bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacotherapy of Aggressive Behavior
Authors: Pabis Derails J , Stanislav Steven W
Published: January 2017

OBJECTIVE:

To review the definition, clinical characteristics, prevalence, etiology, neurochemistry, and pharmacologic treatment of aggressive behavior, and provide recommendations regarding the use of specific pharmacologic agents for treating aggressive behavior.

DATA SOURCES:

Data from the scientific literature were analyzed, interpreted, and summarized. An English-language MEDLINE search yielded clinical trials, case reports, letters, and review articles addressing the etiology and pharmacotherapy of aggression.

STUDY SELECTION:

Because few well-controlled studies are available in aggression research, all literature addressing the pharmacologic treatment of aggressive behavior, as well as the neurochemistry and psychobiology of aggressive behavior, was reviewed.

DATA EXTRACTION:

The literature was reviewed on the basis of the particular pharmacotherapy and the specific population used. A separate review of the treatment of aggressive behavior in the elderly was included.

DATA SYNTHESIS:

The literature was assessed for applicability to clinical practice and usefulness to the general clinician. Recommendations were made from the primary literature in conjunction with trends in clinical practice. Pharmacotherapy is a primary mainstay of treatment for aggressive patients. In individuals for whom behavioral intervention alone is unsuccessful, drug therapy should be initiated along with continued nonpharmacologic intervention. Short-acting benzodiazepines and high-potency antipsychotic agents are effective in treating acute aggression on a short-term or as needed basis. Agents such as lithium, beta-adrenergic blockers, carbamazepine, valproic acid, buspirone, trazodone, serotonin reuptake inhibitors, and clozapine may be useful in the chronic management of aggressive behavior. Every attempt should be made to streamline drug therapy in patients with chronic aggression and comorbid psychiatric disorders.

CONCLUSIONS:

On the basis of available research and extensive clinical experience, lithium or propranolol should be considered as first-line antiaggressive agents in patients without comorbid psychiatric disorders. A minimum trial period for assessing drug efficacy should last at least 6–8 weeks at maximum tolerated dosages. Patients responding to pharmacotherapy should be reevaluated every 3–6 months, and periodic medication tapers and/or drug-free periods should be attempted.
Methemoglobinemia Induced by an Over-the-Counter Medication
Authors: Tush Gretchen M , Kuhn Robert J
Published: January 2017

OBJECTIVE:

To report a case of methemoglobinemia induced by benzocaine and resorcinol (Vagisil) cream, an over-the-counter medication that was used to treat diaper rash in a neonate.

CASE REPORT:

A 6-day-old, 3350-g white boy was found to be cyanotic with blue mucous membranes on presentation. He had a diaper rash that was red and irritated, which his mother had treated with Vagisil cream. Methemoglobinemia secondary to absorption of benzocaine and resorcinol (1,3-benzenediol) from the Vagisil was diagnosed, with a methemoglobin level of 35% on admission (normal 0.4–1.5). Intravenous methylene blue 3 mg (1 mg/kg) was given; the neonate's skin color returned to normal 45 minutes after the dose.

DISCUSSION:

Methemoglobinemia is a condition in which hemoglobin is oxidized to the ferric form. Oxidized hemoglobin, methemoglobin, is incapable of reversibly binding oxygen at the physiologic partial oxygen pressure. Main causes of methemoglobin formation are exposure to certain oxidizing agents and drugs, deficiency of one of the enzymes necessary for reduction of methemoglobin to hemoglobin, or the presence of an abnormal hemoglobin resistant to reduction. Clinical manifestations of methemoglobinemia include diffuse slate-gray cyanosis with low oxygen saturation in the absence of respiratory distress. A single intravenous dose of methylene blue 1–2 mg/kg is the treatment of choice.

CONCLUSIONS:

Newborn infants are at increased risk for methemoglobinemia due to diminished enzyme systems required to reduce ferrihemoglobin to ferrohemoglobin, as well as because fetal hemoglobin is more easily oxidized than is adult hemoglobin. It is important to recognize possible drug reactions and educate parents on the potential risks of treatment with over-the-counter medications, especially in neonates.
Modified Lapidus Procedure for the Treatment of Hypermobile Hallux Valgus
Authors: Bednarz Paul A. , Manoli Arthur
Published: January 2017

The intermediate outcome of patients who underwent a modified Lapidus procedure for the treatment of hallux valgus secondary to a hypermobile first ray was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 31 feet in 26 patients who underwent a modified Lapidus procedure. All working patients (100%) returned to full-time work. Six patients were retired and one was unemployed prior to surgery. There was an average of eight months until sports or unlimited activities were performed, and an average 16 weeks until conventional shoes could be worn. All patients but one (96%) were satisfied with the surgery and knowing their results would have the surgery again. Postoperative pain relief satisfaction was totally satisfied in 19 patients, satisfied with reservations in six patients, and not satisfied in one patient. Postoperative appearance satisfaction was totally satisfied in 21 patients and satisfied with reservations in five patients. Postoperative joint motion was no noticeable stiffness in 22 patients, noticeable stiffness but not bothersome in three patients, and stiffness that impairs activity in one patient (two feet). In the radiographic measurements, there was an average improvement of 10 degrees in the hallux valgus angle, 10 degrees in the intermetatarsal angle, two degrees in the lateral metatarsal-floor angle and two grades in the sesamoid position. Complications experienced were five recurrent deformities, two metatarsalgias, and one deep vein thrombosis. One of the five recurrences became symptomatic and required a revision.
Bone Scintigraphic Findings of Os Trigonum: A Prospective Study of 100 Soldiers on Active Duty
Authors: Sopov Vladimir , Liberson Aharon , Groshar David
Published: January 2017

PURPOSE: To determine the clinical significance of an increased uptake of 99mTc methylene-diphosphonate (Tc-MDP) in the os trigonum region seen on bone scintigrams of soldiers on active duty.

PATIENTS AND METHODS: Radionuclide whole-body skeletal imaging and physical examination of the foot were carried out in 100 consecutive soldiers on active duty referred for evaluation of suspected stress-injury of the lower limbs, back pain, and different skeletal trauma. Lateral radiographs of the foot were performed in those with increased uptake of Tc-MDP at the site of os trigonum. Radiographic, scintigraphic, and clinical findings were correlated.

RESULTS: Among 200 feet, 27 (13.5%) showed an increased uptake of Tc-MDP in the os trigonum region. The right side was affected in six patients, the left side in 11 and five patients had bilaterally increased uptake. On X-rays, 31 of 44 feet showed the os trigonum. Only 10 of these 27 feet (37%) had a symptomatic os trigonum.

CONCLUSIONS: Our results suggest that increased uptake of Tc-MDP in the os trigonum region is a frequent finding among active soldiers and is of limited value in detecting symptomatic os trigonum.
Screw Loosening in an In Vitro Mid Fibular Osteotomy Model under Dynamic Loading Conditions
Authors: Graham Aaron K. , Hess Daniel P. , Stephens Heidi M.
Published: January 2017

The purpose of this study was to evaluate the effect of cyclic loading on screw fixation in an experimental bone plating model. The test specimens consist of plated porcine fibulae subjected to cyclic compressive, bending and torsional loading. Breakaway torque measurements of orthopedic screws are found to be significantly less than the screws tightening torque. The breakaway torque for a given screw and tapped bone hole is found to be consistent after repeated tightening, and is proposed as a viable approach to quantify bone screw loosening. After cyclic loading at moderate levels no screw loosening was identified, but instead an apparent paradoxical tightening, as observed in breakaway torque measurements of the screws. Cyclic loading of a plated fibular fracture was not found to cause screw loosening unless accompanied by gross failure as found under excessive load levels.
Fourth Toe Flexion Sign: A New Clinical Sign for Identification of the Superficial Peroneal Nerve
Authors: Stephens M.M. , Kelly Paula M.
Published: January 2017

We describe a clinical sign for identification of the superficial peroneal nerve. Flexion of the fourth toe accentuates the subcutaneous course of the cutaneous branches of the superficial peroneal nerve. Thirty feet from 15 volunteers were examined for presence of this sign. Twenty-six of 30 feet had a positive sign that was confirmed by infiltrating the observed nerve with 1% lig-nocaine and correlating the consequent area of hypoaes-thesia with the known distribution of the superficial peroneal nerve.
Isolated Avulsion Fracture at the Plantar Lateral Base of the First Metatarsal: A Case Report
Authors: Kwak Ho-Yoon , Bae Sang-Wook
Published: January 2017

We present a case of isolated avulsion fracture at the plantar lateral base of the first metatarsal without injuries of the tarsometatarsal joint. Few case reports can be found in the literature and it has been reported only as a part of the tarsometatarsal joint injuries. The basis for the diagnosis is discussed, as well as the nature of acute rupture of the peroneus longus tendon.
Children and Managed Care: What Research can, can’t, and Should Tell Us about Impact
Authors: Simpson Lisa , Fraser Irene
Published: January 2017

The speed and ubiquity of the move from fee-for-service to managed care raises questions about how these changes affect children. This article examines (1) the pace and context of the move to managed care for children, (2) potential opportunities and challenges emerging from these changes, (3) research findings on how managed care affects children, and (4) next steps for learning more. The research review provides a consistent answer to whether managed care is good for children: it depends on what kind of managed care, which children, and under what circumstances. This finding suggests lessons for future research: (1) focus on particular features of managed care, (2) get inside the “black box” of managed care and examine providers, (3) expand the portfolio of research on children: research on adults cannot “trickle down” to children, (4) foster research partnerships and networks, and (5) focus on poor and chronically ill children.
The Third-Person Effect of Online Advertising of Cosmetic Surgery: A Path Model for Predicting Restrictive Versus Corrective Actions
Authors: Lim Joon Soo
Published: January 2017

Using survey data with a national representative of U.S. adult women, the current study tested both the perceptual and behavioral hypotheses for the third-person effect of online advertising of cosmetic surgery (OACS) in a theoretical process model. A strong third-person perception (TPP) was observed in assessing the influence of OACS. The results of a path analysis revealed that the self–other exposure gap and social undesirability were positive predictors of the TPP. TPP had a direct impact on support for regulation (SFR) of OACS and an indirect effect on corrective actions. Both SFR and online political self-efficacy (OPSE) were the good predictors for corrective actions.
National Organization of Nurse Practitioner Faculties
Authors: Vanderhoef Dawn M. , Delaney Kathleen R.
Published: January 2017

BACKGROUND: No data exist about how directors of psychiatric mental health (PMH) graduate nurse practitioner (NP) programs have dealt with moving their programs to a lifespan model. It is equally unclear as to how many programs have changed to a doctor of nursing practice (DNP) level of clinical education. OBJECTIVES: The purpose of this survey was to gather data on the state of graduate PMH NP education as they align with regulatory models. DESIGN: A brief survey was sent via e-mail to 118 program directors of PMH NP programs. RESULTS: Seventy-six program directors responded (64% return rate). Their responses indicate all programs have transitioned to a PMH NP lifespan model and about a third to the DNP level. Securing child clinical placements is a significant issue. CONCLUSION: Significant challenges exist to growing the PMH NP lifespan workforce including how to assist PMH clinical nurse specialists, Adult PMH NPs, and other NPs wanting to obtain the PMH NP lifespan degree.
External specialist support for school self-evaluation: Testing a model of support in Irish post-primary schools
Authors: O’Brien Shivaun , McNamara Gerry , O’Hara Joe , Brown Martin
Published: January 2017

With an increasing emphasis on school self-evaluation as a mechanism for school improvement, many countries provide a range of supports to guide schools through the self-evaluation process. While models of support vary across jurisdictions, there are a number of common approaches that prevail, including the provision of an external specialist to support the school self-evaluation process. However, there is very little research carried out in relation to models of external specialist support for school self-evaluation. Building on previous research this article explores the implementation of a specific model of external specialist support for school self-evaluation in five Irish post-primary schools (student age cohort 12–18 years). This model differs from the standard set of supports provided by the Department of Education and Skills to schools in Ireland. The model was developed and facilitated by a researcher from the Dublin City University, Centre for Evaluation, Quality and Inspection. An action research methodology was used to implement and test the model of support in five schools and the related findings are outlined. While the findings are relevant to the Irish context they may have a wider application for self-evaluation policy and practice in other jurisdictions. The model may have particular relevance for jurisdictions where self-evaluation is being introduced for the first time or where implementation issues exist.
Claudication as an ‘Orphan Disease’: Rationale and Goals of Drug Therapy for Peripheral Arterial Disease
Authors: Hirsch Alan T
Published: January 2017

Patients with peripheral arterial disease are often perceived to suffer from a disorder whose pathogenesis and symptoms are not amenable to drug therapies. This clinical misperception remains prevalent despite an abundance of data suggesting that diverse pharmacotherapies may modulate the natural history of this disease. Patients with chronic limb arterial occlusive disease suffer from a disease that is characterized by: (1) a prolonged asymptomatic state that can be identified by simple physical examination and confirmed by measurement of the ankle brachial index; (2) a multi-year period of symptomatic claudication; and (3) a variable rate of progression to critical limb ischemia or acute arterial occlusion. This stage-dependent disease progression is mediated via the dynamic, but as yet incompletely understood, interaction of factors that elicit endothelial dysfunction, atherogenesis, and thrombosis. Current data suggest that each of these contributory disease processes can be modulated by extant pharmacotherapies. Additionally, many novel pharmacotherapeutic agents that are currently under investigation may further improve the ability of clinicians to modulate these fundamental biologic processes.

Pharmacologic therapies should be targeted to decrease the rate of limb arterial disease progression, to improve limiting symptoms, and to prolong life. Symptoms of claudication can be objectively assessed via both exercise testing and disease-specific questionnaires. The presence of lower extremity atherosclerotic disease is predictive of the presence of coronary heart disease and a foreshortened five-year survival. Current data suggest that clinical investigations should be able to effectively stratify this relative risk via use of both clinical variables (e.g., age, diabetes mellitus, tobacco use, etc.) or by measurement of the ankle brachial index (ABI). The role of the physician is to decrease suffering and to prolong life. Judicious administration of medical therapies can play a critical role in helping the vascular practitioner accomplish these goals.
The impact of construction and gentrification on an outdoor trans sex work environment: Violence, displacement and policing
Authors: Lyons Tara , Krüsi Andrea , Pierre Leslie , Small Will , Shannon Kate
Published: January 2017

The objective of this study was to investigate how environmental and structural changes to a trans outdoor work environment impacted sex workers in Vancouver, Canada. The issue of changes to the work area arose during qualitative interviews with 33 trans sex workers. In response, ethnographic walks that incorporated photography were undertaken with trans sex workers. Changes to the work environment were found to increase vulnerabilities to client violence, displace trans sex workers, and affect policing practices. Within a criminalized context, construction and gentrification enhanced vulnerabilities to violence and harassment from police and residents.
Do predictors of return to work and recurrence of work disability due to mental disorders vary by age? A cohort study
Authors: Mattila-Holappa Pauliina , Ervasti Jenni , Joensuu Matti , Ahola Kirsi , Pentti Jaana , Oksanen Tuula , Vahtera Jussi , KivimÄki Mika , Virtanen Marianna
Published: January 2017

Background: The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. Methods: We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21–34, 35–50 and >50 years. Results: A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21–34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28–1.46) and 35–50 years (HR = 1.22, 95% CI = 1.18–1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09–1.52) and 35–50 years (HR = 1.20, 95% CI = 1.03–1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. Conclusions:The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age.
A new empirical approach for predicting heat strain in workers exposed to hot indoor environments
Authors: Aliabadi Mohsen , Farhadian Maryam , Jalali Mahdi , Jahangiri Mohammad , Negahban Amir R.
Published: January 2017

There is still a great need for a comprehensive index that could fully describe heat stress and, at the same time, provides a reliable correlation with the physiological responses of the human body. Using artificial neural networks, this study aims to present a new empirical model for predicting heat strain based on body core temperature in workers exposed to hot indoor environments. The study group consisted of 165 male workers working in heat treatment processes of metal industries in the central Iran. A predictive model was developed using eight parameters: age, metabolism rate, body mass index, body surface area, dry-bulb temperature, globe temperature, air velocity and relative humidity. The multilayer feed forward neural networks with different structures were developed using R 3.2.2 statistical software. The results showed that the mean square error of the core temperature predicted by the proposed model was 0.25℃. Based on the Garson algorithm, the dry-bulb and globe temperatures were found to be the most important factors that could affect the human heat strain. The proposed model can be a useful tool for occupational health professionals in analysing heat strain in hot environments.
Severe Vascular Gunshot Injuries of the Extremities: A Ten-Year Nation-Wide Analysis from Finland
Authors: Mäkitie I. , Mattila V. M. , Pihlajamäki H.
Published: January 2017

Background and Aims:

Gunshot wounds affecting the main vessels of the extremities mostly threaten limb salvage. The purpose of this study was to analyse the nature and severity of civilian vascular gunshot injuries of the extremities using a nation-wide database.

Material and Methods:

Retrospective analysis of the Finnish Hospital Discharge Register, hospital records and death certificates over a 10-year period from January 1, 1990 to December 31, 1999.

Results:

Thirty-two individuals with the mean age of 33 years (17–68) sustained 43 severe vascular injuries to the extremities caused by gunshots. The incidence was 6.0 (95% CI: 4.1–8.5) per 10, 000, 000 person-years and did not change significantly during the period. Four of the injured died. The most common anatomical locations of vascular injuries were the femoral artery (6 lesions), popliteal artery (6) and superficial femoral artery (5). Use of alcohol was detected in ten cases (32% of patients) and of illegal drugs in seven cases (22%). Five patients (18% of non-fatal injuries) required vascular re-operation caused by post-operative problems. Five amputations were performed as primary treatment.

Conclusions:

Severe vascular gunshot injuries of the extremities are not common in Finland. The need for primary amputation or vascular re-operations is noteworthy.
The Role of Adrenal Scintigraphy in the Preoperative Management of Primary Aldosteronism
Authors: Volpe C. , Enberg U. , Sjögren A. , Wahrenberg H. , Jacobsson H. , Törring O. , Hamberger B. , Thorén M.
Published: January 2017

Background and Aims:

Differentiation between the two major subgroups of primary aldosteronism, bilateral hyperplasia and aldosterone producing adenoma is essential since therapy in the former is medical and in the latter surgical. The aim of the present study was to evaluate the clinical utility of adrenocortical scintigraphy in the management of primary aldosteronism.

Material and Methods:

[131I] norcholesterol (NP-59) scintigraphy with dexamethasone suppression for subclassification and lateralization of primary aldosteronism was evaluated in 49 patients with long-term follow-up after diagnosis and treatment

Results:

Thirty-three patients with the diagnosis of aldosterone producing adenoma were operated with adrenalectomy. Preoperative scintigraphy showed lateralized isotope uptake in 27/33 patients while 6 showed no uptake. Twenty-two were cured and three significantly improved. Thus, in 25/33 (76%), scintigraphy showed the correct side as the patients benefited of surgery. Two patients did not improve. Fourteen patients with a probable diagnosis of bilateral hyperplasia had normal scintigraphies.

Conclusions:

In the present retrospective study we found limited sensitivity of NP-59 scintigraphy. However, when a lateralized scintigraphic uptake is achieved it has a high accuracy. Scintigraphy may be used as an adjunct in cases where adrenal venous sampling is inconclusive.
The Role of Surgery in Crohn's Disease: A Retrospective Analysis from a Single Hospital
Authors: Aarnio M. T. , Mecklin J.-P. , Voutilainen M.
Published: January 2017

Background:

Traditionally, in Crohn's disease (CD), surgery has played an essential role in the treatment of complications. TNF-α-blockers have significantly improved results of conservative treatment but they do not definitely cure Crohn's disease.

Aim:

Our aim was to examine the prevalence of and indications for surgical procedures in CD in our hospital.

Material and Methods:

A retrospective survey included all CD patients diagnosed in our hospital referral area during a 10-year period in 1996–2005.

Results:

Altogether 114 new patients with CD were diagnosed, 56 (49%) males, 58 (51%) females. The median follow-up time was 5.0 years. In all, 31 (27%) patients underwent some surgical procedure, and of these, 12 (39%) underwent an emergency operation. The most common indication for surgery was bowel obstruction. The most frequent procedures were ileocolic resection in 12 (39%) patients and small bowel resection in 10 (32%).

Conclusions:

Almost one-third of CD patients needed surgical therapy in an early phase of their disease, and more than one-third of these underwent an emergency procedure. Obstructive symptoms were the most common indication for surgery in the early phase of CD.
Prevention of Rupture of Abdominal Aortic Aneurysm
Authors: Savolainen H. , Novak J. , Dick F. , Widmer M.K. , Carrel T. , Schmidli J. , Meier B.
Published: January 2017

Background and Aims:

Two thirds of patients with an abdominal aortic aneurysm (AAA) have relevant coronary artery disease (CAD). AAAs are prevalent in up to 16% of smokers with CAD. General screening of AAA is controversial. Aim was to assess the potential of finding AAA prior to rupture among patients with known CAD. Main endpoint was whether AAA could have been found during follow-up by sonography or at other time of cardiovascular evaluation.

Material and Methods:

Retrospective study. 213 consecutive, formerly unknown emergently operated AAAs, treated emergently for symptoms (n = 91) or rupture (n = 122) (rAAA) between January 1998 and June 2005. Patient charts were analysed and primary care physicians contacted.

Results:

At presentation, mean age was 71 (+/–9) years, twenty (9%) were female. AAA had a mean diameter of 7.6 cm. Two thirds (143) were clinically obese (BMI 27 +/–5). 137 (64%) were active smokers, 32 (15%) had diabetes, 151 (71%) were hypertensive, and 80 (38%) received statin treatment. CAD had been diagnosed in 95 (45%) 9 years earlier and followed up. Thirty-five (16%) had had myocardial infarction. Echocardiography had been performed in 52 (24%). Thirty day mortality after open surgery was 25 (21%).

Conclusion:

All patients with rAAA had been seen by a GP or cardiologist within a year prior to presentation. The cost effectiveness of selective AAA screening should be evaluated in a larger study.
Temporal Patterns of Death after Trauma: Evaluation of Circadian, Diurnal, Periodical and Seasonal Trends in 260 Fatal Injuries
Authors: Søreide K.
Published: January 2017

Background:

Temporal patterns of trauma deaths may indicate potential for prevention or systems improvement, but have been poorly investigated in the Scandinavian trauma population. This study examines patterns in trauma deaths to the occurrence in hour and time of the day, day and time in the week, and month and season.

Materials and Methods:

Investigation of the temporal patterns of death in 260 fatalities undergoing autopsy. Time of death were explored according to time of the day (hour; day/night), time of the week (day of week; weekday/weekend) and time of the year (month; season) and analyzed for difference in gender, age, injury type and severity, and mechanisms of injury and death.

Results:

A total of 260 trauma deaths were included, of which 125 (48%) died in hospital and 194 (75%) were male. No particular peak-hour of the day when deaths occurred was found. One-third of deaths occurred during weekends. For inhospital deaths during weekends, significantly more patients had respiratory distress (RR > 20 or < 16 in 72.5% for weekends and 47.0% for weekdays; p = 0.008) and hypotension (SBP < 90mmHg in 61% vs 40%; p = 0.048) during weekends. Deaths occurred with some monthly variance demonstrated with two monthly peaks in February/March and July/August, respectively. Overall, no statistically different seasonal differences in the occurrence of traumatic deaths, nor any differences in cause of death, type or severity of injury, nor in physiological parameters was found. However, a higher number of inhospital deaths presented with reduced consciousness level (GCS < 8) and severe head injuries (AIS-head ≥ 4) during spring and summer (P = 0.045, chi-square for trend) compared to winter and fall.

Conclusions:

Trauma deaths in a Scandinavian population did not demonstrate statistically significant differences in overall circadian, weekly or seasonal patterns of trauma death occurrence. However, the impact of fatal head injuries during spring and summer warrants further investigation.
Business models at the bottom of the pyramid
Authors: Ladd Ted
Published: January 2017

Social enterprises serve distributed electricity to the bottom of the world’s economic pyramid (BoP), where 4 billion people live on less than US$2 per day and 1.6 billion lack access to electricity. Current mainstream theories of business models do not fully explain the logic by which these ventures create and capture value. Through interviews with 30 practicing entrepreneurs selling distributed electricity directly to rural BoP consumers, we employ grounded theory to derive a new framework of business models for the BoP that embeds the venture’s offering into the context of the marketplace, including the consumer’s social network, daily habits, mental models, and product constellations. This framework also incorporates affordability and the influences of government regulation. With further research, several of the concepts proposed in this framework might also apply to business models in other BoP sectors and in developed, mature, competitive markets.
Re-visions: Remarks on the Love of Cinema: An Interview by Oliver Davis
Authors: Rancière Jacques
Published: January 2017

In this interview philosopher Jacques Rancière looks again at his earlier work on cinema. The interview opens with some remarks on the meaning of cinephilia before moving on to a detailed discussion of the process of aesthetic and political transformation he calls ‘de-figuration’, a process which is central to his work on art and aesthetics. Later in the interview Rancière re-engages with films by directors Jean-Luc Godard and Chris Marker in the light of his more recent work on emancipated spectatorship.
Peer Assisted Study Sessions and Student Performance: The Role of Academic Engagement, Student Identity, and Statistics Self-efficacy
Authors: Spedding Jason , Hawkes Amy J , Burgess Matthew
Published: January 2017

The initial year of university is often a sensitive period for new students. Commencing students may lack the necessary skills and resources to adapt to unfamiliar learning environments. One intervention demonstrating academic benefits is Peer Assisted Study Sessions (PASS). PASS is a structured peer led study group where students collectively share knowledge and solve course-related tasks. To date there has been limited empirical exploration into how PASS enhances student performance outcomes. To amend this gap, the current study used both a cross-sectional ( n = 264) and a matched longitudinal ( n = 76) survey design, combined with PASS attendance and course performance data, to investigate three psychological mechanisms that may mediate these effects: increased academic engagement, a positive student identity, and increased statistics self-efficacy. Sampling a first-year psychology cohort enrolled in an introductory statistics course, both cross-sectional and longitudinal analyses found a positive relationship between PASS attendance and academic performance. Furthermore, self-efficacy mediated the relationship between PASS attendance and student performance.
Successful Use of Kidneys from Deceased Donors with Acute Renal Failure
Authors: Khader A. A. Al , Shaheen F. A. , Attar B. A. , Elamin K. M. , Ghamdi F. Al , Jondeby M.
Published: January 2017

Background

Kidneys from deceased donors with acute renal failure are not widely used.

Objective

To compare outcomes for recipients of kidneys from donors with acute renal failure at organ recovery with outcomes for recipients of kidneys from donors with normal serum levels of creatinine.

Methods

Records of deceased donors and recipients of their organs at the Saudi Center for Organ Transplantation from 2003 to 2005 were reviewed. A total of 33 donors (donating 65 kidneys to 65 recipients) with elevated serum levels of creatinine (>1.7 mg/dL) and 94 donors (donating 188 kidneys to 188 recipients) with normal (<1.1 mg/dL) serum levels of creatinine at organ recovery and their respective recipients were compared. Both groups had normal creatinine levels at admission.

Results

Recipients in both groups had similar renal function at discharge and follow-up. Delayed graft function occurred more often ( P= .009) in the recipients of kidneys from donors with acute renal failure (47.7%) than in recipients of kidneys from donors with normal creatinine levels (29.8%). Elevation of serum level of creatinine at organ recovery did not correlate significantly with kidney function at discharge or last follow-up or with graft survival.

Conclusions

Survival of patients or grafts at 1, 2, and 3 years did not differ significantly between the recipients in the 2 groups. Only the frequency of delayed graft function differed between the 2 groups.
A Pharmacoeconomic Analysis of Liver Transplant Charges
Authors: Clifford Timothy M. , Johnston Thomas D. , Jeon Hoonbae , Gedaly Roberto , Ranjan Dinesh
Published: January 2017

Objective

To analyze hospital charges for all liver transplant admissions to determine major cost drivers of the total charge.

Study Design

Retrospective review of hospital billing records.

Methods

Hospital charges were collected for all liver transplant admissions between July 1995 and December 2005 and 276 billing records were included in the analysis. Charges were itemized into pharmacy, inpatient room, laboratory, organ acquisition, and other.

Results

Despite maintaining a median length of stay of about 10 days, hospital charges increased from 1995 to 2005. Mean total pharmacy charges (± SEM) before a 1998 cost-containment initiative were $17 405 ±$4080 and constituted a 12% fraction of total charges, but had reduced to $11238 ±$2828 (7.8% of total charges) immediately thereafter, decreasing to $9891 ±$2351 (3.7% of total charges) for the most current period (2005). The increase in the total charge was largely driven by an increase in the organ acquisition charge and daily laboratory and room charges.

Conclusions

Pharmacy charges no longer are a major contributor to the total liver transplant charges at our institution. A major reduction in total liver transplant charge can now only be achieved by targeting other cost centers such as laboratory, room, and organ acquisition. The transplant team has limited control over these cost centers.
Patients Seeking Alternatives to the Long Waiting List: A Reality Faced by Transplant Physicians
Authors: McKay Dianne , Potter Steven R. , Behrend Terry , Stella Frank , Steinberg Steven
Published: January 2017

The need for deceased donor organs for kidney transplantation in the United States continues to increase. The increasing demand has fueled desperate attempts by patients to circumvent the long waiting list of the United Network for Organ Sharing. We report 4 patients with end-stage kidney disease who sought and obtained a live donor kidney transplant outside the United States. In each case, a nephrologist was following up with the patient regularly. Each patient experienced significant unexpected adverse events after the transplant surgery. Desperate attempts to obtain an organ are common and are likely to continue. Although patients with end-stage renal disease who obtain an organ transplant at an unregulated transplant center can have successful outcomes, transplant physicians should be aware of the common practice and should advise their patients of potential complications associated with acquisition of organs through means that circumvent standard oversight by the United Network for Organ Sharing and by institutions.
Caregivers' Perspectives on Decision Making about Lung Transplantation in Cystic Fibrosis
Authors: Dellon Elisabeth P. , Shores Mitchell D. , Nelson Katherine I. , Wolfe Joanne , Noah Terry L. , Hanson Laura C.
Published: January 2017

Context

Lung transplantation extends survival for some patients with advanced cystic fibrosis, but it is complicated, has many potential risks, and its outcomes are difficult to predict. No standards exist for informed decision making about transplantation.

Objective

To assess decision making from the perspective of caregivers of patients who faced the transplant decision before dying of cystic fibrosis or transplant complications.

Design

Semistructured interviews with descriptive and qualitative content analysis.

Participants

Twenty-eight caregivers of patients with cystic fibrosis who received care at our center and died between 1996 and 2006.

Results

Of 28 patients who considered lung transplantation, 19 (68%) received transplants, 6 (21%) died while waiting for transplant, and 3 (11%) declined transplant. Three caregivers (11%) thought that the patient did not fully understand the reason for transplant referral. Five (18%) thought that the patient did not fully understand potential risks. Ten (36%) thought that alternatives were not fully understood. The only alternatives to transplant identified, progressive illness and the possibility of earlier death without transplant, were unacceptable to most. Thirteen caregivers (46%) reported that the patient thought that declining transplant was not an option. Caregivers described the decision as “easy” for 19 (68%), often expressing a sentiment of “do or die.” Those who described the decision as “easy” recalled fewer elements of informed decision making.

Conclusions

From caregivers' reports, patients with cystic fibrosis may not fully understand risks of and alternatives to lung transplantation. Because a strong desire to prolong life necessitates honest communication about potential outcomes, interventions are needed to facilitate high-quality decision making.
Aneurysm Clipping after Partial Endovascular Embolization for Ruptured Cerebral Aneurysms
Authors: Nomura M. , Kida S. , Uchiyama N. , Yamashima T. , Yamashita J. , Yoshikawa J. , Matsui O.
Published: January 2017

The aim of this study was to investigate the advantages and disadvantages of a two-stage treatment for ruptured cerebral aneurysms; partial embolization in acute stage followed by clipping in chronic stage of subarachnoid hemorrhage.

Between April 1997 and August 1999, twenty ruptured cerebral aneurysms were initially treated endovasculary using Guglielmi detachable coils in our institution. Among them, complete embolization could not be achieved in 6 lesions. For these lesions, subsequent clipping was added. The radiological and operative findings, and outcomes of these cases were retrospectively reviewed.

In 1 case, rerupture occurred during the endovascular procedure. Rerupture was not observed in any cases in the postembolization period. In 2 cases, complications related to the clipping but not the endovascular procedure occurred. These complications included impaired visual acuity for unverified reasons, and memory disturbance due to sacrifice of a perforator arising from the anterior communicating artery. In 3 cases, coil extraction was needed during the clipping, because the loops of the coil extended into the residual neck. Complications related to coil extraction were not observed in these 3 cases.

Acute partial embolization of ruptured aneurysm appears to be effective for the prevention of subsequent rerupture during the subacute period, in which treatment for vasospasm should be performed, and the clipping procedure. However, in the case of relatively large aneurysms, small arteries or other normal structures behind the aneurysm cannot be observed directly during surgery, because of the immovability of the embolized aneurysm. Further, complete clip closure is impossible when loops of coil herniate into the neck. In such situations, coil extraction with or without resection of the aneurysm might be necessary, and care must be taken not to damage parent artery and surrounding vessels.
Influence of the Perianeurysmal Environment on Rupture of Cerebral Aneurysms Preliminary Observation
Authors: Sugiu K. , Jean B. , Ruiz D. San Millan , Martin J-B. , Delavelle J. , Rüfenacht D. A.
Published: January 2017

We evaluate the perianeurysmal environment and study parameters potentially influencing rupture of cerebral aneurysms. 101 consecutive aneurysm cases were retrospectively evaluated using radiological observation including imaging documents such as MR, CT and DSA studies. Aneurysm contact with perianeurysmal environment was classified and correlated with aneurysm shape, size, location and likely rupture point. Topographic relation of the aneurysm to the cisternal compartment was studied. Presence of contact with the surrounding structures was evaluated for bone, dura, brain, cranial nerves, arteries, and veins.

The aneurysm shape and likely rupture point was found to be significantly influenced by the aneurysm environment. Depending on aneurysm type, location and size, the growth pattern also exhibited signs of interaction with the environment. Overall, there was no significant difference in the largest average diameter of the dome of ruptured (7.8 mm) and unruptured (6.7 mm) aneurysms. When compared to unruptured aneurysms (6/42), the presence of a bleb was more frequent in ruptured aneurysm (41/59).

The perianeurysmal environment was found to have a significant influence on aneurysmal rupture pattern, whenever direct contact between the aneurysm and the anatomical structures in the perianeurysmal environment was visualized. This influence was independent of aneurysm size. Aneurysm size seems to be a poor indicator for the risk of rupture when compared to shape of the aneurysm and the degree of direct contact with the perianeurysmal environment.
An Early Experience of Endovascular Treatment for Cerebral Aneurysms Harboring Blebs
Authors: Matsumaru Y. , Sonobe M. , Mashiko R. , Nakai Y. , Takahashi S. , Nose T.
Published: January 2017

Re-rupture of cerebral aneurysms often occurs at their blebs, and the treatment of cerebral aneurysms harboring blebs has been considered difficult. To prevent rupture during embolization, the authors have tried to deliver coils only into aneurysm domes, without inserting coils, a microcatheter, or a microguidewire into the blebs. Here, to prove such a treatment strategy, the authors report early experience in 3 cases with cerebral aneurysms harboring blebs.
Electromicroscopic Investigation of the Efficacy of FactorXIII for Coil Embolization in Experimental Aneurysms Preliminary Report
Authors: Konishi Y. , Hino K. , Shimada A. , Sato E. , Hara M. , Saito I.
Published: January 2017

In recent years, endovascular treatment has often been used to treat cerebral aneurysms. Basic investigation to elucidate the process of endothelial cell growth within aneurysms is a crucial problem. We performed elecrtro-detachable coil embolization in aneurysms under administration of blood coagulation factor XIII, a wound-healing accelerator, and examined changes in endothelial cells on the surface of the inserted coil with a scanning electron microscope.

Experimental aneurysms produced in animals were treated by coil embolization and histological changes in embolized coil after the treatment of factor XIII were investigated.

Aneurysms were produced in four matured swines under general anesthesia and coil embolization was performed with a elecrtro-detachable coil. The aneurysms were resected immediately and 3 weeks after coil embolization, and investigated histologically with a scanning electron microscope. Seven animals were administrated with blood coagulation factor XIII on the day of embolized and the following 4 consecutive days. These aneurysms were also resected 3 weeks after embolization and investigated histologically.

More marked fibroblast proliferation and growth of endothelial cells on the surface of luminal side of embolized coil were seen in the aneurysms in the group administrated with factor XIII than in aneurysms treated without factor XIII.

More effective and sufficient coil embolization can be obtained by administration of factor XIII.
Endovascular Treatment of Direct Carotid-Cavernous Fistulas Using Detachable Coils
Authors: Naito I. , Iwai T. , Negishi M. , Sasaki T.
Published: January 2017

Five direct carotid-cavernous fistulas (direct CCFs) in four patients were treated by an endovascular technique using detachable coils. The embolizations were performed according to one of two strategies. 1) By embolizing the fistula, that is the compartment of the cavernous sinus adjacent to the fistula orifice, after embolization of the draining veins. 2) By embolizing the fistula only. The former strategy was used to treat first two cases and the latter to treat other three cases. In two of the cases in which only the fistula was embolized, a microcatheter was placed in the draining vein via a transvenous route before-hand, in the event that the embolization resulted in an incomplete closure and the draining veins became inaccessible. In four cases, a complete cure was achieved with preservation of the internal carotid artery and in one case, the internal carotid artery containing the fistula was occluded. The embolization of direct CCFs with detachable coils, which are suitable for both transarterial and transvenous approaches, has several advantages over balloon embolization. We believe this procedure will become an alternative treatment.
Embolization of Arteriovenous Malformations Prior to Radiosurgery
Authors: Miyachi S. , Negoro M. , Okamoto R. , Otsuka G. , Suzuki O. , Yoshida J.
Published: January 2017

Embolization prior to radiosurgery is useful to reduce the AVM nidus for adequate planning for radiosurgery. In 37 cases we encountered, patients with the least radiosurgical effects had diffuse type nidus, where the feeders embolized with absorbable embolic materials had the possibility of recanalization. The main purpose of embolization is to prevent bleeding while the radiosurgical effects are being fully obtained. Thus, nidus embolization and the occlusion of fistulous feeders, meningeal feeders and intranidal aneurysms using permanent embolic materials are essential, since effective and successful embolization can increase the occlusion rate and shorten the period until complete occlusion following radiosurgery.
Postmortem Pathological Examination of a Case One Month after Carotid Artery Stenting
Authors: Otsuka Y. , Waki R. , Yutani C. , Ishibashi-Ueda H. , Onodera T. , Kimura K.
Published: January 2017

There have been few pathological reports on human carotid stenting.

A 73-year-old diabetic male with 80% stenosis in the left carotid bifurcation. Despite no neurological events, he died of pneumonia one month after. Findings pathological examination revealed: successful dilatation without deformity of the stent, eccentric compression and partial disruption of the plaque by struts, thrombi around disrupted plaque, and neointimal growth.

Findings were generally compatible with those reported on coronary stenting. Case accumulation is required to clarify an exact pathological process and establish a procedure to reduce complications.