bluuebunny/crossref_metadata_2025 huggingface dataset:
The Fate of the Fixed Syndesmosis Over Time
Authors: Gennis Elisabeth , Koenig Scott , Rodericks Deirdre , Otlans Peters , Tornetta Paul
Published: June 2015

Background:

A prior study demonstrated statistical widening of the syndesmosis within weeks of elective screw removal. However, no information is available as to the radiographic outcomes of screw retention. The aim of this study was to evaluate radiographic syndesmotic widening and talar shift over time in patients treated with syndesmotic screws and to compare screw removal with retention along with other potential risk factors that may have led to tibia-fibula diastasis after weightbearing.

Methods:

One hundred sixty-six skeletally mature patients with ankle fractures and concomitant syndesmotic injuries were treated with syndesmotic reduction and screw fixation. The syndesmosis was evaluated intraoperatively either by a stress test or direct visualization. If the syndesmosis was incompetent, it was reduced and stabilized with syndesmotic screws to maintain reduction. Anteroposterior, mortise, and lateral radiographs at presentation, postoperatively, and at follow-up after weightbearing were evaluated. We measured the medial clear space (MCS), tibia-fibula overlap (OL), and tibia-fibula clear space (CS). Screws that were retained were graded as loose/broken or intact.

Results:

The fibula shifted an insignificant amount on postoperative mortise radiographs after elective syndesmotic screw removal at 3 months or more after initial fixation, indicated by a slightly greater CS and lower OL. The MCS did not change from preoperative to postoperative screw removal. There was no change in the radiographic markers from the postoperative to final follow-up images in those whose screws became loose or broken. Likewise, there was no radiographic difference if screws remained intact versus those that were loose or broken.

Conclusion:

In contradistinction to prior work, we found that only very mild widening (0.5 mm) of the tibia-fibula space occurred after weightbearing following syndesmotic fixation. The removal of syndesmotic screws at 3 months resulted in a slightly lower OL (<1 mm) and greater CS (0.5 mm) on mortise radiographs than screw retention even if the retained screws loosened or broke. This was not associated with any talar subluxation, and these differences were not statistically significant. The mortise remained intact whether the syndesmotic screws were removed, were loosened or broken, or remained solid.

Level of Evidence:

Level IV, retrospective case series.
Concomitant Ankle Injuries Associated With Tibial Shaft Fractures
Authors: Jung Ki Jin , Chung Chin Youb , Park Moon Seok , Chung Myung Ki , Lee Dong Yeon , Koo Seungbum , Lee Kyoung Min
Published: June 2015

Background:

Ankle injuries associated with tibial shaft fractures can cause postoperative ankle pain and stiffness even when satisfactory bony union has been achieved. Although several previous studies have described these injuries, they have not been clearly defined or classified in terms of ankle injury type or need for surgical fixation.

Methods:

Seventy-one consecutive patients (mean ± SD age, 48.3 ± 16.7 years; 37 men and 34 women) with tibial shaft fractures who underwent computed tomography examination were included. Data were collected including age, sex, body mass index, fracture location of the tibia and fibula (in percentile of length), tibial fracture shape (spiral, oblique, transverse), presence and pattern of concomitant ankle injuries (on the distal tibial articular surface), and necessity for surgical fixation of ankle injuries. Factors associated with concomitant ankle injuries associated with tibial shaft fractures were analyzed by logistic regression analysis.

Results:

A total of 47 (64.7%) of the 71 tibial shaft fractures involved concomitant ankle injuries, including 8 cases of combined lateral malleolar fracture, posterior malleolar fracture, and anterior inferior tibiofibular ligament (AITFL) avulsion fracture; 9 cases of combined posterior malleolar fracture and AITFL avulsion fracture; 6 cases of combined lateral malleolar fracture and posterior malleolar fracture; 1 case of combined lateral malleolar fracture and AITFL avulsion fracture; 10 cases of posterior malleolar fracture; 7 cases of lateral malleolar fracture; 5 cases of AITFL avulsion fracture; and 1 unclassified fracture. Of these, 34 of the ankle injuries required surgical fixation. Spiral-type tibial shaft fracture was significantly associated with concomitant ankle injury ( P = .001).

Conclusions:

Orthopaedic surgeons should be aware that tibial shaft fractures, especially spiral-type fractures, are frequently associated with ankle injuries, such as lateral malleolar fractures, posterior malleolar fractures, and AITFL avulsion fractures. A considerable portion of these cases may necessitate surgical fixation. We recommend all spiral-type tibial shaft fractures routinely undergo computed tomography examination.

Level of Evidence:

Level III, comparative series.
Mid-term Results of Intramuscular Lengthening of Gastrocnemius and/or Soleus to Correct Equinus Deformity in Flatfoot
Authors: Rong Kai , Ge Wen-tao , Li Xing-chen , Xu Xiang-yang
Published: June 2015

Background:

Intramuscular lengthening of the gastrocnemius and/or soleus (Baumann procedure) is widely used in patients who have cerebral palsy, with several advantages over other lengthening techniques. Tightness of the gastrocnemius or gastrocnemius-soleus complex has been confirmed to be related to flatfoot deformity. The purpose of this study was to evaluate the mid-term results of the Baumann procedure as a part of the treatment of flatfoot with equinus deformity.

Methods:

We reviewed 35 pediatric and adult patients (43 feet) with flatfoot who underwent the Baumann procedure for the concomitant equinus deformity. The mean duration of follow-up was 39.4 months. Preoperative and follow-up evaluations included the maximal angle of dorsiflexion of the ankle with the knee fully extended and with the knee flexed to 90 degrees, the American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS-AH) scores, and postoperative complications.

Results:

Preoperatively, the mean angle of passive ankle dorsiflexion with the knee extended was −4.7 ± 2.7 degrees and that with the knee flexed was 2.3 ± 2.5 degrees. At the final follow-up, both values improved significantly by a mean of 13.6 degrees ( P < .001) and 9.7 degrees ( P < .001), respectively. The average AOFAS-AH scores improved from 56.8 points preoperatively to 72.1 at the final follow-up. Recurrence of equinus was observed in 3 patients (4 feet). There were no cases of overcorrection, neurovascular injury, or healing problems.

Conclusions:

Our results indicate that the Baumann procedure can effectively and sequentially correct the tightness of the gastrocnemius or the gastrocnemius-soleus complex in patients with flatfoot deformity, without obvious postoperative complications.

Level of Evidence:

Level IV, retrospective case series.
Software pipelining for graphic processing unit acceleration: Partition, scheduling and granularity
Authors: Liu Bozhong , Qiu Weidong , Jiang Lin , Gong Zheng
Published: June 2015

The graphic processing unit (GPU) is becoming increasingly popular as a performance accelerator in various applications requiring high-performance parallel computing capability. In a central processing unit (CPU) or GPU hybrid system, software pipelining is a major task in order to deliver accelerated performance, where hiding CPU–GPU communication overheads by splitting a large task into small units is the key challenge. In this paper, we carry out a systematic investigation into task partitioning in order to achieve maximum performance gain. We first validate the advantage of even partition strategy, and then propose the optimal scheduling, with detailed study into how to achieve optimal unit size (data granularity) in an analytical framework. Experiments on AMD and NVIDIA GPU platforms demonstrate that our approaches achieve around 31 – 59% performance improvement using software pipelining.
Masculinities at the Margins of “Middle Adulthood”
Authors: Bartholomaeus Clare , Tarrant Anna
Published: June 2015

The intersections of masculinities and age have attracted relatively little theorizing. This article examines the theoretical implications of young/old age and masculinities by bringing together two bodies of literature (young age and masculinities and old age and masculinities) and two research studies (one with pre-teenage school students in Australia and one with grandfathers in the United Kingdom). We focus on two key themes: caring practices and relations and the divide between physical activity and intellectual pursuits. Drawing on these themes, we show how age allows for gender transgressions and practices of gender equality and how young boys and old men can also uphold a discourse of hegemonic masculinity, despite age-related tensions. We conclude by arguing that a consideration of age has much to offer in terms of thinking about how gender is socially constructed and illuminates the complex power relations of age and gender categories.
Getting Out the Vote With Evaluative Thinking
Authors: Bhatti Yosef , Dahlgaard Jens Olav , Hansen Jonas H. , Hansen Kasper M.
Published: June 2015

Democratic institutions often do not evaluate their instruments. By working closely with authorities, we developed a field experiment to examine an initiative to increase voter turnout among 18-year-olds that had not previously been evaluated. Particular attention was paid to developing an appropriate program theory and to designing the evaluation in a manner that was consistent with legal and ethical requirements. The program distributed different versions of mobilization letters to the newly enfranchised voters. The treatment effect was positive on turnout and diminished the gap in turnout across population groups, and the effects of the treatments were strongest for individuals with the lowest initial propensity to vote. Cost-effectiveness analysis indicated that the price of an additional vote was approximately USD$136. Our findings influenced policy design and helped establish the principle of evaluative thinking as an integrated part of the future program.
Clinical and MRI phenotype of children with MOG antibodies
Authors: Fernandez-Carbonell Cristina , Vargas-Lowy David , Musallam Alexander , Healy Brian , McLaughlin Katherine , Wucherpfennig Kai W , Chitnis Tanuja
Published: June 2015

Objective:

To investigate the clinical and magnetic resonance imaging (MRI) features of anti-myelin oligodendrocyte glycoprotein (MOG) antibody-seropositive pediatric demyelinating syndromes.

Methods:

Serum samples collected from 74 children with suspected demyelinating disorders whom were being followed at Massachusetts General Hospital were incubated with control green fluorescent protein (GFP)- and MOG-GFP-transfected Jurkat cell clones. The binding ratios were calculated using flow cytometry. Using statistical analyses, we compared the demographic, clinical and radiological features in our seropositive and seronegative patients.

Results:

We found that 13 out of 74 (17.5%) patients were seropositive for MOG. The MOG-seropositive patients were younger than the seronegative patients ( p = 0.049). No single disease category predominated among the seropositive patients, nor was one group more likely to have a polyphasic course. There were two out of four neuromyelitis optica (NMO) patients who had MOG antibodies; both were seronegative for aquaporin −4 (AQP4) antibodies. One had monophasic disease and the other had frequent relapses. There was a bimodal distribution of the MOG-seropositive patients by age at onset, with a distinct younger group (4–8 years) having a high prevalence of encephalopathy and an older group (13–18 years), whom presented almost exclusively with optic neuritis. MRI analysis demonstrated the absence of corpus callosum lesions in the seropositive patients ( p = 0.012). The annualized relapse rate (ARR) and the Expanded Disability Status Scale (EDSS) results at 2 years did not differ between the seropositive and seronegative patients.

Conclusion:

MOG antibodies are found across a variety of pediatric demyelinating syndromes having some distinct clinical and MRI features.
Cognitive and patient-reported outcomes in adults with pediatric-onset multiple sclerosis
Authors: Baruch Natalie F , O’Donnell Ellen H , Glanz Bonnie I , Benedict Ralph HB , Musallam Alexander J , Healy Brian C , Rintell David , Chitnis Tanuja
Published: June 2015

Background:

Little is known about long-term cognitive and patient-reported outcomes of pediatric-onset multiple sclerosis (POMS).

Objective:

The objective of this paper is to compare cognitive and patient-reported outcomes in adults with POMS vs. adult-onset MS (AOMS).

Methods:

We compared standardized patient-reported measures MSQOL54, MFIS, CES-D and SDMT in adult patients with MS onset prior to and after age 18, using data gathered in the Comprehensive Longitudinal Investigations in MS at Brigham and Women’s Hospital (CLIMB) study.

Results:

Fifty-one POMS and 550 AOMS patients were compared. SDMT scores were significantly lower in POMS after adjusting for age (−7.57 (−11.72, −3.43; p < 0.001), but not after adjusting for disease duration. Estimated group difference demonstrated lower normative z scores in POMS vs. AOMS in unadjusted analysis (−0.74 (95% CI: −1.18, −0.30; p = 0.0009) and after adjusting for disease duration (−0.60; 95%CI: −1.05, −0.15; p = 0.0097). Findings were unchanged in a subset of POMS diagnosed prior to age 18. In unadjusted and adjusted analyses, no significant differences were observed in health-related quality-of-life, fatigue, depression or social support between POMS and AOMS.

Conclusions:

Younger age of onset was associated with more impairment in information-processing speed in adults with POMS compared to AOMS, and remained significant when controlling for disease duration in age-normed analysis. The two groups were similar in terms of patient-reported outcomes, suggesting similar qualitative experiences of MS.
The effects of three different distraction methods on pain and anxiety in children
Authors: Sahiner Nejla Canbulat , Bal Meltem Demirgoz
Published: June 2015

This study aims to investigate of three different distraction methods (distraction cards, listening to the music of cartoon and balloon inflation) on pain and anxiety relief of children during phlebotomy. This study is a prospective, randomized, and controlled trial. The sample consisted of 6 to 12 years old children who require blood tests. Children were randomized into four groups as the distraction cards, the music, the balloon inflation, and the control. Data were obtained by conducting interviews with the children, their parents, and the observer before and after the procedure. The pain levels of the children were assessed by the parent and observer reports as well as self-report using the Wong-Baker FACES. The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale. One hundred and twenty children (mean age: 9.1 ± 1.6 years) were included. The self-reported procedural pain levels showed significant differences among the study groups ( p = .040). The distraction card group (2.33 ± 3.24) had significantly lower pain levels ( p = .057) than the control group (4.53 ± 3.23). The procedural child anxiety levels reported by the observer showed a significant difference among the study groups ( p = .032). All the forms of distraction significantly reduced pain and anxiety perception.
Measuring mental well-being: A validation of the Short Warwick–Edinburgh Mental Well-Being Scale in Norwegian and Swedish
Authors: Haver Annie , Akerjordet Kristin , Caputi Peter , Furunes Trude , Magee Christopher
Published: June 2015

Aims: Mental health, currently one of the biggest challenges worldwide, requires attention and research. The aim of this study was to examine the psychometric properties of the Short Warwick–Edinburgh Mental Well-Being Scale (SWEMWBS), and validate the scale for use in Norway and Sweden. SWEMWBS, which includes both hedonic and eudemonic principles of mental well-being, could facilitate useful future studies. Method: Data were collected among Norwegian and Swedish hotel managers ( N=600) through self-rated online questionnaires. Tests used to examine the psychometric properties of the scale included descriptive statistics, correlations, reliability analyses, and explorative factor analyses in SPSS, as well as confirmatory factor analyses in AMOS. Robustness tests were run for gender and country subsamples. Results: The scale showed adequate internal consistency and reliability. Results of the confirmatory factor analysis showed moderate fit in Norway and Sweden. In addition, the scale showed acceptable construct, criterion-related, and discriminant validity. Conclusion: The psychometric properties of the SWEMWBS were acceptable in both the Norwegian and the Swedish translations of the scale.
Overcoming digital divides in higher education: Digital literacy beyond Facebook
Authors: Radovanović Danica , Hogan Bernie , Lalić Danijela
Published: June 2015

The accelerated development of Information and Communications Technology has had a profound impact on the education system, both online and offline. In a South East European country such as Serbia, new technologies shape information, communication, and collaboration dynamics while contributing to a persistent digital divide regarding the skills necessary to obtain, process, evaluate, and communicate information. In this article, we explore digital divides between students and teachers in higher education with a focus on tensions surrounding digital literacy and collaboration. We apply Weber’s theory of stratification to an empirical case study of the digital divide in higher education in Serbia. We draw upon international indicators, secondary statistical sources, and primary semi-structured interviews with students and teachers in higher education. Through this analysis, we illustrate how forms of stratification intervene when trying to integrate new technologies and technology-oriented practices into the classroom. We consider stratification in terms of the traditional digital divide of access as well as stratification along lines of status, politics, and motivations. We interpret educators’ reluctance to adopt new technology as a reaction to the technology’s capacity to challenge the educators’ legitimacy, expertise, and preferred teaching materials. Students compound this situation with both greater familiarity and yet less focus on source credibility.
Association of angiotensin ІІ type 1 receptor (A1166C) polymorphism with breast cancer risk: An update meta-analysis
Authors: Chen Fangguo , Chen Guiling , Dou Yan , Xu Xinyun
Published: June 2015

Objective:

Previous studies on the relationship between angiotensin ІІ type 1 receptor ( AT1R) gene (A1166C) polymorphism and breast cancer did not reach the same conclusion. In the present study, we aimed to further evaluate the relationship between the AT1R gene A1166C polymorphism and breast cancer risk.

Methods:

We selected five case-control studies related to AT1R gene A1166C polymorphism and breast cancer by searching PubMed, EMBase, Chinese Biomedical Literature Database, Chinese CNKI, Web of Science, and the Wanfang database. We utilized Q-test and I2 test to detect the heterogeneity between each study. A random-effects model (I2 > 50%; p < 0.10) or a fixed-effects model (I2 < 50%; p > 0.10) was utilized to merge the odds ratio (OR) and 95% confidence interval (CI) during the meta- analyses.

Results:

The present study included 972 patients with breast cancer and 1336 cancer-free control subjects. By meta-analysis, we found A1166C polymorphism was associated with decreased risk for breast cancer in Caucasian population in an additive model (C vs. T: OR = 0.77, 95% CI: 0.62–0.96, p = 0.02). However, we did not find associations in other genetic models (AC+CC vs. AA: OR = 0.78, 95% CI: 0.50–1.22, p = 0.28; CC vs. AA+AC: OR = 1.64, 95% CI: 0.94–2.85, p = 0.08).

Conclusion:

We concluded that AT1R gene A1166C polymorphism was associated with reduced risk for breast cancer.
Is it appropriate to use Western guidelines for breaking bad news in non-Western emergency departments? A patients’ perspective
Authors: Labaf Ali , Jahanshir Amirhosein , Baradaran Hamid , Shahvaraninasab Amir
Published: June 2015

Objective

To find whether Western guidelines on breaking bad news in a nonemergency department are appropriate for an emergency department of a non-Western country; according to patients’ preferences.

Method

We designed a 19 items questionnaire of Likert-type scale and interviewed 156 patients in the emergency department of a referral hospital in Iran.

Results

The patients’ preferences in 9 out of 19 statements were similar to the guidelines. “Using the maternal language” received the strongest agreement. The strongest disagreement was on “encouraging the patients to talk after receiving bad news.” The summative scores of subsection indicated strong agreement for cultural issues, followed by communication skills, breaking bad news session, and privacy.

Conclusion

The patients’ preferences were not completely consistent with the guidelines. We could not determine if it was a situational or cultural issue. However, it is reasonable to design a new guideline for breaking bad news, considering these factors.
Management of Brain Metastasis in Patients With Pulmonary Neuroendocrine Carcinomas
Authors: Kotecha Rupesh , Zimmerman Amy , Murphy Erin S. , Ahmed Zain , Ahluwalia Manmeet S. , Suh John H. , Reddy Chandana A. , Angelov Lilyana , Vogelbaum Michael A. , Barnett Gene H. , Chao Samuel T.
Published: June 2015

Background:

The patterns of intracranial failure in patients with brain metastasis from pulmonary neuroendocrine carcinoma (PNEC) remain unknown.

Methods:

From 1998 to 2013, 29 patients with the diagnosis of PNEC were treated for brain metastasis: 16 patients (55%) underwent whole-brain radiation therapy (WBRT), 5 (17%) patients underwent WBRT with a stereotactic radiosurgery (SRS) boost, and 8 (28%) patients underwent primary SRS alone.

Results:

The median age at treatment was 61 years (range: 44-84 years) and the median follow-up was 9.6 months (0-157.4 months). Of the patients treated with SRS alone, 1 patient had radiographic local progression of disease and 1 patient had a distant intracranial failure. Of the patients treated with WBRT with or without an SRS boost, 9 patients developed intracranial progression, including 1 local failure. No differences in rates of intracranial progression or local failure between the 2 groups ( P = .94 and P = .44, respectively) were observed. The actuarial rates of distant intracranial failure at 12 months were 32.9% (95% confidence interval [95% CI] 8.9%-56.8%) and 25% (95% CI 0.0%-67.4%) in patients undergoing primary WBRT or SRS, respectively ( P = .31). The median overall survival was 15.8 months in patients treated with WBRT and 20.4 months in patients treated with primary SRS ( P = .78).

Conclusion:

Patients with brain metastasis from PNECs can be effectively treated with either WBRT or SRS alone, with a pattern of failure more consistent with non-small cell lung cancer than small cell lung cancer. In this series, there was not a statistically significant increased risk of distant intracranial failure when patients were treated with primary SRS.
Dietary essentiality of “nutritionally non-essential amino acids” for animals and humans
Authors: Hou Yongqing , Yin Yulong , Wu Guoyao
Published: June 2015

Based on growth or nitrogen balance, amino acids (AA) had traditionally been classified as nutritionally essential (indispensable) or non-essential (dispensable) for animals and humans. Nutritionally essential AA (EAA) are defined as either those AA whose carbon skeletons cannot be synthesized de novo in animal cells or those that normally are insufficiently synthesized de novo by the animal organism relative to its needs for maintenance, growth, development, and health and which must be provided in the diet to meet requirements. In contrast, nutritionally non-essential AA (NEAA) are those AA which can be synthesized de novo in adequate amounts by the animal organism to meet requirements for maintenance, growth, development, and health and, therefore, need not be provided in the diet. Although EAA and NEAA had been described for over a century, there are no compelling data to substantiate the assumption that NEAA are synthesized sufficiently in animals and humans to meet the needs for maximal growth and optimal health. NEAA play important roles in regulating gene expression, cell signaling pathways, digestion and absorption of dietary nutrients, DNA and protein synthesis, proteolysis, metabolism of glucose and lipids, endocrine status, men and women fertility, acid–base balance, antioxidative responses, detoxification of xenobiotics and endogenous metabolites, neurotransmission, and immunity. Emerging evidence indicates dietary essentiality of “nutritionally non-essential amino acids” for animals and humans to achieve their full genetic potential for growth, development, reproduction, lactation, and resistance to metabolic and infectious diseases. This concept represents a new paradigm shift in protein nutrition to guide the feeding of mammals (including livestock), poultry, and fish.
RTEF-1 protects against oxidative damage induced by H2O2 in human umbilical vein endothelial cells through Klotho activation
Authors: Sun Shan , Cheng Bei , Sun Pan-Ge , Wu Xiao-Hua , Wu Qin-Qin , He Ping
Published: June 2015

Oxidative stress is a main risk factor of vascular aging, which may lead to age-associated diseases. Related transcriptional enhancer factor-1 (RTEF-1) has been suggested to regulate many genes expression which are involved in the endothelial angiogenesis and vasodilation. However, whether RTEF-1 has a direct role in anti-oxidation and what specific genes are involved in RTEF-1-driven anti-oxidation have not been elucidated. In this study, we found that overexpressing RTEF-1 in H2O2-treated human umbilical vein endothelial cells decreased senescence-associated-β-galactosidase (SA-β-gal)-positive cells and G0/G1 cells population. The expressions of p53 and p21 were decreased in H2O2-treated RTEF-1 o/e human umbilical vein endothelial cells. However, specific small interfering RNA of RTEF-1 totally reversed the anti-oxidation effect of RTEF-1 and inhibited RTEF-1-induced decreased p53 and p21 expressions. It demonstrated that RTEF-1 could protect cells from H2O2-induced oxidative damage. In addition, we demonstrated that RTEF-1 could up-regulate Klotho gene expression and activate its promoter. Furthermore, Klotho small interfering RNA significantly blocked RTEF-1-driven endothelial cell protection from H2O2-induced oxidative damage and increased p53 and p21 expressions. These results reveal that RTEF-1 is a potential anti-oxidation gene and can prevent H2O2-induced endothelial cell oxidative damage by activating Klotho.
Radial force measurement of endovascular stents: Influence of stent design and diameter
Authors: Matsumoto Takuya , Matsubara Yutaka , Aoyagi Yukihiko , Matsuda Daisuke , Okadome Jun , Morisaki Koichi , Inoue Kentarou , Tanaka Shinichi , Ohkusa Tomoko , Maehara Yoshihiko
Published: June 2015

Background and purpose

Angioplasty and endovascular stent placement is used in case to rescue the coverage of main branches to supply blood to brain from aortic arch in thoracic endovascular aortic repair. This study assessed mechanical properties, especially differences in radial force, of different endovascular and thoracic stents.

Material and methods

We analyzed the radial force of three stent models (Epic™, E-Luminexx® and SMART®) stents using radial force-tester method in single or overlapping conditions. We also analyzed radial force in three thoracic stents using Mylar® film testing method: conformable Gore®-TAG®, Relay®, and Valiant® Thoracic Stent Graft.

Results

Overlapping SMART stents had greater radial force than overlapping Epic or Luminexx stents ( P < 0.01). The radial force of the thoracic stents was greater than that of all three endovascular stents ( P < 0.01).

Conclusions

Differences in radial force depend on types of stents, site of deployment, and layer characteristics. In clinical settings, an understanding of the mechanical characteristics, including radial force, is important in choosing a stent for each patient.
Positive Empathy and Prosocial Behavior: A Neglected Link
Authors: Telle Nils-Torge , Pfister Hans-Rüdiger
Published: June 2015

Empathy facilitates everyday social interactions and has often been linked in the literature to prosocial behavior. Robust evidence has been found for a positive relationship between experiencing empathy and behaving prosocially. However, empathy, and the empathy–prosocial behavior relationship in particular, has been studied mostly in combination with negative emotions. Less research has been conducted on empathy for positive emotions, and the link between positive empathy and displayed prosocial behavior has not been intensively investigated so far. The purpose of the present article is thus twofold: first, we review and summarize research evidence on empathy for positive emotions, and second, we propose that people’s motivation to maintain an experienced positive affect is a viable mechanism linking positive empathy and prosocial behavior.
The use of local anaesthesia in general practice
Authors: Williams Catrin
Published: June 2015

The term anaesthesia is from the Greek and means ‘loss of sensation’. It enables painful and invasive procedures to be performed with little distress to the patient. Local anaesthesia is a method used to apply anaesthetic to one site, usually topically or subcutaneously. The first recorded use of a local anaesthetic to provide anaesthesia for a surgical procedure was in 1884 when Koller used cocaine to anaesthetise the eye. This initially led to widespread enthusiasm and use of cocaine; however, this was soon tempered by reports of toxic effects and death. Minor surgery in primary care has been shown to be cost-effective and popular with patients. Despite an improvement in the safety of local anaesthetics it is important to get the correct dose and type of anaesthetic and to be aware of potential adverse effects.
Evaluation of practice change in Tanzanian health professionals 12 months after participation in an Infection Prevention and Management Course
Authors: Jones Mark , Gower Shelley , Whitfield Ann , Thomas Susan
Published: June 2015

Background:

Hospital-acquired infection (HAI) is a problem confronting developing countries. Education programmes have been shown to be effective in increasing awareness and changing practice in health professionals.

Methods:

Practice change in health professionals who completed an Infection Prevention and Management Course in Tanzania was explored via focus group 12 months after completion of the course.

Findings:

Positive changes in infection control practice were found, along with barriers to more widespread change.

Conclusions:

Providing tailored and continuing education programs to hospital staff, including managers, is recommended.
Chemotherapy use in stage III colon cancer: a National Cancer Database analysis
Authors: Upadhyay Smrity , Dahal Sumit , Bhatt Vijaya Raj , Khanal Nabin , Silberstein Peter T.
Published: June 2015

Background:

Although adjuvant chemotherapy in stage III colon cancer improves overall survival, prior studies have shown that it is underused. We analyzed different factors that may influence its use.

Methods:

This is a retrospective study of stage III colon cancer patients ( n = 207,718) diagnosed between 2000 and 2011 in the National Cancer Data Base (NCDB). The NCDB contains ~70% of new cancer diagnosis from >1500 American College of Surgeons accredited cancer programs in the United States and Puerto Rico. The chi-squared test was used to determine any difference in characteristics of patients who did or did not receive chemotherapy.

Results:

A total of 35% of all stage III colon cancer patients, and 38% of stage III cases undergoing surgery, did not receive adjuvant chemotherapy. The use of chemotherapy had increased in recent years (64% in 2007–2011 versus 59% in 2000–2002; p < 0.0001). Its use was lower in whites (61%), females (60%), patients ⩾60 years (55%), patients with one or more comorbidities (55%), nonacademic centers (62%), those with medicare insurance (52%), lower education (61%) and income levels (59%, all p < 0.0001). The nonwhite and uninsured were more likely to be <60 years old.

Conclusion:

More than one-third did not receive adjuvant chemotherapy, although its use has increased in more recent years. Age was one of the most important determinants of chemotherapy use, which may explain higher rates in nonwhite and uninsured. In addition to patient characteristics, race, gender and socioeconomic factors influence chemotherapy use. These findings have important implications for healthcare reform.
Between the state and the individual: ‘Big Society’ communitarianism and English Conservative rhetoric
Authors: Gibson Howard
Published: June 2015

During his quest for leadership of the English Conservative Party, David Cameron declared his intention to turn Britain into a Big Society. In May 2010, having gained office as Prime Minister, he unveiled a string of policies to bring his vision to fruition. After five years, however, talk of the Big Society has withered in public debate such that today only the press refer to it, and then as a policy in decline. This article argues that as an attempt to revitalise citizenship and local communities, and deal with the apparent ills of state centralism and liberal atomism, it was destined to fail. This is because it coincided, intentionally some have said, with an austerity crisis that made talk of the Big Society politically feasible; left Big Capitalism, the cause of austerity, untouched; was seemingly reticent to divert power to localities; under-theorised the nature and complexity of modern communities; and was an attempt at depoliticisation by diverting risk to bodies such as charities and schools.
Continuing education of civics teachers for teaching the European Union: Results of the Jean Monnet project PEB
Authors: Oberle Monika , Forstmann Johanna
Published: June 2015

The European dimension is of salient importance for understanding and shaping politics especially, but not only, in Europe. The European Union by now has become a compulsory content of civics classes in secondary schools throughout Germany. For teachers, however, teaching this topic is connected with manifold difficulties, for example, due to the complexity and dynamics of European integration, the (perceived) distance of European Union politics, and popular prejudices. European Union content and didactics are not always included in teacher training; moreover, civics is often taught by teachers who have not been trained in this subject. Thus, special continuing education for civics teachers with regard to teaching the European Union is needed. In the context of the Jean Monnet project Politiklehrerfortbildung zur nachhaltigen Vermittlung Europäischer Bürgerschaftskompetenzen [Civics teachers’ continuing education for sustainable teaching of European citizen competencies] ( http://peb.uni-goettingen.de ), 180 teachers participated in nine continuing education courses throughout Germany. The training courses were developed at Göttingen University and designed to update both teachers’ knowledge on European integration (focus: Treaty of Lisbon; the ‘Euro Crisis’) and their capacity to convey European Union knowledge and competencies to pupils. Practical experiences in various methodological approaches were integrated into the training course as well as a visit of a member of the European Parliament. The courses were accompanied by an empirical study with pre-, post- and follow-up-tests (standardized questionnaires, both paper and pencil and online; pre/post sample N = 179). This contribution introduces several key results of the accompanying study regarding the European Union-related characteristics of participating teachers (e.g. the relation between European Union knowledge and attitudes towards the European Union, controlling for background variables such as gender and school type), the current practice – including goals, approaches, methods and problems – of teaching the subject of the European Union from a teachers’ perspective and the effects of the teachers’ continuing education series Politiklehrerfortbildung zur nachhaltigen Vermittlung Europäischer Bürgerschaftskompetenzen.
Examining the Relation Between Mood and Rumination in Remitted Depressed Individuals
Authors: Koster Ernst H. W. , Fang Lin , Marchetti Igor , Ebner-Priemer Ulrich , Kirsch Peter , Huffziger Silke , Kuehner Christine
Published: June 2015

Cognitive theories of recurrent depression suggest that the relationship between mood and cognition is altered by previous depressive episodes. In individuals remitted from depression (RMD) this would be linked to a larger susceptibility for new depressive symptoms. This study explored whether the association between mood and rumination indeed is different between RMD and nondepressed controls relying on dynamic systems theory (DST). From DST we selected entropy, defined here as the level of unpredictability in the relation between mood and rumination, as the main variable of interest. Daily electronic dairy measures of mood and rumination were administered in 31 RMD patients and 32 healthy controls. The results indicate that mean levels of rumination and negative mood were elevated in RMD compared with controls. At the group level, entropy did not differ significantly and entropy was also not associated with the number of episodes. However, entropy predicted depressive symptoms in the RMD group and the brooding subtype of rumination in both groups at the 6-month follow-up. These data are specific for entropy and were not obtained using mean levels of momentary mood and rumination.
Ruminative Thinking
Authors: Mor Nilly , Daches Shimrit
Published: June 2015

Impairments in cognitive processes have been theorized to play a critical role in rumination, a well-established risk factor for depression. In this review, we outline central theories that present cognitive impairments as causal contributors to ruminative thinking and review relevant findings from cross-sectional and prospective studies. We then focus on experimental evidence gathered within the paradigm of cognitive bias modification (CBM). Although CBM has generated considerable interest in relation to anxiety and depression, it has only recently emerged in the field of rumination. After considering the purpose and possible advantages of CBM procedures, we review CBM work related to rumination and discuss key limitations and implications within this developing area of research. Among our recommendations, we outline ways to contrast and integrate cognitive theories of rumination, as well as to obtain stronger bias modification procedures.
Sex Differences in Outcome After an Acute Achilles Tendon Rupture
Authors: Grävare Silbernagel Karin , Brorsson Annelie , Olsson Nicklas , Eriksson Bengt I. , Karlsson Jon , Nilsson-Helander Katarina
Published: June 2015

Background:

Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women.

Purpose:

To evaluate whether there are any differences in outcome between the sexes by combining the data from 2 large randomized controlled trials that used identical outcome measures.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included in the evaluation were patients from 2 consecutive randomized controlled trials comparing surgical and nonsurgical treatment performed at our research laboratory. Patients who had a rerupture were excluded from analysis. A total of 182 patients (152 males, 30 females), with mean ± SD age of 40 ± 11 years, were included; 94 (76 males, 18 females) were treated with surgery and 88 (76 males, 12 females) nonsurgically. Patient-reported outcome was evaluated using the Achilles tendon Total Rupture Score (ATRS), and the functional outcome was measured with a heel-rise test (measurement of muscular endurance and heel-rise height) at 6 and 12 months after injury.

Results:

Male patients had a greater improvement in heel-rise height at 12 months ( P = .004). When each treatment group was analyzed separately, it was found that female patients had significantly ( P < .03) more symptoms after surgical treatment (mean ± SD ATRS, 59 ± 24) compared with males at 6 (73 ± 19) and 12 months (74 ± 27 vs 86.5 ± 17). This sex difference was not found in the nonsurgical treatment group. For the entire group, there were no significant differences between treatments on ATRS at 6 and 12 months. The surgical group had significantly better results compared with the nonsurgical group in heel-rise endurance at 6 and 12 months and in heel-rise height recovery at 6 months ( P < .03 for both).

Conclusion:

Sex differences were demonstrated, and female patients had a greater degree of deficit in heel-rise height as compared with males, irrespective of treatment. Females had more symptoms after surgery both at 6 and 12 months, but this difference was not found when treated nonsurgically.

Clinical Relevance:

Further research is needed to determine whether women will benefit more from nonsurgical compared with surgical treatment after an Achilles tendon rupture.
Micromechanics based modelling of deformation behaviour of grain refined rheocast Al–7Si–0.3Mg alloy
Authors: Das P. , Islam Sk. T. , Das S.
Published: June 2015

Microscale deformation behaviour, plastic strain localisation and plastic instability of grain refined rheocast Al–7Si–0.3Mg alloy have been studied here, following micromechanical approach. Micromechanics based simulations have been performed by means of the two-dimensional representative volume element of the actual microstructure, using the popular finite element (FE) package ABAQUS. The molten alloy has been rheocast after grain refiner addition, using cooling slope, and comparison has been made with its conventional cast counterpart. Effect of grain size, shape and its orientation on microlevel stress/strain state of the material, before the final failure, has been predicted in the present study. Increasing uniformity in stress and strain distribution at the microscale has been evidenced with the increasing sphericity and volume fraction of the primary Al phase.
Diabetic foot: prevalence, knowledge, and foot self‐care practices among diabetic patients in Dar es Salaam, Tanzania – a cross‐sectional study
Authors: Chiwanga Faraja S. , Njelekela Marina A.
Published: June 2015

Background

At the time of diagnosis, more than 10 % of people with type 2 diabetes mellitus have one or two risk factors for a foot ulceration and a lifetime risk of 15 %. Diabetic foot ulcers can be prevented through well‐coordinated foot care services. The objective of this study was to determine knowledge of foot care and reported practice of foot self‐care among diabetic patients with the aim of identifying and addressing barriers to preventing amputations among diabetic patients.

Methods

Patients were randomly selected from all public diabetic clinics in Dar es Salaam. A questionnaire containing knowledge and foot care practice questions was administered to all study participants. A detailed foot examination was performed on all patients, with the results categorized according to the International Diabetes Federation foot risk categories. Statistics were performed using SPSS version 14.

Results

Of 404 patients included in this study, 15 % had foot ulcers, 44 % had peripheral neuropathy, and 15 % had peripheral vascular disease. In multivariate analysis, peripheral neuropathy and insulin treatment were significantly associated with presence of foot ulcer. The mean knowledge score was 11.2 ± 6.4 out of a total possible score of 23. Low mean scores were associated with lack of formal education (8.3 ± 6.1), diabetes duration of < 5 years (10.2 ± 6.7) and not receiving advice on foot care (8.0 ± 6.1). Among the 404 patients, 48 % had received advice on foot care, and 27.5 % had their feet examined by a doctor at least once since their initial diagnosis. Foot self‐care was significantly higher in patients who had received advice on foot care and in those whose feet had been examined by a doctor at least once.

Conclusions

The prevalence of diabetic foot is high among patients attending public clinics in Dar es Salaam. There is an urgent need to establish coordinated foot care services within the diabetic clinic to identify feet at risk, institute early management, and provide continuous foot care education to patients and health care providers.
Molecular drivers of lobular carcinoma in situ
Authors: Logan Greg J. , Dabbs David J. , Lucas Peter C. , Jankowitz Rachel C. , Brown Daniel D. , Clark Beth Z. , Oesterreich Steffi , McAuliffe Priscilla F.
Published: June 2015

Lobular carcinoma in situ (LCIS) is considered to be a risk factor for the development of invasive breast carcinoma, but it may also be a non-obligate precursor to invasive lobular carcinoma (ILC). Many LCIS lesions do not progress to ILC, and the molecular changes that are necessary for progression from LCIS to ILC are poorly understood. Disruption in the E-cadherin complex is the hallmark of lobular lesions, but other signaling molecules, such as PIK3CA and c-src, are consistently altered in LCIS. This review focuses on the molecular drivers of lobular carcinoma, a more complete understanding of which may give perspective on which LCIS lesions progress, and which will not, thus having immense clinical implications.
Adolescent endogenous sex hormones and breast density in early adulthood
Authors: Jung Seungyoun , Egleston Brian L. , Chandler D. Walt , Van Horn Linda , Hylton Nola M. , Klifa Catherine C. , Lasser Norman L. , LeBlanc Erin S. , Paris Kenneth , Shepherd John A. , Snetselaar Linda G. , Stanczyk Frank Z. , Stevens Victor J. , Dorgan Joanne F.
Published: June 2015

Introduction

During adolescence the breasts undergo rapid growth and development under the influence of sex hormones. Although the hormonal etiology of breast cancer is hypothesized, it remains unknown whether adolescent sex hormones are associated with adult breast density, which is a strong risk factor for breast cancer.

Methods

Percentage of dense breast volume (%DBV) was measured in 2006 by magnetic resonance imaging in 177 women aged 25–29 years who had participated in the Dietary Intervention Study in Children from 1988 to 1997. They had sex hormones and sex hormone-binding globulin (SHBG) measured in serum collected on one to five occasions between 8 and 17 years of age. Multivariable linear mixed-effect regression models were used to evaluate the associations of adolescent sex hormones and SHBG with %DBV.

Results

Dehydroepiandrosterone sulfate (DHEAS) and SHBG measured in premenarche serum samples were significantly positively associated with %DBV (all Ptrend ≤0.03) but not when measured in postmenarche samples (all Ptrend ≥0.42). The multivariable geometric mean of %DBV across quartiles of premenarcheal DHEAS and SHBG increased from 16.7 to 22.1 % and from 14.1 to 24.3 %, respectively. Estrogens, progesterone, androstenedione, and testosterone in pre- or postmenarche serum samples were not associated with %DBV (all Ptrend ≥0.16).

Conclusions

Our results suggest that higher premenarcheal DHEAS and SHBG levels are associated with higher %DBV in young women. Whether this association translates into an increased risk of breast cancer later in life is currently unknown.

Clinical trials registration

ClinicalTrials.gov Identifier, NCT00458588 April 9, 2007; NCT00000459 October 27, 1999