bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge of Nonmedical Individuals about Cardiopulmonary Resuscitation in Case of Cardiac Arrest: A Cross-Sectional Study in the Population of Jeddah, Saudi Arabia
Authors: Qara Fadi Jandali , Alsulimani Loui K. , Fakeeh Maged M. , Bokhary Diyaa H.
Published: January 2019

Introduction. In cardiac arrest victims, providing a high-quality cardiopulmonary resuscitation (CPR) is a fundamental component of initial care, especially in the out-of-hospital settings. In this study, we sought to assess the knowledge of nonmedical people regarding cardiopulmonary resuscitation in the case of out-of-hospital cardiac arrest. Methods. A cross-sectional survey containing 22 questions was administered to individuals aged ≥ 18 years, who were not health care providers. Sample included residents of Jeddah, Saudi Arabia. The survey included knowledge about cardiac arrest findings, previous experience with CPR, knowledge of basic life support (BLS), and concerns related to CPR. Results. The fully completed survey forms of 600 respondents were analysed. Out of these, 28.7% stated that they had previously received training in CPR. Regarding manifestations of cardiac arrest, 40.7% suggested loss of consciousness, 36.8% suggested cessation of breathing, and 24.7% suggested cessation of circulation. Only 11.7% among respondents were found to be able to perform chest compressions. Also, only 9.2% could perform mouth-to-mouth ventilation, and 29.5% were able to perform both. While 55.5% knew the location for performing chest compressions, 44.7% knew the correct depth, and only 18.5% knew the correct compression–ventilation rate. Bystander CPR had been performed by only 10.7%. Conclusion. In our sample, we found lack of knowledge regarding CPR. We advise for a coordinated national effort to improve the public awareness about CPR performance. This may include mass education, specialized training, and setting legislations.
Practical Employment of Granular Computing to Complex Application Layer Cyberattack Detection
Authors: Kozik Rafał , Pawlicki Marek , Choraś Michał , Pedrycz Witold
Published: January 2019

Network and information security are regarded as some of the most pressing problems of contemporary economy, affecting both individual citizens and entire societies, making them a highlight for homeland security. Innovative approaches to handle this challenge are undertaken by the scientific community, proposing the utilization of the emerging, advanced machine learning methods. This very paper puts forward a novel approach to the detection of cyberattacks taking inventory of the practical application of information granules. The feasibility of utilizing Granular Computing (GC) as a solution to the most current challenges in cybersecurity is researched. To the best of our knowledge, granular computing has not yet been widely examined or used for cybersecurity application purposes. The major contribution of this work is a method for constructing information granules from network data. We then report promising results on a benchmark dataset.
Dynamic Control Scheme of Multiswarm Persistent Surveillance in a Changing Environment
Authors: Jing Tian , Wang Weiping , Wang Tao , Li Xiaobo , Zhou Xin
Published: January 2019

The persistent surveillance problem has been proved to be an NP hard problem for multiple unmanned aerial vehicle systems (UAVs). However, most studies in multiple UAV control focus on control cooperative path planning in a single swarm, while dynamic deployment of a multiswarm system is neglected. This paper proposes a collective control scheme to drive a multiswarm UAVs system to spread out over a time-sensible environment to provide persistent adaptive sensor coverage in event-related surveillance scenarios. We design the digital turf model to approximate the mixture information of mission requirements and surveillance reward. Moreover, we design a data clustering-based algorithm for the dynamic assignment of UAV swarms, which can promote workload balance, while also allowing real-time response to emergencies. Finally, we evaluate the proposed architecture by means of simulation and find that our method is superior to the conventional control strategy in terms of detection efficiency and subswarm equilibrium degree.
Quantitative Evaluation of Display Contrast of Gd-EOB-DTPA-Enhanced Magnetic Resonance Images: Effects of the Flip Angle and Grayscale Gamma Value
Authors: Inoue Yusuke , Hata Hirofumi , Nakajima Ai , Matsunaga Keiji , Ohzeki Yusuke , Hashimoto Tetsuya , Haradome Hiroki
Published: January 2019

Introduction. Display contrast can be changed nonlinearly by manipulating the gamma value of the grayscale. We investigated the contrast of the hepatobiliary-phase images acquired with different flip angles (FAs) and displayed with different gamma values in Gd-EOB-DTPA-enhanced magnetic resonance imaging. Material and Methods. Twenty patients with liver tumors were studied. Hepatobiliary-phase images were acquired at low (12°) and high (30°) FAs. Low-FA images were converted to simulate images displayed with different gamma values, using ImageJ software. To assess image contrast, the liver-to-muscle signal ratio (LMR), liver-to-spleen signal ratio (LSR), contrast ratio (CR), liver signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated. Results. The LMR, LSR, and CR were higher in the high-FA images than in the low-FA original images. Although the SNR was lower in the high-FA images, indicating an increase in noise, the CNR was higher. Raising the gamma value increased the LMR, LSR, and CR, notably decreased the SNR, and slightly decreased the CNR. Conclusion. Increasing the FA enhanced image contrast, supporting its usefulness for improving the delineation of focal liver lesions. Although the associated increase in noise may be problematic, raising the grayscale gamma value enhances the display contrast of low-FA images.
Experimental Study on Backfilling Mine Goafs with Chemical Waste Phosphogypsum
Authors: Cao Zhiwei , Liu Bing , Li Xibing , Li Diyuan , Dong Longjun
Published: January 2019

To explore the feasibility of cemented paste backfill with phosphogypsum (PG), bleeding water and rheological tests (slump and on-site pipeline loop tests) were performed with PG backfill slurry (PGBS). In the bleeding water test, the PGBS concentration with minimal bleeding water was measured between 60.87 and 67.61%; in the rheological slump test, values of 61 to 68% were determined for the on-site pipeline loop test. The rheological pipeline loop test demonstrated that the resistance coefficient is lowest when the concentration is no higher than 65%. Through industrial experiments, PG slurry with a concentration of 64%–65% backfill was successfully applied to the goaf. The experimental results demonstrate that PGBS with characteristics of “less bleeding water” and “improved pumpability” is obtained when its concentration is between 61 and 65%. Paste-like PG slurry was proven to be optimal for cemented PG backfilling technology.
An Evaluation of PROMIS Health Domains in Sarcoma Patients Compared to the United States Population
Authors: Wilke Benjamin , Cooper Anna , Scarborough Mark , Gibbs C. Parker , Spiguel Andre
Published: January 2019

Background. The Patient Reported Outcomes Measurement Information System (PROMIS) is a patient-directed system that allows comparisons across medical conditions. With this tool, comparisons can now be made between rare conditions, such as sarcomas, and more common ailments, of the United States general population. This allows comparisons between rare conditions, such as sarcomas, to more common ailments, or even the United States (US) general population. Objectives. Our purpose was to use PROMIS to compare outcomes in patients that had undergone resection of a nonmetastatic sarcoma to the US population. Methods. One hundred thirty-eight patients were included in the analysis. These patients were divided into early (<2 years) and late follow-up (>2 years). Results. We evaluated results from seven health domains and found significantly lower scores in the physical function and depression domains. These differences were present in both the early and late cohorts when compared to the US population. Conclusion. While physical function was found to be worse in the sarcoma cohorts, we observed significantly improved levels of depression in these patients when compared to the US population. This finding was maintained over time and is an important reminder that a patient’s goals and desires change following a cancer diagnosis and must be taken into consideration when planning treatment and determining a successful outcome.
Broadband Dielectric Properties of Fe2O3·H2O Nanorods/Epoxy Resin Composites
Authors: Meisak Darya , Macutkevic Jan , Bychanok Dzmitry , Selskis Algirdas , Banys Juras , Kuzhir Polina
Published: January 2019

A series of polymer composites based on epoxy resin with a 5–40 vol.% concentration of goethite (Fe2O3·H2O) nanorods was produced. The electrical percolation threshold in these composites was determined as 30 vol.% of nanorods. The dielectric properties of the composites both below and above the percolation threshold were studied in a wide temperature (200 K–450 K) and frequency (from Hz to THz) ranges. The dielectric properties of composites below the percolation threshold are mainly determined by the relaxation in a pure polymer matrix. The electrical properties of composites above the percolation threshold are determined by the percolation network, which is formed by the goethite nanorods inside the polymer matrix. Due to the finite conductivity of the epoxy resin, the electrical conductivity at high temperatures occurs in the composites both above and below the percolation threshold.
Activation of the Lysosome-Associated Membrane Protein LAMP5 by DOT1L Serves as a Bodyguard for MLL Fusion Oncoproteins to Evade Degradation in Leukemia
Authors: Wang Wen-Tao , Han Cai , Sun Yu-Meng , Chen Zhen-Hua , Fang Ke , Huang Wei , Sun Lin-Yu , Zeng Zhan-Cheng , Luo Xue-Qun , Chen Yue-Qin
Published: January 2019

Purpose:

Despite many attempts to understand mixed-lineage leukemia (MLL leukemia), effective therapies for this disease remain limited. We identified a lysosome-associated membrane protein (LAMP) family member, LAMP5, that is specifically and highly expressed in patients with MLL leukemia. The purpose of the study was to demonstrate the functional relevance and clinical value of LAMP5 in the disease.

Experimental Design:

We first recruited a large cohort of leukemia patients to validate LAMP5 expression and evaluate its clinical value. We then performed in vitro and in vivo experiments to investigate the functional relevance of LAMP5 in MLL leukemia progression or maintenance.

Results:

LAMP5 was validated as being specifically and highly expressed in patients with MLL leukemia and was associated with a poor outcome. Functional studies showed that LAMP5 is a novel autophagic suppressor and protects MLL fusion proteins from autophagic degradation. Specifically targeting LAMP5 significantly promoted degradation of MLL fusion proteins and inhibited MLL leukemia progression in both an animal model and primary cells. We further revealed that LAMP5 is a direct target of the H3K79 histone methyltransferase DOT1L. Downregulating LAMP5 with a DOT1L inhibitor enhanced the selective autophagic degradation of MLL oncoproteins and extended survival in vivo; this observation was especially significant when combining DOT1L inhibitors with LAMP5 knockdown.

Conclusions:

This study demonstrates that LAMP5 serves as a “bodyguard” for MLL fusions to evade degradation and is the first to link H3K79 methylation to autophagy regulation, highlighting the potential of LAMP5 as a therapeutic target for MLL leukemia.
The Clonal Evolution of Metastatic Osteosarcoma as Shaped by Cisplatin Treatment
Authors: Brady Samuel W. , Ma Xiaotu , Bahrami Armita , Satas Gryte , Wu Gang , Newman Scott , Rusch Michael , Putnam Daniel K. , Mulder Heather L. , Yergeau Donald A. , Edmonson Michael N. , Easton John , Alexandrov Ludmil B. , Chen Xiang , Mardis Elaine R. , Wilson Richard K. , Downing James R. , Pappo Alberto S. , Raphael Benjamin J. , Dyer Michael A. , Zhang Jinghui
Published: January 2019

To investigate the genomic evolution of metastatic pediatric osteosarcoma, we performed whole-genome and targeted deep sequencing on 14 osteosarcoma metastases and two primary tumors from four patients (two to eight samples per patient). All four patients harbored ancestral (truncal) somatic variants resulting in TP53 inactivation and cell-cycle aberrations, followed by divergence into relapse-specific lineages exhibiting a cisplatin-induced mutation signature. In three of the four patients, the cisplatin signature accounted for >40% of mutations detected in the metastatic samples. Mutations potentially acquired during cisplatin treatment included NF1 missense mutations of uncertain significance in two patients and a KIT G565R activating mutation in one patient. Three of four patients demonstrated widespread ploidy differences between samples from the sample patient. Single-cell seeding of metastasis was detected in most metastatic samples. Cross-seeding between metastatic sites was observed in one patient, whereas in another patient a minor clone from the primary tumor seeded both metastases analyzed. These results reveal extensive clonal heterogeneity in metastatic osteosarcoma, much of which is likely cisplatin-induced.

Implications:

The extent and consequences of chemotherapy-induced damage in pediatric cancers is unknown. We found that cisplatin treatment can potentially double the mutational burden in osteosarcoma, which has implications for optimizing therapy for recurrent, chemotherapy-resistant disease.
Total 12-Lead QRS Voltage in Patients Having Orthotopic Heart Transplantation for Heart Failure Caused by Adriamycin-Induced Cardiomyopathy
Authors: Roberts William C. , Haque Sarah , Hall Shelley A.
Published: January 2019

Objective: Although several studies have described the effects of adriamycin on the heart, electrocardiographic total 12-lead QRS voltage (distance in millimeters from the peak of the R wave to the nadir of either the Q or S wave, whichever was deeper, with 10 mm [1 mV] being standard) both before and after orthotopic heart transplantation (OHT) has not been reported. This study describes the total 12-lead QRS voltage in 8 patients studied at Baylor University Medical Center at Dallas, from 1994 to June 2018, who underwent OHT for severe heart failure caused by anthracycline-induced cardiomyopathy. Method: Prior to OHT, the total 12-lead non-paced QRS voltages ranged from 86 to 189 mm (mean 125 ± 56) and for paced QRS voltages from 82 to 113 mm (mean 97 ± 15). The total 12-lead QRS voltages post-OHT ranged from 100 to 190 mm (mean 130 ± 30). Total 12-lead QRS voltages were lower in patients with a pacemaker than without. Results/Conclusion: These low voltages are like those found in patients with carcinoid syndrome, severe cardiac adiposity, cardiac amyloidosis, and cardiac sarcoidosis.
Long-Term Prognosis of Patients with Obscure Gastrointestinal Bleeding: A Retrospective Cohort Study
Authors: Arai Makoto , Matsumura Tomoaki , Ohta Yuki , Kiyono Soichiro , Hayashi Masahiro , Taida Takashi , Saito Keiko , Okimoto Kenichiro , Maruoka Daisuke , Nakagawa Tomoo , Katsuno Tatsuro , Kato Naoya , Takiguchi Yuichi
Published: January 2019

Aims: We evaluated the long-term prognosis of patients with obscure gastrointestinal bleeding (OGIB) who underwent capsule endoscopy (CE). Methods: In our hospital, 429 patients underwent CE between November 2007 and March 2012. Among them, 259 patients underwent CE as the first examination for OGIB and were then followed at 77 clinics and hospitals. The clinical characteristics were investigated, including age, gender, overt/occult bleeding, the use of antithrombotic drugs and NSAIDs, complications (liver cirrhosis and hemodialysis), and CE. We asked the medical institutions for their survival data as of August 2017 (> 5 years after CE). Results: The prognoses of 240 patients (92.6%) were analyzed. The average follow-up period was 55.7 (1–115) months. During the follow-up period, 57 patients (23.8%) died and the survival rates were 90.5% at 1 year, 81.7% at 3 years, and 74.7% at 5 years. Age 65 years or older and liver cirrhosis were predictive factors for a poor prognosis. Rebleeding occurred in 42 patients (17.9%) and small bowel cancer and gastrointestinal stromal tumor were found at 12 and 21 months after CE, respectively. Conclusions: Patients with OGIB showed a poor prognosis, especially those who were elderly or who had liver cirrhosis.
Deregulated microRNAs and Adiponectin in Postmenopausal Women with Breast Cancer
Authors: Peña-Cano María Isabel , Saucedo Renata , Morales-Avila Enrique , Valencia Jorge , Zavala-Moha Jose A. , López Adriana
Published: January 2019

Background: Obesity is a risk factor for breast cancer (BC). Some mechanisms through which obesity can lead to cancer development are insulin-like growth factors (IGFs), adipokines, and microRNAs (miRs). The objective of the study was to determine whether miR-17-5p, miR-195-5p, and miR-221-3p expressions were deregulated in serum samples of obese and nonobese postmenopausal women with BC. In addition, insulin, adiponectin, leptin and IGFs were analyzed. Methods: Fifty postmenopausal women with newly diagnosed BC and 50 postmenopausal healthy women were evaluated. Differences in miRs between BC and healthy cases and between obese and lean participants were analyzed. Receiver operating characteristic curves for miRs for discriminating patients with or without BC were established, and relationships between the miRs, adipokines, and breast tumor characteristics were also investigated. Results: miR-17-5p and miR-195-5p were higher in patients with BC in comparison to the controls, while miR-221-3p and adiponectin were significantly lower. Increased levels of miR-195-5p allowed the differentiation of BC from controls with a sensitivity of 83.3 and a specificity of 78.3%, and were associated with lobular and poorly differentiated cancer. There was no difference in miRs levels between obese and lean groups. Conclusions: Circulating miRs and adiponectin were deregulated in postmenopausal women with BC.
Effect of Caffeine Intake on Postoperative Ileus: A Systematic Review and Meta-Analysis
Authors: Gkegkes Ioannis D. , Minis Evelyn Eleni , Iavazzo Christos
Published: January 2019

Background: Postoperative ileus prolongs both hospital stay and patients’ morbidity, having at the same time a great impact on health care costs. Coffee, a worldwide popular, cheap beverage might have an important effect on the motility of the postoperative bowel. Methods: PubMed, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched. Results: Four studies met the inclusion criteria of our meta-analysis. A total of 341 patients were included. The postoperative administration of coffee significantly reduces the time to first bowel movement, the time to first flatus and the time to tolerance of solid diet. Safe conclusions could not be drawn regarding the additional use of laxatives, the necessity for reinsertion of nasogastric tube or the need for reoperation as all the aforementioned outcomes did not present any statistically significance. None of the complications were attributed to the administration of coffee. Conclusion: The administration of coffee as a postoperative ileus prevention measure can change the way postoperative enhanced recovery is applied. Even though the mechanism of action of coffee is not fully known, currently available literature demonstrates a significant improvement in gastrointestinal motility without having any impact on postoperative morbidity. Studies with higher methodological quality can offer a more careful evaluation of the clinical use of this popular beverage.
Type 2 Diabetes and Hypertension
Authors: Sun Dianjianyi , Zhou Tao , Heianza Yoriko , Li Xiang , Fan Mengyu , Fonseca Vivian A. , Qi Lu
Published: January 2019

Rationale:

In observational studies, type 2 diabetes mellitus (T2D) has been associated with an increased risk of hypertension, and vice versa; however, the causality between these conditions remains to be determined.

Objectives:

This population-based prospective cohort study sought to investigate the bidirectional causal relations of T2D with hypertension, systolic and diastolic blood pressure (BP) using Mendelian randomization (MR) analysis.

Methods and Results:

After exclusion of participants free of a history of heart failure, cardiovascular disease, cardiac procedures, and non-T2D diabetes mellitus, a total of 318 664 unrelated individuals with qualified genotyping data of European descent aged 37 to 73 from UK Biobank were included. The genetically instrumented T2D and hypertension were constructed using 134 and 233 single nucleotide polymorphisms, respectively. Seven complementary MR methods were applied, including inverse-variance weighted method, 2 median-based methods (simple and weighted), MR-Egger, MR-robust adjusted profile scores, MR-Pleiotropy Residual Sum and Outlier, and multivariate MR. The genetically instrumented T2D was associated with risk of hypertension (odds ratio, 1.07 [95% CI, 1.04–1.10],
P
=3.4×10
−7
), whereas the genetically determined hypertension showed no relationship with T2D (odds ratio, 0.96 [0.88–1.04],
P
=0.34). Our MR estimates from T2D to BP showed that the genetically instrumented T2D was associated with a 0.67 mm Hg higher systolic BP (95% CI, 0.41–0.93,
P
=5.75×10
–7
) but not with a higher diastolic BP. There was no clear evidence showing a causal effect of elevated systolic BP or diastolic BP on T2D risk. Positive pleiotropic bias was indicated in the hypertension→T2D relation (odds ratio, of MR-Egger intercept 1.010 [1.004–1.016],
P
=0.001) but not from T2D to hypertension (1.001 [0.998–1.004],
P
=0.556).

Conclusions:

T2D may causally affect hypertension, whereas the relationship from hypertension to T2D is unlikely to be causal. These findings suggest the importance of keeping an optimal glycemic profile in general populations, and BP screening and monitoring, especially systolic BP, in patients with T2D.
Central Arterial Stiffness Is Associated With Structural Brain Damage and Poorer Cognitive Performance: The ARIC Study
Authors: Palta Priya , Sharrett A. Richey , Wei Jingkai , Meyer Michelle L. , Kucharska‐Newton Anna , Power Melinda C. , Deal Jennifer A. , Jack Clifford R. , Knopman David , Wright Jacqueline , Griswold Michael , Tanaka Hirofumi , Mosley Thomas H. , Heiss Gerardo
Published: January 2019

Background

Central arterial stiffening and increased pulsatility, with consequent cerebral hypoperfusion, may result in structural brain damage and cognitive impairment.

Methods and Results

We analyzed a cross‐sectional sample of
ARIC
‐
NCS
(Atherosclerosis Risk in Communities–Neurocognitive Study) participants (aged 67–90 years, 60% women) with measures of cognition (n=3703) and brain magnetic resonance imaging (n=1255). Central arterial hemodynamics were assessed as carotid‐femoral pulse wave velocity and pressure pulsatility (central pulse pressure). We derived factor scores for cognitive domains. Brain
magnetic resonance imaging
using 3‐Tesla scanners quantified lacunar infarcts; cerebral microbleeds; and volumes of white matter hyperintensities, total brain, and the Alzheimer disease signature region. We used logistic regression, adjusted for demographics,
apolipoprotein E
ɛ4, heart rate, mean arterial pressure, and select cardiovascular risk factors, to estimate the odds of lacunar infarcts or cerebral microbleeds. Linear regression, additionally adjusted for intracranial volume, estimated the difference in log‐transformed volumes of
white matter hyperintensities
, total brain, and the
Alzheimer disease
signature region. We estimated the mean difference in cognitive factor scores across quartiles of carotid‐femoral pulse wave velocity or
central pulse pressure
using linear regression. Compared with participants in the lowest carotid‐femoral pulse wave velocity quartile, participants in the highest quartile of carotid‐femoral pulse wave velocity had a greater burden of
white matter hyperintensities
(
P
=0.007 for trend), smaller total brain volumes (−18.30 cm
3
; 95%
CI
, −27.54 to −9.07 cm
3
), and smaller
Alzheimer disease
signature region volumes (−1.48 cm
3
; 95%
CI
, −2.27 to −0.68 cm
3
). These participants also had lower scores in executive function/processing speed (β=−0.04
z
score; 95%
CI
, −0.07 to −0.01
z
score) and general cognition (β=−0.09
z
score; 95%
CI
, −0.15 to −0.03
z
score). Similar results were observed for
central pulse pressure
.

Conclusions

Central arterial hemodynamics were associated with structural brain damage and poorer cognitive performance among older adults.
A new genus of the family Portunidae (Crustacea: Decapoda: Brachyura) and the identity of Portunus (Cycloachelous) yoronensis Sakai, 1974
Authors: NGUYEN T. S. , NG PETER K. L.
Published: January 2019

A new genus is established for Neptunus (Achelous) dubia Laurie, 1906, a species that ranges from the eastern Indian Ocean to the Philippines and French Polynesia. This species is probably closest to Cycloachelous Ward, 1942, with regard to the carapace shape and form of the chelipeds, but has a very unique adult male sternal medial groove with two prominent deep depressions on sternite 8 in the sterno-abdominal cavity to accommodate distinctive male first gonopods, that differs from all known portunid genera. Portunus (Cycloachelous) yoronensis Sakai, 1974, described from Japan, is confirmed to be a junior synonym of N. (A.) dubia Laurie, 1906.
Pharmaceutical Industry Funding of Health Consumer Groups in Australia: A Cross-sectional Analysis
Authors: Fabbri Alice , Swandari Swestika , Lau Edith , Vitry Agnes , Mintzes Barbara
Published: January 2019

Relationships between consumer organizations and pharmaceutical manufacturers are the focus of transparency efforts in some jurisdictions, including Australia. This study describes the frequency and nature of industry sponsorship of Australian health consumer organizations and examines the link between sponsorship of the most highly funded organizations and manufacturers’ requests for public reimbursement of products for related health conditions. We downloaded 130 transparency reports covering the period January 2013 to December 2016 from the website of Medicines Australia and carried out a descriptive analysis. For the most heavily funded organizations and their sponsors, we examined Public Summary Documents of the Pharmaceutical Benefits Advisory Committee to identify relevant products under consideration for public reimbursement over the study period. Thirty-four pharmaceutical companies provided 1,482 sponsorships to 230 organizations, spending a total of AU$34,507,810. The top clinical areas in terms of amount of funding received were cancer, eye health, and nervous system disorders. The sponsors of the most highly funded groups were companies that in most cases had drugs under review for public reimbursement for conditions covered by these organizations. Interactions between the pharmaceutical industry and consumer organizations are common and require careful management to prevent biases that may favor sponsors’ interests above those of patients and the public.
The co-production of public value in community development: can street-level professionals make a difference?
Authors: Vanleene Daphne , Voets Joris , Verschuere Bram
Published: January 2019

This article deals with the different roles of the street-level professional in achieving public value in a co-productive community development project. The article focuses, in particular, on the question of how engaged street-level professionals combine different roles – as friend, leader, representative and mediator – in order to empower and include their target audience, thereby contributing to public value creation. This question was explored in a qualitative case study in a community development project in Ostend (Belgium). The study indicated that the street-level professional needed to adopt different role combinations in a well-considered way in order to influence the co-productive process that affected public value creation. More specifically, the combination of friend–leader, as well as the leader–mediator combination, can empower co-producers and thus create personal value for these co-producers. Moreover, professionals carefully consider the combination of friend–leader to support community value over personal value. Also, by combining the friend, leader and representative roles, professionals can include more co-producers and create a stronger sense of community value. This article concludes that there is a need for an engaged professional who has sufficient time and autonomy to apply the combinations as needed. Additionally, we note that more research on these different role cocktails is necessary in order to provide a clear framework of the different combinations that professionals can apply.

Points for practitioners

From our research, we can make two key recommendations for practitioners. First, in order to empower and include vulnerable participants to co-produce, professionals need to develop the right skill set to fulfil the roles needed to engage with participants. Second, and relatedly, this also implies sufficient autonomy (vis-a-vis policymakers) for the professionals at the street level, which will enable them to consider what is needed for the co-production project to become successful in terms of inclusion and empowerment.
Advocacy for women migrant workers in Malaysia through an intersectionality lens
Authors: Miles Lilian , Lewis Suzan , Teng Lai Wan , Yasin Suziana Mat
Published: January 2019

Analysing labour migration through the lens of intersectionality provides valuable insights into the complex identities of women migrant workers and the multiple discriminations they struggle with. Intersectionality advocates argue that only through adopting such an approach can women’s multiple discriminations be challenged. Drawing on a case study of seven non-governmental organisations and one focus group of women migrant workers in a non-Western context, Malaysia, we explore how advocacy organisations understand, interpret and adopt an intersectional approach in advancing the rights of its women migrant workers. We show that there are challenges, specific to the local context, which reduce the likelihood of organisations doing so. The Malaysian experience likely has significance for similar advocacy in other Asian countries.
How do workers benefit from skill utilisation and how can these benefits be enhanced?
Authors: Boxall Peter , Huo Meng-Long , Winterton Jonathan
Published: January 2019

This article uses national-level data to examine the benefits for workers of better skill utilisation and the question of how opportunities to use skills in the workplace can be enhanced. Analysis of the New Zealand data in the 2005 and 2015 rounds of the International Social Survey Programme confirms that better skill utilisation is generally associated with a broad range of beneficial outcomes, including higher employee income, better opportunities for career advancement, higher job satisfaction, greater organisational commitment and lower turnover intentions. In addition, skill utilisation serves as a significant mediator between work autonomy and employee outcomes, particularly in the 2015 survey. As a general rule, better utilisation of employee skills will occur in organisational climates in which employee autonomy is encouraged.
Advancing conceptualisation of university entrepreneurial ecosystems: The role of knowledge-intensive entrepreneurial firms
Authors: Link Albert N , Sarala Riikka M
Published: January 2019

University entrepreneurial ecosystems are increasingly important in facilitating innovation and entrepreneurial opportunities in today’s knowledge-based economies. However, we have an incomplete understanding of the demand side of university entrepreneurial ecosystems regarding the role of the entrepreneurial firm as the key user of university knowledge. We propose that use of university knowledge positively influences entrepreneurial firm performance and that the entrepreneurial firm’s resources and capabilities facilitate its ability to create value from university knowledge. We test our hypotheses on survey data of 3853 knowledge-intensive entrepreneurial firms from 10 European countries. Our study contributes to an increased understanding of the economic, societal and technological contributions of universities by empirically illustrating the role of firm resources and capabilities as moderators of value in university entrepreneurial ecosystems.
Hand hygiene compliance and accuracy in a university dental teaching hospital
Authors: Cheng Hsin-Chung , Peng Bou-Yue , Lin Meei-Liang , Chen Sam Li-Sheng
Published: January 2019

Objective

This study aimed to evaluate compliance with guidelines on hand hygiene by examining five handwashing categories in postgraduate year (PGY) dentists at a university teaching hospital and to evaluate the accuracy rates of handwashing.

Methods

Through direct observation, trained PGY dentists were monitored throughout their daily care routine of before contact with patients, before using an instrument, after contact with patients, upon direct exposure to patients’ fluids, and while touching the patients’ surrounding area. Hand hygiene opportunities were considered complete in each category. A total of 16,597 hand hygiene opportunities across 37 individuals were observed from July to October 2012 and from September to October 2013.

Results

The overall handwashing compliance rate was 34.7%. The handwashing compliance rate was higher during work in oral surgery services (92.8%) than during work in general clinical practice (34.2%). The accuracy rate of handwashing was also higher during work in oral surgery services (87.5%) than during work in general clinical practice (51.0%). Similar results were obtained across all five handwashing categories.

Conclusions

Handwashing compliance and accuracy rates are low in PGY dentists. More education and continuous monitoring are suggested to improve handwashing compliance, as well as the correct handwashing procedures for dentists.
Postobstructive Pulmonary Oedema—A Case Series and Review
Authors: McConkey P. P.
Published: January 2019

Six cases of post-extubation pulmonary oedema in otherwise healthy patients are reported. All were preceded by an episode of laryngospasm and followed a clinical course similar to that previously documented in cases of post-obstructive pulmonary oedema. Frank haemoptysis was a feature of five of the presentations. One patient was reintubated and ventilated, two were admitted to the intensive care unit for mask CPAP, one was managed with CPAP in the recovery ward and two with supplemental oxygen only. All cases resolved fully within 24 hours. Some evidence points to the syndrome being the result of airway bleeding rather than true pulmonary oedema. The literature suggests that it occurs more commonly than is generally thought, with a frequency of 0.05 to 0.1% of all anaesthetics, and is often unrecognised or misdiagnosed. Most cases occur in the early postoperative period, so anaesthetists are well placed to witness, investigate and manage this interesting condition.
Congenital Myasthenic Syndrome: A Rare, Potentially Treatable Cause of Respiratory Failure in a “Floppy” Infant
Authors: McConkey P. P. , Mullens A. J.
Published: January 2019

A four-month-old infant, thought to suffer from cerebral palsy, presented with respiratory failure on the background of a gradually deteriorating general level of function. Whilst being ventilated in intensive care he was noted to have severe muscle weakness. A disorder of the neuromuscular junction was suspected and he was subsequently demonstrated to have a congenital myasthenic syndrome. Anticholinesterase therapy produced a dramatic recovery. The congenital myasthenic syndromes and the diagnosis of a “floppy baby” are briefly reviewed.
Intubation Conditions and Postoperative Myalgia in Outpatient Dental Surgery: A Comparison of Succinylcholine with Mivacurium
Authors: Deehan S. , Henderson D. , Stewart K.
Published: January 2019

Ninety-four patients undergoing elective outpatient third molar extraction were recruited into a double-blind, randomized, prospective trial comparing mivacurium (group M) with succinylcholine (Group S) for conditions for endotracheal intubation and the occurrence of postoperative myalgia. Anaesthesia was induced with fentanyl 1 μg.kg-1 and propofol 2.5 mg.kg-1 in all patients. Group S patients were given gallamine 20 mg while group M patients were given mivacurium 0.2 mg.kg-1. Manual ventilation was commenced and anaesthesia maintained with nitrous oxide 70% and isoflurane 1 to 2% in oxygen. After two minutes, group S patients were given succinylcholine 1.5 mg.kg-1 and group M patients 0.9% saline. Nasotracheal intubation was performed 30 seconds later. Intubating conditions in group M were significantly better than those in group S (P<0.001). The incidence of postoperative myalgia was 9.5% in group M and 26% in group S but this was not statistically significant (P=0.09). We propose that mivacurium is a suitable neuromuscular blocker to use for endotracheal intubation in outpatient dental surgery.
An Analysis of Excess Mortality not Predicted to Occur by Apache III in an Australian Level III Intensive Care Unit
Authors: Buist M. , Gould T. , Hagley S , Webb R.
Published: January 2019

The APACHE III derived standardized mortality ratio has been suggested as a statistic to measure intensive care unit (ICU) effectiveness. From 1991 data collected on 519 consecutive admissions to the Royal Adelaide Hospital ICU a standardized mortality ratio of 1.25 was calculated. Of the 174 deaths only 95 had a prediction of death greater than 0.5. As part of a quality assurance study we undertook a retrospective case note audit to try to identify factors that were associated with the low mortality prediction (<0.5) in hospital deaths.

Firstly we analysed the patient population that died to determine the factors that were different between patients who had a mortality prediction of greater than 0.5 versus those who had a mortality prediction of less than 0.5. Next we analysed the patient population with a mortality prediction of less than 0.5 and compared actual survivors with patients who died in hospital.

Amongst low mortality prediction patients admitted to the Royal Adelaide Hospital ICU we identified age, a history of acute myocardial infarction, presentation to ICU after a cardiac arrest or with an elevated creatinine and the development of acute renal failure and septicaemia during the ICU admission as being associated with in-hospital mortality. We also documented that late hospital deaths on the ward after ICU discharge occurred more frequently with low predicted hospital mortality ICU patients.

Factors other than the APACHE III score may be associated with hospital deaths of ICU patients.
The European Donor Hospital Education Programme (EDHEP): Enhancing Communication Skills with Bereaved Relatives
Authors: Morton J. , Blok G. A. , Reid C. , Van Dalen J. , Morley M.
Published: January 2019

Intensive care medical and nursing staff self-rate their communication skills as improved following attendance at the European Donor Hospital Education Programme (EDHEP) workshop. A prospective study was conducted to determine what impact EDHEP has on communication skills. Doctor-nurse pairs from 10 experimental and 10 control Intensive Care Units undertook two standardized simulated relative encounters (Breaking Bad News and Donation Request) at three measurement points (pre, post and follow-up).

Nurses showed no change in communication skills. Experimental group doctors showed significant improvement in breaking bad news and requesting donation; most of these improvements were not maintained. Control group doctors showed some improvement in breaking bad news, indicating that participating in measurement by itself initiates some transient change in communication skills.

Attendance at EDHEP does lead to significant improvement in some, but not all, communication skills essential in breaking bad news and requesting donation. Further research is necessary to determine what factors additional to EDHEP will contribute to enduring change in these particular skills.
Anaesthetic Management of a Patient with Low Tracheal Obstruction Requiring Placement of a T-Y Stent
Authors: Wong A. Y. C. , Lawmin J. C. , Irwin M. G.
Published: January 2019

A 60-year-old man with a history of oesophagectomy for carcinoma presented with worsening dysphagia, dyspnoea and tachypnoea secondary to oesophageal stricture and tumour invasion of the trachea causing a “ball-valve” obstruction. The patient required placement of a T-Y tracheobronchial stent to relieve the airway obstruction and was successfully managed using sevoflurane for gaseous induction followed by maintenance with propofol total intravenous anaesthesia.
Epileptiform Activity in the EEGs of Two Nonepileptic Children under Sevoflurane Anaesthesia
Authors: Schultz A. , Schultz B. , Grouven U. , Korsch G.
Published: January 2019

Two case reports of nonepileptic children are presented, who developed paroxysmal EEG potentials in routinely performed EEG recordings during inhalation of sevoflurane, 7 and 8% by volume respectively. Taking into account several reports from the literature about epileptiform potentials or convulsive movements under similar conditions, it seems to be important to investigate carefully the circumstances under which these phenomena appear as well as possible clinical consequences.
A Multiple-Hospital Anaesthetic Problem Register: Establishment of a Regionally Organized System for Facilitated Reporting of Potentially Recurring Anaesthetic-Related Problems
Authors: Kerridge R. K. , Crittenden M. B. , Vutukuri V. L. S. P.
Published: January 2019

A regionally organized system aiming to facilitate reporting and retrieval of information about potentially recurring anaesthetic-related problems has been established, covering 20 separate hospitals. Components of the system include a reporting package to facilitate use by anaesthetists in busy clinical practice; centralized clerical support; supervision by anaesthetists; reports and laminated cards supplied to the patient; and a permanently accessible database. A new classification system for difficulties in airway management has been developed as part of the system. After initial establishment, the system has been utilized by a broad cross-section of anaesthetists in the region. The first 350 reports are described. The reporting rate is approximately 0.3% of all anaesthetics given in the region. We believe the success of this system has been primarily due to features aiming to facilitate reporting, “local” ownership and supervision by clinical anaesthetists.
Total Intravenous versus Inhalational Anaesthesia for Colonoscopy: A Prospective Study of Clinical Recovery and Psychomotor Function
Authors: Theodorou T. , Hales P. , Gillespie P. , Robertson B.
Published: January 2019

A randomized, prospective study was conducted on 69 patients comparing recovery after two different anaesthetic techniques for ambulatory colonoscopy. Thirty-five patients received an intravenous fentanyl (1 μg/kg), midazolam (0.05 to 0.075 mg/kg) and propofol (10 to 20 mg boluses as required) combination. 34 patients received sevoflurane in 67% nitrous oxide. Drug administration was titrated to clinical signs. At baseline and 30, 60, 90 and 120 minutes after the procedure patient performance on a comprehensive battery of psychomotor tests was recorded. Emergence times were noted. Depth of sedation was assessed at 5 minute intervals for 30 minutes after the end of the procedure. Emergence times were faster in the fentanyl/midazolam/propofol group by 2.2 minutes. A lower sedation score was detected at 20 minutes in the sevoflurane/nitrous oxide group. Psychomotor impairment was of a greater magnitude and more prolonged by 30 to 90 minutes in the fentanyl/midazolam/propofol group. It is concluded that a sevoflurane/nitrous oxide anaesthetic has a suitable recovery profile for ambulatory colonoscopy and results in faster recovery of cognitive function compared with a fentanyl, midazolam and propofol combination.
Life-Threatening Cardiac Failure in a Healthy Young Female with Irukandji Syndrome
Authors: Little M. , Mulcahy R. F. , Wenck D. J.
Published: January 2019

We present a case of a previously well 24-year-old female patient who developed severe and life-threatening Irukandji syndrome that required ventilation and inotropic support. This case provides further evidence that there are jellyfish other than the Irukandji jellyfish that can cause cardiac decompensation, and there is a suggestion that application of a pressure immobilization bandage may worsen the envenomation. We include our recommended treatment for the Irukandji syndrome.
Are Anaesthetists Prone to Suicide? A Review of Rates and Risk Factors
Authors: Swanson S. P. , Roberts L. J. , Chapman M. D.
Published: January 2019

Suicide represents a major source of mortality in Western countries. There is an emerging literature about suicide and the medical profession. The suicide of an anaesthetist represents a catastrophic event, with painful consequences for family, colleagues and the community at large. This review will examine the literature regarding suicide amongst anaesthetists and trainees in the field. It is presented in three sections. First, it provides an overview of existing epidemiological data, comparing rates in the general population, the medical profession, in general, and in anaesthesia, in particular. Second, risk factors that may account for differences in rates will be discussed. Finally, a series of recommendations has been formulated.
Airway Rescue with the ProSeal™ Laryngeal Mask Airway in the Intensive Care Unit
Authors: Nixon T. , Brimacombe J. , Goldrick P. , Mcmanus S.
Published: January 2019

We report the successful use of the ProSeal™ laryngeal mask airway for airway rescue in a 41-year-old septic patient who could be neither intubated nor facemask ventilated. In principle, the ProSeal™ laryngeal mask airway offers advantages over the Classic LMA in this situation.
The Correlation between Airborne Methicillin-resistant Staphylococcus aureus with the Presence of MRSA Colonized Patients in a General Intensive Care Unit
Authors: Wilson R. D. , Huang S. J. , McLean A. S.
Published: January 2019

Air sampling directly onto a methicillin-resistant Staphylococcus aureus (MRSA) selective agar was performed at six locations three times weekly over a period of 32 weeks in a new, initially MRSA-free Intensive Care Unit to examine if MRSA is present in air sample cultures and, if so, whether it is affected by the number of MRSA colonized patients present. A total of 480 air samples were collected on 80 days. A total of 39/480 (8.1%) samples were found to be MRSA positive of which 24/160 (15%) positive air samples were from the single rooms, where MRSA colonised patients were isolated, and 15/320 (4.7%) were from the open bed areas. A significant correlation was found between the daily number of MRSA colonized or infected patients in the Unit and the daily number of MRSA positive air samples cultures obtained (r2=0.128; P<0.005). The frequency of positive cultures was significantly higher in the single rooms than in the open bed areas (relative risk=3.2; P<0.001). The results from one of the single rooms showed a strong correlation between the presence of MRSA patients and MRSA positive air samples (relative risk=11.4; P<0.005). Our findings demonstrate that the presence of airborne MRSA in our unit is strongly related to the presence and number of MRSA colonized or infected patients in the Unit.