bluuebunny/crossref_metadata_2025 huggingface dataset:
Level of Soft Skill in the Implementation of Work-Based Learning among Community College Students
Authors: Ali Azita Binti , Mahmod Shuhada
Published: February 2018

The issue of graduate unemployment often crops up in the mass media; and more often than not, the discussions have centred on the failure of tertiary educational institutions to churn out quality graduates. Thus, the method of work-based learning (WBL) is seen as a way to improve the soft skills of the graduates. The study was conducted using quantitative research survey; the design of the study used an adapted questionnaire as an instrument. Data were analysed using Statistical Package of Social Science (SPSS) version 20. The respondents consisted of 97 students who attended WBL programmes at a community college. Descriptive statistics was used to extract data from the questionnaires for the calculation of mean. The findings reveal that the level of soft skills among community college students was high, and they include these abilities: communication skills, problem-solving skills, learning and information management, professional ethics skills and leadership skills.
A Descriptive Study towards Green Computing Practice Application for Data Centers in IT Based Industries
Authors: Anthony Jnr. Bokolo , Abdul Majid Mazlina , Romli Awanis
Published: February 2018

The progressive upsurge in demand for processing and computing power has led to a subsequent upsurge in data center carbon emissions, cost incurred, unethical waste management, depletion of natural resources and high energy utilization. This raises the issue of the sustainability attainment in data centers of Information Technology (IT) based industries. Green computing practice can be applied to facilitate sustainability attainment as IT based industries utilizes data centers to provide services to staffs, practitioners and end users. But it is a known fact that enterprise servers utilize huge quantity of energy and incur other expenditures in cooling operations and it is difficult to address the needs of accuracy and efficiency in data centers while yet encouraging a greener application practice alongside cost reduction. Thus this research study focus on the practice application of Green computing in data centers which houses servers and as such presents the Green computing life cycle strategies and best practices to be practiced for better management in data centers in IT based industries. Data was collected through questionnaire from 133 respondents in industries that currently operate their in-house data centers. The analysed data was used to verify the Green computing life cycle strategies presented in this study. Findings from the data shows that each of the life cycles strategies is significant in assisting IT based industries apply Green computing practices in their data centers. This study would be of interest to knowledge and data management practitioners as well as environmental manager and academicians in deploying Green data centers in their organizations.
Environmental Balance Management In Nonformal Education Learning
Authors: Rahmat Abdul , Suryanto Tulus , Rahim Supli Effendi
Published: February 2018

This study aims to determine the direct effect of the learning environment on the learning outcomes about environmental balance, interest in learning on the results of learning about environmental balance, and learning environment learning to interest in learning. This research is a survey research using path analysis technique with the sample of research is student package C in SKB BonebolangoGorontalo 2016/2017 Lesson Year, which amounts to 60 people. There are three variables that are used as research objects, namely two exogenous variables that include learning environment and interest in learning and endogenous variable that is the result of learning about environmental balance. The results of the study indicate that: (a) there is a positive direct effect of the learning environment on the learning outcomes of environmental balance, (b) there is a direct positive influence of interest on the learning outcomes of environmental equilibrium, (c) there is a direct positive influence of the learning environment on learning interest, d) there is an indirect influence of the learning environment on learning outcomes through interest in learning.
Patient’s Behaviour with Coronary heart desease Viewed from Socio-Cultural aspect of Aceh Society in Zainoel Abidin Hospital
Authors: Marniati  , Notoatmodjo Soekidjo , Kasiman Sutomo , Rohadi R kintoko
Published: February 2018

Coronary heart disease (CHD) is a chronic inability of heart to draw an adequate blood on myocardium due to specific problem in coronary artery. When the artery that supplies myocardium is interrupted, thus the heart is unable pumping the blood effectively to fill up an adequate blood perfusion to vital organs and other peripheral tissues. If the perfusion is impaired in time of oxygenation, the patient will threatened by a sudden death. This is a quantitative, analytical and observational research with a design of case study control, in which the subject is CHD patients and the control is non-CHD patients. The research populations were 2318 outpatients with CHD who visited Heart Polyclinic at Zainoel Abidin Hospital Banda Aceh. The sample studied were 92 patients with CHD and 92 patients with non-CHD (control). We used primary and secondary data that processed through editing, coding, entry, cleaning and tabulating. The data was analyzed using univariate, bivariate and multivariate analysis. The results showed that the CHD occurrences are significantly influenced by eating behavior (p = 0,000), smoking habit (p = 0,000) and sporting habit (p = 0,000). Therefore, health workers are expected to increase health promotion in order to improve the quality of life of people, especially in elderly people, by adopting a healthy lifestyle and avoiding CHD risk factors. Moreover, people are also suggested to take regular lipid profile check up and keep off smoking habit in order to do early prevention of CHD.
Screening Drug, Alcohol and Substance Abuse the Psychometric Measures
Authors: Othman Mohamad Hashim , Hussin Huzili , Hussin Kamarudin , Alias N.S.
Published: February 2018

Urinalysis was used in previous studies among higher institution students (n=16252) in Malaysia to answer the question of whether university students are involved in drug abuse. However, the use of urinalysis had faced some problems. The problems were related to human rights issues and the cost to perform the urinalysis was expensive and quite impossible to be implemented to a large population of university students. To overcome this problem, this study was conducted to examine the effectiveness of psychometric measures in screening drug, alcohol and substance abuse. The Substance Abuse Subtle Screening Inventory A2 (SASSI-A2) was used for this purpose. SASSI-A2 is a brief screening tool designed to identify individuals who have a high probability of having a substance use disorder, including both substance abuse and substance dependence. SASSI-A2 comprises of 72 items that are rated on a two point scale with response; true and false. SASSI-A2 was translated into Malay language and it was refined through a back-translation technique and focus group approach. Psychometric testing was undertaken on a sample of 750 university students from five public universities in Malaysia. All participants were aged between 19 and 20 years. Internal consistency coefficients were calculated for the total scale and its subscales. Chronbach's alpha obtained for SASSI-A2 was 0.72. This relatively high level of Chronbach's alpha showed relatively high level of reliability. The results demonstrated that the whole SASSI-A2 meets the fundamental measurement properties and can discriminate groups of higher institution students from high to low on the substance dependency variable. The accuracy of the test has been found to be unaffected by gender, ethnicity, age and years of education. Although more rigorous validation studies are needed, it is recommended that SASSI-A2 be considered for usage to higher institution students populations when a brief, objective, and accurate screening tool for chemical dependency is needed.
Problem-based Learning (PBL) in Sociolinguistics as a Way of Encouraging Active Learning
Authors: Engku Ibrahim Engku Haliza
Published: February 2018

The major concern of this paper is to advocate the integration of PBL strategies in classroom instruction as a way of promoting active learning. It is undoubted that the benefits of problem-based learning (PBL) are numerous. In the sciences, PBL has been well integrated in the curriculum. This research reports of an experience of integrating problem-based learning in an introductory Sociolinguistics course for 60 undergraduates of a Bachelors of English programme through a semester that ran for 14 weeks. A focused group interview and questionnaire were used to find out the perceptions of the students undergoing the hybrid PBL course. The findings of this study reveal that students generally enjoyed the PBL approach and found that they had little choice but to become active learners. Some challenges faced by the learners were also highlighted. These findings have implications for the integration of PBL in the field of social sciences.
Teaching Styles, Learning Styles and the ESP Classroom
Authors: Mei Ph’ng Lee
Published: February 2018

Learner diversity that exists in the classroom plays a role in influencing the teaching and learning process in the classroom. It should be acknowledged in order for the teaching and learning process to be a meaningful and effective process. Thus, this study examined the learning styles preference of engineering students and the teaching styles preferences of their Technical Communication lecturers. The study also looked at whether the students’ learning styles preferences were influenced by their field of study, gender and ethnic backgrounds. Felder and Solomon’s Index of Learning Styles was administered to 588 engineering students while Grasha and Riechmann-Hruska’s Teaching Style Survey was administered to 10 Technical Communication lecturers. The findings revealed that the students have a marked preference for the visual learning style but balanced preferences for the other learning styles dimensions. The students’ field of study, gender and ethnic backgrounds did not seem to influence the students’ learning styles preferences. As for their Technical Communication lecturers, they seem to favour the student-centered teaching approach. All the data support the notion of adopting a balanced teaching approach in the Technical Communication classroom.
Effect of torrefaction pre-treatment on physical and combustion characteristics of biomass composite briquette from rice husk and banana residue
Authors: Amira Atan Nor , Mohamed Nazari Munira , Ayuni Azizan Fathin
Published: February 2018

Biomass is an alternative renewable energy sources that can generates energy almost same as fossil fuel. The depletion sources of fossil fuel had increase the potential use of biomass energy. In Malaysia, rice husk and banana residues are abundantly left and not treated with proper disposal method which later may contribute to environment and health problems. Thus the development of biomass composite briquette made from rice husk and banana residue is one of the potential ways to reduce the problems and hence may contribute the better way to treat the waste by recycling the waste into a form of biomass product. The biomass briquettes are used for thermal applications because it can produce a complete combustion as it has a consistent quality and high burning efficiency. However, the quality of the biomass briquette can be added by application of torrefaction pre-treatment method. Torrefaction is a thermal method that can produce more high quality of the briquette with high calorific value, high fixed carbon content, low volatile matter, and low ash content. This study was conducted to assess the physical and combustion characteristic of the biomass briquette from rice husk and banana residue which was produced through torrefaction process. The biomass briquette, were densified by using hot press machine with temperature of 180°C for about 30 minutes. The briquette produce are 150 μm in particle size with varies in mixing ratio of rice husk to banana residue which are 100:0, 80:20 and 60:40. After the briquetting process, the biomass fuel briquettes have been undergoes parameter testing and the data have been analysed. Result showed the best biomass briquette is developed from torrefied rice husk and banana residue mixed at ratio of 60:40. Moreover, SEM image reveal that torrefaction pre-treatment has shrinkage the fibres size which confirming the thermal stability of the briquette.
A Network Coding-Aware Directional Broadcast Routing Scheme for VANET
Authors: Omar Normaliza , Yaakob Naimah , Farook Rohani S.M. , Husin Zulkifli , Md Zain Aini Syuhada , Elshaikh Mohamed , Abdul Halim Aznor Hanah
Published: February 2018

Recent technological advancements in wireless communications are fundamentally changing the manner by which devices communicates with one another. Modern wireless devices build networks on their own and aid each other in passing information to any device in the network. The aim of this research is to design and develop a robust routing protocol using network coding technique for Vehicular ad hoc networks (VANET). The purpose of the protocol is to disseminate vehicular traffic to the vehicles approaching the problem area, rather than those leaving the problem area. The designed protocol during the research will be more robust, reliable, and efficient with topology change. In this research, network coding and geographical routing models will be used to develop network coding based VANET routing protocol for alerting vehicles approaching the accident area and emergency message dissemination. The network coding model assumed will serve to increase throughput, in this sense reducing packet loss which will provide a robust broadcast routing protocol.
Tourism Led-Inflation: A case of Malaysia
Authors: Shaari M. S. , Tunku Ahmad T. Salha , Razali R.
Published: February 2018

The importance of the tourism industry has prevailed among developed and even developing countries. It has been perceived to be an important contribution to economic growth. However, in the proliferation of studies on inflation, information on the extent to which tourism industry able to influence inflation, is still sparse. Therefore, this study embarks on investigating tourism as a potential factor towards inflation. Data on consumer price index and the number of tourist arrival from 1986 until 2014 are used in the analysis. This study adopts a quantitative approach employing the Autoregressive Distributed Lag (ARDL) approach. Several controlled variables such as money supply, economic growth, government expenditure, and interest rate are also included. The results suggest that the tourism industry plays an important role in determining inflation in both short-and long-runs. Therefore, governments should take proactive measures in ascertaining that any expansion of the tourism industry can avert inflation.
Oral Hygiene Improvement using Combined Mouthwash with Plant extracts
Authors: Makky Essam A. , Ali Muna J. , Yusoff Mashitah M.
Published: February 2018

Dental caries considered as one of the most common infectious diseases affecting mankind today, the dissolution of tooth structure by acid produced as a result of the fermentation of dietary carbohydrates by oral bacteria. The antimicrobial susceptibility of medicinal plants including black pepper, black cumin, cinnamon, cardamom on toothpaste and mouthwash against oral isolates for healthcare improvement was studied. Different oral isolates from 50 selected individuals aged 3 to 60 years were obtained from both genders, and a total of 59 bacterial and yeast isolates were collected, purified, and tested against four different commercial medicinal plants extracts for antimicrobial susceptibility profile. A total of 10 mouthwashes was purchased, and the combined action of the medicinal plants with mouthwash was studied against oral isolates. We found a higher bacterial population was in the age group of 3–40 years than other two groups, with approximately 44%. In addition, the combined action of acetone plant extracts (alone) against oral isolates showed increasing effect profile up to 61.02% when combination A (Ci/N) was added. Also, While, the combined action of medicinal plants with mouthwash was improved 100% with combination C. We conclude that the combination C (P/N/Ca/Ci) with mouthwash showed high susceptibility against oral isolates.
Implementation of Estrus Synchronization and Artificial Insemination Program (GBIB) in West Waringin Kota District, Central Kalimantan Province of Indonesia
Authors: Kristiana Tresia , Hafid Harapin
Published: February 2018

The government has launched a program of self-sufficiency in meat as an effort to overcome the shortage of beef supply to meet the needs of the community, especially when the day of religious festivities. GBIB program Implementation is expected to meet the needs of the community will be beef, as demand for beef is always soaring demand every year, especially ahead of religious festivals. To discuss and review the implementation of the program stretcher author uses the theory EDWARDS III to determine the success or failure of the implementation of the program in the district of Kota Waringin Barat. Issues to be examined are 1) the quality and quantity of resources, 2) communication and dissemination program, 3) Attitude 4) Bureaucracy. This will be the focus to see the successful implementation of the program of snapping / sync Lust and optimize of GBIB in the district of Kota Waringin. This study uses the concept of a qualitative descriptive approach with the aim of providing an overview of how the implementation of the field program and then analyzed using the theory of Edwards III. The results of this study show that: 1) Aspects of Resource (HR, Information, Privileges and amenities), some support as the support means the production of drugs / vitamins and breeding stock (straw) superior adequate and well as the authority and the information available is quite good, while some aspects that do not support such as: HR, execution time, geographical conditions, transport facilities support, 2) aspect Communications (Transmission, Clarity, Consistency and Coordination) strongly supports the implementation of the program GBIB is 3) aspects of attitude (attitude implementer, Support Leader, Incentives for implementing and Transparency), relatively supportive in this program, and 4) Structural Aspects of Bureaucracy (SOP and Fragmentation) still do not support the implementation of the Program snapping Sexual arousal and this Artificial Insemination.
Epilepsy Outcome in Cooled Hypoxic–Ischemic Encephalopathic Newborns
Authors: Podestà Barbara , Briatore Eleonora , Boghi Andrea , Pomero Giulia , Gozzoli Luigi , Pellegrino Gianpaolo , Calzolari Stefano , Marchiò Giuliana
Published: February 2018

Epilepsy is a frequent consequence of neonatal hypoxic–ischemic encephalopathy. It is not yet known if the introduction of therapeutic hypothermia modifies the rate and the characteristics of epilepsy. We report on 59 infants who suffered from hypoxic–ischemic encephalopathy and underwent therapeutic hypothermia. Birth, physiological and biochemical data, frequent electroencephalography (EEG) recordings or continuous EEG monitoring, and magnetic resonance imaging (MRI) were documented in the neonatal period. Prechtl's General Movements evaluation was performed and the Griffiths Scales of Mental Development were applied at 3 and 24 months of age, respectively. Children were followed up for at least 3 years (mean 5 ± 1.6 years). Six children (10%) developed epilepsy. All of them had a severe hypoxic–ischemic encephalopathy and were neurologically impaired at 2 years of age. Furthermore, all of them had a severe pattern of MRI injury and poor neonatal EEG backgrounds. Four of them suffered from neonatal status epilepticus. Four out of six showed a similar epileptic pattern: their epilepsy started early; it was drug resistant; it required an aggressive polytherapy; and it showed a spontaneous improvement after 2 years. The rate of epilepsy in our cooled infants was similar to those reported in other studies on noncooled ones. Only severe hypoxic–ischemic encephalopathy predisposed the cooled infants toward epilepsy. Neonatal status epilepticus and persisting poor EEG backgrounds were predictive of the development of epilepsy in our sample.
The Role of a Single Dose of Vancomycin in Reducing Clinical Sepsis in Premature Infants Prior to Removal of Peripherally Inserted Central Catheter: A Retrospective Study
Authors: George Lovya , Malloy Michael , Fonseca Rafael , Bhargava Vidit
Published: February 2018

Objective Peripherally inserted central catheter (PICC) line removal is associated with bloodstream infections and clinical sepsis. We aim to investigate the role of a single prophylactic dose of vancomycin in decreasing the incidence of central line associated bloodstream infection associated with PICC removal.

Methods A retrospective chart review of patients in the neonatal intensive care unit was conducted. Patients were divided into two study groups based on whether a single dose of vancomycin was administered (exposed) or not (nonexposed). The primary outcome measured was clinical sepsis with or without positive blood culture.

Results The incidence of clinical sepsis in the exposed group was 7.3% compared with 6.3% in the nonexposed group (p-value: 0.7860). The incidence of culture-positive sepsis in the exposed group was 2.2% compared with 1.6% in the nonexposed group (p-value: 0.7673). The overall incidence of clinical and culture-positive sepsis in the subgroup with infants weighing <1,500 g and <32 weeks' gestational age was similar to the main study group.

Conclusion Our data do not support routine vancomycin prophylaxis prior to PICC line removal in premature infants to prevent sepsis associated with PICC removal. However, a large randomized controlled trial is further needed to delineate these results.
Association between Forefoot Bone Length and Performance in Male Endurance Runners
Authors: Ueno Hiromasa , Suga Tadashi , Takao Kenji , Tanaka Takahiro , Misaki Jun , Miyake Yuto , Nagano Akinori , Isaka Tadao
Published: February 2018

Recently, we reported that the forefoot bones were longer in sprinters than in non-sprinters, and that longer forefoot bones correlated with higher sprint performance in sprinters. To further understand the superiority of long forefoot bones in athletic performance, we examined whether forefoot bone length was associated with running performance in endurance runners. The length of the forefoot bones of the big and second toes were measured using magnetic resonance imaging in 45 male well-trained endurance runners and 45 male untrained subjects. After normalization with the foot length, it was found that the forefoot bones of the big and second toes were significantly longer in endurance runners than in untrained subjects (P<0.05 for both). Furthermore, longer forefoot bones of the big toe, but not of the second toe, correlated significantly with better personal best 5000-m race time in endurance runners (r=−0.322, P=0.031). The present findings demonstrated that forefoot bones were longer in endurance runners than in untrained subjects. These findings were similar to our findings for sprinters. In addition, we found that longer forefoot bones may be advantageous for achieving higher running performance in endurance runners.
Dielectrophoresis-based microfluidic platforms for cancer diagnostics
Authors: Chan Jun Yuan , Ahmad Kayani Aminuddin Bin , Md Ali Mohd Anuar , Kok Chee Kuang , Majlis Burhanuddin Yeop , Hoe Susan Ling Ling , Marzuki Marini , Khoo Alan Soo-Beng , Ostrikov Kostya (Ken) , Rahman Md. Ataur , Sriram Sharath
Published: February 2018

The recent advancement of dielectrophoresis (DEP)-enabled microfluidic platforms is opening new opportunities for potential use in cancer disease diagnostics. DEP is advantageous because of its specificity, low cost, small sample volume requirement, and tuneable property for microfluidic platforms. These intrinsic advantages have made it especially suitable for developing microfluidic cancer diagnostic platforms. This review focuses on a comprehensive analysis of the recent developments of DEP enabled microfluidic platforms sorted according to the target cancer cell. Each study is critically analyzed, and the features of each platform, the performance, added functionality for clinical use, and the types of samples, used are discussed. We address the novelty of the techniques, strategies, and design configuration used in improving on existing technologies or previous studies. A summary of comparing the developmental extent of each study is made, and we conclude with a treatment of future trends and a brief summary.
Hall effects on unsteady MHD oscillatory free convective flow of second grade fluid through porous medium between two vertical plates
Authors: VeeraKrishna M. , Subba Reddy G. , Chamkha A. J.
Published: February 2018

The effects of radiation and Hall current on an unsteady magnetohydrodynamic free convective flow in a vertical channel filled with a porous medium have been studied. We consider an incompressible viscous and electrically conducting incompressible viscous second grade fluid bounded by a loosely packed porous medium. The fluid is driven by an oscillating pressure gradient parallel to the channel plates, and the entire flow field is subjected to a uniform inclined magnetic field of strength Ho inclined at an angle of inclination α with the normal to the boundaries in the transverse xy-plane. The temperature of one of the plates varies periodically, and the temperature difference of the plates is high enough to induce the radiative heat transfer. The effects of various parameters on the velocity profiles, the skin friction, temperature field, rate of heat transfer in terms of their amplitude, and phase angles are shown graphically.
Description and Outcomes of a Buprenorphine Maintenance Treatment Program Integrated within Prevention Point Philadelphia, An Urban Syringe Exchange Program
Authors: Bachhuber Marcus A. , Thompson Cole , Prybylowski Ann , Benitez José , Mazzella Silvana , Barclay David
Published: February 2018

Background

Syringe exchange programs are uniquely positioned to offer treatment services to interested clients. Prevention Point Philadelphia recently expanded to offer buprenorphine maintenance treatment through its Stabilization, Treatment, and Engagement Program (STEP). Objective: To describe the STEP model of care and report treatment outcomes.

Methods

Retrospective chart review of patients enrolled in STEP (October 2011-August 2014). Our main outcome measure was time retained in treatment, defined as time from treatment initiation to treatment failure. Secondary outcome measures were buprenorphine and opiate use, from urine toxicology screens. We analyzed retention in treatment using Kaplan-Meier survival estimates; patients who remained in treatment at the end of the study period were censored on that day. For buprenorphine and opiate use, we calculated the percentage of patients who were positive for buprenorphine and opiates in each month of treatment.

Results

Of the 124 patients enrolled in STEP, the median age was 41 (range 21 to 63) and 80% reported injection heroin use. Comorbidities were common: 33% had HIV infection, most reported anxiety (78%) or depression (71%), and 20% were homeless. The most common program outcomes were unplanned self-discharge ( n = 29; 23%), incarceration ( n = 20; 16%), and administrative discharge ( n = 19; 15%). The percentage of patients retained in treatment at 3, 6, 9, and 12 months was 77%, 65%, 59%, and 56%, respectively. Among those retained, the percentage with a positive buprenorphine screen at 3, 6, 9, and 12 months was 88%, 100%, 96%, and 95%, respectively. The percentage with a positive opiates screen was 19%, 13%, 17%, and 16%, respectively.

Conclusions

With a program that blended organizational and community resources, retention in buprenorphine maintenance treatment was comparable to retention rates reported from other settings. Further research should directly compare treatment outcomes in syringe exchange program-based settings versus primary care and specialty settings.
Xylanase and feruloyl esterase from actinomycetes cultures could enhance sugarcane bagasse hydrolysis in the production of fermentable sugars
Authors: Rahmani Nanik , Kahar Prihardi , Lisdiyanti Puspita , Hermiati Euis , Lee Jaemin , Yopi  , Prasetya Bambang , Ogino Chiaki , Kondo Akihiko
Published: February 2018

The addition of enzymes that are capable of degrading hemicellulose has a potential to reduce the need for commercial enzymes during biomass hydrolysis in the production of fermentable sugars. In this study, a high xylanase producing actinomycete strain (Kitasatospora sp. ID06-480) and the first ethyl ferulate producing actinomycete strain (Nonomuraea sp. ID06-094) were selected from 797 rare actinomycetes, respectively, which were isolated in Indonesia. The addition (30%, v/v) of a crude enzyme supernatant from the selected strains in sugarcane bagasse hydrolysis with low-level loading (1 FPU/g-biomass) of Cellic® CTec2 enhanced both the released amount of glucose and reducing sugars. When the reaction with Ctec2 was combined with crude enzymes containing either xylanase or feruloyl esterase, high conversion yield of glucose from cellulose at 60.5% could be achieved after 72 h-saccharification.
The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: A systematic review and meta‐analysis
Authors: Wang Jianhong , Wu Huaiyu , Dong Fajin , Li Binbin , Wei Zhanghong , Peng Quanzhou , Dong Duo , Li Min , Xu Jinfeng
Published: February 2018

To evaluate the value of ultrasonography in the diagnosis of anterior cruciate ligament injury (ACL injury) by conducting a systematic review and meta‐analysis. A literature search was carried out in the Cochrane Library, Embase, Pubmed databases and included studies prior to April 2017. Based on inclusion and exclusion criteria, studies evaluating ultrasound to diagnose ACL injury were selected. MRI, arthroscopy and clinical‐follow were considered the reference standards. The diagnostic accuracy of ultrasound was assessed using a combination of sensitivity, specificity, likelihood ratio (LR), post‐test probability, diagnostic odds ratio (DOR) and by summarizing the area under the receiver operating characteristic (SROC) curve. A total of 4 studies involving 246 patients were eventually included in the analysis. In these four studies, the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, post‐test probability and DOR were 90.0% (95% CI: 77–96), 97% (95% CI: 90–99), 31.08 (95% CI: 8.75–110.41), 0.11 (95% CI: 0.05–0.24), 89% (3%) and 288.81 (95% CI: 78.51–1062.48), respectively. The area under the SROC curve was 0.98 (95% CI: 0.97–0.99). Our meta‐analysis showed that ultrasound can play an important role in the diagnosis of ACL injury. Because of its high sensitivity, high specificity and high diagnostic ability, ultrasound should be a part of the standard diagnostic work‐up of an ACL injury.
Outcomes
Authors: Scott David L.
Published: February 2018

Outcomes evaluate the impact of disease. In rheumatology they span measures of disease activity, end-organ damage, and quality of life. Some outcomes are categorical, such as the presence or absence of remission. Other outcomes involve extended numeric scales such as joint counts, radiographic scores, and quality of life measures. Outcomes can be measured in the short term—weeks and months—or over years and decades. Short-term outcomes, though readily related to treatment, may have less relevance for patients. Clinical trials focus on short-term outcomes whereas observational studies explore longer-term outcomes. The matrix of rheumatic disease outcomes is exemplified by rheumatoid arthritis. Its outcomes span disease activity assessments like joint counts, damage assessed by erosive scores, quality of life evaluated by disease-specific measures like the Health Assessment Questionnaire (HAQ) or generic measures like the Short Form 36 (SF-36), overall assessments like remission, and end result such as joint replacement or death. Outcome measures are used to capture the impact of treating rheumatic diseases, and are influenced by both disease severity and the effectiveness of treatment. However, they are also influenced by a range of confounding factors. Demographic factors like age, gender, and ethnicity can all have crucial impacts. Deprivation is important, as poverty invariably worsens outcomes. Finally, comorbidities affect outcomes and patients with multiple comorbid conditions usually have worse quality of life with poorer outcomes for all diseases. These multiple confounding factors mean comparing outcomes across units without adjustment will invariably show major differences.
Innate vs acquired immunity
Authors: Voll Reinhard E. , Bröker Barbara M.
Published: February 2018

The innate and the adaptive immune system efficiently cooperate to protect us from infections. The ancient innate immune system, dating back to the first multicellular organisms, utilizes phagocytic cells, soluble antimicrobial peptides, and the complement system for an immediate line of defence against pathogens. Using a limited number of germline-encoded pattern recognition receptors including the Toll-like, RIG-1-like, and NOD-like receptors, the innate immune system recognizes so-called pathogen-associated molecular patterns (PAMPs). PAMPs are specific for groups of related microorganisms and represent highly conserved, mostly non-protein molecules essential for the pathogens’ life cycles. Hence, escape mutants strongly reduce the pathogen’s fitness. An important task of the innate immune system is to distinguish between harmless antigens and potentially dangerous pathogens. Ideally, innate immune cells should activate the adaptive immune cells only in the case of invading pathogens.
The evolutionarily rather new adaptive immune system, which can be found in jawed fish and higher vertebrates, needs several days to mount an efficient response upon its first encounter with a certain pathogen. As soon as antigen-specific lymphocyte clones have been expanded, they powerfully fight the pathogen. Importantly, memory lymphocytes can often protect us from reinfections. During the development of T and B lymphocytes, many millions of different receptors are generated by somatic recombination and hypermutation of gene segments making up the antigen receptors. This process carries the inherent risk of autoimmunity, causing most inflammatory rheumatic diseases. In contrast, inadequate activation of the innate immune system, especially activation of the inflammasomes, may cause autoinflammatory syndromes.
Psoriatic arthritis
Authors: Coates Laura C. , Helliwell Philip S.
Published: February 2018

Psoriasis is a chronic skin condition affecting about 3% of Europeans and North Americans. About 15% of people afflicted with psoriasis will develop psoriatic arthritis—cutaneous risk factors for this are psoriasis of the nails, scalp, and flexures. Since most cases of arthritis develop in people with psoriasis, new screening tools, both clinical and imaging, are available. Some genetic factors may also explain susceptibility and severity. Historically, five clinical subgroups have been described but these may be simplified to axial and peripheral involvement, the latter dividing into oligo- and polyarticular patterns. The importance of these clinical subdivisions is still under debate and research but it is clear that there is marked heterogeneity in all manifestations of this disease. In recent times the importance of extra-articular features has gained prominence such that the metabolic syndrome and cardiovascular morbidity are now seen as important features of ’psoriatic disease’. The diverse changes seen in bone on imaging reflect both the underlying pathogenic mechanisms and the ways in which the disease progresses. Recent work with animal models and immunohistochemistry has further advanced our understanding of these features. In the biologic era renewed interest in psoriatic arthritis has stimulated research into outcome assessment and permitted clearer understanding of how these new drugs work on the different aspects of the disease. In addition, improved recognition of the impact of the disease on the person has stimulated the development of new patient-reported outcome tools.
Miscellaneous vasculitides
Authors: Watts Richard A. , Ntatsaki Eleana
Published: February 2018

The vasculitides are a group of relatively rare conditions with a broad spectrum of clinical presentations that can cause significant morbidity and mortality. Classification of the vasculitic syndromes is done according to the size of the vessels affected and also the presence of anti-neutrophil cytoplasmic antibodies (ANCA). Vasculitides can be either primary or secondary to an underlying systemic disease, malignancy, or infection. This chapter covers the spectrum of the secondary vasculitides; some of the non-ANCA-associated primary vasculitides and miscellaneous types of vasculitic syndromes.
Secondary vasculitis can occur in the background of systemic rheumatic diseases such as rheumatoid arthritis, spondyloarthropathies, or other connective tissue diseases. Vasculitis can also present in relation to precipitants such as drugs (propylthiouracil, hydralazine, leucotriene antagonists) or vaccines. Infection (bacterial, mycobacterial, viral, and fungal) has been associated with vasculitis either as a trigger or as a consequence of iatrogenic immunosuppression. Infection-related vasculitis can affect all types and sizes of vessels. Certain forms of vasculitis such as cryoglobulinaemia are closely associated with viral infections and more specifically with HCV infection. There are forms of vasculitis, which appear to be isolated or localized to a single organ, or site (skin, gastrointestinal, genital, and primary central nervous system vasculitis) that may be histologically similar to systemic syndromes, but have a different prognosis. Other conditions that may mimic vasculitis and miscellaneous conditions such as Cogan’s syndrome and relapsing polychondritis are also discussed.
Skeletal dysplasias
Authors: Wordsworth B. P.
Published: February 2018

Bone is metabolically active throughout life and metabolic disturbances may have wide-ranging consequences that are not restricted to altering its mechanics. The study of some genetic bone diseases has already provided remarkable insights into the normal regulation of bone metabolism. Skeletal dysplasias are developmental disorders of the chondro-osseous tissues commonly resulting in short stature, which is often disproportionate. The underlying mutations are often in the structural genes encoding components of the matrix but may also involve growth factors or cell signalling. In contrast, the dysostoses tend to affect single bones or groups of bones, reflecting the transient nature of the many different signalling factors to which they are responsive during development.
Abnormalities of bone density (high or low) may be due to primary deficiency of bone matrix synthesis (e.g. osteogenesis imperfecta and hypophosphatasia) but may also reflect an imbalance between bone formation and resorption. This may be caused by abnormalities of bone formation (e.g. hyperostosis/sclerosteosis and osteoporosis pseudoglioma syndrome) or bone resorption (e.g. classic osteopetrosis and fibrous dysplasia).
Haemoglobinopathies
Authors: Rees David
Published: February 2018

Inherited abnormalities of the globin genes are the commonest single-gene disorders in the world and fall into two main groups: thalassaemias and sickle cell disease. Thalassaemias are due to quantitative defects in globin chain synthesis which cause variable anaemia and ineffective erythropoiesis. Thalassaemia was initially thought to be a disease of the bones due to uncontrolled bone marrow expansion causing bony distortion, although this is now unusual with appropriate blood transfusions. Osteopenia, often severe, is a feature of most patients with thalassaemia major and intermedia, caused by bone marrow expansion, iron overload, endocrinopathy, and iron chelation. Treatment with bisphosphonates is generally recommended. Other rheumatological manifestations include arthropathy associated with the use of the iron chelator deferiprone. Sickle cell disease involves a group of conditions caused by polymerization of the abnormal -globin chain, resulting in abnormal erythrocytes which cause vaso-occlusion, vasculopathy, and ischaemic tissue damage. The characteristic symptom is acute bone pain caused by vaso-occlusion; typical episodes require treatment with opiate analgesia and resolve spontaneously by 5 days with no lasting bone damage. The frequency of acute episodes varies widely between patients. The incidence of osteomyelitis is increased, particularly with salmonella, although it is much rarer than acute vaso-occlusion. Avascular necrosis can affect the hips, and less commonly the shoulders and knees. Coincidental rheumatological disease sometimes complicates the condition, particularly systemic lupus erythematosus (SLE) which is more prevalent in populations at increased risk of sickle cell disease.
Caring in the Margins
Authors: Enestvedt Ruth C. , Clark Kathleen M. , Freborg Kaija , Miller Joyce P. , Leuning Cheryl J. , Schuhmacher Deborah K. , McHale Kristin M. , Baumgartner Katherine A. , Loushin Susan L.
Published: February 2018

Nurses must learn essential skills based in transcultural nursing to address issues of equity and social justice. The development of a model for nursing practice for an urban nurse-led drop-in center for individuals experiencing marginalization provides an opportunity for student nurses to learn transcultural nursing skills that shifts care from acknowledging the need of others to accompanying others on their health journey. The practice model provides the opportunity for undergraduate and graduate nursing students at Augsburg University to de-emphasize tasks and build relationships. Students learn to listen to others' stories and acknowledge their struggles in the margins. Four stages of nursing practice skills, acknowledging others' needs, attending to their struggles, affirming strengths, and ultimately accompanying others, are taught and experienced. At the core of the nursing practice model is the concept of “hospitality.” The nursing practice model serves as guide for student nurses to learn to suspend disbeliefs, withhold judgment, and ultimately reduce stereotypes and stigma to offer a safe space for individuals living in the margins seeking care. The future of nursing requires essential knowledge, skills, and attitudes that shift care from need-based care to accompaniment to address health inequities and provide culturally appropriate care.
A Novel Technique for Exeter Stem Extraction
Authors: MacDonald David R.W. , Harper Lauren , Mitchell Martin
Published: February 2018

We describe a new technique for extraction of the Exeter V40 stem using the readily available Exeter offset broach handle.
Associations of mobile source air pollution during the first year of life with childhood pneumonia, bronchiolitis, and otitis media
Authors: Kennedy Caitlin M. , Pennington Audrey Flak , Darrow Lyndsey A. , Klein Mitchel , Zhai Xinxin , Bates Josephine T. , Russell Armistead G. , Hansen Craig , Tolbert Paige E. , Strickland Matthew J.
Published: February 2018

Background:

Exposure to air pollution from motor vehicles in early life may increase susceptibility to common pediatric infections.

Methods:

We estimated associations between residential exposure to primary fine particulate matter, nitrogen oxides, and carbon monoxide from traffic during the first year of life and incident pneumonia, bronchiolitis, and otitis media events by age 2 years in 22,441 children from the Kaiser Air Pollution and Pediatric Asthma Study, a retrospective birth cohort of children born during 2000–2010 and insured by Kaiser Permanente Georgia. Time to first clinical diagnosis of each outcome was defined using medical records. Exposure to traffic pollutants was based on observation-calibrated estimates from A Research LINE-source dispersion model for near surface releases and child residential histories. Associations were modeled using Cox proportional hazards models, with exposure as a continuous linear variable, a natural-log transformed continuous variable, and categorized by quintiles.

Results:

During follow-up, 2,181 children were diagnosed with pneumonia, 5,533 with bronchiolitis, and 14,374 with otitis media. We observed positive associations between early-life traffic exposures and all three outcomes; confidence intervals were widest for pneumonia as it was the least common outcome. For example, adjusted hazard ratios for a 1-unit increase in nitrogen oxides on the natural log scale (a 2.7-fold increase) were 1.19 (95% CI = 1.12, 1.27) for bronchiolitis, 1.17 (1.12, 1.22) for otitis media, and 1.08 (0.97, 1.20) for pneumonia.

Conclusions:

Our results provide evidence for modest, positive associations between exposure to traffic emissions and common pediatric infections during early childhood.
Development and Validation of a Simultaneous Quantification Method of Ruxolitinib, Vismodegib, Olaparib, and Pazopanib in Human Plasma Using Liquid Chromatography Coupled With Tandem Mass Spectrometry
Authors: Pressiat Claire , Huynh Huu-Hien , Plé Alain , Sauvageon Hélène , Madelaine Isabelle , Chougnet Cécile , Le Maignan Christine , Mourah Samia , Goldwirt Lauriane
Published: February 2018

Background:

A simple, rapid, and sensitive liquid chromatography coupled with tandem mass spectrometry method has been developed and validated for the quantification of ruxolitinib, olaparib, vismodegib, and pazopanib in human plasma.

Methods:

After a simple protein precipitation of plasma samples, the chromatographic separation was performed using an ultraperformance liquid chromatography system coupled with mass tandem spectrometry in a positive ionization mode. The mobile phase consisted of a gradient elution of 10-mmol/L formate ammonium buffer containing 0.1% (vol/vol) formic acid (phase A) and acetonitrile with 0.1% (vol/vol) formic acid (phase B) at a flow rate at 300 µL/min.

Results:

Analysis time was 5.0 minutes per run, and all analytes and internal standards eluted within 1.5–1.73 minutes. The calibration curves were linear over the range from 10 to 2500 ng/mL for ruxolitinib and from 100 to 100,000 ng/mL for olaparib, vismodegib, and pazopanib with coefficients of correlation above 0.99 for all analytes. The intraday and interday coefficients of variation were below 14.26% and 14.81%, respectively, for lower concentration and below 9.94% and 6.37%, respectively, for higher concentration.

Conclusions:

Using liquid chromatography coupled with tandem mass spectrometry, we have developed and validated a simple and rapid assay for the simultaneous quantification of olaparib, vismodegib, pazopanib, and ruxolitinib in human plasma. This method is now part of our therapeutic drug monitoring service provision and is currently used clinically to manage patients prescribed these drugs.