bluuebunny/crossref_metadata_2025 huggingface dataset:
Professional Practice and Innovation: Chronic Disease, Geographic Location and Socioeconomic Disadvantage as Obstacles to Equitable Access to E-Health
Authors: Han Jung Hoon , Sunderland Naomi , Kendall Elizabeth , Gudes Ori , Henniker Garth
Published: March 2016

Despite recent public attention to e-health as a solution to rising healthcare costs and an ageing population, there have been relatively few studies examining the geographical pattern of e-health usage. This paper argues for an equitable approach to e-health and attention to the way in which e-health initiatives can produce locational health inequalities, particularly in socioeconomically disadvantaged areas. In this paper, we use a case study to demonstrate geographical variation in Internet accessibility, Internet status and prevalence of chronic diseases within a small district. There are significant disparities in access to health information within socioeconomically disadvantaged areas. The most vulnerable people in these areas are likely to have limited availability of, or access to Internet healthcare resources. They are also more likely to have complex chronic diseases and, therefore, be in greatest need of these resources. This case study demonstrates the importance of an equitable approach to e-health information technologies and telecommunications infrastructure.
Hospital Coding of Dementia: Is it Accurate?
Authors: Cummings Elizabeth , Maher Roxanne , Showell Christopher Morris , Croft Toby , Tolman Jane , Vickers James , Stirling Christine , Robinson Andrew , Turner Paul
Published: March 2016

This paper investigates the coding of dementia in the episode of care in a pilot study group ( N=48) post hospital discharge and the possible implications of under-coding. The assigned ICD-10-AM codes and Diagnosis Related Groups were reviewed. Results demonstrate under-coding of dementia and of cognitive deficits; poor correlation between admission diagnoses and dementia codes on separation; and changes in individual patients' cognitive status across forms and assessments in the same admission. The complexities of accurately coding dementias will impact upon planning for future treatments and service provision and will have a flow-on effect for patients, hospitals, and patient care in Australia.
The Roles of Users' Personal Characteristics and Organisational Support in the Attitude towards Using ERP Systems in a Spanish Public Hospital
Authors: Escobar-Rodriguez Tomás , Bartual-Sopena Lourdes
Published: March 2016

Enterprise resources planning (ERP) systems enable central and integrative control over all processes throughout an organisation by ensuring one data entry point and the use of a common database. This paper analyses the attitude of healthcare personnel towards the use of an ERP system in a Spanish public hospital, identifying influencing factors. This research is based on a regression analysis of latent variables using the optimisation technique of partial least squares. We propose a research model including possible relationships among different constructs using the technology acceptance model. Our results show that the personal characteristics of potential users are key factors in explaining attitude towards using ERP systems.
Does the PCEHR Mean a New Paradigm for Information Security? Implications for Health Information Management
Authors: Williams Patricia A.H.
Published: March 2016

Australia is stepping up to the new e-health environment. With this comes new legislation and new demands on information security. The expanded functionality of e-health and the increased legislative requirements, coupled with new uses of technology, means that enhancement of existing security practice will be necessary. This paper analyses the new operating environment for Australian healthcare and the legislation governing it, and highlights the changes that are required to meet this new context. Individuals are now more responsible for security and organisations should be prompted to review their security measures in light of the new demands of legislative compliance.
Assessing the Reliability of Causes of Death Reported by the Vital Registration System in Sri Lanka: Medical Records Review in Colombo
Authors: Rampatige Rasika , Gamage Saman , Peiris Sharika , Lopez Alan D
Published: March 2016

Information on causes of death is critical for informed decision making in the health sector. This paper reports findings from a study that measured the accuracy of registered causes of death and quality of medical records for a sample of deaths occurring in hospitals in Colombo, Sri Lanka. Five physicians, trained in medical certification of cause of death, reconstructed death certificates for hospital deaths from medical records and assessed the quality of medical records for this purpose. The majority of medical records were found to be of average quality. Concordance between the underlying cause of death in the vital registration data and that from the ‘gold standard’ (medical records review) diagnosis was 41.4% ( n=249). The sensitivity of all leading causes of death and positive predictive value were below 67%. Major misclassification errors were found in identifying deaths due to vascular diseases and diabetes mellitus. Certified causes of death in Sri Lanka are frequently incorrect, thus limiting their value for health policy and for monitoring progress towards development goals. Sri Lanka, and other countries at a similar level of statistical development, should consider periodically conducting research to evaluate the quality of cause of death reporting at both local and national levels.
Building the ‘Continuous Learning’ Healthcare System
Authors: Jackson Terri
Published: March 2016

Hospitals are data-rich but information-poor. To develop a ‘continuous-learning health care system’ we need to harness our myriad information sources so that every patient encounter becomes the basis for new evidence of what works.
Encoding and Verification of a Computer-Interpretable Guideline: A Case Study of Pressure-Ulcer Management
Authors: Kim Hyun-Young , Park Hyeoun-Ae , Cho InSook , Kim JeongAh , Lee JaeHoon
Published: March 2016

This study examined ways to improve the accuracy of translating clinical practice guidelines (CPGs) into a computer-interpretable guideline (CIG) for pressure-ulcer management using the Shareable Active Guideline Environment (SAGE) guideline model, and aimed to verify the accuracy of the obtained CIG. The study was conducted using the following procedures: selecting CPGs, extracting rules from the selected CPGs, developing a CIG using the SAGE guideline model, and verifying the obtained CIG with test cases using an execution engine. The CIG for pressure-ulcer management was developed based on 38 rules and three algorithms at the semiformal representation level using MS Excel and MS Visio. The CIG was encoded by two Activity Graphs consisting of 115 instances representing algorithms and rules as knowledge elements in the SAGE guideline model. Two errors were found and corrected. Results of the study demonstrated that a CIG representing knowledge on pressure-ulcer management can be effectively developed using commonly available programs and the SAGE guideline model, and that the obtained CIG can be verified with a locally developed execution engine. The CIG developed in the study could contribute to health information management once it is implemented successfully in a clinical decision support system.
Aryl hydrocarbon receptor–dependent enrichment of a megakaryocytic precursor with a high potential to produce proplatelets
Authors: Strassel Catherine , Brouard Nathalie , Mallo Lea , Receveur Nicolas , Mangin Pierre , Eckly Anita , Bieche Ivan , Tarte Karin , Gachet Christian , Lanza François
Published: March 2016

Key Points

Emergence of a CD34+CD41low population with a high capacity to generate proplatelet-producing MKs and functional platelet-like elements. Platelet production is inversely correlated to CYP1B1 expression, a target of the aryl hydrocarbon receptor.
Localization of tamoxifen in human breast cancer tumors by MALDI mass spectrometry imaging
Authors: Végvári Ákos , Shavkunov Alexander S. , Fehniger Thomas E. , Grabau Dorthe , Niméus Emma , Marko‐Varga György
Published: March 2016

Background

Tamoxifen is used in endocrine treatment of breast cancer to inhibit estrogen signaling. A set of stratified ER‐positive and ER‐negative tumor sections was subjected to manual deposition of tamoxifen solution in order to investigate its spatial distribution upon exposure to interaction within thin tissue sections.

Methods

The localization of tamoxifen in tumor sections was assessed by matrix assisted laser deposition/ionization mass spectrometry imaging. The images of extracted ion maps were analyzed for comparison of signal intensity distributions.

Results

The precursor ion of tamoxifen (m/z 372.233) displayed heterogeneous signal intensity distributions in histological compartments of tumor tissue sections. The levels of tamoxifen in tumor cells compared with stroma were higher in ER‐positive tissues, whereas ER‐negative tissue sections showed lower signal intensities in tumor cells.

Conclusions

The experimental model was successfully applied on frozen tumor samples allowing for differentiation between ER groups based on distribution of tamoxifen.
Correction of severe columella and tip retraction in silicone implanted Asian short noses
Authors: Sertel Serkan , Venara-Vulpe Ioana Irina , Pasche Philippe
Published: March 2016

Background

Silicone Implants and other alloplastic materials are frequently used in rhinoplasty to augment Asian short noses. However, nasal deformities as a result of implant-related infections are increasing in incidence. The resulting tissue scarrings hinder the application of traditional techniques of lengthening short noses. The following paper presents a technique to correct severe postoperative retractions of the tip and columella caused by silicone implants.

Methods

We present a retrospective case study of two Asian patients with recurrent acute infections, secondary to silicone dorsum implants, leading to chronic inflammation of the tip and columella. The treatment consisted of implant removal and the immediate nasal reconstruction by combining uni- or bilateral gingivobuccal flaps along with L-shaped costal cartilage grafting. To evaluate the surgical results, various anthropometric measurements, particularly the nasal length (NL) and nasal tip projection (NTP) of pre- and postoperative profile photographs, were analyzed.

Results

Successful nasal lengthening and correction of columellar retraction were achieved. In case I, postoperative NTP and NL increased by 34.7 % and 21.1 %, respectively. In case II, NL and NTP increased by 23.8 % and 10.6 %, respectively. However, case II presented necrosis of the distal extremity of one gingivobuccal flap without rib graft resorption, which later healed by secondary intention.

Conclusion

Pronounced columellar retraction in severe short noses can be successfully managed with a combination of gingivobuccal flaps along with L-shaped costal cartilage grafting. The use of autologous materials decreases the risk of long-term extrusion through the tip. The gingivobuccal flap provides vascularity to the exposed rib cartilage on the columella and prevents its resorption.
Sortilin is associated with the chlamydial inclusion and is modulated during infection
Authors: Teo Wei Xuan , Kerr Markus Charles , Huston Wilhelmina May , Teasdale Rohan David
Published: March 2016

Chlamydia species are obligate intracellular pathogens that have a major impact on human health. The pathogen replicates within an intracellular niche called an inclusion and is thought to rely heavily on host-derived proteins and lipids, including ceramide. Sortilin is a transmembrane receptor implicated in the trafficking of acid sphingomyelinase, which is responsible for catalysing the breakdown of sphingomyelin to ceramide. In this study, we examined the role of sortilin in Chlamydia trachomatis L2 development. Western immunoblotting and immunocytochemistry analysis revealed that endogenous sortilin is not only associated with the inclusion, but that protein levels increase in infected cells. RNAi-mediated depletion of sortilin, however, had no detectable impact on ceramide delivery to the inclusion or the production of infectious progeny. This study demonstrates that whilst Chlamydia redirects sortilin trafficking to the chlamydial inclusion, RNAi knockdown of sortilin expression is insufficient to determine if this pathway is requisite for the development of the pathogen.
Cdk5–Foxo3 axis: initially neuroprotective, eventually neurodegenerative in Alzheimer's disease models
Authors: Shi Chun , Viccaro Keith , Lee Hyoung-gon , Shah Kavita
Published: March 2016

Deregulated Cdk5 causes neurotoxic amyloid beta peptide (Aβ) processing and cell death, two hallmarks of Alzheimer's disease, through the Foxo3 transcriptional factor in hippocampal cells, primary neurons and an Alzheimer's disease mouse model. Using an innovative chemical genetic screen, we identified Foxo3 as a direct substrate of Cdk5 in brain lysates. Cdk5 directly phosphorylates Foxo3, which increased its levels and nuclear translocation. Nuclear Foxo3 initially rescued cells from ensuing oxidative stress by upregulating MnSOD (also known as SOD2). However, following prolonged exposure, Foxo3 upregulated Bim (also known as BCL2L11) and FasL (also known as FASLG) causing cell death. Active Foxo3 also increased Aβ(1–42) levels in a phosphorylation-dependent manner. These events were completely inhibited either by expressing phosphorylation-resistant Foxo3 or by depleting Cdk5 or Foxo3, highlighting a key role for Cdk5 in regulating Foxo3. These results were confirmed in an Alzheimer's disease mouse model, which exhibited increased levels and nuclear localization of Foxo3 in hippocampal neurons, which preceded neurodegeneration and Aβ plaque formation, indicating this phenomenon is an early event in Alzheimer's disease pathogenesis. Collectively, these results show that Cdk5-mediated phospho-regulation of Foxo3 can activate several genes that promote neuronal death and aberrant Aβ processing, thereby contributing to the progression of neurodegenerative pathologies.
Ahead of the Curve: New Insights into Microtubule Dynamics
Authors: Ohi Ryoma , Zanic Marija
Published: March 2016

Microtubule dynamics are fundamental for many aspects of cell physiology, but their mechanistic underpinnings remain unclear despite 40 years of intense research. In recent years, the continued union of reconstitution biochemistry, structural biology, and modeling has yielded important discoveries that deepen our understanding of microtubule dynamics. These studies, which we review here, underscore the importance of GTP hydrolysis-induced changes in tubulin structure as microtubules assemble, and highlight the fact that each aspect of microtubule behavior is the output of complex, multi-step processes. Although this body of work moves us closer to appreciating the key features of microtubule biochemistry that drive dynamic instability, the divide between our understanding of microtubules in isolation versus within the cellular milieu remains vast. Bridging this gap will serve as fertile grounds of cytoskeleton-focused research for many years to come.
Autocrine and paracrine Wingless signalling in the Drosophila midgut by both continuous gradient and asynchronous bursts of wingless expression
Authors: Fang Hsiao Yu , Martinez-Arias Alfonso , de Navascués Joaquín
Published: March 2016

Wingless (Wg)/ Wnt signalling is a major regulator of homeostasis in both the mammalian and Drosophila intestine. In Drosophila the organisation and function of Wingless signalling in the adult intestine remain poorly understood. Here we characterise the pattern of expression of wg, the stabilisation of its effector Armadillo in the adult Drosophila midgut, and correlate them with the response of the cells to Wg signalling activation. We show that in normal homeostasis there is a gradient of Wingless signalling in the intestinal stem cell (ISC) and the undifferentiated progenitor cell (enteroblast, EB) populations along the posterior midgut, with a high point at the midgut-hindgut boundary (pylorus). This gradient results from a combination of two sources of Wingless: a distant source outside the epithelium (the pylorus) and a local one from the ISCs and EBs themselves. Altogether, our studies show that Wingless expression and signalling in the epithelium is not continuous, but operates through bursts that occur randomly in space and time.
Sound mind vs sound heart
Authors: Upadhyay Baljit K , Katz Sara B , Upadhyay Anil , Cherukuri Sathya , Sule Akeem
Published: March 2016

Depressive and anxiety disorders have both have been associated with an increased risk of cardiovascular disease. This article highlights the multifactorial and bidirectional interaction between cardiovascular diseases, depression and anxiety, and the need for early assessment, diagnosis and intervention.
Safe and sustainable increases in day case emergency surgery
Authors: Hotchen Andrew J , Coleman Grant , O'Callaghan John M , McWhinnie Doug
Published: March 2016

Selected patients referred to emergency general surgery departments are suitable for day case emergency surgery with no overnight hospital stay. There are no well-described sustainable pathways for these expedited operations and in many hospitals patients undergo unnecessary admissions and experience long waiting times.

Methods:

The authors proposed a new, sustainable, day case emergency surgery pathway which was implemented to streamline the assessment, treatment and discharge of acute surgical referrals. It requires rapid assessment of the patient by a senior clinician, and ready availability of diagnostic services and operating facilities. To assess this pathway, the authors conducted a prospective audit of general surgical referrals to a district general hospital in the UK.

Results:

During the inclusion period 746 emergency referrals were assessed, 281 (37%) of these underwent an operation. Over a 5-month investigation period, the audit found that approximately 27% of all emergency general surgery patients requiring an operation could be managed with day case emergency surgery. This figure was maintained throughout the duration of the study. Operations included incision and drainage of abscesses, incarcerated hernia repairs and appendicectomies. The average length of stay of all surgical admissions decreased from 5 days to less than 3 days and the median time to senior review was 30 minutes.

Discussion:

The authors have developed a pathway involving permanent members of the surgical assessment team that is sustainable over a 5-month period. The pathway has allowed rapid assessment of patients and reduced unnecessary inpatient stay in a sustainable and reproducible manner.
Unroofing Technique as an Option for the Endoscopic Treatment of Giant Gastrointestinal Lipomas
Authors: Kopáčová Marcela , Rejchrt Stanislav , Bureš Jan
Published: March 2016

Gastrointestinal lipomas are usually asymptomatic, detected incidentally. However, they can cause severe symptoms such as obstruction, invagination, and bleeding. The transsection of an infarcted or large lipoma by needle sphincterotome (needle knife) and/or snare polypectomy of the upper part of the tumour is an option for the endoscopy treatment of giant infarcted lipomas. Cutting a top of lipoma (unroofing technique) allowed flow out of adipose tissue from the lipoma.
Histological Changes of the Middle Ear Ossicles Harvested during Cholesteatoma Surgery
Authors: Školoudík Lukáš , Šimáková Eva , Kalfeřt David , Chrobok Viktor
Published: March 2016

Background: In the cholesteatoma surgery ossicles can be replaced to reconstruct middle ear function. It is important that these ossicles are free of squamous epithelium, to prevent residual disease. This study focuses on the histological findings of the malleus and incus harvested during cholesteatoma surgery. Materials and Methods: Eighty middle ears ossicles were examined in vivo and histologically to consider the relationship of cholesteatoma to ossicles, grade of bone destruction and invasion of cholesteatoma to deeper layers of bone. Results: Serious ossicular destruction was observed more frequently in incus compared to malleus (p = 0.0065). Difference of ossicles destruction between children and adults was not significant (p = 0.3032). Deep invasion of cholesteatoma into the vascular spaces or inner core of the bone was not observed. Conclusions: Autograft ossicles from cholesteatomatous ears should not necessarily be rejected for reconstruction of the ossicular chain. Regarding the histological finding, the authors suggest mechanical cleaning of the ossicle surface to eliminate residual disease.
Paradoxical hyperhidrosis in a patient with ectodermal dysplasia and immunodeficiency
Authors: Aujnarain Amiirah , Chung Catherine , Upton Julia
Published: March 2016

Anhidrotic Ectodermal Dysplasia with Immunodeficiency (EDA-ID) is a pleotropic disorder characterized by dental abnormalities, eccrine sweat dysgenesis, specific facies, fine sparse hair, pale wrinkled skin, and variable immune defects. The condition is caused by hypomorphic mutations (NF) κB Essential modifier protein (NEMO) gene. The clinical phenotype between patients is heterogenous and variable.

Here we report a patient with a known NEMO mutation presenting with clinical features consistent with EDA-ID, except for paradoxical hyperhidrosis despite having a biopsy-proven reduced number of sweat glands.

Statement of novelty: We report a patient with X-linked EDA-ID due to NEMO deficiency who presented with marked diaphoresis despite biopsy-proven reduced sweat glands and ectodermal dysplasia.
Comparing radio-tracking and visual detection methods to quantify group size measures
Authors: Reiczigel Jenő , Mejía Salazar María Fernanda , Bollinger Trent K. , Rózsa Lajos
Published: March 2016

1. Average values of animal group sizes are prone to be overestimated in traditional field studies because small groups and singletons are easier to overlook than large ones. This kind of bias also applies for the method of locating groups by tracking previously radio-collared individuals in the wild. If the researcher randomly chooses a collared animal to locate a group to visit, a large group has higher probability to be selected than a small one, simply because it has more members.

2. The question arises whether location of groups by means of finding collared animals has smaller or greater bias than searching for groups by visual observation. If the bias is smaller or same, this method can be recommended for finding groups. However, such a comparison cannot be made by speculation, only by empirical investigation.

3. The present study compares the two methods empirically, by statistically comparing group size measures (mean, median, quantiles, frequency distribution, and ‘typical group size’) between two data sets. These data sets comprise of Rocky Mountain mule deer group size values collected in the same area during the same period of time, referring either to groups located by the traditional ‘search and observe method’ or located by tracking formerly collared individuals.

4. All group size measures are statistically similar in the two samples, thus we conclude that the two methods yielded similar biases. Although the true group size measures are not known, we presume that both methods have overestimated them. We propose that these results do not necessary apply to other species, thus cannot be generalized. The reason for this is that bias may depend on factors specific to the species: bias of visual observation may depend on how well the species conceals itself in the existing habitat, and the bias associated with finding groups using collared animals is likely dependent on group size distribution and also on the proportion of collared animals in the population.
Phase field approaches of bone remodeling based on TIP
Authors: Ganghoffer Jean-François , Rahouadj Rachid , Boisse Julien , Forest Samuel
Published: March 2016

The process of bone remodeling includes a cycle of
repair, renewal, and optimization.
This adaptation process, in response to
variations in external loads and chemical driving factors, involves three
main types of bone cells: osteoclasts, which remove the old pre-existing
bone; osteoblasts, which form the new bone in a second phase; osteocytes,
which are sensing cells embedded into the bone matrix, trigger the
aforementioned sequence of events. The remodeling process involves
mineralization of the bone in the diffuse interface separating the marrow,
which contains all specialized cells, from the newly formed bone. The main
objective advocated in this contribution is the setting up of a modeling and
simulation framework relying on the phase field method to capture the
evolution of the diffuse interface between the new bone and the marrow at
the scale of individual trabeculae. The phase field describes the degree of
mineralization of this diffuse interface; it varies continuously between the lower value (no mineral)
and unity (fully mineralized phase, e.g. new bone), allowing the
consideration of a diffuse moving interface. The modeling framework is the
theory of continuous media, for which field equations for the mechanical,
chemical, and interfacial phenomena are written, based on the thermodynamics
of irreversible processes. Additional models for the cellular activity are
formulated to describe the coupling of the cell activity responsible for
bone production/resorption to the kinetics of the internal variables.
Kinetic equations for the internal variables are obtained from a
pseudo-potential of dissipation. The combination of the balance equations
for the microforce associated to the phase field and the kinetic equations
lead to the Ginzburg–Landau equation satisfied by the phase field with a
source term accounting for the dissipative microforce.
Simulations illustrating the proposed framework are performed in a one-dimensional
situation showing the evolution of the diffuse interface separating new bone
from marrow.
A Three-Dimensional Analysis Of The Wheel - Railway Contact In Case Of A Charge Transfer
Authors: Tudorache Cristina , Sebeşan Ioan
Published: March 2016

A series of factors are acting are acting on the wheels of the railway vehicle causing load transfers capable of having an effect on safety transportation The evaluation of vehicle – runway interaction phenomena establishes traffic safety conditions. In this paper we present a three-dimensional approach of the wheel - railway contact in case of load transfer and for a path with shortfall or with profile S78 super-elevation excess. The vehicle – runway interaction phenomena establishes traffic safety conditions. In this paper we present a three-dimensional approach of the wheel - railway contact in case of load transfer and for a path with shortfall or with profile S78 super-elevation excess is analyzed.
A gender perspective on gambling clusters in Sweden using longitudinal data
Authors: Romild Ulla , Svensson Jessika , Volberg Rachel
Published: March 2016

Aims

This study describes five groups of gamblers and changes in their gambling involvement and gambling problems over four years with a particular focus on whether gambling problems among men and women develop differently within the five groups.

Design

The study sample is a subset of participants from the Swedish Longitudinal Gambling Study (Swelogs). Six different clusters of past-year gambling, based on frequency of participation in the nine most common forms of gambling in Sweden (lotteries, horses, number games, sports games, bingo, poker, slot machines, casino games or TV contests) were identified in Two-Way Cluster Analysis after the first wave of data collection in 2008/09. There were 2,508 individuals identified in EP1 (n=5,012) who then also participated in waves EP2 and EP3 and were selected for the present analysis.

Methods

Statistical analysis was done in SPSS 22.0 using Pearson's Chi-Square test of Independence (or Fisher's Exact test when the requirements or expected frequency were not met for Pearson's Test), Mann-Whitney U-test and logistic regression. P-values below 0.05 were regarded as significant.

Results

Gambling remains gendered in Sweden. Even though the clusters are based on gambling activities, there are differences between men and women within the clusters as regards the gambling participation patterns.

Conclusions

Men and women gamble differently, but they may still be equals in their total experience of gambling and in relation to how their gambling problems develop. All differences need to be taken into consideration when preventive actions or messages are created.
Interest in Currency Trading Learning – Preferred Methods and Motivational Factors
Authors: Pintar Rok , Jereb Eva , Čudanov Mladen , Urh Marko
Published: March 2016

Background and purpose: This paper analyzes the interest of potential users for learning in the field of currency trading or foreign exchange (forex, FX). The purpose of our article is a) to present currency trading, b) to present different options, methods and learning approaches to educating in forex, c) to present the research results discovering the interest of potential users for learning in the field of currency trading.

Methodology: For gathering data, an online questionnaire was used. It was distributed so that the survey sample covers socio-demographic variables (gender, age, working status, relationship status, financial status of credit and educational level). Interest in learning in the field of currency trading was assessed. Descriptive statistics, t-test, paired samples test, homogeny test of variances, and ANOVA were used.

Results: It was determined that people are interested in learning about currency trading, especially younger ones (< 30 years), who prefer e-learning as their learning approach. Obtaining and possessing the right information is the strongest motivation factor and fearing not having enough necessary prior knowledge is the strongest discouraging factor for learning about currency trading.

Conclusion: Education of users in the field of currency trading is becoming increasingly popular with the development of e-learning.
Treatment of Perianal Fistulas in Poland
Authors: Dziki Łukasz , Mik Michał , Trzciński Radzisław , Włodarczyk Marcin , Skoneczny Mariusz , Dziki Adam
Published: March 2016

A perianal fistula is a pathological canal covered by granulation tissue connecting the anal canal and perianal area epidermis. The above-mentioned problem is the reason for the patient to visit the surgeonproctologist. Unfortunately, the disease is characterized by a high recurrence rate, even despite proper management.

The aim of the study was to determine the current condition of perianal fistula treatment methods in everyday surgical practice, considering members of the Society of Polish Surgeons. Material and methods. 1523 members of the Society of Polish Surgeons received an anonymous questionnaire comprising 15 questions regarding perianal fistula treatment in everyday practice.

Results. Results were obtained from 807 (53%) members. After receiving answers, questionnaire results were collected, analysed, and presented in a descriptive form.

Conclusions. Study results showed that most Polish surgeons choose the fistulectomy/fistulotomy method. Considering treatment of perianal fistulas the most important issue is to find the correct, primary fistula canal. Further methods should be individually selected for each patient. One should also remember that every fistula is different. Surgical departments that operate a small number of perianal fistulas should direct such patients to reference centers.
Plädoyer für eine regional differenzierte, sektorenübergreifende Versorgung
Authors: Hämel Kerstin
Published: March 2016

Unterschiede im regionalen Versorgungsbedarf und Versorgungsprobleme in ländlichen und strukturschwachen Regionen werden seit einigen Jahren intensiv diskutiert. Benötigt werden Zielvorstellungen wie diese angegangen werden können. Modelle einer umfassenden Primärversorgung bieten gute Möglichkeiten für eine regional differenzierte, sektorenübergreifende Versorgung.
Regionale MRSA-Prävalenzen
Authors: Bellmann Maike
Published: March 2016

Krankenhausinfektionen, so auch Methicillin-resistente Staphylococcus aureus (MRSA)-Infektionen, stellen für Krankenhäuser eine große Herausforderung dar. Anhand der Krankenhausstatistik wurden Untersuchungen zur Häufigkeit von MRSA auf regionaler Ebene angestellt. Dieser Beitrag zeigt regionale Prävalenzunterschiede von MRSA zwischen den Bundesländern und zwischen den Landkreisen am Beispiel Sachsens auf.
Ausrichtung innovativer Versorgungskonzepte für multimorbide Patienten
Authors: Gräßel Elmar , Hollederer Alfons , Drexler Hans , Kolominsky-Rabas Peter
Published: March 2016

Innovative Versorgungskonzepte für multimorbide Patienten sollten auf die Beseitigung von Versorgungsdefiziten ausgerichtet sein. Diese sind Fehlversorgung, isoliertes Agieren verschiedener Leistungserbringer des Gesundheitssystems, mangelnder Einbezug des häuslichen Umfeldes in die Handlungsplanung, regionale Versorgungsunterschiede und mangelnde Berücksichtigung spezifischer Versorgungsbedürfnisse von Menschen mit Demenz. Es wird die Skizze eines innovativen Versorgungskonzepts dargestellt.
Strategien zur Überwindung regionaler Versorgungsunterschiede am Beispiel Brustkrebs
Authors: Prechel-Radon Sebastian , Räbiger Jutta
Published: March 2016

Die Versorgung von Krebserkrankungen in Deutschland weist eine Reihe unerwünschter Versorgungsunterschiede auf. Bei lebensbedrohlichen Krankheiten ist Versorgungsgerechtigkeit besonders gefordert. Internationale Studien und Übersichtsarbeiten weisen unterschiedliche Auswirkungen und Einflussgrößen regionaler Unterschiede und Überlebensraten von Krebspatienten aus. Mit versorgungspolitischen Strategien wird versucht, die Unterschiede abzubauen.
New experiences with foamed bitumen asphalts in hungarian road building
Authors: Puchard Zoltan , Gorgenyi Agnes
Published: March 2016

The use of low temperature (LT) asphalt products can result in a significant decrease of temperature required for asphalt production. This reduces energy costs and consumption. Moreover, safety during asphalt production and laying improves because the amount of potentially harmful vapours and aerosols decreases. Temperature decrease, in addition to the above, reduces the short-term ageing of bitumen in the asphalt production process, and ultimately has a positive impact on the durability of pavements.

COLAS Group in Hungary considers propagating the use of low temperature sorts of asphalt in road construction in Hungary as a high priority innovation task

Between 2012 and 2014, COLAS Group equipped its asphalt mixers with units from different manufacturers, capable of producing foamed bitumen, at four COLAS Group mixing plants in Hungary.

This was followed by several test production runs and course laying with asphalt mixes containing foamed bitumen. Some of the foam asphalt mixes were produced and laid at low temperatures. The other part of the mixes were produced at conventional temperature and were layed after 2 - 2.5 hours of transport. The test asphalt mixtures were made with 50/70 and 10/40-65 modified bitumen also containing 10-20% RA.

We compared the compactability of foamed bitumen mixtures produced with four different foaming kits. We produced Marshall specimens at various compaction temperatures, tested the bulk densities of the specimens, then represented the bulk densities subject to the compaction temperature. We established the following:

the Marshall bulk density (better compactability) of foamed bitumen asphalt mixes is higher for all asphalt types compared to the normal bitumen mixtures,

higher Marshall bulk density of foamed bitumen asphalt mixes can be achieved both in normal (50/70) and modified bitumen mixtures (25/55-65,10/40-65),

better compactability of foamed bitumen asphalt mixes is independent of the type of the foaming kit. It works for all types of foaming kits.
Wittgenstein and His Literary Executors
Authors: Erbacher Christian
Published: March 2016

Rush Rhees, Georg Henrik von Wright and Elizabeth Anscombe are well known as the literary executors who made Ludwig Wittgenstein’s later philosophy available to all interested readers. Their editions of Wittgenstein’s writings have become an integral part of the modern philosophical canon. However, surprisingly little is known about the circumstances and reasons that made Wittgenstein choose them to edit and publish his papers. This essay sheds light on these questions by presenting the story of their personal relationships—relationships that, on the one hand, gave Rhees, von Wright and Anscombe distinct insights into Wittgenstein’s philosophizing; and, on the other hand, let Wittgenstein assume that these three former students, and later colleagues and friends, were the most capable of preparing his work for publication. Using hitherto unpublished archival material as well as information from published recollections, the essay sketches the development of the personal and philosophical bonds from which the literary heirs’ distinct ways of handling Wittgenstein’s unpublished writings grew in later years.
The hypercoagulable state in hyperthyroidism is mediated via the thyroid hormone β receptor pathway
Authors: Elbers Laura P B , Moran Carla , Gerdes Victor E A , van Zaane Bregje , Meijers Joost C M , Endert Erik , Lyons Greta , Chatterjee Krishna , Bisschop Peter H , Fliers Eric
Published: March 2016

Objective

Hyperthyroidism is associated with a hypercoagulable state, but the underlying mechanism is unknown. Patients with resistance to thyroid hormone (RTH) due to defective thyroid hormone receptor β (THRB orTHRB) exhibit elevated circulating thyroid hormones (TH) with refractoriness to TH action inTHRB-expressing tissues. We tested the hypothesis that the hypercoagulable state in hyperthyroidism is mediated via theTHRB.

Design

We conducted a cross-sectional study from November 2013 to January 2015 in 3 hospitals in the Netherlands and the United Kingdom.

Methods

Patients with RTH due to defectiveTHRB(n=18), patients with hyperthyroidism (n=16) and euthyroid subjects (n=18) were included. TH concentrations and markers of coagulation and fibrinolysis were measured. Data are expressed as median (interquartile range).

Results

Free thyroxine (FT4) levels were slightly higher in hyperthyroid patients than in RTH patients (53.9 (30.5–70.0) and 34.9 (28.4–42.2)pmol/L, respectively,P=0.042). Both groups had raised FT4levels compared with euthyroid subjects (14.0 (13.0–15.8)pmol/L,P≤0.001). Levels of von Willebrand factor (VWF), factor (F) VIII, fibrinogen andd-dimer were significantly higher in hyperthyroid patients than in RTH patients (VWF 231 (195–296) vs 111 (82–140)%, FVIII 215 (192–228) vs 145 (97–158)%, fibrinogen 3.6 (3.0–4.4) vs 2.8 (2.5–3.2)g/L,d-dimer 0.41 (0.31–0.88) vs 0.20 (0.17–0.26)mg/L, respectively,P≤0.001), while there were no differences between RTH patients and euthyroid controls.

Conclusions

Parameters of coagulation and fibrinolysis were elevated in hyperthyroid patients compared with patients with RTH due to defectiveTHRB, whereas these parameters were not different between euthyroid controls and RTH patients, despite elevated FT4concentrations in RTH patients. This indicates that the procoagulant effects observed in hyperthyroidism are mediated via theTHRB.
Screening for GPR101 defects in pediatric pituitary corticotropinomas
Authors: Trivellin Giampaolo , Correa Ricardo R , Batsis Maria , Faucz Fabio R , Chittiboina Prashant , Bjelobaba Ivana , Larco Darwin O , Quezado Martha , Daly Adrian F , Stojilkovic Stanko S , Wu T John , Beckers Albert , Lodish Maya B , Stratakis Constantine A
Published: March 2016

Cushing’s disease (CD) in children is caused by adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. Germline or somatic mutations in genes such as MEN1, CDKIs, AIP, and USP8 have been identified in pediatric CD, but the genetic defects in a significant percentage of cases are still unknown. In this study, we investigated the orphan G-protein-coupled receptor GPR101, a gene known to be involved in somatotropinomas, for its possible involvement in corticotropinomas. We performed GPR101 sequencing, expression analyses by RT-qPCR and immunostaining, and functional studies (cell proliferation, pituitary hormone secretion, and cAMP measurement) in a series of patients with sporadic CD secondary to ACTH-secreting adenomas in whom we extracted DNA from peripheral blood and pituitary tumor samples (n=36). No increased GPR101 expression was observed in tumors compared with normal pituitary (NP) tissues, nor did we find a correlation between GPR101 and ACTH expression levels. Sequence analysis revealed a very rare germline heterozygous GPR101 variant (p.G31S) in one patient with CD. Overexpression of the p.G31S variant did not lead to increased growth and proliferation, although modest effects on cAMP signaling were observed. GPR101 is not overexpressed in ACTH-secreting tumors compared with NPs. In conclusion, rare germline GPR101 variant was found in one patient with CD, but in vitro studies did not support a consistent pathogenic effect. GPR101 is unlikely to be involved in the pathogenesis of CD.
A Standardized Discharge Process Decreases Length of Stay for Ventilator-Dependent Children
Authors: Baker Christopher D. , Martin Sara , Thrasher Jodi , Moore Heather M. , Baker Joyce , Abman Steven H. , Gien Jason
Published: March 2016

OBJECTIVE:

Children who require chronic mechanical ventilation via tracheostomy are medically complex and require prolonged hospitalization, placing a heavy burden on caregivers and hospital systems. We developed an interdisciplinary Ventilator Care Program to relieve this burden, through improved communication and standardized care. We hypothesized that a standardized team approach to the discharge of tracheostomy- and ventilator-dependent children would decrease length of stay (LOS), reduce patient costs, and improve safety.

METHODS:

We used process mapping to standardize the discharge process for children requiring chronic ventilation. Interventions included developing education materials, a Chronic Ventilation Road Map for caregivers, utilization of the electronic medical record to track discharge readiness, team-based care coordination, and timely case management to arrange home nursing. We aimed to decrease overall and pediatric respiratory care unit LOS as the primary outcomes. We also analyzed secondary outcomes (mortality, emergency department visits, unplanned readmissions), and per-patient hospital costs during 2-year “preintervention” and “postintervention” periods (n = 18 and 30, respectively).

RESULTS:

Patient demographics were not different between groups. As compared with the preintervention cohort, the overall LOS decreased 42% (P = .002). Pediatric respiratory care unit LOS decreased 56% (P = .001). As a result, unplanned readmissions, emergency department visits, and mortality were not increased. Direct costs per hospitalization were decreased by an average of 43% (P = .01).

CONCLUSIONS:

Although LOS remained high, a standardized discharge process for chronically ventilated children by an interdisciplinary Ventilator Care Program team resulted in decreased LOS and costs without a negative impact on patient safety.
A call to the Church: Embrace children with disabilities
Authors: Flickner Natalie Ann
Published: March 2016

Children with Disabilities are one of the groups of children most in need globally. The author uses her personal story of growing up as a child with mild cerebral palsy to express her solidarity and highlight the multiple needs of children with disabilities around the world. These children should no longer be stigmatized by the world wide church but instead be embraced and ministered to in the name of Jesus.
Advanced oxidative degradation of bisphenol A and bisphenol S
Authors: Mehrabani-Zeinabad Mitra , Achari Gopal , Langford Cooper H.
Published: March 2016

In this study, the degradation of two emerging contaminants, bisphenol A (BPA) and bisphenol S (BPS), in spiked water and secondary treated waste water samples were investigated using four different oxidation methods: ultraviolet C (UVC) (254 nm), UVC/hydrogen peroxide (H2O2), ozone (O3) and ultraviolet A (UVA)/ozone (365 nm). Investigation of the effect of light intensity on the rate constants of UVC and UVC/hydrogen peroxide processes and identification of intermediates in the degradation process were conducted. The highest degradation rates were achieved for the UVA/ozone process with k values of 2·2 or 1·9 min−1 in secondary treated waste water (absorbance at 254 nm = 0·164 AU). Based on the results, the fate of BPA and BPS in municipal waste water as they move through the UV (254 nm) disinfection unit of a local waste water treatment plant in Calgary, Canada, was evaluated. It was concluded that in the UV disinfection unit, only 1% and 6% of BPA and BPS were degraded respectively. However, should 0·042 M hydrogen peroxide be added to the waste water stream entering the disinfection unit, 56% of BPA and 47% of BPS can be degraded. By implementation of ozone and UVA/ozone processes, degradation levels could exceed >95%.
The Promise of a Qualitative Case Study Approach for Research on Caregiver Involvement in Inpatient Traumatic Brain Injury Rehabilitation
Authors: Eady Kaylee , Moreau Katherine
Published: March 2016

Purpose: To demonstrate that, theoretically, a qualitative case study approach holds substantial promise for conducting research on caregiver involvement in inpatient traumatic brain injury (TBI) rehabilitation. Methods: Narrative reviews of the TBI rehabilitation and case study literature are presented to explain our rationale for advocating the use of a qualitative case study approach for research in this area. Results: We found that there are four interconnected reasons why this research approach is well suited for investigating caregiver involvement in in-patient TBI rehabilitation. More specifically, a qualitative case study approach allows us to: (a) address the context of inpatient TBI rehabilitation; (b) account for the complexity of caregiver involvement; (c) adapt research to the practical and ethical needs of TBI inpatients and their caregivers; and (d) create research that is congruent with family-centered theory. Conclusion: A qualitative case study approach has the ability to address the complexity and context that surrounds caregiver involvement in inpatient TBI rehabilitation. A case study approach is also congruent with the characteristics of inpatient rehabilitation settings and can take into consideration family-centered theory, which is instrumental to understanding caregiver involvement.
The Unpredictable Prognosis of Medicare - A Book Review on Chronic Condition: Why Canada’s Health-Care System Needs to be Dragged Into the 21st Century by Jeffrey Simpson
Authors: Brennan Kelly
Published: March 2016

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Employment conditions of the EU
Authors: Mueeth A Alkahtani Yaser
Published: March 2016

The case-study analyses the main economic conditions of the EU from points of view of emphasizing the employment, human resource management at EU-27 level. The different unemployment levels of EU member states stimulated the increasing gap between member states in GDP per capita, which was from 44% to 271% of the EU-27 average at the beginning of 2011. The unemployment rate of EU-27 increased from 6,7% in 2000 to 8,8% in 2010 based on the internal market conditions and influences of the world economic crisis after 2008. The human resource management has several problems in EU-27, for example the highly level of unemployment, less skilled level of employees, the unemployment rate is very highly in almost the entire EU even in case of youth under 25 year between 21,0-22,3% in 2010-2011.