bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationships between access to and use of a patient-centered medical home and healthcare utilization and costs: A cohort study using Medical Expenditure Panel Survey data from 2007 to 2010
Authors: Xin Haichang , Kilgore Meredith L , Menachemi Nir , Sen Bisakha (Pia)
Published: September 2015

Objective

The patient-centered medical home has emerged as an innovative healthcare delivery model that holds the conceptual promise to improve healthcare quality while reducing costs. This study is among the first to examine how patient perceived patient-centered medical home is related to utilization and costs for emergency department and inpatient care nationwide in the U.S.

Methods

This retrospective cohort study used data from the 2007–2010 Medical Expenditure Panel Survey. This study focused upon insured individuals aged 18 and older. In each two-year cohort, we measured and identified a full patient-centered medical home group, a partial patient-centered medical home group (with a usual source of care but not a patient-centered medical home), and an unknown patient-centered medical home group. Using negative binomial regression and generalized linear models, we conducted the analysis while controlling for covariates at baseline. Given the nature of the complex survey design, we adjusted weights and variance.

Results

The study sample consisted of 15,595 individuals, representing a total of 368 million people in the U.S. In the trend of outcome changes from the baseline to the follow-up year, the full and partial patient-centered medical home groups demonstrated reduced efficiency for the 2007–2008 cohort, but increased efficiency for the 2009–2010 cohort, as compared to the no regular provider group.

Conclusions

Overall, the empirical evidence does not indicate whether patient-centered medical home models reduce healthcare utilization and costs, but it does suggest their potential as mechanisms for achieving healthcare system efficiency, when primary care practices have grown from early to middle stage of patient-centered medical home transformation. A longer observation window and holistic view on all stages of patient-centered medical home growth may be more informative on patient-centered medical home’s efficiency.
Highly efficient microwave-assisted synthesis of photoactive polyamides bearing 5-(3-acetoxynaphthoylamino)benzamide moieties
Authors: Rafiee Zahra
Published: September 2015

A novel aromatic dicarboxylic acid monomer, 5-[4-(3-acetoxynaphthoylamino)benzoylamino]isophthalic acid, was prepared in five steps. The direct polycondensation of this dicarboxylic acid with several aromatic diamines was performed under microwave irradiation and conventional heating in the presence of triphenyl phosphite/pyridine/ N-methyl-2-pyrrolidone/calcium chloride. The polymerization reactions were effectively preceded, and the resulting novel photoactive polyamides (PAs) were obtained in high yields and moderate inherent viscosities in the range of 0.32–0.58 dL g−1. Thermogravimetric analysis results showed that polymers were thermally stable, 10% weight loss temperatures were in excess of 430°C and 488°C, and char yields at 800°C under nitrogen atmosphere were higher than 62%. The resulting polymers exhibited ultraviolet–visible absorption bands at 268 and 312 nm in N,N-dimethylformamide (DMF) solution. Their photoluminescence in DMF solution demonstrated fluorescence emission bands maxima around 367 and 429 nm for all of the PAs.
Elastic-plastic analysis for wet multidisc brake during repeated braking
Authors: Ji Zhanling , Li Yunhua , Xi Rui , Jia Juntao
Published: September 2015

To reveal the mechanism and evolution laws of the braking performance declining from heat load in the repeated braking applied for wet multidisc brake, a finite element analysis was carried out by using the bidirectional thermal-structure coupling method. Based on the fundamental principles of the energy conservation and virtual work principle, the elemental equations between temperature and heat load, and deformation displacement and load with heat transferring boundary conditions and heat–structure interaction were derived. Taking a steel disk in the brake for example, the deformation state of its elements, and the starting time, the location, the severity, and evolution laws of the plastic deformation were analyzed and demonstrated by using dimensionless stress distribution contours. The area in contact along the interface and the ratio of the element numbers to produce plastic deformation to the total element numbers on the steel disk were described by contact ratio and plasticity ratio, respectively. Moreover, the results under the repeated braking case were compared with that under the lasting braking case, which indicates that the influence of the temperature load on the performance declining of the repeated braking case is much lower than one of the lasting braking case, and the temperature is lower than 40 K and the plasticity ratio is smaller than 0.35 after the braking time is longer than 350 s. The conducted finite element analyses provided the theoretical fundamentals for the design and the application of the brake in the heavy type of trucks.
The influence of lubrication on the frictional characteristics of threaded joints for planetary gearboxes
Authors: De Agostinis M , Fini S , Olmi G
Published: September 2015

Planetary gearboxes generally consist of a ring gear, or gear body, connected with the input and output flanges by means of several screws, equally spaced along the diameter. The ring gear is manufactured with steel, whereas the flanges are usually made of cast iron. These screws must provide axial preload between the parts, allowing the assembly withstanding the breakaway torque given by the difference between the output and input torque applied to the gearbox. For a given screw geometry, the axial preload can be calculated, provided that the friction coefficients in the thread and in the underhead are known. Most often, the tightening torque is the only parameter being controlled during assembly and service operations. Hence, it is mandatory to know the friction coefficients of the joint. These depend, among others, on the hardness, roughness and texture of the mating surfaces, as well as on the lubrication state of the joint. In fact, the addition of a lubricant modifies the tribological behavior of the joint, thus the wearing evolution of the surfaces across repeated tightening operations. The present work tackles the following two aspects: (i) the characterization of the preloading force–tightening torque relationship on the actual component by means of a dedicated specimen, (ii) the evaluation of the influence of lubrication on the evolution of the frictional characteristics of the joint across several re-tightening operations. The present work has been carried out by means of both numerical finite element analyses and experimental stress analysis techniques.
Dual-mode frequency splitting elimination of ring periodic structures via feature shifting
Authors: Wang Yaoyao , Wang Shiyu , Zhu Dianhua
Published: September 2015

Ring periodic structures are widely spread in engineering applications, where natural frequencies can split due to the deviation from axisymmetry. This work aims at the elimination of the dual-mode natural frequency splitting by using feature shifting. A concept of equivalent feature is introduced based on the grouping idea and an analytical model with discrete features is established. The relationships between the group number, feature number, shifting angle and excited circumferential wavenumber are identified as closed-form expressions. The splitting for structures with unshifted standard features depends on the feature number and wavenumber regardless of the grouping patterns. The equivalence between various groupings is verified. Simple rules governing the dual-mode splitting are elaborated, where one splitting is removed by a combination of equivalent feature number and wavenumber, and the other is eliminated by feature shifting. The rules allow immediate estimation and elimination of the dual-mode splitting where the modified structures still hold symmetry. The results can find application in vibratory structures where the frequency splitting is the key concern. The main results are verified by the Finite Element method.
Kinematics analysis and experimental investigation of an inclined feeder with horizontal vibration
Authors: Ma Hao-Wen , Fang Gang
Published: September 2015

This paper presents a novel design of an inclined feeder with a chute that vibrates like a simple pendulum. It is designed with a horizontal vibration and an inclined chute for feeding steel scraps in electric furnace steelmaking. The simplified model of the feeder and the governing equations of kinematics analysis are introduced. Numerical integration programs were developed to investigate the kinematics characteristics of the feeder. The inclination angle of the chute and the vibration frequency, two vital impact factors affecting the motion of the fed block, were analyzed. Compared with the traditional horizontal chute feeder, this novel feeder has proved to be more efficient and speed-controllable. An experimental prototype was fabricated and feeding tests were performed. Results indicate that good agreement between calculation and experiment was achieved on the motion of the fed block. A stepped chute was proposed to solve the problem of block intertwining and uneven dropping during the feeding. The simulation of the multi-block feeding showed that the feeding with the stepped chute was steadier than that with the smooth chute. This research indicates that the mathematical model is able to predict the motions of the system and the new feeder will be capable and effective in performing the steel scrap feeding task.
Calculation of arbitrary tooth shapes to support gear design
Authors: Zimmer Maximilian , Otto Michael , Stahl Karsten
Published: September 2015

This article provides a mathematical framework based on the basic law of gear kinematics for calculating the tooth geometry of arbitrary gear types. The described algorithms are illustrated by means of practical applications, especially nonstandard gearings. The computed geometry is exported as a point cloud with integrated STEP-modeling. Thus, further analysis of the generated gear types are possible, e.g. by computer-aided design or finite-element software tools as well as manufacturing on 5-axis-CNC or forging machines.
Experimental modelling of lipping in insulated rail joints and investigation of rail head material improvements
Authors: Beaty Philip , Temple Barnaby , Marshall Matthew B , Lewis Roger
Published: September 2015

An insulated rail joint is a component used to join two abutting rails while keeping them electrically separated from one another. This allows for the construction of track circuits and train detection within signalling systems. Electrical failure of the joints can be caused by plastic flow of the rail steel over the insulating gap, known as lipping. In this paper, this failure mode has been experimentally modelled using twin-disc testing and indicative conclusions have been formed. It has been found in this testing that the thickness of the endpost does not have an effect on the rate of lipping, however, the endpost and rail material do have an effect. An endpost with a higher compressive strength will perform better and tougher/harder rail steel will also improve performance. The application of a laser clad layer of tougher material on the running surface, however, gave the greatest resistance to lipping.
Numerical investigation on impact of blowing control in flush-mounted S-shaped inlet to rear fan-stage performance
Authors: Liu Lei , Chen Fu , Song Yanping , Chen Huanlong , Yu Jianyang
Published: September 2015

In this paper, numerical simulation of the whole structure of a half flush-mounted S-shaped air-intake and the rear fan stage was conducted for investigating the impact of air-intake exit distortion on the fan-stage performance. Considering substantial boundary layer ingesting, a scheme of blowing control imposed near the first bend of the inlet where the flow separation occurs was also carried out. The results show that the air intake internal separation is eliminated, and the distorted air region at its exit decreases significantly after blowing, simultaneously, the aerodynamic performance of the rear fan stage improves dramatically. The choked mass flow increases about 1.45%, and the maximum isentropic efficiency as well as the corresponding total pressure ratio at this point increases about 1.83% and 1%, respectively. In addition, the distorted fluid always covers several blade passages no matter with blowing control or not when it goes through the fan stage. Both relative total pressure and velocity of air in these distorted blade passages are lower than that in other uniform passages and have slightly increased with blowing. Under effect of the inlet flow angle increase caused by the non-uniform air admission and the adverse pressure gradient in the rear part of the flow passage, serious flow separation occurs at the stator blade suction side but mainly exists at 50% span and below and weakens after blowing control.
Reactive arthritis at the Sydney Sexual Health Centre 1992–2012: declining despite increasing chlamydia diagnoses
Authors: Mason E , Wray L , Foster R , Jamil MS , Guy R , McNulty A , Donovan B
Published: September 2015

Summary

Reactive arthritis is an under-studied complication of genital Chlamydia trachomatis infection (chlamydia). We assessed trends and risk factors for reactive arthritis in a large urban sexual health clinic. Using a case-control design, data on reactive arthritis cases and controls at the Sydney Sexual Health Centre over the period 1992–2012 were extracted and multivariate analyses were performed. Trend analyses were performed on reactive arthritis diagnoses. Over the 1992–2012 study period, 85 reactive arthritis cases were diagnosed at Sydney Sexual Health Centre. The rate of reactive arthritis diagnoses decreased over time (23 in 1992–1996 to one in 2007–2011 and none in 2012), while chlamydia diagnoses increased (770 in 1992–1996 to 2257 in 2007–2011). In multivariate analysis, factors independently associated with a reactive arthritis diagnosis were: being male (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.04–10.32; p = 0.043) or born overseas (aOR 2.69; 95% CI 1.27–5.70; p = 0.010), while a past sexually transmitted infection other than chlamydia or non-gonococcal urethritis was protective (aOR 0.21; 95% CI 0.10–0.45; p < 0.001). Reactive arthritis was not associated with current or recent chlamydia infection ( p = 0.184) but was marginally associated with past non-gonococcal urethritis ( p = 0.080). This study found a decline in reactive arthritis diagnoses despite an increase in chlamydia diagnoses.
First case of chancroid in 14 years at the largest STI clinic in Paris, France
Authors: Fouéré Sébastien , Lassau François , Rousseau Clotilde , Bagot Martine , Janier Michel
Published: September 2015

We report the first case of chancroid seen at our clinic in 14 years. It was diagnosed by nuclear acid amplification test in a male patient returning from Madagascar. Although the disease is considered on the verge of disappearance even in tropical countries, its real potential for reemergence – due to new strains of Haemophilus ducreyi, underreporting and a lack of widespread use of molecular testing – could be underestimated.
Point-of-care testing for HIV in an Irish prison setting: results from three major Irish prisons
Authors: Bannan Ciaran L , Lynch Pamela A , Conroy Emmett P , O’Dea Siobhan , Surah Saloni , Betts-Symonds Graham , Lyons Fiona E
Published: September 2015

HIV is more prevalent in the prison population compared to the general population. Prison inmates are at an increased risk of blood-borne infections. Considerable stigma has been documented amongst inmates with HIV infection. In collaboration with the schools, healthcare facilities, prison authorities and inmate Irish Red Cross groups in Wheatfield, Cloverhill and Mountjoy prisons in Dublin, Ireland, the Department of Genito Urinary Medicine and Infectious Diseases at St James’ Hospital in Dublin developed a campaign for raising awareness of HIV, educating inmates about HIV and tackling HIV stigma. Following this campaign, large-scale point-of-care testing for HIV was offered over a short period. In total, 741 inmates were screened for HIV. One inmate tested positive for HIV. We experienced a large number of invalid test results, requiring formal laboratory serum testing, and a small number of false positive results. Large-scale point-of-care testing in the Irish prison setting is acceptable and achievable.
Bye-bye Bolitho? The curious case of the Medical Innovation Bill
Authors: Miola José
Published: September 2015

Lord Saatchi’s Medical Innovation Bill, which has been reintroduced into parliament, is a deeply flawed piece of prospective legislation. The way in which it has been presented is different from what it actually does, and it dilutes the law’s ability to protect patients. It also attempts to solve a problem that does not exist. Moreover, the unintended consequences inherent in the Bill provide the potential for it to be actively harmful rather than benignly useless. This article identifies the myths propagated on behalf of the Bill, examines the current legal position and the Bill’s framework and argues that the Bill must not become law.
Socioeconomic inequalities in breast and cervical screening coverage in England: are we closing the gap?
Authors: Douglas Elaine , Waller Jo , Duffy Stephen W , Wardle Jane
Published: September 2015

Objective

Health policy in the UK is committed to tackling inequalities in cancer screening participation. We examined whether socioeconomic inequalities in breast and cervical cancer screening participation in England have reduced over five years.

Methods

Cross-sectional analyses compared cervical and breast screening coverage between 2007/8 and 2012/13 in Primary Care Trusts (PCTs) in England in relation to area-level income deprivation.

Results

At the start and the end of this five year period, there were socioeconomic inequalities in screening coverage for breast and cervical screening. Inequalities were highest for breast screening. Over time, the coverage gap between the highest and lowest quintiles of income deprivation significantly reduced for breast screening (from 12.3 to 8.3 percentage points), but not for cervical screening (5.3 to 4.9 percentage points).

Conclusions

Efforts to reduce screening inequalities appear to have resulted in a significant improvement in equitable delivery of breast screening, although not of cervical screening. More work is needed to understand the differences, and see whether broader lessons can be learned from the reduction of inequalities in breast screening participation.
Federal Farmworker Housing Standards and Regulations, Their Promise and Limitations, and Implications for Farmworker Health
Authors: Joyner Ann Moss , George Lance , Hall Mary Lee , Jacobs Ilene J. , Kissam ED , Latin Shelley , Parnell Allan , Ruiz Virginia , Shadbeh Nargess , Tobacman Janet
Published: September 2015

The housing available to most farmworkers is substandard and unacceptable in 21st-century America. The federal government established minimal occupational safety and health standards applicable to migrant farmworker labor camps decades ago, and some states have statutory schemes and regulations that set standards for farm labor camps and employee housing. Many of these federal and state regulations no longer reflect current employment and housing trends, and enforcement success varies greatly. These regulations implicitly recognize the connection between housing conditions and health, but do not effectively address that connection. This review describes the current state of farmworker housing, discusses laws and regulations pertaining to such housing, and highlights the literature on health risks associated with inadequate housing. We propose specific recommendations to strengthen enforcement and reduce the risks of substandard housing for the health of farmworkers and their families.
Farmworker Housing Quality and Health
Authors: Arcury Thomas A. , Jacobs Ilene J. , Ruiz Virginia
Published: September 2015

On 11 November 2014, Farmworker Housing Quality and Health: A Transdisciplinary Conference was convened to draw together experts from the variety of disciplines who contribute to research and practice focused on farmworker housing and health in order to delineate current knowledge and propose next steps. The conference addressed three specific aims: (1) to consolidate current knowledge on characteristics and quality of housing provided for farmworkers; (2) to delineate pertinent directions and areas for farmworker housing health and safety research and policy; and (3) to facilitate the development of working groups to support the implementation of research, education, and engineering projects to improve farmworker housing. This article provides an overview of the conference.
A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction
Authors: Gabriel Emmanuel , Kukar Moshim , Groman Adrienne , Alvarez-Perez Amy , Schneider Jaclyn , Francescutti Valerie
Published: September 2015

Background:

Patients with stage IV cancer and bowel obstruction present a complicated management problem. The aim of this study was to evaluate the role of the palliative care service (PC) in the management of this complex disease process.

Methods:

A retrospective analysis was conducted of all patients admitted to Roswell Park Cancer Institute with stage IV cancer and bowel obstruction from 2009 to 2012 after the institution of a formal PC. This cohort was matched to similar patients from 2005 to 2008 (no palliative care service or NPC). Patient characteristics and outcomes included baseline demographics, comorbid conditions, do-not-resuscitate (DNR) status, laboratory parameters, medical and surgical management, length of stay, symptom relief, and disposition status.

Results:

A total of 19 patients were identified in the PC group. Based on the PC group baseline characteristics, 19 patients were identified for the NPC group using matched values. Regarding outcomes, there were significant differences in the medication regimens (narcotics, octreotide, and Decadron) between the 2 groups. In the PC group, 14 of 19 patients showed improvement compared to 9 of 19 in the NPC group. Nearly 60% of patients in the PC group had a formal DNR order versus 10.5% in NPC ( P = .002). A significantly higher percentage of patients were discharged to hospice in the PC group (47.4% vs 0.0%, P = .006).

Conclusion:

Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.
Effective viscoelastic properties of micro-cracked heterogeneous materials
Authors: Nguyen TN , Nguyen ST , Vu M-H , Vu MN , Gasser Alain , Rekik Amna
Published: September 2015

The aim of this paper is to model the effective viscoelastic properties of micro-cracked masonry based on a homogenization approach. The masonry is modeled as a mixture of a micro-cracked viscoelastic mortar matrix and isotropic elastic brick inclusions. Firstly, the effect of micro-cracks on the effective viscoelastic properties of mortar is considered at micro-scale. Secondly, brick inclusions are added in the micro-cracked mortar matrix at mesoscale to simulate effective viscoelastic properties of masonry. The modified Maxwell viscoelastic model is employed for noncracked, micro-cracked mortar matrix and micro-cracked masonry. The use of the same modified Maxwell model of the noncracked mortar to model the viscoelastic properties of the micro-cracked mortar is an approximation. This approximation is carried out in the short- and the long-term behaviors in the Laplace–Carson space. It is validated in transient situation with exact solutions obtained from the inverse Laplace–Carson transform for simple loading conditions. This technique allows avoiding the complexity of the inverse Laplace–Carson transform. The isotropic case with random orientation distribution of open micro-cracks in mortar and with spherical brick inclusions is considered.
Doctoral Students in Music Education
Authors: Martin Lisa D.
Published: September 2015

The purpose of this study was to examine music education doctoral students’ shifting occupational identity beliefs, career intent and commitment, and overall confidence for teaching in higher education. A total of 124 music education doctoral students, enrolled at 29 institutions of higher education in the United States, completed a onetime, 29-item online questionnaire. Participants identified more strongly as music teacher educators than as K–12 music teachers, and they were more committed to pursuing a career in higher education than K–12 teaching on completing their degree. However, participants who taught K–12 music concurrently during the degree were more likely to consider returning to K–12 teaching on degree completion. Music education doctoral students demonstrated confidence in their ability to train future K–12 music educators but lacked confidence in their ability to achieve a high-quality life balance in higher education. Implications for music education doctoral programs are discussed.
The Effect of Obesity on Functional Outcomes and Complications in Total Ankle Arthroplasty
Authors: Gross Christopher E. , Lampley Alexander , Green Cynthia L. , DeOrio James K. , Easley Mark , Adams Samuel , Nunley James A.
Published: September 2015

Background:

The prevalence of obesity in the United States is staggering. Currently, the effect of obesity on third-generation total ankle replacement (TAR) is unknown.

Methods:

We prospectively identified a consecutive series of 455 primary TARs operated between May 2007 and September 2013 who had a minimum follow-up of 2 years. We identified 266 patients with a body mass index (BMI) <30 (control), 116 with a BMI between 30 and 35 (Obese I), and 73 with a BMI >35 (Obese II). Clinical outcomes including wound issues, infection rate, complications, and failure rates were compared. Functional outcomes including American Orthopaedic Foot & Ankle Society hindfoot score, Short Form–36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), Foot and Ankle Disability Index (FADI), and Foot and Ankle Outcome Score (FAOS) were compared. Average patient follow-up in the Obese I group was 44.7 ± 17.3 months, Obese II was 42.7 ± 16.4 months, and 45.2 ± 17.4 months in the control group.

Results:

Age, race, and smoking history in the obese group were not significantly higher than the control group; however, sex was significantly related to BMI. There was no difference in complication, infection, or failure rates between the groups. Preoperatively, the Obese II group had significantly lower SF-36 scores and higher SMFA function, FADI, and FAOS Symptoms scores. For each of the Obese I, Obese II, and control groups, all functional outcome scores 1 year postoperatively and at most recent follow-up were significantly improved. However, at most recent follow-up, Obese II patients had lower FAOS Pain and SF-36 scores and higher FADI and SMFA Functional scores.

Conclusion:

Total ankle arthroplasty in obese patients was a relatively safe procedure. Although obese patients after TAR had lower functional outcome scores compared to their nonobese counterpart, they did experience significant functional and pain improvements at most recent follow-up.

Level of Evidence:

Level III, comparative series.
Modal control of a hydraulically driven redundant actuated fully parallel mechanism
Authors: He Jing-feng , Jiang Hong-zhou , Tong Zhi-zhong
Published: September 2015

In this paper, we consider the problem of modal-space control for the hydraulically driven fully parallel mechanism with actuation redundancy. Firstly, the mechanical-hydraulic interaction system is transformed into modal-space model. Then, independent modal decoupled systems for the redundant mechanism are obtained. According to the eigenvalue frequency characteristics, two types of modal systems – zero eigenvalue modal systems and nonzero ones – naturally result and these systems can be treated separately. For the nonzero eigenvalue modal systems, it is convenient to employ dynamic pressure feedback control to regulate damping. For the zero eigenvalue modal systems, we give a proof to show that they just lie in the null space of the Jacobian of the mechanism, then it is more appropriate to implement force control for this type of modal system. Some simulation results further explain the proposed modal-space control method.
Analysis of hydropower unit vibration signals based on variational mode decomposition
Authors: An Xueli , Pan Luoping , Zhang Fei
Published: September 2015

The vibration signals of hydropower units are nonstationary when serious vortex occurs in the draft tube of the hydraulic turbine. The traditional signal analysis method based on Fourier transform is not suitable for the nonstationary signals. In the face of the nonstationarity of such signals and the limitation of the empirical mode decomposition method, a new nonstationary and nonlinear signal analyzing method based on variational mode decomposition (VMD) is introduced into hydropower unit vibration signals analysis. Firstly, VMD is used to decompose the signal into an ensemble of band-limited intrinsic mode functions components. Then, frequency spectrum analysis of these components is conducted to obtain the characteristic frequencies of the signal caused by the serious vortex of hydraulic turbine. Analysis of real test data shows that this proposed method can effectively suppress mode mixing. It can realize accurate analysis of nonstationary vibration signals. This provides a new way for analyzing hydropower unit vibration signals.
The Influence of Remote Monitoring on Clinical Decision Making
Authors: Williams Cynthia , Wan Thomas T. H.
Published: September 2015

The aim of this study was to examine the meaningful use of remote monitoring. In partnership with a home health care agency, we examined the degree to which the information obtained from remote monitoring influenced change in decisions that affect readmission rates among patients diagnosed with heart failure. Hospital utilization was highly associated with nurses’ clinical decisions to go to the hospital; the additional data provided by technology did not modify decisions. The role of nurses in heart failure management is critical to quality outcomes. Investments into remote monitoring technology should accompany strategies to enhance decision making and align clinical decision making with quality goals.
Cancer Fatalism, Literacy, and Cancer Information Seeking in the American Public
Authors: Kobayashi Lindsay C. , Smith Samuel G.
Published: September 2015

Information seeking is an important behavior for cancer prevention and control, but inequalities in the communication of information about the disease persist. Conceptual models have suggested that low health literacy is a barrier to information seeking, and that fatalistic beliefs about cancer may be a mediator of this relationship. Cancer fatalism can be described as deterministic thoughts about the external causes of the disease, the inability to prevent it, and the inevitability of death at diagnosis. This study aimed to examine the associations between these constructs and sociodemographic factors, and test a mediation model using the American population-representative Health Information and National Trends Survey (HINTS 4), Cycle 3 ( n = 2,657). Approximately one third (34%) of the population failed to answer 2/4 health literacy items correctly (limited health literacy). Many participants agreed with the fatalistic beliefs that it seems like everything causes cancer (66%), that one cannot do much to lower his or her chances of getting cancer (29%), and that thinking about cancer makes one automatically think about death (58%). More than half of the population had “ever” sought information about cancer (53%). In analyses adjusted for sociodemographic characteristics and family cancer history, people with limited health literacy were less likely to have ever sought cancer information (odds ratio [ OR] = 0.63; 0.42-0.95) and more frequently endorsed the belief that “there’s not much you can do . . .” ( OR = 1.61; 1.05-2.47). This fatalistic belief partially explained the relationship between health literacy and information seeking in the mediation model (14% mediation). Interventions are needed to address low health literacy and cancer fatalism to increase public interest in cancer-related information.
Baseline Evaluation of a Participatory Mobile Health Intervention for Dengue Prevention in Sri Lanka
Authors: Lwin May O. , Vijaykumar Santosh , Lim Gentatsu , Fernando Owen Noel Newton , Rathnayake Vajira Sampath , Foo Schubert
Published: September 2015

Challenges posed by infectious disease outbreaks have led to a range of participatory mobile phone–based innovations that use the power of crowdsourcing for disease surveillance. However, the dynamics of participatory behavior by crowds in such interventions have yet to be examined. This article reports results from a baseline evaluation of one such intervention called Mo-Buzz, a mobile-based crowdsource-driven socially mediated system developed to address gaps in dengue surveillance and education in Colombo, Sri Lanka. We conducted a 30-minute cross-sectional field survey ( N = 404) among potential users of Mo-Buzz in Colombo. We examined individual, institutional, and cultural factors that influence their potential intention-to-use Mo-Buzz and assessed if these factors varied by demographic factors. Descriptive analysis revealed high perceived ease-of-use (PEOU; M = 3.81, SD = 0.44), perceived usefulness (PU; M = 4.01, SD = 0.48), and intention-to-use (PI; M = 3.91, SD = 0.46) among participants. Analysis of variance suggested participants in the 31 to 40 years age group reported highest PEOU, whereas the oldest group reported high perceived institutional efficacy ( M = 3.59, SD = 0.64) and collectivistic tendencies. Significant differences (at the p < .05 level) were also found by education and income. Regression analysis demonstrated that PU, behavioral control, institutional efficacy, and collectivism were significant predictors of PI. We concluded that despite high overall PI, future adoption and use of Mo-Buzz will be shaped by a complex mix of factors at different levels of the public health ecology. Implications of study findings from theoretical and practical perspectives related to the future adoption of mobile-based participatory systems in public health are discussed and ideas for a future research agenda presented.
Influence of two administration rates of alfaxalone at induction on its relative potency in cats: a pilot study
Authors: Bauquier Sébastien H , Warne Leon N , Carter Jennifer E , Whittem Ted , Beths Thierry
Published: September 2015

Objectives

The aim of the study was to evaluate, in a controlled, randomised, masked clinical trial, the influence of administration rate of alfaxalone at induction on its relative potency in cats and to report the incidence of cardiorespiratory adverse effects.

Methods

Twelve healthy female domestic cats admitted for ovariohysterectomy were premedicated with buprenorphine 20 µg/kg intramuscularly and alfaxalone 3.0 mg/kg subcutaneously. Sedation scores were established (using a published scale ranging from 1 [no sedation] to 5 [profound sedation]) prior to anaesthesia induction with alfaxalone intravenously at 2 mg/kg/min (group A2; n = 6) or 0.5 mg/kg/min (group A0.5; n = 6) to effect until orotracheal intubation was achieved. Sedation scores and alfaxalone induction doses were compared between the groups, using a Mann–Whitney exact test. Results are reported as median and range. Presence of apnoea (no breathing for more than 30 s) or hypotension (mean arterial blood pressure <60 mmHg) within 5 mins postintubation was also reported.

Results

Although sedation scores (1.5 [range 1.0–3.0] and 2.5 [range 1.0–3.0] for A2 and A0.5, respectively) were not significantly different ( P = 0.32), cats in group A2 required significantly more alfaxalone (4.3 mg/kg [range 3.4–7.0 mg/kg]) than group A0.5 (2.1 mg/kg [range 1.5–2.5 mg/kg]) ( P = 0.002). Two cats in each group presented postinduction apnoea, and two cats in group A2 and three cats in group A0.5 presented postinduction hypotension.

Conclusions and relevance

The use of a slower induction infusion rate resulted in an increase in the alfaxalone relative potency without obvious cardiorespiratory benefit.
A tribological study of piston rings lubricated by power law oils
Authors: Zavos Anastasios , Nikolakopoulos Pantelis G
Published: September 2015

A 2D axisymmetric hydrodynamic model was developed considering fluid structure interaction analysis in order to solve the Navier–Stokes equations. The effect of lubricants viscosities in terms of both monograde and multigrade oils, on the produced piston ring friction force are compared, using smooth and textured piston rings. The novelty of the current paper is the solution of the Navier–Stokes equations with the use of power law lubricants, which act in non-Newtonian shear for the piston ring friction problem. The lubricant viscosity variation in relation to the temperature has been taken into account. Simulation shows a good prediction at lower loads and higher piston speeds. The hydrodynamic pressure, the oil film thickness and the friction force on smooth and textured flat piston ring are predicted and presented.
Teledermatology as a means to improve access to inpatient dermatology care
Authors: Sharma Priyank , Kovarik Carrie L , Lipoff Jules B
Published: September 2015

Many hospitals have limited inpatient dermatology consultation access. Most dermatologists are outpatient-based and may find the distance and time to complete inpatient consultations prohibitive. Teledermatology may improve access to inpatient dermatology care by reducing barriers of distance and time. We conducted a prospective two-phase pilot study at two academic hospitals comparing time needed to complete inpatient consultations after resident dermatologists initially evaluated patients, called average handling time (AHT), and time needed to respond to the primary team, called time to response (TTR), with and without teledermatology with surveys to capture changes in dermatologist opinion on teledermatology. Teledermatology was only used in the study phase, and patients were seen in-person in both study phases. Teledermatology alone sufficiently answered consultations in 10 of 25 study consultations. The mean AHT in the study phase (sAHT) was 26.9 min compared to the baseline phase (bAHT) of 43.5 min, a 16.6 min reduction ( p = 0.004). The 10 study cases where teledermatology alone was sufficient had mean study TTR (sTTR) of 273.3 min compared to a baseline TTR (bTTR) of 405.7 min, a 132.4 min reduction ( p = 0.032). Teledermatology reduces the time required for an attending dermatologist to respond and the time required for a primary team to receive a response for an inpatient dermatology consultation in a subset of cases. These findings suggest teledermatology can be used as a tool to improve access to inpatient dermatology care.
Tele-health services for the elderly: A novel southern Italy family needs-oriented model
Authors: De Cola Maria C , De Luca Rosaria , Bramanti Alessia , Bertè Francesco , Bramanti Placido , Calabrò Rocco S
Published: September 2015

Introduction

The world population is aging. By 2050, the global population aged over 65 years will have doubled, leading to big societal challenges for ensuring healthy, independent, and productive lives for older people. Thus, innovative local and national initiatives for e-health services are growing in an attempt to overcome such problems.

Methods

We examined the effects of a telehealth system, i.e. tele-monitoring of vital parameters and neurological/psychological tele-counseling, within a family-centred service provided by a local day centre. We evaluated the clinical and neurobehavioral symptoms of 18 elderly patients (aged 65 years and over) and the care burden of their 20 caregivers, besides the usability of the tool.

Results

The one-way repeated analysis revealed a significant worsening in daily living activities ( p < 0.01 and p = 0.02, respectively for Activities of Daily Living (ADL) and Independent IADL (IADL)) versus a significant improvement of the patients' psychiatric condition ( p < 0.001), besides a significant gradual reduction of the caregivers burden ( p < 0.001). Health status perception increased through time (from an average score of 5.67 ± 1.08 at baseline to 7.72 ± 1.32 at the end of the study).

Discussion

It appears that a telehealth system integrated in a local health care service may significantly improve elderly persons’ behaviour, and also reduce the caregivers’ burden.
Using mobile technology to motivate adolescents with type 1 diabetes mellitus: A systematic review of recent literature
Authors: Deacon Anthony J , Edirippulige Sisira
Published: September 2015

Introduction

Behavioural interventions have been shown to improve outcomes in patients with type 1 diabetes mellitus (T1DM). There are a small number of studies that suggest text-messages (TM), native mobile applications (NMAs), and other mobile tools may be useful platforms for delivering behavioural interventions to adolescents.

Aim

The aim of this study was to explore, by way of a systematic review of available literature, (a) the outcomes of interventions using mobile technology for youth with T1DM and (b) what mobile technologies, functional design elements and aesthetic design elements have the best evidence to support their use.

Methods

A search of six online databases returned 196 unique results, of which 13 met the inclusion criteria.

Results

Four studies were randomised controlled trials (RCTs), and all others prospective cohort studies. TM (10) was the most common intervention technology, while NMAs were used in four studies. The most common outcome measured was HbA1c (9); however, only three studies showed a significant decrease. Similarly, the results reported for other outcome measures were mixed. The studies included in this review suggest that interventions which have data collection and clinician support functionality may be more effective in improving adherence and glycaemic control, but more evidence is needed. Further, the evidence base supporting the use of NMAs in T1DM management for adolescents is weak, with most studies adopting TM as the intervention tool. Overall, the studies lack adequate descriptions of their methodology, and better quality studies are required to inform future intervention design.
The raped woman as a horrific sublime and the Bangladesh war of 1971
Authors: Mookherjee Nayanika
Published: September 2015

This article examines the relationship between aesthetics and politics when invoking the imagery of war-time rape. It explores the prevalent way in which the raped woman of the Bangladesh war of 1971 is imagined in contemporary Bangladesh through the circulation of rumours, narratives of encounters and photographs. In 1971, faced with a large number of rape survivors after the war, the Bangladeshi government publicly designated any woman raped in the war a birangona (meaning brave woman /war-heroine). Over the last 40 years in Bangladesh, there has existed a public memory of wartime rape through various literary, visual and testimonial forms. These aesthetic representations of the war-heroine can be understood through Rancière’s politics by other means – of that of the distribution of the sensible – through the horrific sublime figuration of the birangona. As an idea that is not readily apparent, these diverse oral, visceral and visual strategies make the birangona visible and comprehendible as bhoyonkor (horrific). The figuration of the birangona as a horrific sublime also brings to the surface Lyotard’s formulation of the ‘encoding’ – the underlying moral values and judgment – that are implicit in the feelings that enable the readability of the war-heroine. I interrogate these hegemonic affective aesthetics (the way wartime rape is often narrowly described) through a nuanced ethnographic account of the birangona’s life trajectory. This less categorised, non-semiotic figuration of the birangona is the interventionary mode, the politics – in Rancière’s formulation – through which this idea of the horrific sublime can be disrupted.
Student teacher beliefs on grammar instruction
Authors: Graus Johan , Coppen Peter-Arno
Published: September 2015

The role of grammar teaching in foreign language education is a controversial one both in second language acquisition (SLA) research and language pedagogy and, as a result, a potential source of confusion to student teachers. The objective of this study was to gain insight into the beliefs on grammar teaching of student teachers of English as a foreign language enrolled in undergraduate and postgraduate teacher education programmes at Dutch universities of applied sciences. To this end a questionnaire was developed and validated based on four construct pairs from SLA literature: meaning- versus form-focused instruction, focus on form (FonF) versus focus on forms (FonFs), implicit versus explicit instruction, and inductive versus deductive instruction. Overall, respondents ( n = 832) were found to prefer form-focused, explicit, inductive instruction, and FonFs. However, higher-year undergraduates’ and postgraduates’ results showed a trend towards a preference for more meaning-focused and implicit instruction, and FonF. When learner level was factored in, however, these forms of language instruction were considered subordinate to more traditional form-focused approaches for teaching higher-level language learners.
Tendon Graft Healing in Multiligament Reconstructed Knee Detected by FDG-PET/CT: A Pilot Study
Authors: Itälä A. , Alihanka S. , Kosola J. , Kemppainen J. , Ranne J. , Kajander S.
Published: September 2015

Background and Aims:

The detection of graft viability is challenging in the multiligament reconstructed knee. Magnetic resonance imaging gives structural information but lacks the capability to assess biological activity of the grafts. 18F-labeled fluorodeoxyglucose positron emission tomography combined with computer tomography is shown to be a sensitive method for imaging tissue metabolism and viability. The aim of the present study was to evaluate the feasibility of fluorodeoxyglucose positron emission tomography combined with computer tomography imaging in the detection of the replacement graft metabolism in multiligament reconstructed knees.

Materials and Methods:

Seven patients (17–44 years) with multiligament reconstructed knee underwent fluorodeoxyglucose positron emission tomography combined with computer tomography to evaluate the biological activity of replacement grafts. The degree of fluorodeoxyglucose uptake reported as standard uptake values from the region of interest was analyzed 3–24 months postoperatively.

Results:

In all patients, the fluorodeoxyglucose positron emission tomography combined with computer tomography showed increased fluorodeoxyglucose uptake in all replacement grafts at different follow-up time points. Furthermore, fluorodeoxyglucose was higher at femoral condyles of operated knees compared to contralateral reference values.

Conclusion:

This pilot study shows a significant increase in tendon graft metabolism during two first years of postoperative healing. The fluorodeoxyglucose positron emission tomography combined with computer tomography imaging seems to be adequate method of assessment of graft metabolism and viability during postoperative healing. The clinical value of fluorodeoxyglucose positron emission tomography combined with computer tomography imaging, however, warrants further evaluation with longitudinal studies with a larger patient population.