bluuebunny/crossref_metadata_2025 huggingface dataset:
Antipsychotic Polypharmacy and Corrected QT Interval: A Systematic Review
Authors: Takeuchi Hiroyoshi , Suzuki Takefumi , Remington Gary , Uchida Hiroyuki
Published: January 2017

Objective:

It remains unclear whether antipsychotic polypharmacy, a common clinical practice, is related to an increased risk of corrected time between start of Q wave and end of T wave (QTc) interval prolongation. We conducted a systematic review of the literature to address this important issue.

Method:

A systematic literature search was conducted in October 2014, using MEDLINE, Embase, and PsycINFO. Studies and case reports were included if they reported QTc intervals or QTc interval changes before and after antipsychotic polypharmacy or QTc intervals in both antipsychotic polypharmacy and monotherapy groups.

Results:

A total of 21 articles (10 clinical trials, 4 observational studies, and 7 case reports) met inclusion criteria. The clinical trials have shown that a combination treatment with risperidone or pimozide is not obviously related to an increase in QTc interval, whereas ziprasidone or sertindole combined with clozapine may prolong QTc interval. Among the 4 observational studies, antipsychotic polypharmacy was not clearly associated with QTc prolongation in 3 studies, each cross-sectional. In contrast, one prospective study showed a significant increase in QTc interval following antipsychotic coadministration. The case reports indicated an increased risk of QTc prolongation in at least some patients receiving antipsychotic polypharmacy.

Conclusions:

Currently available evidence fails to confirm that antipsychotic polypharmacy worsens QTc prolongation in general, although the evidence is scarce and inconsistent. Clinicians are advised to remain conservative in resorting to antipsychotic polypharmacy, as a combination of some QTc-prolongation liable antipsychotics may further prolong QTc interval, and efficacy supporting the clinical benefits of antipsychotic polypharmacy is equivocal, at best.
Reasons and Determinants for Perceiving Unmet Needs for Mental Health in Primary Care in Quebec
Authors: Dezetter Anne , Duhoux Arnaud , Menear Matthew , Roberge Pasquale , Chartrand Elise , Fournier Louise
Published: January 2017

Objective:

To evaluate the mental health care needs perceived as unmet by adults in Quebec who had experienced depressive and (or) anxious symptomatology (DAS) in the previous 2 years and who used primary care services, and to identify the reasons associated with different types of unmet needs for care (UNCs) and the determinants of reporting UNCs.

Method:

Longitudinal data from the Dialogue Project were used. The sample consisted of 1288 adults who presented a common mental disorder and who consulted a general practitioner. The Hospital Anxiety and Depression Scale was used to measure DAS, and the Perceived Need for Care Questionnaire facilitated the assessment of the different types of UNCs and their motives.

Results:

About 40% of the participants perceived UNCs. Psychotherapy, help to improve ability to work, as well as general information on mental health and services were the most mentioned UNCs. The main reasons associated with reporting UNCs for psychotherapy and psychosocial interventions are “couldn't afford to pay” and “didn't know how or where to get help,” respectively. The factors associated with mentioning UNCs (compared with met needs) are to present a high DAS or a DAS that increased during the past 12 months, to perceive oneself as poor or to not have private health insurance.

Conclusions:

To reduce the UNCs and, further, to reduce DAS, it is necessary to improve the availability and affordability of psychotherapy and psychosocial intervention services, and to inform users on the types of services available and how to access them.
Psychotherapy in Contemporary Psychiatric Practice
Authors: Hadjipavlou George , Hernandez Carlos A Sierra , Ogrodniczuk John S
Published: January 2017

Objective:

American data suggest a declining trend in the provision of psychotherapy by psychiatrists. Nevertheless, the extent to which such findings generalize to psychiatric practice in other countries is unclear. We surveyed psychiatrists in British Columbia to examine whether the reported decline in psychotherapy provision extends to the landscape of Canadian psychiatric practice.

Method:

A survey was mailed to the entire population of fully licensed psychiatrists registered in British Columbia ( n = 623). The survey consisted of 30 items. Descriptive statistics were used to characterize the sample and psychotherapy practice patterns. Associations between variables were evaluated using nonparametric tests.

Results:

A total of 423 psychiatrists returned the survey, yielding a response rate of 68%. Overall, 80.9% of psychiatrists ( n = 342) reported practicing psychotherapy. A decline in the provision of psychotherapy was not observed; in fact, there was an increase in psychotherapy provision among psychiatrists entering practice in the last 10 years. Individual therapy was the predominant format used by psychiatrists. The most common primary theoretical orientation was psychodynamic (29.9%). Regarding actual practice, supportive psychotherapy was practiced most frequently. Professional time constraints were perceived as the most significant barrier to providing psychotherapy. The majority (85%) of clinicians did not view remuneration as a significant barrier to treating patients with psychotherapy.

Conclusions:

Our findings challenge the prevailing view that psychotherapy is in decline among psychiatrists. Psychiatrists in British Columbia continue to integrate psychotherapy and pharmacotherapy in clinical practice, thus preserving their unique place in the spectrum of mental health services.
An Integrated Medical and Psychosocial Treatment Program for Psychotic Disorders: Patient Characteristics and Outcome
Authors: Malla Ashok K , Norman Ross MG , McLean Terry S , Cheng Stephen , Rickwood Ann , McIntosh Elizabeth , Cortese Leonardo , Diaz Kristine , Voruganti LP
Published: January 2017

Objectives:

To provide an overview of a comprehensive and integrated case-management program that incorporates principles of assertive community treatment and combines effective medical and psychosocial interventions and to present the results of a process and outcome evaluation of the program, with particular emphasis on its impact on service utilization and consumer satisfaction.

Method:

Data on demographic, clinical, and several outcome measures were collected on all patients who received care in the program for a minimum of 6 months. For process evaluation we assessed the extent to which the program adhered to its goals and satisfied the patients, their families, and community-service agencies. Outcome-evaluation data on the number and length of hospital admissions were compared for each subject with individual historical data for a period equal to the time spent in the program. In addition, relapses of psychotic symptoms that did not result in hospital admissions were calculated for each patient while in the program.

Results:

Demographic, clinical, and treatment characteristics of clients show that the program has succeeded in maintaining its focus on providing services to relatively chronically ill patients with psychotic disorders over a mean period of 3 years. The process-evaluation data indicated a high level of satisfaction by patients, families, and other service agencies with the services received. Information on outcome variables showed that the program achieved significantly lower rates of hospital admissions and relapse of psychosis than expected. There was a highly significant reduction achieved in the utilization of inpatient hospital resources for patients receiving care in the program. Most of the inpatient service utilization was attributed to patients either who were resistant to treatment with antipsychotic agents or who refused to accept or comply with medication.

Conclusions:

It is possible to provide effective continuity of care from inpatient treatment to community adjustment for most individuals with psychotic disorders across the spectrum by blending hospital and community resources within an integrated case-management model of care.
Relationship between Attachment-Felt Security and History of Suicidal Behaviours in Clinical Adolescents
Authors: West Malcolm L , Spreng Sheila W , Rose Sarah M , Adam Kenneth S
Published: January 2017

Objective:

This study was designed to test the hypothesis that adolescents who perceive their attachment figures as unavailable (low felt security) would be overrepresented in the case group of adolescents with a history of suicidal behaviours.

Method:

One hundred and eighty-seven adolescents in psychiatric treatment participated in this retrospective case-comparison study of attachment-felt security and history of suicidal behaviours. All participants completed the following measures: Adolescent Attachment Questionnaire, Perceived Social Support From Friends Scale, Rosenberg Self-Esteem Scale, Beck Hopelessness Scale, the depression syndrome scale of the Youth Self Report, and Adam's Suicidal Ideation and Behavior protocol.

Results:

The comparison group comprised 101 adolescents who had never experienced suicidal ideation or behaviour; the case group included 86 adolescents with a history of suicidal behaviour. We found that perceived unavailability and high levels of depressive symptomatology were predictive of suicidal behaviours. We also found a strong association between being older and having high levels of angry distress in adolescents with a history of suicidal behaviours.

Conclusion:

The advantage of including an assessment of parent-adolescent attachment with clinical adolescents is noted.
Hospital Days in Risperidone-Treated Patients
Authors: Dickson Ruth A , Dalby J Thomas , Addington Donald , Williams Richard , McDougall Gerald M
Published: January 2017

Objective:

To compare inpatient hospital days of a group of “real world” schizophrenia-spectrum patients for 3 years prior to and 3 years after risperidone initiation.

Method:

This is a retrospective cohort study using a mirror-image design of hospital days in 120 patients over a 6-year period. Hospital admission and discharge information was obtained from chart review and database extraction at 3 outpatient treatment sites. The sample comprised all patients attending these clinics who were prescribed risperidone during the first year of the drug's release.

Results:

Patients separated into 3 treatment groups: those who were prescribed risperidone for 3 uninterrupted years (N = 35), those who interrupted but resumed risperidone use and were prescribed the drug at 3 years (N = 8), and those who discontinued risperidone during the 3-year follow-up period (N = 77). The group continuing risperidone to 3 years demonstrated a significant decrease in hospital days after risperidone treatment, in contrast to the other 2 groups. The reduction in inpatient days for the total sample was not statistically significant.

Conclusion:

In this outpatient clinic sample, the 29% of patients who continued on risperidone showed a significant reduction in inpatient hospital days, from an average of 17.2 days per year in the 3 years before risperidone treatment to an average of 2.1 days per year for the 3 years of risperidone treatment.
Tracheostomy in the ICU
Authors: Conlan A. Alan , Kopec Scott E.
Published: January 2017

The placement of a tracheostomy has become a routine procedure for intensive care unit patients who are mechanical ventilator dependent for a period of time, usually exceeding 1 or 2 weeks. It is vital for the intensivist to be familiar with all aspects of tracheostomies care including the timing of converting a patient to a tracheostomy, types of procedure, risks and benefits, and issues of daily care including oral feedings, speech, and decannulation. In this article we provide a comprehensive review for the intensivist regarding tracheostomies in the intensive care setting. We specifically review indications, timing, surgical options including percutaneous dilation tracheostomy, complications, decannulation, oral feeding, speaking devises, stomal stents, and routine tracheostomy care.
Diagnosis and Management of Pericardial Disease
Authors: Hoit Brian D.
Published: January 2017

The pericardium serves many important functions but is not essential for life. Pericardial heart disease comprises only pericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is affected by virtually every category of disease. Thus the critical care physician is likely to encounter the patient with pericardial disease in a variety of settings, either as an isolated phenomenon or as a complication of a variety of systemic disorders, trauma, or certain drugs. Despite exhaustive etiological lists, the cause of pericardial heart disease is often never identified. This article reviews the diagnosis and management of acute and chronic pericarditis with an emphasis on those areas of greatest interest to the intensivist.
Cognitive Decline, Body Mass Index, and Waist Circumference in Community-Dwelling Elderly Participants
Authors: Rodríguez-Fernández Jorge Mario , Danies Emily , Martínez-Ortega José , Chen William C.
Published: January 2017

Objective:

The aim of this study was to explore the association of body mass index (BMI), waist circumference (WC), and BMI and WC changes over time with cognitive decline in a nationally representative sample.

Methods:

A total of 5239 participants (≥65 years) were followed for 3 years as part of the National Health and Aging Trends Study. Cox proportional hazard regression was applied to model the risk of cognitive decline.

Results:

BMI, after adjusting for WC and main confounders, was associated with reduced risk of cognitive decline (hazard ratio [HR] 0.97 for each unit BMI increase, 0.95-0.99). After stratifying by gender and age, this effect remained significant among females and young elders ≤80 years. A BMI decrease and WC increase >10% over the study period were associated with increased risk of cognitive decline (HR 1.98, 1.16-3.38; HR 1.30, 1.04-1.62, respectively).

Conclusion:

In the elderly individuals, lean mass, as measured by BMI adjusted for WC, was associated with reduced risk of cognitive decline. Loss of lean mass and gain of fat mass, as measured by WC adjusted for BMI, were associated with elevated risk of cognitive decline.
Nonmotor Symptoms in Parkinson Disease: A Descriptive Review on Social Cognition Ability
Authors: Palmeri Rosanna , Lo Buono Viviana , Corallo Francesco , Foti Maria , Di Lorenzo Giuseppe , Bramanti Placido , Marino Silvia
Published: January 2017

Parkinson disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. Nonmotor symptoms include cognitive deficits and impairment in emotions recognition ability associated with loss of dopaminergic neurons in the substantia nigra and with alteration in frontostriatal circuits. In this review, we analyzed the studies on social cognition ability in patients with PD. We searched on PubMed and Web of Science databases and screening references of included studied and review articles for additional citations. From initial 260 articles, only 18 met search criteria. A total of 496 patients were compared with 514 health controls, through 16 different tests that assessed some subcomponents of social cognition, such as theory of mind, decision-making, and emotional face recognition. Studies on cognitive function in patients with PD have focused on executive function. Patients with PD showed impairment in social cognition from the earliest stages of disease. This ability seems to not be significantly associated with other cognitive functions.
Effect of microstructural changes on thermal, electrical, and mechanical properties of HDPE reinforced by sisal fibers
Authors: Abou-Kandil Ahmed I , Shehata AB , Yousef E , El-Sabbagh I , Salem K
Published: January 2017

Chemically modified sisal fibers are used to reinforce high-density polyethylene to seek applications in electrical appliances and car industry requiring light composite materials with superior mechanical and dielectric properties. Conventional methods of chemical modification using sodium hydroxide are used together with new modifications using benzoyl chloride and benzoyl peroxide in order to improve the compatibility between the hydrophilic fiber surface and the hydrophobic polymer matrix. Mechanical properties have been improved by more than 50%, and improved thermal and electrical properties are achieved using the resulting microcomposite material. The resulting microcomposite can accordingly find its way in electrical appliances and in the car industry replacing metallic parts especially those requiring high dielectric constant and superior mechanical properties.
Effect of the initial fiber alignment on the mechanical properties for GMT composite materials
Authors: Song Yuyang , Gandhi Umesh , Koziel Adam , Vallury Srikar , Yang Anthony
Published: January 2017

A glass-mat-reinforced thermoplastic (GMT) material is widely used in the automotive industry for components such as underbody shields, seat structures, front/rear bumper, and front-end modulus. Due to the higher residual length of the glass strands, GMT usually offers better mechanical properties than injection-molded fiber-reinforced thermoplastics. The GMT material is typically manufactured by compression molding (CM) of preimpregnated fibers–reinforced resin sheets called mat. Two types of mats, one with discontinuous random (RD) fibers and other with aligned continuous fibers, are considered in this study. A stack of such mats with different combinations is used to tailor the mechanical properties of the final part. During the CM, the fibers in the mat flow with the resin and change the alignment. In this study, we are presenting an approach to account for the initial condition, such as fiber length, orientation and concentration of the fibers in the mat, and process conditions used, to develop a material model for the finished part. First, a stack of mat with known fiber orientation, length, and concentration as initial conditions is simulated for CM to predict the fiber orientation in the finished part. Next, the material model for the finished parts is developed using a Mori–Tanaka homogenization approach. The fiber orientation in the finished part is mapped from the CM simulation. For the fiber concentration and fiber length distribution, we used an empirical approach. The cross section of the finished part is investigated under optical microscope, and the fiber length and concentration are estimated based on the microstructure and initial stacking of mats. The predicted fiber orientation tensor is verified with orientations measured using computerized tomography (CT) scan on actual parts. The material model is verified by comparing the predicted performance with the actual tensile and bending test results.
Intentions to Participate in Training Among Older Unemployed People
Authors: Sousa-Ribeiro Marta , Sverke Magnus , Coimbra Joaquim Luís , De Witte Hans
Published: January 2017

While a considerable number of studies have focused on factors driving employees to voluntarily participate in training programs, much less is known on this topic with regard to the unemployed population, in particular the older unemployed, who often are in a vulnerable labor market position due to educational deficits and skills obsolescence. This study proposes and investigates a serial mediator model of older unemployed individuals’ training intentions grounded in propositions from social cognitive theory and the theory of planned behavior as well as prior models of employee involvement in training. The results, based on cross-sectional questionnaire data from 176 unemployed Portuguese individuals aged 40+, suggest that age, education, and proactivity have an indirect effect on training intentions via learning self-efficacy and training-related outcome expectations. Age was also directly related to stronger training intentions. These results may be useful for interventions aiming to encourage older unemployed individuals’ participation in training.
Developing Effective Disease State Management Programs
Authors: Hohenleitner Stacy Grant , Minniti Martha Jean
Published: January 2017

Disease state management programs, while still relatively new, are becoming a trend among home health care agencies. The article discusses components of a successful disease state management program, which include focusing on the entire population, addressing all phases of the disease, using well-designed clinical pathways, employing highly qualified and well-trained nurses, providing effective patient education, encouraging active participation by the patient, developing a positive relationship between the physician and nurse and between the nurse and case manager, and telephone intervention. The article also covers controversies about disease state management programs and how to address them.
Caring for Cancer Patients at Home: The Effect on Family Caregivers
Authors: Borneman Tami
Published: January 2017

The purpose of this article is to illustrate the many demands placed on caregivers of cancer patients at home as a result of health care shifting from the acute care setting to the home. Case scenarios are presented from a study in progress, “Pain Education for Elderly Cancer Patients at Home.” Increasingly, caregivers assume responsibility for complex cancer care at home. The cases illustrate the impact of care on quality of life of family caregivers. Nurses can provide support for family caregivers through interventions such as providing respite, ensuring continuity of care, and referring patients to support groups.
Does the Availability of Hospital Beds Affect Utilization Patterns? The Case of End-of-Life Care
Authors: Wilson Donna M. , Truman Corrine D.
Published: January 2017

Hospital downsizing in Canada during the 1990s raised public concern over the availability of hospital care, in addition to heightening administrative interest in improving or maximizing hospital utilization. One ongoing concern about hospital utilization is that a disproportionately large share of hospital resources is used by terminally ill and dying people. A research study using 1992/1993–1996/1997 in-patient abstracts data for the province of Alberta, Canada, was undertaken to explore and describe hospital utilization by dying in-patients. This investigation found only 48.2% of all deaths in Alberta over the five years studied involved hospital in-patients. An 18.5% reduction in the number of in-patient deaths and an 83.3% reduction in length of final stay occurred when 50% of acute care beds were closed, which was followed by an increase when beds began reopening — in terms of both the number of in-patient deaths (4.8%) and the average length of stay (2.6%). The ratio of men to women, the average age of dying in-patients, and the intensity of hospital care changed relatively little over those five years. Most in-patients were admitted for nursing care; in 51.3% of all cases, no diagnostic or therapeutic procedures were performed prior to death. These findings indicate hospital bed availability influences admission to hospital and length of stay, but not treatment decisions affecting seriously ill and dying patients. In addition, reduced length of stay appears to have been a widespread response to hospital downsizing, with this change substantially preserving individual access to hospitals.
Longitudinal Study of Health Maintenance Organization Efficiency
Authors: Rollins James , Lee Kwangsoo , Xu Yihua , Ozcan Yasar A.
Published: January 2017

Longitudinal studies looking at health maintenance organization (HMO) efficiency in the United States have not been performed before this study—previously there have only been small inter-group studies comparing efficiencies. The objectives here were twofold: to analyse HMO efficiency longitudinally, using a data envelopment analysis (DEA) model; and to compare the various types of HMOs and their efficiency using DEA. A cohort of HMOs was followed longitudinally and a number of variables measuring efficiency were studied. Data were derived from the HMO database survey (HCIA Inc.) for 1993–1997. Thirty-six HMOs were followed over a five-year period, and baseline input and output variables were collected. These measures are proxies for efficiency using the DEA methodology. Over all, using the DEA model it was demonstrated that HMOs tended to improve efficiency over time. Independent Practice Association HMOs appeared to show the highest level of improved efficiency. HMO type, profit status, federal eligibility and age were predictive variables for efficiency. Results of this study demonstrate that HMOs are improving efficiency longitudinally, and in general, certain specific models are longitudinally more efficient than others. Moreover, attributes of efficient HMOs have been identified. For policy-makers looking at efficiency, this information can be used to determine which HMO models are more appropriate when trying to achieve cost containment and effectiveness.
Pressures and Constraints on General Management
Authors: Stewart Rosemary
Published: January 2017

A discussion of pressures and constraints on general management is not straightforward. Pressures and constraints can be seen both as external influences and as individually determined. This dual origin is important so that general managers can help themselves, and be helped, to be more in control of their jobs and their environment. Drawing on the findings from the Templeton tracer study of DGMs and from the Templeton DGMs' group, the paper considers a range of possible pressures and constraints on DGMs. It argues that an effective general manager will know which pressures and constraints are external and which are self-imposed and will know which can and should be changed.
Who Decides Which Pharmacy Services are Provided in UK National Health Service Hospitals?
Authors: Cotter S. M. , McKee M. , Strong P. M.
Published: January 2017

An interview survey of 129 UK National Health Service doctors, nurses, pharmacists and managers at eight acute care hospitals was conducted in 1994. The survey examined several topics including whether the introduction of the internal market had affected hospital pharmacy services and what those effects had been. An internal market has been introduced and it has had significant effects on the nature and structure of hospital pharmacy services. Directorate pharmacy services were available at six sites. Contracts for specific, usually novel, services had been implemented at one site and contracts had been introduced widely at another hospital. However, all the features of a market were not present at any site. Market orientation also has implications for the equity of service provision, primarily because decision-making regarding service provision is increasingly in the hands of the clinical directors, rather than pharmacy managers. The effects of this change are not yet clear.
Monitoring Health Care System Performance in Iowa
Authors: Rohrer J. E. , Vaughan M.
Published: January 2017

Monitoring the performance of the health care delivery system is a public health function that becomes more important as organized delivery systems begin to take control over large portions of the medical care market. The study reported here illustrates how standard medical care epidemiology can be applied to analysis of health care system performance to aid governmental efforts to monitor new developments in the medical care market. In order to evaluate the efficiency of hospital care delivered in Iowa, age- and sex-adjusted population admission rates for five common procedures were generated for all 99 counties. The five common procedures were defined as follows: hernia, tonsillectomy, cesarean section, hysterectomy, and cholecystectomy. In addition, variations in 11 ambulatory care-sensitive condition rates were analyzed. Residents of at least 15 counties were at significantly greater than average risk for receiving each of the common procedures (χ2 test, P < 0.05). Counties that had a high rate for one procedure tended to have a high rate for at least one other procedure. Several counties had more than twice the mean rate. Even a 10% reduction, when added across all five common procedures, amounts to well over 2000 hospitalizations avoided. It is assumed that reductions would be concentrated in high-rate counties. If a 50% reduction could be achieved in only part of the ambulatory care-sensitive procedures, more than 10 000 hospital admissions could be avoided.
Toward a Systems Quality Paradigm: Relating Health Outcomes, Resource Expenditures, and Appropriateness of Cholecystectomy Patients
Authors: Bradbury R. C. , Golec J. H. , Steen P. M.
Published: January 2017

This study addresses the question for cholecystectomy patients of whether there is an association among manifesting better health outcomes and the quantity of hospital resources consumed when the appropriateness of this surgery is also considered. 10 043 cholecystectomies performed by 218 surgeons in 43 Pennsylvanian hospitals are analysed using data from an administrative data set. Performance measures are adjusted for admission severity of illness and other patient variables. The results demonstrate a statistically significant positive association between adjusted hospital total charges and adjusted morbidity controlling for whether specified clinical criteria are met that validate the need for a cholecystectomy. This study illustrates a systems quality paradigm wherein performance is examined in terms of health outcomes, appropriateness and resource expenditures, as well as the relationships among these three dimensions.
The Use of ‘Expectation Enactment’ as a Conceptual Framework for Assessing Managerial Effectiveness: An NHS Hospital Trust Example
Authors: Willcocks S.
Published: January 2017

This paper examines managerial effectiveness in the National Health Service, utilizing a conceptual framework devised by Fondas and Stewart (1994) which focuses upon the concept of ‘expectation enactment’. The conceptual framework is applied to a National Health Service trust; more specifically, it is used to examine the managerial effectiveness of clinical managers at this trust.

The data for this paper is derived from a larger qualitative study of three NHS case studies. The data was collected from a series of in-depth interviews with clinical managers and general managers. In one of these case studies, part of the analysis was undertaken utilizing concepts put forward by Fondas and Stewart (1994). These will form the basis of this paper.
The Costs of Quality: An Interactive Model of Appraisal, Prevention and Failures
Authors: Broyles R.W. , Al-Assaf A.F.
Published: January 2017

The control of spending on health care while improving or maintaining quality is one of the most difficult problems confronting policy analysts. In this paper hypothetical data and an Excel spreadsheet are used to develop a model that estimates the costs of quality management. The focus is on the interaction between appraisal costs, prevention costs and the costs of failures. This approach enables the health service organization to estimate the costs associated with each of the three components and to assess the influence of appraisal and prevention on failure costs. The article concludes with a discussion of methods that might be used to assemble the required data and the benefits that might be derived by adopting the model.
The Lion, the Honey, and the New Timnite Woman: Joseph and Aseneth and the Samson Cycle
Authors: Brenna Christopher
Published: January 2017

This study presents a solution for the symbol of the honeycomb employed in Joseph and Aseneth, an ancient Hellenistic Jewish novel, by recognizing signals throughout the rest of the narrative that point to an allegorical reading of Samson's encounter with the lion in Judg. 14.5–9. The thesis is that the author of Joseph and Aseneth is providing an allegorical reading of Judg. 14.5–9, where Samson is a type of wayward Israel and the Timnite woman represents foreign domination. The lion and the honey are interpreted as symbols of Samson's subsequent victory over his Philistine foes, and this symbolical movement is applied to Aseneth's transformed identity. Aseneth is a new Timnite woman and Joseph is a new Samson, reconfigured to triumph over her seductive influence. Parallels are drawn between a constructed allegorical reading of the Samson cycle and the encounter of Aseneth with Joseph and later with the heavenly man. The theological themes upon which such a reading relies are discussed.
Free vibration characteristics of delaminated composite pretwisted stiffened cylindrical shell
Authors: Rout Mrutyunjay , Hota Sasank Shekhara , Karmakar Amit
Published: January 2017

Effects of delamination on free vibration characteristics of laminated stiffened cylindrical shells with pretwist are analyzed by finite element method. The investigation is carried out using an eight-noded quadratic isoparametric shell element, which incorporates the transverse shear deformation and rotary inertia along with a three-noded beam element for the stiffener. The multipoint constraint algorithm has been included to guarantee the compatibility of deformation, equilibrium of resultant forces, and moments at delamination crack tip. The general dynamic equilibrium equation is derived from Lagrange’s equation of motion for moderate rotational speeds for which the Coriolis effect is neglected. The standard eigenvalue problem is solved utilizing QR iteration algorithm. The accuracy of the present formulation is validated with benchmark solutions is available in the literature. The present work concerns about the effects of delamination, fiber orientation, twist angle, stiffener depth-to-shell thickness ratio, and rotational speed on the fundamental frequency of shallow cylindrical shells with stiffener. Representative mode shapes for some typical case of the stiffened shell for different twist angles and rotational speeds are also presented.
Application of monotonic adaptive kernel for optimization: A case study
Authors: Abid Muhammad , Hussain Masroor , Khan Ayesha , Wajid Hafiz A
Published: January 2017

Optimization is considered to be the integral part of designing a wide range of engineering solutions. Manual optimization is a hectic job to obtain desired optimized results using hit and trial method. Monotonic adaptive kernel algorithm optimizes the solution to the target stress by using linear interpolation function and checking current values on every iterative step and computing differential load. Using monotonic adaptive kernel algorithm, numerical simulations are conducted on gasketed bolted flange pipe joints to achieve required preload in the bolts as per industrial guidelines for their optimized performance. It is observed that the monotonic adaptive kernel algorithm produces more accurate and fast results conforming to the desired target values as compared to the manual and semiautomatic optimization techniques implemented for the gasketed bolted flange pipe joint.
The influence of iron oxides on wheel–rail contact: A literature review
Authors: Zhu Yi
Published: January 2017

In contrast to other third-body layers – such as water, oil, sand, and leaves – iron oxides exert a constant influence on the friction and wear of wheel–rail contact. However, studies that focus on the influence of iron oxides have not been conducted systematically until the 21st century. This study is a comprehensive presentation of early and recent research works related to the influence of iron oxides on the wheel–rail contact. The characteristics of iron oxides in general and those between railway wheels and rails are discussed. A comparison of various laboratory tests and their relation to actual conditions is also presented. The authors find that the influence of various types of iron oxides on friction and adhesion differs. The thickness of the iron oxide layer also affects the friction and wear. However, the results obtained from laboratory rigs differ from those obtained in field testing. Therefore, it is critical to formulate a standard procedure that produces iron oxides that are similar to those observed in the field. Compared to the case of wheel–rail friction and adhesion, the influence of iron oxides on wear is not so well investigated. Thus, further research in those areas is warranted.
Heterosexually Acquired Human Immunodeficiency Virus Infection in Women in Copenhagen: Sexual Behaviour and other Risk Factors
Authors: Smith E , Kroon S , Gerstoft J , Kvinesdal B , Mathiesen L R
Published: January 2017

In order to describe the risk pattern including sexual behaviour among HIV-infected women in Copenhagen we studied the charts of all women tested seropositive between January 1985 and August 1988 in the three main hospitals handling HIV/AIDS. One hundred and fifteen women were positive for HIV antibodies: 35 (31%) were infected by heterosexual contact and 63 (55%) were intravenous drug users. Among the heterosexually transmitted cases 25 (71%) had intercourse with a man from a high risk group and nine women had intercourse with a known HIV antibody positive man without known risk factors. Use of condoms was claimed by 31% of the heterosexually-transmitted women before the HIV test, and by 74% ( P=0.002) after the test.

In 1988 73% of the women tested HIV positive were infected by heterosexual contact, in 1985 only 14%. We conclude that among HIV infected women in Copenhagen heterosexual transmission is a problem. These women seem to change sexual behaviour when informed about HIV positivity.
Aetiology of Non-Gonococcal Urethritis: A Possible Relation to other Infections
Authors: Mitchell S A , Shukla S R , Thin R N
Published: January 2017

Chlamydia trachomatis can be identified in up to 60% of cases of non-gonococcal urethritis (NGU) and the aetiology of most of the remainder is obscure. This paper reports a role for other genitourinary (GU) infections such as candidiasis, warts and herpes simplex, in the causation of NGU. One hundred and ten men fulfilled the entry criteria which included the probability that their contacts would attend the department. Fifty-four of the 110 men had GU infections other than NGU; 56 had no other infections. NGU was detected in 31 (57%) of cases with other GU infections and 8 (26%) were chlamydiae-positive: in contrast NGU was found in only 10 (18%) of those with none of the other infections and 3 (30%) were chlamydiae-positive. Chlamydiae-negative NGU was, therefore, more common in those with other GU infections. Forty-five (86%) of 52 contacts of 41 patients with NGU had various GU infections such as candidosis and anaerobic vaginosis, in contrast with other GU infections in only 7 (23%) of 30 contacts of men with no other GU infections. Other GU infections in patients and their contacts appeared significantly related to the presence of chlamydiae-negative NGU.
Single-Dose Therapy of Anogenital and Pharyngeal Gonorrhoea with Ciprofloxacin
Authors: Balachandran T , Roberts A P , Evans B A , Azadian B S
Published: January 2017

A single dose of ciprofloxacin, 250 mg by mouth, was used in an open study to treat pharyngeal or rectal gonorrhoea or both in 64 patients (32 men and 32 women). The study also included 151 men with urethral gonorrhoea and 53 women with cervical or urethral gonorrhoea.

Ciprofloxacin cured 63 (98%) patients with pharyngeal or rectal gonorrhoea (including 5 patients with penicillinase-producing Neisseria gonorrhoeae; PPNG), 147 (97%) men with urethral gonorrhoea (including 8 with PPNG) and 52 (98%) women with cervical or urethral gonorrhoea. All the isolates of N. gonorrhoeae were sensitive to 0.03 mg/l of ciprofloxacin. Five of the 6 patients with treatment failure were subsequently cured by a single oral dose of ciprofloxacin 250 mg. None of the patients reported an adverse reaction.

Ciprofloxacin 250 mg as a single oral dose is effective and safe in treating patients with pharyngeal or rectal gonorrhoea, including those with PPNG strains.
Predictors of AIDS Knowledge, Condom use and High-Risk Sexual Behaviour among Women in Dar-Es-Salaam, Tanzania
Authors: Kapiga Saidi H , Lwihula George K , Shao John F , Hunter David J
Published: January 2017

Reducing the number of sex partners and using condoms are the major means for individuals to protect themselves from STDs and AIDS in sub-Saharan Africa. To identify predictors of having only one sex partner in the last year and to assess knowledge and use of condoms among women of reproductive age in Dar-es-Salaam, Tanzania, we interviewed 2285 women at 3 representative family planning clinics between February 1991 and June 1992. After interview, blood and genital specimens were collected for laboratory diagnosis of HIV and other sexually transmitted diseases (STDs). Although knowledge of sexual transmission of AIDS was very high, less than a half of the respondents (42.8%) mentioned use of condoms as an AIDS preventive measure. Younger and more educated women were more likely to mention use of condoms for AIDS prevention, however only 4.6% of women interviewed were regular users of condoms, while 19.8% were occasional users. The majority of women who had never used a condom (57.5%) reported not using condoms because ‘men did not like them’. Condom use was positively associated with increasing level of education and increasing number of sexual partners. 14.8% of women reported having more than one sex partner in the last year; this behaviour was more likely among cohabiting women (increased by 210%); HIV-positives (increased by 120%); and among women with STDs (increased by 50%). The fact that condom use was positively associated with factors previously shown to be risk factors for HIV in this population suggests that AIDS prevention activities have been partially successful in reaching women at risk. However, condoms were still only used by a minority of women in the high-risk strata of these risk factors. Men's negative attitude about condoms was identified as the major reason for low condom usage; interventions aiming at increased condom use need to target male attitudes.
Outreach STD Clinics for Prostitutes in Edinburgh
Authors: Scott G R , Peacock W , Cameron S
Published: January 2017

This paper describes the establishment of Genito-Urinary Medicine outreach clinics based in 2 drop-in centres for female prostitutes in Edinburgh; 242 women have received medical care at these outreach clinics. STD screening has been carried out on 160 (63%), detecting one case of gonorrhoea, 11 cases of chlamydia, 11 cases of genital warts, and 2 cases of recurrent genital herpes. With regards to HIV serostatus, 8 women were already known to be HIV seropositive and 18 were known to be seronegative. One hundred and fifteen women have been tested at the outreach clinics, yielding one positive result. The serostatus of 91 women is unknown. There have been 42 pregnancies, some of which were conceived through client contact. The prevalence of STDs including HIV is low and would suggest that condom usage is high. However, this level of usage is associated with significant numbers of unwanted pregnancies. Prostitutes in Edinburgh do not appear to act as a significant focus for dissemination of HIV infection.
Female Sexual Health Problems in a Drug Dependency Unit
Authors: Morrison Clive L , Ruben Susan M , Beeching Nick J
Published: January 2017

The Government of the United Kingdom has produced a strategic plan called the Health of the Nation aimed at achieving better health in key areas including a reduction in rates of unwanted pregnancies, sexually transmitted diseases and cervical cancer.

Conventional health care systems fail some groups with special needs. This cross-sectional interview study was undertaken to determine the level and type of contraceptive use, and the attitudes of female opiate abusers to the use and availability of contraceptives and cytology services. The subjects were 201 opiate-dependent women enrolled in a methadone maintenance programme in a large drug dependency unit: 169 (84.5%) were sexually active and 65 (44.2%) of non-pregnant sexually active women did not use a contraceptive method. Thirty-six (43.9%) of those using a contraceptive were using condoms, with which the majority were dissatisfied. Sixty-one (30.3%) had never had a cervical cytology smear and of those who had, 21.4% reported an abnormal result.

The contraceptive practices and uptake of cervical screening services by the women studied are inadequate, reflecting poor use of conventional health care services. In addition to providing information on safer sexual practices, particularly promotion of condom use, we suggest that drug dependency units should expand their role to provide educational and preventative services to include aspects of women's health.
Clinical Parameters Associated with Recalcitrant Oral Candidosis in HIV Infection: A Preliminary Study
Authors: McCreary C , Bergin C , Pilkington R , Kelly G , Mulcahy F
Published: January 2017

Clinical resistance in oropharyngeal candidosis is an increasingly significant management problem in HIV-seropositive patients. This study was undertaken to identify predisposing risk factors including the isolation of particular species of Candida which may be associated with the development of clinical resistance. The effect of particular antifungal prescribing regimens was also assessed.

Data were compiled by chart review of 2 groups, each of 10 HIV-seropositive CDC stage IV patients with recurrent oropharyngeal candidosis.

All patients had swabs taken at intervals during treatment and all Candida isolates were species typed. The patients in group 1 exhibited Candida infections which did not respond clinically to standard therapeutic regimens. The second patient group did respond to standard oral antifungal therapies.

An association was found between the frequent utilization of azoles, particularly fluconazole and the development of clinically resistant oral candidosis. The number of Candida isolates grown from the initial swab was also significantly related to the development of resistance.
Private Costs Associated with Abdominal Aortic Aneurysm Screening: The Importance of Private Travel and Time Costs
Authors: Bryan Stirling , Buxton Martin , McKenna Mike , Ashton Hilary , Scott Alan
Published: January 2017

Objectives —

To assess the importance of the private costs incurred by patients when making a judgment on the economics of screening for abdominal aortic aneurysm (AAA), and to explore the variation in such costs depending on screening location.

Setting —

A district general hospital and general practitioner surgeries.

Methods —

Four hundred and ninety nine consecutive subjects attending for AAA screening completed a questionnaire asking about travel arrangements for the journey to and from the clinic, the distance travelled, the time taken, the mode of transport, and any out-of-pocket expenses incurred. In addition, at the clinic each subject was asked what activities they had forgone in attending the clinic. Time was valued differently depending on whether work or leisure activities were forgone. The total private cost for each attender was calculated and comparison was made between attenders at hospital and at general practice.

Results —

A significantly greater proportion of subjects were accompanied when attending hospital than when attending general practitioner (GP) surgeries. Most attenders travelled by car, but the journey time was significantly longer for those visiting hospital. The expected total private cost associated with attendance for AAA screening was £5.47. Attendance at GP surgeries had a lower private cost (£4.21) than attendance at hospital (£6.87). Only 7·3% of all men surveyed, and 6·5% of all companions, would have been taking part in some form of paid occupation if they had not attended for screening.

Conclusion —

Despite the fact that most attenders for AAA screening will be retired, the associated private costs are appreciable and should be considered in assessing the economics of such screening programmes. The level of private costs varied depending on the location of screening: clinics held at GP practices had lower private costs than those held at hospital.