bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing interprofessional learning in the community setting
Authors: Pitt Margaret , Kelley Alison , Carr Jacqui
Published: June 2014

Given the need to facilitate and manage care, making every consultation count, knowledge of—and working with—different professional care providers is essential. To optimise care outcomes for clients, the adoption of interprofessional working is essential. This article describes how interprofessional learning was embedded in a community nursing practice placement environment with student nurses and students from other professions.
The prevalence, aetiology and management of wounds in a community care area in Ireland
Authors: Skerritt Louise , Moore Zena
Published: June 2014

This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care.
Exudate: friend or foe?
Authors: Jones Menna Lloyd
Published: June 2014

Wound exudate is an essential component in the normal process of wound healing. However, excess exudate has always been a major challenge for clinicians and a source of embarrassment and discomfort for the patient. The challenge for healthcare staff is to provide a wound healing environment that offers the optimal amount of exudate to promote healing. This article provides the reader with an understanding of the benefits and problems associated with exudate.
Influencing dressing choice and supporting wound management using remote ‘tele-wound care’
Authors: King Brenda
Published: June 2014

This article describes a local involvement in a project to evaluate a remote system of wound management, incorporating the use of digital and mobile technology. It outlines how this involvement influenced the current system of ‘tele wound care’ (remote wound management) in a large community organisation. The system allows remote wound assessment, management advice and ongoing monitoring of wounds to ensure that the dressing choice remains appropriate and that timely wound care support can be provided to community nurses, practice nurses and GPs.
Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers
Authors: Hughes Maria A
Published: June 2014

Pressure ulcers, a key quality of care indicator, cause emotional distress to the patient, affecting quality of life. They also have significant financial implications for the NHS. Pressure ulcer prevention and management are fundamental aspects of nursing. This article reports on the Wirral Community Trust's policy and guidelines for the maintenance of skin integrity. Tissue viability nurses have a duty to review and assess new prevention devices and dressings as they become available to ensure a high standard of care is provided. A report of an evaluation of the use of KerraPro in combination with current best practice guidelines for the prevention or treatment of pressure ulcers is provided. The author concludes that silicone pressure-reducing pads are a valuable tool in the prevention and treatment of pressure ulcers when used in combination with recommendations from the latest guidelines.
The value of preceptorship for newly qualified midwives
Authors: Feltham Christina
Published: June 2014

The aim of the study was to examine the views and learning needs of student midwives at the point of registration in order to inform the development of a new preceptorship programme for newly qualified midwives using a qualitative phenomenological approach. Ten third year student midwives enrolled on an undergraduate BSc Midwifery programme were included in the study. Questionnaires and a focus group session were employed to collect data. Eight students returned the questionnaire and nine attended the focus group. Data were thematically analysed using an inductive approach.

The results suggest that preceptorship is highly valued by the students questioned and a period of preceptorship in a maternity unit they are familiar with was highlighted as being important in building confidence. It was also suggested that preceptorship programmes should focus on clinical skills enhancement, ward management and socialisation into the workplace.
Evaluating inspections
Authors: Webb Penny
Published: June 2014

With the number of complaints following inspection on the rise, and the many stories circulating of settings frustrated at their experience both during and after, what can Ofsted do to regain trust?
The child at the centre
Authors: Rodriguez-Leon Lucy
Published: June 2014

How much of our practice and provision really has the child at the heart of its thinking, or do we take far too much account of outside influences. Perhaps a lesson can be learnt from Greek mythology?
The child in the mirror
Authors: Brown Paula
Published: June 2014

Mirrors and reflections fascinate children of all ages. Here, we consider the ways in which we can use reflective surfaces of all kinds to support fun and extremely engaging cross-curricular activities.
Getting into position
Authors: Chalmers Debbie
Published: June 2014

During the Early Years Foundation Stage, children are learning to understand and use prepositions and positional language, and practitioners can provide many activities to develop these abilities.
Factors influencing post-stroke rehabilitation participation after discharge from hospital
Authors: Koh Wei Ling E , Barr Christopher J , George Stacey
Published: June 2014

Aim:

To explore what the obstacles are that deter patients from continuing stroke rehabilitation after discharge from hospital in Singapore.

Methods:

In this qualitative study, individual semi-structured telephone interviews were undertaken and analysed using inductive thematic analysis. Thirty one stroke patients, who had been discharged from the hospital after inpatient rehabilitation (mean age=66.46 years, mean duration post-discharge=95.82 days), were interviewed.

Results:

Five themes were identified as obstacles to post-discharge stroke rehabilitation including: the means to access rehabilitative services; lapse in discharge coordination; family members’ views and actions; discrepancies in expectation; and the perception that rehabilitation is simple. Participants indicated a need for timely and appropriate information, delivered according to their individualised needs.

Conclusion:

Study findings revealed that the absence of a smooth transition through the continuum of stroke care and not having a common understanding of rehabilitation accounts for the lack of adherence to therapy recommendations. The results suggest that clinicians need to be more aware of their role in providing well-coordinated information about therapy. The study also highlighted the need to review the goal-setting processes that guide the course of rehabilitation. Goals should be more patient-centred to reduce the discrepancies in expectations of rehabilitation. There needs to be a greater involvement of carers in discharge planning to minimise the dissatisfaction in care arrangements and information delivery.
Rebuilding identity after brain injury: Standard cognitive and music-evoked autobiographical memory training
Authors: Gurr Birgit , Foxhall Mia , Shinoda Jun , Baird Amee
Published: June 2014

Background:

This paper presents a report involving a male patient who had experienced a subarachnoid haemorrhage. He presented with profound anterograde and retrograde amnesia, which caused him to be severely confused about his social contacts and his environment.

Aim:

To describe the complexity of amnesia and identity loss and examine how the combination of cognitive and music-evoked autobiographical training affected a person with anterograde and retrograde amnesia following subarachnoid haemorrhages (acquired brain injury [ABI]).

Method:

The 47-year-old male patient, who had worked as a DJ for some parts of his life previously had a good memory of musical events and facts about musical artists. This patient received an applied cognitive training programme (part I), which was based on spaced retrieval and errorless learning methods. The patient also received therapy involving the administration of music-evoked emotional responses (part II). The cognitive training programme consisted of 13 hourly sessions spread over four weeks. The music-based intervention included 5 hourly sessions, which took part place over two weeks.

Results:

Part I optimised the patient's name recall and local orientation. The resulting recovery of day-to-day memory and the awareness of the dependence on learning strategies led to the patient having a realisation of his severe loss of autobiographical memory. The patient became frustrated, angry and depressed and was at risk of disengaging from most areas of his neuro-rehabilitation programme. Part II enabled the patient to link the music or the artist with autobiographical events and to elicit emotional responses to such events. These were stringed into an autobiographical narrative with the result that the patient gained insight into the person he used to be and connected with past emotional experiences. The regained autobiographical memories were maintained beyond the training context.

Conclusion:

The patient's mood and motivation to continue his neuro-rehabilitation programme improved. This enabled him to make further progress regarding his functional independence.
Staged bilateral total knee replacement
Authors: Scott C. E. H. , Murray R. C. , MacDonald D. J. , Biant L. C.
Published: June 2014

We explored the outcome of staged bilateral total knee replacement (TKR) for symmetrical degenerative joint disease and deformity in terms of patient expectations, functional outcome and satisfaction. From 2009 to 2011, 70 consecutive patients (41 female) with a mean age of 71.7 years (43 to 89) underwent 140 staged bilateral TKRs at our institution, with a mean time between operations of 7.8 months (2 to 25). Patients were assessed pre-operatively and at six and 12 months post-operatively using the Short Form-12, Oxford knee score (OKS), expectation questionnaire and satisfaction score. The pre-operative OKS was significantly worse before the first TKR (TKR1), but displayed significantly greater improvement than that observed after the second TKR (TKR2). Expectation level increased from TKR1 to TKR2 in 17% and decreased in 20%. Expectations of pain relief and stair-climbing were less before TKR2; in contrast, expectations of sporting and social activities were greater. Decreased expectations of TKR2 were significantly associated with younger age and high expectations before TKR1. Patient satisfaction was high for both TKR1 (93%) and TKR2 (87%) but did not correlate significantly within individuals. We concluded that satisfaction with one TKR does not necessarily translate to satisfaction following the second.

Cite this article: Bone Joint J 2014;96-B:752–8.
A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis
Authors: Romanò C. L. , Logoluso N. , Meani E. , Romanò D. , De Vecchi E. , Vassena C. , Drago L.
Published: June 2014

The treatment of chronic osteomyelitis often includes surgical debridement and filling the resultant void with antibiotic-loaded polymethylmethacrylate cement, bone grafts or bone substitutes. Recently, the use of bioactive glass to treat bone defects in infections has been reported in a limited series of patients. However, no direct comparison between this biomaterial and antibiotic-loaded bone substitute has been performed.

In this retrospective study, we compared the safety and efficacy of surgical debridement and local application of the bioactive glass S53P4 in a series of 27 patients affected by chronic osteomyelitis of the long bones (Group A) with two other series, treated respectively with an antibiotic-loaded hydroxyapatite and calcium sulphate compound (Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded demineralised bone matrix (Group C; n = 22). Systemic antibiotics were also used in all groups.

After comparable periods of follow-up, the control of infection was similar in the three groups. In particular, 25 out of 27 (92.6%) patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out of 22 (86.3%) in Group C showed no infection recurrence at means of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up, respectively, while Group A showed a reduced wound complication rate.

Our results show that patients treated with a bioactive glass without local antibiotics achieved similar eradication of infection and less drainage than those treated with two different antibiotic-loaded calcium-based bone substitutes.

Cite this article: Bone Joint J 2014; 96-B:845–50.
Autologous wound drains have no effect on allogeneic blood transfusions in primary total hip and knee replacement
Authors: Thomassen B. J. W. , den Hollander P. H. C. , Kaptijn H. H. , Nelissen R. G. H. H. , Pilot P.
Published: June 2014

We hypothesised there was no clinical value in using an autologous blood transfusion (ABT) drain in either primary total hip (THR) or total knee replacement (TKR) in terms of limiting allogeneic blood transfusions when a modern restrictive blood management regime was followed. A total of 575 patients (65.2% men), with a mean age of 68.9 years (36 to 94) were randomised in this three-arm study to no drainage (group A), or to wound drainage with an ABT drain for either six hours (group B) or 24 hours (group C). The primary outcome was the number of patients receiving allogeneic blood transfusion. Secondary outcomes were post-operative haemoglobin (Hb) levels, length of hospital stay and adverse events.

This study identified only 41 transfused patients, with no significant difference in distribution between the three groups (p = 0.857). The mean pre-operative haemoglobin (Hb) value in the transfused group was 12.8 g/dL (9.8 to 15.5) versus 14.3 g/dL (10.6 to 18.0) in the non-transfused group (p < 0.001, 95% confidence interval: 1.08 to 1.86). Post-operatively, the median of re-transfused shed blood in patients with a THR was 280 mL (Interquartile range (IQR) 150 to 400) and in TKR patients 500 mL (IQR 350 to 650) (p <  0.001). ABT drains had no effect on the proportion of transfused patients in primary THR and TKR. The secondary outcomes were also comparable between groups.

Cite this article: Bone Joint J 2014;96-B:765–71.
Graft-bending angle and femoral tunnel length after single-bundle anterior cruciate ligament reconstruction
Authors: Shin Y. S. , Ro K. H. , Jeon J. H. , Lee D. H.
Published: June 2014

We used immediate post-operative in vivo three-dimensional computed tomography to compare graft bending angles and femoral tunnel lengths in 155 patients who had undergone single-bundle reconstruction of the anterior cruciate ligament using the transtibial (n = 37), anteromedial portal (n = 72) and outside-in (n = 46) techniques.

The bending angles in the sagittal and axial planes were significantly greater but the coronal-bending angle was significantly less in the transtibial group than in the anteromedial portal and outside-in groups (p < 0.001 each). The mean length of the femoral tunnel in all three planes was significantly greater in the transtibial group than the anteromedial portal and outside-in groups (p < 0.001 each), but all mean tunnel lengths in the three groups exceeded 30 mm. The only significant difference was the coronal graft- bending angle in the anteromedial portal and outside-in groups (23.5° vs 29.8°, p = 0.012).

Compared with the transtibial technique, the anteromedial portal and outside-in techniques may reduce the graft-bending stress at the opening of the femoral tunnel. Despite the femoral tunnel length being shorter in the anteromedial portal and outside-in techniques than in the transtibial technique, a femoral tunnel length of more than 30 mm in the anteromedial portal and outside-in techniques may be sufficient for the graft to heal.

Cite this article: Bone Joint J 2014;96-B:743–51.
The treatment and outcome of peri-prosthetic infection of the ankle
Authors: Kessler B. , Knupp M. , Graber P. , Zwicky L. , Hintermann B. , Zimmerli W. , Sendi P.
Published: June 2014

The treatment of peri-prosthetic joint infection (PJI) of the ankle is not standardised. It is not clear whether an algorithm developed for hip and knee PJI can be used in the management of PJI of the ankle. We evaluated the outcome, at two or more years post-operatively, in 34 patients with PJI of the ankle, identified from a cohort of 511 patients who had undergone total ankle replacement. Their median age was 62.1 years (53.3 to 68.2), and 20 patients were women. Infection was exogenous in 28 (82.4%) and haematogenous in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%) chronic. Staphylococci were the cause of 24 infections (70.6%). Surgery with retention of one or both components was undertaken in 21 patients (61.8%), both components were replaced in ten (29.4%), and arthrodesis was undertaken in three (8.8%). An infection-free outcome with satisfactory function of the ankle was obtained in 23 patients (67.6%). The best rate of cure followed the exchange of both components (9/10, 90%). In the 21 patients in whom one or both components were retained, four had a relapse of the same infecting organism and three had an infection with another organism. Hence the rate of cure was 66.7% (14 of 21). In these 21 patients, we compared the treatment given to an algorithm developed for the treatment of PJI of the knee and hip. In 17 (80.9%) patients, treatment was not according to the algorithm. Most (11 of 17) had only one criterion against retention of one or both components. In all, ten of 11 patients with severe soft-tissue compromise as a single criterion had a relapse-free survival. We propose that the treatment concept for PJI of the ankle requires adaptation of the grading of quality of the soft tissues.

Cite this article: Bone Joint J 2014;96-B:772–7.
Exam Corner – June 2014
Authors: Khanduja V.
Published: June 2014

The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and Clinical Examination. The Vivas are further divided into four sections comprising Basic Science, Adult Pathology, Hands and Children’s Orthopaedics and Trauma. The Clinical Examination section is divided into Upper and Lower limb cases. The aim of this section in the Journal is to focus specifically on the trainees preparing for the exam and to cater to all the sections of the exam. The vision is to complete the cycle of all relevant exam topics (as per the syllabus) in four years.
Processo de colonização do manguezal do Rio Tavares por análise da estrutura de diferentes bosques
Authors: Oliveira Rafaela Gomes de , Tognella Mônica Maria Pereira
Published: June 2014

Mangrove forests physiography was studied to understand colonization process. Two transects were made perpendicular to the Tavares River and twelve plots were established along the inundation flux. The quadrats were delimited and took structural dates as individual’s density, tree stature and diameter breast height. Avicennia schaueriana was the dominant species and Rhizophora mangle and Laguncularia racemosa were registries. Nine quadrats was dominated by A. schaueriana, two of them showed R. mangle and one, L. racemosa. A. schaueriana are the most adapted specie, dominating in basal area and it is the first specie to colonize the plots. Our structural dates give us some classification of the stand colonization. We differ forest in: colonization, development and mature.
Outpatient Management of Heart Failure in the United States, 2006–2008
Authors: Mosalpuria Kailash , Agarwal Sunil K. , Yaemsiri Sirin , Pierre-Louis Bredy , Saba Samir , Alvarez Rene , Russell Stuart D.
Published: June 2014

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States.

We analyzed data from the National Ambulatory Medical Care Survey of 2006–2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments.

Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization.

In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.
Sex-Specific Biatrial Volumetric Measurements Obtained with Use of Multidetector Computed Tomography in Subjects with and without Coronary Artery Disease
Authors: Budoff Matthew J. , Pagali Sandeep R. , Hamirani Yasmin S. , Chen Andy , Cheu Gordon , Gao Yanlin , Li Dong , Mao SongShou
Published: June 2014

Atrial volumetric measurement has proven clinical implications. Advances in cardiac imaging, notably the precision enabled by multidetector computed tomography (MDCT), herald the need for new criteria of what constitutes normal volumetric measurements. With use of 64-slice MDCT, we compared the atrial volumes in healthy individuals with those in individuals with coronary artery disease.

By means of manual segmentation, we measured biatrial volume in 686 participants who underwent retrospective electrocardiographic-gated MDCT angiographic evaluation. The study population included a control group of 203 persons with no cardiac abnormalities, and a study group of 483 patients with obstructive coronary artery disease. All variables were compared between men and women and between the groups.

We found a significant difference in left atrial end-systolic and end-diastolic volumes between men and women in the control group (P <0.05); however, right atrial volumes were similar. In comparison with the entire control group, the coronary artery disease group had significantly higher left atrial volume, significantly lower right atrial stroke volume, and significantly lower biatrial ejection fraction, except for left atrial ejection fraction in men. Right atrial volume and left atrial stroke volume were not significantly different. The results imply that a sex-specific reference value is necessary for left atrial volumetric evaluation, and that left atrial volume and biatrial ejection fraction (excluding left atrial ejection fraction in men) might be useful during diagnosis and prognosis in patients who have coronary artery disease.
Cardiac Sarcoidosis Presenting as Constrictive Pericarditis
Authors: Darda Saba , Zughaib Marcel E. , Alexander Patrick B. , Machado Christian E. , David Shukri W. , Saba Souheil
Published: June 2014

In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association.

We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient's clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient's case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.
Cardioverter-Defibrillator Implantation to Treat Cardiac Fibroma-Induced Ventricular Tachycardia in a 70-Year-Old Woman
Authors: Hakim Fayaz Ahmad , Pandit Anil , Mookadam Farouk , Mamby Sylvia
Published: June 2014

Benign cardiac fibroma is rarely reported in adults. Its clinical symptoms are related to outflow obstruction or dysrhythmias. We present the case of a 70-year-old woman who had a syncopal episode from ventricular tachycardia caused by cardiac fibroma. Because of unfavorable tumor anatomy, the patient was not a candidate for surgical excision, and she declined orthotopic heart transplantation. To prevent sudden cardiac death, we placed an implantable cardioverter-defibrillator, and the patient remained well throughout the 2-year follow-up period. To our knowledge, this is the first report of implantable cardioverter-defibrillator therapy to treat an adult patient's unresectable cardiac fibroma.
Asymptomatic Young Man with Danon Disease
Authors: Kim Jiwon , Parikh Parag , Mahboob Mohammad , Arrighi James A. , Atalay Michael K. , Rowin Ethan J. , Maron Martin S.
Published: June 2014

Danon disease is a rare, codominant X-linked genetic disorder characterized by the triad of left ventricular hypertrophy, mental retardation, and peripheral myopathy. This disease is caused by mutations in the gene that encodes lysosomal associated membrane protein 2 (LAMP2), a deficiency of which results in the accumulation of autophagic granular débris within the vacuoles of muscle cells. This is a report of an asymptomatic 19-year-old man with Danon disease in the absence of mental retardation or clinically significant skeletal myopathy. This case underscores the importance of accurate diagnosis of unexplained left ventricular hypertrophy, in order to establish an appropriate treatment plan and to advise genetic counseling.
Multidetector Computed Tomographic Imaging of Erdheim-Chester Disease
Authors: Yuceler Zeyneb , Kantarci Mecit , Karabulut Nevzat , Ogul Hayri , Bayraktutan Ummugulsum , Akman Canan
Published: June 2014

Erdheim-Chester disease is a rarely reported disease that can affect nearly every organ and chiefly infiltrates the connective, perivascular, and adipose tissue. The disease is a form of non-Langerhans-cell histiocytosis characterized by the proliferation of foamy histiocytes; its cardiovascular complications carry a severe prognosis. We present the case of a 29-year-old woman who was admitted for analysis of her angina. Our evaluation with use of cardiac multidetector computed tomographic angiography revealed large mediastinal soft tissue that compressed the patient's left anterior descending coronary artery. To our knowledge, this is the first report of the use of low-dose, dual-source, 256-slice multidetector computed tomography to characterize Erdheim-Chester disease that exclusively caused angina and stenosis of a coronary artery in a young adult.
Frozen Elephant Trunk Repair for Descending Thoracic Aortic Dissection in a Man with a Hostile Left Pleural Cavity
Authors: Kent William D.T. , Manjunath Adarsh , Malaisrie S. Chris
Published: June 2014

The frozen elephant trunk procedure is a hybrid, single-staged alternative to conventional surgery for repairing diffuse pathologic conditions of the thoracic aorta. This approach is particularly advantageous in patients who have pathologic conditions of the left side of the chest, because the descending thoracic aorta can be repaired without entering a hostile pleural cavity.

We present the case of a 67-year-old man who had undergone repair of acute type A aortic dissection. He presented with aneurysmal dilation of the descending thoracic aorta secondary to chronic dissection, a large acute dissection of the proximal ascending aorta, and a large paraesophageal hernia that made him a poor candidate for conventional, 2-staged open aortic repair. We describe the hybrid frozen elephant trunk technique that we used to repair the aorta, and its broader advantages.
Isolated Spontaneous Celiac Artery Dissection in a 47-Year-Old Man with von Willebrand Disease
Authors: Rehman Aziz Ur , Almanfi Abdelkader , Nadella Srikanth , Sohail Umair
Published: June 2014

Isolated spontaneous dissection of the celiac artery is rare, and its occurrence without aortic dissection is even rarer. The typical symptom of this dissection is acute-onset abdominal pain. Complications of the condition include aneurysm formation, rupture, and abdominal-organ ischemia or infarction, especially in the liver or spleen. We report the case of a 47-year-old man with von Willebrand disease who had an isolated spontaneous dissection of the celiac artery. We used computed tomography and computed tomographic angiography in the diagnosis and characterization of the dissection. To our knowledge, this is the first report of celiac artery dissection in a patient with von Willebrand disease.
Clinical outcomes of minimally invasive endoscopic and conventional sternotomy approaches for atrial septal defect repair
Authors: Chu Michael W.A. , Losenno Katie L. , Fox Stephanie A. , Adams Corey , Al-Habib Hamad , Guo Ray , Menkis Alan H. , Kiaii Bob
Published: June 2014

Background: Concerns remain that minimally invasive atrial septal defect (ASD) repair may compromise patient outcomes. We compared clinical outcomes of adult patients undergoing ASD repair via a minimally invasive endoscopic approach versus a “gold standard” sternotomy. Methods: We retrospectively reviewed the clinical outcomes of consecutive patients who underwent ASD patch repair at our institution between 2002 and 2012. We compared inhospital/30-day mortality, postoperative complications, length of stay in hospital and in the intensive care unit and blood product requirements between patients who underwent right mini-thoracotomy (MT) and those who underwent conventional sternotomy. Results: During the study period, 73 consecutive patients underwent ASD patch repair at our institution: 51 (age 47 ± 16 yr, 66.7% women) in the MT group and 22 (age 46 ± 21 yr, 59.1% women) in the sternotomy group. In-hospital mortality was similar between the 2 groups (MT 0% v. sternotomy 4.5%, p = 0.30). There were no significant differences in any postoperative complications or blood product requirements. No patients in the MT group suffered stroke, retrograde aortic dissection or leg ischemia. Mean intensive care unit (MT 1.2 ± 1.2 d v. sternotomy 1.7 ± 2.2 d, p = 0.26) and hospital length of stays (MT 5.1 ± 2.2 d v. sternotomy 6.3 ± 3.6 d, p = 0.17) were similar between the groups; however, there was a trend toward fewer patients requiring prolonged hospital stays (> 10 d) in the MT group (3.9% v. 18.2%, p = 0.06). Conclusion: Repair of ostium secundum and sinus venosus ASD can be performed safely via MT endoscopic approach with similar outcomes as sternotomy. Patient preference for a more cosmetically appealing incision may be considered without concern of compromised outcomes.
The distance of L∞ from BMO on metric measure spaces
Authors: Kinnunen Juha , Shukla Parantap
Published: June 2014

This work has two principal aims. The first is to obtain a characterization of the closure of
Complementarity and transition to modern economic growth
Authors: Jeong Hyeok , Kim Yong
Published: June 2014

The Thai Socio-Economic Survey suggests that new labor market entrants increasingly enter activities with high and positive productivity growth (modern sector), but continue to enter activities with low productivity growth (traditional sector). Workers appear to stick to their initial choice of entry between these two sectors throughout their work careers. We postulate that the transition from the traditional to modern sector is gradual because sector-specific work experience complements labor. We measure the technology
A classroom-based assessment method to test speaking skills in English for Specific Purposes
Authors: Alberola Colomar María Pilar
Published: June 2014

This article presents and analyses a classroom-based assessment method to test students' speaking skills in a variety of professional settings in tourism. The assessment system has been implemented in the Communication in English for Tourism course, as part of the Tourism Management degree programme, at Florida Universitaria (affiliated to the University of Valencia). Based on our ESP teaching experience, we have noticed a need to design an assessment procedure that would enable us gather several samples of students' speaking competencies throughout the course. An extended process that involved research and meetings with colleagues and students led to the development of the assessment method in question, which can be described as a multimodal communicative approach to testing, organized as continuous assessment, and fully related to the course syllabus. To enhance validity and reliability, we have opted to create an assessment procedure based on a combination of testing formats, rating criteria and rating scales. The procedure involves two testers and the overall grade is based on the results obtained in seven tests. The article reviews contributions to the assessment of speaking abilities, presents our testing procedure, describes its implementation, discusses its advantages and disadvantages, and concludes by analysing its washback effect and pedagogical implications.
Using exemption examinations to assess Finnish business students' non-formal and informal learning of ESP: a pilot study
Authors: Tuomainen Satu
Published: June 2014

In recent years Finnish university language centres have increasingly developed procedures for assessing and recognising the skills in English for Specific Purposes (ESP) that students acquire in various non-formal and informal learning environments. This article describes the procedures developed by the University of Eastern Finland Language Centre to assess business students' non-formal and informal learning of ESP language and communication skills. The examinations are held every semester for students seeking exemption from the ESP courses that form part of their undergraduate degree in business and economics. In the examinations the students' skills and abilities are tested using the same criteria and methods as in the courses from which exemption is sought.

The article also describes how business students perceive the exemption examination process as a means to recognising and assessing their non-formally and informally acquired ESP language and communication skills. Applying a mixed methods research design, the data presented was elicited from business students who participated in the ESP exemption examinations at the University of Eastern Finland Language Centre in the autumn semester 2012. The results of this pilot study indicate that the students regard the exemption examination process as their preferred means of demonstrating prior learning of ESP, and consider the pre-examination guidance and information provided by the teachers and the self-assessment instructions functional and sufficient. These findings encourage the further development of the ESP exemption examination system at the University of Eastern Finland Language Centre.
Piloting a polychotomous partial-credit scoring procedure in a multiple-choice test
Authors: Tsopanoglou Antonios , Ypsilandis George S. , Mouti Anna
Published: June 2014

Multiple-choice (MC) tests are frequently used to measure language competence because they are quick, economical and straightforward to score. While degrees of correctness have been investigated for partially correct responses in combined-response MC tests, degrees of incorrectness in distractors and the role they play in determining the test-taker's final score remain comparatively unexplored. This pilot study examines degrees of incorrectness in MC test items and their potential impact on the overall
Investigating language assessment literacy: Collaboration between assessment specialists and Canadian university admissions officers
Authors: Baker Beverly A. , Tsushima Rika , Wang Shujiao
Published: June 2014

There are increasing numbers of non-native English speaking applicants to Canadian universities (AUCC 2008a, 2010), which are committed to promoting linguistic and cultural diversity (AUCC 2008b). One result of this trend is that university admissions officers, as gatekeepers, are faced with a growing and potentially confusing array of language test scores when making their decisions. These admissions decision makers need a certain amount of language assessment literacy (LAL) to enable them to make use of these language test scores effectively and ethically (O’Loughlin 2011, 2013). This article reports on the first phase of a project designed to address this challenge. The project involves the collaboration of assessment professionals and admissions officers across Canada in determining the LAL base needed for users of language test scores in university admissions decision-making.

This first phase of research consisted of a survey with university admissions officers across Canada, inquiring about their knowledge, beliefs, and levels of confidence in making use of language test scores in decision-making. Results have begun to reveal the nature of the LAL needed for these users, and have suggested the most appropriate content for later informational workshops with admissions officers (Phase 2 of the project). While some evidence of misunderstanding was identified, respondents demonstrate awareness of concepts related to validity in language assessment, albeit without making use of the conventional language of the field.
Testing intercultural competence in (International) English: Some basic questions and suggested answers
Authors: Camerer Rudi
Published: June 2014

The testing of intercultural competence has long been regarded as the field of psychometric test procedures, which claim to analyse an individual's personality by specifying and quantifying personality traits with the help of self-answer questionnaires and the statistical evaluation of these. The underlying assumption is that what is analysed and described as a candidate's personality can be treated as an indicator of that same person's practical performance in intercultural encounters. From the point of view of a test constructor for language competence, all intercultural tests of this type raise basic questions concerning their construct and predictive validity.

Against this background, this article firstly examines the shortcomings of personality-based tests of intercultural competence. Secondly, based on relevant parts of the CEFR as well as on the work of numerous contributors to the international debate, a practicable construct of intercultural communicative competence is suggested. Special attention is paid to the concept of politeness in intercultural encounters and the role of English as a lingua franca (ELF). Thirdly, a basic outline of a criterion-based test of intercultural competence in English is provided. The test procedures on which this article draws have been extensively piloted and are part of a training package including test specifications, course materials and teacher-training material.
Weakly complex homogeneous spaces
Authors: Moroianu Andrei , Semmelmann Uwe
Published: June 2014

We complete our recent classification (2011) of compact inner symmetric spaces with weakly complex tangent bundle
by filling up a case which was left open, and extend this classification
to the larger category of compact homogeneous spaces with positive Euler characteristic. We show that
a simply connected compact equal rank homogeneous space has weakly complex tangent bundle if and only
if it is a product of compact equal rank homogeneous spaces which either carry an invariant almost complex structure
(and are classified by Hermann (1955)), or have stably trivial tangent bundle (and are classified by
Singhof and Wemmer (1986)), or belong to an explicit list of weakly complex spaces which have neither
stably trivial tangent bundle, nor carry invariant almost complex structures.
On orbit spaces of representations of compact Lie groups
Authors: Gorodski Claudio , Lytchak Alexander
Published: June 2014

We investigate orthogonal representations of compact Lie groups from the
point of view of their quotient spaces, considered as metric spaces. We study metric spaces which are simultaneously quotients of
different representations and investigate properties of the corresponding
representations. We obtain some structural results and apply them
to study irreducible representations of small copolarity. As an important tool, we classify all irreducible
representations of connected groups with cohomogeneity four or five.
On Frege’s ‘Modes of Presentation’ in Signs
Authors: Solomonick Abraham
Published: June 2014

Gottlob Frege introduced a new dimension to the characterization of signs - that of ‘mode of presentation’. The same referent may be represented by different signs and in different manners, revealing it with dissimilar depth and profundity. The mode of presentation varies due to the fact that the same denoted object changes in the course of time and under alternating circumstances, but also because people designating it have unequal means for doing so. Herein I undertake to explicate these facts as they occur in semiotic reality.
Trailblazers Paving the Way to Semioethics
Authors: Ponzio Augusto , Petrilli Susan
Published: June 2014

Like the Roman divinity Janus, Western semiotics has two faces, one turned towards Europe including the Tartu-Moscow tradition, now renominated the Tartu-Moscow-Bloomington tradition, and the other turned towards semiotics in the United States. Semiotics today ensues from different phases of development across the twentieth century - from “communication (code) semiotics”, to “signification semiotics” to “interpretation (significance) semiotics”. In this paper we draw attention to some of the authors who have most inspired our research on sign, language, and communication, influencing its development in the direction of “semioethics” in a global semiotic framework. Fundamental concepts addressed here include metaphor, abduction, iconicity, homology, as that between linguistic and nonlinguistic work, otherness, singularity and responsibility, eventness and participative understanding.
Steeping in Traditional Chinese Philosophy
Authors: Lingling Peng
Published: June 2014

This article investigates the design structure of ancient Decorative Chinese Calligraphy, an art form that is steeped in traditional Chinese philosophy, and explores the relationship between calligraphic form and its denotation. Three design characteristics are distinguished: “circle heaven and square earth”, “being symmetrical or balanced”, and “in harmony with myriad things”. Examples of Decorative Chinese Calligraphy are analyzed from the epistemological, semiotic, aesthetic, and cultural perspective of ancient Chinese culture.
The Reception of Tartu Semiotics in China
Authors: Chang Han-liang , Han Lei , Wu Shuo-yu Charlotte
Published: June 2014

This essay traces the reception of Tartu semiotics in the Chinesespeaking world, including Mainland China and Taiwan. Our preliminary survey covers materials of three main categories: (1) research projects, (2) postgraduate degree theses, and (3) publications in Chinese and other languages. A number of common features in cross-cultural reception are identified, such as the temporal gap in theory travelling, the role of a third language mediating source and target languages, the phenomenon of negative influence, and the political interference with the introduction and reception of foreign cultural products. Because of its predominant interest in the dynamics of culture as sign system and inter-systemic dialogue, Tartu Semiotics is becoming increasingly attractive to the growing Chinese semiotic community.
Synthesis of nanostructured MgO powders with photoluminescence by plasma-intensified pyrohydrolysis process of bischofite from brine
Authors: Zhang Haibao , Cao Tengfei , Cheng Yi
Published: June 2014

Nanostructured MgO powders were synthesized by an ultra-high temperature pyrohydrolysis process of bischofite (MgCl2·6H2 O) in a radio frequency (RF) induction thermal plasma system. The structure, morphology and optical properties were characterized by X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and Raman spectroscopy. The results showed that MgO nanopowders with two different morphologies were fabricated: near spherical MgO nanoparticles with size in the range of 20∼40 nm and 1D nanobelts with a width of about 100 nm. The photoluminescence (PL) studies showed that both of these two kinds of nanostructured MgO powders exhibited a strong ultraviolet-green PL emission under the excitation of 325 nm He-Ne laser.
Effects of vitamin E combined with antioxidants on wood flour/polypropylene composites during accelerated weathering
Authors: Peng Yao , Liu Ru , Cao Jinzhen , Guo Xi
Published: June 2014

The aim of this research was to investigate the influence of different antioxidant systems containing vitamin E (VE) and antioxidant 168 (AO) on the photodegradation of wood flour/polypropylene (WF/PP) composites, as well as to provide insight into the processes taking place in these systems during weathering. Five groups of composites were treated in a QUV accelerated weathering tester for a total of 960 h. The surface color and the flexural properties of the weathered samples were tested. Additionally, the weathered surface was characterized by SEM, ATR-FTIR, and XPS. The results were: (1) composites with VE and AO showed less loss of flexural strength and modulus, as well as less color fading and fewer cracks on weathered surfaces than surfaces without antioxidants; (2) AO reacted with hydroperoxide and quinones and showed a synergistic effect with VE to further improve the anti-weathering ability of the composites; (3) 0.2% VE and 1.0% AO was the optimal formulation, yielding the best anti-weathering properties among all.