95% CI 0.16–0.97, p = 0.04); physicians in practice for <20 years were more likely to prescribe anticoagulation (OR 3.39, 95% CI 1.28–8.93, p = 0.01); and physicians who believed both cardiologist and family doctor should be involved in managing anticoagulation were more likely to prescribe anticoagulation (OR 3.28, 95% CI 1.02–10.5, p = 0.05).

Conclusions:

Patients on aspirin were less likely to be anticoagulated. Physicians in practice for <20 years and who believed that both the general practitioner and cardiologist should be involved in managing anticoagulants were more likely to prescribe anticoagulation.
Generous corporations? A Maussian analysis of international drug donations
Authors: Guilbaud Auriane
Published: January 2018

In this article, I claim that using Marcel Mauss’ The Gift can prove fruitful in analyzing pharmaceutical donations, the role of interests in gift-giving, the complex intertwining of the domains of the gift and commerce, and in contributing to a theory of social justice. Drug donations refer to the practice of giving medicines “for free,” outside of the drug market, with the ultimate goal of reaching populations in need. So an object (a drug) otherwise sold on the market (even if sometimes at a subsidized price), and usually subject to a specific commercial process, enters a different circuit and distribution system. Yet, even if drug donations seem to break with the logic of exchange constitutive of the market, they are intimately linked to market dynamics. This is especially true in the case of corporate drug donations, because of the nature of the donor and the presence of ulterior motives. Accordingly, this practice can be explained with the help of a Maussian understanding of the gift, where gift-giving is not disinterested and does not have to result from pure altruism, but can very well be part of a larger process of accumulating wealth and power.
Correlation Between Third Trimester Glycemic Variability in Non-Insulin-Dependent Gestational Diabetes Mellitus and Adverse Pregnancy and Fetal Outcomes
Authors: Panyakat Wanwadee Sapmee , Phatihattakorn Chayawat , Sriwijitkamol Apiradee , Sunsaneevithayakul Prasert , Phaophan Amprapha , Phichitkanka Aporn
Published: January 2018

Background:

Gestational diabetes mellitus (GDM) is a pregnancy-related metabolic complication. Despite optimal glycemic control from self-monitoring blood glucose (SMBG) in non-insulin-dependent GDM, variations in pregnancy outcomes persist. Glycemic variability is believed to be a factor that causes adverse pregnancy outcomes. Continuous glucose monitoring system (CGMS) detects interstitial glucose values every 5 minutes, and glycemic variability data from CGMS during the third trimester may be a predictor of fetal birth weight and pregnancy outcomes. The aim of this study was to investigate correlation between third trimester glycemic variability in non-insulin-dependent GDM and fetal birth weight.

Method:

This prospective study was conducted in 55 pregnant volunteers with non-insulin-dependent GDM that were recruited at 28 to 32 weeks’ gestation from the outpatient clinic of the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital during the study period of August 1 to December 31, 2016. Patients had CGMS installed for at least 72 hours and glycemic variability data were analyzed.

Results:

Of 55 enrolled volunteers, the data from 47 women were included in the analysis. Mean CGMS duration was 85.5 ± 12.83 hours. No statistically significant correlation was identified between glycemic variability in third trimester and birth weight percentiles, or between third trimester CGMS parameters and pregnancy outcomes in the study.

Conclusion:

Based on these findings, third trimester glycemic variability data from CGMS are not a predictor of fetal birth weight percentile, and no significant association was found between CGMS parameters and adverse pregnancy outcomes; thus, CGMS is not necessary in non-insulin-dependent GDM.
Immediate Weight Bearing After Hallux Valgus Correction Using Locking Plate Fixation of the Ludloff Osteotomy: A Retrospective Review
Authors: Neufeld Steven K. , Marcel John J. , Campbell Michael
Published: January 2018

Background. A Ludloff osteotomy is a common procedure used to correct hallux valgus deformities. Traditionally, the osteotomy is stabilized with screws only, thus requiring the patient to be non–weight bearing until healed. There have been no outcome studies analyzing immediate weight bearing after Ludloff osteotomy for hallux valgus. Methods. Of the 350 patients (390 feet) who underwent a Ludloff osteotomy fixed with a locking plate and prescribed an immediate weight-bearing postoperative protocol, 288 patients (326 feet) were included in the analysis. Average radiographic follow-up was 8 months, and hallux-valgus angle (HVA), intermetatarsal angle (IMA), and any hardware failures or hypertrophic callus formation were recorded. The Foot Function Index (FFI) was assessed in 103 patients at an average of 44 months postoperatively. Results. Average IMA and HVA correction were 7.6° and 21.6°, respectively (P < .0001). Loss of HVA and IMA correction of 4.6° and 2.3°, respectively, were noted between the initial postoperative films and final weight-bearing films. The average FFI score calculated for the 103 respondents was 10.4 out of a possible 100, indicating relatively low pain and disability. Complication rates were consistent with most other published postoperative protocols, with the most commonly seen being superficial infection (4.9%) and symptomatic hardware (4.6%). Conclusion. An immediate weight-bearing protocol for Ludloff osteotomies fixed with locking plates results in recurrence rates that are similar to those found with other protocols. Patient function is quite high and pain low following this protocol. The most commonly observed complications were superficial infection and symptomatic hardware requiring removal.

Levels of Evidence: Level IV
Setting Up a Horizon Scanning System: A U.S. Federal Agency Example
Authors: Hines Andy , Bengston David N. , Dockry Michael J. , Cowart Adam
Published: January 2018

Managers and policy makers are continually working toward a desired future within a context of rapid and turbulent change. To be effective in this context, they must look ahead to anticipate emerging trends, issues, opportunities, and threats. Horizon scanning is a foresight method that can help managers and policy makers develop and maintain a broad and externally focused forward view to anticipate and align decisions with both emerging (near-term) and long-term futures. This article reports on the design and early stage development and implementation of a horizon scanning system established for the U.S. Forest Service (USFS), Strategic Foresight Group, and developed cooperatively with the University of Houston Foresight Program. The goal of the project is to develop an ongoing horizon scanning system as an input to developing environmental foresight: insight into future environmental challenges and opportunities, and the ability to apply that insight to prepare for a sustainable future. In addition, the horizon scanning system is supported by volunteers from within the Forest Service. By including participants from throughout the Forest Service, the project seeks to foster a culture of foresight within the organization, and eventually to develop a more forward looking organizational structure for the USFS and other natural resource management agencies. Lessons learned from the experience to date are shared as well as future challenges for keeping the horizon scanning system in good working order—current, relevant, and consistent.
Leadership style of nurse managers as perceived by registered nurses: A cross-sectional survey
Authors: Goh Andy Ming Jin , Ang Shin Yuh , Della Phillip Roy
Published: January 2018

Given rapid changes in the health care landscape, nurse leaders need to be equipped with effective leadership skills. Those who are aware of their styles of working and its impact on their employees could adopt a better leadership style. The study aim was to assess the leadership styles of nurse leaders, as perceived by their employees. The secondary objectives were to explore differences between self-ratings and others’ ratings of leadership styles, as well as correlation between perceived leadership styles and organisational outcomes. A cross-sectional survey was conducted among registered nurses from four inpatient wards in an acute tertiary hospital in Singapore. Respondents were asked to complete a questionnaire that consisted of demographic questions, the Multifactor Leadership Questionnaire and the Organizational Commitment Questionnaire, as well as a Three-index item Questionnaire, to elicit turnover intention. A total of 111 completed surveys (37% response) were received. Overall, registered nurses reported that their nurse leaders exhibited both transformational and transactional leadership behaviours and, to a lesser extent, laissez-faire. Of interest was the finding that nurse leaders in this study tend to rate themselves higher than others rate them. The results implied a need to incorporate self-awareness elements in nursing leadership development programmes.
Student-initiated use of technology – Friend and foe
Authors: Wiklund Matilda , Andersson Annika
Published: January 2018

A multitude of different technologies are used in school today. Some are provided by the school and others are brought by the individual teacher or student. In addition, different applications are available. In this study the focus is on student-initiated uses of technology and how it conditions learning. Based on a case study with surveys, interviews and an observational time study, it is shown that students appear to be the most frequent users of technology in the classroom and for the most part initiate its use. We also show that they often initiate uses directed towards communication and inquiry. Against the prevailing understanding that students mainly use technology for extra-curricular activities, we found that most of the student-initiated technology and applications related to the task in hand and were therefore not regarded as problematic by teachers or students. However, with regard to student-initiated uses of social media, games and communicative applications the picture is more diverse. In this context, teachers and students complain that such use may distract students, although some regard it as rewarding, for example due to the informal learning or time for contemplation and relaxation that results. We conclude by questioning the dichotomies of curricular–non-curricular and intended–unintended learning and we argue for the need to add contemplation to the taxonomy used for understanding the educational use of information technologies as conditions for learning.
PESTEL factors for e-learning revisited: The 4Es of tutoring for value added learning
Authors: Graham Deryn
Published: January 2018

There is a growing prevalence in the use of digital media for education management and international partnerships; however, research continues to reflect the position that the absence of social interaction is a major barrier to a positive on-line learning experience. In 2007, a paper described the application of PESTE (Political, Economic, Social, Technical and Environmental) factors from Sociology to the employment of e-learning, leading to the proposal of PESTE factors for educational software, and e-learning in particular. This paper recaps the findings of the 2007 paper, and revisits the application of the now trans-national framework for the employment of e-learning, before applying PESTEL (Political, Economic, Social, Technical, Environmental and Legal) factors to e-learning. It then proceeds to consider the influence of the latest innovations: MOOCs (Massive Open Online Courses) and Flipped Learning. Finally, the future of learning technologies is discussed and conclusions drawn, including the 4Es of Tutoring for Value Added Learning.
Merging risk and financial communication: Understanding how Prudential creates and solves the retirement risk
Authors: Anderson Lindsey B.
Published: January 2018

As the number of people nearing or entering the retirement phase of careers continues to grow, financial service companies, like Prudential Financial, will become increasingly important to the public. This point is especially true given that there is a lack of preparedness surrounding retirement planning. This project explores how Prudential discursively constructed the concept of retirement through a qualitative content analysis of the organizational website. Results show that Prudential used a traditional problem–solution persuasive framework as it situated retirement as a risk and offered self-serving solutions that could mitigate the potential threat. Specifically, risk was constructed through the construction of a grand narrative that showed challenges associated with retirement and relied on trusted sources and rational evidence. The solution was then depicted as an efficacious process that was future-oriented through the telling of stories by current retirees. Based on these findings, a set of theoretical contributions regarding retirement and risk communication were developed, including the extension of risk communication to the financial sector and showing how organizations can simultaneously use grand and individual narratives to both highlight and resolve a potential threat. Ultimately, this research provides the opportunity to further examine how the concept of retirement is constructed by organizations through the lens of risk communication.
Exploring health insurance services in Sudan from the perspectives of insurers
Authors: Salim Anas Mustafa Ahmed , Hamed Fatima Hashim Mahmoud
Published: January 2018

Background:

It has been 20 years since the introduction of health insurance in Sudan. This study was the first one that explored health insurance services in Sudan from the perspectives of the insurers.

Methods:

This was a qualitative, exploratory, interview study. The sampling frame was the list of Social Health Insurance and Private Health Insurance institutions in Sudan. Participants were selected from the four Social Health Insurance institutions and from five Private Health Insurance companies. The study was conducted in January and February 2017. In-depth individual interviews were conducted with a convenient sample of key executives from the different health insurers. Ideas and themes were identified and analysed using thematic analysis.

Results:

The result showed that universal coverage was not achieved despite long time presence of Social Health Insurance and Private Health Insurance in Sudan. All participants described their services as comprehensive. All participants have good perception of the quality of the services they provide, although none of them investigated customer satisfaction. The main challenges facing Social Health Insurance are achieving universal coverage, ensuring sustainability and recruitment of the informal sector and self-employed population. Consumers’ affordability of the premiums is the main obstacle for Private Health Insurance, while rising healthcare cost due to economic inflation is a challenge facing both Social Health Insurance and Private Health Insurance.

Conclusion:

In spite of the presence of Social Health Insurance and Private Health Insurance in Sudan, the country is still far from achieving universal coverage. Moreover, the sustainability of health insurance is questionable. The main reasons include low governmental financial resources and lack of affordability by beneficiaries especially for Private Health Insurance. This necessitates finding solutions to improve them or trying other types of health insurance. The quality of services provided by Social Health Insurance and Private Health Insurance was described as good, but no insurance in Sudan measured customer satisfaction as yet.
Volume Estimates in Chronic Hemodialysis Patients by the Watson Equation and Bioimpedance Spectroscopy and the Impact on the Kt/Vurea calculation
Authors: Noori Nazanin , Wald Ron , Sharma Parpia Arti , Goldstein Marc B.
Published: January 2018

Background:

Accurate assessment of total body water (TBW) is essential for the evaluation of dialysis adequacy (Kt/Vurea). The Watson formula, which is recommended for the calculation of TBW, was derived in healthy volunteers thereby leading to potentially inaccurate TBW estimates in maintenance hemodialysis recipients. Bioimpedance spectroscopy (BIS) may be a robust alternative for the measurement of TBW in hemodialysis recipients.

Objectives:

The primary objective of this study was to evaluate the accuracy of Watson formula–derived TBW estimates as compared with TBW measured with BIS. Second, we aimed to identify the anthropometric characteristics that are most likely to generate inaccuracy when using the Watson formula to calculate TBW. Finally, we derived novel anthropometric equations for the more accurate estimation of TBW.

Design and Setting:

This was a cross-sectional study of prevalent in-center HD patients at St Michael’s Hospital.

Patients:

One hundred eighty-four hemodialysis patients (109 men and 75 women) were evaluated in this study.

Measurements:

Anthropometric measurements including weight, height, waist circumference, midarm circumference, and 4-site skinfold (biceps, triceps, subscapular, and suprailiac) thickness were measured; fat mass was measured using the formula by Durnin and Womersley. We measured TBW by BIS using the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany).

Methods:

We used the Bland-Altman method to calculate the difference between the TBW derived from the Watson method and the BIS. To derive new equations for TBW estimation, Pearson’s correlation coefficients between BIS-TBW (the reference test) and other variables were examined. We used the least squares regression analysis to develop parsimonious equations to predict TBW.

Results:

TBW values based on the Watson method had a high correlation with BIS-TBW (correlation coefficients = 0.87 and P < .001). Despite the high correlation, the Watson formula overestimated TBW by 5.1 (4.5-5.8) liters and 3.8 (3.0-4.5) liters, in men and women, respectively. Higher fat mass and waist circumference (general and abdominal obesity) were correlated with the greater TBW overestimation by the Watson formula. We created separate equations for men and women based on weight and waist circumference.

Limitations:

The main limitation of our study was the lack of an external validation for our novel estimating equation. Furthermore, though BIS has been validated against traditional reference standards, our assumption that it represents the “gold standard” for body compartment assessment may be flawed.

Conclusions:

The Watson formula generally overestimates TBW in chronic dialysis recipients, particularly in patients with the highest waist circumference. Widespread reliance on the Watson formula for derivation of TBW may lead to the underestimation of Kt/Vurea..
Longitudinal assessment of falls in patients with Parkinson’s disease using inertial sensors and the Timed Up and Go test
Authors: Greene Barry R , Caulfield Brian , Lamichhane Dronacharya , Bond William , Svendsen Jessica , Zurski Connie , Pratt Dyveke
Published: January 2018

Objective

To examine the predictive validity of a TUG test for falls risk, quantified using body-worn sensors (QTUG) in people with Parkinson's Disease (PD). We also sought to examine the inter-session reliability of QTUG sensor measures and their association with the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score.

Approach

A six-month longitudinal study of 15 patients with Parkinson’s disease. Participants were asked to complete a weekly diary recording any falls activity for six months following baseline assessment. Participants were assessed monthly, using a Timed Up and Go test, quantified using body-worn sensors, placed on each leg below the knee.

Main results

The results suggest that the QTUG falls risk estimate recorded at baseline is 73.33% (44.90, 92.21) accurate in predicting falls within 90 days, while the Timed Up and Go time at baseline was 46.67% (21.27, 73.41) accurate. The Timed Up and Go time and QTUG falls risk estimate were strongly correlated with UPDRS motor score. Fifty-two of 59 inertial sensor parameters exhibited excellent inter-session reliability, five exhibited moderate reliability, while two parameters exhibited poor reliability.

Significance

The results suggest that QTUG is a reliable tool for the assessment of gait and mobility in Parkinson’s disease and, furthermore, that it may have utility in predicting falls in patients with Parkinson’s disease.
Assessing the validity of pressure-measuring insoles in quantifying gait variables
Authors: DeBerardinis Jessica , Dufek Janet S , Trabia Mohamed B , Lidstone Daniel E
Published: January 2018

Introduction

Pressure-measuring insoles can provide a portable alternative to existing gait analysis tools. However, there is disagreement among researchers on their accuracy and the appropriate calibration methods. The purposes of this study were to (1) determine the validity of pressure-measuring insoles for calculating stance time and support-phase impulse during walking using two calibration procedures, and (2) examine the effect of insole size on the results.

Methods

Data were collected from 39 participants (23.5 ± 3.24 yrs, 66.7 ± 17.5 kg, 1.64 ± 0.09 m), each wearing appropriately sized insoles as they walked over two consecutive force platforms. Two calibration methods were evaluated: (1) manufacturer’s recommendation, and (2) a participant weight-based approach. Qualitative and quantitative evaluations were conducted.

Results

The results indicated that the insoles measured longer stance times than the force platform (differences are less than 10%). Both calibration methods resulted in inaccurate impulse values (differences are 30 and 50% for the two calibration methods, respectively). The results showed that when using the first calibration method, impulse values depended on insole size. The second calibration consistently underestimated the impulse.

Conclusions

It was concluded that while the insoles provide acceptable qualitative representation of the gait, the two studied calibration methods may lead to a misleading quantitative assessment.
Autologous US-guided PRP injection versus US-guided focal extracorporeal shock wave therapy for chronic lateral epicondylitis: A minimum of 2-year follow-up retrospective comparative study
Authors: Alessio-Mazzola Mattia , Repetto Ilaria , Biti Besmir , Trentini Roberto , Formica Matteo , Felli Lamberto
Published: January 2018

Purpose:

To compare the efficacy of two independent groups of patients treated with ultrasound (US)-guided extracorporeal shock wave (ESW) therapy and with US-guided injection of platelet-rich plasma (PRP) for chronic lateral epicondylitis (LE) with a minimum of 2-year follow-up.

Methods:

We retrospectively evaluated 63 patients treated for chronic LE (31 patients with autologous US-guided PRP injection and 32 patients with US-guided focal ESW therapy) from 2009 to 2014. All the patients were evaluated by means of Roles–Maudsley (RM) score, quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score, visual analogic scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) to retrospectively assess the pain relief, level of activity, the self-reported function and subjective satisfaction at minimum of 2-year follow-up.

Results:

Both US-guided autologous PRP injection and US-guided focal ESW administration proved effective in chronic LE with significant improvement in the QuickDASH, VAS, RM and PRTEE scores ( p < 0.0001). No adverse effects or complications were recorded in any groups. No differences were found in recurrence rate and final results of the QuickDASH, VAS, RM and PRTEE scores between the two groups ( p > 0.05). The mean time between treatment and symptom resolution was significantly shorter for the PRP treatment ( p = 0.0212); furthermore, the mean time to return to the normal activities was quicker for PRP group ( p = 0.0119).

Conclusion:

Both PRP injection and ESW therapy are feasible and safe options for the treatment of chronic LE with low risk of complications and with good long-term follow-up results. US-guided PRP injection has quick efficacy when compared with US-guided focal ESW therapy.
Comparison of 3 Knee-Specific Quality-of-Life Instruments for Patients With Meniscal Tears
Authors: Sgroi Mirco , Kocak Semra , Reichel Heiko , Kappe Thomas
Published: January 2018

Background:

Meniscal tears are a common cause of knee pain and disability. The objective measurement of the health-related quality of life of patients with meniscal tears plays a key role in clinical evaluation and therapeutic decision making. Several evaluation tools have been used to measure the effects of meniscal tears on knee function and quality of life. However, most of these tools are nonspecific for meniscal pathology.

Purpose/Hypothesis:

The purpose of the present study was to compare the capability of 3 commonly used knee assessment tools to measure the impact of meniscal tears on knee function and quality of life: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario Meniscal Evaluation Tool (WOMET). Our null hypothesis was that no difference would exist among the 3 assessment tools.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A total of 207 consecutive patients (mean ± SD: age, 52.6 ± 14.3 years) with arthroscopically confirmed meniscal tear were included. Preoperatively, 3 knee function and quality-of-life scores were obtained: KOOS, WOMAC, and WOMET. The relative outcome scores of the questionnaires were compared postoperatively.

Results:

The sum scores (relative scores) were as follows: 234.2 ± 92.5 (55.7%) for the KOOS, 132.6 ± 54.3 (55.5%) for the WOMAC, and 113 ± 30.8 (71%) for the WOMET. The relative score results for the WOMET were significantly higher than those for the WOMAC and the KOOS (both P < .01), while no significant difference was found between the WOMAC and the KOOS ( P = .735).

Conclusion:

A greater impact on health-related quality of life for patients with meniscal tears can be measured with the WOMET when compared with the WOMAC and the KOOS. Therefore, using the WOMET can be recommended for the evaluation of knee function and quality-of-life impairment of patients with meniscal tears.
Effects of Varying Reverberation on Music Perception for Young Normal-Hearing and Old Hearing-Impaired Listeners
Authors: Reinhart Paul N. , Souza Pamela E.
Published: January 2018

Reverberation enhances music perception and is one of the most important acoustic factors in auditorium design. However, previous research on reverberant music perception has focused on young normal-hearing (YNH) listeners. Old hearing-impaired (OHI) listeners have degraded spatial auditory processing; therefore, they may perceive reverberant music differently. Two experiments were conducted examining the effects of varying reverberation on music perception for YNH and OHI listeners. Experiment 1 examined whether YNH listeners and OHI listeners prefer different amounts of reverberation for classical music listening. Symphonic excerpts were processed at a range of reverberation times using a point-source simulation. Listeners performed a paired-comparisons task in which they heard two excerpts with different reverberation times, and they indicated which they preferred. The YNH group preferred a reverberation time of 2.5 s; however, the OHI group did not demonstrate any significant preference. Experiment 2 examined whether OHI listeners are less sensitive to (e, less able to discriminate) differences in reverberation time than YNH listeners. YNH and OHI participants listened to pairs of music excerpts and indicated whether they perceived the same or different amount of reverberation. Results indicated that the ability of both groups to detect differences in reverberation time improved with increasing reverberation time difference. However, discrimination was poorer for the OHI group than for the YNH group. This suggests that OHI listeners are less sensitive to differences in reverberation when listening to music than YNH listeners, which might explain the lack of group reverberation time preferences of the OHI group.