bluuebunny/crossref_metadata_2025 huggingface dataset:
Two new species of Mycterothrips (Thysanoptera: Thripidae) from Southwestern China
Authors: LI YAJIN , LI ZHENGYUE , ZHANG HONGRUI
Published: November 2017

Mycterothrips gongshanensis sp.n. and M. yelangi sp.n. are described from Southwestern China. Both species have been collected from tea (Camellia sinensis), and M. gongshanensis sp.n. is a potential pest in tea gardens. An identification key is provided to the Mycterothrips species recorded from China.
Isometopus anlasi sp. nov. (Heteroptera: Miridae) from Turkey
Authors: ÇERÇİ BARIŞ , DURSUN AHMET
Published: November 2017

A new species of the genus Isometopus, Isometopus anlasi sp. nov. (Heteroptera: Miridae) is described based on both male and female specimens. Habitus of male, female and last instar nymph, and parameres are illustrated. Data on biology and plant associations of the new species are also recorded. Additionally, an updated key for the European and Middle Eastern species of Isometopus is provided.
Some Properties of Residual R-norm Entropy and Divergence Measures
Authors: Linu M. N. , Sunoj S. M.
Published: November 2017

Shannon entropy plays an important role in measuring the expected uncertainty contained in the probability density function about the predictability of an outcome of a random variable. However, in certain systems, Shannon entropy may not be appropriate, where some generalized versions of it are only suitable. One such generalization is due to Boekee and Lubee [1] , called R-norm entropy. Recently, Nanda and Das [2] studied the R-norm entropy and its divergence measure in the context of used items, useful in reliability modelling. In the present article, we further study R-norm entropy and divergence in the context of weighted models. We also extend these measures to the conditionally specified and conditional survival models, and studied their properties.
The Church as “Good Enough” Parent: The Psychodynamics of the Polish Solidarity Movement
Authors: Sochaczewski Janina
Published: November 2017

This article explores the role of the Roman Catholic Church in the Polish Solidarity movement ( Solidarność) in the early 1980s. While Solidarity has primarily been examined as a politically and economically motivated movement, a study of its religious dimensions lends insight into the psychosocial factors underlying the quest for a return to Poland’s “true identity.” This study employs the theoretical concepts of Donald Winnicott in order to demonstrate how figures and symbols of religious authority may play the role of the “good enough” parent at the collective level, and how religious institutions may provide a “holding environment” that allows for the de-atomization of society, permitting community members to co-create and explore non-violent alternatives of resistance.
Documentation of Child Maltreatment in Electronic Health Records
Authors: Karatekin Canan , Almy Brandon , Mason Susan Marshall , Borowsky Iris , Barnes Andrew
Published: November 2017

International Classification of Diseases codes for child maltreatment can aid surveillance and research, but the extent to which they are used is not well established. We documented prevalence of the use of maltreatment-related codes, examined demographic characteristics of youth assigned these codes, and compared results with previous studies. Data were extracted from electronic health records of 0- to 21-year-olds assigned 1 of 15 maltreatment-related International Classification of Diseases, Ninth Revision, codes who had encounters in a large medical system over a 4-year period. Only 0.02% of approximately 2.5 million youth had a maltreatment-related code, replicating other studies. Results provide a dramatic contrast to much higher rates based on self-report or informant-report and referrals to Child Protective Services. Lack of documentation of maltreatment in electronic health records can lead to missed chances at early intervention, inadequate coordination of health care, insufficient allocation of resources to addressing problems related to maltreatment, and flawed public health data.
In pursuit of love: ‘Safe passages’, migration and queer South Asians in the US
Authors: Adur Shweta Majumdar
Published: November 2017

In the last decade or two the notion of human security has emerged as a benchmark for assessing the quality of everyday lives. Despite the paradigmatic shift, scholarly inquiries on human security rarely center sexual migrants. This article attends to this gap. Based on 30 in-depth interviews and supplemented with web material, the article describes the unique and multidimensional vulnerabilities endured by queer immigrants of color – queer South Asians – in the US. The article simultaneously contextualizes and moves beyond the areas of law and public policy, to examine queer migration and security from the subjective lens of the migrants (documented, undocumented, refugee and asylees) in order to demonstrate that safety, security and acceptance are negotiated with multiple agents (such as intimate partners, family, co-ethnic community, etc.) amid social cleavages (such as class, nationality, religion, gender and age) that facilitate or interrupt migration in ‘glocal’ contexts where the global and local intersect in complex ways to suffuse all such experiences.
Access to healthcare for vulnerable migrant women in England: A human security approach
Authors: Jayaweera Hiranthi
Published: November 2017

The focus of this article is on post-migration entitlement and access to health security of women international migrants in England who are in vulnerable circumstances. Here ‘health security’ is defined as the protection of health within a broader public health context. The aim is to understand the factors underlying migrants’ vulnerabilities and how national and local health policies and practices respond in allowing or denying them rights to healthcare, thus impacting their ability to safeguard their health. This article is predominantly concerned with experiences of access to healthcare of categories of migrant women who may be in vulnerable situations including asylum seekers, refugees, refused asylum seekers or other undocumented migrant women, women with no recourse to public funds who are supported by local authorities, trafficked women, Roma women, women with limited fluency in English, and migrants from the European Union (EU) with no health insurance card. By examining empirical evidence of such women’s experiences of entitlement and access to healthcare we are able to gain theoretical insight into the relationship between migration, gender and human (health) security.
Histories of the late nineteenth to early twentieth century immigration and our time
Authors: Samaddar Ranabir
Published: November 2017

Recent studies on welfare state and schemes suggest a different way of understanding modern governance in which the study of the nation is not at the centre of political understanding. Instead, of significance in such studies is the inadequately explored history of governing a mobile, unruly world of population flows. These works have given us a sense of the hidden histories of conflicts, desperate survivals, and new and old networks. Studies of hunger in the nineteenth century, of itinerant movements, transportations of coolies, spread of famines, shipping of children and adult women, trafficking in sex and labour, and pieces of welfare legislation to cope with this great infamy tell us how actually we have arrived at our own time of subject formation. This is certainly different from conventional nation-centred histories. Working within this new strand of history writing, labour historians have tried to recognise the political significance of labour migration in the late nineteenth and early twentieth century. Their works suggest a different way of writing the history of the nation form in the last two centuries, where the extra-nationalist narrative of mobile labour constitutes a different universe. Through all these studies two issues have come closer as marks of modern time – on one hand mixed up, messy, population flows, provoking desperate governmental responses, on the other hand innovations at a furious pace in humanitarian methods, functions, institutions and principles. Modern humanitarianism had to combine the old techniques with new ones of care, protection, information gathering, interference, intervention and invention of a skewed theory of sovereignty, a one-sided theory of responsibility, and the gigantic humanitarian machines which would be likened to the transnational corporations (TNCs). In practical terms this means today managing the societies which produce the obdurate refugees and migrants to stop them from leaving the shores, to keep them within the national territorial confines, and eventually to manage societies in ‘an enlightened way’. Managing moving population groups became the deus ex machina of modern governmentality. This will not be a straightforward history, as national, gender-related, race, and several other factors contributed to the making of a hugely heterogeneous labour market. The subjectivities produced in that process have contributed to the contentious history of our time.
Class, identity, and insecurity: Bangladeshi temporary migrants in the United Arab Emirates
Authors: Khondker Habibul Haque
Published: November 2017

The main task of this article is to link the issue of the identity of migrants to the human security of migrants with temporary labor status. This article explores not only the politico-economic circumstances of temporary labor migration amid conditions of insecurity, vulnerability, and precarity, and its social and cultural underpinnings, which are mediated by migrants’ class position, but also the consequences on temporary migrants’ identities. The temporary migrant workers from Bangladesh in the Gulf Coordinating Council (GCC) countries including the United Arab Emirates (UAE) belong to multiple spaces yet their families and homes are foremost anchors in their narratives of belonging. The space most temporary migrant workers occupy is glocal with a specific focus on geography as well as the community. The article addresses the class-based identity and human security of the temporary Bangladeshi migrants in the UAE.
Negotiating the boundaries of social membership: The case of aging return migrants to Taiwan
Authors: Sun Ken Chih-Yan
Published: November 2017

This article focuses on the experiences of aging returnees who have moved back to Taiwan after retiring in the United States to illustrate how older return migrants develop a set of narratives about their membership in the homeland. Drawing on data collected from life history interviews with 58 aging return migrants, the author argues that the encounter between aging returnees and a drastically evolving home society demands that aging return migrants carefully negotiate insider-versus-outsider boundaries. These boundary-making practices represent the efforts and struggles of older migrants to justify their decision to resettle in their homeland and to construct social rights as returning migrants. On the one hand, the respondents engage with various forms of ‘inclusionary boundary work’ to explain why they wanted to move back and become part of Taiwan after spending decades overseas. On the other hand, returnees in this study sense striking differences between themselves and their co-ethnics in contemporary Taiwan. These findings point to the ways in which aging migrants grapple with traditions, modernity, and membership when trying to fulfill their right to seek an ideal life across borders.
Unemployment as a liminoid phenomenon: Identity trajectories in times of crisis
Authors: Daskalaki Maria , Simosi Maria
Published: November 2017

This article explores the formation of work identities in times of financial crisis and extreme austerity. In particular, we build upon prior studies of liminality, a state of in-betweenness and ambiguity, and explore how individuals, whose employment opportunities and career paths have been disrupted, construct their work/professional identities. The study draws on 39 semi-structured interviews conducted in Greece, where high levels of unemployment and economic stagnation prevail. Persistent crisis and austerity have prompted extended periods of instability and unpredictability during which the unemployed narratively (re)construct their past, present and future work selves. We propose that frequent job changes and persistent lack of work are not linear experiences but, instead, require multiple and, at times, ambiguous, fluid and incomplete identifications. These identifications include attempts to re-affirm prior stable professional identities, to institute new, yet still unidentified, careers or to enact what we term ‘liminoid identity positions’. When in liminoid positions, instead of pursuing intangible work futures, the unemployed create anti-structural spaces in which they collectively practice alternative forms of work and organization. Concluding, the article provides grounds for the study of individuals’ capacity to challenge the neoliberal restructuring of work and the possibilities for transformation in periods of unemployment and crisis.
Acculturative stress and coping among Korean immigrant elders residing in non-Korean ethnic enclaves
Authors: Rhee Stephanie L
Published: November 2017

Few studies that have been conducted on Korean immigrant elders have been carried out in areas without Korean ethnic enclaves due to their small numbers and proportion. This nonprobability cross-sectional study utilized a structured survey to examine the relationships of acculturative stress, coping, and depressive symptoms among 108 non-institutionalized Korean immigrant elders residing in areas without Korean ethnic enclaves. Multivariate analysis results indicated that acculturative stress might be the most significant risk factor for depressive symptoms, which could decrease coping efficacy of social support and increase somatic symptoms of Korean immigrant elders residing in non-Korean ethnic enclaves. Implications for future research, practice, and policy are discussed.
State Control and the Effects of Foreign Relations on Bilateral Trade
Authors: Davis Christina L. , Fuchs Andreas , Johnson Kristina
Published: November 2017

Can governments still use trade to reward and punish partner countries? While World Trade Organization (WTO) rules and the pressures of globalization restrict states’ capacity to manipulate trade policies, politicization of trade is likely to occur where governments intervene in markets. We examine state ownership of firms as one tool of government control. Taking China and India as examples, we use new data on bilateral trade disaggregated by firm ownership type as well as measures of political relations based on bilateral events and United Nations voting data to estimate the effect of political relations on import flows since the early 1990s. Our results support the hypothesis that imports controlled by state-owned enterprises are more responsive to political relations than imports controlled by private enterprises. This finding suggests that politicized import decisions will increase as countries with partially state-controlled economies gain strength in the global economy. Extending our analysis to exports for comparison, we find a similar pattern for Indian but not for Chinese exports and offer potential explanations for these differential findings.
Election-Day Experiences and Evaluations of Electoral Integrity in Unconsolidated Democracies: Evidence from Nigeria
Authors: Kerr Nicholas Nathan
Published: November 2017

Why do voters’ evaluations of elections in unconsolidated democracies appear to be unaffected by election-day events? Among the handful of studies that examine the consequences of election experiences in countries with less experience with multiparty elections, a majority finds that what happens on election day does not matter. I seek to reexamine this puzzle using original post-election survey data on the 2015 Nigerian presidential elections. First, I distinguish between voters’ evaluations of the process (1) at their own polling stations ( local) and (2) across the entire country ( national). Second, I highlight three types of election-day experiences that are relevant for unconsolidated democracies: experience with manipulation, administrative irregularities, and election observers. Multivariate regression results indicate that all three experiences are associated with local and national perceptions of electoral integrity. However, the salience of some experiences, such as interactions with election observers, depends on whether voters make local or national election integrity evaluations.
The Career Path of an Indonesian EFL Teacher: A Professional Capital Perspective
Authors: Yumarnamto Mateus
Published: November 2017

Three components of teachers’ professional capital are human capital, social capital, and decisional capital according to Hargreaves and Fullan (2012). These three aspects of professional capital are meant to be part and parcel of developing the teaching profession. In this article, the author focusses on professional capital as a framework by putting the emphasis on the decisional aspect. In this study, the decisional capital is not only found at the micro level of education: the classroom and school level. Beyond that, a teacher also needs to make professional decisions that will affect her/his professional growth and trajectory. To illustrate this professional path through the lens of decisional capital, the author outlines the narrative of decision-making of an Indonesian English as a Foreign Language (EFL) teacher. The findings of the study shed light on the Indonesian teacher’s journey to becoming an English teacher and how the journey has been marked by her decisions regarding her career and her engagement with the professional communities in Indonesia.
On the transformation of children at-risk into an investment proposition: A study of Social Impact Bonds as an anti-market device
Authors: Neyland Daniel
Published: November 2017

Following the financial crisis of 2008, the UK government accelerated a number of market-based interventions into public problems. Experimenting with new forms of intervention provided a moment to effectively problematize the public sector as a whole and its budgets, opening up for discussion the basis for making an intervention, and the methods and costs involved. Questions were posed of the apparently irreducible costs associated with supposedly intractable problems of government (such as homelessness, vulnerable children or crime). In particular, crisis and austerity became a means to give new momentum to a series of experimental ways to shape the social investment market that had been under discussion in various forms since at least 2000. Social Impact Bonds form one particular type of intervention. They involve drawing together investors with delivery agencies, the third sector and national and local government, coordinated by a commissioner. In the recent move by the UK government to set up and use Social Impact Bonds, much has been made of the opportunity they represent to introduce competition, efficiency, efficacy, private sector thinking and investment to a range of different social problems. As the first results of these experiments are now emerging, this article reports on a study conducted into a market-based intervention that experiments with the transformation of ‘children at-risk’ into an investment proposition through a Social Impact Bond. The article suggests that the Social Impact Bond can be usefully explored by drawing on Science and Technology Studies (STS) treatments of markets as collective, heterogeneous assemblages. However, in contrast to scholars who focus on market devices, the article argues that the Social Impact Bond in practice operates as something akin to an anti-market device. The article begins with an introduction to Social Impact Bonds. It then explores the means through which market-based competition and an investment proposition were anticipated, but did not emerge through the composition and enactment of the Bond. It concludes with an assessment of the anti-market device and the future of Social Impact Bonds.
Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults
Authors: Kennedy Jae , Wood Elizabeth Geneva , Frieden Lex
Published: November 2017

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.
Beyond the Self-Legislation Model of Democracy: James Bohman’s Approach to Democratic Theory
Authors: Warren Mark E.
Published: November 2017

James Bohman’s work involves a paradigm shift in how we conceive democracy in complex, pluralized, globalized contexts comprised of multiple, overlapping constituencies that often have broad extension in space and time. He breaks with theories that view democracy as comprised of a bounded demos legislating for itself, and which conceptualize democracy as ways of organizing territorial, state-organized political entities. Elements of a progressive democratic theory that travels across borders should be built out of three ideas: (a) a nonutopianism that pays close attention to the “circumstances of politics”; (b) institutions that enable nondomination, which helps to push conflict resolution toward the democratic media of deliberation, bargaining, compromise, and voting; and (c) reflexive institutions that enable the deliberative generation, revision, and renewal of collective procedures and decisions, and which organize the creativity, intelligence, and energy of individuals.
Random Deviations Improve Micro–Macro Predictions: An Empirical Test
Authors: Mäs Michael , Helbing Dirk
Published: November 2017

Many sociological theories make critically different macropredictions when their microassumptions are implemented stochastically rather than deterministically. Deviations from individuals’ behavioral patterns described by microtheories can spark cascades that change macrooutcomes, even when deviations are rare and random. With two experiments, we empirically tested whether macrophenomena can be critically shaped by random deviations. Ninety-six percent of participants’ decisions were in line with a deterministic theory of bounded rationality. Despite this impressive microlevel accuracy, the deterministic model failed to predict the observed macrooutcomes. However, a stochastic version of the same microtheory largely improved macropredictions. The stochastic model also correctly predicted the conditions under which deviations mattered. Results also supported the hypothesis that nonrandom deviations can result in fundamentally different macrooutcomes than random deviations. In conclusion, we echo the warning that deterministic microtheories can be misleading. Our findings show that taking into account deviations in sociological theories can improve explanations and predictions.
High-Risk Violent Prisoners’ Patterns of Change on Parole on the DRAOR’s Dynamic Risk and Protective Factors
Authors: Polaschek Devon L. L. , Yesberg Julia A.
Published: November 2017

Few studies have examined change after treatment completion; such investigations can enhance our understanding of how a rehabilitative intervention leads to reduced recidivism. The current study uses growth curve modeling to investigate change in dynamic risk factors in the community, following two samples of high-risk violent men for up to 12 months on parole. While in prison, one sample had completed intensive psychological treatment, whereas the other completed no programs or briefer programs. As expected, based on Dynamic Risk Assessment for Offender Re-Entry (DRAOR) scores, intensive program completers entered the community with higher protective and lower stable and acute dynamic factors, and showed less variability on acute risk factors, as did all of those with better initial scores. But the two samples improved at a similar rate over the course of parole. Those with initially poorer scores changed less on parole except for protective factors; those with stronger initial protective scores showed less change.
Improvement of the creep resistance of glycidyl azide polyol energetic thermoplastic elastomer-based propellant by nitrocellulose filler and its mechanism
Authors: Sun Qili , Sang Chao , Wang Zhen , Luo Yunjun
Published: November 2017

To investigate the effects of nitrocellulose (NC) content on the creep properties of glycidyl azide polyol energetic thermoplastic elastomer (GAP-ETPE)-based propellant, creep behaviour was studied by rotary rheometer under various shear stress and temperatures. Experimental results showed that creep strain and creep rate of samples increase with the increasing shear stress level, and similar creep behaviour tendency was observed under elevated temperature. When filled with 1 and 2 wt% NC, the creep strain and creep rate of GAP-ETPE/NC-based propellant were significantly less than the unfilled state, indicating that the NC contents partly inhibited the mobility of the binder segment and improved the creep resistance of GAP-ETPE-based propellant. Moreover, the constitutive equations of the creep curves were obtained from the four-element mechanical model, and the fitting results coincided well with the experimental data. Among the fitting parameters, the elastic modulus of high elastic deformation, E2, and the viscosity of Voigt units, η2, were sensitive and promising for the evaluation of creep strain of the GAP-ETPE-based propellant. Finally, the creep resistance model was established and verified by Fourier transform infrared spectroscopy, glass temperature and physical crossing point density of GAP-ETPE/NC-based propellant. Upon analysis of the experimental data, we concluded that the creep resistance mechanism of GAP-ETPE/NC-based propellant came from NC altering the flow lines of the continuous phase and restricted chain mobility in the propellant, which improved the creep resistance.
Emergency Surgery: Atavistic Refuge of the General Surgeon?
Authors: Lankester B J A , Britton D C , Holbrook A G , Umpleby H C , Tate J J T , Budd J , Maddox P R , Horrocks M
Published: November 2017

A prospective audit of emergency soft-tissue surgery for an eight-week period revealed that general surgical emergency operations were more than twice as common as those undertaken in other soft-tissue specialties. The audit reveals that emergency general surgery needs an increase in resources, an increase in available staff and an increase in the role of the consultant general surgeon on call. An alternative solution would be to admit soft-tissue emergencies by specialty and develop specialist emergency services.
Reducing Risk by Improving Standards of Intrapartum Fetal Care
Authors: Young Peter , Hamilton Rosie , Hodgett Sheena , Moss Mary , Rigby Claire , Jones Peter , Johanson Richard
Published: November 2017

Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward—guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality of care was assessed by use of the CESDI system in all babies born with an Apgar score of 4 or less at 1 min and/or 7 or less at 5 min. 540 babies (4.3%) had low Apgar scores, and neither the percentage nor gestational age differed significantly between audit periods. In the baseline audit, care was judged suboptimal (grade II/III) in 14 (74%) of 19 cases, and in the next four periods it was 23%, 27%, 27% and 32%. In the latest audit period, after further educational interventions, it was 9%. Many of the failures to recognize or act on abnormal events were related to CTG interpretation. After the interventions there was a significant increase in cord blood pH measurement. There were no differences between audit periods in the proportion of babies with cord pH <7.2. These results indicate that substantial improvements in quality of intrapartum care can be achieved by a programme of clinical riskmanagement.
Why do we have Apocrine and Sebaceous Glands?
Authors: Porter Alan M W
Published: November 2017

The secretions of sebaceous and apocrine glands fulfil an important thermoregulatory role in cold-stressed and heat-stressed hunter-gatherers. In hot conditions the secretions emulsify eccrine sweat and thus encourage the formation of a sweat sheet and discourage the formation and loss of sweat drops from the skin. In colder conditions sebum changes its nature and repels rain from skin and hair.
Design or Accident? The Natural History of Teenage Pregnancy
Authors: Seamark Clare
Published: November 2017

The UK has the highest rate of teenage pregnancy in Western Europe. A retrospective record-based study was conducted in an East Devon general practice to gain greater understanding of the outcome of first teenage pregnancy and subsequent reproductive history. The comparison group was women who had first conceived between the ages of 25 and 29 years.

149/673 women born between 1968 and 1977 became pregnant when teenagers. Of these, 70 (47%) had the baby, 67 (45%) had a termination and 10 (7%) had a spontaneous miscarriage; 2 others experienced fetal loss. Of the women aged 25-29 at first conception, 127 (92%) had the baby, 6 (4%) had a termination and 5 (4%) had a miscarriage. 40 (27%) of the teenage group went on to have a second teenage pregnancy, including 12 of the 67 who had their first pregnancy terminated.

Although teenage pregnancy is often viewed as unplanned and unwanted, the reality is more complex. Among this group, many first pregnancies were desired. Even among those whose first pregnancy was terminated, 18% went on to have a baby while still a teenager.
A Diagnostic Sign in Migraine?
Authors: de Silva R N
Published: November 2017

At the bedside it was noted that, after ocular fundoscopy, patients with migraine complained more often of an afterimage than did non-migraineurs. This phenomenon was then investigated in consecutive patients attending a general neurology outpatient clinic.

The relative risk for the diagnosis of migraine in patients reporting an after-image was 2.91 (95% confidence interval 1.96 to 4.34), and the sensitivity, specificity and positive predictive value of this observation for the diagnosis of migraine were 0.63, 0.75 and 0.55 respectively. After-images were equally likely to be reported by migraineurs with and without aura, and by patients with migraine equivalents.

The after-image phenomenon probably reflects the heightened sensitivity to visual stimuli of patients with migraine. Although a diagnosis of migraine is primarily established by the patient's history, the presence of an afterimage following ocular fundoscopy may support this diagnosis.
Off-the-Cuff Cellular Phone Consultations in a Family Practice
Authors: Peleg Roni
Published: November 2017

In Israel the public tends to make use of informal medicine alongside organized health services, and cellular phones now allow contact with physicians at almost any time or place. For three months in 1999 a family physician documented all consultations on medical subjects conducted by cellular phone, the phone being available 24 hours a day. There were 94 cellular phone medical consultations, of mean duration 5.8 min (range 2-18). Only 11 took place over the weekend, and 63 took place while the clinic was open. The most common reasons for consultation were advice on treatment (29%) and a second opinion (28%). In 48 cases the consultation was for a close relative rather than the caller. In 42 cases the request for consultation came while the physician was busy with other patients.

The results of this small personal study confirm that the practice of informal consultations now extends to the cellular phone. Technologies of this sort demand new rules of conduct, if we are to avoid the various hazards of off-the-cuff medicine.
Exploring the Causes of Adverse Events in NHS Hospital Practice
Authors: Neale Graham , Woloshynowych Maria , Vincent Charles
Published: November 2017

In a previous paper we reported that 10.8% of patients admitted to two large hospitals in Greater London experienced one or more adverse events, of which half were deemed preventable. Here we examine the underlying causes of errors in clinical practice. Rather than identifying specific errors made by individuals, we have looked at possible faults in the organization of care. Adverse events were grouped according to stages in the care process: diagnosis, preoperative assessment and care, operative or invasive procedure (including anaesthesia), ward management, use of drugs and intravenous fluids and discharge from hospital.

Less than 20% of preventable adverse events were directly related to surgical operations or invasive procedures and less than 10% to misdiagnoses. 53% of preventable adverse events occurred in general ward care (including initial assessment and the use of drugs and intravenous fluids) and 18% in care at the time of discharge. Probable contributory factors in these errors included dependence on diagnoses made by inexperienced clinicians, poor records, poor communication between professional carers, inadequate input by consultants into day-to-day care, and lack of detailed assessment of patients before discharge.
Medicolegal Consequences of Postoperative Intra-Abdominal Adhesions
Authors: Ellis Harold
Published: November 2017

Postoperative adhesions are an almost invariable consequence of abdominal and pelvic surgery. Their most important morbidity is small-bowel obstruction, but other sequelae include female infertility and dyspareunia and increased risk of visceral injury at subsequent laparotomy or laparoscopy. Whether chronic abdominal pain is truly a consequence of adhesions is debatable, although it is likely to be accepted as an entity by both patients and their legal advisors. Of 14 successful claims dealt with by a British medical defence organization, 5 were for perforations after laparoscopic division of adhesions, 2 for adhesions after laparoscopic surgery, 1 for infertility as a result of adhesions and 6 for delayed diagnosis of obstruction. General practitioners, surgeons and gynaecologists need to be aware of the increasing burden of medicolegal claims arising from these complications.
Nephrotoxicity in the Elderly Due to Co-Prescription of Angiotensin Converting Enzyme Inhibitors and Nonsteroidal Anti-Inflammatory Drugs
Authors: Adhiyaman Vedamurthy , Asghar Muhammad , Oke Anthony , White Anthony D , Shah Ikram U
Published: November 2017

Both angiotensin converting enzyme inhibitors and nonsteroidal anti-inflammatory drugs can lead to functional renal insufficiency. In an observational study we assessed the frequency of this adverse effect in patients aged over 75 years receiving these drugs in combination. In one year, out of 1500 patients whose records were screened, 12 were prescribed this combination. 2 developed acute renal failure, of whom one died and the other recovered after discontinuation of both drugs. 4 patients showed deterioration in renal function, which returned to normal after one of the drugs was stopped. Renal function remained stable in 6 patients: patients with deterioration in renal function were older and more likely to be on diuretics.

This drug combination is commonly nephrotoxic in the elderly and should be avoided, especially in those taking diuretics.
Inappropriate Admissions: Thoughts of Patients and Referring Doctors
Authors: Campbell John
Published: November 2017

Research on inappropriate hospital admissions has tended to neglect the views of the referring doctors and the patients. In this study, the Appropriateness Evaluation Protocol was applied to a random sample of 102 emergency medical admissions. The patients and doctors were then presented with a list of possible alternatives to admission that might have been used at the point of referral.

Case notes were available for 88 patients. As judged by these, 28% of admissions were inappropriate, the commonest reason being the potential for treatment or tests to have been performed as outpatient procedures; next commonest was the possibility of lower level care. The response rate to the questionnaires was about two-thirds, for both doctors and patients. Of the general practitioners and casualty doctors who responded, 60% specified alternatives to admission that they would have considered, and the equivalent figure for patients was 70%. For both groups the major preferences were same-day outpatient assessment and admission to a community hospital.

Referring doctors and patients, in this survey, favoured alternatives to acute medical care in proportions much higher than that of supposedly inappropriate admission.
Can Homeopaths Detect Homeopathic Medicines by Dowsing? A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: McCarney R , Fisher P , Spink F , Flint G , van Haselen R
Published: November 2017

Dowsing is a method of problem-solving that uses a motor automatism, amplified through a pendulum or similar device. In a homeopathic context, it is used as an aid to prescribing and as a tool to identify miasm or toxin load. A randomized double-blind trial was conducted to determine whether six dowsing homeopaths were able to distinguish between Bryonia in a 12c potency and placebo by use of dowsing alone.

The homeopathic medicine Bryonia was correctly identified in 48.1% of bottle pairs (n=156; 95% confidence interval 40.2%, 56.0%; P=0.689).

These results, wholly negative, add to doubts whether dowsing in this context can yield objective information.
The Danger of Wearing an Anorak
Authors: Cheung Chui M G , Durrani Omar M , Lim Ming S , Ramchandani Mahesh , Banerjee Somnath , Murray Philip I
Published: November 2017

Campaigns to reduce road traffic accidents have paid little attention to the way headgear could interfere with vision. Binocular visual field measurement was undertaken in six healthy volunteers wearing four different types of anorak.

All four anoraks greatly reduced the horizontal and superior field of vision. The anorak producing the worst reduction resulted in a width of vision of 99° and only 15° of vision above eye level, versus 167° and 52° respectively without an anorak.

Anorak wearers should turn their heads to look sideways before crossing the road.
Suspected Testicular Torsion: A Survey of Clinical Practice in North West England
Authors: Pearce I , Islam S , Mcintyre I G , O'Flynn K J
Published: November 2017

Several aspects of the management of suspected testicular torsion are controversial. A questionnaire was mailed to all 33 consultant urologists in the North West region of England to elicit their policies for routine clinical management. 29 of 33 questionnaires were returned (2 incomplete).

As regards radiological investigation, 4 consultants always request ultrasound examination; the others do not favour routine imaging. When the diagnosis of testicular torsion is confirmed at operation, all consultants would perform bilateral testicular fixation, although with considerable variations in technique; most use Vicryl sutures (66%) and three-point fixation (57%). One-third would do an ipsilateral orchidopexy if there was no clear evidence of testicular torsion at operation.

The variation revealed by this survey prompted an attempt to formulate a protocol for management. A review of the published work indicates that, in cases of proven testicular torsion, treatment should include bilateral fixation with delayed-absorption or nonabsorbable sutures; fixation should be at three points. When torsion is not found at operation, there is no evidence of benefit from orchidopexy.
Self-Regulation in Hospital Waiting Lists
Authors: Smethurst D P , Williams H C
Published: November 2017

There is evidence that hospital waiting lists in the UK are resistant to shortening because reductions in length generate increases in referrals. We explored this concept by examining outpatient data for eight specialties in a large hospital centre over 17 months. Correlation coefficients were calculated by regressing waiting list density (numbers waiting more than 26 weeks) against referral rate.

In three of the eight specialties, with the longest waiting lists, referral rates were significantly related, after one month's delay, to waiting list density (P<0.01)—dermatology, R=0.68; ear-nose-throat R=0.78; trauma/orthopaedics (R=0.64). These were the three with the longest lists.

These results help to explain why initiatives to shorten waiting lists are commonly ineffective in the long term.
Effect of Breaking Bad News on Patients’ Perceptions of Doctors
Authors: Barnett Mandy M
Published: November 2017

The breaking of bad news is a routine but difficult task for many health professionals. There are numerous anecdotes of insensitive practice but the subject has attracted little systematic research. We therefore interviewed 106 patients with advanced cancer (from an original sample of 195) to assess their perceptions of the doctors involved in their care. Aspects of the ‘breaking bad news’ event were recorded during discussion of the illness history and were subsequently rated. Participants were also asked to nominate doctors under the headings ‘most helpful’ and ‘less helpful’, and completed standardized psychological screening questionnaires.

In 94 of the 106 cases the bad news had been given by a doctor, usually a surgeon. Of the 13 doctors categorized as ‘most helpful’ when breaking bad news, 8 were general practitioners; of the 7 categorized as ‘less helpful’ all were surgeons. 69% of patients were neutral or positive about the bad-news consultation, but 20% were negative and 6% very negative. Doctors in surgical specialties were significantly more likely to be rated poorly than non-surgical specialists or general practitioners.

Surgeons were the group of doctors most likely to break bad news, but non-surgical doctors were rated more positively in performance of the task. This finding has implications for training.
Wet Combing for Head Lice: Feasibility in Mass Screening, Treatment Preference and Outcome
Authors: Stichele R H Vander , Gyssels L , Bracke C , Meersschaut F , Blokland I , Wittouck E , Willems S , De Maeseneer J
Published: November 2017

There is no scientific consensus on the best way to control head louse infestation in schoolchildren. A study was conducted to test the feasibility and acceptability of a screening campaign by wet combing and a community approach to head-louse control with home visits, and to explore parents’ treatment preferences and treatment outcomes. A non-controlled intervention (advice on treatment options offered to all positive children) was nested within an epidemiological prevalence study. All children in three primary schools in Ghent, Belgium, were invited to take part in screening by wet combing (n=677, 3–11 years). Positive children were offered structural treatment advice, a home visit on day 7, and a check by wet combing on day 14.

83% of the children were screened. The prevalence of active infestation (living moving lice) was 13.0% in school 1 and 19.5% in school 3. In school 2, prevalence of signs of active and past infestation was 40.7%. A home visit was made to 58% of the positive children. 85% of the positive children were screened again on day 14. Wet combing was the most widely used treatment, followed by chemical treatment and a combination of the two. In school 1 and 3 51% were cured, and in school 2 24% became nit-free. A wet combing screening campaign and a community-oriented approach to head-louse control is feasible though resource-intensive. The prevalence of head lice was high and the cure rate was low, with either topical treatments or wet combing.
Delay in Diagnosis of Slipped Upper Femoral Epiphysis
Authors: Ankarath S , Ng A B Y , Giannoudis P V , Scott B W
Published: November 2017

Treatment of slipped upper femoral epiphysis (SUFE) is directed at preventing progressive slippage, minimizing deformity and avoiding avascular necrosis and chondrolysis. Delay in treatment adversely affects long-term outcomes. In a retrospective study we assessed delays between symptom onset and evaluation of the patient in an orthopaedic department. 27 patients aged 10–16 years were grouped by source of referral (general practitioner or accident and emergency department), and hips were classified as stable or unstable according to ability to bear weight.

The 27 children had 37 affected hips, 31 stable and 6 unstable. In the 20 patients referred by general practitioners, mean delay from symptom onset to orthopaedic evaluation was 119 days (range 2–504); in the 7 referred from accident and emergency departments it was 95 days (1–482). In the latter group the slips were more likely to be acute and unstable. 9 (45%) of the patients in the general-practitioner group had hip radiography before referral, all correctly diagnosed though not all the examinations included the recommended frog-lateral views.

Long delays between onset and diagnosis of SUFE are most likely in patients with mild symptoms, able to bear weight on the hip. Any adolescent with undiagnosed hip or knee pain that has lasted more than a week should undergo radiological investigation of the hip, with frog-lateral as well as anteroposterior views.
Cardiovascular Autonomic Dysfunction in Africans Infected with Human Immunodeficiency Virus
Authors: Nzuobontane Divine , Ngu Blackett Kathleen , Christopher Kuaban
Published: November 2017

The effects of human immunodeficiency virus (HIV) on cardiovascular autonomic function have been little investigated in African patients. We performed standard heart-rate and blood pressure tests on 75 consecutive consenting patients referred for an HIV test in Yaounde, Cameroon. 54 patients proved to be HIV-infected (30 having progressed to AIDS).

Cardiovascular autonomic dysfunction was present in 8 (28%) patients with AIDS and in 1 (4%) HIV-positive patient without AIDS; no HIV-negative individuals had abnormal results. If borderline results are included, over 80% of HIV-positive patients had cardiovascular autonomic dysfunction.

In HIV-infected patients, simple tests such as blood pressure responses to standing or handgrip can warn of cardiovascular autonomic dysfunction, thus signalling the need for added precautions when invasive procedures are proposed.