bluuebunny/crossref_metadata_2025 huggingface dataset:
Engaging Parents to Promote Children’s Nutrition and Health
Authors: Dev Dipti A. , Byrd-Williams Courtney , Ramsay Samantha , McBride Brent , Srivastava Deepa , Murriel Ashleigh , Arcan Chrisa , Adachi-Mejia Anna M.
Published: January 2017

Purpose:

Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health.

Design:

Qualitative.

Setting:

State-licensed center-based childcare programs.

Participants:

Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience.

Methods:

In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted.

Results:

Two overarching themes were barriers and strategies to communicate with parents about children’s nutrition. Barriers to communication included—(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included—(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents.

Conclusion:

Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children’s nutrition and health.
Meeting Sleep Guidelines Is Associated With Better Health-Related Quality of Life and Reduced Premature All-Cause Mortality Risk
Authors: Loprinzi Paul D. , Joyner Chelsea
Published: January 2017

Purpose:

To examine whether meeting sleep guidelines (7-9 hours/night) is associated with better health-related quality of life (HRQOL) and reduced all-cause mortality risk.

Design:

Prospective cohort study.

Setting:

2005 to 2010 National Health and Nutrition Examination Survey.

Participants:

A total of 13 423 adults.

Measures:

Sleep duration and HRQOL were assessed from self-report; covariates assessed via survey, examination, and laboratory data; and mortality assessed through 2011 via matching from the National Death Index.

Analysis:

Cox proportional hazard regression and ordinal logistic regression.

Results:

After adjusting for age, gender, race–ethnicity, body mass index, education, smoking, white blood cell level, iron level, red blood cell distribution width, mean platelet volume, blood pressure, diabetes, coronary artery disease, physical activity, and depression, those meeting sleep guidelines had an 19% reduced risk of premature all-cause mortality (hazard ratio = 0.81; 95% confidence interval [CI]: 0.67-0.99; P = .04). After adjustments, those meeting sleep guidelines had better HRQOL (β = −0.30; 95% CI: −0.38 to −0.21; P < .001). Results for the ordinal regression and Cox proportional analyses were similar in unadjusted and minimally adjusted models.

Conclusion:

Obtaining optimal levels of sleep is associated with better HRQOL and reduced premature mortality risk, independent of demographic, behavioral, and biological conditions. These findings underscore the importance of achieving optimal levels of sleep.
“Ambulance Thieves, Clowns, and Naked Grandfathers”
Authors: Bochantin Jaime E.
Published: January 2017

Using qualitative methods, this study explores humor as an interactional, sensemaking practice and examines how public safety employees (PSEs) and their family members navigate the relationship between work and home. Results from 95 interviews and eight focus groups indicate that both PSEs and their families use humor in productive and unproductive ways and introduce a new way, via Humorous Bilateral Emotional Labor, to understand how humor is used. In addition, a new concept of sensetaking is introduced.
Adverse Gastrointestinal Effects of Nonsteroidal Anti-Inflammatory Drugs
Authors: Erstad Brian L. , Lipsy Robert J.
Published: January 2017

There are a substantial number of adverse reactions attributable to nonsteroidal anti-inflammatory drug (NSAID) therapy, particularly of the gastrointestinal (GI) tract. The stomach is most commonly affected, although injury may occur from esophagus to colon. The incidence of developing serious GI toxicity seems to be three times as great in users compared with nonusers of NSAIDs. Age greater than 60 years, history of GI problems, previous corticosteroid use, and recency of NSAID use seem to increase the risk of toxicity. Short-term studies have found differences in ulceration or bleeding caused by various NSAIDs. However, there are insufficient long-term clinical trials involving adequate numbers of patients to demonstrate substantial advantages for any particular NSAID based on its toxicity profile. Prostaglandin inhibition seems to be one mechanism responsible for the GI toxicity of NSAIDs, but it is probably not the only mechanism. When serious GI bleeding occurs, the NSAID use must be stopped, although omeprazole and misoprostol have been used successfully to treat gastroduodenal ulcerations in patients while continuing NSAID therapy. Misoprostol and possibly omeprazole have effectively prevented GI ulceration associated with NSAID therapy, but questions remain regarding patient selection, length of therapy, and their utility in preventing serious GI bleeding. At this time, routine prophylaxis for patients receiving long-term NSAID therapy cannot be recommended.
Health Maintenance Organization Drug Education Pharmacists' Influence on Acid Gastric Drug Prescribing and Costs
Authors: Oesterman Paul J.
Published: January 2017

With health care reform came the advent of cost-conscious prescribing. Many measures contributed to this, including formulary control, physician education, and clinical pharmacy. Initial efforts in this regard were limited to the in-patient setting, but as health care reform continued, the significance of cost-effective prescribing in the ambulatory care setting has evolved. This article provides a brief historical look at cost-effective prescribing and how the efforts of a clinical pharmacist have successfully influenced the prescribing patterns for the acid-gastric products, and reduced expenditures in a Northern California health maintenance organization (HMO) medical center.
Case Management through Productivity Engineering in the Home Health Care Setting: Part 2: Implementation of the Intensity of Home Care Acuity Scale
Authors: Scemons Donna , Jones Jennie , Stafford Diane M.
Published: January 2017

The business aspect of home health care has become more demanding of managers and clinicians requiring home care to meet the highest quality standards and to be delivered in a timely, efficient, effective, and cost-effective manner. This requires home health care to develop tools to meet these many and varied demands. The tool developed by Kaiser Permanente Valley's Member Service Area Continuing Care Department was the Intensity of Home Care Acuity Scale (IHCAS). The implementation process for this tool included a well-planned schedule of presentations by a variety of continuing care personnel. The process also included staff review and feedback. This second part of a three-installment article presents the implementation process for the IHCAS.
The Information Challenge In Home Health Care
Authors: Pace Karen Beckman
Published: January 2017

Health care in general, and home health care specifically, are information intensive. Today, success demands not only effective internal information management but also access to reliable aggregate information at the national, state, and local levels. Home care organizations need to compare their cost, quality, and utilization information to reference databases to evaluate their services and improve performance. But until recently achieving standardized national information was not easy. Currently several initiatives are underway that will help facilitate the availability of standardized information. These initiatives will be discussed in detail. Home care organizations need to develop an information strategy to meet their internal information needs as well as enhance their ability to contribute to the aggregate information about the ‘ industry. Home care organizations that are best able to collect, compile, obtain, and use information will be the most successful.
Chronic Disease Management: What Happens When Home Health Care Is Completed?
Authors: Stomper Amy P.
Published: January 2017

As the chronic illness population increases, health care organizations are looking for ways to help promote Wellness and prevent illness. The Chronic Disease Management Program (CDMP) was developed in a Midwest hospital's home care department to provide services. The target population was those chronically ill who were no longer eligible for skilled home care, but continued to require ongoing monitoring. Admission criteria and service provision protocols were developed. Patients were visited on an average of once a month by a nurse, free of charge, with a focus on the management of chronic disease. Outcome measurement included patient/physician satisfaction, quality of life measures, and a financial cost analysis. Results demonstrated a high level of satisfaction, stabilized or improved quality of life, and significant financial savings.
Effect of Group Versus Home Visit Safety Education and Prevention Strategies for Falling in Community-Dwelling Elderly Persons
Authors: Abreu Natalia , Hutchins Jennifer , Matson John , Polizzi Nicole , Seymour Connie J.
Published: January 2017

This research study explored the effectiveness of group versus home education in teaching fall prevention to community-dwelling elderly. Twelve elderly volunteered to participate. Group 1 received an inservice instructing them in prevention strategies. Group 2 received individual home visits for the same purpose. All subjects received follow-up home visits to assess modifications and fall occurrence. Statistical analysis showed no significant difference between the two groups at follow-up or within Group 2 initially or at follow-up. Further research is needed to explore more effective teaching strategies to emphasize the importance of prevention and affect modification of the home environment.
Telenursing and Nurse–Patient Communication Within Fertility, Inc.
Authors: Johnson Bethany , Quinlan Margaret M. , Marsh Jaclyn S.
Published: January 2017

The purpose of this study is to examine patient perceptions of practitioner–patient communication in reproductive endocrinology and infertility (REI) practices. During this study, we uncovered the importance of telenursing for nurse–patient communication during REI treatment. Telenursing, which is defined as the use of wireless technology for out-of-office communication, is the basis for out-of-office communication. We examined participants’ conceptualization of supportive and unsupportive communication, through the lens of biomedicalization theory. After conducting 23 interviews, we conclude that telenursing is integral to providing holistic nursing care during treatment at REI practices. We discuss efficient and effective uses of telenursing and patients’ positive perceptions telenursing and assess telenursing as both an embrace of and form of resistance to biomedicalization within Fertility, Inc. Theoretical and practical implications are offered, including suggestions for increasing patient access to telenursing while protecting REI nurses from burnout.
Managing Strategic Service Change in the NHS
Authors: Pettigrew Andrew , McKee Lorna , Ferlie Ewan
Published: January 2017

This paper reports some early findings from a major research project which explores strategic service change in the NHS in the post-Griffiths era. We begin by briefly reviewing the relevant literature on change and general management in the NHS, and go on to outline the particular features of the research design. We then isolate some key emergent themes from a preliminary analysis of the data, highlighting two themes in greater depth. In our final section, we will attempt to reflect on some of the common factors associated with the achievement of strategic change. The project is funded by the NHSTA and a consortium of eight Regional Health Authorities.
General Management and Medical Autonomy in the National Health Service
Authors: Harrison Stephen , Hunter David J. , Marnoch Gordon
Published: January 2017

Clinical freedom is an elastic concept and its practical meaning to clinicians varies with time and context. Management pressure on clinical freedom is also likely to be elastic. Resource constraints are increasing pressure on clinical freedom. The paper reviews the nature of such pressure and considers the extent to which general managers have successfully eroded medical autonomy. Drawing on emerging evidence from research in progress on the impact of general management, the paper concludes that there is little sign of change in doctor-manager relations. They continue to inhabit a shared culture of medical autonomy in which only rarely do managers challenge clinicians.
Regionalization of Tertiary Care: Impact of Safe Cardiovascular Volumes in Iowa
Authors: Rohrer J. E. , Vaughan M. S. , Wenzel R. P.
Published: January 2017

The outcomes of cardiovascular care for individual patients are known to be better when treatment is provided in hospitals where the volume of such care is greater. We examined the impact of establishing safe volume thresholds on hospitals now performing such procedures in the state of Iowa by analysing the relationship between various volume thresholds and the number of hospitals that would continue to provide the service if the thresholds were enforced. Four procedures performed in hospitals in Iowa in 1990 were studied: coronary artery bypass graft surgery, vascular surgery, cardiac valve surgery, and cardiac catheterization. The analysis was conducted assuming current per capita procedure rates and repeated assuming reduced procedure rates. The study finds that the 12 hospitals now performing coronary artery bypass graft surgery in Iowa could be reduced to two, providers of vascular surgery could be reduced to as low as four from the current 33, the 10 providers of cardiac valve surgery might be reduced to one, and catheterization could be provided at two rather than 22 hospitals.
Health Care Rationing: Can we Afford to Ignore Euthanasia?
Authors: Ward P. R.
Published: January 2017

Explicit rationing decisions are being made to encompass a wide range of health care issues. Voluntary euthanasia has largely been excluded from this debate due to, in my view, the emotive nature of the issue.

Euthanasia is an issue in which economists have been largely excluded and in which ethicists and philosophers dominate. It is the purpose of this paper to review the economic and ethical literature on euthanasia and to discuss their compatibility within the debate on euthanasia.

The potential cost savings by the use of advance directives, do-not-resuscitate orders, and futile care withdrawal are then reviewed, as are the potential cost savings created by hospice care. As a conclusion, the ethical and economic arguments are then balanced to assess their compatibility.

It is the contention of this paper that reducing medical care costs near the end of life should not be a taboo subject, and that rationing decisions could focus on an exploration of this area and the approaches to it, which are ethically justifiable and economically worthwhile.

The introduction of a policy of voluntary euthanasia could have a large impact on the rationing of health care resources whilst also promoting patient choice and an arena for a more dignified death.
Organizational Power and Conflict regarding the Hospital—Physician Relationship: Symbolic or Substantive?
Authors: Rivers P. A. , Woodard B. , Munchus G.
Published: January 2017

The purpose of this paper is to provide a critical review of organizational power and conflict regarding the hospital—physician relationship. The issue of power being symbolic and/or substantive is discussed. The classification (Mintzberg Model) of organizations as simple structures, machine bureaucracies, professional bureaucracies, divisionalized forms and adhocracies are reviewed. Also, the issue of whether the perceived autonomy that professional employees enjoy increases the likelihood that an executive level manager in a professional bureaucracy (hospital entity) will devote substantial attention to influencing symbolic outcomes as opposed to substantive outcomes in a machine bureaucracy is discussed. In conclusion, conflicts between hospitals and physicians can be resolved in two ways: (1) by avoiding controversial decisions that might threaten the powers and prerogatives of professional groups; and (2) by agreeing to decisions that hold something for everyone involved in the hospital—physician power relationship.
Improving General Practitioner Access to Physiotherapy: A Review of the Economic Evidence
Authors: Hensher M.
Published: January 2017

The provision of physiotherapy via general practitioner (GP) ‘direct access’ arrangements or in primary care itself has become increasingly common in the UK. Evidence on the economics and the cost-effectiveness of alternative methods of organizing access to physiotherapy services is reviewed, and the likely impacts of different organizational models are discussed. GP direct access physiotherapy and primary care provision appear to have a lower average cost than consultant access physiotherapy models, while GP direct access appears to minimize health care resource use per patient. Primary care physiotherapy provision appears to minimize the costs to patients of seeking care, and appears to generate a greater demand for service than other models. The extent to which physiotherapy provision in primary care can substitute for physiotherapy and other resources in the hospital sector is discussed, as is the extent to which patients may benefit from receiving physiotherapy in primary care. It is argued that continued expansion of access to physiotherapy should be critically appraised, and its ability to improve health status compared with that achievable in alternative patient groups who might benefit from physiotherapy in hospital or rehabilitation settings.
Partnerships in Purchasing: Development of Consortium-Based Purchasing among GP Fundholders
Authors: Laing A. , Cotton S.
Published: January 2017

In the last few years there have been considerable changes in the National Health Service (NHS) in the UK. Arguably the most significant of these has been the introduction of competition. Central to this development has been the introduction of general practice (GP) fundholding, whereby practices purchase health care for their patients directly from competing suppliers. Those practices which have become fundholders have faced considerable challenges in developing their purchasing function, given the complexities of contracting within the context of the NHS internal market. Although one of the original aims of GP fundholding was to facilitate locally responsive purchasing, such have been the complexities of contracting that many fundholding practices have attempted to reduce the managerial demands of purchasing through membership of purchasing consortia. Based on an in-depth study of GP fundholders across Scotland, this paper explores the development of consortium-based purchasing. Specifically, this paper seeks to address three issues central to the evolution of such consortium-based purchasing. Firstly, the patterns of organizational structure and the operational dynamics of such consortia. Secondly, the impact of such consortia on the process of fundholder purchasing. Thirdly, the managerial implications of purchasing through such consortia for the participating practices. In addressing these issues, it will examine whether such patterns of purchaser development have impacted on the evolution of locally responsive purchasing.
Student Utilization of Health Services at a University Hospital in Turkey
Authors: Kisa A. , Dziegielewski S.F.
Published: January 2017

This paper gives the results of the first pilot study of health care utilization by Turkish university students who receive much of their student health-related services from an affiliated university hospital. The survey was distributed to 393 students and a response rate of 59.8% was obtained. In general students did not report satisfaction with the health services they received. This finding is significant because the hospital concerned is considered ‘state of the art’ in Turkey. Significant levels of dissatisfaction were noted across several treatment and provider variables, and comparisons with American health services are made. Suggestions for improving the student health services in the country are generated and future research recommendations are highlighted.
2 Baruch and the Syriac Codex Ambrosianus (7a1): Studying Old Testament Pseudepigrapha in Their Manuscript Context
Authors: Lied Liv Ingeborg
Published: January 2017

This article presents three hypotheses that may shed light on the place of 2 Baruch in the Syriac Codex Ambrosianus, the sixth-/seventh-century Old Testament codex that contains the only known complete copy of 2 Baruch. Whereas scholars of 2 Baruch have generally treated this copy in isolation from the rest of the manuscript, using it primarily as a witness to the (hypothetical) early Jewish text, this essay approaches 2 Baruch as an integral part of the codex, exploring codicological elements, the order and organization of books, as well as paratextual features. Inspired by the perspective of New Philology, this article contributes to the ongoing discussions about the origins, transmission and transformation of the so-called Old Testament Pseudepigrapha, claiming the importance of studying them in the manuscript contexts in which they are copied. The article will also be a contribution to the further study of the Codex Ambrosianus and the engagement with 2 Baruch among Syriac Christians.
Machining error reduction by combining of feed-speed optimization and toolpath modification in high-speed machining for parts with rapidly varied geometric features
Authors: Ma Jian-wei , Jia Zhen-yuan , Song De-ning , Wang Fu-ji , Si Li-kun
Published: January 2017

Parts with rapidly varied geometric features are usually crucial parts in high-end equipment and widely applied in the fields of aerospace, energy and power, which are difficult or inefficient to process because of the more special structure and the higher requirement of machining precision. High-speed machining technology provides an effective method for parts with rapidly varied geometric features to solve the contradiction between high demand and low machining efficiency. However, as the existence of rapidly varied geometric features, the machining toolpath for such parts is always complex free-form curve and the actual moving speed of the workbench of the NC machine tool cannot reach the feed-speed set in the NC program timely due to the drive constraint of NC machine tool. Furthermore, the machine tool would vibrate violently when machining the rapidly varied geometric features. In this way, the big machining error will be formed. A machining error reduction method by combining of feed-speed optimization and toolpath modification in high-speed machining for such parts is proposed. First, considering that the actual feed-speed cannot reach the programmed value when the toolpath curvature is too large, the feed-speed is optimized with the constraints of jerk and acceleration limitations of the feed shafts, and a feed-rate smoothing algorithm is applied. Then, the compensated cutter locations are calculated via machining-error estimation. Finally, the modified NC codes are acquired according to the optimized feed-speed and the compensated toolpath. By combining the feed-speed optimization and toolpath modification, the high precision and high efficiency machining can be realized. The experimental results demonstrate the feasibility of the proposed approach. This study provides an effective approach to reduce the machining error in high-speed machining, and is significant for improving the processing precision and efficiency of parts with rapidly varied geometric features.
Developing an active variable-wheelbase system for enhancing the vehicle dynamics
Authors: Soltani Amir , Goodarzi Avesta , Shojaiefard Mohammad Hassan , Khajepour Amir
Published: January 2017

In order to enhance the vehicle dynamics, this paper presents a novel and innovative yaw moment control system in which the longitudinal positions of the wheels are individually controlled. For this purpose, the proposed concept is analytically and numerically studied first, and it is shown that the method can considerably modify the inherent characteristics of a vehicle, such as the handling and the steerability. This system can generate a stabilizing yaw moment, without any considerable changes in the total lateral force and the total longitudinal force of the vehicle. Finally, a comprehensive vehicle model together with an intelligent fuzzy control strategy are developed to evaluate the effectiveness of the active variable-wheelbase system in different driving conditions. Based on the simulation results, this system has the potential to be considered as a new alternative technique for vehicle dynamics control in the future.
Self-adaptive phase compensation characteristics and safeguard-phase-margin design of an unsymmetrical current-sensing resistor for magnetically suspended flywheels
Authors: Ren Yuan , Chen Xiaocen , Cai Yuanwen , Miao Cunxiao , Wang Weijie
Published: January 2017

This paper presents the self-adaptive phase compensation characteristics and quantitative design of an unsymmetrical current-sensing resistor for magnetically suspended flywheel (MSFW) system with strong gyroscopic effects. Aimed at the nutation stability of the MSFW control system, the self-adaptive phase compensation characteristics of PWM H-bridge unipolar switching power amplifiers with unsymmetrical current-sensing resistor with inductance variations is analyzed firstly, including the initial compensation frequency and compensation phase in the compensation working regions. Secondly, the quantitative safeguard-phase margin design method for the asymmetrical factor in H-bridge unipolar switching power amplifiers is proposed based on the nutation stability criterion. Finally, the influence of the unsymmetrical current-sensing resistance network on the nutation stability is further analyzed. Simulation and experimental results demonstrate the correctness and effectiveness of the proposed method.
Mechanism study of performance enhancement in a subsonic axial flow compressor with recirculating casing treatment
Authors: Wang Wei , Chu Wuli , Zhang Haoguang
Published: January 2017

The improvements in both compressor efficiency and stability have been observed in a subsonic axial flow compressor with recirculating casing treatment. The study aims to understand the underlying flow mechanisms of the beneficial effect on the compressor efficiency of recirculating casing treatment. The recirculating casing treatment was investigated experimentally and numerically. In the experiment, static pressure fluctuations over the rotor tip were measured with fast-response pressure transducers. Whole-passage time-accurate simulations were also implemented to help in understanding the flow details. The unsteadiness of double-leakage flow and its effect on the loss generated at the rotor tip were discussed in detail for the solid casing. The effect of recirculating casing treatment on the double-leakage flow related loss was subsequently investigated. The results indicate that the double leakage flow is a main loss source in the rotor tip region. The double-leakage flow is completely unsteady, which induces a cyclical fluctuation of the amount of loss generated in the rotor tip region for the solid casing. With the recirculating casing treatment installed, the high-energy jet created in recirculating loops changes the unsteady characteristics of double-leakage flow by getting it diffused over the rotor tip gap along the chordwise direction, which results in the loss fluctuation that is dominated by the high-energy jet rather than the unsteadiness of double-leakage flow. The double-leakage flow is also pushed downstream by the jet and the amount is reduced when it passes through the recirculating loops. The effect of recirculating casing treatment on the double-leakage flow is primarily responsible for the improvement in the compressor efficiency.
Optimal sliding model error feedback control for relative motion of Lorentz-augmented spacecraft
Authors: Cao Lu , Zhang Zhidong , Shi Jianjun , Wang Yanrong , Li Hengnian
Published: January 2017

Two typical relative motion control problems of Lorentz-augmented spacecraft implemented in the Earth's magnetic field are studied and further discussed. The Lorentz force acts on a charged spacecraft that could actively generate and modulate when it is flying through a magnetic field, and provides a new concept of propellantless propulsion strategy for spacecraft formation flying and hovering system control. It is a fact that the directions of Lorentz force are limited by the local magnetic field. In view of this reason, it does not provide or satisfy the required control acceleration for spacecraft formation flying and hovering timely; therefore, it always works as an auxiliary strategy to reduce the fuel consumptions. Based on the above considerations, a dynamical model for relative motion of charged spacecraft, including the effects of the J2 perturbation and the Lorentz force, is derived and its application to spacecraft formation flying and hovering control problems are discussed. Then, the optimal sliding model error feedback control method is derived based on the novel dynamical model, which is proposed by theory integrating between optimal sliding model control theory and the principle of minimum sliding mode error. Moreover, the optimal design of the required charge for the Lorentz spacecraft and the thruster-output control acceleration has been developed with details. It is shown that the proposed controller owns the advantages of the optimal control theory and has the ability to estimate and offset the unknown disturbances. The numerical simulations are performed to illustrate the efficacy of the proposed dynamical model and controller to maintain the spacecraft formation flying and hovering system with optimal fuel consumptions and high precision in the presence of the unknown disturbances.
Sexual Behaviour, Aids and Poverty in Sub-Saharan Africa
Authors: Prual Alain , Chacko Sunil , Koch-Weser Dieter
Published: January 2017

Within the rapidly progressing pandemic of the acquired immunodeficiency syndrome (AIDS) Sub-Saharan Africa plays a disproportionally large role. The reported data indicate that heterosexual transmission is the predominant cause for the rapid spread in this, one of the world's poorest regions. Prostitution, though poorly understood in the African context, unstable family structure, lack of male circumcision, aversion to, and high cost of, condom use, and risky sexual behaviour, including multiple sexual contacts and partners, are causal and facilitating factors in the rapid spread of HIV infection. Virtually all of these factors are related to poverty. Education and information, which in the absence of an effective curative drug and/or vaccine, would be essential, is also a costly undertaking. Deeper understanding of and increased attention to the economic, as well as social and cultural, parameters of the Sub-Saharan AIDS endemic is needed for the implementation of preventive measures.
Subclinical Human Papillomavirus Infection of the Male Lower Genital Tract: Colposcopy, Histology and DNA Analysis
Authors: Chow V T K , Tay S K , Tham K M , Lim-Tan S K , Bernard H U
Published: January 2017

In 25 partners of women with genital human papillomavirus (HPV) infection or cervical intraepithelial neoplasia, colposcopic examination revealed the existence of subclinical HPV infection of the male lower genital tract in 22 cases. It manifested either as short papillae tipped with acetowhite changes, or flat acetowhite lesions on the foreskin, glans, periurethral region, scrotum, perineum and/or perianal region. Multiple lesions involving several anogenital areas were common. Some of these abnormalities were small and inconspicuous. Of these 22 cases, 17 had histological evidence of HPV infection. Although Southern blot hybridization detected HPV DNA in only one case, polymerase chain reaction (PCR) analysis revealed HPV DNA in 20 cases There were 10 cases of HPV 16. Subclinical HPV disease is best identified by colposcopy and confirmed by PCR. In treating HPV disease, colposcopic recognition of subclinical HPV disease forms an essential part of the management plan.
Blood-Taking Practices and Needle-Stick Injuries in House Officers
Authors: Woolley P D , Palfreeman A J , Patel R , Talbot M D , Samarasinghe P L
Published: January 2017

The blood-taking practices and prevalence of needle-stick injuries were recorded for 46 house officers working at the two largest teaching hospitals in Sheffield and 38 house officers working at three hospitals in London.

Wearing gloves when performing venesection or inserting an intravenous cannula was generally perceived as making the procedure more difficult and no house officer in either centre wore gloves when performing routine venesection.

Twenty-five (54.3%) of the house officers from Sheffield resheathed needles by hand, while a further 14 (28.3%) placed the sheath onto a work surface before attempting to manoeuvre the needle back into its sheath. Only 7 (17.4%) house officers denied resheathing needles after performing venesection. Twenty-seven (58.7%) admitted to having had a needle-stick injury within 3 months of commencing their first house officer post.

Twenty-seven (71.1%) of the house officers from London resheathed needles, the remainder disposing of the needle by placing it straight into an appropriate container. Twenty-five (66%) admitted to having had a needle-stick injury the first 6 months of being a house officer.

Training in the correct techniques of venesection with emphasis on either avoiding resheathing needles or resheathing safely is essential early in the medical student curriculum and needs regular repetition.
Meatoscopy: A Simple Technique to Examine the Distal Anterior Urethra in Men
Authors: Thin R N
Published: January 2017

A common problem is to determine the site of the base of meatal warts in men and if the lesions will be suitable for the treatments available in genitourinary medicine (GUM) or sexually transmitted diseases (STD) clinics. Formal endoscopy requires sterile conditions and is therefore an expensive procedure. A simple safe cheap alternative is meatoscopy using an auroscope with inflation. This allows inspection of the anterior urethra to a depth of 5 or 6 cm. With this technique 175 examinations were performed on 153 patients. Warts were confined to the lips in 27 (56%) of 48 patients with meatal warts; in an additional 5 patients with meatal warts the warts arose from deep in the fossa navicularis and in 16 patients with meatal warts there were additional warts in the fossa navicularis invisible on clinical examination. No urethral warts were seen in 103 patients without meatal warts, comprising 47 patients with external genital warts and 56 without any warts.

It is concluded that meatoscopy should be undertaken in all patients with meatal warts to determine the site of their base and to assess if there are any more proximal warts. This should be done as soon as the meatal warts are seen, and urethritis has been excluded, so that appropriate treatment can be planned.
An Investigation, by Questionnaire, of Cases of Recalcitrant Vaginal Trichomoniasis Seen in Genitourinary Medicine Clinics in the United Kingdom
Authors: Kinghorn G R ,   British Co-operative Clinical Group
Published: January 2017

A total of 24 cases of recalcitrant trichomoniasis were reported from 18 centres widely scattered throughout the UK. Most cases had received numerous courses of unsuccessful treatment. Nine (75%) of 12 tested isolates had a decreased susceptibility to metronidazole. Local laboratories were often unable to evaluate fully trichomonal isolates and it is recommended that consideration be given to the establishment of a national reference laboratory. Although there were no universal cures, successful alternatives to conventional treatments are detailed.
Prevalence of Urogenital Chlamydia Trachomatis Infection in El Salvador I. Infection during Pregnancy and Perinatal Transmission
Authors: Posada Ana Berta Cañas , Jonasson Jon , de Linares Leonor , Bygdeman Solgun
Published: January 2017

One-hundred and twenty-nine pregnant women in labour (age range 15–46 years; median age 23) and 42 infants born to chlamydia-positive mothers (age range 5–15 days; median age 10) were investigated to estimate the prevalence and incidence, respectively, of Chlamydia trachomatis infection in San Salvador, El Salvador.

Urethral and cervical samples were obtained from all women and conjunctival specimens were taken from both eyes of each child. The chlamydial antigen was detected with the commercial Pharmacia Chlamydia EIA kit. Direct immunofluorescence (DFA) (Syva MicroTrak) was used for confirmation. In the newborns both EIA and DFA tests on direct preparations from ocular smears were performed on all the samples.

The prevalence of chlamydial infection in pregnant women was 44% (57/129). The incidence of chlamydial infection in neonates was 64% (27/42), and the majority of the infected children (56%) had conjunctivitis. Referring to individuals rather than specimens the sensitivity of EIA tests on conjunctival samples from the infants was low (37%) as compared with 91% on urethral and cervical specimens from the pregnant women.
Prevalence of Epstein-Barr Virus and Human Papillomavirus in Cervical Samples from Women Attending an STD-Clinic
Authors: Voog Ewa , Ricksten Anne , Löwhagen Gun-Britt
Published: January 2017

A group of 91 women attending the STD-clinic, Department of Dermato-venereology, Sahlgrenska Hospital, Gothenburg, were screened for EBV DNA and HPV DNA of the cervix with the PCR-technique. Presence of EBV DNA was demonstrated in 35 (38%) women and HPV DNA in 30 (33%) women. Fourteen (15%) women had both EBV DNA and HPV DNA present. Without the colposcope 20 of these women had macroscopic signs of HPV infection on the vulva and/or vagina and 71 had no signs of infection. Presence of EBV DNA was not correlated to clinical signs of HPV infection.
Noise reduction mechanisms for the inclined leading edge vaned diffuser in a centrifugal fan
Authors: Wu Qi Gong , Wei Zhang
Published: January 2017

An experimental and numerical study to explore the noise reduction mechanism for the inclined leading edge vaned diffuser in centrifugal fans is described. Inclined leading edge vaned diffuser is useful in improving fan performance, increasing operating range, and reducing fan noise. The generation of fan noise is related to the pressure fluctuation on the diffuser vane surface, particularly the leading edge. Numerical results show that pressure fluctuation on the inclined leading edge vaned diffuser surface remarkably decreases, unlike that of the original diffuser. The pressure fluctuation is dominated by the components at the blade passing frequency and its second harmonic.
Sample Size Determination for a Trial of-Breast Cancer Screening under Age 50: Population versus Case Mortality Approach
Authors: Peer Petronella G M , Verbeek André L M , Straatman Huub
Published: January 2017

Objective —

To determine the efficacy of screening for breast cancer in women aged 40 to 49.

Methods —

A large number of women will have to be enrolled to ensure adequate statistical power. Attention will be restricted to the deaths from breast cancer that occur among comparable groups of patients with breast cancer rather than to an analysis in which all women entering into the trial are considered at risk of dying from breast cancer (population mortality analysis). As the new trial is likely to be conducted in regions where screening has been established for all women from age SO onward, comparability may be reached by including the breast cancers detected at the routine screening examination at age 50.

Conclusions —

When comparability of cases can be reached, such a case mortality analysis requires 15–30% fewer women to be enrolled than a population approach.
Setting Standards for Cervical Screening Fail-Safe Mechanisms: A Target Based on an Audit of Cytopathology Laboratory Records
Authors: Roberts Emilie , Barrow Steve , Cook G A , Walsworth-Bell J P
Published: January 2017

Objective —

To examine the efficacy of cytopathology laboratories in monitoring action following an abnormal cervical smear.

Setting —

11 screening laboratories serving 19 districts in the former North Western region of the United Kingdom.

Method —

944 validated cases were identified at 11 laboratories. The screening history for each abnormal smear was obtained from the screening laboratory and compared with the records from the relevant family health services authority (FHSA) database.

Results —

Laboratories held complete follow up records in 740 (78·4%) cases; the FHSA records extended this to 910 (96·4%) cases. Poor communication was the main problem; computerisation was not necessary to improve fail-safe procedures.

Conclusions —

Audit of fail-safe procedures is a valuable purchasing tool, identifying weaknesses and strengths, setting and maintaining standards.
Diagnostic Accuracy of Immunochemical Faecal Occult Blood Test for Gastric Cancer
Authors: Nakama Hidenori , Kamijo Noboru , Fujimori Kazuya , Fattah A S M Abdul , Zhang Bing
Published: January 2017

Objectives

–Toinvestigate the accuracy of the immunochemical occult blood test in screening for gastric cancer and to evaluate whether or not the upper digestive tract should be examined when the occult blood test is positive but there is no abnormal sign in the colorectum.

Methods

–In a case-control study an occult blood test was carried out on 150 subjects with gastric cancer, ISO subjects with colorectal cancer, and on 300 healthy subjects. Data were analysed from 44 996 persons attending a population screening programme who underwent both radiological gastric cancer screening (barium meal) and colorectal cancer examination by occult blood test.

Results

–In the case—control study the occult blood test was positive in 27/150 (18%) subjects with gastric cancer, in 112/150 (75%) subjects with colorectal cancer, and in 24/300 (8%) healthy controls. In the population screening programme the occult blood test was positive in 4/50 (8%) persons with gastric cancer and 3232/44 950 (7%) persons without gastric cancer,- indicating no difference between them.

Conclusions

–These data show that the immunochemical faecal occult blood test is worthless as a screening test for gastric cancer, and that examination of the upper digestive tract is unnecessary in cases where the faecal occult blood test is positive but there is no sign of colorectal disease.
Infrastructure in Africa
Authors: Bond James
Published: January 2017

As a continent, Africa is the least endowed region in the world in terms of infrastructure. It also does not perform well on the quality of infrastructure services delivered to users. Infrastructure is scarce, and its performance is generally poor: high cost, erratic, and undependable. Africa’s low infrastructure endowment is particularly prevalent in sub-Saharan Africa (SSA), above all a reflection of this region’s low gross domestic product (GDP) per capita income levels and low population density. Poor quality of infrastructure services results from chronic financial weakness in the sector, as users do not pay full cost for services they receive, as well as from weak operational and financial management. Spending needs are not met, assets are not well maintained, and the sector suffers from a deficit in management skills. However, it will not be enough to simply increase financing flowing to infrastructure investments. New sources of financing and systemic changes to the way infrastructure services are delivered to improve their quality will also be needed to ensure that Africa’s infrastructure is operated efficiently and maintained effectively.
Organic Farming: Ex Post Strategy or Ex Ante Business Analysis?
Authors: Leaver Adam
Published: January 2017

Recent strategy debates have emphasised the importance of skilled management to build core competencies within the firm and thus nurture competitive advantage. For some, the competency of management is so crucial that market maturity is simply just a state of mind. This paper critically reviews this claim through an investigation of the structure and dynamics of the organic food sector.

This paper argues that “resource-based” arguments are less strategy discourses and more histories of successful or failed companies. As such they are difficult to apply to ex ante situations such as agriculture, where the market is mature yet there are no obvious solutions. The organic sector offers one way out for farmers, but it too is constrained or governed by its sectoral environment and operating ratios. In conclusion this paper argues that market maturity is therefore not a stale of mind because sectoral pressures create real economic and financial problems which individual managers alone cannot solve.
Internationalization Strategies, Networking and Functional Discretion
Authors: Jaklič Marko
Published: January 2017

International networking seems to be a very useful concept especially for internationalization of small and medium-sized companies (SMEs) in (small) catching-up economies, since it is possible to overcome some of the problems of knowledge and technology as well as capital accumulation. However, an important set of questions pertains to the position of a partner within a network of relationships. I will argue that a functional discretion or a “freedom of business functions” and their development, especially the marketing and R&D functions, should be a strategic goal for a company striving to be well positioned in a network.

For introductory purposes three models describing internationalization strategies of firms are distinguished: the theory of internalization, the model of the internationalization process, and the network approach to internationalization.1 The latter describes industrial markets as networks of relationships between companies. Then I describe the nature of cooperation and competition in networks, discuss problems and management of networks and introduce the concept of the positioning of companies in networks. Based on internationalization and networking concepts I develop a “3-Phase Internationalization” model, which helps to develop a pattern of thinking about the functional discretion of a company in various stages of the internationalization process. In effect, this model may be seen as a means of integrating the main theories of internationalization. In the last part of the article we present two Slovenian cases of networks in internationalization as illustrations of the theoretical discussion. I conclude that functional discretion may well be a development issue for states or regional economies as well as a critical strategic issue for companies.