bluuebunny/crossref_metadata_2025 huggingface dataset:
Shell buckling, without ‘imperfections’
Authors: Calladine Christopher R
Published: February 2018

The buckling behaviour of thin shell structures under load has been a persistent challenge to engineering designers and researchers over many decades. In this article I consider two unusual experimental studies on the buckling of thin-walled elastic cylindrical shells, each of which sheds intriguing light on the buckling phenomena. The classical theory of buckling of thin cylindrical shells under axial compression predicts that the buckling stress will be proportional to t/ R– the ratio of thickness to radius – other things being equal. But collected results of experimental studies from many laboratories, when plotted on log–log scales, show clearly that the buckling stress is actually proportional to ( t/ R)1.5, with the measured buckling stresses being scattered through a factor of about 4 for shells with R/ t > 200. Such scatter is commonly judged to be in accord with Koiter’s theory of ‘imperfection sensitivity’. But that theory lays no claim to an understanding of the empirical 1.5-power law. I claim that a key to this situation is the experimental performance of some small-scale open-topped silicone rubber shells, buckling under their own weight, which clearly demonstrates a 1.5-power law, but with very little scatter. The buckling mode of these shells involves almost entirely inextensional deformation, with a single small dimple growing near the base, separated from the rest of the shell by a narrow boundary layer that accounts for almost all of the dimple’s elastic strain energy. A straightforward, simple analysis of the mechanics of the dimple is consistent with the experimental 1.5-power law. As noted above, experimental buckling loads of shells that are closed at both ends also show the empirical 1.5-power law, but now with significant statistical scatter. A second aim of the paper is to throw light on that phenomenon. I venture to attribute it to the effect of the boundary conditions of the shell. I adduce support for this view from experimental observations on the buckling of a shell with special, frictional end-fittings. That feature produces significantly higher collapse loads, and with much smaller scatter, than for corresponding shells with fixed boundaries; and it permits striking pre-buckled deformations to occur, of a kind not previously noted. It will be appreciated that neither of the two parts of this article depends on the widely accepted theory of imperfection-sensitivity; hence my choice of title. It is a pleasure for me to submit this article to a special publication in honour of Michael Rotter, with whom I have discussed matters of this sort through three decades.
Global Television Formats and Their Impact on Production Cultures: The Remaking of Music Entertainment Television in India
Authors: Ganguly Lauhona
Published: February 2018

This article focuses on the impact of global television formats on local (nonformat) homegrown shows and examines how formats reshape industrial–cultural conventions for local productions. Empirically, the article looks at how (Indian) Idol rewrites cultural values, assumptions, and norms for nonfictional entertainment, particularly music talent shows in India. Using a production studies approach, analysis zooms in on production negotiations—the strategies and goals of the Idol format, specific calculations targeting Indian market, and how rival, homegrown shows review and revise (or reject) a format’s appeals. By investigating how producers from local nonformat shows such as Saregamapa (discussed further in the article) deliberate and rewrite their productions to challenge and overcome Idol’s allure while also adopting Idol’s features, this article argues that format copying is a coping mechanism, which reveals the tactical, creative, and cultural responses to the power of global media capital and not creative lethargy or mere copycatting.
Assessment of Postural Ergonomics and Surgical Performance in Laparoendoscopic Single-Site Surgery Using a Handheld Robotic Device
Authors: Sánchez-Margallo Francisco Miguel , Sánchez-Margallo Juan A.
Published: February 2018

Purpose. New laparoscopic devices are being continuously developed to overcome some of the technical and ergonomic limitations of laparoendoscopic single-site (LESS) surgery. This study aims to assess the surgeon’s surgical performance and ergonomics during the use of a handheld, robotic-driven, articulating laparoscopic instrument during LESS surgery. Methods. Seven right-handed experienced surgeons took part in this study. A set of basic suturing tasks and digestive and urological procedures in a porcine model were performed. Surgeons used both a conventional laparoscopic needle holder and a robotic device. The learning curve, execution time, and precision using the surgical needle were assessed. The surgeon’s posture was analyzed using a motion tracking system and a data glove. Results. After the training period, execution time on the intracorporeal suturing was significantly shorter using the conventional needle holder. The precision was higher using the conventional instrument in the horizontal plane, but the number of attempts to position the needle was lower using the robotic device (1.625 ± 0.250 vs 1.188 ± 0.375 attempts). The extension of the elbow (134.681 ± 14.35° vs 120.631 ± 13.134°) and the flexion of the shoulder (26.122 ± 7.411° vs 18.475 ± 14.166°) were significantly lower using the robotic instrument. The wrist posture using the robotic device was ergonomically acceptable during both surgical procedures. Conclusions. Results show a positive learning curve in ergonomics and surgical performance using the robotic instrument during LESS surgery. This instrument improves the surgeon’s body posture and the needle positioning errors. The use of the robotic instrument is feasible and safe during LESS partial nephrectomy and sigmoidectomy procedures.
Complications of Radial Column Plating of the Distal Radius
Authors: Galle Samuel E. , Harness Neil G. , Hacquebord Jacques H. , Burchette Raoul J. , Peterson Brett
Published: February 2018

Background: Distal radius fractures treated with open reduction and internal fixation are commonly stabilized with a volar locking plate; however, more complex fracture patterns may require supplemental fixation with fragment-specific implants. The objective of this study was to evaluate the outcomes of distal radius fractures treated with radial column plates. Methods: A consecutive series of 61 patients who sustained distal radius fractures underwent radial column plating alone or in conjunction with other implants between August 2006 and January 2014. Thirty-one patients returned for follow-up or returned a mailed questionnaire at an average of 4.1 years. The outcomes measures included Visual Analog Scale (VAS); Disabilities of the Arm, Shoulder and Hand (DASH); and Patient-Rated Wrist Evaluation (PRWE) scores. Results: Sixty-one patients with a mean age of 55 years (range, 20-87) met inclusion criteria and were available for follow-up or chart review at an average of 5.2 years (range, 1.6-9.0 years). Seventeen of 61 (28%) underwent radial column plate removal. Twenty patients returned for final follow-up examination, and 11 completed questionnaires via mail. Subjective scores included a mean postoperative VAS of 0.72, DASH score of 17.2, and PRWE score of 15.7. Hardware sensitivity and wrist stiffness were the most common complications at final follow-up. Conclusions: Radial column plating of the distal radius is a safe treatment modality and a valuable adjunct in the setting of complex distal radius fractures, but patients should be counseled that there is a 28% chance that hardware removal may be required. Our retrospective review found evidence of few complications and objective scores consistent with return to normal function.
The Internet of Robotic Things
Authors: Simoens Pieter , Dragone Mauro , Saffiotti Alessandro
Published: February 2018

The Internet of Robotic Things is an emerging vision that brings together pervasive sensors and objects with robotic and autonomous systems. This survey examines how the merger of robotic and Internet of Things technologies will advance the abilities of both the current Internet of Things and the current robotic systems, thus enabling the creation of new, potentially disruptive services. We discuss some of the new technological challenges created by this merger and conclude that a truly holistic view is needed but currently lacking.
Bioinspired sprawling robotic leg and a path-planning procedure
Authors: Juárez-Campos Ignacio , Núñez-Altamirano Diego A , Márquez-Pérez Lucia , Romero-Muñoz Leonardo , Juárez-Campos M Eunice , Juárez-Campos Beatriz
Published: February 2018

This article shows the characteristics of a sprawling robotic leg inspired by the limb postures of certain reptilian animals known as sprawling-legged creatures. The main part of the robotic limb is based on the eight-bar Peaucellier–Lipkin linkage, and its main attribute is the ability to trace a true straight line, due to the rotational motion of the input link. However, when the eight-bar linkage is modified, it is capable of tracing true circular concave or convex arcs, when two of its constitutive links have distinct and precise lengths. This gives rise to the concepts of concavity and convexity, related to a robotic leg based on the Peaucellier–Lipkin mechanism, such as the one described herein. Our bioinspired robotic leg can trace concave or convex curves, as well as straight lines, making it a reptile-like robotic limb that is very similar to the natural one. We also introduce the concept of rotation center tuning, which refers to the ability of the leg to adapt its posture to the center of rotation of the entire walking machine, resulting in an easy and suitable gait process. The theoretical information is illustrated through the simulation of an example that provides a path-planning procedure, focusing on the rotation center tuning process and a walking gait. The example also includes the design of an elliptical path projected onto the cylindrical workspace and followed by the reptilian foot.
Representation of data journalism practices in the South Korean and US television news
Authors: Lim Jeongsub
Published: February 2018

Few studies have investigated how television news is represented through data journalism. To fill this gap, this study compared data news content from South Korean and that from US television networks using the grounded theory method. The following differences were found: South Korean television networks ( KBS, SBS, MBC, and JTBC) highlight social issues, politics, and lifestyle; while American television networks ( ABC, CBS, NBC, CNN) cover the economy, social issues, and politics. Both television networks rely on government sources and seldom provide raw data. The South Korean networks use a static graph and an infographic most frequently, while the US networks favor a number pull quote and a static graphic. The South Korean networks prefer complex, visually appealing elements (e.g., an infographic), while the American networks prefer less complex and less visually appealing elements (e.g., a number pull quote). The South Korean networks prefer the news forms of ‘visualization,’ ‘condensity,’ and ‘typification,’ and the US networks prefer ‘visualization,’ ‘typification,’ ‘condensity,’ and ‘completeness.’ The degree of user participation is extremely low in both countries’ networks.
Response to Phillips and Smith
Authors: Hines J Dwight
Published: February 2018

My response to Phillips and Smith’s, ‘Comparative approaches to gentrification’ begins by acknowledging that the piece represents an important step toward greater clarity within the discussion of gentrification. From there, I lobby for the expansion of the means of comparison beyond those focused on in the piece. The alternate means of comparison that I propose are what are commonly referred to as cultural narratives and my contention is that by comparing and contrasting the stories that people rely upon to represent, explain, justify, and recount their behavior, either as creators or consumers of gentrifiable space offer another significant means by which to understand the relationship(s) between differing gentrification events. Drawing on preexisting research in the rural American West, I offer brief examples of how this method can be applied to explain and describe and thereby compare the actions and motives of gentrifiers.
Radial neuropathy following arterial line removal: A rare complication from a routine ICU procedure
Authors: Khalifeh Ali , Khashab Tamara , Huffner Michael , Rezvani Zahra N , Kwan Justin , Toursavadkohi Shahab
Published: February 2018

Radial artery thrombosis is a rare complication of cannulation. There are no reported cases of acute thrombosis and severe acute neuropathy in the setting of cannula discontinuation. We report a case of acute radial nerve mono-neuropathy following thrombosis after radial arterial line removal. The thrombus was immediately evident on exam and diagnostic imaging after cannula discontinuation. The patient was consented and promptly taken to OR for immediate repair. Mild radial neuropathy persisted despite immediate repair. Immediate recognition of signs and symptoms is essential for diagnosis and management, especially in the high-risk population.
The University Is an Organization: Teaching Organizational Behavior by Relying on Students’ University Experience
Authors: Mozahem Najib A. , Ghanem Carla M.
Published: February 2018

One of the primary challenges in teaching Organizational Behavior concepts is that undergraduate business students often have little or no work experience. We propose a method that utilizes students’ experience in the university as the basis for understanding these concepts. This understanding is achieved by highlighting the fact that the university is an organization and that students are members of this organization. Students are encouraged to think about how the material applies to them in the university. This approach, we believe, has increased students’ interest in the material and helped them reflect on the concepts, thus providing opportunities to grow and develop both as students and as individuals. We used surveys that were distributed in the university and answered by the students. Students participated in experiments, and in many instance, they were surprised by the results.
Midostaurin: its odyssey from discovery to approval for treating acute myeloid leukemia and advanced systemic mastocytosis
Authors: Stone Richard M. , Manley Paul W. , Larson Richard A. , Capdeville Renaud
Published: February 2018

Midostaurin was a prototype kinase inhibitor, originally developed as a protein kinase C inhibitor and subsequently as an angiogenesis inhibitor, based on its inhibition of vascular endothelial growth factor receptor. Despite promising preclinical data, early clinical trials in multiple diseases showed only modest efficacy. In 1996, the relatively frequent occurrence of fms-like tyrosine kinase 3 (FLT3) activating mutations in acute myeloid leukemia (AML) was first recognized. Several years later, midostaurin was discovered to be a potent inhibitor of the FLT3 tyrosine kinase and to have activity against mutant forms of KIT proto-oncogene receptor tyrosine kinase, which drive advanced systemic mastocytosis (SM). Through a series of collaborations between industry and academia, midostaurin in combination with standard chemotherapy was evaluated in the Cancer and Leukemia Group B 10603/RATIFY study, a large, phase 3, randomized, placebo-controlled trial in patients with newly diagnosed FLT3-mutated AML. This was the first study to show significant improvements in overall survival and event-free survival with the addition of a targeted therapy to standard chemotherapy in this population. Around the same time, durable responses were also observed in other trials of midostaurin in patients with advanced SM. Collectively, these clinical data led to the approval of midostaurin by the US Food and Drug Administration and the European Medicines Agency for both newly diagnosed FLT3-mutated AML and advanced SM.
The validation study on a three-dimensional burn estimation smart-phone application: accurate, free and fast?
Authors: Cheah A. K. W. , Kangkorn T. , Tan E. H. , Loo M. L. , Chong S. J.
Published: February 2018

Background

Accurate total body surface area burned (TBSAB) estimation is a crucial aspect of early burn management. It helps guide resuscitation and is essential in the calculation of fluid requirements. Conventional methods of estimation can often lead to large discrepancies in burn percentage estimation. We aim to compare a new method of TBSAB estimation using a three-dimensional smart-phone application named 3D Burn Resuscitation (3D Burn) against conventional methods of estimation—Rule of Palm, Rule of Nines and the Lund and Browder chart.

Methods

Three volunteer subjects were moulaged with simulated burn injuries of 25%, 30% and 35% total body surface area (TBSA), respectively. Various healthcare workers were invited to use both the 3D Burn application as well as the conventional methods stated above to estimate the volunteer subjects’ burn percentages.

Results

Collective relative estimations across the groups showed that when used, the Rule of Palm, Rule of Nines and the Lund and Browder chart all over-estimated burns area by an average of 10.6%, 19.7%, and 8.3% TBSA, respectively, while the 3D Burn application under-estimated burns by an average of 1.9%. There was a statistically significant difference between the 3D Burn application estimations versus all three other modalities (p < 0.05). Time of using the application was found to be significantly longer than traditional methods of estimation.

Conclusions

The 3D Burn application, although slower, allowed more accurate TBSAB measurements when compared to conventional methods. The validation study has shown that the 3D Burn application is useful in improving the accuracy of TBSAB measurement. Further studies are warranted, and there are plans to repeat the above study in a different centre overseas as part of a multi-centre study, with a view of progressing to a prospective study that compares the accuracy of the 3D Burn application against conventional methods on actual burn patients.
Vocalization in caterpillars: a novel sound-producing mechanism for insects
Authors: Rosi-Denadai Conrado A. , Scallion Melanie L. , Merrett Craig G. , Yack Jayne E.
Published: February 2018

Insects have evolved a great diversity of sound-producing mechanisms largely attributable to their hardened exoskeleton, which can be rubbed, vibrated or tapped against different substrates to produce acoustic signals. However, sound production by forced air, while common in vertebrates, is poorly understood in insects. We report on a caterpillar that ‘vocalizes’ by forcing air into and out of its gut. When disturbed, larvae of the Nessus sphinx hawkmoth (Sphingidae: Amphion floridensis) produce sound trains comprising a stereotyped pattern of long (370 ms) followed by multiple short-duration (23 ms) units. Sounds are emitted from the oral cavity, as confirmed by close-up videos and comparing sound amplitudes at different body regions. Numerical models using measurements of the caterpillar foregut were constructed to test hypotheses explaining sound production. We propose that sound is generated by ring vortices created as air flows through the orifice between two foregut chambers (crop and oesophagus), a mechanism analogous to a whistling kettle. As air flows past the orifice, certain sound frequencies are amplified by a Helmholtz resonator effect of the oesophagus chamber. Long sound units occur during inflation, while short sound units occur during deflation. Several other insects have been reported to produce sounds by forced air, but the aeroacoustic mechanisms of such sounds remain elusive. Our results provide evidence for this mechanism by showing that caterpillars employ mechanisms similar to rocket engines to produce sounds.
Joaquina Barata Teixeira: legado intelectual e humano ao Serviço Social na Amazônia
Authors: Sá Maria Elvira Rocha de , Nascimento Nádia Socorro Fialho
Published: February 2018

Por ocasião dos 80 anos do Serviço Social no Brasil, completados em 2016, prestamos homenagem aos 80 anos de vida da assistente social Joaquina Barata Teixeira, professora aposentada da Universidade Federal do Pará (UFPA), que na sua trajetória profissional atuou como Pró-Reitora de Planejamento da mesma Universidade, foi Presidente do Conselho Regional de Serviço Social (CRESS/PA - 1ª Região), membro do Comitê Executivo da International Federation of Social Workers (Federação Internacional de Trabalhadores Sociais/FITS), representante do CRESS/PA e do Conselho Federal de Serviço Social (CFESS) no Comitê Latino-americano e Caribenho de Organizações Profissionais de Trabalho Social/Serviço Social (COLACATS, antigo Comitê Mercosul) e, integra o atual Conselho [Editorial] Ampliado da Revista Serviço Social & Sociedade.
Memórias e resistências de assistentes sociais contra a ditadura
Authors: Neves Daniela , Diniz Tânia Maria Ramos de Godoi , Werkema Rafael
Published: February 2018

O Serviço Social na história da ditadura civil militar. Este é o tema desta mostra fotográfica, apresentada por meio do Projeto Serviço Social, Memórias e Resistências contra a Ditadura, neste espaço de “diálogo em imagens”. O projeto foi idealizado e realizado a muitas mãos pelo Conselho Federal de Serviço Social (CFESS). Seus primeiros esboços foram discutidos na gestão “Tempo de Luta e Resistência”  (2011-2014) e finalizados na gestão “Tecendo na luta a manhã desejada” (2014-2017).
“Desalambrando” histórias: o Serviço Social e as lutas sociais no Chile (1970-1973)
Authors: Pinto Alexander Panez , Marro Kátia , Duriguetto Maria Lúcia , Molina Paula Vidal , Neves Victor , Bravo Víctor Orellana
Published: February 2018

Resumo – No Chile, o Serviço Social, no período da Reconceituação, apresentou fortes mudanças nos seus fundamentos teórico-metodológicos e ético-políticos, mudanças que estavam sintonizadas com o cenário político de alta efervescência da luta de classes. Na virada da década de 1960 à década de 1970, as forças organizativas da classe trabalhadora – partidos e movimentos sociais de esquerda – levaram o Chile a ser o primeiro país no mundo em que uma coalizão com um programa de construção do socialismo conquistou o governo pela via eleitoral. Neste cenário, o Serviço Social chileno estabeleceu relações e posicionamentos, produzindo uma rica reflexão de docentes, discentes e profissionais em relação à formação profissional e às ações interventivas. Neste artigo, explicitaremos reflexões iniciais da conjuntura chilena do governo da Unidade Popular (UP) e as relações do Serviço Social com as organizações e movimentos sociais, as quais serão evidenciadas pela análise dos Trabalhos de Conclusão de Curso (TCCs)[1] e dos artigos da Revista de Trabajo Social da PUC. Palavras-Chave: Unidade Popular; Serviço Social; Reconceituação; lutas sociais; Chile.  Abstract–Social work in Chile during the Reconceptualization period presented deep changes, in a context of high social effervescence. At the turn of the 1960s to the 1970s, the consolidation of the working class and left-wing parties led Chile to become the first country in the world to conquerthe government by electoral means, with a program building towards socialism. In a context of intensification of social struggles, Chilean social work established relationships and stances, producing a rich reflection of teachers, students, and professionals in relation to professional training and intervention. This article is the first delivery of results of an ongoing research that reviews the relationship of Social Service with social movements and struggles based on the analysis of final papers for graduation and articles fromRevista de Trabajo Social, from Pontificia Universidad Católica de Chile. Keywords: popular unity; Social Service;reconceptualization;social struggles; Chile. [1]A pesquisa nos TCCs da Universidad de Chile teve a colaboração dos discentes de Trabajo Social: Ismael Quinteros, Denisse Carvajal, Ankari Canales e Javiera Ramírez.
CONCEPÇÕES DE LEITURA E LINGUAGEM: DIÁLOGOS COM BAKHTIN
Authors: Morais Jacqueline de Fatima Dos Santos , Da Silva Jacqueline Martins
Published: February 2018

Este trabalho é um recorte de uma investigação de mestrado já finalizada. Após uma breve apresentação da pesquisa que originou este artigo, privilegiamos as discussões sobre concepções de linguagem e de leitura. Para isso, partimos das ideias de Bakhtin e enfocamos a linguagem como construção social, expressão viva de experiências, resultando de interações humanas. O texto traz ainda um diálogo com Paulo Freire, tanto no que se refere as suas reflexões sobre leitura como na discussão sobre formação docente. Defendemos a leitura como ato dialógico, como ato produzido na interação entre leitor/texto/auto. Por fim, defendemos a necessidade de ouvirmos as vozes de professores e professoras e levarmos em conta suas experiências na formulação de políticas e práticas formativas.
Comunicação alternativa como instrumento externo de compensação: possibilidades para a aprendizagem de alunos com múltiplas deficiências
Authors: Rocha Maira Gomes de Souza da , Pletsch Márcia Denise
Published: February 2018

O texto reflete sobre o uso da comunicação alternativa (CA) como ferramenta para possibilitar os processos de aprendizagem e desenvolvimento de alunos com múltiplas deficiências não usuários da linguagem oral. Empregamos os referenciais da pesquisa qualitativa utilizando como procedimentos de coleta de dados observações com registro em diário de campo, entrevistas semiestruturadas e abertas, assim como filmagens das práticas docentes. A pesquisa foi realizada com duas professoras do Atendimento Educacional Especializado (AEE) de uma escola pública da Baixada Fluminense e quatro alunos com múltiplas deficiências por elas atendidos. Com base na perspectiva histórico-cultural nossos resultados, entre outras questões, evidenciaram possibilidades de aprendizagem desses sujeitos; a importância da utilização de recursos de CA, os quais em função das especificidades dos sujeitos com múltiplas deficiências acabavam funcionando como instrumentos de compensação em benefício do processo de ensino e aprendizagem destes alunos.
Initial assessment and management of stroke
Authors: Sibson Lynda , Khadjooi Kayvan
Published: February 2018

This second article, in a two-part series on stroke, will review and outline the importance of the initial assessment and management of patients with stroke in hospital. Stroke affects over 111 000 individuals per year, with almost 1 million individuals managing daily with its after-effects in England. The management of patients with stroke has rapidly developed in recent years, with widespread access to intravenous thrombolytic therapy for the preponderance (85%) of acute ischaemic stroke, while the remaining haemorrhagic strokes (15%) can potentially be managed with a decompressive hemicraniectomy procedure. Further developments include mechanical thrombectomy that treats large-vessel occlusive stroke using an interventional neuroradiology procedure called mechanical thrombectomy. Ensuring delivery of appropriate stroke treatments relies on the accurate assessment of the patient, with particular attention to their past medical history, cardiovascular risk factors and access to hyperacute stroke care. The key risks factors for stroke will also be discussed, as many of these may only present at stroke diagnosis. A range of stroke assessment tools, including their effectiveness, will be discussed in addition to differential stroke diagnosis and stroke mimics.
Reflections of Research
Authors: Yang Yujie
Published: February 2018

The British Heart Foundation (BHF) annual image competition, Reflections of Research, provides a glimpse into the cutting-edge research that the BHF funds
Cardiovascular devices increase risk of infective endocarditis
Authors: Palmer Sarah Jane
Published: February 2018

In this monthly feature, Sarah Jane Palmer delves into topical news, the latest research and what the experts are saying on subjects related to cardiology and cardiac nursing practice.
See fit
Authors: Russell Meredith Jones
Published: February 2018

Settings in Newham are being helped to improve children's health, reports Meredith Jones Russell
In the balance
Authors: Martin Claire
Published: February 2018

Developing toddlers' balance and co-ordination is a priority at one setting in the US, writes Claire Martin
Acute myeloid leukaemia: A guide for practice nurses
Authors: Perry Margaret Ann
Published: February 2018

Acute myeloid leukaemia is a rare cancer of the white blood cells. Margaret Ann Perry provides an overview of the signs, symptoms and treatment for practice nurses

This article is part two of a series on types of leukaemia and focuses on acute myeloid leukaemia. Acute myeloid leukaemia is the most common leukaemia in adults, and although it can occur at any age, it is more commonly seen in older adults. Approximately 3000 new cases are diagnosed each year in the UK. Acute myeloid leukaemia develops rapidly, unlike other types of leukaemia. Practice nurses who run minor illness clinics may see patients who present complaining of fever, fatigue, weight loss, excessive bruising and nose bleeds, and anaemia-related symptoms, such as shortness of breath or chest pain.
What is Rightbreathe and why is it needed?
Authors: Attar-Zadeh Darush
Published: February 2018

Darush Attar-Zadeh explains why a website and app called RightBreathe can help clinicians select the correct inhaler for their patient as part of a shared decision-making process
How to get the most out of your BNF
Authors: Callachand Naimah
Published: February 2018

The British National Formulary is an essential resource for prescribers. Naimah Callachand explains how to use it to its full potential
Injecting insulin safely and effectively
Authors: Diggle Jane
Published: February 2018

Correct injection technique is crucial to obtaining optimal, and safe, effects from insulin, as Jane Diggle explains
Optimising insulin therapy to individual need
Authors: Hamson Kim
Published: February 2018

A large proportion of patients with type 2 diabetes go on to require insulin. Kim Hamson explains why optimisation of insulin therapy is needed
A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice
Authors: Jaulim A , Srinivasan A , Hori S , Kumar N , Warren AY , Shah NC , Gnanapragasam VJ
Published: February 2018

Introduction

The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon’s learning curve in robotic prostatectomy.

Methods

All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases.

Results

For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively.

Conclusions

Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience.
Risk stratification of 282 differentiated thyroid cancers found incidentally in 1369 total thyroidectomies according to the 2015 ATA guidelines; implications for management and treatment
Authors: Christakis I , Dimas S , Kafetzis ID , Roukounakis N
Published: February 2018

Introduction

The purpose of this study was to evaluate the incidence of incidental differentiated thyroid carcinoma in thyroid operations for a benign preoperative diagnosis, to identify the risk factors involved and to risk stratify the cancer patients according to the 2015 American Thyroid Association (ATA) guidelines.

Materials and methods

The study was a retrospective review of all thyroidectomy operations performed in a single institution (January 2004 to January 2009). We excluded patients with a preoperative diagnosis of thyroid malignancy.

Results

Incidental differentiated thyroid carcinoma was diagnosed in 282/1369 patients (21%). The incidental group had a significantly higher number of males (19% vs 14%, P = 0.033) and a higher number of patients with histopathological evidence of thyroiditis (35% vs 25%, P = 0.004). There was a higher number of lymph nodes present in the incidental group but numbers did not reach statistical significance (17% vs 13%, P = 0.079). There were 270 cases in the ATA low-risk group (96%) and 12 cases in the ATA intermediate-risk group (4%). Patients with an ATA intermediate risk had a statistically higher number of capsule invasion, extrathyroidal extension and angioinvasion (P < 0.001, P < 0.001 and P < 0.001, respectively). Overall, 22% of patients with an incidental differentiated thyroid carcinoma should be considered for radioactive iodine 131I treatment. 29 of the 191 patients in American Joint Committee on Cancer stage I should be considered for radioactive iodine treatment (15%).

Conclusions

Males and patients with thyroiditis are at a higher risk for an incidental differentiated thyroid carcinoma. One of every five of patients diagnosed with cancer will need radioactive iodine treatment, even some patients with stage I disease.
The surgical arrest of post-tonsillectomy haemorrhage: Hospital Episode Statistics 12 years on
Authors: Osborne MS , Clark MPA
Published: February 2018

Introduction

The risk of returning to theatre for arrest of haemorrhage following tonsillectomy can be determined from analysis of the Hospital Episode Statistics data provided by the Department of Health website. This method was employed previously for data between 1998–2002 and was repeated in this study to observe any changes over this time period.

Materials and methods

Hospital Episode Statistics data for England from 2010–2016 were used. The number of tonsillectomies and surgical arrest of post-tonsillectomy haemorrhage were considered for children and adults.

Results

Of 267,159 tonsillectomies performed over the six-year period, 5027 (1.88%) returned to theatre for control of bleeding. This was 3.5 times more likely in adults than children (P < 0.0001). Comparison with the previous study showed an increase in return to theatre rates following tonsillectomy of 1.06%, from 0.82% to 1.88%.

Conclusion

Adults are more likely than children to require and arrest of haemorrhage post-tonsillectomy. Return to theatre rates have increased since 2004 at an estimated additional cost to NHS England of £1,415,056 per annum. The causes of this observed increase have yet to be determined.
Experimental Behaviour of Steel Tubular Columns for Varying in Filled Concrete
Authors: Sangeetha P. , Senthil R.
Published: February 2018

This paper investigates the behaviour of axially-loaded tubular columns filled with M20 grade concrete and partially replaced concrete. The parameters varying in the study are slenderness ratio (13.27, 16.58 & 19.9), and normal M20 grade concrete, partially replaced quarry dust and concrete debris. The effects of the various concrete mixes and composite action between the steel tube and the concrete core are studied and a graph visualizing the differences between the load carrying capacity and the axial deflection is plotted. Some of the performance indices like the Ductility Index (DI), Concrete Contribution Ratio (CCR), Confinement Index (θ) and Strength Index (SI) are also evaluated and compared amongst the CFST columns. From the results it has been noted that an increase in the L/D ratio decrease the behaviour of the composite columns irrespective of the in filled materials. The composite action was achieved in the CFST columns filled with partially replaced quarry dust and concrete debris when compared with hollow steel columns. The load carrying capacity of the CFST column increases by 32 % compared with the hollow tubular columns.
Biosimilar medicines and patient registries – expectations, limitations, and opportunities
Authors: Sutka R , Pec J , Pecova T
Published: February 2018

Introduction: Biology therapies in a various medical specializations and for a broad spectrum of indications were launched during last two decades. As a new in class the therapies were obliged to provide additional data re gar ding efficacy and safety after their real medical practice integration. Patient registries, databases collecting various patient data, were introduced to grant data on the treatment effectiveness, safety, and long-term on treatment survival. Satisfactory treatment effect and acceptable safety profile were confirmed after couple of years of careful observation. However, the benefits were usually offered at much higher treatment costs compared to the standard therapies. Biologically similar drugs, so-called biosimilars (B.S), are being launched after original molecule patent protection expiry during recent years. They were expected as an ideal solution to avoid distinct impact on the medical budget: comparable effect for less money. The unsubstantiated doubts about biosimilar efficacy and safety were the reason of the late launch in many markets. Since biosimilars are considered as new therapy entities, the cautiousness to certain extent should be required. Information gained from post-marketing observations and patient registries over several years, confirmed the biosimilar product comparable quality. Healthcare budget savings could secure easier therapy access for more new patients.
On Interruptions in Doctor–Patient Interactions: Who Is the Stranger Here?
Authors: Cusen Gabriela
Published: February 2018

Even though interruptions in various areas of spoken interaction have been the focus of research which deals with such issues as power and dominance, more recently, this focus seems to have been on the many functions they can hold. One research area in which interruptions may be given less attention is that of doctor-patient interactions (see, for example, Menz & Al-Roubaie 2008). This paper investigates the issue of interruptions in medical interviews. From a corpus of 26 medical interviews, one was selected for a pilot qualitative context-bound analysis meant to inform the following analysis of the whole corpus at later stages of the study. The findings of the analysis demonstrate that it seems possible to use the existing analytical framework for the identification of types of interruptions characteristic of medical interviews in the Romanian context.
The Harvard Law Review and the Iroquois Influence Thesis
Authors: Jensen Erik M.
Published: February 2018

In a recent Developments in the Law chapter on the Indian Civil Rights Act, authors and editors at the Harvard Law Review seemed to take seriously the so-called “Iroquois influence thesis,” the idea that basic principles of the American government were derived from American Indian nations, in particular the Iroquois Confederacy. Although the influence thesis has acquired a life of its own, being taught in some of America’s elementary and secondary schools, it is nonsense. (One of the sources cited in support of this made-up history is a congressional resolution, as if Congress has some special, historical expertise.) Nothing in American Indian law and policy should depend on the influence thesis, and it is unfortunate that a prominent law review has given it credence. This article explains how the Harvard folks were misguided and why the influence thesis should be interred.
Harmonization of PCR-based detection of intestinal pathogens: experiences from the Dutch external quality assessment scheme on molecular diagnosis of protozoa in stool samples
Authors: Schuurs Theo A. , Koelewijn Rob , Brienen Eric A.T. , Kortbeek Titia , Mank Theo G. , Mulder Bert , Stelma Foekje F. , van Lieshout Lisette , van Hellemond Jaap J.
Published: February 2018

Background:

Real-time PCR methods are increasingly used in routine patient care settings not only to determine the presence or absence of pathogens in patient materials, but also to obtain semiquantitative results to estimate the pathogen load. However, it is so far unknown how well these methods are harmonized among different laboratories.

Methods:

Sets of stool samples were distributed three to four times per year to ca. 25–40 participating laboratories within the European Union as part of an external quality assessment scheme (EQAS) for the detection of gastrointestinal protozoa. This paper presents the results obtained over a 3-year period for Entamoeba histolytica, Entamoeba dispar, Giardia lamblia, Cryptosporidium species and Dientamoeba fragilis.

Results:

Although both false-positive and false-negative results were reported, the overall sensitivity and specificity were high. The substantial differences in the quantitative output of the real-time PCR assays could be traced back to differences in DNA isolation procedures between different laboratories.

Conclusions:

Participation in an EQAS proved to be important as it provides information on how the real-time PCR methods used by the participant compares to the generally reported results and indicates how procedures could be improved. Semiquantitative results of real-time PCR methods are not exchangeable between laboratories as long as the diagnostic procedures are not harmonized. Intralaboratory comparison of semiquantitative real-time PCR results seems only possible by the use of calibration curves derived from well-validated standards in clinical material and not by spiking solutions with purified DNA.
Effect of soft cations on carbon steel corrosion in chloride media
Authors: Das Sudip , Baranwal Prince Kumar , Rajaraman Prasanna Venkatesh
Published: February 2018

The effect of soft cations (Na+, K+, NH4
+) on the corrosion behavior of carbon steel in chloride (Cl−) media was investigated using various electrochemical and nonelectrochemical techniques. Data revealed that the corrosion rate is higher in the case of ammonium chloride solution following the order NH4
+>K+>Na+. The polarization and electrochemical impedance spectroscopy (EIS) measurements indicated a significant influence of cations on both the corrosion rate and the mechanistic reaction pathway of carbon steel dissolution in Cl− media. The EIS measurement showed two time constants in all the cases. Electrical equivalent circuit was employed to model the EIS data. The surface morphology and the corrosion products were also analyzed. It was found that the hydration energy of cations and the initial pH of the solution play a critical role in describing the effect of cations present in Cl− media on carbon steel corrosion.
Sign Markup Language in a Multimodal Context
Authors: Chen Linda Jianlin , Huang Jianbin
Published: February 2018

The process of “telling through words” and “understanding by insight” of a language are closely related to high-context and low-context cultures. Various concepts and knowledge systems constitute a hierarchy of cognitive domain networks. Bilingual and multilingual sign markup language can be seen everywhere in a multicultural setting, which is full of cognition, construal, and variation in the process of cross-cultural communication under the multilingual context. Sign markup language is presented in a multimodal discourse form, such as business language, advertising language, commercial logos, slogans, or propagation language. It contains known and unknown information and foreground and background cultures, changing with technological knowledge and history development. The cross-cultural cognitive research of sign markup language in a multimodal context is increasingly important, especially in today’s society undergoing the development of economic globalization, high-speed information, urban internationalization, and data digitization. Based on instances of sign markup language, the present paper will apply the theory of memes in sign markup language to analyze and put forward the cognitive mechanism used in multimodal contexts.
Social Innovations for the Disadvantaged Rural Regions: Hungarian Experiences of the New Type Social Cooperatives
Authors: Róbert Tésits , Levente Alpek
Published: February 2018

The study explores the spatial specificities of the new type of social cooperatives, with an emphasis on assessing the dichotomy appearing in relation to advanced and disadvantaged areas. It also looks at the features of operation, employment role and long-term sustainability, proposing support and further development opportunities. The key goals initially set of the cooperatives have not yet been implemented uniformly. They could not have met the requirements of significant development in local economy, enhancement of self-sufficiency and the transit role entailing labour market reintegration. However, they have already fulfilled the social objectives; namely, long-term local employment almost completely. The problems are mainly caused by lack of capital resulting from the lack of creditworthiness and the difficulty of further expansion of market opportunities. For further development, new, preferably county or national level markets should thus be targeted. Hence, to achieve favourable changes, the development of well-founded marketing strategies will be necessary.
Oxygen-plasma treatment-induced surface engineering of biomimetic polyurethane nanofibrous scaffolds for gelatin-heparin immobilization
Authors: Ghorbani Farnaz , Zamanian Ali
Published: February 2018

Polyurethane (PU) has been extensively used in vascular tissue engineering due to its outstanding mechanical performance and blood compatibility behavior. Here, biomimetic PU-based scaffolds were prepared using an electrospinning technique and gelatin-heparin was introduced as a surface modifier after oxygen plasma treatment to improve cell attachment and release an anticoagulation agent. Morphology, Fourier transform infrared (FTIR) spectroscopy, compression strength, swelling and biodegradation ratio, drug release level and cellular interactions were evaluated. According to the scanning electron microscopy (SEM) micrographs, gelatin-heparin immobilized PU nanofibers exhibited a smooth surface and a bead free structure that nanofibers distributed in the range of 300–1000 nm. The mechanical strength of constructs, swelling and biodegradation ratio, and drug release level illustrated higher values for oxygen plasma-treated samples compared with bilayered scaffolds. Cellular adhesion and biocompatibility ameliorated after plasma treatment. All the mentioned findings indicated the initial physicomechanical and biological potential of biomimetic PU-based fibers in the improvements of vascular scaffolds.