bluuebunny/crossref_metadata_2025 huggingface dataset:
Bioequivalence of Generic Thioridazine Drug Products—The FDA Viewpoint
Authors: Hamrell Michael R. , Martinez Marilyn N. , Dighe Shrikant V. , Parkman Paul D.
Published: February 2017

The phenothiazines are among the most widely used drugs to treat symptoms commonly associated with acute and chronic psychoses. One of the commonly prescribed compounds within this class of drugs is thioridazine, available both as a generic product as well as the innovator product, Mellaril. Each of these products is coded as bioequivalent and consequently therapeutically equivalent by the Food and Drug Administration (FDA). A recent issue of this journal contained an article that raised a number of questions concerning the bioequivalence of the generic versions of thioridazine that have been approved by the FDA. Their article was based in part on information obtained from the FDA as well as information supplied to the authors by Sandoz, Inc., the manufacturer of the original thioridazine drug product Mellaril. The FDA has reviewed its original decision of bioequivalence. Based on this reassessment, the FDA strongly rejects the assertion by the authors that several of the approved generic thioridazine products are not bioequivalent. The rationale behind the FDA decisions and the FDA's viewpoint on the bioequivalence of generic thioridazine drug products is discussed in detail.
Desipramine-, Not Tartrazine-, Induced Drug Eruption
Authors: Ellsworth Allan , Gross David
Published: February 2017

A 46-year-old woman's antidepressant therapy was changed from doxepin to desipramine because of sedative side effects. Within ten days of initiation of desipramine, a pruritic, morbilliform rash developed. The rash extended despite attempts to continue therapy with a tartrazine-free desipramine as well as antihistamines and prednisone. The rash promptly improved when desipramine was discontinued. Classic drug eruptions are quite uncommon with tricyclic antidepressants. Tartrazine, a common additive in the food and drug industry, is implicated in a number of hypersensitivity reactions. Our report presents an apparent case of desipramine-induced drug rash independent of tartrazine, and discusses the nonassociation of tartrazine.
Intravenous Labetalol in the Management of Resistant Hypertensive Emergency
Authors: Ngole Peter M.
Published: February 2017

A case of intravenous labetalol in the treatment of a resistant hypertensive emergency is reported. Although there have been several reports of the use of oral labetalol in resistant hypertension, no intravenous administration in hypertensive emergency resistant to other drugs has been reported to date. A 36-year-old black female with BP of 270/160 mm Hg with complaints greater than one month's duration of dizziness, severe headaches, blurred vision, shortness of breath, vomiting, palpitations, flushing, agitation, diarrhea, weakness, and weight loss, was treated successfully with intravenous labetalol after she failed to respond to other established parenteral antihypertensive drugs. The patient received labetalol 20 mg iv bolus, and then 20 mg every ten minutes until a cumulative dose of 200 mg was attained. Labetalol produced a prompt but smooth reduction in BP without any reflex tachycardia or other adverse effects. Intravenous labetalol may be safe and effective for the management of rapid BP control in hypertensive emergencies resistant to other parenteral antihypertensive agents.
Effect of Chronically Administered Ketoconazole on the Elimination of Theophylline in Man
Authors: Heusner James J. , Dukes George E. , Rollins Douglas E. , Tolman Keith G. , Galinsky Raymond E.
Published: February 2017

Ketoconazole, a nitrogen-substituted imidazole, has been shown to be a potent in vitro inhibitor of cytochrome P-450-mediated metabolic processes. Conflicting reports exist concerning the in vivo effect of ketoconazole on concomitantly administered drugs that require these metabolic processes for clearance. Therefore, the effect of multiple-dose ketoconazole on the elimination of theophylline, a drug metabolized by cytochrome P-450, in ten healthy, nonsmoking males (aged 18–40 years) was evaluated. Each subject received aminophylline 6 mg/kg iv before and at the end of seven days of ketoconazole 200 mg/d po. Theophylline serum concentrations were determined by fluorescence polarization immunoassay (TDx) at 12 time points over the 24-hour period following each infusion. No statistical difference (two-tailed t-test) in half-life (mean ± SD 7.8 ± 1.8 vs. 8.2 ± 1.9 h) or clearance (0.797 ± 0.201 vs. 0.722 ± 0.133 ml/min/kg) could be demonstrated for theophylline before or after ketoconazole administration. Theophylline dosage adjustment is probably not necessary for concomitant theophylline and ketoconazole drug therapy.
Adverse Reactions of Piroxicam
Authors: D'Arcy P. F. , Gerber Dewald
Published: February 2017

During the approximately five years (1981–86) that piroxicam has been available in South Africa, the Medicines Safety Centre has received 31 reports of adverse reactions associated with this drug. Among these are two reactions not previously recorded in the literature, paresthesia and hair loss. This article records drug events associated with piroxicam worldwide and tabulates those received by the Centre.
Prazosin-Induced First-Dose Phenomenon Possibly Associated with Hemorrhagic Stroke: A Report of Three Cases
Authors: Lin Min-Shung , Hsieh Wen-Ju
Published: February 2017

A small initial dose of prazosin ranging from 0.5 to 1 mg has been recommended to avoid the first-dose phenomenon characterized by a sudden and severe drop in blood pressure after the administration of the first dose of prazosin. However, even with an initial dose of 0.5 mg, hypotension with consciousness disturbance developed in three hypertensive patients with recent cerebral hemorrhage. We present this report to alert physicians and pharmacists about the potential risk of the first-dose phenomenon even at the recommended initial doses of prazosin in hypertensive patients who have suffered a recent stroke.
Gastrointestinal Side Effects with Erythromycin Preparations
Authors: Carter Barry L. , Woodhead Jerold C. , Cole Katherine J. , Milavetz Gary
Published: February 2017

This study was designed to determine the incidence and severity of gastrointestinal (GI) side effects in patients taking erythromycin. More patients complained of GI side effects with the enteric-coated tablet (70.8 percent) than with the stearate (51.4 percent) or the ethylsuccinate (48.9 percent) salts. The enteric-coated tablet was associated with a higher incidence of individual adverse reactions; more patients discontinued it because of adverse GI effects. These data demonstrate a high incidence of GI side effects to erythromycin. Additionally, GI side-effect incidence appears to be higher with the enteric-coated tablet.
Aerosol Corticosteroids for the Treatment of Asthma
Authors: Johnson Cary E.
Published: February 2017

In an effort to maximize the efficacy of corticosteroid treatment in asthma and minimize the adverse reactions, steroid therapy has evolved to the inhalation route of administration with aerosol compounds having potent topical antiinflammatory activity and minimal systemic effects. Corticosteroids exhibiting these properties that are available in the U.S. include beclomethasone dipropionate, triamcinolone acetonide, and flunisolide. The success or failure of patient response to orally inhaled corticosteroids is often a function of adequate drug delivery rather than the efficacy of the drug itself. Patients who cannot use the inhaler accurately may benefit from the use of a spacer or reservoir device. The three aerosolized corticosteroids have specific pharmacologic differences; however, none of these differences has translated into a clinically significant advantage or disadvantage of one product over the others. These agents should be considered for adjunctive therapy in patients whose asthma is not adequately controlled by beta-agonist bronchodilators, theophylline, or cromolyn sodium.
Continuous Nasogastric Morphine Infusion
Authors: Ingebretson Mark C. , Pucino Frank , Beck Carol L. , Strommen Gordon L. , Mcaskill A. Cherilyn , Rao Uma P. , Almazan Marietta A.N.
Published: February 2017

Morphine sulfate is the narcotic analgesic most commonly used for pain treatment in terminally ill patients. This case report demonstrates a new method of morphine administration. A 56-year-old terminally ill cancer patient with severe pain from metastatic adenocarcinoma of the lung required continuous nasogastric feeding and around-the-clock narcotic analgesics. The patient was safely and effectively converted from a continuous intravenous morphine infusion to continuous nasogastric morphine-enteral feedings. This method of administration may benefit patients receiving continuous enteral tube feedings who either require high-dose morphine therapy or are unable to use the oral administration route.
Impact of Pharmacist Intervention on Oral Theophylline Therapy in Adult Inpatients
Authors: Blackbourn Jennifer , Sunderland V. Bruce
Published: February 2017

The impact of clinical pharmacy services on the utilization of oral theophylline therapy was evaluated in a ten-week study involving 138 adult inpatients. The study initially involved an independent prospective five-week audit of theophylline use, in which clinical pharmacists monitored theophylline therapy and any interventions were designed so as not to influence future actions taken by medical officers with regard to oral theophylline therapy. The second part of the study involved active intervention by clinical pharmacists and a concurrent five-week audit of theophylline use. The study has demonstrated that clinical pharmacist intervention significantly increased the number of patients receiving a theophylline assay when indicated, from 43 to 83 percent; the number of assays appropriately sampled, from 58 to 85 percent; the number of appropriate dosage adjustments, from 63 to 86 percent; and the number of patients with a measured serum theophylline concentration in the therapeutic range, from 17 to 47 percent. These results show that clinical pharmacists can have a significant impact on patient care by efficient monitoring and individualizing theophylline therapy.
Implications of the Neglect of Stereochemistry in Pharmacokinetics and Clinical Pharmacology
Authors: Ariëns Everd J.
Published: February 2017

An outline is given of the implications of stereoselectivity in biological action and the use of racemic fixed-ratio combinations in pharmacology and pharmacotherapeutics. Pitfalls of the neglect of stereochemistry, such as generation of senseless pharmacokinetic data, are exemplified and emphasized.
Calcium-Channel Blockers in Acute Myocardial Infarction
Authors: Babich Michele F. , Kalin Miriam L. , Mcleod Donald C.
Published: February 2017

The calcium-channel blockers are useful in treating a variety of cardiovascular disorders. Due to their antiischemic and spasmolytic properties, these agents have been studied in the prophylaxis and treatment of acute myocardial infarction. This article reviews this application with respect to reduction of mortality, infarct size, and reinfarction rate. Of the agents currently available for clinical use, nifedipine has been studied most extensively. This agent shows no beneficial effects in this setting and its use may in fact be harmful. Of the few trials that have been conducted with verapamil, none have shown decreased mortality. Verapamil may reduce infarct size although further confirmation is required. Diltiazem is the only agent that has been shown to have short- and long-term benefits in the patient with acute myocardial infarction. Proper patient selection is of utmost importance in ensuring successful therapy. In particular, those patients with non-Q-wave infarctions and/or normal left ventricular function can be expected to derive the most benefit in terms of reducing mortality and reinfarction rate associated with the acute event.
Monitoring Antibiotic Usage in the Hospital
Authors: Huber Steve , Dozier Nicky
Published: February 2017

The authors outline the quality indicators being developed by the Joint Commission on Accreditation of Health Care Organizations to compare hospital performance. The Joint Commission has provided several incentives to encourage antibiotic monitoring based on criteria derived from standard practice, as defined in the literature, and on the clinical judgment of the medical staff. In addition, the drug review process should be continuous and should encompass all areas of drug use in the hospital, including effectiveness in terms of disease outcome as well as cost efficiency. The authors discuss procedures under development in their institution to promote cost efficiency and informed discussion regarding clinical use of antibiotics on the formulary. Microbiology reporting, drug use, requests for nonformulary drugs, and unusual patterns of infection and sensitivities are tracked to identify problem areas and a feedback loop is used to inform the medical staff.
Interaction of Microbiology and Pharmacokinetics in the Selection of Appropriate Antibiotic Therapy
Authors: Nightingale Charles H.
Published: February 2017

Factors that affect a drug's microbiological activity include drug concentration and duration at the binding site and cell wall penetration. Pharmacokinetics can be used as the basis for substituting one drug for another in some cases. By replacing cefoxitin with cefotetan, our hospital saved $120 000–140 000 a year. Several cephalosporins are compared using microbiological and pharmacokinetic data. For example, the microbiological activity of ceftriaxone lasts for at least 12 hours with Staphylococcus aureus and for almost 24 hours with Enterobacteriaceae. Clinical experience with beta lactams has demonstrated that maintaining serum concentrations above the target organism's minimum concentration required to inhibit 90 percent of the organisms for 50 percent or more of the dosing interval is associated with successful therapy.
Classic Article: Foot & Ankle 1:15, 1980 Traumatic Dislocations of the First Metatarsophalangeal Joint
Authors: Jahss Melvin H.
Published: February 2017

The mechanics, anatomy, and pathomechanics of traumatic dorsal dislocation of the first metatarsophalangeal joint are discussed. There are two basic types of dislocations. In Type I, dislocation of the hallux with the sesamoids occurs without disrupting the sesamoid mass. Such cases are usually irreducible on closed reduction, the metatarsal head being incarcerated by the conjoined tendons with their intact sesamoids. In Type II, there is either associated disruption of the intersesamoid ligament (Type IIA) or a transverse fracture of one of the sesamoids (Type IIB). In Type II, the sesamoid disruption usually permits closed reduction.
Surgical Anatomy and Accuracy of Percutaneous Achilles Tendon Lengthening
Authors: Salamon Michael L. , Pinney Stephen J. , Van Bergeyk Anthony , Hazelwood Scott
Published: February 2017

Background: Percutaneous Achilles tendon lengthening is frequently done to treat gastrocsoleus equinus contracture. To our knowledge, no study has documented the proximity of tendinous or neurovascular structures to the nearest edges of each hemisection in a percutaneous Achilles tendon lengthening, the complication rates related to injury of such structures, or the Achilles tendon rupture rates from inaccurate cuts. Thus, our goal was to document these distances and determine the accuracy of this procedure. Methods: We performed triple-hemisection percutaneous Achilles tendon lengthening (Hoke technique) in 15 cadaver specimens and documented the distance from each cut edge to various relevant anatomical structures. We also documented the accuracy of each cut (diameter of hemisection divided by total tendon diameter), with a reference goal of 50% transection at each level. Results: We found that percutaneous Achilles tendon lengthening is a relatively accurate procedure with hemisections averaging 50% for the middle cut and 60% at the most proximal cut, and 55% at the distal cut. Some tendinous and neurovascular structures are, on average, less than 1 cm from the nearest margin of a given hemisection and are, therefore, at risk. These included the flexor hallucis longus at the middle and proximal cuts (9.1 mm and 5.7 mm, respectively), the tibial nerve at the proximal cut (8.3 mm), and the sural nerve at the middle-lateral cut (7.9 mm). Conclusion: In cadavers, reasonably accurate cuts can be made, with some vital structures less than 1 cm from the cut tendon.
Eight-Year Results of a Minimally Constrained Total Ankle Arthroplasty
Authors: San Giovanni Thomas P. , Keblish David J. , Thomas William H. , Wilson Michael G.
Published: February 2017

Background: Few studies have reported the intermediate to long-term results of minimally constrained total ankle replacements. The purpose of this study was to investigate the efficacy and safety of a minimally constrained total ankle prosthesis in a select low-demand patient population. Methods: We reviewed a consecutive series of patients with rheumatoid arthritis who underwent a Buechel-Pappas total ankle replacement (BP TAR) between 1990 to 1997. Thirty-one ankle arthroplasties were performed in 23 patients with rheumatoid arthritis. One patient was lost to followup (deceased) and two ankles that failed resulted in fusion (overall survivorship − 93%). This left 28 ankles (21 patients) that were re-evaluated clinically and radiographically with an average followup of 8.3 (range 5.0 to 12.2) years. Preoperative and postoperative ranges of motion were measured and AOFAS hindfoot scores were calculated. Recent weightbearing radiographs were reviewed for evidence of component subsidence, radiolucent lines, and osteolysis. Results: In 25 of 28 ankles (89%), patients were completely satisfied with the result of their ankle replacement and rated their pain as only mild to none; three (11%) patients were dissatisfied. Radiographic analysis revealed stable, well-positioned implants with evidence of biologic ingrowth in 23 ankles (82%), while five implants were interpreted as being at risk for impending failure because of marked tibial or talar component subsidence (18%). Component subsidence did not correlate with the presence or absence of radiolucent lines. Only one ankle demonstrated clear evidence of osteolysis. Ten intraoperative medial malleolar fractures occurred (32% of ankles) during implantation of the prosthesis, though in only one did this adversely affect patient outcome. Nine postoperative complications (29%) occurred; four wound dehiscences, four stress fractures, and one medial malleolar nonunion. Conclusions: Improvements in prosthetic design such as cementless fixation and decreased constraint appear to make total ankle arthroplasty a more predictable procedure over this period of followup. Despite a variety of complications, we are encouraged by the intermediate-term results in a select low-demand arthritic population.
Value of Radiographs in the Initial Evaluation of Nontraumatic Adult Heel Pain
Authors: Levy Jonathan C. , Mizel Mark S. , Clifford Paul D. , Temple H. Thomas
Published: February 2017

Background: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surgeons for evaluation. A thorough history and physical examination are often sufficient for diagnosis, yet radiographs usually are ordered during the initial evaluation. The purpose of this study was to evaluate the value and cost-effectiveness of these radiographs. Methods: A retrospective chart and radiographic review of 157 consecutive adults (215 heels) presenting with nontraumatic heel pain was done to evaluate the utility of routine radiographs in the initial evaluation. Results: The most common diagnosis was plantar fasciitis (80.9%, 174 of 215). Radiographs were normal in (17.2%, 37 of 215), and incidental radiographic findings were observed in 81.4% (175 of 215). The most common incidental findings were plantar calcaneal spurs (59.5%, 128 of 215) and Achilles spurs (46.5%, 100 of 215). Only (2%, 4 of 215) of all patients had abnormal findings that prompted further evaluation. Conclusions: Routine radiographs are of limited value in the initial evaluation of nontraumatic plantar heel pain in adults and were not necessary in the initial evaluation. Radiographs should be reserved for patients who do not improve as expected or present with an unusual history or confounding physical findings.
Effect of Foot and Ankle Position on Tarsal Tunnel Compartment Volume
Authors: Bracilovic Ana , Nihal Aneel , Houston Vern L. , Beattie Aaron C. , Rosenberg Zehava S. , Trepman Elly
Published: February 2017

Background: Tarsal tunnel pressure is increased when the foot and ankle are positioned in eversion or inversion from neutral, aggravating symptoms of tarsal tunnel syndrome in some patients. Space-occupying lesions may cause tarsal tunnel syndrome. We hypothesized that positional change of the foot and ankle from neutral to eversion or inversion causes decreased tarsal tunnel compartment volume that may aggravate symptoms of posterior tibial nerve entrapment. Methods: MRI of 13 ankles in nine healthy subjects in three positions (neutral, eversion, inversion) were obtained with respect to the malleolar-calcaneal plane; this plane was defined by the distal tip of the anterior colliculus of the medial malleolus, the medial tubercle of the posterior calcaneal tuberosity, and the lateral tubercle of the posterior calcaneal tuberosity. The borders of the tarsal tunnel noted on the MRI were traced with a computer digitizing apparatus to determine the cross-sectional area of the tarsal tunnel on each image, and the slice thickness and interspace distance for the seven central images were used to calculate tarsal tunnel volume. Results: The mean tarsal tunnel volume was significantly greater when the foot and ankle were in neutral position (21.5 ± 0.9 cm3) than in either full eversion (18.0 ± 0.9 cm3; p ≤ 0.001) or inversion (20.3 ± 1.0 cm3; p ≤ 0.001). Conclusions: The results support the hypothesis that eversion and inversion of the foot and ankle cause decreased compartment volume of the tarsal tunnel and increased tarsal tunnel pressure that may contribute to symptoms of posterior tibial nerve entrapment in tarsal tunnel syndrome. Clinical relevance: Neutral immobilization of the foot and ankle may relieve symptoms of posterior tibial nerve entrapment in tarsal tunnel syndrome by minimizing pressure on the nerve and maximizing tarsal tunnel compartment volume available for the nerve.
Clinicians' Assessment of the Hindfoot: A Study of Reliability
Authors: Keenan Anne-Maree , Bach Timothy M.
Published: February 2017

Background: Static measurements of position of the hindfoot and clinical assessment of motion of the hindfoot often are used in the assessment of foot function and manufacturing of orthoses. However, the reliability and validity of static measurements and dynamic observation and assessment of the hindfoot are controversial. The purpose of this investigation was to examine reliability of static and dynamic assessments of the hindfoot in a setting that reproduced clinical conditions. Methods: Twenty-four healthy participants were evaluated by four experienced clinicians for four commonly used static measurements and dynamic assessment of hindfoot function. The protocol was repeated 2 weeks later. Results: Results indicated that reliability of results, both intertester and from test to test were poor to fair for static measurements of the hindfoot ( r = 0.075 to r = 0.755, p < 0.05). The error estimates associated with these measures were high; subtalar neutral position and resting calcaneal stance position both demonstrated measurement errors of more than 4 degrees (95% confidence intervals − 4.1 degrees and 5.1 degrees, respectively). Retest reliability of dynamic assessments were considered reasonable for only one clinician ( κ = 0.55). Intertester agreement was poor among all clinicians. Conclusion: Clinicians taking static measurements demonstrated large errors that do not reflect the precision that has been assumed in clinical theory using these measurements. The availability of static assessments did not improve dynamic assessment. This poor reliability calls into question the importance placed on static and dynamic measurements of the hindfoot in clinical decision-making.
Gliding Resistance of the Posterior Tibial Tendon
Authors: Uchiyama Eiichi , Kitaoka Harold B. , Fujii Tadashi , Luo Zong-Ping , Momose Toshimitsu , Berglund Lawrence J. , An Kai-Nan
Published: February 2017

Background: Abnormal gliding of the posterior tibial tendon may lead to mechanical trauma, degeneration, and eventually posterior tibial tendon dysfunction. Our study analyzed the gliding resistance of the posterior tibial tendon in intact feet and in feet with simulated flatfoot deformity. Methods: An experimental system was developed that allowed direct measurement of gliding resistance at the tendon-sheath interface. Seven normal fresh-frozen cadaver foot specimens were studied, and gliding resistance between the posterior tibial tendon and sheath was measured. The effects of ankle and hind-foot position and the effect of flatfoot deformity on gliding resistance were analyzed. Gliding resistance was measured for 4.9 N applied load to the tendon. Results: Mean gliding resistance for the neutral position was 77 ± 13.1 (×10−2 N). Compared to neutral position, dorsiflexion increased gliding resistance and averaged 130 ± 38.9 (×10−2 N), and plantarflexion decreased gliding resistance and averaged 35 ± 12.6 (×10−2 N). Flatfoot deformity increased gliding resistance compared to normal feet, averaging 104 ± 17.0 (×10−2N) for neutral, 205 ± 55.0 (×10−2 N) for dorsiflexion, and 58 ± 21.3 (×10−2N) for plantarflexion. Conclusions: The findings indicate that patients with a preexisting flatfoot deformity may be predisposed to develop posterior tibial tendon dysfunction because of increased gliding resistance and trauma to the tendon surface.
The Subventricular Zone: A Key Player in Human Neocortical Development
Authors: Ortega J. Alberto , Memi Fani , Radonjic Nevena , Filipovic Radmila , Bagasrawala Inseyah , Zecevic Nada , Jakovcevski Igor
Published: February 2017

One of the main characteristics of the developing brain is that all neurons and the majority of macroglia originate first in the ventricular zone (VZ), next to the lumen of the cerebral ventricles, and later on in a secondary germinal area above the VZ, the subventricular zone (SVZ). The SVZ is a transient compartment mitotically active in humans for several gestational months. It serves as a major source of cortical projection neurons as well as an additional source of glial cells and potentially some interneuron subpopulations. The SVZ is subdivided into the smaller inner (iSVZ) and the expanded outer SVZ (oSVZ). The enlargement of the SVZ and, in particular, the emergence of the oSVZ are evolutionary adaptations that were critical to the expansion and unique cellular composition of the primate cerebral cortex. In this review, we discuss the cell types and organization of the human SVZ during the first half of the 40 weeks of gestation that comprise intrauterine development. We focus on this period as it is when the bulk of neurogenesis in the human cerebral cortex takes place. We consider how the survival and fate of SVZ cells depend on environmental influences, by analyzing the results from in vitro experiments with human cortical progenitor cells. This in vitro model is a powerful tool to better understand human neocortex formation and the etiology of neurodevelopmental disorders, which in turn will facilitate the design of targeted preventive and/or therapeutic strategies.
Occupational Radiation Exposure of Anesthesia Providers: A Summary of Key Learning Points and Resident-Led Radiation Safety Projects
Authors: Wang Rachel R. , Kumar Amanda H. , Tanaka Pedro , Macario Alex
Published: February 2017

Anesthesia providers are frequently exposed to radiation during routine patient care in the operating room and remote anesthetizing locations. Eighty-two percent of anesthesiology residents (n = 57 responders) at our institution had a “high” or “very high” concern about the level of ionizing radiation exposure, and 94% indicated interest in educational materials about radiation safety. This article highlights key learning points related to basic physical principles, effects of ionizing radiation, radiation exposure measurement, occupational dose limits, considerations during pregnancy, sources of exposure, factors affecting occupational exposure such as positioning and shielding, and monitoring. The principle source of exposure is through scattered radiation as opposed to direct exposure from the X-ray beam, with the patient serving as the primary source of scatter. As a result, maximizing the distance between the provider and the patient is of great importance to minimize occupational exposure. Our dosimeter monitoring project found that anesthesiology residents (n = 41) had low overall mean measured occupational radiation exposure. The highest deep dose equivalent value for a resident was 0.50 mSv over a 3-month period, less than 10% of the International Commission on Radiological Protection occupational limit, with the eye dose equivalent being 0.52 mSv, approximately 4% of the International Commission on Radiological Protection recommended limit. Continued education and awareness of the risks of ionizing radiation and protective strategies will reduce exposure and potential for associated sequelae.
Exploring visitor experience at a mountain attraction
Authors: Milman Ady , Zehrer Anita
Published: February 2017

The study explores visitor experience while visiting a mountain attraction in the Alpine region of Tirol, Austria, through participant observations, informal conversations, and photography. A grounded theory approach was adopted to uncover the meaning of visitors’ overall experience and deduct a possible theory that may contribute to a better understanding of visitor experiences at mountain attractions. The data collected from 600 subjects at the attraction’s four stopovers concluded that the visiting experience was a process that involved a blend of events composed of material and human elements. Guest experiences were also practiced on a passive–active continuum, where some of the experiential consumption activities were focused beyond the mountain itself, primarily viewing the landscape and photography. The study affirms the importance of participant observation as a methodological tool to study visitors at a tourist attraction, discusses implications for management, and offers recommendations for enhancing the overall guest experience.
Delivering occupational therapy hand assessment and treatment sessions via telehealth
Authors: Worboys Tess , Brassington Melinda , Ward Elizabeth C , Cornwell Petrea L
Published: February 2017

Introduction

Telehealth offers a solution to assist delivery of occupational therapy (OT) services for hand therapy in rural and remote locations. However, there is currently no evidence to validate this service model. The aim of this study was to examine the validity of clinical decisions made during hand therapy sessions conducted via telehealth compared to a traditional clinical model (TCM) assessment, and explore patient and clinician satisfaction.

Methods

Eighteen patients referred for hand therapy to a rural/remote hospital-based outpatient service were assessed simultaneously via telehealth and a TCM assessment. An allied health assistant supported data collection at the patient end. Hand function was assessed using a range of objective measures, subjective scales and patient reported information. Minimal level of percent exact agreement (PEA) between the telehealth OT (T-OT) and the TCM-OT was set at ≥80%.

Results

Level of agreement for all objective measures (dynamometer and pinch gauge reading, goniometer flexion and extension, circumference in millimetres) ranged between 82% and 100% PEA. High agreement (>80% PEA) was also obtained for judgements of scar and general limb function, exercise compliance, pain severity and sensitivity location, activities of daily living and global ratings of change (GROC) scores. There was 100% PEA for overall recommendations. Minimal technical issues were experienced. Patient and clinician satisfaction was high.

Discussion

Clinical decisions made via telehealth were comparable to the TCM and consumers were satisfied with telehealth as a service option. Telehealth offers the potential to improve access to hand therapy services for rural and remote patients.
Sexual orientation, bullying for being labeled gay or bisexual, and steroid use among US adolescent boys
Authors: Parent Mike C , Bradstreet Tyler C
Published: February 2017

Use of anabolic-androgenic steroids is a public health concern for adolescent boys. This study examined bullying based on being labeled gay/bisexual and steroid use among US adolescent boys, including sexual orientation disparities. Data from 2660 boys from the 2015 Youth Behavior Risk Survey were used. Among heterosexual boys, steroid use was higher among those who reported being bullied due to being labeled gay or bisexual. No such relationship existed among non-heterosexual boys. The results speak to the need to address issues of masculinity in clinical work with boys and young men.
Language teacher cognitions and intercultural language teaching: The New Zealand perspective
Authors: Oranje Jo , Smith Lisa F
Published: February 2017

The New Zealand school curriculum was last revised in 2007, at which time a new emphasis was placed on culture in language teaching. The practice of intercultural language teaching is implicit in the curriculum document and explicit in the curriculum guide, which features a set of principles for intercultural communicative language teaching (iCLT). This article presents a study on the extent to which New Zealand language teachers’ beliefs and practices are aligned with intercultural language teaching (ILT). A questionnaire administered to New Zealand language teachers included a number of items used in a seminal seven-nation comparative study conducted by Lies Sercu and her colleagues, as well as other items developed from relevant literature. Expanding on previous studies’ use of item-by-item analyses, multi-item scales to measure alignment of New Zealand teacher’s beliefs and practices with ILT were developed, which yielded good internal reliabilities. The findings revealed an apparent mismatch between beliefs and practices, with teachers being favourably disposed towards ILT but not practising the approach in their classrooms. Interpretation of the data using concepts from teacher cognition research suggested that the differences represented tensions between teachers’ abstract, theoretical beliefs and their concrete, practical beliefs. We argue that supporting teachers’ applied knowledge of developing intercultural communicative competence (ICC) will allow them to recognize that those beliefs need not be discordant.
Changes in physical fitness of a home-based physical exercise program in childhood obesity: A quasi-experimental uncontrolled study
Authors: Lisón Juan Francisco , Bruñó-Soler Alejandro , Torró Isabel , Segura-Ortí Eva , Alvarez-Pitti Julio
Published: February 2017

Few studies have evaluated the changes in physical fitness (PF) of obese children and adolescents of a physical activity program for the treatment of obesity, and even fewer have explored the modality of home-based physical exercise. The objective of this study is to evaluate the changes in PF and body composition (BC) of a home-based physical exercise for treating childhood obesity. Thirty-three overweight/obese children and adolescents participated for six months in a home-based intervention that combined aerobics and muscular strength exercises. The results were compared, before and after the intervention, for the different PF components (VO2max, abdominal muscle resistance strength, and lower body explosive strength) and BC (body mass index Z-score (BMI-Z), percentage of body fat, and fat-free mass) variables. A significant reduction was observed in the percentage of body fat (4.7%) and the BMI- Z score (.23), and there was an increase in the fat-free mass of 2.9 kg ( p < .001). In addition, the VO2max showed a significant increase ( p < .05). The results of the different strength tests also showed significant improvements ( p < .05). Our findings support the effectiveness of this program improving not only BC but also PF. However, our results should be interpreted with caution due to lack of control group.
Legalization in context: The design of the WTO’s dispute settlement system
Authors: Elsig Manfred
Published: February 2017

This article asks why the dispute settlement provisions of the multilateral trading system underwent significant reforms during the negotiations that led to the creation of the World Trade Organization (WTO) in 1995. Why did the leading trading powers accept a highly legalized system that departed from established political–diplomatic forms of settling disputes? The contribution of this article is threefold. First, it complements existing accounts that exclusively focus on the United States with a novel explanation that takes account of contextual factors. Second, it offers an in-depth empirical case study based on interviews with negotiators who were involved and novel archival evidence on the creation of the new WTO dispute settlement system. Third, by unpacking the long-standing puzzle of why states designed a highly legalized system, it addresses selected blind spots of the legalization and the rational design literatures with the aim of providing a better understanding about potential paths leading toward significant changes in legalization.
Learning history in early childhood: Teaching methods and children’s understanding
Authors: Skjæveland Yngve
Published: February 2017

This article discusses the teaching of history in early childhood education and care centres and children’s understanding of history. Based on interviews with eight Norwegian early childhood education and care teachers and on interpretative phenomenological analysis, the article shows how the early childhood education and care centres teach history, how children respond to the teaching, and what kind of understanding of history and historical time children express. The findings are discussed in light of theories of history didactics. The teachers had positive experiences with the implementation of history projects and developed a variety of methods and teaching approaches. They also expressed a highly positive assessment of children’s ability to acquire knowledge of history. In particular, it appears that physical and bodily experiences, along with teachers’ storytelling, stimulated the children’s interest and understanding of history. Some of the older children – the five- to six-year-olds – expressed an emerging historical consciousness. This indicates that although historical understanding in early childhood might be limited, the teaching of history in early childhood education and care can lay the foundation for historical consciousness and its later development at school.
Sociology’s missed opportunity: John Stuart-Glennie’s lost theory of the moral revolution, also known as the axial age
Authors: Halton Eugene
Published: February 2017

In 1873, 75 years before Karl Jaspers published his theory of the Axial Age in 1949, unknown to Jaspers and to contemporary scholars today, Scottish folklorist John Stuart Stuart-Glennie elaborated the first fully developed and nuanced theory of what he termed “the Moral Revolution” to characterize the historical shift emerging roughly around 600 BCE in a variety of civilizations, most notably ancient China, India, Judaism, and Greece, as part of a broader critical philosophy of history. He continued to write on the idea over decades in books and articles and also presented his ideas to the fledgling Sociological Society of London in 1905, which were published the following year in the volume Sociological Papers, Volume 2. This article discusses Stuart-Glennie’s ideas on the moral revolution in the context of his philosophy of history, including what he termed “panzooinism”; ideas with implications for contemporary debates in theory, comparative history, and sociology of religion. It shows why he should be acknowledged as the originator of the theory now known as the axial age, and also now be included as a significant sociologist in the movement toward the establishment of sociology.
Third culture indigenous kids: neo-colonialism and student identities in Nigerian international schools
Authors: Emenike Nkechi W , Plowright David
Published: February 2017

This study examines the extent to which indigenous Nigerian students attending international schools in their own country are able to successfully negotiate their identities from conflictual perspectives within their schools and home communities. Using a sample of 66 students aged 12 to 18 years, from two international schools in Nigeria, the findings show the students appeared to display different identities in relation to the degree to which they conformed to expectations of both environments. The article argues that the negotiating of indigenous students’ identities results in the forming of a third space within which they are subjected to ideological and cultural pressures. They are thus referred to as third culture indigenous kids (TCIKs).
“Nanny State” Politics: Causal Attributions About Obesity and Support for Regulation
Authors: Haider-Markel Donald P. , Joslyn Mark R.
Published: February 2017

We posit that individuals develop causal stories to explain the world around them, including events, behaviors, and conditions in society. These are narratives that attribute causes to controllable components, such as individual choices, or uncontrollable components, such as broader forces in the environment. We use attribution theory to understand how group identity and individual characteristics may shape causal attributions about obesity. Based on previous empirical findings, we argue that attributions and identity can explain policy preferences. We test our hypotheses using individual-level data from a unique national survey of American adults. Our findings suggest that partisan and weight identities predispose people to make certain attributions about obesity, and these attributions influence policy preferences related to obesity. We suggest policymakers need to consider public attributions about obesity and future research should develop more refined measures of attributions.
Men With a Terminal Illness Relax Their Criteria for Facial Attractiveness
Authors: Danel Dariusz P. , Siennicka Agnieszka E. , Fedurek Pawel , Frackowiak Tomasz , Sorokowski Piotr , Jankowska Ewa A. , Pawlowski Boguslaw
Published: February 2017

According to the life history paradigm, in life-threatening conditions, sexual selection criteria are relaxed in order to increase the probability of a last resort reproduction, ultimately contributing to reproductive success. This should be reflected in loosened mating preferences — a process observed in nonhuman animals. Studies investigating this aspect in humans, however, are scarce. This study explored the aesthetic preferences towards facial and nonfacial stimuli in terminally ill patients with heart failure (HF) and their healthy, same-sex peers. The aim was to examine if these two groups of men demonstrate different patterns of aesthetic judgments. Using a 7-point scale, 65 male patients with HF and 143 healthy men evaluated the perceived attractiveness of 15 photographs (five adult male faces, five adult female faces, and five nonfacial pictures). A mixed-design analysis of variance was run to assess group differences in aesthetic preferences. Compared to healthy controls, stimuli. HF patients rated the pictures using significantly higher scores, but this applied only to male and female, but not nonfacial, stimuli. We propose that lower criteria for facial attractiveness in HF patients are linked to relaxation of mate preferences as a result of a life-threatening conditions, and that this process can be an adaptive mating strategy from an ultimate, evolutionary perspective. However, other mechanisms (e.g., seeking social support) may be also responsible for the observed patterns.
Adaptive variable structure control of input delay non-minimum phase hypersonic flight vehicles
Authors: Huang Dedong , Hu Xiaoxiang , Yan Xunliang
Published: February 2017

An adaptive variable structure control strategy is proposed for the output tracking control of input delay non-minimum hypersonic flight vehicles. The problem is challenging because of the complex nonlinearity of hypersonic flight vehicles and the existence of input delay. The nonlinear model of hypersonic flight vehicles is partially linearized, and a state tracking model is constructed based on the ideal internal dynamics of hypersonic flight vehicles. A filtered tracking error is introduced to handle the input delay. A variable structure control strategy is proposed for the stability of filtered tracking error system, and an adaptive law is established for the unknown perturbations. Finally, the effectiveness of the proposed control method is shown by the simulation results.
Unidirectional variable stiffness hydraulic actuator for load-carrying knee exoskeleton
Authors: Zhu Jun , Wang Yu , Jiang Jinlin , Sun Bo , Cao Heng
Published: February 2017

This article presents the design and experimental testing of a unidirectional variable stiffness hydraulic actuator for load-carrying knee exoskeleton. The proposed actuator is designed for mimicking the high-efficiency passive behavior of biological knee and providing actively assistance in locomotion. The adjustable passive compliance of exoskeletal knee is achieved through a variable ratio lever mechanism with linear elastic element. A compact customized electrohydraulic system is also designed to accommodate application demands. Preliminary experimental results show the prototype has good performances in terms of stiffness regulation and joint torque control. The actuator is also implemented in an exoskeleton knee joint, resulting in anticipant human-like passive compliance behavior.
Glenohumeral arthrodesis for late reconstruction of flail shoulder in patients with traumatic supraclavicular brachial plexus palsy
Authors: Thangarajah Tanujan , Lambert Simon M.
Published: February 2017

Background

Flail shoulder can occur following a brachial plexus injury and is characterized by painful subluxation of the glenohumeral joint and the inability to independently position the hand in space. The present study aimed to report the clinical outcomes following glenohumeral arthrodesis for late reconstruction of flail shoulder in patients with traumatic supraclavicular brachial plexus palsy.

Methods

Seven patients were included in the present study and were followed-up for a mean of 98 months (range 27 months to 197 months). The mean age at the time of surgery was 48 years (range 28 years to 80 years) and the mean time to surgery from injury was 5 years (range 2.5 years to 8 years).

Results

Six patients achieved bony union with a mean time to fusion of 4.7 months (range 2 months to 8 months). Non-union occurred in one case. The mean Oxford Shoulder Score improved from 11 pre-operatively (range 4 to 16) to 27 postoperatively (range 16 to 40) ( p = 0.016), and the mean Subjective Shoulder Value improved from 7 (range 0 to 15) pre-operatively to 45 (range 15 to 100) postoperatively ( p = 0.029).

Conclusions

In our series, glenohumeral arthrodesis was associated with few complications, and effectively reduced pain and improved functional outcome in this selected patient population.