bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome after Robotic-Assisted Thymectomy in Children and Adolescents with Acetylcholine Receptor Antibody-Positive Juvenile Myasthenia Gravis
Authors: Kölbel Heike , Müllers Maximilian , Kaiser Olaf , Ismail Mahmoud , Swierzy Marc , Rueckert Jens-Carsten , Schara Ulrike , Della Marina Adela
Published: June 2017

The aim of our study was to describe the long-term outcomes after robotic-assisted thymectomy in a cohort of acetylcholine receptor (AChR)-antibody (Ab)–positive, generalized juvenile myasthenia gravis (JMG). We retrospectively analyzed a cohort of 18 patients (15 females and 3 males) who underwent robotic-assisted thymectomy. At the time of diagnosis, 12/18 patients were prepubertal; the mean age was 9.8 years at the onset of the disease. All patients received therapy with pyridostigmine; additional immunotherapy included: corticosteroid therapy in 18/18, azathioprine in 14/18 patients, mycophenolate mofetil in 4/18, and cyclosporine in 1/18 patients. Eight patients received intravenous immunoglobulin and four plasma exchange. The mean age of patients at thymectomy was 11.7 years (range: 4.2–16 years). The mean duration of postoperative stay was 2.9 days. Thymectomy was followed by gradual clinical improvement (39% patients achieved clinical remission) and dose reduction in steroid therapy in all patients during the follow-up period (mean: 27.4 months). In children and adolescents with AChR-Ab–positive JMG, thymectomy has a beneficial effect on the weaning off immunosuppressive therapy in patients with generalized symptoms and should be considered as a part of multimodal therapy. Robotic-assisted thymectomy is a safe procedure with low morbidity and a comparable clinical outcome compared with the open sternal procedure.
Das Krankenhausstrukturgesetz: Hehre Ziele – Ernüchternde Umsetzung
Authors: Dittmann Heidi
Published: June 2017

Mit dem Krankenhausstrukturgesetz sollen Strukturen geschaffen werden, die auch in Zukunft eine qualitativ hochwertige Gesundheitsversorgung
der Bevölkerung ermöglichen. Ein wesentliches Element der Reform besteht im Einbezug der Qualität in die Krankenhausvergütung. Bei
andauernden Qualitätsdefiziten ist ein Ausschluss aus der Landesbedarfsplanung vorgesehen. Im Beitrag wird dem hehren Ziel der
Qualitätsverbesserung die ernüchternde Umsetzung auf Landesebene am Beispiel Thüringens gegenübergestellt. Anstatt eine Marktbereinigung um
qualitativ ineffiziente Anbieter zu begrüßen, bekennen sich die Fraktionen des Thüringer Landtags zu allen Standorten und nehmen per
Rechtsverordnung alle an der Notfallversorgung teilnehmenden Kliniken von der Möglichkeit des Ausschlusses aus. Etwaige strukturelle
Änderungen werden konterkariert.
Genotypic variation in carbon fixation, δ13C fractionation and grain yield in seven wheat cultivars grown under well-watered conditions
Authors: Baruah Kushal Kumar , Bharali Ashmita , Mazumdar Aninda , Jha Gulshan
Published: June 2017

Biotic carbon (C) sequestration is currently being considered as a viable option for mitigating atmospheric carbon dioxide (CO2) emission, in which photosynthesis plays a significant role. A field experiment was conducted between 2013 and 2015 to investigate the efficiency of seven modern wheat varieties for CO2 fixation, C partitioning, δ13C fractionation in the leaves, and grain yield. A strong correlation between flag leaf photosynthesis and stomatal density (r = 0.891) was detected. Photosynthetic efficiency was highest in the variety WH-1021 (28.93 µmol m–2 s–1). Grain yield was influenced by biomass accumulation in the heads and these were significantly correlated (r = 0.530). Our results show that upregulated biomass partitioning to the developing kernels of wheat was inversely proportional to biomass accumulation in the roots, and led to a higher grain yield. These results led us to conclude that identification of a wheat genotype like WH-1021 followed by WH-1080 and WH-711, with higher isotopic discrimination in the flag leaves, stomatal densities, water use and photosynthetic efficiencies along with higher grain yield, can contribute to sustainable agriculture in future climate change situation in India. A yield increment of 9–48% was recorded in WH-1021 over other six tested wheat varieties.
Implementing marine ecosystem-based management: lessons from Australia
Authors: Smith David C. , Fulton Elizabeth A. , Apfel Petrina , Cresswell Ian D. , Gillanders Bronwyn M. , Haward Marcus , Sainsbury Keith J. , Smith Anthony D. M. , Vince Joanna , Ward Tim M.
Published: June 2017

Ecosystem-based management (EBM) is now widely accepted as the best means of managing the complex interactions in marine systems. However, progress towards implementing and operationalizing it has been slow. We take a pragmatic approach to EBM. Our simple definition is balancing human activities and environmental stewardship in a multiple-use context. In this paper, we present case studies on the development and implementation of EBM in Australia. The case studies (Australia’s Ocean Policy, the Great Barrier Reef, New South Wales (NSW) marine estate, Gladstone Harbour, and South Australia and Spencer Gulf) span different spatial scales, from national to regional to local. They also cover different levels of governance or legislated mandate. We identify the key learnings, necessary components and future needs to support better implementation. These include requirements for clearly identified needs and objectives, stakeholder ownership, well defined governance frameworks, and scientific tools to deal with conflicts and trade-offs. Without all these components, multi-sector management will be difficult and there will be a tendency to maintain a focus on single sectors. While the need to manage individual sectors remains important and is often challenging, this alone will not necessarily ensure sustainable management of marine systems confronted by increasing cumulative impacts.
Abilities of a Densitometric Analysis of Computed Tomography Images and Hemorrhagic Parameters to Predict Outcome Favorability in Patients With Intracerebral Hemorrhage
Authors: Kim Hakseung , Yang Xiaoke , Choi Young Hun , Yoon Byung C , Kim Keewon , Kim Dong-Joo
Published: June 2017

BACKGROUND

Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability.

OBJECTIVE

To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes.

METHODS

Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted.

RESULTS

The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes.

CONCLUSION

Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.
“Bringing heaven down to earth”: the purpose and place of religion in UK food aid
Authors: Power Madeleine , Small Neil , Doherty Bob , Stewart-Knox Barbara , Pickett Kate E.
Published: June 2017

Purpose

This paper uses data from a city with a multi-ethnic, multi-faith population to better understand faith-based food aid. The paper aims to understand what constitutes faith-based responses to food insecurity, compare the prevalence and nature of faith-based food aid across different religions and explore how community food aid meets the needs of a multi-ethnic, multi-faith population.

Design/methodology/approach

The study involved two phases of primary research. In Phase 1, desk-based research and dialogue with stakeholders in local food security programmes were used to identify faith-based responses to food insecurity. Phase 2 consisted of 18 semi-structured interviews involving faith-based and secular charitable food aid organizations.

Findings

The paper illustrates the internal heterogeneity of faith-based food aid. Faith-based food aid is highly prevalent and the vast majority is Christian. Doctrine is a key motivation among Christian organizations for their provision of food. The fact that the clients at faith-based, particularly Christian, food aid did not reflect the local religious demographic is a cause for concern in light of the entry-barriers identified. This concern is heightened by the co-option of faith-based organizations by the state as part of the “Big Society” agenda.

Originality/value

This is the first academic study in the UK to look at the faith-based arrangements of Christian and Muslim food aid providers, to set out what it means to provide faith-based food aid in the UK and to explore how faith-based food aid interacts with people of other religions and no religion.
Addressing food insecurity: a systemic innovation approach
Authors: Zivkovic Sharon
Published: June 2017

Purpose

This paper aims to question the utility of addressing food insecurity through food assistance programmes and by separating food security into pillars, and it argues for a systemic innovation and complexity approach. This is achieved by demonstrating that food insecurity is a wicked problem and therefore needs to be addressed holistically.

Design/methodology/approach

To establish that food insecurity is a wicked problem, characteristics of food insecurity are aligned to characteristics of wicked problems. The need to address wicked problems holistically through a systemic innovation approach and an understanding of complexity theory is discussed by referring to the literature. How to take such an approach for addressing food insecurity is illustrated by describing the use of an online tool that takes a systemic innovation and complexity approach.

Findings

Given food insecurity is a wicked problem and needs to be addressed holistically, the focus when addressing food insecurity should not be on programmes or pillars. Instead, it needs to be on increasing the coherence and building the adaptive capacity of food insecurity solution ecosystems.

Practical implications

This paper provides insights into the nature of food insecurity and how to address food insecurity.

Originality/value

For the first time, this paper aligns characteristics of food insecurity to characteristics of wicked problems and demonstrates how an online tool for systemic innovation can assist food insecurity solution ecosystems to address food insecurity.
Working separately but together: appraising virtual project team challenges
Authors: Zuofa Tarila , Ochieng Edward G.
Published: June 2017

Purpose

This paper aims to extend the extant knowledge on virtual teams by examining the challenges of virtual project teams in organisations in Nigeria.

Design/methodology/approach

Data were collected through semi-structured interviews. Totally, 20 interviews were recorded, transcribed and analysed. Validity and reliability were achieved by first assessing the plausibility in terms of already existing knowledge on some of the virtual project team issues identified by participants.

Findings

The findings from this study confirmed the growing relevance of virtual project teams in highly competitive global business environments. It emerged that some of the challenges identified in the study had some level of congruence with those previously identified from similar studies from other geographical locations. The findings also suggested that challenges in virtual project teams can be linked to the organisation, the project team and the virtual environment or even a combination of all.

Practical implications

The present study corroborates the position that managing virtual project teams requires additional efforts to attain their objectives through effective communications and the adoption of appropriate technology.

Originality/value

The originality of this study lies in its exploration of virtual project team challenges in a sub-Saharan Africa country (Nigeria). By identifying the challenges associated with virtual project teams, stakeholders will be better able to successfully establish and manage virtual project teams better.
Consensus‐building on developing dysphagia competence: a North West of England perspective
Authors: Guthrie Susan , Lancaster John , Stansfield Jois
Published: June 2017

Background

Dysphagia has been an increasing area of practice for speech and language therapists (SLTs) for over 20 years, and throughout that period there has been debate about how practical skills in dysphagia can best be developed. The implementation of the new Royal College of Speech and Language Therapists (RCSLT) framework was considered from a regional perspective seeking to establish consensus across different speech and language therapy settings.

Aim

To explore practical solutions to the development of dysphagia competency in new graduates whilst acknowledging the wide variation in staffing and clinical dysphagia experience across the geographical and clinical landscape in the North West of England.

Methods & Procedures

A four‐phase study involved a literature search; interviews with experts in the field of dysphagia; a survey to identify current practice; and a two‐round Delphi process.

Outcomes & Results

Five themes emerged for dysphagia competency development: development of practical skills; supervision; clinical excellence networks; workforce planning; and postgraduate formal training. Challenges, and solutions to these, were identified through the phases of the study. A model for dysphagia competency development relevant to the North West context was achieved by consensus.

Conclusions & Implications

There are many practical ways of developing dysphagia competency. The themes and model generated provide constructive support to services in adopting the most appropriate methods for their own settings.
National Museum of African American History and Culture: A New Integration?
Authors: Rice Faun
Published: June 2017

The National Museum of African American History and Culture (NMAAHC) marks a milestone moment in American history; the project has taken almost a century to come to fruition. Beginning with the first glimpse of the new monumental building on the National Mall, a NMAAHC visitor encounters complex symbols and histories. This review explores NMAAHC's historical context alongside its symbolic capital and its inaugural exhibitions, focusing on the central topic of the museum's efforts to embody “a new integration,” a space wherein all Americans can see their country through the lens of the African American experience.
Children's Museums: A Look Back at the Literature
Authors: Herz Rebecca Shulman
Published: June 2017

This article examines nine articles from the Curator archive, from 1960–2017, on the topic of children's museums. It concludes that despite enormous changes in these museums over the 60‐year span, there are a number of trends consistent in the literature. The article concludes with a call to museums to invest in research in order to understand the impact of our work, and to help us ensure we are really achieving what we claim to.
Museums and the Future of a Healthy World: “Just, Verdant and Peaceful”
Authors: Sutton Sarah W. , Wylie Elizabeth , Economopoulos Beka , O'Brien Carter , Shapiro Stephanie , Xu Shengyin
Published: June 2017

Museums hold the physical and intellectual resources, abilities, creativity, freedom, and authority to foster the changes the world needs most. The authors offer a mantra for the field's role in creating a world where people and cultures flourish as the environment thrives. The text includes a variety of international calls‐to‐action, and provides example institutional responses. The authors are all members of PIC Green, the American Alliance of Museums’ professional network on environmental sustainability.
Global Design Strategy for Cancer Patient Education Materials: Haiti Pilot Case Study
Authors: Cardenas Carlos , Schleimer Lauren E. , Olsen Maia , Manzo Veronica , Guay Rachael , Kim Taerim , Desameau Peter‐Gens , Damuse Ruth , Shulman Lawrence N. , Huang Franklin W. , Bhatt Ami S.
Published: June 2017

Cancer care providers at Queen Elizabeth Central Hospital in Malawi identified a need for educational materials for their low‐literacy patients. Global Oncology, a nonprofit focused on improving cancer care, research, and education in resource‐limited settings, partnered with THE MEME to develop cancer patient educational materials (PEMs). The goal of the project was to create clinically relevant and culturally appropriate low‐literacy PEMs to improve clinical care, support services, and patient adherence in resource‐limited settings. The team also aimed to develop a product strategy and business model for long‐term sustainability. The article introduces the challenge from a global health perspective and the ways design can have a significant impact. It presents the collaborative process of developing the “Cancer and You” booklet for multiple cultural contexts and focuses on the results of a pilot study in Haiti evaluating the efficacy of the design in simplifying complex medical information, facilitating patient education, and improving communication.
No Such Thing as Killer Robots
Authors: Robillard Michael
Published: June 2017

There have been two recent strands of argument (one offered by Rob Sparrow and the other offered by Duncan Purves, Ryan Jenkins, and Bradley Strawser) arguing for the pro tanto impermissibility of fully autonomous weapon systems (AWS). On Sparrow's view, AWS are impermissible because they generate a morally problematic ‘responsibility gap’. According to Purves et al., AWS are impermissible because moral reasoning is not codifiable and because AWS are incapable of acting for the ‘right’ reasons. I contend that these arguments are flawed and that AWS are not morally problematic in principle. Specifically, I contend that these arguments presuppose an incoherent conception of an AWS as somehow making genuine decisions but not being morally responsible for those very same decisions. Rather than conceiving of AWS in this way, I argue that an AWS is either a socially‐constructed institution that has been physically instantiated or it is a genuine agent. If it is the former, then we should treat AWS as we do any other collective action problem. If it is the latter, then we should treat AWS as responsibility‐bearers, but also as bearers of rights and/or interests. To reject this disjunction is not only conceptually incoherent but also potentially morally dangerous.
The Importance of Allies and Allied Organizations: Sexual Orientation Disclosure and Concealment at Work
Authors: Wessel Jennifer L.
Published: June 2017

Lesbian, gay, and bisexual (LGB) individuals must make decisions regarding the extent to which they disclose their sexual orientation to others each time they encounter a new individual. Although researchers have acknowledged potential person‐to‐person variation in sexual orientation disclosure, we know little as to the effects of individual, group, and organizational characteristics on within‐person variation in sexual orientation disclosure decision‐making. We also know little of how different types of support relatively predict disclosure. The present study takes a multilevel approach and examines the role of different levels of support (at the individual recipient level, the coworker group level, and the organization level) on sexual orientation disclosure, focusing on LGB working adults. A one‐with‐many multilevel design accounted for coworker relationships (N = 371) being nested within LGB employees (k = 125). Results showed that disclosure was predicted by the perceived supportiveness of the potential recipient of that information, the most supportive person in the LGB employee's work group, and the organization itself. A relative weight analysis suggests that organizational policies and the most supportive coworker are stronger predictors of disclosure across the coworker group, compared to mean coworker supportiveness.
Cholelithiasis in adult bearded dragons: retrospective study of nine adult bearded dragons (Pogona vitticeps) with cholelithiasis between 2013 and 2015 in southern Germany
Authors: Gimmel A. , Kempf H. , Öfner S. , Müller D. , Liesegang A.
Published: June 2017

With an increased number of pet reptiles, many diseases occur due to nutritional disorders. Between 2013 and 2015, irregular gallbladder contents (sludge/choleliths) in adult bearded dragons (Pogona vitticeps) were recorded in many of the routinely conducted necropsies at the reptile rescue station in Munich (Auffangstation für Reptilien, München e.V., Munich, Germany). Nine animals, six from the rescue station and three from an associated veterinary practice (Tierärztliche Praxis für Exoten, Augsburg, Germany), were studied. Gallbladder contents from all animals were analysed at the Institute for Clinical Chemistry in Zurich, Switzerland. In three of nine animals, one cholelith composed of 100% calcium carbonate (CaCO3) was detected and it precipitated either as pure calcite or as a calcite:vaterite combination. In the remaining six animals, analyses suggested a protein‐based material. The detection of choleliths/sludge was not anticipated at necropsy or surgery in eight of nine animals. The diet of the six animals from the rescue station was retrospectively described as mainly insects, whereas the diet of the three animals from the veterinary practice also contained little plant matter. Fed insect species were mealworm larva (Tenebrio molitor), house cricket (Acheta domestica), migratory locust (Locusta migratoria) and zophobas larva (Zophobas morio), all high in protein and fat. In other species, a nidus must be present for CaCO3 to precipitate. As a protein‐based sludge was detected in six gallbladders, it is possible that a high‐protein diet could lead to such a nidus and subsequently to cholelith formation. Cholelithiasis seems to be a rising problem in adult bearded dragons and is likely underdiagnosed, as many choleliths were found at necropsy. This rise in cholelithiasis may correlate with an unnatural high‐protein, high‐fat insect‐based diet instead of a balanced plant‐based diet.
Evaluation of an in vitro system to simulate equine foregut digestion and the influence of acidity on protein and fructan degradation in the horse′s stomach
Authors: Strauch S. , Wichert B. , Greef J. M. , Hillegeist D. , Zeyner A. , Liesegang A.
Published: June 2017

The aim of this study was to improve an in vitro system in order to gather optimized information on the digestion of different forages in the horse′s upper gastrointestinal tract. Therefore, foregut digestion of several forages was simulated in vitro (Part 1). The effect of different pH values on in vitro fructan degradation of two selected grasses (Part 2) was tested subsequently. Part 1: We hypothesized that our system produces representative results simulating digestive processes in the upper alimentary tract, but neglects microbial fermentation. In vitro digestion of six forages (grass mixture for horses, grass mixture for cows (GMC), tall fescue, English perennial ryegrass (ER), white clover, lucerne) was performed in two phases with pepsin and pancreatin. The results are consistent with current data from in vivo studies, including a degradation of crude protein and monosaccharides as well as a relative increase in fibres. Interestingly, a loss of fructan was measured in two feedstuffs (ER/GMC: 4.1/4.4% DM fructan before and 0.59/0.00% DM after simulated foregut digestion). Part 2: As fructans are thought not to be fragmented by digestive enzymes, another hypothesis was developed: acidic hydrolysis leads to a degradation of fructans. To evaluate the influence of gastric pH on the digestion of fructan and protein, different pH values (2, 3 and 4) were adjusted in a second series of in vitro foregut digestion trials with ER and GMC. As expected, the highest degradation of protein was seen at the lowest pH (protein in ER/GMC at pH 2: 6.11/8.28% DM and at pH 4: 7.73/10.64% DM), whereas fructan degradation was highest at pH 4 (fructan in ER/GMC at pH 2: 1.63/1.95% DM and at pH 4: 1.31/0.91% DM). We presume that not only acidic hydrolysis but also plant enzymes cause the loss of fructans in an acidic environment.
Beet pulp intake and hairball faecal excretion in mixed‐breed shorthaired cats
Authors: Loureiro B. A. , Monti M. , Pedreira R. S. , Vitta A. , Pacheco P. D. G. , Putarov T. C. , Carciofi A. C.
Published: June 2017

Hairball formation may induce vomiting and intestinal obstruction in predisposed cats. Some insoluble fibres as sugarcane fibre and cellulose can prevent hairball formation. The aim of this study was to evaluate the effect of beet pulp consumption, a moderate soluble and fermentable fibre source, on faecal trichobezoars excretion in adult shorthaired cats fed kibble diets. Eighteen mixed‐breed shorthaired cats and three extruded diets were used as follows: a basal diet without added fibre source (PB0–8.8% dietary fibre); BP8–8% inclusion of beet pulp (17.5% of dietary fibre); BP16–16% inclusion of beet pulp (23.8% of dietary fibre). The cats were fed during 31 days and faeces quantitatively collected during three periods of 3 days each (from days 3–5; 15–17; 26–28). Gastrointestinal transit time was determined in the last 3 days of study (from days 29–31). The trichobezoars were separated from faeces, collected, dried and washed in ether for complete removal of all faecal material. The results were submitted to repeated‐measure analysis of variance and means evaluated by polynomial contrast (p < 0.05). Beet pulp increased faecal production (p < 0.001) and reduced gastrointestinal transit time (p = 0.003). No alterations were found on trichobezoar faecal excretion, both as considered in number per cat per day of mg per cat per day (p > 0.05). Beet pulp intake did not reduce the number or the size of hairballs eliminated via faeces of shorthaired cats.
Why we should develop guidelines and quantitative standards for using genetic data to delimit subspecies for data‐poor organisms like cetaceans
Authors: Taylor Barbara L. , Perrin William F. , Reeves Randall R. , Rosel Patricia E. , Wang John Y. , Cipriano Frank , Scott Baker C. , Brownell Robert L.
Published: June 2017

Obtaining the representative morphological data required for traditional taxonomy is difficult, and sometimes impossible, for cetaceans, especially large ones. As a result, three quarters of the 88 currently recognized extant species have no subspecies and 40 taxa likely have additional unnamed taxa. Conservation needs give urgency to improving taxonomy because unnamed taxa are unlikely to receive protection equivalent to that received by named taxa. Genetic data can improve efforts to delimit subspecies, but the markers and methods used have varied and the magnitude of genetic difference used to justify subspecies distinctions across studies has also varied. Here, we define the concepts of populations, subspecies, and species to establish a foundation for developing guidelines (data to include and analyses to conduct) and quantitative standards (the magnitude of differentiation expected at different taxonomic levels) for using genetic data to support taxonomic recognition. Our definition is particularly applicable to data‐poor groups because it allows for naming a subspecies when there is uncertainty about whether lineages have diverged sufficiently for species‐level recognition. This allows a species that lacks convincing data for lineage divergence to be recognized as a subspecies while sufficient data are accrued, which could take decades for some cetaceans.
Comparison of Subsidy Schemes for Reducing Waiting Times in Healthcare Systems
Authors: Qian Qu , Guo Pengfei , Lindsey Robin
Published: June 2017

This study analyzes subsidy schemes that are widely used in reducing waiting times for public healthcare service. We assume that public healthcare service has no user fee but an observable delay, while private healthcare service has a fee but no delay. Patients in the public system are given a subsidy s to use private service if their waiting times exceed a pre‐determined threshold t. We call these subsidy schemes ( s,  t) policies. As two extreme cases, the ( s,  t) policy is called an unconditional subsidy scheme if t = 0, and a full subsidy scheme if s is equal to the private service fee. There is a fixed budget constraint so that a scheme with larger s has a larger t. We assess policies using two criteria: total patient cost and serviceability (i.e., the probability of meeting a waiting time target for public service). We prove analytically that, if patients are equally sensitive to delay, a scheme with a smaller subsidy outperforms one with a larger subsidy on both criteria. Thus, the unconditional scheme dominates all other policies. Using empirically derived parameter values from the Hong Kong Cataract Surgery Program, we then compare policies numerically when patients differ in delay sensitivity. Total patient cost is now unimodal in subsidy amount: the unconditional scheme still yields the lowest total patient cost, but the full subsidy scheme can outperform some intermediate policies. Serviceability is unimodal too, and the full subsidy scheme can outperform the unconditional scheme in serviceability when the waiting time target is long.
High‐order Corrected Estimator of Asymptotic Variance with Optimal Bandwidth
Authors: Chan Kin Wai , Yau Chun Yip
Published: June 2017

Estimation of time‐average variance constant (TAVC), which is the asymptotic variance of the sample mean of a dependent process, is of fundamental importance in various fields of statistics. For frequentists, it is crucial for constructing confidence interval of mean and serving as a normalizing constant in various test statistics and so forth. For Bayesians, it is widely used for evaluating effective sample size and conducting convergence diagnosis in Markov chain Monte Carlo method.

In this paper, by considering high‐order corrections to the asymptotic biases, we develop a new class of TAVC estimators that enjoys optimal
‐convergence rates under different degrees of the serial dependence of stochastic processes. The high‐order correction procedure is applicable to estimation of the so‐called smoothness parameter, which is essential in determining the optimal bandwidth. Comparisons with existing TAVC estimators are comprehensively investigated. In particular, the proposed optimal high‐order corrected estimator has the best performance in terms of mean squared error.
Al-Qaeda Understandings from Seyed Qutb's Jihadi Thoughts
Authors: Anari Hassan Hajizadeh , Jalali Reza , Ashrafi Akbar , Ardestani Ahmad Bakhshayesh , Ghasemtabar Seyed Mohammad Mehdi
Published: June 2017

Seyed Qutb is one of the great theorists of Egypt Muslim population who could propagate his thoughts among Egyptian youths and adolescents through writing the books such as “fi zelal al Quran “and “Maalem fe al tarigh”. Presenting some problems such as like social justice in Islam, people's Ignorance in present age and world division into Islam and Atheism, He eloquently announced idolatry of all governments and its solution as being Jihad or emigration.Stating such thoughts influenced Arab youths greatly as after executing him, jihadi groups including Al-Qaeda were created influenced by his thoughts. In their method and thought they followed Seyed Qutb but in jurisprudence and beliefs they imitated salafists like Ibn Tamie; as Abdullah Azam says: I had been the pupil of four persons: In thought the pupil of Seyed Qutb, in jurisprudence pupile of Now; in beliefs the pupil of Ibn Tamie and in mental issues pupil of Ibn Qayem. So Al-Qaeda is a combined group that has adopted his strategic way from Seyed Qutb's thoughts and his beliefs from Ibn Tamie and now we observe that abusing Qutbi's ideas Wahhabism invites Arab youths to war and jihad, but with special goals from which none are accordance with Seyed Qutb's goals.
Mistaken identity: haemoglobinuria secondary to paravalvular leak masking as haematuria
Authors: Meadows Sam , Gordon Patrick , Inman Richard
Published: June 2017

Haemolytic anaemia caused by a paravalvular leak presenting as progressively worsening red urine. Haemoglobinuria was easily mistaken for gross haematuria, resulting in extensive invasive urological investigation that proved to be futile. Further investigation following an emergency admission led to the realisation that intravascular haemolysis secondary to a paravalvular leakâ€”presenting 43 years following metallic valve insertionâ€”was the cause of discoloured urine and newly presenting symptomatic anaemia. This case highlights that there remains other causes of what often appears to be haematuria, and further exploration of alternative causes should be considered when no urological cause is found.
Retrorectal tumour simulating vaginal birth: an exceptional case of emergency surgery indication
Authors: Alvarez-Sarrado Eduardo , Pous-Serrano Salvador , Carreño Saenz Omar , Pamies-Gilabert Jose
Published: June 2017

Cystic retrorectal tumours are a very rare entity that pose a problem in differential diagnosis between congenital cyst and other lesions. We present a 49-year-old female patient presenting a perineal bulge which was discovered simulating a vaginal birth associated with prolapsed haemorrhoids grade IV. The interest of this case resides in the surgical indication of a big presacral cyst demonstrated via CT causing acute intense pain due to pelvic organ compression, as no emergent surgery management has been reported up to date.
QUAD fever: beware of non-infectious fever in high spinal cord injuries
Authors: Goyal Jyoti , Jha Rakesh , Bhatia Paramjeet , Mani Raj Kumar
Published: June 2017

A case of cervical spinal cord injury and quadriparesis with prolonged fever is being described. Initially, the patient received treatment for well-documented catheter-related bloodstream infection. High spiking fever returned and persisted with no obvious evidence of infection. The usual non-infectious causes too were carefully excluded. QUAD fever or fever due to spinal cord injury itself was considered. The pathogenetic basis of QUAD fever is unclear but could be attributed to autonomic dysfunction and temperature dysregulation. Awareness of this little known condition could help in avoiding unnecessary antimicrobial therapy and in more accurate prognostication. Unlike several previous reported cases that ended fatally, the present case ran a relatively benign course. The spectrum of presentations may therefore be broader than hitherto appreciated.
Thyrotoxic periodic paralysis as an initial presentation of Graves’ disease in a Saudi patient
Authors: Alqahtani SF , Aleithan MM
Published: June 2017

Thyrotoxic periodic paralysis (TPP) is a well-known complication of hyperthyroidism, characterised by recurrent flaccid paralysis with hypokalaemia. To date, only five cases of this rare disorder have been reported in Saudi Arabia. Here, we report an additional case involving a 25-year-old Saudi man who presented with lower limb paralysis and severe hypokalaemia. Clinically, he showed symptoms and signs suggestive of Graves’ disease, which was confirmed by laboratory investigations. Carbimazole, a beta-blocker and potassium replacement were administered, resulting in dramatic improvement of the TTP. This case emphasises the importance of considering TPP in patients with acute muscle weakness and the importance of promptly initiating treatment and preventing relapse of TPP.
Ominous triad triggered by high-dose glucocorticosteroid therapy
Authors: Bär Sarah , Daudel Fritz , Zueger Thomas
Published: June 2017

Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis—a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy. Our patient’s condition was further aggravated by a circulatory shock, haemodynamic relevant bleeding from a duodenal ulcer and psychotic symptoms. In the intensive care unit, intravenous insulin infusion, fluid resuscitation, catecholamine support, electrolyte supplementation, endoscopic haemoclipping and antibiotic and antipsychotic treatment were administered, leading to a continuous improvement of the patient’s health state.
ANTI-CORROSION PERFORMANCE OF 1,3-BENZOTHIAZOLE ON 410 MARTENSITIC STAINLESS STEEL IN H2SO4
Authors: LOTO ROLAND TOLULOPE
Published: June 2017

The corrosion inhibition effect of synthesized 1,3-benzothiazole at very low concentrations on 410 martensitic stainless steel in 3[Formula: see text]MH2SO4 solution was studied through potentiodynamic polarization and weight loss measurements. The observation showed that the organic compound performed effectively with average inhibition efficiencies of 94% and 98% at the concentrations studied from both electrochemical methods due to the inhibition action of protonated inhibitor molecules in the acid solution. The amine and aromatics functional groups of the molecules active in the corrosion inhibition reaction were exposed from Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) spectroscopic analysis. Thermodynamic calculations showed cationic adsorption to be chemisorption adsorption, obeying the Langmuir adsorption isotherm. Images from optical microscopy showed an improved morphology in comparison to images from corroded stainless steel. Severe surface deterioration and macro-pits were observed in the uninhibited samples.
High-Dimensional Nash Equilibria Problems and Tensors Applications
Authors: Abdou J. E. , Safatly E. , Nakhle B. , El Khoury A.
Published: June 2017

We propose, in this work, an overview on tensors application in game theory, and basically on Nash equilibria problems. In this paper, we extend the classic normal form of a game to a new form called Tensor form. We present some tensors concepts and operations with detailed examples and then we propose an efficient methodology to solve pure and mixed high-dimensional Nash equilibria problems using tensors operations. The efficiency of this methodology is shown in numerical examples for pure and mixed strategy. An algorithm based on tensors is also implemented to describe and solve these problems.
A Cell-Based Smoothed Finite Element Method for Free Vibration Analysis of a Rotating Plate
Authors: Du C. F. , Zhang D. G. , Liu G. R.
Published: June 2017

A cell-based smoothed finite element method (CS-FEM) is formulated for nonlinear free vibration analysis of a plate attached to a rigid rotating hub. The first-order shear deformation theory which is known as Mindlin plate theory is used to model the plate. In the process of formulating the system stiffness matrix, the discrete shear gap (DSG) method is used to construct the strains to overcome the shear locking issue. The effectiveness of the CS-FEM is first demonstrated in some static cases and then extended for free vibration analysis of a rotating plate considering the nonlinear effects arising from the coupling of vibration of the flexible structure with the undergoing large rotational motions. The nonlinear coupling dynamic equations of the system are derived via employing Lagrange’s equations of the second kind. The effects of different parameters including thickness ratio, aspect ratio, hub radius ratio and rotation speed on dimensionless natural frequencies are investigated. The dimensionless natural frequencies of CS-FEM are compared with those other existing method including the FEM and the assumed modes method (AMM). It is found that the CS-FEM based on Mindlin plate theory provides more accurate and “softer” solution compared with those of other methods even if using coarse meshes. In addition, the frequency loci veering phenomena associated with the mode shape interaction are examined in detail.
Peculiar properties of phase transitions in Na0.5Bi0.5TiO3−0.06BaTiO3 lead-free relaxor ferroelectrics seen via acoustic emission
Authors: Dul’kin Evgeniy , Tiagunova Jenia , Mojaev Evgeny , Roth Michael
Published: June 2017

Na[Formula: see text]Bi[Formula: see text]TiO3-0.06BaTiO3 relaxor ferroelectrics (RFEs) ceramic samples were investigated by means of dielectric and acoustic emission methods in the temperature range of 70–350[Formula: see text]C and in dependence on frequency. Dielectric curve exhibits two anomalies: strongly dispersive the local maximum, within 130–180[Formula: see text]C and slightly dispersive the smeared high-temperature maximum within 300–310[Formula: see text]C. Acoustic emission exhibits the five groups of bursts: near 123[Formula: see text]C, 150–180[Formula: see text]C, near 225[Formula: see text]C, 300–310[Formula: see text]C and 327[Formula: see text]C. The first and third groups of acoustic emission bursts correspond to phase transitions of R[Formula: see text]c-P[Formula: see text]bm phases coexisting in this temperature, range, while the fourth and fifth groups of acoustic emission bursts correspond to P[Formula: see text]bm-P[Formula: see text] /mbm-Pm[Formula: see text] m phase transitions. The second group of acoustic emission bursts corresponds to strongly dispersive local maximum at which no phase transition has been proved in Na[Formula: see text]Bi[Formula: see text]TiO3-0.06BaTiO3. The existence and the location of the intermediate temperature, [Formula: see text], in Na[Formula: see text]Bi[Formula: see text]TiO3-0.06BaTiO3 compound are discussed.
Switched signed graphs of integer additive set-valued signed graphs
Authors: Sudev N. K. , Chithra K. P. , Germina K. A.
Published: June 2017

Let [Formula: see text] denote a set of non-negative integers and [Formula: see text] be its power set. An integer additive set-labeling (IASL) of a graph [Formula: see text] is an injective set-valued function [Formula: see text] such that the induced function [Formula: see text] is defined by [Formula: see text], where [Formula: see text] is the sumset of [Formula: see text] and [Formula: see text]. An IASL of a signed graph [Formula: see text] is an IASL of its underlying graph [Formula: see text] together with the signature [Formula: see text] defined by [Formula: see text]. A marking of a signed graph is an injective map [Formula: see text], defined by [Formula: see text] for all [Formula: see text]. Switching of signed graph is the process of changing the sign of the edges in [Formula: see text] whose end vertices have different signs. In this paper, we discuss certain characteristics of the switched signed graphs of certain types of integer additive set-labeled signed graphs.
Simulation and Testing of a Linear Array of Modified Four-Square Feed Antennas for the Tianlai Cylindrical Radio Telescope
Authors: Cianciara Aleksander J. , Anderson Christopher J. , Chen Xuelei , Chen Zhiping , Geng Jingchao , Li Jixia , Liu Chao , Liu Tao , Lu Wing , Peterson Jeffrey B. , Shi Huli , Steffel Catherine N. , Stebbins Albert , Stucky Thomas , Sun Shijie , Timbie Peter T. , Wang Yougang , Wu Fengquan , Zhang Juyong
Published: June 2017

A wide bandwidth, dual polarized, modified four-square antenna is presented as a feed antenna for radio astronomical measurements. A linear array of these antennas is used as a line-feed for cylindrical reflectors for Tianlai, a radio interferometer designed for 21[Formula: see text]cm intensity mapping. Simulations of the feed antenna beam patterns and scattering parameters are compared to experimental results at multiple frequencies across the 650–1420[Formula: see text]MHz range. Simulations of the beam patterns of the combined feed array/reflector are presented as well.
Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals
Authors: Arcidiacono Gabriele , Matt Dominik T. , Rauch Erwin
Published: June 2017

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system.
Measuring Family Members’ Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire
Authors: Nadin Shevaun , Miandad Mohammed Ali , Kelley Mary Lou , Marcella Jill , Heyland Daren K.
Published: June 2017

Rationale. Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families’ satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families’ perceptions of the EOLC experience and to be self-administered.Methods and Results.Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added.Phase 2. The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered.Phase 3. The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach’s alpha coefficients (range: .88–.94) indicated internal consistency.Conclusion. This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families’ perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.