bluuebunny/crossref_metadata_2025 huggingface dataset:
Workplace-based clinical leadership training increases willingness to lead
Authors: MacPhail Aleece , Young Carmel , Ibrahim Joseph Elias
Published: April 2015

Purpose

– The purpose of this paper is to reflect upon a workplace-based, interdisciplinary clinical leadership training programme (CLP) to increase willingness to take on leadership roles in a large regional health-care centre in Victoria, Australia. Strengthening the leadership capacity of clinical staff is an advocated strategy for improving patient safety and quality of care. An interdisciplinary approach to leadership is increasingly emphasised in the literature; however, externally sourced training programmes are expensive and tend to target a single discipline.

Design/methodology/approach

– Appraisal of the first two years of CLP using multiple sourced feedback. A structured survey questionnaire with closed-ended questions graded using a five-point Likert scale was completed by participants of the 2012 programme. Participants from the 2011 programme were followed up for 18 months after completion of the programme to identify the uptake of new leadership roles. A reflective session was also completed by a senior executive staff that supported the implementation of the programme.

Findings

– Workplace-based CLP is a low-cost and multidisciplinary alternative to externally sourced leadership courses. The CLP significantly increased willingness to take on leadership roles. Most participants (93 per cent) reported that they were more willing to take on a leadership role within their team. Fewer were willing to lead at the level of department (79 per cent) or organisation (64 per cent). Five of the 11 participants from the 2011 programme had taken on a new leadership role 18 months later. Senior executive feedback was positive especially around the engagement and building of staff confidence. They considered that the CLP had sufficient merit to support continuation for at least another two years.

Originality/value

– Integrating health-care professionals into formal and informal leadership roles is essential to implement organisational change as part of the drive to improve the safety and quality of care for patients and service users. This is the first interdisciplinary, workplace-based leadership programme to be described in the literature, and demonstrates that it is possible to deliver low-cost, sustainable and productive training that increases the willingness to take on leadership roles.
Leading processes of patient care and treatment in hierarchical healthcare organizations in Sweden – process managers’ experiences
Authors: Nilsson Kerstin , Sandoff Mette
Published: April 2015

Purpose

– The purpose of this study is to gain better understanding of the roles and functions of process managers by describing Swedish process managers’ experiences of leading processes involving patient care and treatment when working in a hierarchical health-care organization.

Design/methodology/approach

– This study is based on an explorative design. The data were gathered from interviews with 12 process managers at three Swedish hospitals. These data underwent qualitative and interpretative analysis with a modified editing style.

Findings

– The process managers’ experiences of leading processes in a hierarchical health-care organization are described under three themes: having or not having a mandate, exposure to conflict situations and leading process development. The results indicate a need for clarity regarding process manager’s responsibility and work content, which need to be communicated to all managers and staff involved in the patient care and treatment process, irrespective of department. There also needs to be an emphasis on realistic expectations and orientation of the goals that are an intrinsic part of the task of being a process manager.

Research limitations/implications

– Generalizations from the results of the qualitative interview studies are limited, but a deeper understanding of the phenomenon was reached, which, in turn, can be transferred to similar settings.

Originality/value

– This study contributes qualitative descriptions of leading care and treatment processes in a functional, hierarchical health-care organization from process managers’ experiences, a subject that has not been investigated earlier.
Catchment zoning for freshwater conservation: refining plans to enhance action on the ground
Authors: Hermoso Virgilio , Cattarino Lorenzo , Kennard Mark J. , Watts Mathew , Linke Simon
Published: April 2015

Recent advances in freshwater conservation planning allow addressing some of the specific needs of these systems. These include spatial connectivity or propagation of threats along stream networks, essential to ensure the maintenance of ecosystem processes and the biodiversity they sustain. However, these peculiarities make conservation recommendations difficult to implement as they often require considering large areas that cannot be managed under conventional conservation schemes (e.g. strict protection).

To facilitate the implementation of conservation in freshwater systems, a multizoning approach with different management zones subject to different management regimes was proposed. So far, this approach has only been used inpost hocexercises where zones were allocated using expert criteria. This might undermine the cost‐effectiveness of conservation recommendations, because both the allocation and extent of these zones have never been optimized using the principles of systematic planning.

Here, we demonstrate how to create a catchment multizone plan by using a commonly applied tool in marine and terrestrial realms. We first test the capability of Marxan with Zones to address problems in rivers by using a simulated example and then apply the findings to a real case in the Daly River catchment, northern Australia. We also demonstrate how to address common conservation planning issues, such as accounting for threats or species‐specific connectivity needs in this multizone framework, and evaluate their effects on the spatial distribution and extent of different zones.

We found that by prioritizing the allocation of zones subject to different management regimes, we could minimize the total area in need of strict conservation by a twofold factor. This reduction can be further reduced (threefold) when considering species’ connectivity needs. The integration of threats helped reduce the average threats of areas selected by a twofold factor.

Synthesis and applications. Catchment zoning can help refine conservation recommendations and enhance cost‐effectiveness by prescribing different management regimes informed by ecological needs or distribution of threats. Reliable information on these factors is a key to ensure soundness of planning. Freely available software can be used to implement the approach we demonstrate here.
Individual size inequality links forest diversity and above‐ground biomass
Authors: Zhang Yu , Chen Han Y. H.
Published: April 2015

Despite the mounting evidence for positive diversity–productivity relationships found in controlled experiments, diversity effects on productivity in natural systems remain hotly debated. Understanding the multivariate links between diversity and productivity in natural systems, in particular natural forests that host the majority of terrestrial biodiversity and provide essential services for humanity, remains a critical challenge for ecologists.

We analysed data from 448 plots of varying tree species diversity, stand ages and local nutrient availability in Canada's boreal forest (52°30′–55°24′ N latitude and 102°36′–108° W longitude). We used structural equation models to link multivariate relationships between above‐ground biomass, tree species diversity, stand age and soil nutrient availability.

Above‐ground biomass increased with diversity indirectly via increasing tree size inequality, increased with stand age and was higher on sites of medium soil nutrient regime directly as well as indirectly via increased tree size inequality.

Synthesis. Our results demonstrate positive diversity effects on above‐ground biomass in natural forests of diverse forest ages and soil resource availability. Furthermore, we show that tree size inequality acts as a mechanism for the positive diversity effects on above‐ground biomass and as a mechanism in regulating above‐ground biomass and species diversity simultaneously via interactions among individuals in natural forests.
Bacterial diversity along a 2600 km river continuum
Authors: Savio Domenico , Sinclair Lucas , Ijaz Umer Z. , Parajka Juraj , Reischer Georg H. , Stadler Philipp , Blaschke Alfred P. , Blöschl Günter , Mach Robert L. , Kirschner Alexander K. T. , Farnleitner Andreas H. , Eiler Alexander
Published: April 2015

The bacterioplankton diversity in large rivers has thus far been under‐sampled despite the importance of streams and rivers as components of continental landscapes. Here, we present a comprehensive dataset detailing the bacterioplankton diversity along the midstream of the Danube River and its tributaries. Using 16S rRNA‐gene amplicon sequencing, our analysis revealed that bacterial richness and evenness gradually declined downriver in both the free‐living and particle‐associated bacterial communities. These shifts were also supported by beta diversity analysis, where the effects of tributaries were negligible in regards to the overall variation. In addition, the river was largely dominated by bacteria that are commonly observed in freshwaters. Dominated by the acI lineage, the freshwater SAR11 (LD12) and the Polynucleobacter group, typical freshwater taxa increased in proportion downriver and were accompanied by a decrease in soil and groundwater‐affiliated bacteria. Based on views of the meta‐community and River Continuum Concept, we interpret the observed taxonomic patterns and accompanying changes in alpha and beta diversity with the intention of laying the foundation for a unified concept for river bacterioplankton diversity.
Indoor air bacterial communities in Hong Kong households assemble independently of occupant skin microbiomes
Authors: Wilkins David , Leung Marcus HY , Lee Patrick KH
Published: April 2015

More than in any other habitat, humans exert a large influence on microbial communities indoors. Frequent contact between occupant skin and indoor surfaces causes indoor surface microbial communities to be largely assembled from and thus closely resemble occupant skin microbiomes. While indoor air and dust are known to also contain many human‐associated taxa, household air communities have not yet been directly compared with occupant skin microbiomes. We sampled microorganisms from air, surfaces and occupant skin in 19 Hong Kong households and used Illumina sequencing of the V4 hypervariable region of the 16S rRNA gene to investigate the dispersal relationships between the bacterial communities at each site. Our results confirmed that indoor surfaces bear the ‘bacterial fingerprint’ of household occupant skin. However, while air communities contained abundant human‐associated taxa and were household specific, air communities in each household did not resemble occupant skin from that household any more than occupant skin from other households. Our results suggest that, at least in Hong Kong, indoor air bacterial communities may be assembled largely from outdoor air and occupant body sites other than skin, and unlike surface communities do not harbour the occupants' skin ‘bacterial fingerprint’.
Breast cancer diagnosis: biographical disruption, emotional experiences and strategic management in Thai women with breast cancer
Authors: Liamputtong Pranee , Suwankhong Dusanee
Published: April 2015

In this article we draw on Bury's theory of biographical disruption to discuss the meanings of, and emotional experiences related to, being diagnosed with breast cancer among southern Thai women. Qualitative methods, including in‐depth interviewing and drawing methods, were used to collect data from 20 women with breast cancer. The women perceived breast cancer to be a rhok raai; an evil or dread disease. They believed that breast cancer would lead to death. The disruption in their biography occurred when they detected abnormalities indicating breast cancer. The women's narratives revealed their chaotic lives upon this diagnosis and the news precipitated in them shock, fear, anxiety and loss of hope. Although they experienced chaos and disruption, the women cultivated strategies that helped them cope with their experiences by accepting their fate and adhering to Buddhist beliefs and practices. Through their narratives of biographical disruption, the women in our study offer healthcare providers knowledge that could lead to an appreciation of their needs and concerns. This knowledge is crucial for health professionals who wish to provide emotional support to women who have been diagnosed with breast cancer in Thailand and elsewhere.
Review of Mechanical Properties, Migration, and Potential Applications in Active Food Packaging Systems Containing Nanoclays and Nanosilver
Authors: Kuorwel Kuorwel K. , Cran Marlene J. , Orbell John D. , Buddhadasa Saman , Bigger Stephen W.
Published: April 2015

The incorporation of nanomaterials into a range of polymeric materials shows great potential for developing new active food packaging systems. Although there are many suggested benefits of nanoparticles (NPs) in food packaging, there are also potential risks due to the possibility of such particles migrating into foodstuffs. This has obvious implications for human health and it may also negatively impact on marketing and consumer confidence. This review focuses on 2 particular types of nanomaterials: nanoclays and nanosilver, with a view to examining the effects of these on system mechanical properties (nanoclays) and antimicrobial efficacy (nanosilver). It further reports on the various migration studies, techniques for characterization, and measurement of NPs as well as the potential migration of NPs from packaging into foodstuffs. Assessment of the literature to date suggests there is an urgent need for further research in order to devise better NP detection methods and to determine the likelihood of their migration from packaging materials into foodstuffs.
The outcomes of works councils: the role of trust, justice and industrial relations climate
Authors: Kougiannou Konstantina , Redman Tom , Dietz Graham
Published: April 2015

This article investigates trust and organisational justice as antecedents of works council (WC) effectiveness perceptions and the moderating role of industrial relations climate on this relationship. A 2‐year longitudinal study of WC participants in two UK organisations (a housing association and a professional services firm) was undertaken. Results show positive significant relationships between both trust and organisational justice, and WC outcomes of WC performance, WC usefulness and outcome satisfaction. Industrial relations climate is found to moderate the relationship between justice and WC performance, WC usefulness, and outcome satisfaction.
An endogenous growth model for the evolution of water rights systems
Authors: Costa Lawrence W.
Published: April 2015

This article presents a model to help explain the transition path from one water management system to another, typically a commons framework to one of tradable permit‐based property rights. Furthermore, drawing from transaction cost literature, the model demonstrates how this takes place when externalities (the strain on water resources) become severe enough to warrant the increased transaction costs inherent with more complex water rights management frameworks.
Exposure to topical chloramphenicol during pregnancy and the risk of congenital malformations: a Danish nationwide cohort study
Authors: Thomseth Vilde , Cejvanovic Vanja , Jimenez‐Solem Espen , Petersen Kasper M. , Poulsen Henrik E. , Andersen Jon T.
Published: April 2015

Purpose

To investigate whether exposure to topical chloramphenicol in the first trimester of pregnancy is associated with congenital malformations.

Methods

The authors conducted a nationwide cohort study including all women giving live birth between 1997 and 2011 in Denmark. All women redeeming at least one prescription of chloramphenicol eye drops or eye ointment during the first 84 days of pregnancy were identified. Logistic regression was used to estimate the odds ratios of malformations among exposed women compared to non‐exposed women.

Results

966 372 births between 1997 and 2011 were included. A total of 6024 women were exposed to topical chloramphenicol in the first trimester. The rate of congenital malformations was 3.50% among offspring of exposed mothers and 3.49% among unexposed. Exposure to topical chloramphenicol in the first trimester was not associated with major congenital malformations (adjusted odds ratio = 1.06, 95% CI 0.91–1.22) or specific major malformations. The number of redeemed prescriptions decreased significantly during pregnancy as compared to before and after pregnancy (p < 0.0001).

Conclusion

In this study, we found no association between dispensing of chloramphenicol eye drops or eye ointment in the first trimester of pregnancy and major congenital malformations. This is in accordance with a previous study analysing the risk of systemic chloramphenicol.
Laboratory parameters identify familial haemophagocytic lymphohistiocytosis from other forms of paediatric haemophagocytosis
Authors: Yasumi Takahiro , Hori Masayuki , Hiejima Eitaro , Shibata Hirofumi , Izawa Kazushi , Oda Hirotsugu , Yoshioka Kouhei , Nakagawa Kenji , Kawai Tomoki , Nishikomori Ryuta , Ohara Osamu , Heike Toshio
Published: April 2015

Haemophagocytic lymphohistiocytosis (HLH) is a life‐threatening syndrome of immune dysregulation and is classified as primary or secondary according to the underlying aetiology. The treatment strategies recommended for these two groups differ substantially; however, it is thought to be impossible to predict the underlying causes of HLH using conventional laboratory tests. Recent studies show that serum levels of soluble interleukin‐2 receptor (sIL2R) and ferritin are useful for differentiating some forms of HLH. The present study reports that combinations of common laboratory parameters, such as the percentage of total lymphocytes within the peripheral blood leucocyte population, serum levels of lactate dehydrogenase and the sIL2R/ferritin ratio, are useful for identifying patients with familial haemophagocytic lymphohistiocytosis and for differentiating the underlying aetiology of paediatric HLH during the early course of the disease. These findings suggest that the pathogenesis of HLH differs greatly in terms of innate and adaptive immunity depending on the aetiology and may provide a new approach to unravelling the complex pathophysiology underlying this syndrome.
Accuracy of Three‐Dimensional Printed Templates for Guided Implant Placement Based on Matching a Surface Scan with CBCT
Authors: Kernen Florian , Benic Goran I. , Payer Michael , Schär Alex , Müller‐Gerbl Magdalena , Filippi Andreas , Kühl Sebastian
Published: April 2015

Background

Reference elements are necessary to transfer a virtual planning into reality for guided implant placement. New systems allow matching optical scans with three‐dimensional radiographic images.

Purpose

To test whether digitally designed three‐dimensional printed templates (D‐temp) fabricated by matching surface scans and cone beam computed tomography (CBCT) images differ from the templates fabricated in‐lab (L‐temp) by using a physical transfer device for the positioning of the guiding sleeves.

Materials and Methods

L‐temp were fabricated for eight human lower cadaver‐jaws applying a digital planning software program (smop, Swissmeda AG, Zürich, Switzerland) using a Lego® (Lego Group, KIRKBI A/S, Billund, Denmark) brick as reference element and the respective transfer device (X1‐table). Additionally, digital templates (D‐temp) using the identical planning data sets and software were virtually designed and three‐dimensional printed, after matching a surface scan with CBCT data. The accuracy of both templates for each planning was evaluated determining the estimated coronal, apical, and angular deviation if templates were used for implant placement.

Results

Mean coronal deviations for L‐temp were 0.31 mm (mesial/distal), 0.32 mm (lingual/buccal), and 0.16 mm and 0.23 mm for D‐temp, respectively. The mean apical deviations for L‐temp were 0.50 mm (mesial/distal), 0.50 mm (lingual/buccal). and 0.25 mm and 0.34 mm for the D‐temp, respectively. Differences between both devices were statistically significant (p < .05).

Conclusions

A higher accuracy of implant placement can be achieved by using three‐dimensional printed templates produced by matching a surface scan and CBCT as compared with templates which use physical elements transferring the virtual planning into reality.
Neuropsychiatric manifestations of Sydenham's chorea: a systematic review
Authors: Punukollu Mallika , Mushet Nadine , Linney Marisa , Hennessy Colm , Morton Michael
Published: April 2015

Aim

Sydenham's chorea is a post‐streptococcal, autoimmune, neuropsychiatric movement disorder. Sydenham's chorea is a major criterion for diagnosis of acute rheumatic fever with the implication of potential long‐term sequelae including cardiac complications. It is well established that there is psychiatric comorbidity in Sydenham's chorea, but there are variations in the literature regarding the nature and prevalence of psychiatric diagnoses associated with Sydenham's chorea. The aim of this review was to systematically evaluate the evidence for psychiatric symptoms presenting with Sydenham's chorea. Knowledge of comorbid psychiatric symptomatology will support early diagnosis and treatment, leading to improved long‐term outcomes for children with Sydenham's chorea.

Method

The study used a systematic search strategy, using MEDLINE, MEDLINE in Process, EMBASE, and The Cochrane Library. Abstracts were screened to identify relevant papers which were then assessed further. Eligible papers were summarized.

Results

A total of 1429 abstracts of relevant studies were found, and 49 papers reporting neuropsychiatric symptoms in Sydenham's chorea were summarized. Obsessive‐compulsive disorder was the most commonly studied, and hence reported, neuropsychiatric symptom in children with Sydenham's chorea. The studies analysed used a variety of tools to identify affected children and used different methods for analysing results. Attention‐deficit–hyperactivity disorder, affective disorders, tic disorders, executive function disturbances, and psychotic features were also reported as comorbidities.

Interpretation

There is good evidence of neuropsychiatric comorbidities in Sydenham's chorea. In countries with a high prevalence of rheumatic fever, the early recognition of salient cognitive and psychiatric symptoms may aid in the management of Sydenham's chorea.
Migration and employment interactions in a crisis context
Authors: David Anda M. , Marouani Mohamed Ali
Published: April 2015

This article analyses how a crisis impacts labour markets in origin countries through migration channels. For this purpose, we develop a novel dynamic general equilibrium model with a focus on the interlinkages between migration, the labour market and education. The main innovation of the paper is the retrospective modelling in general equilibrium of the impact of an economic crisis to isolate the impact of migration on local unemployment. The impact of the crisis on education decision is captured through endogenous returns to education. The simultaneity of the crisis in Tunisia and its partners worsened the labour market situation mainly through the increase in labour supply. The main result of this study is that migration is indeed one of the main determinants of the unemployment increase and that remittances have a higher impact than the variation of emigration flows. The low skilled bear the highest costs in terms of unemployment and wage decline.
Negative priming of native soil organic carbon mineralization by oilseed biochars of contrasting quality
Authors: Rittl T. F. , Novotny E. H. , Balieiro F. C. , Hoffland E. , Alves B. J. R. , Kuyper T. W.
Published: April 2015

Oilseed‐derived biochar, a by‐product of pyrolysis for biodiesel production, is richer in aliphatic compounds than the commonly studied wood‐derived biochar, affecting both its mineralization in soil and its interaction with native soil organic carbon (nSOC). Here, we investigated the soil C sequestration potential of three different oilseed biochars derived from C3 plant material: soyabean, castor bean and jatropha cake. The chemical composition of these biochars was determined by elemental analysis (CHN) and 13C NMR spectroscopy. The cumulative CO2 efflux from 30‐day laboratory incubations of biochar mixed with a sandy soil containing nSOC from C4 plants was measured as a proxy for mineralization rate. The relative contribution of each source to CO2 production was calculated based on the 13C‐signatures of total CO2 efflux and the source materials (soil and biochars). Our results showed that: (i) castor bean biochar contained relatively large amounts of aliphatic compounds, resulting in a greater mineralization rate than soyabean and jatropha biochars; (ii) CO2 efflux from the soil‐biochar mixtures originated mostly from the biochars, suggesting that these biochars contain rapidly decomposable compounds; and (iii) all three oilseed biochars decelerated nSOC mineralization. This negative priming effect appeared to be caused by different factors. We conclude that oilseed biochars have the potential to increase soil C stocks directly and increase soil C sequestration indirectly in the short term through negative priming of nSOC mineralization.
Wolf teeth and their extraction
Authors: Hole S. L.
Published: April 2015

The equine first premolar or ‘wolf tooth’ (Triadan 05) is a normal vestigial tooth, which is often absent, but when present most commonly lies rostral to the second maxillary premolar (Triadan 06). The routine extraction of wolf teeth has been performed historically and is contentious, but clinically indicated in some instances. This review article aims to summarise concisely the limited peer reviewed literature on wolf teeth and to describe the practice of their extraction. Extraction is usually performed in the standing sedated horse, and complications are avoided with good surgical planning, analgesia and instrumentation.
Thoracotomy for repair of a large dorsal diaphragmatic hernia in an 18‐year‐old mare
Authors: Shnaiderman‐Torban A. , Epstein A. , Kelmer G.
Published: April 2015

An 18‐year‐old Arabian‐mix mare was presented with a history of severe colic. Emergency exploratory celiotomy revealed diaphragmatic hernia, with a large rent in the left dorsal aspect of the diaphragm and large colon volvulus. Attempts to close the defect in the diaphragm in dorsal recumbency were unsuccessful. Therefore, a thoracic approach through lateral thoracotomy was elected, and a mesh was attached to the diaphragm using skin staples. While in dorsal recumbency, the mare suffered from significant respiratory acidosis. Thus, the mare was tilted into reverse Trendelenburg (30° head upward) and ventilation improved markedly. The mare recovered uneventfully, and was doing well 5 years after surgery.
The effect of hemodialysis session on postural strategies in older end‐stage renal disease patients
Authors: Magnard Justine , Lardy Julien , Testa Angelo , Hristea Dan , Deschamps Thibault
Published: April 2015

Patients suffering from end‐stage renal disease experience multiple disabilities, such as muscle wasting, weakness, higher postural sway, and fall rates compared with healthy population, which has a negative effect on physical functioning and autonomy. The vital treatment of hemodialysis is recognized to induce important post‐hemodialysis fatigue, hypotension, cramps, and headache due to the rapid fluid redistribution, among others. Nevertheless, even the well‐known negative effect of aforementioned consequences of hemodialysis treatment, its effect on physical function, especially postural balance, is unclear. Thus, this study hypothesized the adverse effect of hemodialysis treatment on postural sway in 12 end‐stage renal disease patients (mean age 63.3 ± 11 years) through the analysis of center‐of‐pressure (COP) trajectories recorded before and immediately after hemodialysis session. Evident postural alterations were observed at post‐hemodialysis balance assessment for COP position‐based (Fs < 7.7, P < 0.02) and COP velocity‐based variables (Fs > 2.33, P < 0.05), without changes in complexity of COP time series in anteroposterior and mediolateral directions. These results suggest that period after hemodialysis treatment is particularly unsafe, as evidenced by important disability in postural control, and highlight the importance of the medical support and falls‐related prevention strategies of these older frail patients after hemodialysis treatment.
Clinical and histological features of idiosyncratic liver injury: Dilemma in diagnosis of autoimmune hepatitis
Authors: Kuzu Ufuk Bariş , Öztaş Erkin , Turhan Nesrin , Saygili Fatih , Suna Nuretdin , Yildiz Hakan , Kaplan Mustafa , Akpinar Muhammet Yener , Akdoğan Meral , Kaçar Sabite , Kiliç Zeki Mesut Yalin , Köksal Aydin Şeref , Ödemiş Bülent , Kayaçetin Ertuğrul
Published: April 2015

Aim

Drug‐induced liver injury (DILI) is becoming a worldwide problem with its still unexplained properties.

Methods

The data of patients who were diagnosed with DILI between January 2008 and December 2013 were assessed.

Results

Five patients had been diagnosed with intrinsic and 82 patients with idiosyncratic DILI. The most common causative agents were antimicrobial drugs. The most common injury pattern was hepatocellular. When patients with bilirubin levels of more than 5 mg/dL were divided into two groups according to receiving steroid therapy (n = 11) or not (n = 40), there was not any significant difference according to their clinical results (P > 0.05). Five of the idiosyncratic DILI patients were diagnosed with drug‐induced autoimmune hepatitis (DI‐AIH). In histopathological examination, hepatic rosette formation and emperipolesis were observed to be more common among patients with DI‐AIH when compared with ones without (P < 0.05). Interestingly, in the remaining patients with DILI (n = 77), three of them were diagnosed with classic autoimmune hepatitis during long‐term follow up (range, 11–51 months).

Conclusion

The most common causes were antimicrobials, but any agents that have not been defined to cause DILI can induce DILI. The efficacy of steroids in DILI has not been observed but all deaths were observed in the steroid‐free group. The association of DILI and AIH was observed in two different types in terms of diagnosis in our study. The first association was DI‐AIH. The second one is the classical AIH which developed in three patients after a few months following spontaneous recovery of DILI.
The Politics of Migration, Church, and State: A Case Study of the Catholic Church in Ireland
Authors: Gray Breda
Published: April 2015

This article investigates the ways in which a shift from post-colonial nation building to neoliberal state restructuring has shaped church and Irish state relations regarding migrant welfare. It develops the extensive work of Bäckström and Davie (2010) and Bäckström et al. (2011) on how majority churches in European countries are reclaiming a social welfare role as the state relinquishes this responsibility: first, by examining the domain of migrant welfare which is not developed in their work; and second, by arguing that majority church pro-migrant service provision, as it has evolved in recent decades, can be understood in relation to an emergent neoliberal mode of collective responsibility for migrant welfare. It suggests that in spite of other factors and forces that undermine Irish Catholic Church authority, the marketization of more domains of life in the first decades of the twenty-first century has given new significance to Catholic Social Teaching and pro-migrant church initiatives.
LOCAL ANESTHETIC TECHNIQUES IN GERIATRIC SURGERY*
Authors: PONKA JOSEPH L. , WELBORN J. KEITH , SANCHEZ SERGIO M.
Published: April 2015

In the march of medical progress it is possible to lose sight of certain useful techniques for the care of the patient. Today the general availability of excellent medical anesthesia tends to minimize the use of local anesthesia. With the increasing age of our population, the incidence of cardiac, renal, pulmonary and metabolic diseases likewise has increased. Local anesthetic techniques can be used effectively and safely in such cases. New local anesthetic agents that can produce safe anesthesia have created a renewed interest in local anesthesia, particularly for older or poor‐risk patients. If the disease process can be successfully treated under local anesthesia, it is to the patient's advantage. In considering the various techniques of producing anesthesia, the welfare of the patient must be the primary consideration. The interests of time, expense, and convenience to the anesthesiologist or surgeon must not be served at the expense of the patient's welfare.
THE DISTURBED GERIATRIC PATIENT
Authors: WOLFF KURT
Published: April 2015

It is well known that the geriatric patient frequently becomes disturbed, upset, excited, quarrelsome and irritable. Consequently, he can and does become a serious management problem both inside and outside a psychiatric institution. Generally, tranquilizers are given to this kind of patient. However, most of the time the effects of such medication are of only a temporary nature. If tranquilizers are discontinued, these patients frequently relapse into their previous state of disturbed and hostile behavior. When tranquilizers are given for as long as three months without any significant improvement in the patient's disturbed behavior, it is doubtful whether this type of drug will solve the treatment problem. For this reason the author studied, over a period of five years, 100 male geriatric patients aged 65 and older who were in the Veterans Administration Hospital, Coatesville, Pennsylvania. The purpose of the study was to gain a better understanding of the basic cause of the psychiatric disturbances involved.
DISTINGUISHING CHARACTERISTICS OF THE AGING FROM A MEDICAL CARE ADMINISTRATION VIEWPOINT*
Authors: SMITH ELEANOR
Published: April 2015

DR. LORENZE: The next speaker will be Dr. Eleanor Smith, who is Deputy Chief of the Adult Health Protection and Aging Branch, The Division of Medical Care Administration in the Public Health Service, Washington, D.C.
THE PROSTATIC NODULE: A CHALLENGE AND A PROBLEM*
Authors: Melicow Meyer M.
Published: April 2015

Abstract

Cancer of the prostate begins as a microscopic lesion without signs or symptoms—carcinoma “in situ.” It can be an incidental finding at prostatectomy or at autopsy. The terms “latent,” “occult,” “incipient” and “early cancer” of the prostate are also evaluated.

As the prostatic neoplasm grows, a desmoplastic reaction follows and the accumulation of malignant cells and connective‐tissue elements unite to form a palpable hard nodule. There are still no subjective symptoms unless benign prostatic hypertrophy is also present. Though this palpable nodule (about 1 cm in diameter) is the earliest detectable evidence of cancer, it already contains millions of cells. Fortunately, invasion through the capsule into neighboring tissue and/or metastasis has not necessarily occurred, and in some cases ablative treatment still can be successful. At this stage of the disease, the challenge is to detect the nodule. For this reason it is important that every male over 40 have a periodic digital rectal examination, performed carefully and gently. Prostatic lesions other than cancer can produce a hard nodule. For definitive diagnosis and documentation, a perineal prostatic biopsy is necessary. If the biopsy results are positive, malignancy is proved, but if the biopsy results are negative, malignancy is not ruled out since significant tissue areas may have been missed. Anaplasia may suggest extension but does not ensure that this has taken place. Perineural invasion often occurs, without spread. The pathological findings must be correlated with the results of digital rectal examination, radiography, and determinations of the serum acid phosphatase level. There are two stages of prostatic cancer in which the serum acid phosphatase level may not be elevated: 1) the early stage—carcinoma “in situ” or the small localized nodule—and 2) the late stage when the cells are anaplastic and no longer functioning. Otherwise the level is high.

Objectives in therapy are: 1) removal of the cancer (radical prostatectomy), but only if the patient's physical condition permits, and 2) palliation by decreasing the endogenous adrogen level (bilateral orchiectomy) and/or increasing the estrogen level (orally or by injections). Although prostatic cancer is hormonally dependent in the early stages, there is a tendency toward autonomy. What to do for the hormonally independent cancer is the problem.
MEDICAL CARE IN SOME ILLINOIS NURSING HOMES: FIVE‐YEAR FOLLOW‐UP, 1961–1966*
Authors: Kramer Charles H. , Kramer Daniel R.
Published: April 2015

Abstract

A 1961‐versus‐1966 comparison was made of conditions in some Illinois nursing homes with regard to improvement (or otherwise) in the quantity and quality of medical care provided by attending physicians and medical advisors. The surveys were conducted by means of questionnaires given to the administrators of the nursing homes—66 administrators in 1961 and 52 others in 1966. The results were analyzed statistically.

Despite all the recent publicity about the inadequate care of the aged in nursing homes, there was little objective evidence of improvement in the quantity or quality of medical care and services provided between 1961 and 1966 in this sample of Illinois nursing homes. On the contrary, there was a trend toward less satisfactory relationships between physicians and the nursing homes they serve.

These data point up serious problems for physicians, administrators, public health officials and others responsible for the medical care in nursing homes.
ETIOLOGY AND TREATMENT OF GOUT—MODERN CONCEPTS
Authors: Riccitelli M. L.
Published: April 2015

Abstract

Gout, one of the oldest recorded syndromes in medical history, is still a biochemical mystery. Primary gout is characterized by a derangement in purine metabolism and an elevated concentration of uric acid in the blood. Gout may also occur secondarily in diseases associated with reduced urinary excretion of uric acid or increased nuclear breakdown in body tissues. The metabolic abnormality in primary gout is probably an inherited trait, though this has not been proved.

The differential diagnosis of any swollen painful joint should always include gout. The most important diagnostic signs of gout are sudden periodic attacks of acute arthritis, an elevated level of serum uric acid, relief of pain by a therapeutic trial of colchicine and, later in the course of the disease, the presence of tophi around the joints or urate crystals in the synovial fluid. Renal damage is one of the major complications of chronic tophaceous gout and a frequent cause of death. Proteinuria is often the only manifestation of early renal involvement.

Treatment is discussed from the standpoints of diet, drug therapy, use of the artificial kidney, and the surgical excision of tophi. Described under drug therapy are the effects of colchicine (still the drug of choice for acute attacks), phenylbutazone, ACTH, corticosteroids, indomethacin, allopurinol, and the uricosuric agents (probenecid, salicylates and sulfinpyrazone).
RHEUMATOLOGY AND THE GASTROINTESTINAL TRACT
Authors: PALMER WALTER L.
Published: April 2015

Abstract: Several associations of mesenchymal disease with gastrointestinal disease are discussed, e.g., scleroderma and its alimentary manifestations, erythema nodosum and pyoderma gangrenosum as complications of chronic ulcerative colitis, and the relationship between arthritis and ulcerative colitis. Most of the article is concerned with the relationship between peptic ulcer and arthritis, and the drugs used in therapy. Several reports in the literature are cited. A principal finding is that patients with rheumatoid disease are particularly prone to peptic ulcer. The pathogenesis of peptic ulcer depends upon the balance between digestive secretions and mucosal resistance in the stomach and duodenum.

Several substances can be ulcerogenic, e.g., gastrin, histamine, aspirin, phenylbutazone and cinchophen. Possibly ulcerogenic are (large doses) testosterone and corticosteroids. Since corticosteroids are among the most beneficial drugs for the treatment of some mesenchymal diseases and ulcerative colitis, this point is an important one. We should not conclude that a disease is drug‐induced just because it follows administration of the drug. This is particularly applicable to peptic ulcer, which seems to occur secondarily or in association with a large variety of disorders.
FIBROSITIS
Authors: TRAUT EUGENE F.
Published: April 2015

Abstract. Fibrositis—muscular or nonarticular rheumatism—is a controversial diagnosis; nevertheless it represents a real entity, whether primary or secondary. The outstanding symptoms are pain and stiffness. Objective findings are “trigger areas” and indurations. The most common sites are the soft tissues of the neck, shoulder, elbow, carpal tunnel, palms (Dupuytren's contracture) and low back, but sometimes the syndrome is generalized.

Therapy for each type is outlined. The immediate treatment usually includes the administration of analgesics, immobilization of the affected area, and infiltration of the trigger points with procaine and adrenocortical steroids. Physical therapy (heat, massage and described exercises) is indispensable.
MEDICARE AND THE FUTURE OF HEALTH SERVICES*
Authors: Witkin Erwin
Published: April 2015

Abstract

Near the second anniversary of the beginning of Medicare, the statistics are discussed from the viewpoints of costs, efficiency, shortage of personnel, incentives and changes in requirements and payment methods.

Despite the changes already necessitated in the Medicare program and the many changes that are certain to be made in the future, we can all share in its current success. Medicare is operating very well and is accomplishing its objective of helping the elderly citizens of this nation to meet their health costs with dignity and self‐respect.
RENAL‐CELL CARCINOMA IN SIBLINGS: A CASE REPORT
Authors: Klinger Milton E.
Published: April 2015

Abstract

This case report concerns the fourth recorded instance of renal‐cell carcinoma occurring in two members of the same immediate family—a sister and brother in the geriatric age group.

In the sister's case, nephrectomy was performed and the patient is alive and clinically well three years later even though operation revealed extensive involvement of the hilar structures of the kidney. The brother is being managed with chemotherapy and radiation because of widespread carcinoma.
PARAMEDICAL SERVICES FOR OLDER AMERICANS*
Authors: Spear Mel
Published: April 2015

Abstract

This article outlines the kinds of services that can be rendered by persons other than physicians in complementing the necessary physician's services involved in meeting the objectives for older people embodied in the Older Americans Act. Clearly, if health is to be interpreted in terms of physical, emotional and social well‐being, a team approach is imperative. Every older American is entitled to quality health‐care services, including prevention and diagnosis, no matter where he is—in his own home, a home for the aged, an extended care facility, or a hospital. The role of the physician, though paramount, must be related also to the roles of a variety of other types of personnel, both nonprofessional and professional. Knowing the importance of supportive services, the physician must determine which services are needed and must also seek the people who can provide them.
FROM CUSTODIAL CARE TO INTENSIVE TREATMENT OF THE GERIATRIC PATIENT*
Authors: Korson Selig M.
Published: April 2015

Abstract

The Mental Health Institute at Independence, Iowa, as part of a progressive State mental health program, made substantial gains in treatment of the mentally ill, with a marked reduction in the average daily census even though the admission rate had increased. Because of limited funds, however, the treatment of geriatric patients did not approach the progress made in other areas of the hospital. In 1966, with the aid of a grant from the National Institute of Mental Health, the intensive treatment of geriatric patients became a reality. The staff was strengthened in all disciplines and a fully equipped physiotherapy department was added to the geriatric unit. Whereas previously all patients over 65 were admitted to psychiatric units, under the new plan these patients were admitted directly to the geriatric unit. There they received a complete medical and psychiatric review before being assigned to one of two areas within the unit. In one area were the patients who had potential for making substantial gains with intensive psychiatric treatment (group and individual therapy, ward government, remotivation techniques, occupational therapy and other activity therapies such as music, recreation, adult education and homemaking services, as well as intensive case work by experienced social workers). In the second area were the patients who were markedly regressed and organically deteriorated; even some of these showed enough improvement to be transferred to the more intensive unit. Patients unable to benefit from intensive treatment were transferred to nursing homes. Under the new regimen, the discharge rate for geriatric patients increased from 36 per cent to 59 per cent, and the discharge rate to their homes from 28 per cent to 47 per cent. The average length of stay in the hospital was markedly reduced from 112 days to 65 days.
A NEW LOOK AT GERIATRIC CARE
Authors: Kobrynski B.
Published: April 2015

Abstract

A geriatric program should meet the varying needs of elderly people, which may range from simple financial assistance to active medical rehabilitation and long‐term nursing, care. To make a geriatric program succeed, health, welfare and social agencies must work closely together. It is important that a full range of services be available in a community so as to assure the elderly person of proper care at the proper time. Because of the high incidence of crippling chronic disease in the older age group, there is a great need for hospital facilities which are equipped and staffed adequately to provide modern rehabilitation therapies. Elderly people with severe, irreversible conditions and terminal patients need a nursing facility where therapies which lessen discomfort and boost morale are available. This is best achieved when the nursing facility is closely associated with a hospital or is a part of a hospital.
AMYLOID IN THE WHITE PEKIN DUCK: A FLUORESCENCE MICROSCOPIC STUDY*
Authors: Rigdon R. H. , Schwartz Philip
Published: April 2015

Abstract

No amyloid was found in the liver of 6 normal white Pekin ducks, 72 days old, but hepatic amyloid was present in 14 of 15 ducks, 217 to 992 days old. The spleen, adrenals, heart, lungs, pancreas, intestine, oviduct, and sympathetic ganglion were also affected in some of the ducks.

Fluorescence microscopic examination of histologic sections treated with thioflavin‐S is the most effective and reliable technique for the demonstration of amyloid deposits in ducks.

The occurrence of amyloid in the duck is discussed in relation to the presence and location of amyloid in man and other animals, and in relation to aging.