bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond regulatory capture: Coproducing expertise for critical infrastructure protection
Authors: Slayton Rebecca , Clark‐Ginsberg Aaron
Published: September 2017

Complex industries such as petroleum production, civil aviation, and nuclear power produce “public risks” that are widely distributed and temporally remote, and thus tend to be ignored by the risk producers. Regulation is perhaps the most common policy tool for governing such risks, but requires expert knowledge that often resides solely within the industries. Hence, many scholars and policymakers raise concerns about “regulatory capture,” wherein regulation serves private interests rather than the public good. This paper argues that regulatory capture framing has tended to limit understanding of expertise and its role in governing public risks. Most studies of regulatory capture treat expertise as a source of knowledge and skills that are created exogenously to political processes, and which can therefore be politically neutral. By contrast, we draw on work in science and technology studies that highlight the value‐laden and relational nature of knowledge and expertise, showing how its formation is endogenous to political processes. Thus, we argue for both broadening analyses of regulatory capture to consider the historically contingent and uncertain process of creating expert knowledge, and going beyond the capture framing by considering the challenge of negotiating different epistemologies and ways of life. We illustrate this analytic strategy by examining the history of and current debate about critical infrastructure protection standards to protect the United States electric power grid from cyberattack. We conclude by considering the broader implications of these findings for governing public risks.
Currency Crises in Post‐Soviet Russia
Authors: JOHNSON JULIET , WOODRUFF DAVID
Published: September 2017

Currency crises have been a recurrent feature of Russia's post‐Soviet experience. This article examines three episodes of sudden and sharp ruble depreciation in 1998, 2008, and 2014–16. We examine these crises and their political consequences as iterative episodes in the Russian government's ongoing efforts to deal with its structural dependence on energy revenues and international capital flows. We argue that the 1998 crisis and the Russian government's response to it proved effective in transforming policies and institutions that had contributed to the ruble's collapse, but also paradoxically reinforced the central role of resource revenues and international capital flows in Russia's political economy. Policy decisions after 2008 then represented variations on a theme, leaving the Russian government better able to manage future currency crises while simultaneously maintaining and deepening the state's underlying structural vulnerabilities as well as its patronage‐based political‐economic system. The crisis of 2014–16 may, however, ultimately bring greater shifts in policy as Russia adapts to fundamentally changed international circumstances.
The Empress Undressed: Dress, Disguise, and the Next Generation in Pushkin's Prose
Authors: MURPHY AMANDA
Published: September 2017

This study uses close reading of clothing imagery to unlock a system by which Pushkin was able to enshroud his political messages in layers of apparel and textual patterning that would have been accessible to his peers. Despite Pushkin's profound “genre consciousness,” commonalities across texts suggest that each item of apparel carries a particular semiotic “charge,” which acts similarly to repeating lexical items or rhyming patterns. Though dress is closely related to the themes of social status and mobility, which occupied Pushkin during the final decade of his life, scholars have been reluctant to attribute import to the clothing items he selected for his heroes, and especially for his heroines. I will show that, for characters of both genders, certain articles of clothing allude to Pushkin's mixed feelings about the social changes initiated by Peter's reforms as well as his negative interpretation of Catherine the Great's influence on Russian society.
Supporting spirituality in the care of older people living with dementia: a hermeneutic phenomenological inquiry into nurses’ experiences
Authors: Toivonen Kristiina , Charalambous Andreas , Suhonen Riitta
Published: September 2017

Background

Spirituality is defined as a search for answers to existential questions about the meaning of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve affiliation with a specific religion. Studies on spirituality have focused on palliative care, and there are limited studies into the spirituality in the care of older people with dementia.

Aim

To describe the experiences of nurses supporting spirituality in the care of older people living with dementia.

Method

This study, informed by Heideggerian hermeneutic phenomenology, was conducted in 2014/15. Data were collected by interviewing a purposive sample of 17 nurses.

Results

Supporting the spirituality of older people with dementia was seen as understanding their spirituality within a framework of person‐centeredness and individuality. The participants came to understand the spiritual needs of older people with dementia through both verbal and nonverbal expression and by learning about older people's individual spiritual backgrounds. Meeting spiritual needs meant approaching the person with dementia as a valuable human as well as paying attention, to and supporting, his/her personal philosophy of life within nursing care.

Conclusion

Learning and developing an understanding of the spiritual needs of older people with dementia is challenging. The nurses offered person‐centred, spiritual care, to people with dementia from a variety of perspectives, which is important in the provision of comprehensive care. There is a need to find usable tools to help nurses to learn and understand the individual spiritual needs of older people with dementia and to explore how these older adults experience having their spirituality supported within their nursing care.
Cinematic Plateau and Sustainable Tourism
Authors: Eskandari Sina
Published: September 2017

When we are speaking about the cinematic plateau, cinematic natural landscapes or even the cinematic city, it means the locations outside the cinematic studios, the landscapes or locations which are set by a cinematographer in the background of his/her story.The cinematic plateau brings about sustainable tourism, because it does not need any specific season or special calendar and it is sufficient for the tourist to visit just the plateau and register the moment with the space.Producing film and registering the moments in special locations, the cinematographer unconsciously encourages the viewers to take a trip to the locations of shooting for recollection and to inject a new blood into the economic vessels of these regions.Focusing on the province of Almeria in Spain, this research is an attempt to learn about the cinematic plateaus, to introduce touristic spaces, to study how to attract cinematic tourists and to present new approaches for the dynamism of this industry.
Gordon Matta-Clark: “en algún lugar fuera de la ley”
Authors: Alliez Éric
Published: September 2017

“Nadie podía construir edificios cómo Gordon los destruía”, leemos en la edición de Flash Art, publicada poco después de la muerte del artista. En este artículo, se parte de la violencia tanto física como social de las intervenciones de Gordon Matta-Clark (su “brutalidad de líneas puras”), con el fin de introducir la relación (y la negación en dicha relación) entre Matta-Clark y los arquitectos a quienes él coloca “en los extremos opuestos del polo” a su propia operación anarquitectónica. Sin embargo, lo que Matta-Clark propone no es tanto un uso alternativo del recinto del espacio, sino el diagrama de una nueva enunciación espacial que, como se intenta mostrar aquí, ofrece una perspectiva nueva de los mismos términos en los que se planteó la pregunta del arte al final de la década de 1960.
Ontología del arte (de masas) de las historietas
Authors: Mourilhe Fabio
Published: September 2017

Este trabajo tiene como objetivo describir la arte de masa dentro de la filosofía del arte y su especificidad en las historietas. Con el apoyo inicial de la obra de Noël Carroll en el arte de masas, tenga en cuenta las condiciones necesarias y suficientes para caracterizar este arte como ocurre en las historietas y más tarde frente a su condición ontológica. Por lo tanto, es posible considerar de manera global las características que tienen relevancia en el establecimiento y el fundamento de la relación entre las historietas, el arte y la autenticidad.
Procesos de identización en el arte contemporáneo: construir una identidad colectiva a través de una cartografía identitaria en la red
Authors: Gómez Redondo Carmen , Fontal Merillas Olaia
Published: September 2017

En base a las propuestas de la nueva museología y la educación patrimonial se pretende profundizar, desde la perspectiva educativa, en los procesos de identización en el arte contemporáneo. En este estudio el arte contemporáneo se muestra como herramienta para la generación de identidades colectivas, cumpliendo así con la función social y cultural del arte que se plantea desde las posturas teóricas. Para ello se ha diseñado una acción educativa con una actividad clave: una cartografía identitaria virtual donde los participantes generan un mapa de la identidad colectiva entramada por ellos a partir de elementos patrimoniales individuales que comparten y consensuan. A través del método etnográfico se obtienen dos principales resultados: en primer lugar, la construcción consciente de una identidad del grupo, en la que tienen cabida los elementos patrimoniales trabajados y en segundo lugar la importancia de la afectividad en la creación de lazos identitarios.
Clasificación de instituciones prestadores de servicios de salud según el sistema de cuentas de la salud de la Organización para la Cooperación y el Desarrollo Económico: el caso de Colombia
Authors: Prada-Ríos Sergio Iván , Pérez-Castaño Ana Melissa , Rivera-Triviño Andrés Felipe
Published: September 2017

En Colombia las instituciones prestadoras de servicios de salud (IPS) públicas tienen una clasificación según tres niveles de complejidad: bajo, medio y alto. Esto no sucede con las IPS privadas. Esta carencia dificulta los análisis comparativos entre prestadores privados. Para suplir esta necesidad se desarrolló un algoritmo de clasificación de IPS de acuerdo con la metodología del Sistema de Cuentas de la Salud utilizado en los países de la Organización para la Cooperación y el Desarrollo Económico. Se utilizó como fuente de información la base de datos de servicios habilitados del Registro Especial de Prestadores para 2015. Los resultados muestran que en el país el 66 % de las IPS son de atención ambulatoria, el 17 % hospitales, el 11 % centros de pro­moción y prevención y el 6 % prestadores de servicios auxiliares. La concentración de activos es opuesta, pues se encontró que los hospitales tienen el 90.5 % de los activos.
Impacto de la implementación de la prueba rápida del VIH/ITS en un centro de atención especializada en Brasil
Authors: Bones-Rocha Kátia , Torres de Carvalho Fernanda , Almeida-Weber João Luís , Silvana-Both Nalu , Pizzinato Adolfo
Published: September 2017

Objetivo: evaluar el impacto de la implementación de la consejería y prueba rápida del VIH e infecciones de transmisión sexual en un centro especializado de consejería y diagnóstico de VIH (CE). Método: estudio analítico con un grupo de intervención y un grupo control en el cual fueron comparadas las medias mensuales de las pruebas y consejerías realizadas entre un centro especializado que implementó la prueba rápida de VIH para todos los pacientes (CE caso) y otro centro especializado que utiliza la modalidad tradicional de la prueba (diagnóstico en treinta días) (CE control). Resultados: el CE (caso) tuvo un aumento significativo en el nú­mero de pruebas realizadas entre los dos periodos. En el CE (caso) hubo una disminución en la proporción de personas de la población general que se hicieron la prueba y un aumento en las personas más vulnerables al VIH. Conclusiones: la implementación de la prueba rápida tuvo un impacto positivo en el número de pruebas realizadas y también en el acceso a las personas en situación de vulnerabilidad.
A Novel Method for Repeatable Failure Testing of Annulus Fibrosus
Authors: Werbner Benjamin , Zhou Minhao , O'Connell Grace
Published: September 2017

Tears in the annulus fibrosus (AF) of the intervertebral disk can result in disk herniation and progressive degeneration. Understanding AF failure mechanics is important as research moves toward developing biological repair strategies for herniated disks. Unfortunately, failure mechanics of fiber-reinforced tissues, particularly tissues with fibers oriented off-axis from the applied load, is not well understood, partly due to the high variability in reported mechanical properties and a lack of standard techniques ensuring repeatable failure behavior. Therefore, the objective of this study was to investigate the effectiveness of midlength (ML) notch geometries in producing repeatable and consistent tissue failure within the gauge region of AF mechanical test specimens. Finite element models (FEMs) representing several notch geometries were created to predict the location of bulk tissue failure using a local strain-based criterion. FEM results were validated by experimentally testing a subset of the modeled specimen geometries. Mechanical testing data agreed with model predictions (∼90% agreement), validating the model's predictive power. Two of the modified dog-bone geometries (“half” and “quarter”) effectively ensured tissue failure at the ML for specimens oriented along the circumferential-radial and circumferential-axial directions. The variance of measured mechanical properties was significantly lower for notched samples that failed at the ML, suggesting that ML notch geometries result in more consistent and reliable data. In addition, the approach developed in this study provides a framework for evaluating failure properties of other fiber-reinforced tissues, such as tendons and meniscus.
Investigation on the Shock Control Using Grooved Surface in a Linear Turbine Nozzle
Authors: Lei Xinguo , Qi Mingxu , Sun Harold , Hu Liangjun
Published: September 2017

Radial flow variable nozzle turbine (VNT) enables better matching between a turbocharger and engine and can improve the engine performance as well as decrease the engine emissions, especially when the engine works at low-end operation points. With increased nozzle loading, stronger shock wave and clearance leakage flow may be generated and consequently introduces strong rotor–stator interaction between turbine nozzle and rotor, which is a key concern of rotor high-cycle fatigue (HCF) failure. With the purpose of developing a low shock wave intensity turbine nozzle, the influence of grooved vane on the shock wave characteristics is investigated in the present paper. A Schlieren visualization experiment was first carried out on a linear turbine nozzle with smooth surface and the behavior of the shock wave was studied. Numerical simulations were also performed on the turbine nozzle. Guided by the visualization and numerical simulation, grooves were designed on the nozzle surface where the shock wave was originated and numerical simulations were performed to investigate the influence of grooves on the shock wave characteristics. Results indicate that for a smooth nozzle configuration, the intensity of the shock wave increases as the expansion ratios increase, while the onset position is shifted downstream to the nozzle trailing edge. For a nozzle configuration with grooved vane, the position of the shock wave onset is shifted upstream compared to the one with a smooth surface configuration, and the intensity of the shock wave and the static pressure (Ps) distortion at the nozzle vane exit plane are significantly depressed.
Analysis of Forced Response for Bladed Disks Mistuned by Material Anisotropy Orientation Scatters
Authors: Zang Chaoping , Tan Yuanqiu , Petrov E. P.
Published: September 2017

A new method is developed for the forced response analysis of mistuned bladed disks manufactured from anisotropic materials and mistuned by different orientations of material anisotropy axes. The method uses (i) sector finite element (FE) models of anisotropic bladed disks and (ii) FE models of single blades and allows the calculation of displacements and stresses in a mistuned assembly. A high-fidelity reduction approach is proposed which ensures high-accuracy modeling by introducing an enhanced reduction basis. The reduction basis includes the modal properties of specially selected blades and bladed disks. The technique for the choice of the reduction basis has been developed, which provides the required accuracy while keeping the computation expense acceptable. An approach for effective modeling of anisotropy-mistuned bladed disk without a need to create a FE model for each mistuning pattern is developed. The approach is aimed at fast statistical analysis based on Monte Carlo simulations. All components of the methodology for anisotropy-mistuned bladed disks are demonstrated on the analysis of models of practical bladed disks. Effects of anisotropy mistuning on forced response levels are explored.
Aqueous Au-Pd colloids catalyze selective CH
4
oxidation to CH
3
OH with O
2
under mild conditions
Authors: Agarwal Nishtha , Freakley Simon J. , McVicker Rebecca U. , Althahban Sultan M. , Dimitratos Nikolaos , He Qian , Morgan David J. , Jenkins Robert L. , Willock David J. , Taylor Stuart H. , Kiely Christopher J. , Hutchings Graham J.
Published: September 2017

A radical route from methane to methanol

The conversion of methane into chemicals usually proceeds through high-temperature routes that first form more reactive carbon monoxide and hydrogen. Agarwal
et al.
report a low-temperature (50°C) route in aqueous hydrogen peroxide (H
2
O
2
) for oxidizing methane to methanol in high yield (92%). They used colloidal gold-palladium nanoparticles as a catalyst. The primary oxidant was O
2
; isotopic labeling showed that H
2
O
2
activated methane to methyl radicals, which subsequently incorporated O
2
.

Science
, this issue p.
223
Genome Sequence of an Unusual Reassortant H1N1 Swine Influenza Virus Isolated from a Pig in Russia, 2016
Authors: Sobolev Ivan , Kurskaya Olga , Murashkina Tatyana , Leonov Sergey , Sharshov Kirill , Kabilov Marsel , Alikina Tatyana , Tolstykh Natalia , Gorodov Vladimir , Alekseev Alexander , Shestopalov Alexander
Published: September 2017

We report here the genome sequence of the influenza A virus strain A/swine/Siberia/1sw/2016, isolated from a swine in Russia. On the basis of sequence analysis, A/swine/Siberia/1sw/2016 is characterized by unusual surface glycoproteins phylogenetically distinct from those of swine A(H1N1)pdm09 influenza virus.
Draft Genome Sequence of Natranaerobius trueperi DSM 18760
T
, an Anaerobic, Halophilic, Alkaliphilic, Thermotolerant Bacterium Isolated from a Soda Lake
Authors: Guo Xiaomeng , Liao Ziya , Holtzapple Mark , Hu Qingping , Zhao Baisuo
Published: September 2017

The anaerobic, halophilic, alkaliphilic, thermotolerant bacterium
Natranaerobius trueperi
was isolated from a soda lake in Wadi An Natrun, Egypt. It grows optimally at 3.7 M Na
+
, pH 9.5, and 43°C. The draft genome consists of 2.63 Mb and is composed of 2,681 predicted genes. Genomic analysis showed that various genes are potentially involved in the adaptation mechanisms for osmotic stress, pH homeostasis, and high temperatures.
First Complete Genome Sequences of Xanthomonas citri pv. vignicola Strains CFBP7111, CFBP7112, and CFBP7113 Obtained Using Long-Read Technology
Authors: Ruh Mylène , Briand Martial , Bonneau Sophie , Jacques Marie-Agnès , Chen Nicolas W. G.
Published: September 2017

Xanthomonas citri
pv. vignicola strains cause bacterial blight of the legume crop cowpea. We report whole-genome sequences of three
X. citri
pv. vignicola strains obtained using PacBio single-molecule real-time sequencing. Such genomic data provide new information on pathogenicity factors, such as transcription activator-like effectors.
Insights into the Draft Genome Sequence of a Haitian Variant Vibrio cholerae Strain Isolated from a Clinical Setting in Kerala, South India
Authors: Narendrakumar Lekshmi , Suryaletha Karthika , Reghunathan Dinesh , Prasannakumar Manoj , Thomas Sabu
Published: September 2017

We report here the draft genome sequence of a Haitian variant
Vibrio cholerae
strain, W4-13, isolated from Kerala, South India, possessing cholera toxin gene in chromosomes I and II. The sequence will be useful to achieve a profound understanding on its evolution, with emphasis on its pathogenesis and antibiotic resistance.
Draft Genome Sequence of the Gluten-Hydrolyzing Bacterium Bacillus subtilis GS 188, Isolated from Wheat Sourdough
Authors: Rashmi B. S. , Gayathri Devaraja
Published: September 2017

The draft genome sequence of
Bacillus subtilis
GS 188, a novel spore-forming probiotic bacterium with gluten-hydrolyzing potential, was isolated from wheat sourdough and provides deep insights into the beneficial features of this strain for its use in the preparation of gluten-reduced wheat foods for humans with celiac disease.
Complete Genome Sequence of Staphylococcus epidermidis ATCC 12228 Chromosome and Plasmids, Generated by Long-Read Sequencing
Authors: MacLea Kyle S. , Trachtenberg Ariel M.
Published: September 2017

Staphylococcus epidermidis
ATCC 12228 was sequenced using a long-read method to generate a complete genome sequence, including some plasmid sequences. Some differences from the previously generated short-read sequence of this nonpathogenic and non-biofilm-forming strain were noted. The assembly size was 2,570,371 bp with a total G+C% content of 32.08%.
Basic Processes in
Salmonella
-Host Interactions: Within-Host Evolution and the Transmission of the Virulent Genotype
Authors: Diard Médéric , Hardt Wolf-Dietrich
Published: September 2017

Transmission and virulence are central aspects of pathogen evolution. However, in many cases their interconnection has proven difficult to assess by experimentation. Here we discuss recent advances from a mouse model for
Salmonella
diarrhea. Mouse models mimic the enhanced susceptibility of antibiotic-treated individuals to nontyphoidal salmonellosis. In streptomycin-pretreated mice,
Salmonella enterica
subspecies 1 serovar Typhimurium efficiently colonizes the gut lumen and elicits pronounced enteropathy. In the host’s gut,
S.
Typhimurium forms two subpopulations that cooperate to elicit disease and optimize transmission. The disease-causing subpopulation expresses a set of dedicated virulence factors (the type 3 secretion system 1 [TTSS-1]) that drive gut tissue invasion. The virulence factor expression is “costly” by retarding the growth rate and exposing the pathogen to innate immune defenses within the gut tissue. These costs are compensated by the gut inflammation (a “public good”) that is induced by the invading subpopulation. The inflamed gut lumen fuels
S.
Typhimurium growth, in particular that of the TTSS-1 “off” subpopulation. The latter grows up to very high densities and promotes transmission. Thus, both phenotypes cooperate to elicit disease and ensure transmission. This system has provided an experimental framework for studying within-host evolution of pathogen virulence, how cooperative virulence is stabilized, and how environmental changes (e.g., antibiotic therapy) affect the transmission of the virulent genotype.
Respiratory manifestations of gastro-oesophageal reflux in children
Authors: de Benedictis Fernando Maria , Bush Andrew
Published: September 2017

Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients’ symptoms. Evidence for the assessment of children with suspected extraoesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.
Follow-up after gestational diabetes: a fixable gap in women’s preventive healthcare
Authors: Bernstein Judith Apt , Quinn Emily , Ameli Omid , Craig Myrita , Heeren Timothy , Lee-Parritz Aviva , Iverson Ronald , Jack Brian , McCloskey Lois
Published: September 2017

Objective

Gestational diabetes mellitus (GDM) is a known harbinger of future type 2 diabetes mellitus (T2DM), hypertension, and cardiac disease. This population-based study was designed to identify gaps in follow-up care relevant to prevention of T2DM in a continuously insured sample of women diagnosed with GDM.

Research design and methods

We analyzed data spanning 2005–2015 from OptumLabs Data Warehouse, a comprehensive, longitudinal, real-world data asset with deidentified lives across claims and clinical information, to describe patterns of preventive care after GDM. Women with GDM were followed, from 1 year preconception through 3 years postdelivery to identify individual and healthcare systems characteristics, and report on GDM-related outcomes: postpartum glucose testing, transition to primary care for monitoring, GDM recurrence, and T2DM onset.

Results

Among 12 622 women with GDM, we found low rates of glucose monitoring in the recommended postpartum period (5.8%), at 1 year (21.8%), and at 3 years (51%). A minority had contact with primary care postdelivery (5.7% at 6 months, 13.2% at 1 year, 40.5% at 3 years). Despite increased population risk (GDM recurrence in 52.2% of repeat pregnancies, T2DM onset within 3 years in 7.6% of the sample), 70.1% of GDM-diagnosed women had neither glucose testing nor a primary care visit at 1 year and 32.7% had neither at 3 years.

Conclusions

We found low rates of glucose testing and transition to primary care in this group of continuously insured women with GDM. Despite continuous insurance coverage, many women with a pregnancy complication that portends risk for future chronic illness fail to obtain follow-up testing and may have difficulty navigating between clinician specialties. Results point to a need for action to close the gap between obstetrics and primary care to ensure receipt of preventive monitoring as recommended by both the American Diabetes Association and the American Congress of Obstetricians and Gynecologists.
Engaging patients through an iBooks-based patient portal tutorial
Authors: Leisy Heather , Ahmad Meleha , Guevara Gabriella , Smith Roland Theodore
Published: September 2017

Introduction

Patient portals or personal health records allow patients to access their health information and communicate with their physician’s office outside of their clinic visit. As such, their use has been observed to increase patient engagement and decrease administrative costs. Despite these advantages, patient adoption and successful use of patient portals remains low. Here we assess the feasibility and efficacy of an iBooks-based tutorial in increasing comfort and compliance with personal health record use.

Methods

We created and published a 5-min iBooks-based tutorial describing our institution’s patient portal features. We administered the tutorial, along with presurvey and postsurvey, to ophthalmology clinic patients.

Results

Of 70 participants, 50% had already registered for our institution’s patient portal. Registered patients had viewed labs (74%, n=26) and messaged providers (57%, n=20) but rarely used other features such as scheduling appointments (17%, n=6) or requesting refills (26%, n=9). After the tutorial, comfort levels in knowledge on how to use portal features increased by 20%–80%, depending on portal feature and registration status. Main barriers to portal usage were preference for telephone-based communication (26%, n=18) and knowledge of portal existence (21%, n=15). The majority (86%, n=60) agreed the tutorial would increase their utilisation of the patient portal.

Conclusion

Tutorials increase knowledge and awareness of patient portal features, allowing these features to be fully used. An iBooks-based approach allows patients to successfully access and use tutorial content outside of the clinic.
Hospital comparison of stroke care in Sweden: a register-based study
Authors: Lekander Ingrid , Willers Carl , Ekstrand Elisabeth , von Euler Mia , Fagervall-Yttling Birgitta , Henricson Lena , Kostulas Konstantinos , Lilja Mikael , Sunnerhagen Katharina S , Teichert Jörg , Pessah-Rasmussen Hélène
Published: September 2017

Background and purpose

The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix).

Method

Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14 125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1 year post-stroke.

Results

The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix.

Conclusion

Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified.
Crossover trial to test the acceptability of a locally produced lipid-based nutrient supplement (LNS) for children under 2 years in Cambodia: a study protocol
Authors: Borg Bindi , Mihrshahi Seema , Griffin Mark , Chamnan Chhoun , Laillou Arnaud , Wieringa Frank T
Published: September 2017

Introduction

The acceptability and efficacy of existing ready-to-use supplementary and therapeutic foods has been low in Cambodia, thus limiting success in preventing and treating malnutrition among Cambodian children. In that context, UNICEF and IRD have developed a locally produced, multiple micronutrient fortified lipid-based nutrient supplement. This food is innovative, in that it uses fish instead of milk as the animal source food. Very few supplementary foods have non-milk animal source foods, and in addition they have not been widely tested. This trial will assess the novel food’s acceptability to children and caregivers.

Methods and analysis

This is a cluster-randomised, incomplete block, 4×4 crossover design with no blinding. It will take place in four sites in a community setting in periurban Phnom Penh. Healthy children aged 9–23 months (n=100) will eat each of four foods for 3 days at a time. The amount they consume will be measured, and at the end of each 3-day set, caregivers will assess how well their child liked the food. After 12 days, caregivers themselves will do a sensory test of the 4 foods and will rank them in terms of preference.

Ethics and dissemination

Ethical clearance was received from the University of Queensland Medical Research Ethics Committee (2014001070) and from Cambodia’s National Ethics Committee for Health Research (03/8 NECHR).

Registration

ClinicalTrials.gov, identifier: LNS-CAMB-INFANTS;NCT02257437. Pre-results.
Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months
Authors: Crellin Dianne J , Harrison Denise , Hutchinson Adrian , Schuster Tibor , Santamaria Nick , Babl Franz E
Published: September 2017

Introduction

Infants and children are frequently exposed to painful medical procedures such as immunisation, blood sampling and intravenous access. Over 40 scales for pain assessment are available, many designed for neonatal or postoperative pain. What is not well understood is how well these scales perform when used to assess procedural pain in infants and children.

Aim

The aim of this study was to test the psychometric and practical properties of the Face, Legs, Activity, Cry and Consolability (FLACC) scale, the Modified Behavioural Pain Scale (MBPS) and the Visual Analogue Scale (VAS) observer pain scale to quantify procedural pain intensity in infants and children aged from 6–42 months to determine their suitability for clinical and research purposes.

Methods and analysis

A prospective observational non-interventional study conducted at a single centre. The psychometric and practical performance of the FLACC scale, MBPS and the VAS observer pain scale and VAS observer distress scale used to assess children experiencing procedural pain will be assessed. Infants and young children aged 6–42 months undergoing one of four painful and/or distressing procedures were recruited and the procedure digitally video recorded. Clinicians and psychologists will be recruited to independently apply the scales to these video recordings to establish intrarater and inter-rater reliability, convergent validity responsiveness and specificity. Pain score distributions will be presented descriptively; reliability will be assessed using the intraclass correlation coefficient and Bland-Altman plots. Spearman correlations will be used to assess convergence and linear mixed modelling to explore the responsiveness of the scales to pain and their capacity to distinguish between pain and distress.

Ethics and dissemination

Ethical approval was provided by the Royal Children’s Hospital Human Research Ethics Committee, approval number 35220B. The findings of this study will be disseminated via peer-reviewed journals and presented at international conferences.
Incidence of laboratory-confirmed influenza disease among infants under 6 months of age: a systematic review
Authors: Fell Deshayne B , Johnson Jeanene , Mor Zohar , Katz Mark A , Skidmore Becky , Neuzil Kathleen M , Ortiz Justin R , Bhat Niranjan
Published: September 2017

Objectives

The aim of this systematic review was to assess incidence rates of laboratory-confirmed influenza (LCI) outcomes among infants under 6 months of age.

Design

Systematic literature search and review of indexed studies in PubMed, EMBASE, the Cochrane Library and CINAHL Plus from inception to 19 April 2017.

Setting

Population-based estimates from community or hospital settings.

Participants

Infants under 6 months of age.

Primary and secondary outcome measures

LCI illness in ambulatory care settings, LCI hospitalisation, LCI intensive care unit admission and LCI death. Only studies with population-based incidence data were included.

Results

We identified 27 primary studies, 11 of which were from the USA, four were from other non-US high-income settings and the remaining were from lower-middle-income or upper-middle-income countries. Most studies (n=23) assessed incidence of LCI hospitalisation, but meta-analysis to pool study-specific rates was not possible due to high statistical and methodological heterogeneity. Among US studies, the reported incidence of LCI hospitalisation ranged from 9.3 to 91.2 per 10 000 infants under 6 months for seasonal influenza, while the only US-based estimate for pandemic H1N1 influenza was 20.2 per 10 000 infants. Reported rates for LCI hospitalisation for seasonal influenza from other countries ranged from 6.2 to 73.0 per 10 000 infants under 6 months, with the exception of one study with an estimated rate of 250 per 10 000 infants. No events were reported in five of the nine studies that evaluated LCI death among infants under 6 months.

Conclusion

Our review of published studies found limited data on LCI outcomes for infants under 6 months, particularly from non-US settings. Globally representative and reliable incidence data are necessary to fully evaluate influenza disease burden and the potential impact of maternal influenza immunisation programme on morbidity and mortality in young infants.
A randomised controlled cross-over double-blind pilot study protocol on THC:CBD oromucosal spray efficacy as an add-on therapy for post-stroke spasticity
Authors: Marinelli Lucio , Balestrino Maurizio , Mori Laura , Puce Luca , Rosa Gian Marco , Giorello Laura , Currà Antonio , Fattapposta Francesco , Serrati Carlo , Gandolfo Carlo , Abbruzzese Giovanni , Trompetto Carlo
Published: September 2017

Introduction

Stroke is the most disabling neurological disorder and often causes spasticity. Transmucosal cannabinoids (tetrahydrocannabinol and cannabidiol (THC:CBD), Sativex) is currently available to treat spasticity-associated symptoms in patients with multiple sclerosis. Cannabinoids are being considered useful also in the treatment of pain, nausea and epilepsy, but may bear and increased risk for cardiovascular events. Spasticity is often assessed with subjective and clinical rating scales, which are unable to measure the increased excitability of the monosynaptic reflex, considered the hallmark of spasticity. The neurophysiological assessment of the stretch reflex provides a precise and objective method to measure spasticity. We propose a novel study to understand if Sativex could be useful in reducing spasticity in stroke survivors and investigating tolerability and safety by accurate cardiovascular monitoring.

Methods and analysis

We will recruit 50 patients with spasticity following stroke to take THC:CBD in a double-blind placebo-controlled cross-over study. Spasticity will be assessed with a numeric rating scale for spasticity, the modified Ashworth scale and with the electromyographical recording of the stretch reflex. The cardiovascular risk will be assessed prior to inclusion. Blood pressure, heart rate, number of daily spasms, bladder function, sleep disruption and adverse events will be monitored throughout the study. A mixed-model analysis of variance will be used to compare the stretch reflex amplitude between the time points; semiquantitative measures will be compared using the Mann-Whitney test (THC:CBD vs placebo) and Wilcoxon test (baseline vs treatment).

Ethics and dissemination

The study was registered on the EudraCT database with number 2016-001034-10 and approved by both the Italian Medicines Agency (Agenzia Italiana del Farmaco) and local Ethics Committee ‘Comitato Etico Regionale della Liguria’. Data will be made anonymous and uploaded to a open access repository. Results will be disseminated by presentations at national and international conferences and by publication in journals of clinical neuroscience and neurology.
Women’s decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey
Authors: Ghose Bishwajit , Feng Da , Tang Shangfeng , Yaya Sanni , He Zhifei , Udenigwe Ogochukwu , Ghosh Sharmistha , Feng Zhanchun
Published: September 2017

Objectives

The aim of this study was to determine the association between women’s decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women.

Settings

This is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully.

Participants

Cross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent's own healthcare, large household purchases, having a say on child’s healthcare and visiting to family or relatives were included in the analysis.

Results

Prevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner.

Conclusion

Neither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services.
Efficacy and safety of an extemporaneous preparation of 2% ganciclovir eye drops in CMV anterior uveitis
Authors: Keorochana Narumon , Choontanom Raveewan
Published: September 2017

Background

To evaluate the efficacy and safety of an extemporaneous preparation of 2% ganciclovir topical eye drops in cytomegalovirus (CMV) anterior uveitis because many studies have confirmed the benefits of topical ganciclovir in varying concentrations.

Design

The study employed a retrospective cohort design.

Methods

This study enrolled 11 eyes (11 patients) with CMV anterior uveitis. All cases were proved by positive PCR for CMV DNA from aqueous tapping and received topical 2% ganciclovir, applied every 2 hours daily as induction therapy then tapered off and stopped based on clinical response. Outcome measures were best-corrected visual acuity, anterior chamber cell, coin-shaped and other keratic precipitates, intraocular pressure (IOP), the number of antiglaucoma drugs used, the frequency of steroid eye drops used daily and side effects over a 12-month follow-up period. Side effects after applying topical 2% ganciclovir were recorded using questionnaires and eye examination.

Results

Mean age was 49.0±17.8 years. IOP, number of antiglaucoma drugs used and keratic precipitates decreased significantly at first week (p<0.013, p<0.024 and p<0.031, respectively) followed by decreased anterior chamber cells and significantly reduced frequency of applying steroid eye drops at 4 weeks (p<0.034 and p<0.017, respectively). Visual acuity significantly improved at 5 months continuously. All clinical improvement was maintained to 12 months, and keratic precipitates were eliminated in 90% of all cases. However, in 27% of discontinued medicine cases, inflammation was recurrent. No significance was observed in all factors between recurrent and non-recurrent groups. The most common side effect was eye irritation (27.27%). No severe complications from the medicine was detected.

Conclusion

Extemporaneous preparation topical 2% ganciclovir was effective and safely controlled CMV anterior uveitis. The medication is non-invasive, economical and convenient for hospitals where commercial topical ganciclovir is unavailable.
Is Brazil going to achieve the road traffic deaths target? An analysis about the sustainable development goals
Authors: Blumenberg Cauane , Martins Rafaela C , Calu Costa Janaína , Ricardo Luiza I C
Published: September 2017

Objective

To describe the temporal relationship between the road traffic mortality rate and gross domestic product (GDP) per capita in Brazil, and make an annual prediction of the evolution of both indicators until 2020, the end of the Sustainable Development Goals (SDGs) monitoring period.

Methods

Brazilian road traffic mortality rate official data were described from 2000 to 2015, while the GDP per capita official data were described from 2000 to 2013. GDP per capita and traffic mortality rate predictions were performed until 2020 using fractional polynomial analysis. Correlations were assessed using Pearson’s correlation coefficient.

Results

From 2000 to 2015, there were over 446 000 road crashes fatal victims in Brazil. The road traffic mortality rate was positively related to the Brazilian GDP per capita, with a strong correlation (r=0.89; p<0.001) from 2000 to 2013 and a mild correlation (r=0.55; p<0.001) considering the whole period (2000–2020). The predictions show a reduction on the road traffic mortality rates in Brazil; however, if this same reduction pace continues, we estimate that the country will reach 12.4 road crash deaths per 100 000 inhabitants in 2020, a reduction of only 13.4% compared with 2015.

Conclusion

If the same mortality reduction pace continues in Brazil, the country will not reach the proposed SDG, which is to reduce by half the number of deaths per 100 000 inhabitants. In addition, an intertwined conciliation between economical growth, sustainable development and public policies is needed in order to meet such an overwhelming goal.
Time to consider a targeted HPV vaccination programme for male military recruits
Authors: Sharp William M J , Nadarzynski T , Dufty N E
Published: September 2017

Human papillomaviruses (HPV) are the most common type of sexually transmitted infection in men but also related to high-risk cancers. This article considers the epidemiology of HPV in the male military population, the UK vaccination programme and the current UK Joint Committee on Vaccination and Immunisation recommendations. Military men may not benefit from HPV herd immunity and may have a different risk profile; vaccination may in turn reduce the operational burden of HPV-related disease within this population. Military men may benefit from a targeted vaccination programme, and the paper calls for urgent consideration of approaches that could protect them from acquiring HPV.