bluuebunny/crossref_metadata_2025 huggingface dataset:
Marriage and Managers' Attitudes to Risk
Authors: Roussanov Nikolai , Savor Pavel
Published: July 2014

Marital status can both reflect and affect individual preferences. We explore the impact of marriage on corporate chief executive officers (CEOs) and find that firms run by single CEOs exhibit higher stock return volatility, pursue more aggressive investment policies, and do not respond to changes in idiosyncratic risk. These effects are weaker for older CEOs. Our findings continue to hold when we use variation in divorce laws across states to instrument for CEO marital status, which supports the hypothesis that marriage itself drives choices rather than it just reflecting innate heterogeneity in preferences. We explore various potential explanations for why single CEOs may be less risk averse.

Data, as supplemental material, are available at http://dx.doi.org/10.1287/mnsc.2014.1926 .

This paper was accepted by Wei Jiang, finance.
Dynamic Pricing with an Unknown Demand Model: Asymptotically Optimal Semi-Myopic Policies
Authors: Keskin N. Bora , Zeevi Assaf
Published: July 2014

We consider a monopolist who sells a set of products over a time horizon of T periods. The seller initially does not know the parameters of the products' linear demand curve, but can estimate them based on demand observations. We first assume that the seller knows nothing about the parameters of the demand curve, and then consider the case where the seller knows the expected demand under an incumbent price. It is shown that the smallest achievable revenue loss in T periods, relative to a clairvoyant who knows the underlying demand model, is of order [Formula: see text] in the former case and of order log T in the latter case. To derive pricing policies that are practically implementable, we take as our point of departure the widely used policy called greedy iterated least squares (ILS), which combines sequential estimation and myopic price optimization. It is known that the greedy ILS policy itself suffers from incomplete learning, but we show that certain variants of greedy ILS achieve the minimum asymptotic loss rate. To highlight the essential features of well-performing pricing policies, we derive sufficient conditions for asymptotic optimality.
Nutrient Status of Cambo dian Soils, Rationalisation of Fertiliser Recommendations and the Challenges Ahead for Cambodian Soil Science
Authors: Blair Graeme , Blair Nelly
Published: July 2014

Soils of Cambodia are low in fertility and conventional rice cultivation destroys any structure that they have. Usage of inorganic fertilizers is low and farmers are encouraged to use animal manure. Much of the research conducted on crop responses to manure is based on trials where unrealistically high application rates have been used so the farmers are given false hopes as to what they might achieve through its use. Little response curve data exists on which to base fertilizer rate recommendations and general recommendations have been formulated for the different soil groups. An economic analysis comparing the general recommendation with site specific nutrient management (SSNM) recommendations has been made on the results of a published experiment and shown substantial increases in both profitability and benefit/cost ratio in using the SSNM recommendations on four soil types. Cambodian farmers, like many in the developing world, have to be careful with their limited cash resources in purchasing plant nutrients and more attention need to be paid to producing profitable and reliable fertilizer and manure recommendations.
Tillage System, Crop Residue s and Nitrogen to Improve the Productivity of Direct Seeded Rice and Transplanted Rice
Authors: Singh Avtar , Kumar Rajneesh , Kang J. S.
Published: July 2014

Rice is grown by different techniques for higher productivity with judicious use of inputs and natural resources. Transplanting of paddy seedlings is common method of crop establishment in the irrigated rice systems of Asia but transplanting is labour intensive (30 persons/ha/day). The preparation of land for transplanting paddy (puddling) consumes about 20-40 % of the total water required for growing of crop and subsequently poses difficulties in seed bed preparation for succeeding wheat crop in rotation. It also promotes the formation of hard pan which effects rooting depth of next crop. So, in this paper discussed the different methods of establishment of rice, sowing of rice in the crop residue of wheat with different tillage systems and use of nitrogen for higher productivity of rice.
Influence of Different Typ es Mycorrhizal Fungi on Crop Productivity
Authors: Kaur Raminder , Singh Avtar , Kang J
Published: July 2014

Mycorrhizal fungi greatly enhanced the ability of plants to take up phosphorus and other nutrients those are relatively immobile and exist in low concentration in the soil solution. Fungi can be important in the uptake of other nutrients by the host plant. Zinc nutrition is most commonly reported as being influenced by the association, although uptake of copper (Cu) , iron, N, K, Ca and Mg has been reported to be enhanced. Water uptake may be improved by mycorrhizal association, making more resistant to drought condition. Often both water and nutrient uptake are higher in drought stressed mycorrhizal plants than in non mycorrhizal plants. The fungal strands are capable of altering the water potential of plants and can only alleviate moderate drought stress and in more severe drought conditions they become ineffective.
Dementia and its relationship with food
Authors: Ragdale Stephanie
Published: July 2014

This article provides an overview of dementia and how it relates to nutrition. It examines the evidence for food and nutrition preventing, causing and treating dementia. The article highlights how malnutrition can affect the individual with dementia. The remainder of the article provides an in-depth, focused discussion on the difficulties people may experience in the community in relation to food and eating and the impact this has on family caregivers, with recommendations for achieving optimum nutrition.
Nutrition in early life and the risk of asthma and allergic disease
Authors: Wyness Laura
Published: July 2014

The prevalence of reported cases of asthma and allergic disease has seen a marked increase throughout the world since the 1960s, particularly in more developed, westernised countries. A key focus of research in this area has been the possible adverse effects of foetal and infant exposure to food allergens. There is some evidence that foetal and infant exposure to a range of allergens via the mother and her breast milk is important in the development of normal immune tolerance. Current advice is that pregnant and breastfeeding women do not need to avoid potential food allergens unless they are allergic themselves, or are advised to modify their diet by a health professional. Delaying the introduction of common food allergies beyond 6 months is unlikely to reduce the likelihood of food allergy and allergic disease. The findings of current ongoing trials investigating the potential benefits of early introduction on allergenic foods into the diet of children—as well as the comprehensive review of complementary and young-child feeding advice currently being conducted by the Scientific Advisory Committee on Nutrition—will help inform guidance in this area.
A consumer-driven quality assurance model for midwifery
Authors: Holmes Ann , McGinley Mary , Turnbull Deborah , Shields Noreen , Hillan Edith
Published: July 2014

A quality assurance model for midwifery was used in Glasgow to develop a midwife-managed care programme for healthy women. The programme goals were to provide continuity of carer, individualized care planning and informed choice, and service specifications were written for each goal. While continuity proved difficult to maintain, the remaining specifications were achieved for most women.
‘Persuading’ women to give birth at home — or offering real choice?
Authors: Leap Nicky
Published: July 2014

The midwives of the South East London Midwifery Group Practice make a case for encouraging women to consider homebirth as a safe and viable option. Excellent outcomes are being shown in this NHS practice with a homebirth rate of over 60%.
Midwives and professional status
Authors: Symon Andrew
Published: July 2014

Professionals possess a significant degree of autonomy over their practice, and usually have a similar degree of control over their client base. Autonomy has historically been a problem for midwives, and the notion of control raises questions of the scope for choice and control for the pregnant woman. If midwives want to be considered full professionals, they must resolve these dilemmas.
A personal view of homebirth
Authors: Gibb Donald
Published: July 2014

As a Senior House Officer (SHO) I do not remember coming into contact antenatally with women requesting homebirth. This may have been because there were less (it was 20 years ago!) or because if they did come to the hospital antenatal clinic they were seen by the consultant; I don't know. It was at a time when, in response to stories of catastrophes during homebirth recounted by senior colleagues, there had been a successful campaign to encourage hospital birth. The cases of homebirth I saw as an SHO and as a registrar were those that had gone wrong and been admitted to the labour ward. The perspective was therefore of complications that made an already harassed junior doctor's life even more difficult. I therefore viewed homebirth as at best a risky business and at worst a disaster waiting to happen.
Aromatherapy in practice
Authors: Mason Maggie
Published: July 2014

This article describes one midwife's experience of the powers of vibrational medicine in overcoming the need for orthodox methods of pain relief in labour.
Taking action on pre-eclampsia
Authors: Walker Isabel
Published: July 2014

Pre-eclampsia presents one of the toughest challenges to maternity care, being a complex, unpredictable illness about which much remains unknown. It is difficult to detect and diagnose and cannot be reliably prevented or effectively treated. New leaflets are aiming to inform both midwives and women in the hope of improving care and reducing maternal deaths still further.
Huntleigh Diagnostics' Baby Dopplex 3000
Authors: Ubhi Jane
Published: July 2014

This article outlines some of the causes of a change in fetal heart rate and highlights the necessity for its accurate surveillance. It focuses on the Huntleigh Baby Dopplex 3000.
Challenging assumptions about female prisoners: What you should know
Authors: Hindley Carol
Published: July 2014

Midwives have recently welcomed the Home Secretary's decision to revoke the controversial policy of handcuffing pregnant offenders. This review intends to address some broader but equally fundamental issues about female offenders and how they fare overall within the legal system.
How to get sued: the step by step guide to increase litigation against your trust
Authors: Robinson Jean
Published: July 2014

When I read the letters NHS managers send to complainants, I realize they must have taken a course in ‘How to get sued’, and graduated with honours. For those who are too busy to attend courses at posh hotels, I am offering, free of charge, the Jean Robinson correspondence course in ‘How to increase litigation against your trust’. After 30 years complaints experience I can promise expert tuition. By the time you have finished, you too will be nudging reluctant complainants into court as neatly as a sheepdog herds straggling ewes into the pen.
Do we need support workers in the maternity services?
Authors: Francomb Helen
Published: July 2014

There has been relatively little discussion in the literature regarding the National Vocational Qualification (NVQ) support worker in midwifery. However, some have challenged whether midwives can offer the full range of midwifery care without assistance (Magill-Cuerden, 1994). In January/February 1994 a small research study was conducted to ascertain midwives' perceptions of the role of the support worker in a large consultant maternity unit. Midwives welcomed support in some areas of their work, e.g. hospital wards, but did not wish to see their role eroded, standards of care reduced or fewer midwives employed. Midwives need to establish whether a support worker is needed and if so, their role. They also need to carefully address the issues of training and control.
The prenatal assessment unit: Wolverhampton
Authors: Krzyszowski Deborah
Published: July 2014

Maternity day units have an important role in today's changing maternity services. The prenatal assessment unit at Wolverhampton has evolved from being a high-risk surveillance unit to being a diverse provider of specialist care.
Folic acid for all? Questions about safet
Authors: Robinson Jean
Published: July 2014

‘Folic acid cannot harm you or your baby.’ The Health Education Authority (1997) gives a guarantee and recommends that women wanting to get pregnant should take 0.4mg folic acid (FA) supplements daily. I wish I could be as confident. It is one thing to say ‘No one has found evidence of harm’ but quite another to say there cannot possibly be any. So often such overconfident assurances have proved wrong.
Efanatal: a new dietary suppliment of long chain polyunsaturates
Authors: Leach Joanne , Foster Andrea
Published: July 2014

Maternal nutrition plays a fundamental role in pregnancy because well-nourished women have the best chance of delivering healthy babies and lactating successfully after birth. Long chain polyunsaturates are receiving mounting attention in the nutritional debate as an aid to improving brain and retinal development in the fetus and the newborn baby. This article highlights the potential for health gain.
Hearing it like it is: understanding the views of users
Authors: Gready Meg , Buggins Elisabeth , Newburn Mary , Draper Janet , Fletcher Gillian , Dodds Rosemary , Wang Madeleine
Published: July 2014

This is the third of three articles looking at the involvement of women in the planning and monitoring of maternity services. This article focuses on ways that midwives, and others involved in maternity care, can gather the views of the users of the service.
Do a caesarian and I'll sue!
Authors: Robinson Jean
Published: July 2014

The Trust did not accept liability, but eventually offered £7000. Since she was legally aided, Caroline Spear had no choice but to accept. Not that it was money she was fighting for. Like so many other people who take legal action, she just wanted to stop it happening to someone else. Both she and her solicitor, Jane Hinde, have become heroines to many women who had obstetric treatment imposed on them without consent. It was a landmark case — the first in which a woman successfully sued for a caesarean section she had not wanted and to which she had not given valid consent. I suspect it will not be the last.
Aspects of midwifery care 2: ‘enhanced role’ and social aspects
Authors: Pope Rosemary , Cooney Margaret , Graham Lesley , Holliday Mary , Patel Swatce
Published: July 2014

This is the second in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify and address continuing educational need. The background to the study and the titles of other papers In the series were outlined in the first paper. This paper focuses on two key aspects of the midwife's role: ‘enhanced role’ activities and Social and emotional care. The implications of the findings for practice and education are discussed.
Known complications and rare occurrences
Authors: Symon Andrwe
Published: July 2014

The development of known complications and rare occurrences will test the clinical skill of practitioners. How staff cope in such situations may determine whether or not an allegation of negligence will succeed. Providing advance information about such possibilities must be handled sensitively, and may help to rebut allegations of this nature.
The importance of hands
Authors: Bowley Liz
Published: July 2014

Following the birth of a child, it is essential that the threat of either mother or baby contracting a hospital acquired infection is kept to an alnolute minimum. With hands a primary mode of transmission of nosocomial infections (Larson and Killien 1982), scrupulous handwashing by midwives and health care personnel is the most basic and vital form of infection control. Yet the 1997 Public Health Laboratory Service (PHLS) report (Glynn et al1997) into hospital acquired infection shows little guidance is provided by hospitals on why or even when hands should be washed — let alone outlining the importance of stringent handwashing practice.
Evaluating routine postnatal maternal temperature check
Authors: Takahashi Hiromi
Published: July 2014

Although there is no longer a statutory requirement for midwives to take the maternal temperature routinely in the postpartum period, the practice still remains in midwifery without questioning its significance. In this article the routine midwifery practice of postnatal maternal temperature checking is defined as a screening test and evaluated.
WHO/UNICEF Baby Friendly Initiative — educating for success
Authors: Lang Sandra , Dykes Fiona
Published: July 2014

In 1991, the WHO/UNICEF Baby Friendly Hospital Initiative was launched. Globally, over 12 000 hospitals are now designated as ‘Baby Friendly.’ The Baby Friendly Initiative was launched in the UK in 1994, and to date, five hospitals have received the award. As NHS Trusts work towards gaining ‘Baby Friendly’ status, education of staff has become particularly important. This article, the first of a two part series, describes the adapted European WHO/UNICEF breastfeeding education programme currently being taught in the UK. The course is entitled ‘Breastfeeding management: a modular course’ (WHO/UNICEF, 1997).
Fetal hyperthermia risk from warm water immersion
Authors: Charles Catherine
Published: July 2014

In recent years water pool temperature has been the subject of Intensive debate. This paper revisits some of the issues and reviews some of the scant research carried out into the response of the fetus to hyperthermia. The safety of hot water immersion during labour has recently been questioned following problems with two babies born in Bristol in 1.993. Neither baby was delivered in water, but both mothers remained immersed for some hours during labour, and it was suggested that fetal hyperthermia might have been a factor. The ensuing debate has been hampered by a lack of satisfactory research into the risks and benefits of labour and delivery in water. This study is intended to examine the limited evidence available on the causes and effects of fetal hyperthermia.
Quality assessment in midwifery education: an essential collaboration
Authors: Peat Anne
Published: July 2014

Spare a thought for those of us in higher education as we prepare for a forthcoming subject review by the Higher Education Quality Assessment Agency (HEQAA). The purpose of the assessment is to ensure that education is of an approved quality with six areas under review: curriculum development; teaching, learning and assessing; student progress and attainment; student support; learning resources; quality and enhancement
A new approach to parent education
Authors: Parr Mel
Published: July 2014

Research to date has failed to demonstrate that antenatal classes help prepare women and men for the challenges of early parenting and family life. As part of a larger project, a longitudinal study examined: (1) Key features of the transition to parenthood for ‘low risk’ couples (n=106); (2) Co, pared the adjustments of couples (n=52) who participated in a new parent-infant programme, with couples (n=54) on a ‘waiting list’ control. The study found that (a) A substantial number of the ‘low risk’ women and their partners experienced psychological distress; (b) Concerns were different to the agenda of traditional antenatal classes; (c) Participation in the parent-infant programme led to a significant increase in psychological well-being, confidence as a parent and satisfaction with the couple and parent-infant relationship. Considerations regarding the focus of antenatal classes and the training of midwives as parent educators are raised.
Recommendations for the use of anti-D immunoglobulin for RhD prophylaxis
Authors: Benbow Angie , Wray Julie
Published: July 2014

A Joint working group of the British Blood Transfusion Society and the Royal College of Obstetricians and Gynaecologists (RCOG) have recently revised the recommendations for the use of anti-D immunoglobulin for RhD prophylaxis (Robson et al, 1998). If these new recommendations are widely adopted, they will have far reaching implications for RhD negative women, their babies, and for practitioners including midwives, GPs, obstetricians, gynaecologists and other professionals in contact with pregnant women such as those working in accident and emergency departments. The aim of this first article is to raise awareness of the recommendations and discuss some of the implications for the practice of maternity care.
Heelprick testing of neonates: the role of the midwife
Authors: Corbett Verity , Bedford Helen , Grant Jane , Addison Mike , Streetly Allison
Published: July 2014

Screening of newborns for phenylketonuria and congenital hypothyroidism can prevent brain damage and severe intellectual impairment from these conditions. The success of the national programme relies heavily on the input of midwives. This paper reviews the screening programme, with particular emphasis on the stages at which midwives are involved, drawing on the findings of the recent national audit of the programme.
Why do people sue?
Authors: Symon Andrew
Published: July 2014

There are no definitive answers as to why people sue. In some cases the reason may be financial necessity; in others it may be a means of acquiring an explanation. Communication and trust between service users and providers is vital. Where these fall, the possibility of dissatisfaction (whether or not there has been a poor clinical outcome) is much greater.
Electronic fetal heart monitoring: revisited and reappraised
Authors: Walsh Denis
Published: July 2014

Electronic fetal monitoring (EFM) is used extensively throughout the UK despite a continued debate about its efficacy and its effectiveness. This paper reviews the evidence to date, examines the link between EFM and fetal outcome, discusses fetal sensitivity and specificity issues and looks at the intervention/benefit ratio of EFM, including the risks of caesarean section. It concludes that EFM should be discontinued for women at low obstetric risk because there is no substantive evidence that it reduces perinatal mortality or the incidence of cerebral palsy. It does, though, result in higher Caesarean section rates. There is also no evidence to date that EFM educational materials reduce the false positive rate of EFM Interpretation. However, they should ensure a greater consistency and as long as participants apply the tests referred to in this paper, they continue to be of some value.
The development and evaluation of computerized distance learning material
Authors: Bull Joanna , Sapsed Susan , Zakrzewski Stan
Published: July 2014

Increasing student numbers and a declining unit of resource has encouraged the use of new technology within the higher education curriculum. Computerized self-assessment material on the fetal skull has been developed at the University of Luton for midwifery students as an integral component of a distance learning workbook. This article describes the package and its evaluation.
Are you in the SOUP? The toxicology of institutions
Authors: Robinson Jean
Published: July 2014

There comes a time when consumer advocates realize that if we are going to help patients, we have to fight for the staff first. That time is now. Too many good midwives a releaving, giving up, getting sacked, or anaesthetising their feelings at work in order to survive.
Management and care of cystitis
Authors: Bayliss Jane
Published: July 2014

Cystitis literally means inflammation of the urinary bladder and is a term often used by individuals to describe the symptoms of dysuria and frequency. It is not synonymous with the diagnosis of urinary tract infection (UTI) as it can be either infective or non-infective (Mead, 1996). It can occur in both genders and at any age, but by far the most commonly affected group is sexually active women between the ages of 20 and 50.
Digital engagement in nursing: a urology nurse's journey
Authors: Brocksom Jane E
Published: July 2014

The use of technology is transforming society—underpinning communication, information gathering and collaboration. Indeed, 2013 may prove to be the tipping point for healthcare delivery. No longer are policies and guidance documents being produced solely on the basis of cautions and negatives. We are entering a new era. Documents are now being produced that are constructive, focusing equally on positives and collaboration. Digital engagement within nursing and healthcare communities can be a tremendously positive experience; with the help of online resources, we can be part of the tipping point. From micro blogging to content communities, from collaborative projects to social networking, Web2.0 technology is providing 21st-century practitioners with opportunities we have not yet fully realised the potential of—for ourselves, our patients or our institutions. In this article, I share my personal journey, aiming to show my fellow healthcare practitioners how these technologies might be used to inform and improve nursing practice, within urology and beyond.
The outcome of proximal humeral fractures in the elderly
Authors: Clement N. D. , Duckworth A. D. , McQueen M. M. , Court-Brown C. M.
Published: July 2014

This study describes the epidemiology and outcome of 637 proximal humeral fractures in 629 elderly (≥ 65 years old) patients. Most were either minimally displaced (n = 278, 44%) or two-part fractures (n = 250, 39%) that predominantly occurred in women (n = 525, 82%) after a simple fall (n = 604, 95%), who lived independently in their own home (n = 560, 88%), and one in ten sustained a concomitant fracture (n = 76, 11.9%). The rate of mortality at one year was 10%, with the only independent predictor of survival being whether the patient lived in their own home (p = 0.025). Many factors associated with the patient’s social independence significantly influenced the age and gender adjusted Constant score one year after the fracture. More than a quarter of the patients had a poor functional outcome, with those patients not living in their own home (p = 0.04), participating in recreational activities (p = 0.01), able to perform their own shopping (p < 0.001), or able to dress themselves (p = 0.02) being at a significantly increased risk of a poor outcome, which was independent of the severity of the fracture (p = 0.001).

A poor functional outcome after a proximal humeral fracture is not independently influenced by age in the elderly, and factors associated with social independence are more predictive of outcome.

Cite this article: Bone Joint J 2014;96-B:970–7.
A reverse shoulder arthroplasty with increased offset for the treatment of cuff-deficient shoulders with glenohumeral arthritis
Authors: Middleton C. , Uri O. , Phillips S. , Barmpagiannis K. , Higgs D. , Falworth M. , Bayley I. , Lambert S.
Published: July 2014

Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley–Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p <  0.001). The mean pain at rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p < 0.001). The mean active forward elevation and external rotation increased from 42°(sd 30) and 9°(sd 15) respectively pre-operatively to 78°(sd 39) and 24°(sd 17) post-operatively (p < 0.001). A total of 20 patients required further surgery for complications; 13 required revision of components. No patient developed scapular notching.

The Bayley–Walker prosthesis provides reliable pain relief and reasonable functional improvement for patients with symptomatic cuff-deficient shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time.

Cite this article: Bone Joint J 2014;96-B:936–42.
The operative treatment of fractures of the distal radius is increasing
Authors: Mellstrand-Navarro C. , Pettersson H. J. , Tornqvist H. , Ponzer S.
Published: July 2014

The aim of this study was to investigate the epidemiology of fractures of the distal radius in the Swedish population and to review the methods used to treat them between 2005 and 2010.

The study population consisted of every patient in Sweden who was diagnosed with a fracture of the wrist between 1 January 2005 and 31 December 2010. There were 177 893 fractures of the distal radius. The incidence rate in the total population was 32 per 10 000 person-years. The mean age of the patients was 44 years (0 to 104). The proportion of fractures treated operatively increased from 16% in 2005 to 20% in 2010. The incidence rate for plate fixation in the adult population increased 3.61 fold. The incidence rate for external fixation decreased by 67%. The change was greatest in the 50 years to 74 years age group.

In Sweden, there is an increasing tendency to operate on fractures of the distal radius. The previously reported increase in the use of plating is confirmed: it has increased more than threefold over a five-year period.

Cite this article: Bone Joint J 2014;96-B:963–9.
Mid term results with the curved modular tapered, fluted titanium Revitan stem in revision hip replacement
Authors: Fink B. , Urbansky K. , Schuster P.
Published: July 2014

We report our experience of revision total hip replacement (THR) using the Revitan curved modular titanium fluted revision stem in patients with a full spectrum of proximal femoral defects. A total of 112 patients (116 revisions) with a mean age of 73.4 years (39 to 90) were included in the study. The mean follow-up was 7.5 years (5.3 to 9.1). A total of 12 patients (12 hips) died but their data were included in the survival analysis, and four patients (4 hips) were lost to follow-up. The clinical outcome, proximal bone regeneration and subsidence were assessed for 101 hips.

The mean Harris Hip Score was 88.2 (45.8 to 100) after five years and there was an increase of the mean Barnett and Nordin-Score, a measure of the proximal bone regeneration, of 20.8 (-3.1 to 52.7). Five stems had to be revised (4.3%), three (2.9%) showed subsidence, five (4.3%) a dislocation and two of 85 aseptic revisions (2.3%) a periprosthetic infection.

At the latest follow-up, the survival with revision of the stem as the endpoint was 95.7% (95% confidence interval 91.9% to 99.4%) and with aseptic loosening as the endpoint, was 100%. Peri-prosthetic fractures were not observed.

We report excellent results with respect to subsidence, the risk of fracture, and loosening after femoral revision using a modular curved revision stem with distal cone-in-cone fixation. A successful outcome depends on careful pre-operative planning and the use of a transfemoral approach when the anatomy is distorted or a fracture is imminent, or residual cement or a partially-secured existing stem cannot be removed. The shortest appropriate stem should, in our opinion, be used and secured with > 3 cm fixation at the femoral isthmus, and distal interlocking screws should be used for additional stability when this goal cannot be realised.

Cite this article: Bone Joint J 2014;96-B:889–95.
The use of a lipped acetabular liner decreases the rate of revision for instability after total hip replacement
Authors: Insull P. J. , Cobbett H. , Frampton C. M. , Munro J. T.
Published: July 2014

We compared the rate of revision for instability after total hip replacement (THR) when lipped and non-lipped acetabular liners were used. We hypothesised that the use of a lipped liner in a modular uncemented acetabular component reduces the risk of revision for instability after primary THR. Using data from the New Zealand Joint Registry, we found that the use of a lipped liner was associated with a significantly decreased rate of revision for instability and for all other indications. Adjusting for the size of the femoral head, the surgical approach and the age and gender of the patient, this difference remained strongly significant (p < 0.001).

We conclude that evidence from the New Zealand registry suggests that the use of lipped liners with modular uncemented acetabular components is associated with a decreased rate of revision for instability after primary THR.

Cite this article: Bone Joint J 2014;96-B:884–8.
Exam Corner – July 2014
Authors: Khanduja V.
Published: July 2014

The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and Clinical Examination. The Vivas are further divided into four sections comprising Basic Science, Adult Pathology, Hands and Children’s Orthopaedics and Trauma. The Clinical Examination section is divided into Upper and Lower limb cases. The aim of this section in the Journal is to focus specifically on the trainees preparing for the exam and to cater to all the sections of the exam. The vision is to complete the cycle of all relevant exam topics (as per the syllabus) in four years.
A decade of change in the uptake of parathyroidectomy in England and Wales
Authors: Evans LM , Owens D , Scott-Coombes DM , Stechman MJ
Published: July 2014

Introduction

Since the late 1990s, a number of factors have reduced the threshold for parathyroidectomy in patients with primary hyperparathyroidism. This study examined whether this has translated into increased numbers of parathyroid operations over the last decade.

Methods

A retrospective analysis was performed of the Patient Episode Database for Wales and English Hospital Episode Statistics annual data from 2000 to 2010 for parathyroidectomy admissions per 100,000 population. Statistical analysis was by linear regression.

Results

Between 2000 and 2010 there were 24,247 parathyroid operations in England and Wales (0.005% of the population), with 3 times as many women treated as men. Overall, incidence of parathyroidectomy rose from 3.3/100,000 population in 2000 to 5.8/100,000 in 2010 (p<0.0001). In England, it increased from 3.3/100,000 population to 5.8/100,000 and in Wales, it increased from 2.4/100,000 population to 4.6/100,000. Despite similar population demographics, the difference in the rate of change between England and Wales was significant (p<0.05). Uptake also varied according to age; in those aged 0–14 years, incidence of parathyroidectomy remained static whereas in all other age groups, uptake of parathyroidectomy increased significantly from 2000 to 2010. Most notably, surgical intervention in those aged 60–74 and >75 years nearly doubled over the decade (p<0.0001).

Conclusions

The incidence of parathyroidectomy in adults has increased significantly in the last decade in England and Wales. This likely reflects changes in population demography, available guidelines, lower threshold for referral, changing surgical approach and the realisation that surgical morbidity is now infrequent.
Day-case minimally invasive excision of a giant mediastinal parathyroid adenoma
Authors: Haldar A , Thapar A , Khan S , Jenkins S
Published: July 2014

Inferior parathyroid adenomas in the mediastinum can be a troublesome cause for hypercalcaemia, requiring a full collar incision or, occasionally, a sternotomy. We report a case of a giant parathyroid adenoma in a 61-year-old woman on warfarin, which we excised via a minimally invasive transcervical approach after radiological localisation. The procedure was performed as a day case and, at six weeks, the patient had recovered fully with biochemical resolution of hypercalcaemia. This case demonstrates that focused transcervical excision of giant parathyroid adenomas is a viable option and should be considered prior to neck exploration or sternotomy.
The safety and efficacy of bariatric surgery for obese, wheelchair bound patients
Authors: Williams GJ , Georgiou PA , Cocker DM , Bonanomi G , Smellie J , Efthimiou E
Published: July 2014

Introduction

The aim of this study was to evaluate outcomes of bariatric surgery performed in order to improve mobility in patients with severe mobility limitations.

Methods

Patients with severe mobility impairment (wheelchair bound) who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic adjustable gastric banding (LAGB) surgery to improve their mobility were included in this study. Patients were identified between July 2009 and October 2011 using an electronic prospective bariatric database. Mobility was assessed by questionnaire during clinic follow-up appointments.

Results

Fifteen patients (11 female, 4 male) with a mean age of 48 years (range: 26–71 years) and a mean body mass index of 46kg/m2 (range: 33–54kg/m2) were included. Seven patients (47%) underwent LAGB and eight (53%) LRYGB. The aetiologies of mobility impairment included advanced osteoarthritis (n=6), spinal conditions (n=4), severe bilateral leg oedema and ulceration (n=2), advanced rheumatoid arthritis (n=2) and traumatic paraplegia (n=1). The mean length of hospital stay was 3.8 days. There was no mortality. One patient was lost to follow-up. Of the remaining 14 patients, the mean excess weight loss percentage at a mean of 18.5 months postoperatively was 48% (68% for LRYGB, 20 months; 29% for LAGB, 17 months). Ten patients reported improved mobility. Reduced pain, improved independence and ability to transfer were most commonly cited. Four patients reported no improvement in mobility (three LAGB patients, one LRYGB patient).

Conclusions

Bariatric surgery can safely improve mobility and quality of life in obese patients with severe mobility impairment. Our paper supports the idea that severe mobility impairment should be considered an indication for bariatric surgery in selected patients. LRYGB demonstrated better weight loss and mobility improvement than LAGB. Larger studies are required to establish robust selection criteria for surgery in this group.
Gastric outlet obstruction secondary to incarcerated pylorus in an inguinal hernia
Authors: Creedon L , Peacock O , Singh R , Awan A
Published: July 2014

Inguinal hernias are a common presentation to surgical admission units throughout the world. The majority of presentations are due to hernias containing either fat or small bowel. However, a wide range of intra-abdominal viscera have been demonstrated in inguinal hernias. We report a case of an 87-year-old man who presented with gastric outlet obstruction secondary to an incarcerated inguinal hernia containing the gastric pylorus.
Preoperative identification of anomalous arterial anatomy at pancreaticoduodenectomy
Authors: Müller P , Randhawa K , Roberts KJ
Published: July 2014

The understanding of abdominal vascular anatomy and its anatomical variations is of considerable importance in upper abdominal surgery. We present the rare finding of a common hepatic artery arising from the superior mesenteric artery and passing anterior to the pancreatic gland in a patient undergoing a pancreaticoduodenectomy.
Balancing law, ethics and reality in informed consent for surgery
Authors: Sarela AI , Thomson M
Published: July 2014

Informed consent has different implications and requirements in law and bioethics, and some irreconcilable disputes with the reality of surgical practice in the National Health Service. This article explores and discusses various aspects of informed consent that are of critical importance for practising surgeons in all specialties.
Procedure-based assessments: an appropriate assessment tool?
Authors: Mendes da Costa T
Published: July 2014

The Joint Committee on Surgical Training (JCST), an advisory body to the four surgical royal colleges of the UK and Ireland for all matters relating to surgical training, has identified eight quality indicators specific to orthopaedics and trauma. 1 The sixth indicator is that a minimum of 40 workplace-based assessments (WBAs) be completed per year of training, with some deaneries advocating up to 80 per year.
Shared decision making in healthcare
Authors: Ryan Fiona , Cunningham Susan
Published: July 2014

Shared decision making is at the core of the new-look NHS. Everyone will be familiar with ‘no decision about me without me’ but how familiar are we with actually making shared decisions in practice?
Police Stop-and-Frisk Practices: An Examination of Factors That Affect Officers' Decisions to Initiate a Stop-and-Frisk Police Procedure
Authors: Avdija Avdi S.
Published: July 2014

The purpose of this research is to examine the factors that affect an officer's decision to initiate a stop-and-frisk procedure. The primary objective of this study is to rank-order the typical reasons that were reported by police officers and that were deterministic on initiating a police stop procedure. The second objective of this research is to test whether there is empirical evidence suggesting racialised policing. The analyses are based on data that were originally collected and archived by the New York Police Department on stop-and-frisk police practices in 2006. The analyses in this study show that the top five highest rank-ordered reasons for initiating a police stop were high-crime area, time of day fits the crime incident, fugitive movements by the suspects, casing a victim or location, and proximity to a crime scene. Factors that influenced an officer's decision to frisk the suspect after the initial stop were suspect's gender, followed by suspect's physical proximity to the crime scene, suspect's evasive responses to questions and race.
An Exploratory Examination of the Sources of Socialisation Influencing Juvenile Perceptions of the Police
Authors: Romain Danielle M. , Hassell Kimberly D.
Published: July 2014

A growing body of literature on juvenile perceptions of the police has demonstrated that vicarious misconduct is a significant factor in determining negative attitudes toward the police; however, the extant literature has not examined the potential sources of socialisation that may differentially affect these perceptions. The current study focuses on exploring the influence of socialisation factors in examining whether parents, friends, neighbours and media negatively affect juvenile perceptions of the police. A sample of 207 high-school students from a Midwestern city was surveyed on their general and specific perceptions of the police. The results demonstrate support for the influence of friends on perceptions of the police; both general perceptions and the likelihood of having prior negatively rated contacts. Little support for other socialisation sources (ie, parents, neighbours and the media) was found. The implications for future research are discussed.
The Organisational Structure of Police Departments and Assaults on Police Officers
Authors: Willits Dale W.
Published: July 2014

Previous research links police organisational factors to various police outcomes. However, although research has examined the relationship between specific organisational practices and violence against police, less research has examined the relationship between organisational structure and violence against police officers. Moreover, the research that examines this relationship has typically utilised unreliable data. This study examines the relationship between police organisational structure and assaults on police officers in the USA using data from the 1999–2001 National Incident-Based Reporting System (NIRBS), 2000 Census and 2000 Law Enforcement Management and Administrative Survey (LEMAS) data sets. Negative binomial regression models suggest that organisational context and organisational complexity are important predictors of violence against police officers. Specifically, controlling for other factors, police departments serving more disadvantaged communities report higher rates of assaults against police officers, whereas those that are more functionally and spatially differentiated report lower levels of assault.
Workforce Diversity: Downsizing in the NYPD and its Effect on Minority Integration
Authors: Guajardo Salomon Alcocer
Published: July 2014

Workforce downsizing (ie, the reduction or elimination of positions) may have a significant positive or negative impact on minority employment and the level of diversity that exists within a public agency. This study examines the impact that downsizing has had on the employment of minority police officers and civilians, and levels of diversity in the New York City Police Department (NYDP) from 2000 to 2012 as the agency has reduced its workforce. The findings show that minority integration has increased despite the workforce downsizing. As the NYPD reduced the number of police and civilian positions since 2000, the number of minorities the agency hired increased, while the number of White employees declined, contributing to an increase in the level of workforce diversity.
Ultrastructure of Cytoplasmic and Nuclear Inosine-5’-Monophosphate Dehydrogenase 2 “Rods and Rings” Inclusions
Authors: Juda Pavel , Šmigová Jana , Kováčik Lubomír , Bártová Eva , Raška Ivan
Published: July 2014

Inosine-5′-monophosphate dehydrogenase catalyzes the critical step in the de novo synthesis of guanosine nucleotides: the oxidation of inosine monophosphate to xanthosine monophosphate. This reaction can be inhibited by specific inhibitors, such as ribavirin or mycophenolic acid, which are widely used in clinical treatment when required to inhibit the proliferation of viruses or cells. However, it was recently found that such an inhibition affects the cells, leading to a redistribution of IMPDH2 and the appearance of IMPDH2 inclusions in the cytoplasm. According to their shape, these inclusions have been termed “Rods and Rings” (R&R). In this work, we focused on the subcellular localization of IMPDH2 protein and the ultrastructure of R&R inclusions. Using microscopy and western blot analysis, we show the presence of nuclear IMPDH2 in human cells. We also show that the nuclear pool has an ability to form Rod structures after inhibition by ribavirin. Concerning the ultrastructure, we observed that R&R inclusions in cellulo correspond to the accumulation of fibrous material that is not surrounded by a biological membrane. The individual fibers are composed of regularly repeating subunits with a length of approximately 11 nm. Together, our findings describe the localization of IMPDH2 inside the nucleus of human cells as well as the ultrastructure of R&R inclusions.