bluuebunny/crossref_metadata_2025 huggingface dataset:
Komplementäre und Integrative Medizin in der Facharztweiterbildung Allgemeinmedizin: Ergebnisse einer Bedarfserhebung bei Ärzten in Weiterbildung
Authors: Valentini Jan , Flum Elisabeth , Schwill Simon , Krug Katja , Szecsenyi Joachim , Joos Stefanie
Published: July 2018

Hintergrund: Inhalte aus den Bereichen der klassischen Naturheilverfahren und Komplementärmedizin sind im Rahmen der ärztlichen Approbationsordnung curricular verankert. Im Gegensatz dazu werden in den Weiterbildungsordnungen zum Facharzt für Allgemeinmedizin keine komplementärmedizinischen Inhalte abgebildet. Bisher ist nicht bekannt, ob Ärzte in Weiterbildung (ÄiW) zum Facharzt für Allgemeinmedizin innerhalb ihrer Weiterbildung mit komplementärmedizinischen Verfahren in Kontakt kommen und ob sie solche erlernen bzw. erlernen möchten. Das Ziel der vorliegenden Studie war die Erhebung der Einstellung zum und des Weiterbildungsbedarfs im Bereich Komplementärmedizin bei ÄiW zum Facharzt für Allgemeinmedizin. Methoden: In Rahmen einer Querschnittsstudie erfolgte eine Fragebogen-gestützte Umfrage unter ÄiW zum Facharzt für Allgemeinmedizin innerhalb des Weiterbildungsprogramms «Verbundweiterbildungplus Baden-Württemberg». Diese wurde onlinebasiert initiiert und durch eine papierbasierte Umfrage komplettiert. Ergebnisse: Insgesamt nahmen 138 Teilnehmer der Verbundweiterbildungplus Baden-Württemberg an der Umfrage teil. Der Gesamtrücklauf betrug damit 28%. Dabei zeigte sich, dass die Teilnehmenden ein hohes Interesse an Komplementärmedizin hatten. Gleichzeitig gaben sie an, Unsicherheiten sowohl inhaltlicher als auch formaler Art wahrzunehmen (z.B. Evidenz der einzelnen Methoden und Kostenübernahme durch gesetzliche Krankenkassen). Die große Mehrheit der befragten Ärzte befürwortete, dass in der Weiterbildung zum Facharzt Allgemeinmedizin Kompetenzen aus dem Bereich Komplementärmedizin vermittelt werden. Schlussfolgerungen: Vor dem Hintergrund der weiten Verbreitung komplementärmedizinischer Methoden im hausärztlichen Alltag muss diskutiert werden, ob im Rahmen der Weiterbildung zum Facharzt für Allgemeinmedizin Basiskompetenzen für diesen Bereich definiert werden sollten. Diese könnten beispielsweise in das «Kompetenzbasierte Curriculum Allgemeinmedizin» der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM) einfließen.
Management of Infectious Complications Associated with Acute-on-Chronic Liver Failure
Authors: Engelmann Cornelius , Berg Thomas
Published: July 2018

Introduction: Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods: This review focuses on the best management strategies for patients with ACLF and infections. Using the following terms, an extensive literature research on the Medline database was performed: ‘acute-on-chronic liver failure', ‘infection', ‘ACLF', ‘bacteria', ‘multi-resistance'. Results: Analysis of the literature confirmed that delayed diagnosis and treatment of infections in patients with ACLF results in a poor prognosis. Patients with ACLF should be considered as having a potential infection and should undergo a complete screening for sepsis. Once biochemical analysis indicates a potential infection, such as abnormal levels of C-reactive protein and procalcitonin, antibiotic treatment should be initiated immediately without microbiological culture results. For community-acquired infections third-generation cephalosporins are still the first choice, whereas in the nosocomial setting antibiotics with broader spectrum, such as piperacillin/combactam or carbapenems ± glycopeptides, are preferred. The patient should be re-assessed 48 h after treatment initiation in order to tailor the treatment. Non-response is suspicious, likely due to bacterial resistance or fungal infection, which should be considered when choosing further treatment strategies. Albumin substitution to prevent hepatorenal syndrome and to improve patients' outcome is mandatory in patients with spontaneous bacterial peritonitis. Prophylactic antibiotic therapy is suitable to prevent infections in high-risk patients. Conclusion: The screening for infections and its treatment is an essential part of managing patients with ACLF. In order to improve patients' prognosis, antibiotic treatment should be initiated once an infection is suspected. However, preventive strategies are already established and should be applied according to the guidelines.
Characteristics and Outcomes of Kidney Transplant Recipients with a Functioning Graft for More than 25 Years
Authors: Parajuli Sandesh , Mandelbrot Didier A. , Aziz Fahad , Garg Neetika , Muth Brenda , Mohamed Maha , Armbrust Michael J. , Astor Brad C. , Djamali Arjang
Published: July 2018

Background: Information regarding the clinical characteristics and outcomes of kidney transplant recipients (KTRs) with > 25 years of graft survival is limited. Methods: In this single-center observational study, we characterized KTRs transplanted between 1973 and 1992 with active follow-up as of July 31, 2017. Results: We identified 112 patients with > 25 years of allograft function. The mean posttransplantation follow-up was 29.8 ± 4.0 years. Glomerulonephritis was the most common cause of end-stage renal disease (ESRD) (52%). The majority received live donor transplants (66%), including 25 patients (22%) with human leukocyte antigen-matched kidneys. The incidence of biopsy-confirmed acute rejection was 21%, ranging from 0 to 26 years post transplantation. Donor-specific antibodies (DSA) were checked in 80% of patients at a mean of 28.4 ± 0.11 years post transplantation. Of these, only 15% were positive. The incidence of malignancy was 44%, with nonmelanoma skin cancers being most common. The incidence of infectious complications was 77%, mostly represented by urinary tract infections. At the time of last follow-up, 63% were on a calcineurin inhibitor (CNI)-free regimen, mean serum creatinine was 1.4 ± 0.6 mg/dL, and the prevalence of hypertension and dyslipidemia was 89 and 88%, respectively. Conclusion: The majority of patients with a long-term functioning graft had glomerulonephritis as cause of ESRD, had received a live donor kidney, were on a CNI-free regimen, and had a low incidence of DSA and opportunistic infections. These characteristics define a unique group of patients requiring specific posttransplantation monitoring and management.
Introduction
Authors: Gruber Christiane
Published: July 2018

This special issue of Middle East Journal of Culture and Communication, entitled ‘Creative Dissent: Visual Arts of the Arab World Uprisings’, explores the artistic modes of dissent that have marked the uprisings during and in the aftermath of the so-called ‘Arab Spring’. Scholars working in various fields of the humanities consider the 2011 uprisings’ more creative—and rather fleeting—manifestations, from lived environments activated on the ground to imagined spaces generated by online platforms. Collectively, the contributors underscore that the visual arts of the Arab world uprisings should not be considered by-products or afterthoughts to social and political action. Instead, they are located at the core and at the vanguard, propelling the energetic dimension of crowds both in the streets and in cyberspace.
Observing Clouds in 4D with Multiview Stereophotogrammetry
Authors: Romps David M. , Öktem Ruşen
Published: July 2018

Newly installed stereo cameras ringing the Southern Great Plains (SGP) Atmospheric Radiation Measurement (ARM) site in Oklahoma are providing a 4D gridded view of shallow clouds. Six digital cameras have been installed in pairs at a distance of 6 km from the site and with a spacing of 500 m between cameras in a pair. These pairs of cameras provide stereoscopic views of shallow clouds from all sides; when these data are combined, they allow for a complete stereo reconstruction. The result—the Clouds Optically Gridded by Stereo (COGS) product—is a 4D grid of cloudiness covering a 6 km × 6 km × 6 km cube at a spatial resolution of 50 m and a temporal resolution of 20 s. This provides a unique set of data on the sizes, lifetimes, and life cycles of shallow clouds. This type of information is critical for developing cloud macrophysical schemes for the next generation of weather and climate models.
Creativity at the Knowledge Frontier: The Impact of Specialization in Fast- and Slow-paced Domains
Authors: Teodoridis Florenta , Bikard Michaël , Vakili Keyvan
Published: July 2018

Using the impact of the Soviet Union’s collapse on the performance of theoretical mathematicians as a natural experiment, we attempt to resolve the controversy in prior research on whether specialists or generalists have superior creative performance. While many have highlighted generalists’ advantage due to access to a wider set of knowledge components, others have underlined the benefits that specialists can derive from their deep expertise. We argue that this disagreement might be partly driven by the fact that the pace of change in a knowledge domain shapes the relative return from being a specialist or a generalist. We show that generalist scientists performed best when the pace of change was slower and their ability to draw from diverse knowledge domains was an advantage in the field, but specialists gained advantage when the pace of change increased and their deeper expertise allowed them to use new knowledge created at the knowledge frontier. We discuss and test the roles of cognitive mechanisms and of competition for scarce resources. Specifically, we show that specialists became more desirable collaborators when the pace of change was faster, but when the pace of change was slower, generalists were more sought after as collaborators. Overall, our results highlight trade-offs associated with specialization for creative performance.
Book Review: Kiran Keshavamurthy, Beyond Desire: Sexuality in Modern Tamil Literature
Authors: Govind Nikhil
Published: July 2018

Kiran Keshavamurthy, Beyond Desire: Sexuality in Modern Tamil Literature, New Delhi: Oxford University Press, 2016, 197 pp.
Book Review: Mahesh Rangarajan and K. Sivaramakrishnan, eds, Shifting Ground: People, Animals and Mobility in India’s Environmental History and Mahesh Rangarajan, Nature and Nation: Essays on Environmental History
Authors: Kumar Mayank
Published: July 2018

Mahesh Rangarajan and K. Sivaramakrishnan, eds, Shifting Ground: People, Animals and Mobility in India’s Environmental History, New Delhi: Oxford University Press, 2014, 310 pp.; and Mahesh Rangarajan, Nature and Nation: Essays on Environmental History, Ranikhet: Permanent Black in association with Ashoka University, 2015, 346 pp.
Environmental Protection and Regulations in India: Role of the Central Pollution Control Board
Authors: Chand Prakash
Published: July 2018

Since independence, Indian policymakers have attempted to address environmental problems by passing a number of rules and regulations as per the vision of the constitution and in response to the requirement of time. However, due to the prevalent poverty and the developmental compulsions of the nation, environment and its protection was not a priority of the government till the end of the 1960s. But, the 1972 Stockholm Conference on Human Environment brought a marked shift in India’s approach to environmental issues. The conference proved to be a turning point in India’s perception on environment and facilitated the creation of the National Committee on Environmental Planning and Co-ordination (NCEPC) in 1972. The NCEPC triggered a rise in environmental legislation, beginning with the Water (Prevention and Control of Pollution) Act of 1974, which provided for the creation of Pollution Control Boards for the control of water pollution at national and state levels and empowered them to enforce the law. The boards were later empowered to deal with air pollution by Air (Prevention and Control of Pollution) Act of 1981 and acted as regulatory mechanisms to environmental protection. This article primarily deals with the role of the Central Pollution Control Board as a regulatory authority to environmental protection and regulations in India.
When life gives you lemons: Frank Meyer, authority, and credit in early twentieth-century plant hunting
Authors: Chacko Xan Sarah
Published: July 2018

In the early twentieth century, the United States Department of Agriculture (USDA) funded international expeditions with the aim of finding plant specimens for introduction into the agricultural landscape and the new experimental projects in hybridization. One such agricultural explorer, noted for his eponymous lemon, was Frank Nicholas Meyer, an immigrant from the Netherlands whose expeditions in Asia have brought to the United States celebrated fruit and toxic weeds. Neither professional botanists nor farmers, plant hunters like Meyer worked by taking advantage of historical allegiances to academic programs, while leaning on the authority of their newer national institutions. In addition to plants, through photographs that transposed Chinese landscapes to U.S. environmental counterparts, Meyer contributed to the imagination of the agricultural promise of the American West. The era of these plant explorers has ended but their material trace remains in a variety of spaces and modes of existence that have hitherto been disregarded. Reading Meyer’s letters shows the authority and discipline behind his transformation from gardener’s apprentice to professional plant collector. I argue that photographs and plants are understudied material traces that enable historians to re-examine the means by which credit was received, given, and exchanged. By drawing together these traces, I chart the continued importance of exploration and collection in the twentieth century and show the epistemic continuity between nineteenth-century natural history and twentieth-century experimental science.
Pure delta-9-tetrahydrocannabinol and its combination with cannabidiol in treatment-resistant Tourette syndrome: A case report
Authors: Pichler Eva-Maria , Kawohl Wolfram , Seifritz Erich , Roser Patrik
Published: July 2018

Objectives

Anecdotal reports and preliminary studies suggest a therapeutic potential of cannabis in Tourette syndrome. We report the case of a female patient suffering from treatment-resistant Tourette syndrome.

Methods

Guideline-directed antipsychotic treatment with risperidone and aripiprazole as well as pure delta-9-tetrahydrocannabinol had no significant effect on Tourette syndrome symptomatology.

Results

Following administration of a daily dosage of 10 mg delta-9-tetrahydrocannabinol combined with 20 mg cannabidiol (CBD), the patient showed a rapid and highly significant improvement in the Yale Global Tic Severity Scale.

Conclusions

It can be speculated whether the beneficial effects may rely on the pharmacological properties of cannabidiol.
The effects of vestibular rehabilitation on dizziness and balance problems in patients after traumatic brain injury: a randomized controlled trial
Authors: Kleffelgaard Ingerid , Soberg Helene Lundgaard , Tamber Anne-Lise , Bruusgaard Kari Anette , Pripp Are Hugo , Sandhaug Maria , Langhammer Birgitta
Published: July 2018

Objective:

To investigate the effects of group-based vestibular rehabilitation in patients with traumatic brain injury.

Design:

A single-blind randomized controlled trial.

Setting:

University Hospital (recruitment and baseline assessments) and Metropolitan University (experimental intervention).

Subjects:

A total of 65 patients (45 women) with mild-to-moderate traumatic brain injury (mean age 39.4 ± 13.0 years) were randomly assigned to intervention ( n = 33) or control group ( n = 32).

Intervention:

Group-based vestibular rehabilitation for eight weeks. Participants were tested at baseline (3.5 ± 2.1 months after injury) and at two post-intervention follow-ups (2.7 ± 0.8 and 4.4 ± 1.0 months after baseline testing).

Main measures:

Primary outcome: Dizziness Handicap Inventory. Secondary outcome: High-Level Mobility Assessment Tool. Other outcomes: Vertigo Symptom Scale; Rivermead Post-concussion Symptoms Questionnaire; Hospital Anxiety and Depression Scale; and Balance Error Scoring System. Between-group differences were analyzed with a linear mixed-model analysis for repeated measurements.

Results:

At baseline, no group differences were revealed (personal factors, clinical characteristics and outcome measures). At the first follow-up, statistically significant mean differences in favor of the intervention were found in the primary (−8.7, 95% confidence interval (CI): −16.6 to −0.9) and secondary outcomes (3.7 points, 95% CI: 1.4–6.0). At the second follow-up, no significant between-group differences were found. No significant between-group differences in the other outcomes were found at the two follow-ups.

Conclusion:

The intervention appeared to speed up recovery for patients with dizziness and balance problems after traumatic brain injury. However, the benefits had dissipated two months after the end of the intervention.
Differences in primary palliative care between people with organ failure and people with cancer: An international mortality follow-back study using quality indicators
Authors: Penders Yolanda WH , Onwuteaka-Philipsen Bregje , Moreels Sarah , Donker Gé A , Miccinesi Guido , Alonso Tomás Vega , Deliens Luc , Van den Block Lieve
Published: July 2018

Background:

Measuring the quality of palliative care in a systematic way using quality indicators can illuminate differences between patient groups.

Aim:

To investigate differences in the quality of palliative care in primary care between people who died of cancer and people who died of organ failure.

Design:

Mortality follow-back survey among general practitioners in Belgium, the Netherlands, and Spain (2013–2014), and Italy (2013–2015). A standardized registration form was used to construct quality indicators regarding regular pain measurement, acceptance of the approaching end of life, communication about disease-related topics with patient and next-of-kin; repeated multidisciplinary consultations; involvement of specialized palliative care; place of death; and bereavement counseling.

Setting/participants:

Patients (18+) who died non-suddenly of cancer, cardiovascular disease, or respiratory disease ( n = 2360).

Results:

In all countries, people who died of cancer scored higher on the quality indicators than people who died of organ failure, particularly with regard to pain measurement (between 17 and 35 percentage-point difference in the different countries), the involvement of specialized palliative care (between 20 and 54 percentage points), and regular multidisciplinary meetings (between 12 and 24 percentage points). The differences between the patient groups varied by country, with Belgium showing most group differences (eight out of nine indicators) and Spain the fewest (two out of nine indicators).

Conclusion:

People who died of organ failure are at risk of receiving lower quality palliative care than people who died of cancer, but the differences vary per country. Initiatives to improve palliative care should have different priorities depending on the healthcare and cultural context.
Evaluation of Treatment and Other Factors That Lead to Drug Court Success, Substance Use Reduction, and Mental Health Symptomatology Reduction Over Time
Authors: Baughman Margaret , Tossone Krystel , Singer Mark I. , Flannery Daniel J.
Published: July 2018

Adults presenting with substance use and mental health disorders in the criminal justice system is well documented. While studies have examined drug courts and medication-assisted treatment (MAT), few have examined social and behavioral health indicators, and even fewer have multiple study periods. This study employed a comprehensive approach to studying the MAT contribution to drug court success; reduce substance use, mental health symptoms, and risky behaviors; and the role that violence or trauma plays in mental health symptomatology. Using three time points, our findings indicated that MAT did not play a significant role in the reduction of substance use, risky behaviors, or mental health symptoms or increasing the odds of successful court graduation. However, there was an overall improvement from intake to termination in reduction of substance use, risky behaviors, and mental health symptomatology. Other factors, including social support, may play a role in drug court graduation. Policy implications are discussed.
Measuring orthotropic bending stiffness components of Pinus pinaster by the virtual fields method
Authors: Xavier José , Pierron Fabrice
Published: July 2018

Orthotropic stiffness components of Pinus pinaster Ait. wood are simultaneously determined by means of a heterogeneous plate bending test. The proposed inverse identification approach couples full-field slope measurements provided by deflectometry with the virtual fields methods. Wooden plates oriented in the longitudinal–radial and longitudinal–tangential material planes were manufactured. A procedure was implemented to allow suitable specular reflective coating of the wooden plates, required in the deflectometry technique. Reconstructed curvature fields, applied load and plate dimensions were input in virtual fields methods for material parameter identification, assuming Kirchhoff–Love classical plate theory. Several virtual fields and load cases were analysed to address the identifiability of the method. The values of the orthotropic elastic constants obtained from the proposed approach were found in good agreement with regard to reference ones for the same species and determined from classical tensile, compression and shear mechanical tests.
Development of a Transparent Framework for Pre-Procurement Evaluation of Public–Private Partnership Project Delivery Options
Authors: DeCorla-Souza Patrick
Published: July 2018

This paper reviews value for money (VfM) analyses conducted in the United States to gain an understanding of methods used in addressing key issues in VfM analyses. The paper shows that VfM analysis approaches are inconsistent. In many cases it is difficult to decipher the source of differences between delivery options. Discount rates are sometimes used in a way that reduces credibility of the results. The paper presents some ideas for how these key issues can be approached so that VfM analysis results are more credible, consistent, and transparent.
Effect of Vehicle Speed on Sound Frequency Spectra
Authors: Ogle Timothy W. A. , Wayson Roger L. , Lindeman Win
Published: July 2018

During analysis conducted on data collected by the University of Central Florida for the Florida Department of Transportation (FDOT), which was doing research to develop reference energy mean emission levels for high-speed traffic, other interesting data trends became apparent. One such trend was the relationship of vehicle speed and sound emission spectra. The data base contained real-time one-third octave band data and vehicle characteristics (e.g., speed) and permitted a detailed review of sound emission spectra with respect to vehicle speed. The purpose of this research was to attempt to develop a mathematical relationship between increasing vehicle speed and sound emission spectra. Based on the results of this research several important conclusions were drawn: (a) a trend in the change in sound frequency spectra with respect to vehicle speed may exist for all vehicle types defined in STAMINA 2.0; (b) the change in dominant frequency followed no apparent trend with respect to vehicle speed; (c) the data base used for this research was too small for accurate mathematical modeling of the change in sound frequency versus vehicle speed; and (d) the sound attenuation provided by noise barriers may be underestimated using the current method of estimating barrier attenuation based on an effective frequency of 500 Hz regardless of vehicle speed.
HITEC Evaluation of U.S. Gypsum Sight and Sound Screen
Authors: Cohn Louis F. , Harris Roswell A.
Published: July 2018

A program of laboratory and field-testing designed to evaluate the capabilities and limitations of the U.S. Gypsum Sight and Sound Screen (SSS) is described. The evaluation plan proposes a collaborative testing and evaluation effort to be conducted with volunteer state highway agencies, including a program of field demonstrations. This will occur after a new product evaluation protocol is completed and applied to the SSS system. The study is being conducted as part of Highway Innovative Technology Evaluation Center (HITEC) program of ASCE's Civil Engineering Research Foundation. This study highlights the HITEC evaluation process as it is applied to the SSS.
Residents' Perceptions and Field Measurements of Helicopter Operations
Authors: Prevedouros Panos D. , Prasad B.
Published: July 2018

Despite the considerable research in the area of perceptions and annoyance in relation to noise levels research outside the context of commercial airports and military bases is lacking. Little is known about reactions to helicopter operations in areas where such disturbances are unexpected. Examples of such locations include several national parks and various communities in Hawaii affected by tour operations. A special federal aviation regulation has been enacted for the Grand Canyon National Park, and others may be precipitated from Public Law 100-91. At present, however, no legislative initiatives cover residential communities. The basic question that the research attempted to answer was whether, in towns of low-residential-density, exposure to loud, frequent, or long-lasting helicopter overflights corresponds to a negative attitude toward helicopter tour operations. Perceptual and actual noise measurements were collected, the former with a mail-back questionnaire survey and the latter with an extensive field survey. Investigations in four communities focused on potential relationships between people's annoyance and actual operational characteristics, such as noise intensity, frequency, and overflight duration. The expectation was substantiated that more exposure to helicopter overflights, particularly in terms of frequency and duration, relates to increasing annoyance.
Microhardness and water solubility of expired and non-expired shelf-life composites
Authors: Eliguzeloglu Dalkilic Evrim , Donmez Nazmiye , Kazak Magrur , Duc Bugra , Aslantas Akif
Published: July 2018

Background:

The aim of this study was to determine the Vickers hardness and water solubility of expired and non-expired shelf-life bulk-fill and conventional dental composite material.

Methods:

Four different expired (E) (after 6 months) and non-expired (N) shelf-life composite resin materials (Clearfil Majesty ES-2 Enamel, Clearfil Majesty ES-2 Dentin, Tetric N-Ceram Bulk-Fill, and Tetric N-Ceram) were used. For each tested material, seven specimens were prepared and polymerized with a light curing unit. Vickers hardness measurements were made on the top and bottom surfaces. For the water sorption test, initially all specimens were weighted, the thickness and diameter of each specimen were measured, and the average volume of specimen was calculated. Then, each specimen was immersed in distilled water and kept in an incubator for 7 days and finally weighed again.

Results:

There was not any statistically significant difference between the microhardness results of expired and non-expired shelf-life composites on the top and bottom surfaces (p > 0.05). No significant difference was determined between the non-expired shelf-life composite materials on the top surfaces (p > 0.05). Non-expired Clearfil Majesty ES-2 Dentin showed lower microhardness than non-expired Tetric N-Ceram Bulk-Fill and non-expired Tetric N-Ceram on the bottom surface (p < 0.05). Expired Clearfil Majesty ES-2 Dentin showed lower microhardness results than expired Tetric N-Ceram Bulk-Fill on the top and bottom surfaces (p < 0.05). There was not any significant difference between the water sorption results of expired and non-expired shelf-life composites (p > 0.05). Expired Clearfil Majesty ES-2 Dentin showed higher water sorption than expired Tetric N-Ceram E-TN (p < 0.05).

Conclusion:

Expiration date did not affect the microhardness and water sorption of bulk-fill and conventional composites. The hardness and water sorption of the composite materials varied depending on the type of composites.
Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists
Authors: Sandhu Harman S. , Arora Anish , Brasch Jennifer , Streiner David L.
Published: July 2018

Objectives:

To compare explicit and implicit stigmatizing attitudes towards mental illness among undergraduate students, medical school students, and psychiatrists, and to assess whether attitudes are associated with education level, exposure to, and personal experience with mental illness.

Methods:

Participants from McMaster University were recruited through email. Participants completed a web-based survey consisting of demographics; the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, which measures explicit stigma; and an Implicit Association Test (IAT), measuring implicit bias toward physical illness (diabetes mellitus) or mental illness (schizophrenia).

Results:

A total of 538 people participated: undergraduate students ( n = 382), medical school students ( n = 118), and psychiatrists ( n = 38). Psychiatrists had significantly lower explicit and implicit stigma than undergraduate students and medical school students. Having been diagnosed with mental illness or having had a relationship with someone experiencing one was significantly associated with lower explicit stigma. Mean scores on the OMS-HC “disclosure/help-seeking” subscale were higher compared with the “attitudes towards people with mental illness” subscale. There was no correlation between the OMS-HC and IAT.

Conclusions:

These findings support the theory that increased education and experience with mental illness are associated with reduced stigma. Attitudes regarding disclosure/help-seeking were more stigmatizing than attitudes towards people with mental illness. The groups identified in this study can potentially benefit from anti-stigma campaigns that focus on reducing specific components of explicit, implicit, public and self-stigma.
Removal of bisphenol A and 2,4-Di-tert-butylphenol from landfill leachate using plant- based coagulant
Authors: Aziz A , Agamuthu P , Fauziah SH
Published: July 2018

Landfill leachate contain persistent organic pollutants (POPs), namely, bisphenol A (BPA) and 2,4-Di-tert-butylphenol, which exceed the permissible limits. Thus, such landfill leachate must be treated before it is released into natural water courses. This article reports on investigations about the removal efficiency of POPs such as BPA and 2,4-Di-tert-butylphenol from leachate using locust bean gum (LBG) in comparison with alum. The vital experimental variables (pH, coagulant dosage and stirring speed) were optimised by applying response surface methodology equipped with the Box–Behnken design to reduce the POPs from leachate. An empirical quadratic polynomial model could accurately model the surface response with R2 values of 0.928 and 0.954 to reduce BPA and 2,4-Di-tert-butylphenol, respectively. Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM) were performed on treated flocs for further understanding. FTIR analysis revealed that the bridging of pollutant particles could be due to the explicit adsorption and bridging via hydrogen bonding of a coagulation mechanism. SEM micrographs indicated that the flocs produced by LBG have a rough cloudy surface and numerous micro-pores compared with alum, which enabled the capture and removal of POPs from leachate. Results showed that the reduction efficiencies for BPA and 2,4-Di-tert-butylphenol at pH 7.5 were 76% and 84% at LBG dosage of 500 mg·L−1 and 400 mg·L−1, respectively. Coagulant dosage and pH variation have a significant effect on POPs reduction in leachate. Coagulation/flocculation using LBG could be applied for POPs reduction in leachate as a pre-treatment prior to advanced treatments.
Comparison of three serological assays to measure antibody response to Chlamydia antigen Pgp3 in adolescent and young adults with pelvic inflammatory disease
Authors: Dize Laura , Martin Diana , Gwyn Sarah , Perin Jamie , Gaydos Charlotte , Trent Maria
Published: July 2018

Antibody-based epidemiologic surveillance to determine population-level exposure to sexually transmitted infections could help inform public health fertility preservation strategies. We compared the performance of three platforms to detect antibodies against the Chlamydia trachomatis (CT) antigen Pgp3 – multiplex bead array (MBA), enzyme-linked immunosorbent assay (ELISA), and lateral flow assay (LFA) – on sera from adolescents and young adults (AYAs) with pelvic inflammatory disease (PID). Ninety-five of 118 AYAs diagnosed with PID (80.5%) had positive antibody response to Pgp3 antigen by at least one test, and 78 (66.1%) tested positive by all three tests. Among 27 individuals with infection detected using nucleic acid amplification testing, 92.6% were positive by MBA (25/27), 77.8% (21/27) were positive by ELISA, and 74.1% (20/27) were positive by LFA. These data suggest that the MBA was the most sensitive of the three tests and could be useful in seroepidemiologic studies designed to assess population-level exposure to CT.
Fire-eaters: Professional Soldiers and the Introduction of Conscription in the Dutch-speaking Part of the Prince-Bishopric of Liège, 1756–1815
Authors: Govaerts Sander
Published: July 2018

This study aims to put the introduction of conscription in a new perspective by examining its effects on the careers and backgrounds of professional soldiers. It specifically considers the Dutch-speaking part of the principality of Liège in 1756–1815, and the service records of more than 2,000 men from this area. It argues that soldiers did become more representative for society at large, but this came at the cost of lowering the prestige attached to military service. Conscription effectively undermined the position of professional soldiers, without giving them proper compensation in terms of promotion or financial rewards.
Taking controlling and coercive behaviour seriously: Criminalising domestic violence in NSW
Authors: Causbrook Madeleine
Published: July 2018

This article argues that New South Wales (NSW) needs a domestic violence offence to criminally sanction controlling and coercive behaviour in relationships, and communicate that the harm particular to domestic violence deserves special recognition by the criminal law. It examines formulations of domestic abuse offences in domestic and international jurisdictions and suggests the merits of moving away from offences that focus on physical harm and subjective intention. Finally, a new domestic violence offence is proposed that is modelled on the UK's controlling or coercive behaviour offence, but more precisely defines ‘controlling’ and ‘coercive’ behaviours, and better accords with existing legislation.
Be like water: a personal strategy for clinical psychiatric research
Authors: Looi Jeffrey CL
Published: July 2018

Objectives:

This paper describes, from the personal perspective of a mid-career researcher, principles and advice regarding the development of an embedded clinical psychiatric research program within a medical school and public sector mental health service. From this experience, some general principles are drawn.

Conclusions:

Through careful strategic planning, together with collaboration with the mental health service, it is possible to bootstrap and develop an embedded clinical research program.
A comparison of Indigenous and non-Indigenous users of MindSpot: an Australian digital mental health service
Authors: Titov Nickolai , Schofield Carlie , Staples Lauren , Dear Blake F , Nielssen Olav
Published: July 2018

Objective:

To report on Aboriginal and Torres Strait Islander (Indigenous) users of MindSpot, a national service for the remote assessment and treatment of anxiety and depression.

Methods:

The characteristics and treatment outcomes of Indigenous patients who registered with MindSpot between January 2015 and December 2016, were compared with non-Indigenous users. Changes in psychological distress, depression and anxiety were measured using the Kessler 10-Item (K-10), Patient Health Questionnaire 9-Item (PHQ-9), and Generalised Anxiety Disorder Scale 7-Item (GAD-7), respectively.

Results:

Of 23,235 people who completed a MindSpot assessment between 1 January 2015 and 31 December 2016, 780 (3.4%) identified as Indigenous Australian. They had higher symptom scores, were more likely to live in a remote location, and a third reported no previous contact with mental health services. Fewer Indigenous patients enrolled in a treatment course, but those who did had similar rates of completion and similar reductions in symptoms to non-Indigenous patients.

Conclusions:

MindSpot treatments were effective in treating anxiety and depression in Indigenous Australians, and outcomes were similar to those of non-Indigenous patients. Services like MindSpot are a treatment option that can help overcome barriers to mental health care for Indigenous Australians.
Revising the Royal Australian and New Zealand College of Psychiatrists code of ethics
Authors: Bloch Sidney , Kenn Felicity , Smith Geoffrey
Published: July 2018

Objectives:

To describe the process adopted by the Committee for Professional Practice (CPP) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in devising the 5th edition of its code of ethics and to outline principal changes.

Methods:

CPP members planned, scrutinised and documented the steps taken in preparing the new edition.

Results:

The process, following that used in all previous updates of the code and which had proved effective and productive on each occasion, comprised consultations with RANZCP committees and relevant external stakeholders. Canvasing the views of so many groups was regarded as essential to ensure that multiple perspectives were considered and any bias of the CPP avoided. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) was examined with two aims: promoting a robust clinician and patient partnership, and acknowledging the psychiatrist’s advocacy role. The psychiatrist’s duty to be alert to colleagues’ wellbeing and to safeguard respectful professional relationships was highlighted.

Conclusions:

A comprehensive, rigorous and established review process occurred and was carefully documented resulting in a sound and contemporary revision of the code of ethics. RANZCP members will be duty-bound to adhere to, and apply, the code to optimise their ethical standards.
Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients
Authors: Martin Kevin D. , McBride Trevor , Wake Jeffrey , Van Buren Jeffrey Preston , Dewar Cuyler
Published: July 2018

Background:

Patient-reported outcome measures (PROMs) are taking a more prominent role in orthopedics as health care seeks to define treatment outcomes. The visual analog scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in patients that do not undergo an operative procedure. We hypothesized that patients’ VAS pain scores reported to the surgeon vs the nurse would be the same.

Methods:

This study is a retrospective cohort of 201 consecutive nonoperative foot and ankle patients treated by a single surgeon. Patients were asked to rate pain intensity by a nurse followed by the surgeon using a horizontal VAS, 0 “no pain” to 10 “worst pain.” Differences in reported pain levels were compared with data from the previous cohort of 201 consecutive operative foot and ankle patients.

Results:

The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the surgeon was 4.2 ( P < .001). The mean difference in VAS scores reported for operative patients was 2.9, whereas the mean difference for nonoperative patients was 1.0 ( P < .001).

Conclusion:

This study found statistically significant differences between VAS pain scores reported to the surgeon vs the nurse in nonoperative patients. These results support the trend found in our previous study, where operative patients reported significantly higher pain scores to the surgeon vs the nurse. The mean difference between reported pain scores was significantly higher for operative patients compared to nonoperative patients.

Level of Evidence:

Level III, comparative study.
Randomized Controlled Trial of Micronized Dehydrated Human Amnion/Chorion Membrane (dHACM) Injection Compared to Placebo for the Treatment of Plantar Fasciitis
Authors: Cazzell Shawn , Stewart Jordan , Agnew Patrick S. , Senatore John , Walters Jodi , Murdoch Douglas , Reyzelman Alex , Miller Stuart D.
Published: July 2018

Background:

Failure of conservative management to reduce/eliminate symptoms of plantar fasciitis (PF) may indicate need for advanced treatments. This study reports Level 1 evidence supporting 3-month safety and efficacy of micronized dehydrated human amnion/chorion membrane (dHACM) injection as a treatment for PF.

Methods:

A prospective, single-blind, randomized controlled trial was conducted at 14 sites in the United States. Subjects were randomized to receive 1 injection, in the affected area, of micronized dHACM (n=73) or 0.9% sodium chloride placebo (n=72). Safety/efficacy assessments were conducted at 4 weeks, 8 weeks, 3 months, 6 months, and 12 months postinjection, using visual analog scale (VAS) for pain, Foot Function Index–Revised (FFI-R) score, and presence/absence of adverse events. Primary outcome was mean change in VAS score between baseline and 3 months expressed as difference in means for treatment versus control subjects. Secondary outcome was mean change in FFI-R score between baseline and 3 months expressed as difference in means for treatment versus control subjects.

Results:

Baseline VAS scores were similar between groups. At the 3-month follow-up, mean VAS scores in the treatment group were 76% lower compared with a 45% reduction for controls ( P < .0001), FFI-R scores for treatment subjects had mean reduction of 60% versus baseline, whereas control subjects had mean reduction of 40% versus baseline ( P = .0004). Of 4 serious adverse events, none were related to study procedures.

Conclusion:

Pain reduction and functional improvement outcomes were statistically significant and clinically relevant, supporting use of micronized dHACM injection as a safe and effective treatment for PF.

Level of Evidence:

Level I, prospective randomized trial.
Long-lasting response with polycythemia to third-line axitinib treatment in metastatic renal cell carcinoma: Very rare case presentation
Authors: Dulgar Ozgecan , Cil Ibrahim , Zirtiloglu Alisan , Tural Deniz
Published: July 2018

Introduction

Clear cell renal cell carcinoma is characterized by mutation or inactivation of Von Hippel-Lindau suppressor gene. The mutation of Von Hippel-Lindau mechanism is associated with the upregulation of the hypoxia-inducible factor protein, inducing the overexpression of proteins including erythropoietin and vascular endothelial growth factor. Vascular endothelial growth factor receptor-targeted tyrosine kinase inhibitors are widely used in treatment of metastatic renal cell carcinoma. In paradoxical hematological effect with tyrosine kinase inhibitor therapies, hemoglobin level may be increased, but polycythemia requiring phlebotomy is very rare.

Case description

We present here a case of renal cell carcinoma who received successive treatment with sunitinib, everolimus, and axitinib. While he had a normal hemoglobin level with prior sunitinib treatment, on the sixth week of axitinib treatment, he developed polycythemia and treatment response was seen after axitinib-associated polycythemia.

Conclusion

Progression-free survival (PFS) was 30 months in our case with third-line treatment axitinib. Higher hemoglobin levels may be associated with longer survival. Polycythemia was the first response to treatment of axitinib in our patient. It may be an indicator of persistent treatment response.
Combined Use of a Fiberscope and Fuji Uniblocker for Removal of Retained Bronchial Tissue Glue After Repair of a Disrupted Left Main Bronchus
Authors: Khidr Alaa Mohamed , El Tahan Mohamed R. , Doyle D. John , Aljehani Yasser Maher
Published: July 2018

We describe the novel combined use of a fiberoptic bronchoscope and a Fuji Uniblocker placed outside the endotracheal tube (ETT) for removal of a retained BioGlue polymerized tissue fragment (2.8 × 0.8 cm) from the right main bronchus (RMB). The patient was a trauma victim who presented with a diffuse axonal injury, cervical spine and maxillofacial injuries, and a flail chest, and the procedure we describe took place following the surgical repair of a disrupted left main bronchus. Endoscopic retrieval using different sizes of grasping forceps and a Dormia basket failed to remove the foreign body (FB). Under combined GlideScope videolaryngoscopic and bronchoscopic guidance, a 9.0 F Uniblocker was introduced outside the ETT, placed into the RMB beyond the FB, initially inflated, and then gradually increased in volume during withdrawal from the RMB into the trachea so as to trap the FB between the tip of the ETT and the blocker balloon. The ETT, bronchoscope, blocker catheter, and the FB were then removed from the glottis as a single unit. The FB was then removed using Magill forceps with the aid of a GlideScope. We conclude that the combined use of a GlideScope, bronchoscope, and an Uniblocker placed outside the ETT can be an effective method for removal of a retained FB.
Gastroduodenal Tuberculosis: A Case Series and Review of Literature
Authors: Udgirkar Suhas , Surude Ravindra , Zanwar Vinay , Chandnani Sanjay , Contractor Qais , Rathi Pravin
Published: July 2018

Gastroduodenal tuberculosis is infrequently seen in day-to-day clinical practice with few cases reported in the literature. It is usually associated with features of gastric outlet obstruction. This is a case series of 4 patients with 2 of them having associated lower gastrointestinal involvement. One of them resembled a growth in the cardia of the stomach which responded to antitubercular drugs. Another had duodenal erosions with portal lymph node enlargement which responded to antitubercular drug treatment. None of the patients required surgical management. Gastroduodenal tuberculosis should be considered with a high degree of suspicion when patients present with gastric outlet obstruction or with endoscopic evidence of ulceronodular disease in areas endemic for tuberculosis.