bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Travel Acquired Illness on the World Traveller and Family Doctor and the Need for Pre-Travel Health Education
Authors: McIntosh I.B. , Reed J.M. , Power K.G.
Published: January 2017

This retrospective study involved a 20% quota, age and sex stratified sample of people over 16 years of age, presenting to a group medical practice over a period of one year (N = 1568). A standardised, computer-scored, self-report questionnaire was administered.

The response rate was 98.3%. 42% of respondents had travelled outwith the UK in the previous year. Of those, 42% had become ill whilst abroad. In 20.5% of cases the illness settled without treatment. However, 26% of the patients required consultation with a doctor whilst abroad and 48.4% of those becoming ill required further attention from the family doctor on return home. 5% of ill travellers were admitted to hospital abroad. 8% of all travellers did not have medical insurance cover.

A large and significant population of travellers become ill whilst abroad, and travel-acquired illness has a large impact on general practice, with 1 in 5 travellers seeking GP consultation on return home. Improved practice-generated pre-travel health advice might decrease this burden on primary care.
Domiciliary Nebuliser Therapy — A Valuable Option in Chronic Asthma and Chronic Obstructive Pulmonary Disease?
Authors: Godden D.J. , Robertson A. , Currie N. , Legge J.S. , Friend J.A.R. , Douglas J.G.
Published: January 2017

Domiciliary nebulisers are in widespread use for patients who have severe chronic airways disease, both asthma and chronic obstructive pulmonary disease (COPD). We report a study of the use of domiciliary nebulisers designed to assess practical problems and the value of such therapy in preventing hospital admissions. A total of 405 patients underwent a structured interview at home and their case records were reviewed. Technical performance of the nebuliser compressors was assessed The mean (SD) age of those interviewed was 64.5 (12) years. 185 patients had a physician diagnosis of asthma, and 208 had COPD. 87% patients used their nebuliser at least once daily. Side effects, reported by 54%, were related to frequency of use and commoner in younger patients. 29 subjects (7%) died within 2 years of receiving their nebuliser. Among the survivors, the 2 year periods before and after supply of the nebuliser were compared The percentage of patients requiring hospital admission for exacerbations of lung disease fell from 56% to 46% (p<0.01) but the number and duration of admissions was unchanged Those whose admission duration increased had more severely impaired spirometry when the nebuliser was supplied and had lower activity scores and higher breathlessness scores at the time of interview indicating more severe disease. Approximately half of the compressors were malfunctioning and patients' understanding of the principles of nebuliser treatment was poor.

The provision of domiciliary nebuliser can influence hospital admission inpatients with obstructive airways disease. There is also a need for improved patient education and for technical support which may require the development of a nurse-run nebuliser service.
The Introduction of a Daily Telephone Advice Service: How is it Used and is it Worth the Effort?
Authors: Trevett A.J. , Martin J.R. , Ross W.A. , Macfarlane E.
Published: January 2017

Improving access to medical advice by telephone may reduce unnecessary consultations, limit interruptions through the day and provide a more flexible service to meet patient needs. We advertised and introduced a daily advice line for patients and found that it was used appropriately and to mutual benefit.
Renocolic Fistula: A Case Report
Authors: Duddalwar V.A. , Robertson E.M.
Published: January 2017

Renocolic fistulas are amongst the commonest causes of a renoalimentary fistula. We report a case in which the diagnosis was made on CT examination and confirmed by a barium study and at surgery. A review of literature on causes and investigation of renoalimentary fistulae is presented.
Automatic Ground Surface Reconstruction from mobile laser systems for driving simulation engines
Authors: Craciun Daniela , Deschaud Jean-Emmanuel , Goulette Francois
Published: January 2017

Driving simulation engines represent a cost effective solution for vehicle development, being employed for performing feasibility studies and tests failure and for assessing new functionalities. Nevertheless, they require geometrically accurate and realistic three-dimensional (3D) models in order to allow driver training. This paper presents the Automatic Ground Surface Reconstruction method, a framework that exploits 3D data acquired by Mobile Laser Scanning systems. They are particularly attractive due to their fast acquisition at the terrestrial level. Nevertheless, such a mobile acquisition introduces several constraints for the existing 3D surface reconstruction algorithms. The proposed surface modeling framework produces a regular surface and recovers sharp depth features within a scalable and detail-preserving framework. Experimental results on real data acquired in urban environments allow us to conclude on the effectiveness of the proposed method.
Aspects of Order during the Deformation of Nylon Fibers
Authors: Kelley R. N. , Statton W. O.
Published: January 2017

Different structure parameters can be measured in wide- and small-angle x-ray diffraction patterns of fibers which describe order. A brief study of these parameters is given for fibers of 66 nylon and for fibers of a random copolymer of 66/6 (90/10) which had been produced by a variety of drawing and annealing conditions. No direct correlation of the order parameters is found, suggesting that they vary independently. Part of the long-period intensity is found to be created by heating and is not a remnant of the disruption of the original structure. It is proposed that the gross ordering process is dominated by a thermodynamic mechanism. On the other hand, the local lattice ordering is sensitive to both tension and temperature conditions, and it is proposed that local ordering is dominated by a kinetic mechanism
Equilibrium and Nonequilibrium Thermodynamics of Dyeing in Nonionic Systems
Authors: Milicevic B.
Published: January 2017

A model of a simple mixture in an approximation for highly diluted binary phases is used to develop the primitive model for the dyeing of hydrophobic textile substrates with nonionic dyes. The formalism thus derived provides a simple means for describing the equilibrium properties of such systems. The kinetic behavior of the same systems can be formulated with the phenomenological equations of the thermodynamics of irreversible processes, but it can be shown by the theory of stochastic processes that the model used is of the simplest kind
The Chemical Composition of Aminoethylated Cotton Cellulose
Authors: Roberts Earl J. , Rowland Stanley P.
Published: January 2017

Aminoethylated cotton cellulose (I) was prepared by the reaction of cotton fabric with sodium 2-aminoethyl sulfate in the presence of excess base at 125°C and was analyzed for structural components. d-Glucose, 0-(2-aminoethyl)-d-glucopyranoses (II), polyethylenimines, and ethanolamine were shown to be present in the hydrolyzate of I. The complexity of this cellulose derivative is attributed to the development of carbonyl groups in the cellulose during the reaction and to the subsequent reaction of these groups with amino groups in the substituents, in polyethylenimines, and ethanolamine. The distribution of nitrogen among the II's polyethylenimine, and ethanolamine is estimated to be in the ratio 0.5:0.4:0.1. Quantitative analyses for the ratio of mono-0-(2-aminoethyl) substituents in the 2–0-, 3–0-, and 6–0-positions of the d-glucopyranosyl units were complicated by reactions between the carbonyl function (at C-1) of d-glucose and the amino groups of the substituted glucoses. This ratio was determined to be 0.64:0.14:1.00 after conversion of the amino groups of I to hydroxyl groups by diazotization and analysis in terms of II
Modeling Recidivism Times: Comment on Bloom
Authors: Gaines John A.
Published: January 2017

Bloom (1979) discussed a new mathematical model that has considerable potential for facilitating program evaluations based on analyses of recidivism data. However, he overlooked a rich literature in other fields, such as survival analysis and reliability theory, dealing both with his particular model and the general type of process of which recidivism may be considered an example. Use of results from that literature could have streamlined his discussion. More fundamentally, Bloom did not carry his consideration of the behavioral mechanisms underlying his data to the point where his particular model specification, and no others, followed as a logical necessity. This limits the generalizability of his approach. One possible formulation of underlying relationships leading directly to Bloom's model is suggested.
Goodman and Kruskal's Tau b: Multiple and Partial Analogs
Authors: Gray Louis N. , Williams J. Sherwood
Published: January 2017

Using the logic developed by Goodman and Kruskal, multiple and partial analogs for their measure Tau are suggested. These measures may be of particular utility to survey researchers in situations where the Goodman and Kruskal lambda measures are either inappropriate or inapplicable. This measure has been shown to have a clear proportional reduction in error interpretation. These analogs should be useful and necessary for detailed causal and/or multiple analysis with nominal-level data.
Estimating Nonhierarchical and Nested Log-Linear Models
Authors: Magidson Jay , Swan James H. , Berk Richard A.
Published: January 2017

The recent literature on-log-linear models incorrectly implies that the Iterative Proportional Fitting (IPF) algorithm and associated computer programs such as ECTA can only be used to estimate hierarchical (not nonhierarchical) log-linear models. While ECTA and similar programs are designed for the estimation of hierarchical models, it is shown here that the IPF algorithm (and existing computer programs such as ECTA) can be used to estimate any nonhierarchical model and also many nested log-linear models. The former result follows directly from the symmetry between qualitative/categorical indicator variables and appropriately defined “interaction variables.” The general approach for dichotomous variables is illustrated here using data from the study of “The American Soldier” by Stouffer et al. We also illustrate how the ECTA program can be used to estimate nested models, and show the equivalence between a particular class of nested models and the model of quasi-independence.
Knowing When but Not How! — Mothers' Perceptions and Use of Antibiotics in a Rural Area of Viet Nam
Authors: Halfvarsson J , Heijne N , Ljungman P , Ham M N , Holmgren G , Tomson G
Published: January 2017

Given the world-wide focus on how to rationally use antibiotics, national drug policy programmes have been developed in many countries in order to minimize the environmental antibiotic pressure and thereby hopefully limit increasing bacterial resistance. This study investigated perceptions of antibiotics in a health system with weak drug regulation. The study was conducted in two rural communes in Viet Nam, with a drug market characterized by the increased accessibility and consumption of pharmaceuticals. The study focused on rural mothers' perceptions and use of antibiotics in the treatment of acute respiratory infections (ARI) in children 5 years and under. A combination of qualitative and quantitative methods were used including key informant interviews, focus group discussions, and interviews with mothers and drug vendors.

The study demonstrated that using a combination of qualitative and quantitative methods gives a better understanding of the prevailing perceptions and use of antibiotics in communities.

The results showed that the mothers recognized well the signs of severe ARI and that antibiotics were reserved for more severe illness episodes, where penicillin V and ampicillin were first drugs of choice. However, the mothers' perceptions and use of antibiotics reflects indigenization of antibiotics into traditional Vietnamese thinking and medical practice. This resulted in self-medication and a respect for antibiotics from the mothers' point of view.

A first step towards the rational use of antibiotics is already taken where mothers, as the health decision-maker, know when to initiate antibiotic treatment and try to limit unnecessary use of antibiotics. The next step is to develop a well-functioning health education programme in order to promote the correct use of antibiotics for a successful clinical outcome. This requires acknowledgement of the mothers' culture based behaviour.
Hereditary Congenital Cataracts Associated with Sickle Cell Anaemia in a Nigerian Family
Authors: Babalola O E , Danboyi Peter , Abiose A A
Published: January 2017

Pedigrees of hereditary disorders are rarely reported from sub-Saharan countries because of difficulties inherent in obtaining reliable family histories, case tracing and follow-up. This report relates to a four-generation family in northern Nigeria with dominantly inherited cataracts associated with recessively inherited sickle cell anaemia. It highlights the need for genetic counselling services in clinical practice in the region.
Demographic Characteristics and Risk Factors of First Febrile Seizures: A Jordanian Experience
Authors: Abuekteish F , Daoud A S , Al-Sheyyab M , Nou'man M
Published: January 2017

A prospective study of 203 children admitted with a first febrile seizure was carried out over 18 months. Aseptic meningitis was diagnosed in nine children (4%). The mean age of the children was 19.9 months and the peak age incidence (88%) was between 6 months and 3 years. Complex seizures were seen in 16 cases (8%). There was a history of perinatal asphyxia in 16 patients (8%), positive family history of epilepsy in 3%, of first degree relatives and a history of febrile seizures in siblings in 13%. Upper respiratory tract infection was the commonest triggering factor, diagnosed in 53% of cases. The third child was the most commonly affected (22%) in the family. There was a lower incidence of both complex febrile seizures and history of seizures in siblings compared to other studies. Lumbar puncture should be considered for all children below the age of 2 years, presenting with a first febrile seizure.
Screening for Intestinal Helminth Infestation in a Semi-Urban Cohort of HIV-Infected People in Uganda: A Combination of Techniques May Enhance Diagnostic Yield in the Absence of Multiple Stool Samples
Authors: Brown Michael , Bukusuba Joseph , Hughes Peter , Nakiyingi Jessica , Watera Christine , Elliott Alison , Whitworth James
Published: January 2017

Intestinal helminth prevalence is best determined by using multiple stool samples from each subject, but this may be difficult in the clinic or hospital setting. We used a range of well-established parasitological techniques in a study of interactions between helminth infestation and HIV in a cohort of 412 HIV-infected people in Entebbe, Uganda. Analysis of a single stool sample underestimated helminth prevalence, especially of low-intensity infections, but a combination of Kato-Katz smear, formol-ether concentration (FEC), charcoal culture for Strongyloides and a serum enzyme-linked immunosorbent assay for Schistosoma mansoni antigen (CAA) increased diagnostic yield. Helminths were diagnosed in 23% patients by FEC alone, 35% by FEC and Kato-Katz, 39% by FEC, Kato-Katz and charcoal culture and 49% by a combination of all three tests plus CAA. Performing a range of techniques on a single sample may enhance the detection of parasites. Techniques vary in their sensitivity for different helminths so the appropriate choice of techniques depends on which parasite species are being sought.
Bacterial Infections in Children with HIV/AIDS
Authors: Molyneux Elizabeth
Published: January 2017

HIV/AIDS affects over 850 000 children in Africa. Bacterial infections are frequent in this group of children. Pneumonia, meningitis and septicaemia are especially common, recurrent and most often caused by Streptococcus pneumoniae. Salmonella spp are the most frequently isolated causative agent of septicaemia in malarial areas. Soft tissue, eye and oral infections have a higher incidence in HIV-infected than uninfected children. In all instances the causative agents are not dissimilar from those that cause disease in HIV-uninfected children, but the mortality is greater. Increased bacterial resistance to first line antibiotics has been reported and the use of cotrimoxazole prophylaxis may further influence the resistance pattern of common bacteria.
Other Bacteria and HIV Disease
Authors: Gray K J , French N
Published: January 2017

HIV-infected individuals are predisposed to infection with bacteria, in particular Streptococcus pneumoniae and non-typhi Salmonella. Other bacteria also complicate HIV disease, either because they are inherently pathogenic — Staphylococcus aureus, Enterobacteraciae, bacterial agents of enteritis — or they take advantage of advanced immunosuppression — Rhodococcus spp, Nocardia spp. An understanding of the role of bacteria is essential to the care of HIV-infected patients.
Cold Saline Enema in Priapism - A Useful Tool for Underprivileged
Authors: Bansal Anand Rai , Godara Rajesh , Garg Pradeep
Published: January 2017

Priapism, prolonged painful erection of the penis, is a urological emergency. Untreated, the patient can end up with impotence. Various methods have been described for its treatment but the initial management remains conservative. This study presents our experience with the use of sedation followed by an ice-cold saline enema in the management of priapism.
Rapid Diagnosis of Bacterial Meningitis Using Nitrite Patch Testing
Authors: Maclennan C , Banda E , Molyneux E M , Green D A
Published: January 2017

Urine reagent strips have been used to test cerebrospinal fluid (CSF) in areas where laboratory facilities are unavailable. Protein, glucose and leukocyte esterase patches have been shown to be useful in this context. We propose that the nitrite patch also has a contribution to make: it could provide clinically useful information, at no extra cost. We tested CSF samples from 200 children with suspected meningitis. In a pragmatic approach chosen to reflect the clinical dilemma of whether or not to use parenteral antibiotics, the final laboratory diagnosis was dichotomized into either ‘bacterial meningitis'or ‘not bacterial meningitis’. These diagnostic categories were compared with nitrite patch results, which were either positive or negative. Nitrite patch testing of all CSF, clear CSF and bloody CSF gave positive likelihood ratios of 49, ‘infinity'and 5.8, respectively.
Assessing Prescribing Practice in Church-Owned Primary Healthcare (PHC) Institutions Intanzania: A Pilot Study
Authors: Nsimba S E D , Massele A Y , Makonomalonja J
Published: January 2017

A retrospective survey of prescribing patterns in 10 church-owned primary healthcare (PHC) institutions in Dar es Salaam region, Tanzania, was carried out by trained research assistants in order to assess the prescribing practices of healthcare providers in these institutions. From a total of 15 000 prescriptions, 600 were recorded randomly from patient registers retrospectively. This work was carried out between April to September 1996. Each prescription was recorded using World Health Organization Action Programme on Essential Drugs (WHO/DAP) forms and analysed manually. The average number of drugs per prescription was 2.9; the percentage encounters for injections and antibiotics was 38 and 71, respectively. Ninety-four per cent of all drugs were prescribed according to the essential drug list of Tanzania.
Non-Invasive Ventilation in the Management of Acute Respiratory Failure in Pakistan
Authors: Hussain Syed Fayyaz , Haqqee Raana , Iqbal Javed
Published: January 2017

Data were collected from hospital records on all patients who received non-invasive ventilation (NIV) during the period 1999-2000. Patients were treated with NIV if they had type I or type II respiratory failure or if they had respiratory distress with a respiratory rate above 30/min.

A total of 68 patients (35 males) were studied. NIV was applied using a Respironics Bi-PAP device mostly on a high-dependency unit (HDU). A successful outcome with NIV was achieved in 70% (26/37) of patients with type II failure, 65% (11/17) patients with type I failure and 64% (9/14) patients with respiratory distress. Of the 16 patients considered to be inappropriate for invasive ventilation on admission, eight were treated successfully with NIV.

NIV can be applied successfully in developing countries.
High-Energy Feeding for Protein-Calorie Malnutrition
Authors: Hone N M , Fermor J K
Published: January 2017

The efficacy of high-energy feeding regimens in the nutritional resuscitation of severely malnourished children is established, but most reports come from specialist units, We devised a high-energy feeding mixture using locally available ingredients and applied it in service conditions on 275 unse1ected children. After an initial stabilization period, children were fed 150 kcal/kg/day and protein 4 g/kg/day. The weight gain achieved for the whole series was 8.93 g/kg/day. For the different diagnostic categories the weight gains were: 12.11 g/kg/day for children with marasmic kwashiorkor; 10.01 g/kg/day for children with kwashiorkor; 7.49 g/kg/day for children with marasmus; and 6.39 g/kg/day for children who were underweight. The hospital case fatality was 4.4%. These figures show that rural hospitals can devise and apply high-energy feeding regimens and obtain results as good as those obtained in specialist units
Using Lot Quality Assessment Techniques to Evaluate Quality of Data in a Community-Based Health Information System
Authors: Galvao Loren , Kaye Katherine
Published: January 2017

We report here on the application of lot quality assessment (LQA) techniques by managers of a Save the Children (SC) Child Survival Project in Mbalachanda, Malawi, to evaluate data contained in a community-based health information system. By defining Mots' as the health records for all households with children under 5 years old which were listed on the rosters of village health promoters supervised by a given community health supervisor, and by establishing criteria for ‘acceptability’ of samples drawn from these lots, we were able to identify and offer additional supervision to health workers (supervisors as well as village health promoters) who were not performing adequately. As LQA sampling procedures require that only a small sample be drawn from each lot, the assessment could be conducted easily and quickly. Health workers were found to have the greatest need for help in updating demographic data and information about home-based oral rehydration therapy (ORT) training sessions, and the least for help in recording children's immunization status. We conclude that LQA can be a useful supervisory tool for health programme managers.
Cystic Fibrosis in the United Arab Emirates: An Under-Recognized Condition?
Authors: Dawson K P , Frossard P M
Published: January 2017

Cystic fibrosis has been previously reported in three children only in the United Arab Emirates (UAE). This paper describes 12 Emirati children with the condition seen in a 1 year period in one medical district of the country. The disease is present in the severe, multisystem form in the UAE and these observations suggest that it is more common and more severe than previously recognized.
Peripartum Cardiomyopathy: Experiences at King Edward VIII Hospital, Durban, South Africa and a Review of the Literature
Authors: Desai Dushyant , Moodley Jack , Naidoo Datshana
Published: January 2017

The clinical profile of patients with peripartum cardiomyopathy (PP-CMO) seen in the patient population in Durban, South Africa, is documented. Parameters such as age, multiparity, time of presentation and the role of hypertension in PP-CMO were evaluated. The study comprised 97 patients seen over a 4 year period. Group 1 ( n = 63), had a good outcome at follow-up and group II ( n = 34), had an adverse outcome, namely: persistently severe symptoms New York Hospital Association, Class III/IV; major thromboembolic complications; or a fatal outcome. These results confirm that PP-CMO is more likely to occur in the older and multiparous female. Increasing age and multiparity did not adversely affect outcome. Eighteen per cent of the study group were primiparous, and a third of these had an adverse outcome. Late presentation of symptoms (after 1 month postpartum) tended to favour an adverse outcome ( P = 0.06). Fifteen of the 19 patients with complete obstetric records had antenatal hypertension: in nine blood pressure levels were ≥ 160/110 mmHg. We were unable to ascertain the prognostic value of hypertension in PP-CMO. In conclusion, this study showed a high incidence of PP-CMO in the local African population (1: 1000 deliveries), and a high complication rate (35%): it suggests that early diagnosis and appropriate therapy may avert an adverse outcome.
Chloroquine-Resistant Plasmodium Falciparum Among Children in Calabar, South Eastern Nigeria
Authors: Antia-Obong O E , Alaribe A A A , Young M U , Bassy A , Etim B V
Published: January 2017

Sixty-nine children aged between 6 and 60 months with parasitologically proven Plasmodium falciparum malaria were treated with chloroquine (2.5 mg/kg) in the Children's Emergency Room of the University of Calabar Teaching Hospital (UCTH) in 1993. Thirty subjects (mean age 27.8 months) and 39 (mean age 29.5 months) received chloroquine phosphate suppository (Pharma Deko) and chloroquine sulphate syrup (May & Baker), respectively. The World Health Organization (WHO) 14-day in vivo field test was used in evaluating the response to treatment. In both treatment groups the responses were similar. Overall, parasitological cure occurred in 24 subjects (34.8%) and in the remaining 45 subjects (65.2%) treatment failed (chloroquine resistance). This level of chloroquine resistant Plasmodium falciparum (CRPF) is higher than 53.6% reported in this centre in 1989. Furthermore, in the present study the proportion of RII (46.4%) is significantly higher than 21.4% ( P < 0.02) obtained in 1989. Our findings show a worsening of CRPF in Calabar with RII being the main contributor. This observation indicates the need for continued surveillance of the response of P. falciparum to chloroquine and alternative antimalarials as a means of evolving an effective treatment policy for malaria.
Control of Tubercular Haemoptysis by Bronchial Artery Embolization
Authors: Mani Sanjeev , Mayekar Rajesh , Rananavare Ravi , Maniar Deepti , Joseph J Mathews , Doshi Amita
Published: January 2017

Thirty-seven patients presenting with massive or recurrent haemoptysis secondary to tuberculous aetiology were subjected to bronchial artery angiography. Of these, failure to catheterize the bleeding vessel occurred in two patients while embolization was withheld in two patients due to the presence of anterior spinal artery arising from a common intercosto-bronchial trunk. Immediate arrest of bleeding was performed in the remaining 33 patients by selective embolization of the abnormal bronchial arteries with a resorbable material (Gelfoam). Regular follow up for a duration of 6 months after the procedure revealed relapse of haemoptysis in four patients; three were treated by re-embolization of the abnormal bleeding vessels while one patient died due to aspiration immediately on admission. No recurrence of bleeding was seen in the remaining 29 patients.

It is concluded that bronchial artery embolization is an effective treatment for immediate control of life-threatening haemoptysis.
General Anaesthesia for Cleft Lip and Palate Surgery Team Activities in Cambodia
Authors: Ishizawa Yumiko , Handa Yujiro , Tanaka Katsuyuki , Taki Kazumi
Published: January 2017

Cleft lip and palate surgery team activities in Cambodia were launched in 1989 by a Japanese non-governmental organization. The objectives of the project were to provide appropriate surgical treatment and safe general anaesthesia for local patients, and also to teach general anaesthesia and surgery to local medical staff. A surgery team was sent on four occasions between 1991 and 1993 and a total of 130 patients received surgical treatment and general anaesthesia. Anaesthesia techniques employed included total intravenous anaesthesia in 70 patients and intravenous anaesthesia and low dose halothane in 60 patients. There were no major complications, such as airway obstruction or apnoea in the postoperative period.

Total intravenous anaesthesia is an appropriate technique for patients in developing countries. The teaching of anaesthesia should be emphasized during the surgery team activities.
Dermatology: A Useful Tool in a Depressed Economy
Authors: George A O
Published: January 2017

Dermatology is an aspect of medicine which can help produce a cheap and readily available tool for diagnosis, follow-up and epidemiologic study in a depressed economy such as in the developing countries of Africa and Asia. This would involve the provision of some dermatological training to students of medicine, nursing and other paramedical specialities, to allow maximum utilization of dermatology at the primary, secondary and even tertiary health institutions.
The Role of State Regulation in Consumer-Driven Health Care
Authors: Jost Timothy S. , Hall Mark A.
Published: January 2017

In December of 2003 the Medicare Modernization Act (MMA) added section 223 to the Internal Revenue Code, creating a federal tax subsidy for money contributed to (and earnings accumulated on) health savings accounts, or HSAs. Though public attention was largely focused at that time on the provisions of the MMA creating the new Medicare prescription drug benefit, the MMA was also a major victory for advocates of “consumer-driven health care” who believe that HSAs have the potential to control the cost and improve the quality of health care in the United States, and perhaps even to increase health care access.

Consumer-driven health care advocates believe that the key reason health care costs are out of control in the United States is that most Americans are too generously insured. They believe the solution is to increase consumer sensitivity to cost and effectiveness by making people spend their own money for health care.
FMRI and BF Meet FRE: Brain Imaging and the Federal Rules of Evidence
Authors: Pettit Mark
Published: January 2017

Picture this: a party to a lawsuit proposes to show jurors images of a human brain to support its claim or defense. The other party objects, and the trial judge must make a ruling. What determines how the judge will rule? That is the question I attempt to address.

I begin in Part II by describing very briefly some existing methods of brain imaging—how they work and what they try to do—and cataloging some possible uses of these methods in courtrooms. Part III discusses current legal standards of admissibility of scientific evidence under the Federal Rules of Evidence (FRE). Part IV examines the particular problem of scientific evidence offered to establish that a person was or was not telling the truth. Part V provides a brief history of some past attempts to introduce brain-imaging evidence into courtrooms. The article concludes with some general comments on the issues facing judges when parties to lawsuits offer brain-imaging evidence.
Cost-Benefit Federalism: Reconciling Collective Action Federalism and Libertarian Federalism in the Obamacare Litigation and beyond
Authors: Moncrieff Abigail R.
Published: January 2017

The lawsuits challenging Obamacare’s individual mandate have exposed a rift in federalism theory. On one side of the divide is a view that the national government ought to intervene—and ought to be constitutionally permitted to intervene—whenever the states are “separately incompetent” to regulate a particular subject. According to this view, the primary purpose of the Constitution’s enumeration of national powers is to authorize Congress to fix collective action problems among the states. Borrowing from Robert Cooter and Neil Siegel’s article of the same name, I refer to this view as “collective action federalism.” On the other side of the divide is a view that federalism exists for reasons other than efficiency of regulation and particularly that the Founders created the federal structure for the protection of individual liberty. According to this view, there is inherent value to state power that ought to be preserved against national encroachments.
Lithium and Symptomatic Hyperparathyroidism
Authors: Ananth Jambur , Dubin Stephen E
Published: January 2017

Hyperparathyroidism with or without adenoma has occasionally been reported in association with lithium treatment, and in symptomatic patients depression, psychosis and an exacerbation of existing psychopathology may occur. Three lithium-treated patients with hyperparathyroidism are reported, in whom discontinuation of lithium in one and removal of parathyroid adenomata in two led to both a reduction in plasma calcium levels and an improvement in their psychopathology.
Locked Knee and Osteochondritis Dissecans
Authors: Elsworth Christopher
Published: January 2017

Two patients presenting with a locked knee are described. In both cases a loose body from an osteochondritis dissecans defect had wedged beneath the anterior horn of the lateral meniscus, creating a block to extension which could not be reduced. Arthroscopy and arthroscopic methods proved unsuccessful in the removal of the loose body.
Techniques in Evacuation Proctography in the Diagnosis of Intractable Constipation and Related Disorders
Authors: Roe A M , Bartolo D C C , Mortensen N J McC
Published: January 2017

A technique of evacuation proctography using a simple barium and air mixture is described. The study can be easily combined with a barium enema examination. A series of 35 patients with intractable constipation have been studied and compared with 7 controls. Most of the abnormalities seen using more elaborate methods of defaecography were identified. Variants of rectal intussusception were found in 16 patients. Other diagnoses included rectocele, mucosal and full rectal prolapse, accentuation of puborectalis impression and solitary rectal ulcer. The technique should prove useful in the management of patients with disorders of defaecation.
Event-triggered and self-triggered control for linear systems with actuator saturation
Authors: Zuo Zhiqiang , Li Qingsong , Li Hongchao , Wang Yijing
Published: January 2017

In this paper, both event-triggered and self-triggered transmission strategies are proposed for dynamical systems subject to actuator saturation. The designed triggering condition, which is expected to save more network resources, is closely related to the cases where either the actuator saturates or it does not. The linear quadratic optimal control method is utilized to guarantee the asymptotic stability of the closed-loop systems. Global and local stability results are considered, respectively. For local stability, two sufficient conditions are presented to derive the asymptotic stability region. The minimum inter-transmission time of the proposed triggering mechanism is explicitly formulated to eliminate the Zeno behaviour. Finally, an example is provided to demonstrate the effectiveness of the theoretical results.
Error minimizing linear regulation for discrete-time systems
Authors: Ali Rahat , Malik Mohammad Bilal , Malik Fahad Mumtaz , Liaqat Muwahida
Published: January 2017

This paper presents error minimizing linear regulator (EMLR) for discrete-time, time invariant linear systems. The control objective is tracking of reference signal and rejection of disturbances. EMLR design is based on minimization of a quadratic cost function using canonical form of plant model. The proposed control scheme is based on analytical solution applicable for arbitrary initial conditions. In addition, the control design does not require formulation of Linear Matrix Inequalities and Riccati equations, which are otherwise typical requirements of regulators. Stability analysis of the closed loop system using EMLR is presented along with simulation results for regulation of discretized model of underactuated fourth-order ball and beam system.
Applying First-World Psychological Models and Techniques in a Third-World Context
Authors: Brownell A.J.J. , De Jager A.C. , Madlala C.F.M.
Published: January 2017

Aspects of the indigenous healing system in contemporary South African society

Anthropological research in recent years has clearly shown that health service programmes of technologically advanced societies cannot simply be transplanted to developing societies without taking specific cultural factors into account (Loudon, 1976; Kleinman, 1980; Jansen, 1982). The extensive practice of traditional healing in South Africa has long been established and appears to be gaining momentum (Holdstock, 1979). The different needs of First- and Third-world peoples within South Africa, as manifested in the existence of cultural-specific mental health care and educational systems, are indeed compelling reasons for examining the situation.
Rethinking Development in Latin America: The Search for Alternative Paths in the Twenty-first Century
Authors: Sankey Kyla , Munck Ronaldo
Published: January 2017

In this article, we critically engage with the attempts to construct alternative, post-neoliberal development paths by left and center-left governments in Latin America. While there is a significant degree of diversity between these governments, their development agendas share the common goal of countering the neoliberal disembedding of markets and re-subordinating the economy to society through protective measures promoting social equality, democratization, greater national sovereignty, and regional integration. Within this broad objective, two main currents have emerged. On the one side, there have been attempts to re-engage with traditional problems of development, including economic growth, structural reform, state intervention, control of national resources, regional integration, and social inclusion; on the other side, a more radical sociopolitical project has attempted to develop a different path altogether for re-embedding the economy, one that separates development from its consumerist, materialist, and Western-centric associations of the past in favor of a new form of human development and societal transformation that has engaged with notions of democratic participation, indigenous rights, feminism, and radical ecology. However, over 15 years since its initial emergence, this social and political project appears to be reaching a new turning point characterized by economic decline and political disintegration. In this article, we take the opportunity to assess the efforts that have been made in the search for a new development model. We argue that while significant strides have been taken in the direction of counteracting neoliberal disembedding, the recent downturn has unveiled the cracks and tensions in the attempt to achieve more profound economic and societal transformations for re-embedding the economy.
China’s South–South Cooperation with Latin America and the Caribbean
Authors: Harris Richard L. , Arias Armando A.
Published: January 2017

Since the formation of the People’s Republic of China (PRC) in 1949, China’s political leaders have given priority to securing the country’s sovereignty, national unification, and territorial integrity. This has involved pursuing foreign relations that contribute to an international environment that is conducive to the country’s peaceful development as a prosperous socialist society. In pursuing these strategic goals, the Chinese government and state-owned corporations seek to establish economic and political relations with the Latin American and Caribbean (LAC) countries that are based on the principles and practices of South–South cooperation (SSC). This essay focuses on the extent to which China’s relations with these countries contribute to their mutual benefit, promote their common development, and support the formation of a new multipolar world order based on peace, mutuality, equity, environmental sustainability, and international cooperation.
Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis
Authors: Eren Erdem , Kalkan Toygar , Arslanoğlu Seçil , Özmen Mustafa , Önal Kazım , Tarhan Emine Figen , Akar Servet
Published: January 2017

Objective

To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA).

Study Design

A cross‐sectional study.

Setting

A tertiary university hospital.

Subjects and Methods

A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient’s diagnosis.

Results

Univariate analysis indicated a statistically significant difference in rhinorrhea (P =. 002), postnasal drip (P =. 015), epistaxis (P <. 001), and saddle nose (P =. 017). However, binary logistic regression analysis demonstrated that only history of epistaxis (P =. 012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion (P =. 028), nasal septal perforation (P <. 017), nasal crusting (P <. 001), nasal adhesion (P <. 001), nasal granuloma (P =. 017), and hemorrhagic fragile nasal mucosa (P <. 001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa (P <. 001; odds ratio, 52.9) was a statistically significant predictor of GPA.

Conclusions

Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.
Total arch replacement through a median sternotomy for Kommerell’s diverticulum
Authors: Goto Yoshihiro , Koyama Yutaka , Hosoba Soh , Ogawa Shinji , Fukaya Shunsuke , Okawa Yasuhide
Published: January 2017

Kommerell’s diverticulum with a right aortic arch and aberrant left subclavian artery is a rare anomaly, and the optimal operative strategy has not yet been established. In particular, the approach to the diverticulum is controversial, with the greatest concern being whether or not to add a right thoracotomy to the median sternotomy for distal anastomosis. We successfully performed total arch replacement through a median sternotomy only, by referring to preoperative computed tomography. We think that if the aneurysm is in a shallow position from the tracheal bifurcation, total arch replacement is possible with a midline incision only.
Evaluation of Compression Therapy: Comparison of Three Sub-bandage Pressure Measuring Devices
Authors: Ruckley C. V. , Dale J. J. , Gibson B. , Brown D. , Lee A. J. , Prescott R. J.
Published: January 2017

Objective:

To compare the consistency of the pressure measurements and the practical aspects of three manometers (Salzman MST; Oxford Talley and Diastron) measuring sub-bandage pressures.

Methods:

Five bandages (tubular elastic straight, tubular elastic graduated, short stretch non-elastic, long stretch elastic, cohesive elastic) were applied to standard models comprising foam-covered 9.5 cm, 12.5 cm diameter plastic tubes and a cone by a single expert bandager using a standard spiral technique with 50% overlap for the non-tubular bandages (NTB). The probes of all three machines were positioned at equidistant points around the circumference of each model at three levels corresponding to the ankle, gaiter and mid-calf measuring points of the MST probe. Two readings were taken for each of three separate applications of each bandage. Statistical analysis utilised ANOVA with Bartlett's test.

Results.

A total of 135 readings were made for each machine and 81 for each type of bandage. Mean pressures among the five bandages types ranged from 12.2 to 35.5 mmHg. A pressure gradient was apparent when NTB bandaging the straight tubes (means 24.7, 23.5, 22.4 mmHg) but not with the cone. There was a statistically significant difference between the three machines (Bartlett's test 23.6, p<0.0001), with the lowest variances for the MST and similar variances for the Oxford and Diastron.

Conclusion.

In terms of measurement variance this experiment indicates that the MST is the preferred machine for future experiments.
High Tie with Sclerotherapy for Saphenous Vein Insufficiency
Authors: Neglén Peter , Einarsson Eibert , Eklöf Bo
Published: January 2017

The long-term results after treatment of primary varicose veins with a combination of compression sclerotherapy (CST) and high tie of the incompetent long saphenous vein were studied. Sixty-three legs in 60 patients were operated on. Subjective (by the patient), objective (by the surgeon) and functional (by foot volumetry) assessments were performed just after treatment, 6 months and 1, 3 and 5 years later. The immediate subjective results were excellent but objectively 21% of the patients still had residual varicosities. After 5 years 50% were subjectively well but only 16% of the legs were objectively cured. Among the foot volumetric parameters the expelled volume (EV; ml) and refilling flow/relative expelled volume ratio (Q/EVrel; min−1) best reflected the functional state. Mean EV increase was 56% after treatment but only 16% after 5 years. Q/EVrel normalized initially but deteriorated after 1 year. No significant improvement in any parameter was observed after 5 years. CST combined with high tie cannot replace surgery in patients with main stem insufficiency. The results emphasize the importance in following these patients for at least 5 years. On the whole, functional evaluation with foot volumetry was valuable to assess groups but could not replace the examination of individual patients.
A Simple Doppler Technique for the Rapid Diagnosis of Significant Sapheno-Femoral Reflux
Authors: Milliken J.C. , Dinn E. , O'Connor R. , Greene D.
Published: January 2017

The clinical diagnosis or sapheno-femoral incompetence is frequently inaccurate. Using a simple Doppler technique described below 94% of 155 limbs in 107 patients were correctly diagnosed. In the same group of patients the cough impulse test gave an accurate positive result in only 79%, while in the first 100 limbs of the series tourniquet and tap tests were even less reliable. Since the Doppler technique is readily applicable to large numbers of patients it is concluded that it will be of use in distinguishing those in whom surgery is required from others in whom compression sclerotherapy will be effective.
The Toxicity of Commonly Used Antiseptics on Fibroblasts in Tissue Culture
Authors: Deas Judith , Billings Peter , Brennan Sean , Silver Ian , Leaper David
Published: January 2017

We have allowed the liberal use of antiseptics for wound care to become an established practice with little consideration of any toxicity on exposed healing tissues. The care of open wounds and chronic ulcers is largely delegated to nursing staff with little help or advice from their medical colleagues. Alexander Fleming felt that antiseptics would only be of benefit in septic wounds if they stimulated or conserved natural defence mechanisms! He also regarded the assessment of tissue toxicity as being more important than any antimicrobial effect but there has been little research into this field.