bluuebunny/crossref_metadata_2025 huggingface dataset:
Flexor carpi ulnaris herniation after cubital tunnel release: A case report
Authors: Palumbo Dante , Miller Aden , Smock Elliott , Farner Scott
Published: January 2019

Muscle herniation in the upper extremity is a rare but recognized phenomenon with a paucity of reports in the current literature. In the majority of cases, the herniation is secondary to trauma, with some of the cases due to muscle hypertrophy and increased intra-compartmental pressure from the forced exertion. Treatment for this condition ranges from nonsurgical, repair, or reconstruction to fasciotomy of the flexor carpi ulnaris fascia. Here, we present a case of flexor carpi ulnaris herniation after an open in situ cubital tunnel release in a 57-year-old male 6 years after initial surgery. The patient’s symptoms did not improve with conservative management, and the patient subsequently underwent endoscopic fasciotomy with resolution of his symptoms and maintenance of his wrist and grip strength. The rationale for the treatment chosen is discussed.
Congenital deformation of the posterior arch of the atlas: Subluxation of the atlanto-axial joint with temporary quadriplegia
Authors: Ballhause Tobias M , Velickovic Mirko , Thiesen Darius M , Dreimann Marc
Published: January 2019

Instabilities of the craniocervical junction can be of rheumatic, traumatic, or congenital origin. The reported patient has a congenital malformation of the cervical spine, which is frequently observed in patients with Klippel–Feil syndrome. Her posterior arch of the atlas (C1) is hypoplastic and a chronic subluxation of the atlanto-axial joint would be possible. Although most common fusions in Klippel–Feil syndrome patients exist at C2/3, the majority of studies about Klippel–Feil syndrome deal with pediatric or adolescent individuals. Through extreme flexion of her neck, there was a compression of the spinal cord by the odontoid process. This led to a quadriplegia lasting about 10 min. Over the following weeks, all of her symptoms started to diminish. This situation turned out to be the third episode involving temporary neurological disorders in this 60-year-old female’s life.
Guidelines adherence or chronic total occlusion recanalization of the superficial femoral artery with a stentless approach: The next frontier?
Authors: Rammos Christos , Radecke Tobias , Lortz Julia , Steinmetz Martin , Rassaf Tienush
Published: January 2019

In patients with intermittent claudication and long chronic total occlusions of the superficial femoral artery, a primary surgical bypass or stenting is recommended. However, due to the invasive nature, high complication rates and patient-related comorbidities, surgery is currently not the preferred method and full lesion stenting for long chronic total occlusions has the obvious consequences of permanent metallic implants. We report a case of a patient with a long chronic total occlusion of the superficial femoral artery with intermittent claudication. Endorsing an endovascular-first strategy, he was treated via an antegrade and retrograde approach with a complete recanalization and a stentless treatment with rotational atherectomy and drug-coated balloons. We believe this is a feasible endovascular strategy for the treatment of long chronic total occlusions of the superficial femoral artery for patients refusing open surgery. Further investigations are needed to evaluate long-term clinical outcomes of these novel techniques.
A case of diabetic myonecrosis: A rare complication of a common disease
Authors: Alkhoury Rami
Published: January 2019

Diabetes mellitus is a growing concern in today’s population and a common cause of significant morbidity and mortality in those affected. Diabetic myonecrosis is an uncommon condition that can be seen in uncontrolled, long-standing diabetic patients who complain of localized, sudden-onset muscle pain. We present a 57-year-old woman with type 2 diabetes mellitus who presented to the emergency department with left-sided pelvic pain for the past 2 months. The pain had progressively gotten worse with a significant reduction in the range of motion of her left hip. Magnetic resonance imaging imaging revealed focal enhancement, edema, and enlargement of the left iliacus muscle. Assessment of serum glucose and hemoglobin A1c revealed a history of poor diabetic control, eventually giving rise to a diagnosis of diabetic myonecrosis. She was discharged with a new diabetic regimen, pain control, and outpatient physical therapy.
Solitary fibrous tumor of the pleura with Doege–Potter syndrome: Second recurrence in a 93-year-old female
Authors: Forster Céline , Roumy Aurélien , Gonzalez Michel
Published: January 2019

Solitary fibrous tumors are rare mesenchymal tumors most commonly arising from the pleura. When associated with paraneoplastic syndrome of hypoglycemia caused by the secretion of a high-molecular-weight form of insulin-like growth factor II, it is referred to as the Doege–Potter syndrome. Surgery with complete tumor resection is the only curative treatment. We present here the case of a 93-year-old female diagnosed with a Doege–Potter syndrome who underwent three repetitive surgical resections of recurrent solitary fibrous tumor.
Current strategy for hollow viscus injury with active bleeding: A case report
Authors: Otsuka Hiroyuki , Fukushima Tomokazu , Tsubouchi Youhei , Sakurai Keiji , Inokuchi Sadaki
Published: January 2019

Despite rapid advancements in medical technologies, the use of interventional radiology in a patient with hemodynamic instability or hollow viscus injury remains controversial. Here, we discuss important aspects regarding the use of interventional radiology for such patients. A 74-year-old Japanese male climber was injured following a 10 m fall. On admission, his systolic blood pressure was 40 mmHg. He had disturbance of consciousness and mild upper abdominal pain without peritoneal irritation. Focused assessment sonography for trauma indicated massive hemorrhage in the intra-abdominal cavity. Plain radiographs revealed hemopneumothorax with right-side rib fractures. Thoracostomy to the right thoracic cavity and massive transfusion were immediately performed. Consequently, a sheath catheter was inserted into the common femoral artery for interventional radiology. His systolic blood pressure increased to 80 mmHg owing to rapid transfusion. In the computed tomography scan room, based on computed tomography findings, we judged that it was possible to achieve hemostasis by interventional radiology. The time from hospital admission to entering the angiography suite was 38 min. Transcatheter arterial embolization for hemorrhage control was performed without complications. Following transcatheter arterial embolization, he was admitted to the intensive care unit. All injuries could be treated conservatively without surgery. His post-interventional course was uneventful, and he recovered completely after rehabilitation. Hemorrhage control using interventional radiology should be assessed as a first-line treatment, even in hemodynamically unstable patients having a hollow viscus injury with active bleeding, without obvious findings that indicate surgical repair.
Engineering a foundation for partnership to improve medication safety during care transitions
Authors: Xiao Yan , Abebe Ephrem , Gurses Ayse P
Published: January 2019

There are major gaps and barriers for patients and caregivers after hospital discharge to achieve safe medication use. Patients and caregivers are often not ready to take on the responsibility for medication management when transitioned from inpatient care. Current approaches tend to focus on adding isolated strategies. A system thinking can enable a fundamental transformation to redesign professionals’ interactions with patients and caregivers with an explicit goal to develop patients and caregivers into true partners, with targeted roles, skills, attitude, knowledge, and tool support. We must recognize the fact that medication safety during care transition and, more so, at patient homes is the property of a “work system”, in which the patient and caregivers are at the center, with collaboration with health professionals. Innovative ideas are needed to engineer work system components by systematically examining professionals’ interactions with patients and caregivers, such as those during hospital stays and transitions (e.g. follow-up phone calls, community pharmacist consults, and home visits). Based on human factors principles, we describe a set of recommendations on engineering partnership with patients and their caregivers at different stages of a care episode, to enable productive interactions among work systems that are distributed and are often limited in their ability to exchange information and co-align their interests.
Preconditioning full-waveform inversion with efficient local correlation operators
Authors: Wellington Paul , Brossier Romain , Virieux Jean
Published: January 2019

Full-waveform inversion (FWI) is an iterative locally linearized data-fitting technique. The FWI method attempts to move from an initial low-wavenumber representation of earth parameters to a broader representation of the medium. An issue with the method is that FWI is an ill-posed problem, oversampled for the numerical forward discretization. The success of the model parameter reconstruction can often be greatly affected by external factors such as the presence of noise in the input field data or other artifacts arising from the imaging condition present in the FWI gradient computation. We have developed a strategy for mitigating against the influence of such external factors by preconditioning the discrete data gradient using an efficient differential approach instead of the often used integral formulation. Such an application of a smoothing correlation operator allows one to use prior information to locally filter along expected geological dips while being consistent with faults. The application of this preconditioning strategy to real and synthetic 2D data sets illustrates how this incremental additional step makes the FWI workflow less sensitive to noise and spatial aliasing artifacts. Nothing prevents a possible 3D acoustic extension, thanks to the small added computer cost for this local filter application. Three-dimensional elastic FWI may require this inexpensive filtering strategy due to the prohibitive forward-modeling costs that could be partially mitigated by using a coarse shot increment in conjunction with gradient preconditioning.
Hybrid multiplicative time-reversal imaging reveals the evolution of microseismic events: Theory and field-data tests
Authors: Zhu Tieyuan , Sun Junzhe , Gei Davide , Carcione José M. , Cance Philippe , Huang Chao
Published: January 2019

The generation of microseismic events is often associated with induced fractures/faults during the extraction/injection of fluids. A full characterization of the spatiotemporal distribution of microseismic events provides constraints on fluid migration paths in the formations. We have developed a high-resolution source imaging method — a hybrid multiplicative time-reversal imaging (HyM-TRI) algorithm, for automatically tracking the spatiotemporal distribution of microseismic events. HyM-TRI back propagates the data traces from groups of receivers (in space and time) as receiver wavefields, multiplies receiver wavefields between all groups, and applies a causal integration over time to obtain a source evolution image. Using synthetic and field-data examples, we revealed the capability of the HyM-TRI technique to image the spatiotemporal sequence of asynchronous microseismic events, which poses a challenge to standard TRI methods. Moreover, the HyM-TRI technique is robust enough to produce a high-resolution image of the source in the presence of noise. The aperture of the 2D receiver array (azimuth coverage in 3D) with respect to the microseismic source area plays an important role on the horizontal and vertical resolution of the source image. The HyM-TRI results of the field data with 3D azimuthal coverage further verify our argument by producing a superior resolution of the source than TRI.
Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study
Authors: Li Qun , Xue Yinling , Peng Yuan , Li Lin
Published: January 2019

Objectives: To determine the clinical characteristics and risk factors of Deep Venous Thrombosis (DVT) in patients with gynecological malignant tumor, facilitating gynecologists better prevent the fatal complication.

Methods: The patients with gynecological malignant tumor treated in department of gynecology of our hospital between May 2013 and May 2018 were reviewed retrospectively. The clinical data of patients including gender, age, tumor staging, adenocarcinoma, surgery, operation time, hypertension, hyperlipemia, diabetes, coronary heart disease, radiotherapy, chemotherapy, hospital stay, and postoperative rehabilitation exercise were collected to analyze the clinical characteristics of patients and determine the risk factors of DVT.

Results: In the current study, 67 patients were included in DVT group, and 554 patients were included in Non-DVT group. There were significant differences in age, hypertension, hyperlipemia, operation time, adenocarcinoma, tumor staging, radiotherapy and postoperative rehabilitation exercises between DVT and non-DVT groups (p<0.05). However, there was no significant differences in gender, coronary heart disease, diabetes, surgical treatment and hospital stay (p>0.05). In multivariate analysis, the factors including age, hypertension, adenocarcinoma, radiotherapy, and hyperlipemia were independent risk factors, while rehabilitation exercise was protective factor for DVT.

Conclusion: In cases of gynecological malignant tumor, DVT screening should be given due importance, especially for those patients with old age, hypertension, hyperlipemia, adenocarcinoma, or history of radiotherapy. Rehabilitation exercise should be encouraged in these patients.

How to cite this:Li Q, Xue Y, Peng Y, Li L. Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study. Pak J Med Sci. 2019;35(1):195-199. doi: https://doi.org/10.12669/pjms.35.1.365

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Embedding commissioner visits to general practices to improve childhood immunisations
Authors: McGeown Helen , Moore James , Heffernan Catherine
Published: January 2019

Commissioner visits are routinely used in the NHS; however, their role in improving vaccination services is unknown. This study will evaluate the impact of immunisation commissioner visits to general practice and share the lessons learnt. This study analysed data from 262 practices across London between October 2015 and April 2016. Semi-structured interviews with the immunisation commissioners about the process was also undertaken. We found that commissioners saw the process as time consuming (the team spent a total of 11 weeks in a 6-month period conducting visits) and that adhering to a formalised process was challenging. However, it was a catalyst for developing better working relationships and identifying previously unknown service issues such as workforce shortages, high population turnover, and high rates of migrants with incomplete or unknown immunisation status. Further research on the effectiveness of commissioner visits is therefore warranted.
Prehospital care in isolated neck of femur fracture: a literature review
Authors: O'Connor Rory
Published: January 2019

Around 65 000 people experience a fractured neck of femur (NOF) each year in the UK. It is estimated that one in 10 patients with an NOF fracture will die within 1 month, and one in three will die within 1 year. The bill for NOF fracture, excluding substantial social care costs, is £1 billion per year. Given the exposure that ambulance services have to these patients, several aspects of NOF fracture care could be improved in the prehospital environment, which could also generate significant savings for the NHS. This article reviews the literature regarding NOF fracture care, and highlights aspects that affect ambulance services and prehospital care. A variety of these, including pain management, fast-track systems, fluid therapy and renal impairments, can be improved, but evidence specific to the prehospital environment is lacking.
Human factors, cognitive bias and the paramedic
Authors: Allen James
Published: January 2019

The consequences of human factors and cognitive bias can be catastrophic if unrecognised. Errors can lead to loss of life because of the flawed nature of human cognition and the way we interact with our environment. Seemingly small mistakes or miscommunications can lead to negative outcomes for patients and clinicians alike. It is easy to see therefore why the College of Paramedics now recommends the teaching of human factors at higher education institutions. Using a problem-based approach, this article aims to inform prehospital clinicians about how human factors and cognitive bias can affect them and their practice, and how these can be mitigated.
The Effectiveness of Intercultural Sensitivity Development Activities Integrated With Scientific Research Methods Course
Authors: Tuncel Ibrahim
Published: January 2019

It can be said that effective development of intercultural sensitivity depends on the regulations and practices in the curriculum. Integrated program implementations are seen as one of the ways of regulation. In the study, a nested integration model was used in a single discipline. In this context, scientific research methods are considered as a discipline, and the achievements of this discipline and intercultural sensitivity development activities are integrated. Understanding different cultures correctly and not being prejudiced are very important for the development of intercultural sensitivity. Scientific research methods course provides students with scientific attitudes and behaviors. In this course, it is thought that students will be able to develop sensitivity by examining different cultures with scientific attitudes and behaviors. In this context, it is aimed to reveal the effectiveness of intercultural sensitization development activities integrated with scientific research methods course gains. The quasi-experimental design with a pretest-posttest and a control group was used in the study. The study group comprised of 86 second-grade students in the English Teacher Training Department. In order to measure the intercultural sensitivities of the students before and after the test procedure, the five-point likert type “Intercultural Sensitivity Scale” developed by Chen and Starosta and adapted to Turkish by Bulduk, Tosun and Ardic was used as data collection tool. It is concluded that the curriculum of scientific research methods integrated with intercultural sensitivity development activities is effective in developing students' intercultural sensitivities.
The Effects of Biology Laboratory Practices Supported with Self-regulated Learning Strategies on Students' Self-directed Learning Readiness and Their Attitudes towards Science Experiments
Authors: Kayacan Kadriye , Sonmez-Ektem Isil
Published: January 2019

Self-regulation is an active and constructive process in which students regulate and observe their own behaviour, motivations and cognition by setting their own goals during their learning process. In this study, the aim is to investigate the effects of biology laboratory practices that are supported by self-regulated learning strategies on students’ readiness for self-directed learning and their attitudes towards science experiments in laboratory settings. This study, which was undertaken as a quasi-experimental study in accordance with the pretest-posttest design with a control group, was implemented. Second year students who studied science teaching in the faculty of education at a state university in Konya in the academic year of 2018-2019 made up the sample of this study. There were two groups in the study which were “The Control Group” and “The Experimental Group”. In order to measure the students’ self-directed learning readiness levels, “Scale of Self-Directed Learning Readiness in Laboratory” was used and to measure attitudes towards science experiments “Scale of Attitudes towards Science Experiments” was utilized. Both scales were implemented as pre-tests before the study and as post-tests after the completion of the implementation process. The analysis of the data was conducted via SPSS 18. Independent samples t test was conducted to understand whether biology laboratory practices supported with self-regulated learning strategies have any effect on students’ readiness for self-directed learning and their attitudes towards science experiments in laboratories. According to the findings of the study, biology laboratory practices supported with self-regulated learning strategies were observed to make a significant difference in favour of the experimental group considering their self-directed learning readiness and their attitudes towards science experiments.
Deaf and Hard of Hearing Students’ Perceptions of the Flipped Classroom Strategy in an Undergraduate Education Course
Authors: Al-Ibrahim Amal
Published: January 2019

This study aims to evaluate the academic outcomes of the flipped classroom approach in the teaching of students who are deaf or hard of hearing (DHH). Furthermore, it aims to activate the role of the teacher through encouraging both teachers and students to engage in active learning styles, while acknowledging individual differences. Participants consisted of 12 female undergraduates with hearing disabilities in a 251 CI course (applications of ICT in teaching and learning) at the College of Education, King Saud University. The study was applied throughout a semester on the contents of the course. The content material and pre-class assigned work (e.g. instructional videos and tasks) were delivered through Blackboard (learning management system), while active learning activities were carried out in class. Using mixed methods, students’ perceptions of their new learning environment were explored through a post-term questionnaire distributed at the end of the semester, in addition to writing a reflective report. Furthermore, participants were requested to write a reflective journal at the end of each lecture. Results indicated the effectiveness of the flipped classroom strategy for students. Moreover, the data indicate a positive impact on students' content learning and improved skills (e.g. collaboration and interaction). The content material which was developed for the specific course (251 CI) could be utilized for the remaining students enrolled in this course. The researcher recommends using the flipped classroom teaching strategy for courses in higher education, as the methodology can be extended and implemented through following a similar framework applied in this study.
XW-100: First FDA CLIA-Waived CBC Analyzer Designed for Physician Office Use
Authors: Wu Alan H B , Sellers Jill
Published: January 2019

Background

The XW-100 hematology analyzer (Sysmex America) is the first complete blood count (CBC) instrument waived by the US Food and Drug Administration. This analyzer also tests for a 3-part white blood cell count differential.

Methods

The XW-100 analyzer was evaluated for preanalytical specimen variables including the need for mixing, specimen storage conditions, freeze–thaw cycles, the effect of under filling of tubes, precision, linearity, carryover, limits of the blank, detection, and quantification and interferences from common and CBC-specific substances. The clinical study examined 586 blood samples from 6 CLIA-waived clinical sites and 6 paired moderately complex sites. The point-of-care sites had different medical specialties and were using inexperienced operators. The results of 8 measurements and 4 calculated parameters were compared to a moderately complex point-of-care hematology analyzer (pocH-100i, Sysmex).

Results

The precision was <6% for all analytics, and there was no carryover noted. Samples containing interfering substances were appropriately flagged or suppressed by the instrument. The correlation to the predicate analyzer was highly concordant, producing near unity slope and intercept and minimal bias. Delays from sample collection to testing resulted in decreased performance. The percentage of samples inside the allowable error was >98.8% for all parameters studied.

Conclusion

This CLIA-waived hematology analyzer produces acceptable results and can be used in offices and clinics.
Transition of Methotrexate Polyglutamate Drug Monitoring Assay from Venipuncture to Capillary Blood-Based Collection Method in Rheumatic Diseases
Authors: Brady Kelley , Qu Ying , Stimson Deborah , Apilado Robert , Vezza Alexander Roberta , Reddy Smitha , Chitkara Puja , Conklin John , O'Malley Tyler , Ibarra Claudia , Dervieux Thierry
Published: January 2019

Objective

Methotrexate (MTX) polyglutamate (MTXPG3) levels from isolated red blood cells (RBCs) collected by venipuncture have clinical utility in guiding MTX dosing for patients with rheumatoid arthritis (RA). Our objective was to transition this RBC-based therapeutic drug monitoring (TDM) assay to dried capillary blood collected by fingerstick.

Methods

Patients with RA treated with MTX were enrolled. Specimens were collected by fingerstick (volumetric absorptive microsampler) and venipuncture to measure MTXPG3 from dried capillary blood, total venous blood, and isolated RBCs. MTXPG3 levels from dried capillary blood were measured using LC-MS/MS, converted to RBC equivalent (nmol/L), and compared with those from isolated RBCs (reference method). Following transition to fingerstick collection, comparability in the distributions of dried capillary and venipuncture-based RBC MTXPG3 levels was assessed using the Kolmogorov–Smirnov (K-S) test.

Results

Intraday and interday precision ranged from 2.0% to 10.9% and 3.1% to 10.8%, respectively, at MTXPG3 concentrations ranging from 5 to 100 nmol/L. In 106 participants treated with MTX, MTXPG3 levels from total venous and dried capillary blood were comparable [slope = 0.97 (95% CI, 0.92–1.03); R  2 = 0.92]. Dried capillary blood MTXPG3 converted to RBC equivalent was similar to levels from isolated RBCs (30 ± 18 nmol/L vs 33 ± 19 nmol/L; n = 106). After implementation in the clinical laboratory, RBC equivalents MTXPG3 from the fingerstick method were similar to levels from venipuncture [39 ± 22 nmol/L (n = 825) vs 39 ± 24 nmol/L (n = 47935)] (K-S test P = 0.09). Underexposure to MTX (MTXPG3 ≤5 nmol/L RBCs) was detected in 7.0% and 8.5% patient specimens collected using the fingerstick and venipuncture methods, respectively.

Conclusion

Capillary blood MTXPG3 levels can be used to guide MTX dosing in TDM practice.
‘Doing fifty-five in a fifty-four’: Hip hop, cop voice and the cadence of white supremacy in the United States
Authors: Stoever Jennifer Lynn
Published: January 2019

This article examines how police officers in the United States use a racialized and gendered way of speaking called ‘cop voice’ to provoke fear and extreme forms of compliance from people of colour. Through autoethnographic analysis coupled with sonic attention to how Jay-Z (‘99 Problems’), Public Enemy (‘Get the Fuck Out of Dodge’) and Prince Paul (‘The Men in Blue’) represent ‘cop voice’ through shifts in their rapping flow or by using white guest rappers, ‘Doing 55 in a 54’ argues that police weaponize their voices. Identifying and listening closely to these examples of cop voice reveal how people who are raced as ‘white’ in the United States mobilize this subject position in their voices through particular cadences that audibly signify racial authority, while at the same time, never hearing themselves as doing so.
The Sprout Regulating Compound 1,4-Dimethylnaphthalene Exhibits Fungistatic Activity
Authors: Campbell Michael , Campbell Michael , Adams Rachael , Dobry Emily , Dobson Kara , Dobson Kara , Stefanick Veronica , Till Jessica
Published: January 2019

The compound 1,4-dimethylnaphthalene, originally isolated from dormant potatoes, is currently in use as a commercial sprout inhibitor. Growers and processors report a reduction in fungal infections in potatoes treated with DMN resulting in increased yields. To assess the effects of DMN on fungal growth a culture of Fusarium oxysporum was isolated from potato tubers and identified via DNA fingerprinting using the 18ITS ribosomal region. Growth of F. oxysporum was inhibited by 31% after four days of exposure to DMN but overall rate of spore germination was not affected by DMN treatment. The growth of additional fungi, including Alternaria alternata, Aspergillus niger, Epicoccum nigrum, Gnomoniopsis smithogilvyi, Phoma medicaginis, and Pythium ultimum was inhibited by DMN as was suppression of sporulation in A. niger. These results suggest that DMN is fungistatic at the application levels examined.
The Impact of Secondary Environmental Variables on OECD Healthcare Efficiency: A Robust Conditional Approach
Authors: Gearhart Richard
Published: January 2019

In this paper, I estimate country-level efficiency using a newer order-m estimator where I condition efficiency estimates on secondary environmental variables. This allows me to identify which variables influence the effectiveness of a healthcare delivery system. I find that not controlling for secondary environmental variables leads to the average OECD country being 11% inefficient; after controlling for demographics and economic (social protection) environmental variables, inefficiency reduces to 7% (5%). This provides evidence that a substantial part of the inefficiencies of a healthcare system is related to demographics, socioeconomics, and the structure of the healthcare delivery system. Using the second-stage results, I find lower healthcare spending, both as a percent of GDP and total out-of-pocket, as well as more of the population covered by public health insurance, is related to better efficiency. Lower fertility rates, lower immigration rates, higher incomes, and lower pharmaceutical doses are also consistent with better healthcare efficiency. Lastly, a healthcare system that provides a basic benefits package but allows for purchase of private health insurance, with moderate gatekeeping and flexibility to increase the budget for healthcare through public and private financing, are the most efficient healthcare systems.
Investment, technological progress and energy efficiency
Authors: Díaz Antonia , Puch Luis A.
Published: January 2019

In this paper we propose a theory to study how the aggregate demand of energy responds to energy prices and technical innovations that affect the price of energy services. In our theory, energy use is determined by the interaction of the choice of Energy Saving Technical Change with energy prices and Investment Specific Technical Change (ISTC). The key mechanism is that the energy saving technology is embodied in capital vintages as a requirement that determines their energy intensity. We show that higher ISTC that increases the quality of capital goods is an energy saving device and, therefore, a substitute for Energy Saving Technical Change (ESTC). However, higher ISTC that rises the efficiency in producing capital goods is energy consuming and fosters ESTC to compensate for the amount of energy required by the new investment. A higher price of energy also induces a higher level of ESTC, but the aggregate amount of energy used may not be affected as investment does not change. These effects are amplified with rising prices of energy. Thus, our theory can be used to test when and how we should see a rebound effect in energy use at the aggregate level and to evaluate the aggregate effect of any policy aiming to reduce energy use.
Concept characteristics and variation in lexical diversity in two Dutch dialect areas
Authors: Franco Karlien , Geeraerts Dirk , Speelman Dirk , Van Hout Roeland
Published: January 2019

Lexical diversity, the amount of lexical variation shown by a particular concept, varies between concepts. For the conceptdrunk, for instance, nearly 3000 English expressions exist, includingblitzed, intoxicated, andhammered. For the conceptsober, however, a significantly smaller number of lexical items is available, likesoberorabstinent. While earlier variation studies have revealed that meaning-related concept characteristics correlate with the amount of lexical variation, these studies were limited in scope, being restricted to one semantic field and to one dialect area, that of the Limburgish dialects of Dutch. In this paper, we investigate whether the impact of concept characteristics, viz. vagueness, lack of salience and proneness to affect, is manifest in a similar way in other dialects and other semantic fields. In particular, by extending the scope of the earlier studies to other carefully selected semantic fields, we investigate the generalizability of the impact of concept characteristics to the lexicon as a whole. The quantitative approach that we employ to measure concept characteristics and lexical diversity methodologically advances the study of linguistic variation. Theoretically, this paper contributes to the further development of Cognitive Sociolinguistics by showcasing how meaning can be a source of lexical diversity.
Proximal and distal deictics and the construal of narrative time
Authors: Dancygier Barbara
Published: January 2019

This paper proposes an approach to narrative deixis which offers a coherent analysis of the respective roles of proximal and distal deictic expressions (demonstratives as well as temporal and locative adverbs). The paper starts by arguing that fictional narratives require an approach to deixis which modifies a number of broadly held assumptions, especially as regards the interaction between tense and other deictic forms. It then considers the widely discussed instance of the temporal adverb now in the context of Past Tense. The second part of the paper gives special focus to demonstratives in narrative fiction, showing their role in temporal construals. It argues that both temporal and demonstrative expressions are primarily used to serve narrative viewpoint construction (which includes but is not limited to temporal viewpoint). Examples from several novels are then used to show how the proximal and distal choices of demonstratives, temporal adverbs and locative adverbs structure narrative viewpoint, including narrative representation of character experience. The paper concludes by proposing that in the context of fictional narratives the proximal/distal contrast is more relevant to meaning emergence than individual aspects of deixis, and that the construal of time can be achieved through the whole spectrum of deictic forms, not just tense and temporal adverbs such as now and then.
Toolbox of teaching strategies
Authors: Pan Lei , Xi Hui-Qin , Shen Xiao-Wei , Zhang Chen-Yu
Published: January 2019

A teaching strategy is a method, which can help students to gain knowledge, deliver information, and improve their learning. Different learning environments, such as clinical teaching, online teaching, and face-to-face traditional learning environments, require different teaching strategies for students. Choosing teaching strategies for a course is very important for nurse educators because various factors should be taken into account to make students meet the learning outcomes. The use of modern technologies in teaching strategies can improve students’ competencies and confidences. The purpose of this article is to create a toolbox integrating ten teaching strategies that can be used in different teaching environments.
Clinical surgery-oriented subject librarian services in medical colleges and schools
Authors: He Qiang
Published: January 2019

Regarding subject librarian services for clinical studies, researchers outside China have been focusing on subject service performance, evidence-based medicine, and comprehensive consulting services. In contrast, Chinese researchers have concentrated on service systems and methods but have not established mature systems and methods for clinical surgery-oriented services. Therefore, subject librarians in medical schools should become involved in clinical research and expand their perspective on medical library research. In addition, they should collaborate with clinicians to improve the overall level of research in hospitals while increasing the impact of subject librarian services in medical colleges and schools.
Construction of an ontology-based nursing knowledge system
Authors: Han Shi-Fan , Zhu Rui-Fang , Xue Jia , Yu Qi , Su Yan-Bing , Wang Xiu-Juan
Published: January 2019

This study proposes the establishment of a knowledge-system ontology in the nursing field. It uses advanced data mining techniques, digital publishing technologies, and new media concepts to comprehensively integrate and deepen nursing knowledge and to aggregate sources of knowledge in specialized technical fields. This study applies all forms of media and transmission channels, such as personal computers and mobile devices, to establish a knowledge-transmission system that provides knowledge services such as knowledge search, update retrieval, evaluation, questions and answers (Q&As), online viewing, information subscription, expert services, push notifications, review forums, and online learning. In doing so, this study creates an authoritative and foundational knowledge service engine for the nursing field, which provides convenient, flexible, and comprehensive knowledge services to members of the nursing industry in a digital format.
Development of an accurate nursing program based on function in chronic venous leg ulcers: protocol for matching function status with nursing interventions using the Delphi survey
Authors: Tang Yi-Fan , Hu Xin-Yu , Zhao Jing , Gu Ze-Juan , Xing Shuang-Shuang , Wang Wei-Yun
Published: January 2019

Objective

Venous leg ulceration (VLU) is one of the complications of lower extremity venous reflux and reflux disorder of severe diseases, with many adverse effects on patient’s work and life. Nowadays, more and more patients with VLU accept wound care in community setting. Clinical nurses generally take care of the patients based on their own experiences. Healing in VLU is an incredibly complex process, which puzzles even experts. The majority of general nurses do not have this level of expertise, especially those nurses serving in community. Function is the basis of nursing activities. Patients always show different clinical manifestations and self-care abilities due to various function states, which cannot be reflected completely by the existing nursing practice. How to describe nursing practice standardized in order to demonstrate the effectiveness of interventions and facilitate interdisciplinary communication is another urgent problem. Therefore, the aim of this project is to develop an accurate nursing program based on function in chronic venous leg ulcers, which can both satisfy the needs of patients and promote nursing revolution.

Methods

This study will use International Classification of Functioning Disability and Health as a framework to choose suitable functions and to filter function classification standards of chronic venous leg ulcers through evidence-based systematic research. Nursing interventions related to VLU are selected based on Nursing Interventions Classification, adding other nursing activities by methods of evidence-based systematic review and clinical observation. Then, nursing interventions and function status are matched through steering committee. Finally, the Delphi survey method is adopted to make nursing program native and scientific.

Conclusions

This study is expected to be very significant and meaningful in using standardized nursing terminology. The nursing program established could better meet the needs of both patients with chronic venous leg ulcers and clinical nurses, promoting the development of wound specialist and standardized nursing language.
Early mobilization for mechanically ventilated patients in the intensive care unit: a systematic review and meta-analysis
Authors: Yue Meng , Ma Zhan-Ying , Lei Meng-Jie , Cui Chu-Yun , Jin Yi
Published: January 2019

Background

Early mobilization (EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation (MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.

Methods

A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality. Secondary outcomes were adverse effects and length of stay (LOS) in intensive care unit (ICU) and hospital.

Results

Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.

Conclusions

This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.
Management of early mobilization in intensive care units: a multicenter cross-sectional study
Authors: Zhu Yan-Ping , Xia Li-Xia , Li Guo-Hong
Published: January 2019

Objective

The aim of this study was to assess the management of early mobilization (EM) in Chinese intensive care units (ICUs).

Methods

This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.

Results

We identified 69 ICUs in Jiangsu, China (response rate: 94.2%). 74.2% (1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1% (1,327) reported use of in-bed exercise, 5.7% (77) sitting on a side of bed, 21.7% (294) transfer to chair, and 2.4% (33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation (P<0.01).

Conclusions

Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.
Hemihyperplasia/hemihypertrophy in adolescents: prospective international study
Authors: Vaiman Michael , Shilco Phillip , Roitblat Yulia , Nehuliaieva Lilia , Rosenberg Sari , Leit Aidan , Cleminson Ryan , Shterenshis Michael
Published: January 2019

Aim

The reported incidence of isolated hemihyperplasia (IH) has a very wide range (from 1:13,000 to 1:86,000 live births) and further clarification is needed. We hypothesized that a survey of the birth prevalence of IH among newborn infants may underestimate the incidence of IH by overlooking late-onset cases.

Methods

The prospective international multicenter study utilized the two-steps selection tool for an anonymous survey of volunteers of 15–18 years old. The initial step was “three measurements-three questions” screening, or “face-palms-calves survey”. The subsequent step was an in-depth assessment of selected cases to exclude localized, lesional and syndrome-related cases as well as body asymmetry within normative range and to select suspected cases of IH. This step included measurements of various anatomical regions and a subsequent questionnaire. The participants that were selected in a risk group were advised to refer to medical institutions for clinical, genetic and instrumental investigation.

Results

Out of 6000 of selected participants (male, M 3452, female, F 2548), 229 (3.82%) were selected for detailed investigation and 57 (0.95%) were assigned to the risk group. Only 36 of them were actually referred to medical institutions and in two cases the diagnosis of IH was confirmed.

Conclusion

Our survey indicated the prevalence of IH at the age of adolescence as approximately 1:3000. While IH is a hereditary genetic disorder, it may not be detected in newborns and infants and the true prevalence of the disease can be estimated if older age children are screened.
Batch Adsorption of Synthetic Dye by Maclura Pomifera, a New Eco-Friendly Waste Biomass: Experimental Studies and Modeling
Authors: Bounaas Meryem , Bouguettoucha Abdallah , Chebli Derradji , Reffas Abdelbaki , Gatica José Manuel , Amrane Abdeltif
Published: January 2019

The removal of Methylene blue (MB) from aqueous medium using alkaline modified Maclura pomifera (NaOH-MMP) has been studied in this work. Results showed that a pH value of 6 was favorable for the adsorption of MB. Rate constants of pseudo-first-order, pseudo-second-order and nth kinetic model were determined to analyze the dynamic of the adsorption process; they showed that adsorption kinetics followed a pseudo-second-order and nth kinetic models. The Sips isotherm model was found to be the most relevant to describe MB sorption onto NaOH-MMP with a correlation factor R2 > 0.999. The adsorption capacity of NaOH-MMP was found to be 160 mg g−1 at 25 °C, confirming its biosorbent efficiency for the removal of MB dye from aqueous solutions. Thermodynamic parameters indicated that the MB adsorption onto adsorbent was feasible in nature, spontaneous, and exothermique.
Signal Synthesis Model Reference Adaptive Controller with Genetic Algorithm for a Control of Chemical Tank Reactor
Authors: Goud Harsh , Swarnkar Pankaj
Published: January 2019

Modelling and controlling of Continuous Stirred Tank Reactor (CSTR) is one of the significant problems in the process industry. Chemical reactions inside the CSTR depend on the reference value of the temperature. Design and implementation of suitable control device for such system is a challenge for researchers. This paper proposes the Model Reference Adaptive Control (MRAC) based control strategy as a solution to control problem of CSTR. An enhancement of Signal Synthesis MRAC scheme has been proposed in this study to improve the steady-state and transient-state performance of CSTR. Genetic Algorithm (GA) based controller parameter tuning method is employed to obtain the optimal performance of the controller. This paper presents the design and implementation of conventional Proportional–Integral–Derivative (PID) tuned with Ziegler–Nichols (ZN) tuning method, PID tuned with GA, MRAC, and GA-MRAC for CSTR. Detailed comparison based on simulation studies is also presented to show the improved transient and steady state response with GA-based improved MRAC scheme.