bluuebunny/crossref_metadata_2025 huggingface dataset:
Heat flux distribution and temperature prediction model for dry and wet cylindrical plunge grinding
Authors: Pang Jingzhu , Wu Chongjun , Shen Yiming , Liu Siqi , Wang Qingxia , Li Beizhi
Published: December 2018

The grinding heat is generally partitioned into the workpiece, wheel, chips and fluid in grinding process. The total amount of heat flux entering into the workpiece greatly affects the final workpiece surface temperature, which may cause undesirable workpiece burn. Moreover, the variable grinding chip thickness and fluid injection speed along the grinding contact zone could substantially change the specific energy and the shape of the heat source correspondingly. In this article, a Weibull heat flux distribution model for both dry and wet grinding temperature prediction was proposed by analyzing two key parameters: energy partition Rw and shape parameter k. The value of Rw was obtained by considering the real contact length, the active grits number and the average grit radius r0 on the basis of traditional formulas. The relationship between shape parameters k and useful flow was established by a FLUENT simulation of the convective grinding fluid applied in grinding contact zone with wheel-workpiece minimum clearance. The grinding temperature and grinding force experiments were conducted on a grinding machine MGKS1332/H to validate the proposed heat flux model. The calculated workpiece surface temperature distribution was obtained by using the experimental heat flux obtained by the reverse algorithm, and the error between calculated temperature and experimental temperature was analyzed. With the monitored force signals and the proposed temperature prediction model, the grinding temperature for both dry and wet grinding can be predicted, which will be helpful to the optimization and control of temperature in grinding process.
Energy and exergy analysis of hydraulic free-piston engines
Authors: Wang Lei , Zhao Zhenfeng , Yu Chuncun , Zhang Fujun , Zhao Changlu
Published: December 2018

A hydraulic free-piston engine is an unconventional reciprocating piston internal combustion engine in which the piston assembly motion is determined by in-cylinder gas pressure and load force. Fuel combustion energy is directly converted into hydraulic energy. These affect the work process of cylinder and efficiency of energy conversion. In order to study the energy utilization efficiency and to explore the recovery potential of waste heat energy of hydraulic free-piston engine, in this paper, the energy distribution and waste heat energy characteristics of hydraulic free-piston engine have been studied by combining energy and exergy analysis. The thermal efficiency was analyzed by the first law of thermodynamics, and exergy balance was analyzed by the second law. The effect of the characteristic parameters on the thermal and exergy efficiency was studied through the simulation analysis comparing the energy utilization of hydraulic free-piston engine and conventional engines. The results show that control of the injection timing parameter is effective for optimizing efficiency because the cycle characteristic parameters can be controlled by changing the injection timing. The experimental results show that the thermal efficiency is 40.8% and the exergy efficiency is 46.3%. The simulation result show that the thermal efficiency of hydraulic free-piston engine is 38.0% and the conventional diesel engine is 33.0%.
Fast fault-tolerant control of electric power steering systems in the presence of actuator fault
Authors: Allous Manel , Mrabet Kais , Zanzouri Nadia
Published: December 2018

Electric power steering is an advanced steering system that uses an electric motor to improve steering comfort of the car. As a result, the failures in the electric motor can lead to additional fault modes and cause damage of the electric power steering system performance. Hence, to ensure the stability of this latter, the present paper proposes a new method to reconfigure the fault control. A novelty approach of fast fault estimation based on adaptive observer is also proposed. Moreover, to guarantee optimal and fast control, a fault-tolerant control based on inverse bond graph modeling is designed to construct the behavior of the nominal system. The simulation and the experimental results on a real electric power steering system reveal the importance of the control strategy and show that the proposed approach works as intended.
A usage-based size classification scheme for sedimentary charcoal
Authors: Vachula Richard S
Published: December 2018

Terms referring to charcoal particle size classifications are inconsistent in the paleofire literature. Inconsistencies of terminology prevent effective scientific discourse and research comparability. In this paper, I use the Global Charcoal Database (GCD) to determine the relative usage of sieving size boundaries and use these metadata as a proxy for the consensus of the paleofire community. With consideration of the size classification bounds used in other fields, I propose a standardized size classification system and terminology for charcoal particles. This system consists of macroscopic (>125 μm), mesoscopic (50–125 μm), and microscopic (10–50 μm) charcoal particles and aims to unify paleofire jargon by conforming to the terminology and most commonly used size bounds in the community.
Correlates Between Health Beliefs and Health-Promoting Lifestyle Profiles in the Development of Metabolic Syndrome in Taiwan
Authors: Chen Sue-Hsien , Chen Shu-Ching , Lai Yo-Ping , Chen Pin-Hsuan , Huang Tzu-Yun , Lin Ching-Ching , Yeh Kun-Yun
Published: December 2018

Differences in sociodemographic variables, health beliefs, and a healthy lifestyle all contribute to the varied prevalence of metabolic syndrome (MetS). We investigated the associations among MetS-related risk factors and performed a cross-sectional study, recruiting 1741 Taiwanese residents aged ≥30 years, between August 2014 and August 2015. Data were obtained on sociodemographic factors, health beliefs, and health-promoting lifestyle profiles using questionnaires. Multivariate analysis revealed that age ≥65 years (odds ratio [OR] = 2.17), low educational level (OR = 1.46), body mass index ≥24 kg/m2 (OR = 9.00), more health responsibility (OR = 1.08), and less exercise (OR = 0.924) were independent risk factors for MetS development. A correlation existed between health beliefs and health-promoting lifestyle profiles, suggesting that the establishment of an effective health-promoting program should consider participants’ health beliefs.
Preoperative Evaluation Clinic Redesign: An Initiative to Improve Access, Efficiency, and Staff Satisfaction
Authors: Irizarry-Alvarado Joan M. , Lundy Matthew , McKinney Barbara , Ray Frank A. , Reynolds Virginia E. , Pai Sher-Lu
Published: December 2018

In 2008, Mayo Clinic in Jacksonville, Florida, developed the preoperative evaluation (POE) clinic under the department of anesthesiology to provide preoperative history and physical examination, and medical optimization. Over time, the POE clinic expanded to accommodate more than 90% of surgical patients, outgrowing the initial practice model. The increased patient volume with shortened turnaround times bottlenecked patient access. A multidisciplinary quality improvement team used Define, Measure, Analyze, Improve, and Control methodology to understand the issues, test potential solutions, and develop sustainable processes. With progressive Plan-Do-Study-Act cycles, it moved from small internal tests of change to implementation throughout the institution. Patient access improved by 14% ( P < .001) and triage efficiency by 30% ( P < .001). These elements led to a 14% improvement in operating margin and a 24% improvement in staff satisfaction. Sustainability was ensured with an accessible dashboard of performance indicators.
Stationary solutions for a new hybrid quantum model for semiconductors with discontinuous pressure functional and relaxation time
Authors: Di Michele Federica , Mei Ming , Rubino Bruno , Sampalmieri Rosella
Published: December 2018

In this paper we propose a generalization of the hybrid model for semiconductors already discussed by Chiarelli et al.and Di Michele et al., including a non-constant pressure functional and relaxation time. Roughly speaking, we assume that the normalized electron temperature and the relaxation time in the classical and quantum domains are different from each other. We derive the model heuristically, introducing a generalization of the stress tensor, which accounts for an interface contribute, and afterwards we prove the existence and uniqueness of weak solutions for such a new hybrid model. We apply the approach proposed by Di Michele et al. to obtain the stationary solutions to our problem, namely we prove the existence of the solution for a regularized problem, then we achieve the existence of a weak solution for the hybrid problem as a proper limit of the regular solution previously obtained.
Utilising Bayesian networks to demonstrate the potential consequences of a fuel gas release from an offshore gas-driven turbine
Authors: Loughney S , Wang J , Matellini DB
Published: December 2018

This research proposes the application of Bayesian networks in conducting quantitative risk assessment of the integrity of an offshore gas driven turbine, used for electrical power generation. The focus of the research is centred on the potential release of fuel gas from a turbine and the potential consequences that follow the said release, such as fire, explosion and damage to equipment within the electrical generation module. The Bayesian network demonstrates the interactions of potential initial events and failures, hazards, barriers and consequences involved in a fuel gas release. This model allows for quantitative analysis to demonstrate partial verification of the model. The verification of the model is demonstrated in a series of test cases and through sensitivity analysis. Test case 1 demonstrates the effects of individual and combined control system failures within the fuel gas release model; 2 demonstrates the effects of the 100% probability of a gas release on the Bayesian network model, along with the effect of the gas detection system not functioning; and 3 demonstrates the effects of inserting evidence as a consequence and observing the effects on prior nodes.
An approximate internal model-based neural control for serial robots with multiple clearance joints
Authors: Yang Lixin , Zhang Xianmin
Published: December 2018

A dynamic model of serial robots with multiple clearance joints is developed. The contact phenomenon in the clearance joint is modeled by a continuous dissipative Hertz contact theory, and the friction force is calculated based on the modified Coulomb’s friction law. A neural network method is employed to predict the dynamic response, which avoids the problem in solving the differential algebraic equations. An approximate internal model-based neural control method is proposed to control the undesired effects arising from the joint clearances. The validity of the proposed method is verified by simulation results.
A research on fiber-optic vibration pattern recognition based on time-frequency characteristics
Authors: Marie Tabi Fouda Bernard , Han Dezhi , An Bowen , Li Jingyun
Published: December 2018

To detect and recognize any type of events over the perimeter security system, this article proposes a fiber-optic vibration pattern recognition method based on the combination of time-domain features and time-frequency domain features. The performance parameters (event recognition, event location, and event classification) are very important and describe the validity of this article. The pattern recognition method is precisely based on the empirical mode decomposition of time-frequency entropy and center-of-gravity frequency. It implements the function of identifying and classifying the event (intrusions or non-intrusion) over the perimeter to secure. To achieve this method, the first-level prejudgment is performed according to the time-domain features of the vibration signal, and the second-level prediction is carried out through time-frequency analysis. The time-frequency distribution of the signal is obtained by empirical mode decomposition and Hilbert transform and then the time-frequency entropy and center-of-gravity frequency are used to form the time-frequency domain features, that is, combined with the time-domain features to form feature vectors. Multiple types of probabilistic neural networks are identified to determine whether there are intrusions and the intrusion types. The experimental results demonstrate that the proposed method is effective and reliable in identifying and classifying the type of event.
Exploring product design quality control and assurance under both traditional and crowdsourcing-based design environments
Authors: Niu Xiaojing , Qin Shengfeng , Zhang Haizhu , Wang Meili , Wong Rose
Published: December 2018

Small and medium-sized enterprises face the challenges that they do not have enough employees and related resources to produce high-quality products with limited budget and time. The emergence of crowdsourcing provides an opportunity for them to improve their products by leveraging the wisdom of a large community of crowds, including their potential customers. With this new opportunity, product design could be conducted partially in a traditional design environment (in-house design) and partially in a crowdsourcing environment. This article focuses on product design stages to investigate what key factors affect product design quality and how it can be controlled and assured. First, we define the concept of product design quality and then identify its attributes and sub-attributes. Second, we separately survey key factors affecting product design quality in traditional and crowdsourcing-based design environments, quality control approaches/theories and quality assurance policies in traditional design environment. Third, a comparison of product design quality issues between the traditional and crowdsourcing-based design environments is progressed focusing on various aspects influencing product design activity quality. Finally, we discuss product design quality control approaches and quality assurance policies, quality control challenges and corresponding solutions in crowdsourcing-based design environment.
Updated Bayes identification of displacement constants of curve indeterminate box girder with variable scale theory
Authors: Xi Cheng , Jian Zhang , Chao Jia , Jiawei Tian
Published: December 2018

For curve indeterminate box girder, updated Bayes identification model of displacement constants was derived and studied with the variable-scale optimization theory. First, the updated Bayes objective function of displacement constants of the structure was founded. The gradient matrix of the objective function to displacement constants and the calculative covariance matrix were both deduced. Then, with finite curve strip element method, mechanical analysis of curve indeterminate box girder was completed. With automatic search scheme of quadratic parabola interpolation for optimal step length, the variable scale theory was utilized to optimize the updated Bayes objective function. Then, the identification steps were expounded, and the identification procedure was developed. Through typical examples, it is achieved that the updated Bayes identification model of displacement constants has numerical stability and perfect convergence. The stochastic performances of systematic parameters and systematic responses are simultaneously deliberated in updated Bayes objective function, which can synchronously take the actual measured information at different times into account. The variable-scale optimization method continually changes the spatial matrix scale to generate renewed search directions during the iterations, which certainly accelerates the identification of the displacement constants.
Exploring the impacts of personal factors on clinical leadership in a university hospital
Authors: Budak Fatih , Özer Özlem
Published: December 2018

Background

Clinical leadership is one of the important issues that should be carefully discussed with clinicians in the health sector.

Aims

The aim of this study was to investigate the clinical leadership qualities of physicians and nurses and to examine effect variables such as age, gender, marital status, total working time, educational level, profession, working unit, formal education on management, leadership and clinical leadership on the subdimensions of clinical leadership.

Methods

Participants included physicians and nurses working in a university hospital in Ankara, Turkey, and 261 participants responded to the research instrument. Data were collected from January to March 2016. Descriptive statistics, the significance test of difference between two means, and one-way analysis of variance were used in the data analysis.

Results

The findings revealed that total working time in the health sector and in the current working unit affect all subdimensions of clinical leadership ( p < 0.05). Whereas the subdimension of managing services has the highest mean score, the subdimension of personal qualities has the lowest mean score in clinical leadership.

Conclusion

Clinicians must aspire to achieve professional and managerial levels, which can improve their clinical expertise and clinical leadership skills.
Perioperative nursing: maintaining momentum and staying safe
Authors: McGarry Jon R , Pope Catherine , Green Sue M
Published: December 2018

Background: Perioperative practice underpins one of the key activities of many healthcare services, but the work of perioperative nurses is little known. A better understanding of their work is important to enable articulation of their contribution to clinical practice.

Aim: This study observed the practice of perioperative nurses and explored how they described their role.

Methods: Using ethnographic observation and interview, 85 hours’ observation of 11 nurses were undertaken, and 8 nurses were interviewed.

Results: Thematic analysis was undertaken enabling themes to emerge with two being identified. The first, ‘maintaining momentum’, described the need to keep people and equipment moving. The second, ‘accounting for safety’, referred to the need to keep the patient safe during this dangerous period. Tension between these two phenomena was apparent.

Conclusions: Perioperative nurses describe one of their key roles as maintaining the momentum of the patient’s journey through the operating theatre, but having to balance this with the need to ensure the patient’s safety. A core component of the perioperative nurse’s work is thus management of the tension between these two elements. This study illuminated how these nurses understand their practice.
A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients
Authors: Assi Chahine , Samaha Camille , Chamoun Moussa Moussa , Hayek Tony , Yammine Kaissar
Published: December 2018

Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compared the reliability of the RSFCF in treating such defects among both populations. Methods. This is a retrospective series with a prospective data collection of 24 patients (11 with type 2 diabetes and 13 in trauma settings) treated with an ipsilateral RSFCF for soft tissue defects of the distal leg and the rear foot. Healing events and complications were recorded and compared for both groups. The mean follow-up was 32 months. Results. Diabetic group versus trauma group showed the following results; mean flap healing time of 24 versus 22 days, donor site healing time of 14 versus 16 days, 1 total flap necrosis in both groups, 3 versus 2 cases of skin edge necrosis, 2 cases of temporary venous congestion in both groups, and 8 versus 10 cases of transient hypoesthesia of the lateral border of the foot. No infection was encountered in both groups and no recurrence of infection in the primary infected diabetic patients. Conclusions. We found the RSFCF to be useful, reproducible, and reliable in treating soft tissue defects with a very low frequency of serious complications. Diabetic patients were found to have similar outcomes when compared with trauma patients. Therefore, diabetes might not be a major factor of flap failure.

Levels of Evidence: Level III: Therapeutic
Prevention of Workplace Violence Among Health Care Workers
Authors: Robinson Ivreen
Published: December 2018

Workplace violence is common in health care settings. Occupational and environmental health nurses should educate employees about measures to prevent violence in the workplace.
Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Hip Fracture Surgery
Authors: Soffin Ellen M. , Gibbons Melinda M. , Wick Elizabeth C. , Kates Stephen L. , Cannesson Maxime , Scott Michael J. , Grant Michael C. , Ko Samantha S. , Wu Christopher L.
Published: December 2018

Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway. A literature search was performed for each protocol component, and the highest levels of evidence available were selected for review. Anesthesiology components of care were identified and evaluated across the perioperative continuum. For the preoperative phase, the use of regional analgesia and nonopioid multimodal analgesic agents is suggested. For the intraoperative phase, a standardized anesthetic with postoperative nausea and vomiting prophylaxis is suggested. For the postoperative phase, a multimodal (primarily nonopioid) analgesic regimen is suggested. A summary of the best available evidence and recommendations for inclusion in ERAS protocols for HFx repair are provided.
Family Caregiving and Cancer Pain Management
Authors: Ferrell Betty R.
Published: December 2018

Family caregivers are centrally involved in cancer pain management, especially for patients with advanced disease. This issue is becoming ever more important as care shifts to the outpatient setting and home care and as the aging population creates more patients who have multiple illnesses and family caregivers who often live with serious illnesses. This narrative review evaluated current knowledge and literature regarding family caregivers’ involvement in cancer pain management and identified areas for future research and clinical practice. There is a need for additional research in this area and for clinical models of support for family caregivers as they provide pain management for patients with cancer.
Validation of a Simple Tool for Electronic Documentation of Behavioral Responses to Anesthesia Induction
Authors: Winterberg Abby V. , Ding Lili , Hill Lauren M. , Stubbeman Bobbie L. , Varughese Anna M.
Published: December 2018

BACKGROUND:

Anxiety and distress behaviors during anesthesia induction are associated with negative postoperative outcomes for pediatric patients. Documenting behavioral responses to induction is useful to evaluate induction quality at hospitals and to optimize future anesthetics for returning patients, but we lack a simple tool for clinical documentation. The Induction Compliance Checklist is a tool for grading induction behaviors that is well validated for research purposes, but it is not practical for routine documentation in busy clinical practice settings. The Child Induction Behavioral Assessment tool was developed to provide a simple and easy to use electronic tool for clinical documentation of induction behaviors. The aim of this study was to test the Child Induction Behavioral Assessment tool’s concurrent validity with the Induction Compliance Checklist and the interrater reliability.

METHODS:

This prospective, observational study included 384 pediatric patients undergoing anesthesia inhalation induction. Concurrent validity with the Induction Compliance Checklist and interrater reliability of the Child Induction Behavioral Assessment were evaluated. Two researchers alternated scoring the Induction Compliance Checklist. The 2 researchers independently scored the Child Induction Behavioral Assessment. The anesthesia clinician caring for the patient also independently scored the Child Induction Behavioral Assessment by completing their routine documentation in the patient’s medical record. Two age groups were evaluated (ages 1–3 and 4–12 years old).

RESULTS:

Clinicians’ and researchers’ Child Induction Behavioral Assessment scores demonstrated a strong correlation with the Induction Compliance Checklist (P < .0001). There was an excellent agreement between the 2 researchers’ Child Induction Behavioral Assessment scores for the younger and older age groups, respectively (Kappa [95% CI] = 0.97 (0.94–0.99); K = 0.94 (0.89–0.99)]. The agreement between the researchers and the 117 clinicians who documented Child Induction Behavioral Assessment assessments in the medical record was good overall (intraclass correlation coefficient = 0.70), with fair agreement with the 1- to 3-year-old patients (intraclass correlation coefficient = 0.56) and good agreement for the 4- to 12-year-old patients (intraclass correlation coefficient = 0.74).

CONCLUSIONS:

The Child Induction Behavioral Assessment scale is a simple and practical electronic tool used to document pediatric behavioral responses to anesthesia inductions. This study provides evidence of the tool’s validity and reliability for inhalation inductions. Future research is needed at other hospitals to confirm validity.
Association of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery: A Retrospective Cohort Study
Authors: Oh Tak Kyu , Do Sang-Hwan , Jeon Young-Tae , Kim Jinhee , Na Hyo-Seok , Hwang Jung-Won
Published: December 2018

BACKGROUND:

Postoperative hyperchloremia is known to be related to increases in mortality and morbidity after surgery. However, the relationship between preoperative hyperchloremia and hypochloremia and postoperative mortality and morbidity is not well established. Our aim was to evaluate the relationship between preoperative hyperchloremia or hypochloremia, as assessed using preoperative serum chloride tests, and 90-day mortality and morbidity after noncardiac surgery.

METHODS:

In this retrospective cohort study, we reviewed the medical records of patients >20 years of age who underwent noncardiac surgery between January 2010 and December 2016. Patients were categorized into one of the following groups on the basis of the results of serum chloride testing performed within 1 month before surgery: normochloremia, 97–110 mmol·L−1; hyperchloremia, >110 mmol·L−1; and hypochloremia, <97 mmol·L−1. The primary end point of this study was the difference in postoperative 90-day mortality among the preoperative serum chloride groups. The secondary end point was the difference in postoperative acute kidney injury incidence among the preoperative serum chloride groups.

RESULTS:

A total of 106,505 patients were included in the final analysis (2147 were allocated to the preoperative hypochloremia group and 617 to the hyperchloremia group). Multivariable Cox regression analysis revealed significantly increased 90-day mortality in the hypochloremia (hazard ratio, 1.46; 95% CI, 1.16–1.84; P = .001) and hyperchloremia (hazard ratio, 1.76; 95% CI, 1.13–2.73; P = .013) groups when compared with the normochloremia group. In addition, multivariable logistic regression analysis revealed a 1.83-fold increased odds of acute kidney injury in the preoperative hypochloremia group when compared with the normochloremia group (odds ratio, 1.83; 95% CI, 1.53–2.19; P < .001).

CONCLUSIONS:

Preoperative hypochloremia and hyperchloremia were related to increased 90-day mortality after noncardiac surgery. In addition, preoperative hypochloremia was related to an increased risk for postoperative acute kidney injury.
Weeding Out the Problem: The Impact of Preoperative Cannabinoid Use on Pain in the Perioperative Period
Authors: Liu Christopher W. , Bhatia Anuj , Buzon-Tan Arlene , Walker Susan , Ilangomaran Dharini , Kara Jamal , Venkatraghavan Lakshmikumar , Prabhu Atul J.
Published: December 2018

BACKGROUND:

The recreational and medical use of cannabinoids has been increasing. While most studies and reviews have focused on the role of cannabinoids in the management of acute pain, no study has examined the postoperative outcomes of surgical candidates who are on cannabinoids preoperatively. This retrospective cohort study examined the impact of preoperative cannabinoid use on postoperative pain scores and pain-related outcomes in patients undergoing major orthopedic surgery.

METHODS:

Outcomes of patients who had major orthopedic surgery at our hospital between April 1, 2015 and June 30, 2017 were reviewed. Data were obtained from Networked Online Processing of Acute Pain Information, a locally developed database for our Acute Pain Service. Propensity score matching was used to balance baselines variables including age, sex, type of surgery, history of depression or anxiety, and perioperative use of regional anesthesia between patients who reported use of cannabinoids and those not on this substance. Intensity of pain with movement in the early postoperative period (defined as up to 36 hours after surgery) was the primary outcome of this study. The secondary outcomes (all in early postoperative period) were pain at rest, opioid consumption, incidence of pruritus, nausea and vomiting, sedation, delirium, constipation, impairment of sleep and physical activity, patient satisfaction with analgesia, and the length of Acute Pain Service follow-up.

RESULTS:

A total of 3793 patients were included in the study. Of these, 155 patients were identified as being on cannabinoids for recreational or medical indications in the preoperative period. After propensity score matching, we compared data from 155 patients who were on cannabinoids and 155 patients who were not on cannabinoids. Patients who were on preoperative cannabinoids had higher pain numerical rating score (median [25th, 75th percentiles]) at rest (5.0 [3.0, 6.1] vs 3.0 [2.0, 5.5], P = .010) and with movement (8.0 [6.0, 9.0] vs 7.0 [3.5, 8.5], P = .003), and a higher incidence of moderate-to-severe pain at rest (62.3% vs 45.5%, respectively, P = .004; odds ratio, 1.98; 95% CI, 1.25–3.14) and with movement (85.7% vs 75.2% respectively, P = .021; odds ratio, 1.98; 95% CI, 1.10–3.57) in the early postoperative period compared to patients who were not on cannabinoids. There was also a higher incidence of sleep interruption in the early postoperative period for patients who used cannabinoids.

CONCLUSIONS:

This retrospective study with propensity-matched cohorts showed that cannabinoid use was associated with higher pain scores and a poorer quality of sleep in the early postoperative period in patients undergoing major orthopedic surgery.
Statistical Process Control: No Hits, No Runs, No Errors?
Authors: Vetter Thomas R. , Morrice Douglas
Published: December 2018

A novel intervention or new clinical program must achieve and sustain its operational and clinical goals. To demonstrate successfully optimizing health care value, providers and other stakeholders must longitudinally measure and report these tracked relevant associated outcomes. This includes clinicians and perioperative health services researchers who chose to participate in these process improvement and quality improvement efforts (“play in this space”). Statistical process control is a branch of statistics that combines rigorous sequential, time-based analysis methods with graphical presentation of performance and quality data. Statistical process control and its primary tool—the control chart—provide researchers and practitioners with a method of better understanding and communicating data from health care performance and quality improvement efforts. Statistical process control presents performance and quality data in a format that is typically more understandable to practicing clinicians, administrators, and health care decision makers and often more readily generates actionable insights and conclusions. Health care quality improvement is predicated on statistical process control. Undertaking, achieving, and reporting continuous quality improvement in anesthesiology, critical care, perioperative medicine, and acute and chronic pain management all fundamentally rely on applying statistical process control methods and tools. Thus, the present basic statistical tutorial focuses on the germane topic of statistical process control, including random (common) causes of variation versus assignable (special) causes of variation: Six Sigma versus Lean versus Lean Six Sigma, levels of quality management, run chart, control charts, selecting the applicable type of control chart, and analyzing a control chart. Specific attention is focused on quasi-experimental study designs, which are particularly applicable to process improvement and quality improvement efforts.
ST Segment–Elevation Myocardial Ischemia After Arterial Switch Operation due to Pericardial Drain Placement: A Case Report
Authors: Bhat Imran , Kajal Kamal , Gourav Krishna Parsad , Damodaran Srinath , Munirathinam Ganesh Kumar , Ganesan Rajarajan
Published: December 2018

Myocardial ischemia postarterial switch operation has been reported extensively in the literature and has been almost exclusively ascribed to issues related to coronary artery translocation. Here, we report a case of a 5-week-old child with d-transposition of the great arteries who underwent an arterial switch operation and developed myocardial ischemia after pericardial drain placement, as evidenced by significant ST segment elevation and abnormal regional cardiac wall motion. The ST segment and cardiac wall motion improved once the drain was withdrawn from the pericardium and placed in the retrosternal space. Few reports in the literature describe this complication, particularly in pediatric patients.
Physical Activity Is Associated with Attenuated Disease Progression in Chronic Obstructive Pulmonary Disease
Authors: DEMEYER HELEEN , DONAIRE-GONZALEZ DAVID , GIMENO-SANTOS ELENA , RAMON MARIA A. , DE BATTLE JORDI , BENET MARTA , SERRA IGNASI , GUERRA STEFANO , FARRERO EVA , RODRIGUEZ ESTHER , FERRER JAUME , SAULEDA JAUME , MONSO EDUARD , GEA JOAQUIM , RODRIGUEZ-ROISIN ROBERTO , AGUSTI ALVAR , ANTÓ JOSEP M. , GARCIA-AYMERICH JUDITH
Published: December 2018

Introduction

Chronic obstructive pulmonary disease (COPD) progression is variable and affects several disease domains, including decline in lung function, exercise capacity, muscle strength, and health status as well as changes in body composition. We aimed to assess the longitudinal association of physical activity (PA) with these a priori selected components of disease progression.

Methods

We studied 114 COPD patients from the PAC-COPD cohort (94% male, mean [SD], 70 yr [8 yr] of age, 54 [16] forced expiratory volume in 1 s % predicted) at baseline and 2.6 yr (0.6 yr) later. Baseline PA was assessed by accelerometry. Multivariable general linear models were built to assess the association between PA and changes in lung function, functional exercise capacity, muscle strength, health status, and body composition. All models were adjusted for confounders and the respective baseline value of each measure.

Results

Per each 1000 steps higher baseline PA, forced expiratory volume in 1 s declined 7 mL less (P < 0.01), forced vital capacity 9 mL less (P = 0.03) and carbon monoxide diffusing capacity 0.10 mL·min−1·mm Hg−1 less (P = 0.04), while the St George’s Respiratory Questionnaire symptom domain deteriorated 0.4 points less (P = 0.03), per year follow-up. Physical activity was not associated with changes in functional exercise capacity, muscle strength, other domains of health status or body composition.

Conclusions

Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.
Estimation of the Excess Relative Risk of Malignant Neoplasms among Workers of the Nuclear Industry – Participants of the Accident Liquidation at the Chernobyl NPP
Authors: Шафранский И. , Shafransky I. , Туков А. , Tukov A. , Бирюков А. , Biryukov A. , Сидорин И. , Sidorin I. , Потапова Л. , Potapova L. , Прохорова О. , Prokhorova O. , Удалов Ю. , Udalov Yu. , Ильин Л. , Il'in L. , Лягинская А. , Lyaginskaya A. , Соловьев В. , Solov'ev V.
Published: December 2018

Purpose: To assess the excess relative risk in terms of 1 Sv on the basis of materials on the incidence of malignant neoplasms of workers in the nuclear industry – liquidators of the Chernobyl accident, as well as part of workers who worked or continue to work with sources of ionizing radiation. Material and methods: The data base of the Industry Register of persons exposed to radiation as a result of the Chernobyl accident (ORF) was used in the work. Methods of cohort analysis of the accumulated disease incidence were used, based on Poisson regression and Cox regression. Estimates of the ERR at 1 Sv were calculated using both the traditional scheme using the AMFIT module and the modified formula proposed by Paretzke. Results: It is shown that in some cases, the risk estimates obtained by the modified formula are more realistic, in other cases both estimates have similar values. Conclusion: Analysis of the incidence of solid neoplasms in the liquidator cohort showed: 1. At the dose range < 200 mSv, point estimates of relative risk indicate that there is no dose-associated risk. 2. In the low-dose range for risk assessment, a modified Poisson regression approach that is free of control specifics should be used. 3. The validity of a dose response is characterized by the risks obtained using a dose of occupational exposure. 4. An important issue is the calculation of the risk of radiation-caused diseases with the use of the total dose received by an individual from all types of radiation.
Apps and wearables in the monitoring of mental health disorders
Authors: Patel Sunil , Saunders Kate EA
Published: December 2018

Recent advances in smartphone technology have revealed new opportunities for the diagnosis, monitoring and provision of mental health care. Such digital approaches have the potential to enhance our understanding of the course of mental disorder, enable early diagnosis and generate new treatment targets. However, issues relating to mobile phone ownership, misuse of clinical data, commercial devices and the ethics of such approaches need to be overcome if smartphones are to be routinely used in mental health care. This article reviews the potential as well as the challenges posed by the use of such technologies in mental health settings.
The role of artificial intelligence in orthopaedic surgery
Authors: Panchmatia Jaykar R , Visenio Michael R , Panch Trishan
Published: December 2018

Despite significant advances in orthopaedic surgery, variability still exists between providers and practice locations, and process inefficiencies are found throughout the health care continuum. Evolving technologies, namely artificial intelligence, challenge the status quo by improving patient care in four areas: diagnosis, management, research and systems analysis. Artificial intelligence shows promise in promoting practice efficiency, personalizing patient care, improving institutional research capacity, and expanding high quality orthopaedic care to lower resource settings. Physicians should be involved in the development of artificial intelligence algorithms to ensure that patients derive maximum benefit from new advances while considering the ethical challenges of implementation.
Use of appropriate technology to improve mental health service delivery
Authors: de Silva Prasanna N
Published: December 2018

This article reviews currently available appropriate technologies which have been used in mental health, in order to reduce confusion and delay. Confusion (for example when and where to refer) can lead to error and waste. Similarly delay impacts quality and accessibility of the whole range of mental health services. As most secondary care mental health services use electronic patient records, it is arguably easier to apply technology in this speciality. However, consideration needs to be given to confidentiality and data security. Doctors of all specialities will be exposed to ‘new’ technologies over the next decade, and need to be aware of the direction of travel and its implications.
The role of biologics in the treatment of patients with inflammatory bowel disease
Authors: Selinger Christian P , Carbery Isabel , Al-Asiry Jamal
Published: December 2018

The treatment of inflammatory bowel disease has changed dramatically over the last two decades. The arrival of infliximab as the first biological medicine for inflammatory bowel disease revolutionized its management. Since then the armamentarium of biological medicines for inflammatory bowel disease has grown to five drugs in three different classes. This article highlights the different mechanisms of action and describes the key evidence for their use including drug safety profiles. Furthermore it highlights the current National Institute for Health and Care Excellence recommendations for biological therapy in inflammatory bowel disease and discusses pending changes to the classic treatment algorithms in light of emerging evidence.
The impact of patient feedback on clinical practice
Authors: Kumah Emmanuel , Ankomah Samuel E , Kesse Felix O
Published: December 2018

Feedback from patients about the care they have received is an integral part of quality in health care. This article looks at the extent to which patient feedback impacts the performance of clinicians and provision of clinical care. A non-systematic literature search was conducted in a narrative form on five electronic databases, including English language peer-reviewed articles published within the last 18 years. The effects of patient feedback on clinicians' performance are mixed. The reviewed studies either reported no effects, small non-statistically significant improvements or few statistically significant changes in clinical practice. More policy-level actions and effective organizational leadership are required for the goal of incorporating patient feedback in quality improvement to promote patient centredness in care delivery to be fully realized.
Cerebral oximetry monitoring in OHCA
Authors: Burrell Lisa , Rice Alan
Published: December 2018

Background:

Cerebral oximetry allows non-invasive, real-time monitoring information of cerebral blood flow. It has recently been used to provide information about cerebral perfusion during resuscitation efforts in cases of cardiac arrest and may give an indication of neurological survival. Most of this information has been obtained during the hospital phase of treatment and little is known about cerebral flow in the prehospital phase.

Methods:

A systematic review was carried out, with the PubMed and EMBASE databases searched to identify clinical trials where cerebral oximetry monitoring was performed in the prehospital phase of out-of-hospital cardiac arrest. It aimed specifically to answer the following questions: is cerebral oximetry monitoring feasible in the prehospital environment? Can cerebral oximetry be used as a useful marker of the quality of cardiopulmonary resuscitation in the prehospital setting? Can cerebral oximetry be used to assist decisions around prognostication and futility for out-of-hospital cardiac arrest?

Results:

Five studies were identified for review. Feasibility was demonstrated in four of these. The usefulness of cerebral oximetry in monitoring cardiopulmonary resuscitation has not been well explored in out-of-hospital cardiac arrest. Similarly, data linking intra-arrest cerebral oximetry values and prognosis in out-of-hospital cardiac arrest is sparse.

Conclusions:

Cerebral oximetry is feasible in out-of-hospital cardiac arrest but its usefulness in guiding resuscitation attempts in this environment remains largely unknown.
Key subjects missing hundreds of teachers as crisis continues
Authors: Henshaw Pete
Published: December 2018

An analysis of missed ITT recruitment targets since 2016 show dramatic shortfalls of more than 1,000 teachers in some subjects
School trip tips: Effective planning and organising
Authors: Harvey Gill
Published: December 2018

Gill Harvey offers her advice on planning and running educational and safe school trips, including tips for schools that decide to work with a tour operator or other provider
The financial position of English voluntary organisations: relationships between subjective perceptions and financial realities
Authors: Mohan John , Yoon Yeosun , Kendall Jeremy , Brookes Nadia
Published: December 2018

The financial position of English social policy charities has received much attention, with a particular focus on the difficulties that small- and medium-sized organisations are experiencing. However, in this article we show that the evidence base has a number of limitations. We then demonstrate, analysing data from a survey of more than 1,000 charities, that organisational size, per se, is only one dimension of the problem: perceptions that the operating and financial environment is challenging are related to other organisational characteristics. We then add to the survey data indicators of financial vulnerability to investigate whether there is a relationship between perception (responses to questions about the resources available to charities) and financial reality (the recent financial history of these charities). Somewhat reassuringly, however, we demonstrate that there is a degree of consistency between the perceptions that organisations report and we discuss the implications of the findings.
Reformationsjubiläum 2017. Rückblick, Ernte und neue Herausforderungen
Authors: Käßmann Margot
Published: December 2018

This contribution offers a retrospective on the events of the year 2017 in Germany from the perspective of the Special Envoy for the Reformation Anniversary (of the EKD). It highlights individual climaxes such as the Kirchentag or the World Exhibition of the Reformation in Wittenberg and appreciates the spirit of ecumenical openness and the global horizon of the celebrations. It also discusses some challenges for present-day Christianity, namely preaching in an environment that is both secular and multi-religious. According to the author, it will be decisive to keep the impact of the anniversary alive in the local church communities beyond the year 2017.
Theologie des Kreuzes aus evangelischer Perspektive in ökumenischer Absicht
Authors: Oberdorfer Bernd
Published: December 2018

In September 2017, the feast of the Exaltation of the Holy Cross in Trier was celebrated ecu­menically. It is within this context that this contribution discusses central traits of Luther’s theology of the cross based on the 1518 Heidelberg Disputation and the 1519 Sermon on Preparing to Die (Sermon von der Bereitung zum Sterben). It then identifies important conse­quences of Luther’s focus on the cross in Christology, his understanding of the Lord’s Supper, and in ethics, and draws reception-historical lines to modern Lutheranism. At the end, consi­derations as to the ecumenical relevance of the theology of the cross are presented.