bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of the properties and the structural configurations of fatty acid methyl esters on the properties of biodiesel fuel: a review
Authors: Gopinath A , Sairam K , Velraj R , Kumaresan G
Published: October 2014

Biodiesel is a renewable fuel that is suitable for both stationary and automotive engines. It consists of fatty acid methyl esters and fatty acid ethyl esters when vegetable oils are transesterified with methanol and ethanol respectively. The structural configuration and properties of individual fatty acid methyl esters can significantly influence the biodiesel properties. The purpose of the present work is to review the effects of the properties and the structural configurations of fatty acid methyl esters on various biodiesel properties. The structural configuration includes the molecular structure, the chain length, the saturated or unsaturated nature, the degree of unsaturation and the position of double bonds. Important properties of fatty acid methyl esters are reviewed, and a large number of data consisting of their reported values are given. The viscosity, the cetane number, the heat of combustion, the density, the bulk modulus and compressibility, the iodine value, the oxidative stability, the low-temperature properties, the boiling point, the lubricity, the saponification value, the surface tension, the specific heat, the latent heat of vaporization and the flash point are reviewed in the present study. The reported mathematical equations for estimating the properties of fatty acid compounds and biodiesel are presented. A few studies that recommend enrichment of a particular fatty acid (or acids) which is possible through genetic modification to improve the overall biodiesel properties are also cited. The contribution of a particular fatty acid (or acids) favours some properties while it has an undesirable effect on other properties. Hence the specification of one particular fatty acid profile to improve all the properties of biodiesel is not possible. Considering the low-temperature properties and the oxidative stability, a combination of both saturated fatty acids and unsaturated fatty acids is necessary. Therefore, it is important to decide whether a biodiesel should contain a larger amount of saturated fatty acid esters or unsaturated fatty acid esters in order to obtain better fuel properties. The inherent genetic modification of the fatty acid profile could be the best possibility for addressing several fuel property issues simultaneously.
Derailment safety analysis for a tilting railway vehicle moving on irregular tracks shaken by an earthquake
Authors: Cheng Yung-Chang , Hsu Chin-Te
Published: October 2014

The aim of this paper is to investigate the derailment of a tilting railway vehicle on curved tracks that are experiencing the twin effects of rail irregularities and an earthquake. The nonlinear governing differential equations of motion for a tilting railway vehicle are derived using a heuristic nonlinear creep model and Kalker’s linear theory. The tilting vehicle is modeled as a 24-degree-of-freedom system, with the lateral, roll and yaw motions of each wheelset, as well as the lateral, vertical, roll and yaw motions of the bogie frames and the car body all taken into account. The derailment quotients and offload factors of a tilting railway vehicle experiencing the twin effects of an earthquake on its wheelsets, bogie frames and car body in the lateral direction, and rail irregularities acting on its wheelsets in the lateral direction are investigated at various tilt angles. The obtained results show that, in general, a derailment quotient and an offload factor evaluated with an earthquake taken into consideration are larger than those obtained without consideration of the earthquake. Moreover, the derailment quotient and offload factor of a wheelset increase with an increase in the tilt angle of the railway vehicle experiencing excitations from an earthquake and also rail irregularities. Finally, the effects of suspension parameters on the derailment quotient and offload factor of a wheelset are investigated. Taken together, it is clear that the influences of rail irregularities and an earthquake on the derailment of a tilting railway vehicle cannot be disregarded.
Mechanical concept of W-WING whirl flutter aeroelastic demonstrator
Authors: Cecrdle Jiri , Malecek Jaromir
Published: October 2014

This paper deals with the mechanical concept of a whirl flutter aeroelastic demonstrator. It works out the previous study on the W-WING demonstrator design and summarises the new achievements. The paper gives a theoretical background of the subjected whirl flutter phenomenon and summarises the whirl flutter occurrence in aerospace practice. The second part is focused on the experimental research of whirl flutter. At first, a brief summary of past main developments in this field is provided. The main part deals with the new aeroelastic demonstrator ‘W-WING’, designed and developed at the VZLU. The demonstrator represents wing and engine of a twin turboprop commuter aircraft. Contrary to the most of past demonstrators, it includes thrusting propeller. The demonstrator allows changes of the main structural parameters influencing whirl flutter stability characteristics. The demonstrator is intended for experimental investigations at the VZLU 3m-diameter low-speed wind tunnel. The results will be used for validation of analytical methods and software tools as well as in the frame of research projects.
A predator–prey based mathematical model of the bone remodelling cycle: Exploring the relationship between the model parameters and biochemical factors
Authors: Ji Bing , Yang Qing , Genever Paul G , Patton Ronald J , Fagan Michael J
Published: October 2014

Bone remodelling is a vital process which enables bone to repair, renew and optimize itself. Disorders in the bone remodelling process are inevitably manifested in bone-related diseases, such as hypothyroidism, primary hyperparathyroidism and osteoporosis. In our previous work, a predator–prey based mathematical model was developed to simulate bone remodelling cycles under normal and two pathological conditions, hypothyroidism and primary hyperparathyroidism, for trabecular bone at a fixed point. However, the biochemical meanings of the model parameters were not fully explored. This article first extends the previous work by proposing relationships between the model parameters and biochemical factors involved in the bone remodelling process and by examining whether those relationships do predict the behaviours observed in vivo. The model is then applied to the simulation and investigation of bone remodelling of postmenopausal osteoporosis. The proposed connections are supported by good agreement between the model simulations and published experimental observations for the normal condition and all three pathological variations in bone remodelling.
Information-sharing ethical dilemmas and decision-making for public health nurses in Japan
Authors: Suzuki Chisato , Ota Katsumasa , Matsuda Masami
Published: October 2014

Background:

Information sharing is one of the most important means of public health nurses collaborating with other healthcare professionals and community members. There are complicated ethical issues in the process.

Research objectives:

To describe the ethical dilemmas associated with client information sharing that Japanese public health nurses experience in daily practice and to clarify their decision-making process to resolve these dilemmas.

Research design:

Data were collected using a three-phase consensus method consisting of semi-structured interviews, self-administered questionnaires and a group interview.

Participants and research context:

We surveyed administrative public health nurses in Shizuoka Prefecture, Japan. The semi-structured interviews were carried out with 12 administrative public health nurses, and the self-administered questionnaires were sent to all 899 administrative public health nurses. The group interview was carried out with eight administrative public health nurses.

Ethical considerations:

Ethical approval was granted by the ethics committee of the School of Health Sciences, Nagoya University, Japan (8-158, 9-130).

Findings:

Information-sharing ethical dilemmas occurred most often when clients’ decisions did not coincide with the nurses’ own professional assessments, particularly when they faced clinical issues that were inherently ambiguous. In their decision-making processes, nurses prioritised ‘protection of health and life’.

Discussion:

These findings suggest that, above all, they sought to address urgent risks to clients’ lives while upholding the principle of client autonomy as much as possible. In such cases, the nurses made decisions regarding whether to share information about the client depending on the individual situation.

Conclusion:

Public health nurses should protect the client’s health while taking into consideration their relationship with the client.
The Use of Actor-Level Attributes and Centrality Measures to Identify Key Actors
Authors: Bright David A. , Greenhill Catherine , Reynolds Michael , Ritter Alison , Morselli Carlo
Published: October 2014

Social network analysis (SNA) conducted on criminal networks can identify key players and shed light on important patterns of connectivity. This information can be used to develop interventions to dismantle or disrupt criminal networks. Drawing upon the network capital construct, this study demonstrates that integrating centrality measures (such as degree or betweenness centrality) with other individual attributes related to functional roles and access to tangible and intangible resources will enhance efforts to identify critical actors. Using a drug trafficking network that operated in Australia in the 1990s, we identify actors who are key to the network by virtue of their position in the network, their attributes, and combinations of these factors. Implications for law enforcement practice are discussed.
White Collars and Black Ties
Authors: Bichler Gisela , Schoepfer Andrea , Bush Stacy
Published: October 2014

Focusing on business leaders in control of Fortune 500 companies, this study examines corporate interlock among CEOs with security exchange commission (SEC) violations and CEOs without. Using affiliation networks built from publicly available information, we analyzed rates of participation (outdegree centrality), organizational influence (indegree centrality), and brokerage (betweenness centrality). The findings suggest that a single, integrated network exists. However, within these interlocking directorates, s ubsets of executives exhibit substantial cohesion suggesting the presence of distinct social circles. Only a few organizations and individuals were found to link the subset of offending CEOs to their law-abiding counterparts. Moreover, SEC violators were more socially isolated, thereby increasing the influence of weak ties to active executives playing a controlling role within the network.
Diffusion of Ideas and Technology
Authors: Young Jacob T. N. , Ready Justin T.
Published: October 2014

On-officer videos, or body cameras, can provide objective accounts of interactions among police officers and the public. Police leadership tends to view this emerging technology as an avenue for resolving citizen complaints and prosecuting offenses where victims and witnesses are reluctant to testify. However, getting endorsement from patrol officers is difficult. These incongruent cognitive frames are a cultural barrier to the utilization of innovative technologies. Understanding the mechanisms that lead to the deconstruction of these barriers is essential for the integration of technology into organizations. Using affiliation data collected from a large police department in Southwestern United States over a 4-month period, we find that interactions with other officers provide a conduit for facilitating cognitive frames that increase camera legitimacy.
Experiences of Family Relationships Among Donor-Conceived Families
Authors: Wyverkens Elia , Van Parys Hanna , Buysse Ann
Published: October 2014

In this qualitative evidence synthesis, we explore how family relationships are experienced by parents who used gamete donation to conceive. We systematically searched four databases (PubMed, Web of Science, PsycINFO, and ProQuest) for literature related to this topic and retrieved 25 studies. Through the analysis of the qualitative studies, a comprehensive synthesis and framework was constructed. Following the meta-ethnography approach of Noblit and Hare, four main themes were identified: (a) balancing the importance of genetic and social ties, (b) normalizing and legitimizing the family, (c) building strong family ties, and (d) minimizing the role of the donor. Underlying these four main themes, a sense of being “different” and “similar” at the same time was apparent. Findings are discussed in terms of their implications for studying and counseling donor-conceived families.
Revisiting Symbolic Interactionism as a Theoretical Framework Beyond the Grounded Theory Tradition
Authors: Handberg Charlotte , Thorne Sally , Midtgaard Julie , Nielsen Claus Vinther , Lomborg Kirsten
Published: October 2014

The tight bond between grounded theory (GT) and symbolic interactionism (SI) is well known within the qualitative health research field. We aimed to disentangle this connection through critical reflection on the conditions under which it might add value as an underpinning to studies outside the GT tradition. Drawing on an examination of the central tenets of SI, we illustrate with a field study using interpretive description as methodology how SI can be applied as a theoretical lens through which layers of socially constructed meaning can help surface the subjective world of patients. We demonstrate how SI can function as a powerful framework for human health behavior research through its capacity to orient questions, inform design options, and refine analytic directions. We conclude that using SI as a lens can serve as a translation mechanism in our quest to interpret the subjective world underlying patients’ health and illness behavior.
Organizational Identity and Paradox
Authors: Kozica Arjan M. F. , Gebhardt Christian , Müller-Seitz Gordon , Kaiser Stephan
Published: October 2014

Previous studies have reported changes in organizational identities as a result of external or internal triggers. In contrast, we highlight how the paradoxical nature of an organizational identity can influence stability and change that identity. Using the example of Wikipedia, the free online encyclopedia, we show how a “stable state of instability” of the organization’s collective identity is constantly being reproduced. We contribute to the literature on organizational identity by first analyzing a case in which identity change is not triggered by a disruptive event. Second, we show how the paradoxical nature of identity triggers attempts to reconcile contradictions of the paradox, culminating in permanent state of gradual changes of organizational identity. Finally, we exemplify how, as a form of partial organization where volunteers take part in the identity formation process, Wikipedia copes with the tensions that ensue from its collective identity.
Abraxane® versus Taxol® for patients with advanced breast cancer: A prospective time and motion analysis from a Chinese health care perspective
Authors: Dranitsaris George , Yu Bo , Wang Leiping , Sun Weili , Zhou Yan , King Jennifer , Kaura Satyin , Zhang Adams , Yuan Peng
Published: October 2014

Background

Abraxane® and Taxol® are both effective drugs for the treatment of advanced stage breast cancer. However, each agent possesses unique drug delivery characteristics with the former not requiring premedication and having a considerably shorter recommended infusion time (i.e. 30 min vs. 2–4 h). To measure the overall efficiency and cost-saving potential associated with Abraxane® relative to Taxol®, a time and motion study was undertaken in breast cancer patients treated in China.

Methods

Baseline patient data collection included age, disease stage, number and sites of metastatic disease, and performance status. Time and resource use data were then collected from breast patients being treated with Abraxane® ( n = 12) or Taxol® ( n = 15) in one of three cancer clinics located in Jiangsu, Shanghai, and Beijing. Resource use and time impact on clinical staff were quantified using unit cost estimates. This included costs for drug preparation, administration, materials and supplies, premedication, patient chair time, labor costs, and all acute adverse drug reactions. Outcomes were presented as a mean total time and cost for delivering a dose of Abraxane® or Taxol® and were compared using parametric and non-parametric statistical tests where appropriate. All costs were reported in US dollars (US$1 = 6.1 RMB, as of January 2014).

Results

Patients were comparable with respect to mean age, number of metastatic sites, and performance status. Approximately 9 of 12 (75%) patients received Abraxane® as on a weekly schedule (vs. every 3 weeks) compared to 6 of 15 (40%) with Taxol®. There were 5 (33.3%) acute adverse drug reactions with Taxol®, 3 of which required a physician visit and the initiation of supportive interventions. In contrast, there was only one minor event with Abraxane® (8.3%), which was easily managed with a temporary stoppage of the infusion. From the time and motion study, the mean total time for Abraxane® and Taxol® delivery (preparation, administration, premedication, total chair time, and adverse effects management) was 84 and 282 min respectively ( p < 0.001), with the associated costs being US$59 and US$254 respectively per dose ( p < 0.001).

Conclusion

To our knowledge, this is first such study in breast cancer patients to be undertaken in China. Abraxane® was associated with fewer acute adverse drug reactions and significant reductions in health care resources, physician/nurse time and overall drug delivery costs compared to Taxol®.
The Rayleigh and Courant variational principles in the six-parameter shell theory
Authors: Eremeyev Victor A , Lebedev Leonid P , Cloud Michael J
Published: October 2014

Courant’s minimax variational principle is considered in application to the six-parameter theory of prestressed shells. The equations of a prestressed micropolar shell are deduced in detail. Courant’s principle is used to study the dependence of the least and higher eigenfrequencies on shell parameters and boundary conditions. Cases involving boundary reinforcements and shell junctions are also treated.
Coaching Teachers’ Use of Social Behavior Interventions to Improve Children’s Outcomes
Authors: Stormont Melissa , Reinke Wendy M. , Newcomer Lori , Marchese Dana , Lewis Carla
Published: October 2014

Children with social behavior problems need teachers who are prepared to use evidence-based interventions to increase their likelihood of success. However, it is clear that teachers do not feel prepared to support children in this area. One approach for supporting teachers in using more effective interventions for children with behavior needs is the use of coaching. The purpose of this review of the literature is to explore the research to date that specifically targets coaching teachers on the use of social behavior interventions to improve children’s social behavior outcomes. Criteria were established to increase the generalizability of the results of the review and 29 studies met inclusionary criteria. Of these studies, 86% documented positive findings and the remaining documented neutral findings. Only 31% of studies documented a measure of integrity for the coaching process. Main findings and implications for future research are discussed.
Mobile app self-care versus in-office care for stress reduction: a cost minimization analysis
Authors: Luxton David D , Hansen Ryan N , Stanfill Katherine
Published: October 2014

We calculated the cost of providing stress reduction care with a mobile phone app (Breathe2Relax) in comparison with normal in-person care, the standard method for managing stress in military and civilian populations. We conducted a cost-minimization analysis. The total cost to the military healthcare system of treating 1000 patients with the app was $106,397. Treating 1000 patients with in-office care cost $68,820. Treatment using the app became less expensive than in-office treatment at approximately 1600 users. From the perspective of the civilian healthcare system, treatment using the app became less expensive than in-office treatment at approximately 1500 users. An online tool was used to obtain data about the number of app downloads and usage sessions. A total of 47,000 users had accessed the app for 10–30 min sessions in the 2.5 years since the release of the app. Assuming that all 47,000 users were military beneficiaries, the savings to the military healthcare system would be $2.7 million; if the 47,000 users were civilian, the savings to the civilian healthcare system would be $2.9 million. Because of the large number of potential users, the total societal savings resulting from self-care using the app may be considerable.
Telemedicine as a tool to mitigate cardiometabolic risk associated with serious mental illness
Authors: Moores Jason D , Uppal Sahil , Hernandez Alexandra M , Wilansky Pamela
Published: October 2014

People with serious mental illness suffer from substantially higher rates of cardiometabolic morbidity and mortality than the general population. We have evaluated the efficacy of telemedicine for providing cardiometabolic risk management services compared to in-person care. A retrospective chart review was conducted in order to compare changes in body mass index (BMI), systolic blood pressure and serum triglycerides before and after telemedicine (n = 38). The comparator group (n = 38) was selected from a list of all clients who had a conventional appointment at the metabolic clinic. Analysis of Variance showed an overall effect of treatment on BMI ( P < 0.001), but no significant differences between the groups on BMI ( P = 0.89), systolic blood pressure ( P = 0.62) or fasting serum triglycerides ( P = 0.81). This suggests that telemedicine may be as effective as in-person care and that telemedicine has the potential to improve access to cardiometabolic risk management services for people with serious mental illness.
Trial of telemedicine for patients on home ventilator support: feasibility, confidence in clinical management and use in medical decision-making
Authors: Casavant David W , McManus Michael L , Parsons Susan K , Zurakowski David , Graham Robert J
Published: October 2014

We investigated whether telemedicine (videoconferencing) was feasible in patients with special care needs on home ventilation, whether it affected the confidence of families about the clinical management of their child, and whether it supported clinical decision-making. Videoconferencing software was provided free for 14 families who had a computer and webcam. Families completed questionnaires about clinical management before the addition of telemedicine and 2–3 months after they had used telemedicine. They also completed a questionnaire about their experience with videoconferencing. There were 27 telemedicine encounters during the 9-month study. Families reported higher confidence in clinical care with telemedicine compared to telephone. They also reported that the videoconferencing was high-quality, easy to use, and did not increase their telecommunication costs. The telemedicine encounters supported clinical decision-making, especially in patients with active clinical problems or when the patient was acutely ill. The telemedicine encounters prevented the need for 23 clinic visits, three emergency room visits, and probably one hospital admission. Although the study was small, videoconferencing appears useful in the management of medically fragile patients on home ventilator support, producing high levels of family confidence in clinical management and value to clinicians in their decision-making.
Urologists’ usage and perceptions of urological apps
Authors: Dempster Niall J , Risk Rachel , Clark Ross , Meddings Robert N
Published: October 2014

We conducted a survey of urologists to document their patterns of app usage and perceptions of app quality, and to assess their interest in future app usage. The survey was sent to all urologists on the mailing list of the British Association of Urological Surgeons (BAUS) (n = 1613). A total of 115 responses were received (a response rate of 7%). Most respondents (89%) owned mobile devices capable of downloading apps. Most respondents (79%) used apps and about half (49%) used urological apps; the latter accessed a mean of 2.4 urological apps per month. Significantly more younger (defined as <45 years old) than older urologists used urological apps ( P < 0.001). Respondents’ perception of the overall quality of apps produced for both urologists and patients was relatively low. The respondents' interest in future app usage was strong. There was greatest interest in apps such as logbooks or revalidation ones (87%), reference apps (86%) and ones which aided decision-making (85%). There was considerable support for the implementation of measures to provide urological app quality assurance; most respondents believed app peer review (78%) and validation (78%) would be beneficial and 48% supported regulatory oversight. There appears to be a need for high quality urological apps and opportunities therefore exist for national urological associations and academic units to lead developments.
Retroperitoneoscopic Anatomical Necrosectomy
Authors: Zhao Guodong , Hu Minggen , Liu Rong , Xu Yong
Published: October 2014

Background. Video-assisted retroperitoneal necrosectomy is a minimally invasive surgical technique for the treatment of severe acute pancreatitis. This study evaluated the safety and feasibility of a modified single-stage video-assisted retroperitoneal necrosectomy, retroperitoneoscopic anatomical necrosectomy (REAN). Methods. Between September 2010 and May 2012, a total of 17 patients with infected necrotizing pancreatitis underwent REAN. The surgical procedures were similar to retroperitoneoscopic pancreatectomy, in which 3 trocars are utilized. Briefly, the perirenal space was entered through the posterior pararenal space. Dissection proceeded from posterior to anterior direction to expose the dorsal side of the perirenal fascia. This was opened to reach the anterior perirenal space, where the peripancreatic abscess was located. Necrotic tissue was then debrided and catheter drainage was performed in a single stage. Results. Operating time ranged from 45 to 100 minutes with minimal blood loss. All patients recovered except for one who died. Major perisurgical complications included peritoneal injury (1 patient), splenic vein injury (1 patient), retroperitoneal infection with paralytic ileus (1 patient), hydrothorax and atelectasis (2 patients), and subcutaneous cellulitis beneath the incision (3 patients). Two patients required additional percutaneous catheter drainage, and 1 patient required a laparotomy to debride the remaining necrotic tissue. Postoperative hospital stay ranged from 21 to 64 days. Conclusions. This study demonstrates that REAN, a modified single-stage video-assisted retroperitoneal approach, was safe and feasible for the treatment of infected necrotizing pancreatitis. The advantages of this procedure include direct access with shorter operating time, complete necrotic tissue debridement, easy hemostasis, simple manipulation, and easy drainage.
The impact of preoperative statin therapy on open and endovascular abdominal aortic aneurysm repair outcomes
Authors: Galiñanes Edgar Luis , Reynolds Shaun , Dombrovskiy Viktor Y , Vogel Todd R
Published: October 2014

Objectives

This study evaluated the utilization of preoperative statins and their impact on perioperative outcomes in patients undergoing open or endovascular aortic repair.

Methods

Patients ≥50 years of age with non-ruptured abdominal aortic aneurysm repair were identified in MedPAR files 2007–2008 utilizing ICD-9-CM codes. Preoperative statins use was identified using National Drug Codes in Part D. Chi-square test, multivariable logistic regression, Kaplan-Meier and Cox regression modeling were performed.

Results

In all, 19,323 patients were identified undergoing abdominal aortic aneurysm repair (14,602 endovascular aortic repair and 4721 open aortic repair); 9913 (50.3%) used statins before surgery. Bivariate analysis demonstrated lower rates of hospital, 30-, 90-day and 1-year mortality in patients with statins compared to those without statins after endovascular aortic repair (1.0% vs. 1.45%, p = 0.01; 1.51% vs. 2.3%, p = 0.0004; 3.05% vs. 4.66%, p < 0.0001; 7.91% vs. 11.56%, p < 0.0001, respectively). Multivariable logistic regression adjusting for age, gender, race, comorbidities and procedure demonstrated preoperative statins use was associated with a mortality reduction at 90-days postoperatively (odds ratio = 0.80; 95% CI 0.70–0.91, p = 0.0014) and 1-year postoperatively (odds ratio = 0.76; 95% CI 0.69–0.84, p = 0.0001).

Conclusions

Only half of the patients undergoing abdominal aortic aneurysm repair were prescribed preoperative statins. After adjustment, statins were significantly associated with improved survival during 1 year after surgery and a decreased incidence of lower extremity embolic complications after endovascular aortic repair. These data support a beneficial role of statin use prior to surgery for patients undergoing abdominal aortic aneurysm repair. Further prospective studies are needed to assess the benefit of statins in the perioperative period after 365 days.
Buerger’s disease in the northeast of Iran: Epidemiology and clinical features
Authors: Modaghegh Mohammad-Hadi Saeed , Kazemzadeh Gholam Hosein , Ravari Hassan , Johari Hamed Ghoddusi , Barzanuni Amir
Published: October 2014

Background

The aim of this study is to present our long-term clinical experience in describing a clinical picture of Buerger's disease in our region.

Materials and methods

In a retrospective study, files of 225 patients who were admitted to the hospital with diagnosis of thromboangiitis obliterans in a 10 year period from 2000 to 2010 were reviewed. All data including demographic, signs and symptoms, history of previous illness, history of smoking, medications, laboratory tests, angiography, and details of surgical operation were obtained.

Results

A total of 222 (98.7%) and 3 (1.3%) of patients were male and female, respectively. Average age of hospitalized patients was 40.7 ± 8.5 (20–62) years. A total of 200 patients (88.9%) were active cigarette smokers while 168 (74.7%) of them were opium addicts. The most prevalent symptoms were chronic ulcers (80%) and claudication (63.6%). Minor and major amputation was required in 113 (50.2%) and 41 (18.4%) patients, respectively. Amputation was carried out on the lower limb (80%), upper limb (4.1%), or on both (15.1%). Also, four patients underwent revascularization through surgical bypass procedures.

Conclusions

The diagnosis and treatment of Buerger’s Disease is still a challenge in those communities where the disease is endemic. Therefore, identifying the natural course of the disease can play a pivotal role in the diagnosis and treatment of these patients.
Intravenous iloprost for treatment of critical limb ischemia in patients unsuitable for revascularization
Authors: Çevirme Deniz , Aksoy Eray , Gül Yaşar Gökhan , Erdem Hasan , Adademir Taylan , Köksal Cengiz , Bozkurt Kürşat
Published: October 2014

Introduction

Whether medical therapy alone may reduce the amputation rates in patients with chronic limb ischemia and who are unsuitable for revascularization is a controversial topic. In this study, we aimed to investigate the effects of 1 week infusion of iloprost in the treatment of patients with chronic limb ischemia.

Materials and methods

Twenty-seven consecutive patients were included in the study. There were 23 men (85.2%) and 4 women (14.8%) with a mean age of 68.93 ± 14.84 years. Patients were considered eligible if they were unsuitable for surgical and endovascular revascularization. Follow-up was made on 10th day and 6th month and included ankle brachial index and clinical assessment.

Results

Minor side effects occurred in four patients (16.0%), but the treatment was continued. In-hospital mortality occurred in one patient (4.0%). Another two patients died and four patients received amputation until follow-up (overall mortality 11.1%). There was significant increase in mean ankle-brachial index values between 1st day and 10th day ( p < 0.001), between 1st day and 6th month ( p < 0.001), and between 10th day and 6th month ( p < 0.001).

Conclusion

One-week treatment with iloprost may provide both long lasting symptomatic benefit and may improve hemodynamic parameters, which were shown to predict future amputation.
A preliminary study into the relationship between emotional perception ability and challenging behaviour in adults with an intellectual disability
Authors: Davies Bronwen , Frude Neil , Jenkins Rosemary , Harding Cathy , Hill Caley
Published: October 2014

This preliminary study explores the relationships between challenging behaviour and emotional perception in a population of adults with intellectual disabilities, in order to establish whether there are grounds for further study. Cross-sectional data were collected from 96 participants with intellectual disabilities and 95 carers. The service user participants completed the Emotional Perception Questionnaire, whilst carers completed the Checklist for Challenging Behaviour. Correlational analyses were employed to analyse relationships between the variables. A post hoc between-group analysis was conducted to compare the emotional recognition abilities of people with high-frequency challenging behaviour with those with low-frequency challenging behaviour. Significant negative associations were found between emotional perception and challenging behaviour frequency and management difficulty. Significant differences in emotional perception abilities were found between people with high frequency and those with low-frequency challenging behaviours. The study suggests that emotional perception is important in understanding challenging behaviour.
Telling ‘What Is’: Frame Narrative in Zbig Rybczynski’s Tango, Wendy Tilby and Amanda Forbis’s When the Day Breaks, and Yuri Norstein’s Tale of Tales
Authors: Slowik Mary
Published: October 2014

Using analytic tools developed by the literary critic, James Phelan, the author investigates frame narrative organization in three animated films. Zbig Rybczynski’s Tango uses addition and subtraction to frame mini-stories layered one over the other; Wendy Tilby and Amanda Forbis’s When the Day Breaks uses an A–B–A structure with repetitive events mirroring and revealing each other; and Yuri Norstein’s Tale of Tales uses character narrators that serve as observer/participants, allowing the film to cross narrative genres. This article also investigates the layered viewer response that frame narration requires. All three animations, while not digitally produced, demonstrate the ontological montage Lev Manovich ascribes to the aesthetic logic of digital compositing, which he maintains is layered and ‘first and foremost a conceptual [and] not only a technological operation’.
Animated Worlds of Magical Realism: An Exploration of Satoshi Kon’s Millennium Actress and Paprika
Authors: Mishra Manisha , Mishra Maitreyee
Published: October 2014

This article looks at two of the films of Japanese anime auteur Satoshi Kon – Millennium Actress (2001) and Paprika (2006) through the lens of magical realism. The authors argue that animation can be read as magical realist (which is applied to literature) as opposed to magic realist (which is applied to art), as animation is flowing art and hence has a narrative structure as in literature. While incorporating Wendy Faris’s five characteristics of magical realism in the analysis, the article also introduces additional concepts that are unique to Millennium Actress and Paprika. The authors engage with magical realist apparatuses in these anime, arguing that the two films use unconventional narratives and modes to reveal an Asian (Japanese) identity, uniqueness in form and sense of self. Kon’s films, although rooted in realism, explore the magical that embodies desire and longing in Millennium Actress and an exploration of the unconscious in Paprika.
Science review in research ethics committees: Double jeopardy?
Authors: Humphreys Stephen , Thomas Hilary , Martin Robyn
Published: October 2014

Research ethics committees ‘(RECs) members’ perceptions of their role in regard to the science of research proposals are discussed. Our study, which involved the interviewing of 20 participants from amongst the UK’s independent (Phase I) ethics committees, revealed that the members consider that it is the role of the REC to examine and approve the scientific adequacy of the research – and this notwithstanding the fact that a more competent body will already have done this and even when that other body has the legal responsibility for this function. The problematic nature of this situation, tantamount to double jeopardy, is considered: it can delay research and so add to costs whilst offering no countervailing benefits, or the double jeopardy may be just the cost society imposes, through its RECs, on researchers as the price for research on human subjects.
Comparison of surface temperatures of different synthetic turf systems and natural grass: Have advances in synthetic turf technology made a difference
Authors: Petrass Lauren A , Twomey Dara M , Harvey Jack T , Otago Leonie , LeRossignol Peter
Published: October 2014

Few studies have considered surface temperatures on the most recent synthetic turf products, and no empirical evidence is available on the more technologically advanced cool climate synthetic products which claim to reduce surface temperature. This article compared surface temperatures of typical third-generation synthetic turf with a cool climate product and also compared the synthetic turf products to natural grass to determine whether synthetic turf reacts differently to environmental factors and hence may increase heat-related health risks for participants. Surface temperatures were significantly associated with ambient temperature (F3,376 = 116.02, p < 0.001), relative humidity (F1,376 = 10.15, p = 0.028), and wind (F1,376 = 1.45, p = 0.004) having smaller effects. After adjustment for covariates, mean surface temperatures were significantly lower (40.79 °C) on a cool climate field compared to a typical third-generation field (44.91 °C), although both synthetic fields were considerably warmer than natural grass at the same venue (by 12.46 °C at the metropolitan venue and 22.15 °C at the regional venue). These findings provide initial insight into the potential value of cool climate products and will aid both design and development of synthetic turf products for the future.
Bipolar affective disorder
Authors: Leung Raymond
Published: October 2014

Bipolar affective disorder is a potentially life-long psychiatric illness that is characterised by episodic disturbances in mood between symptoms of mania and depression. The lifetime prevalence is estimated to be between 0.3 and 1.5% with a mean age of onset of 21 years old. The attempted suicide rate is about 25–50% with completed suicide in 10%. Therefore, accurate assessment and recognition of this disorder is important.
Evaluating Quality of Glycemic Control
Authors: Rodbard David
Published: October 2014

Background:

There is need for readily understandable graphical displays of glucose data to facilitate interpretation by clinicians and researchers.

Methods:

(1) Display of the percentage of glucose values above a specified threshold for hyperglycemia (%High) versus percentage of glucose values below a specified threshold for hypoglycemia (%Low). If all glucose values fell within the target range, then all data points would fall at the origin. (2) After an intervention, one can plot the change in percentage of glucose values above a specified threshold for hyperglycemia versus the change in percentage of glucose values below a specified threshold defining hypoglycemia: The quadrants of this graph correspond to (a) increased risk of both hyper- and hypoglycemia, (b) decreased hyperglycemia but increased risk of hypoglycemia, (c) decreases in both hypo- and hyperglycemia, and (d) decreased hypoglycemia but increased hyperglycemia. (3) A 2-dimensional triangular graph can be used for simultaneous display of %High, %Low, and percentage in target range. (4) Display of risk of hyper- versus risk of hypoglycemia based on both frequency and severity of departures from the target range can be used. (5) Graphs (1) and (4) can also be presented using percentile scores relative to a reference population. (6) It is also useful to analyze %Hypoglycemia or risk of hypoglycemia versus mean glucose.

Results:

These methods are illustrated with examples from representative cases and shown to be feasible, practical, and informative.

Conclusions:

These new types of graphical displays can facilitate rapid analysis of risks of hypo- and hypoglycemia simultaneously and responses to therapeutic interventions for individuals or in clinical trials.
A Novel Method to Detect Pressure-Induced Sensor Attenuations (PISA) in an Artificial Pancreas
Authors: Baysal Nihat , Cameron Fraser , Buckingham Bruce A. , Wilson Darrell M. , Chase H. Peter , Maahs David M. , Bequette B. Wayne ,   for the In Home Closed-Loop Study Group (IHCL), Buckingham Bruce A. , Wilson Darrell M. , Aye Tandy , Clinton Paula , Harris Breanne P. , Chase H. Peter , Maahs David M. , Slover Robert , Wadwa Paul , Realsen Jaime , Messer Laurel , Hramiak Irene , Paul Terri , Tereschyn Sue , Driscoll Marsha , Bequette B. Wayne , Cameron Fraser , Baysal Nihat , Beck Roy W. , Lum John , Kollman Craig , Calhoun Peter , Sibayan Judy , Njeru Nelly M. , Sauer Werner , Lott Jennifer , Pickup John C. , Hirsch Irl , Wolpert Howard
Published: October 2014

Background:

Continuous glucose monitors (CGMs) provide real-time interstitial glucose concentrations that are essential for automated treatment of individuals with type 1 diabetes. Miscalibration, noise spikes, dropouts, or pressure applied to the site (e.g., lying on the site while sleeping) can cause inaccurate glucose signals, which could lead to inappropriate insulin dosing decisions. These studies focus on the problem of pressure-induced sensor attenuations (PISAs) that occur overnight and can cause undesirable pump shut-offs in a predictive low glucose suspend system.

Methods:

The algorithm presented here uses real-time CGM readings without knowledge of meals, insulin doses, activity, sensor recalibrations, or fingerstick measurements. The real-time PISA detection technique was tested on outpatient “in-home” data from a predictive low-glucose suspend trial with over 1125 nights of data. A total of 178 sets were created by using different parameters for the PISA detection algorithm to illustrate its range of available performance.

Results:

The tracings were reviewed via a web-based analysis tool by an engineer with an extensive expertise on analyzing clinical datasets and ~3% of the CGM readings were marked as PISA events which were used as the gold standard. It is shown that 88.34% of the PISAs were successfully detected by the algorithm, and the percentage of false detections could be reduced to 1.70% by altering the algorithm parameters.

Conclusions:

Use of the proposed PISA detection method can result in a significant decrease in undesirable pump suspensions overnight, and may lead to lower overnight mean glucose levels while still achieving a low risk of hypoglycemia.
Hypoglycemia Prediction Using Machine Learning Models for Patients With Type 2 Diabetes
Authors: Sudharsan Bharath , Peeples Malinda , Shomali Mansur
Published: October 2014

Background:

Minimizing the occurrence of hypoglycemia in patients with type 2 diabetes is a challenging task since these patients typically check only 1 to 2 self-monitored blood glucose (SMBG) readings per day.

Method:

We trained a probabilistic model using machine learning algorithms and SMBG values from real patients. Hypoglycemia was defined as a SMBG value < 70 mg/dL. We validated our model using multiple data sets. In addition, we trained a second model, which used patient SMBG values and information about patient medication administration.

Results:

The optimal number of SMBG values needed by the model was approximately 10 per week. The sensitivity of the model for predicting a hypoglycemia event in the next 24 hours was 92% and the specificity was 70%. In the model that incorporated medication information, the prediction window was for the hour of hypoglycemia, and the specificity improved to 90%.

Conclusions:

Our machine learning models can predict hypoglycemia events with a high degree of sensitivity and specificity. These models—which have been validated retrospectively and if implemented in real time—could be useful tools for reducing hypoglycemia in vulnerable patients.
The Chronic Injury Glucose Error Grid
Authors: Krouwer Jan S. , Cembrowski George S.
Published: October 2014

Traditional glucose error grids provide error limits for glucose meters. These criteria help to assess the meter’s suitability to prevent acute injury. We present a rationale for an error grid that provides a different set of error limits to help prevent chronic injury in diabetes. For example, glucose values in the no treatment zone of a traditional error grid could be harmful in diabetic retinopathy. The same method comparison data informs both the acute and chronic injury error grids. All of the data are used in an acute injury error grid, whereas only long-term biases populate a chronic injury error grid. These biases can be due to reagent lots and patient specific interferences. An example of a chronic injury glucose error grid is provided using simulated data.
A Randomized Controlled Trial of Effects of Fruit Intake on Cardiovascular Disease Risk Factors in Children (FIST Study)
Authors: Chellappah Jessica , Tonkin Andrew , Douglas Gregg M. Elizabeth , Reid Christopher
Published: October 2014

Background. Dietary habits are known to influence cardiovascular disease (CVD) risk factors, which even in childhood are a predictor of future morbidity. Our objective was determining the impact of a school-based intervention of providing fruit daily in the classroom and its effects on risk factors for CVD, and dietary habits. Methods. The study was a randomized controlled trial involving 2 public and 2 private schools, one of each in an intervention and control group. Measurements at both the start and end of 8 weeks were aimed to identify any changes in physiological measures, and child food choices. Results. The intervention had minimal impact on physiological variables but was effective in improving the amount of fruit and vegetables consumed and preferences toward fruit intake. Parent activity and dietary choices were poor at baseline, but significantly improved in the intervention group compared to the control group over the 8 weeks. Conclusion. This intervention was effective in improving the amount of fruit consumed and attitudes toward fruit intake over just 2 months. It has also shown the importance of not just the school environment but also the home environment in influencing children developing good dietary choice habits and lifestyle.
Conservative management of broken guidewire: Case reports
Authors: Khan Shahid M , Ho David W , Dinaram Temujin , Lazar Jason M , Marmur Jonathan D
Published: October 2014

Fractures of coronary guidewires during percutaneous coronary intervention within a coronary vessel lumen are a rare but serious complication. There have been several cases reported in the literature, some managed with surgical intervention, others with medical therapy. We present two prospective cases from our center. Both cases were managed successfully with medical therapy.