bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment methods in surgical training in the United Kingdom
Authors: Evgeniou Evgenios , Peter Loizou , Tsironi Maria , Iyer Srinivasan
Published: February 2013

A career in surgery in the United Kingdom demands a commitment to a long journey of assessment. The assessment methods used must ensure that the appropriate candidates are selected into a programme of study or a job and must guarantee public safety by regulating the progression of surgical trainees and the certification of trained surgeons. This review attempts to analyse the psychometric properties of various assessment methods used in the selection of candidates to medical school, job selection, progression in training, and certification. Validity is an indicator of how well an assessment measures what it is designed to measure. Reliability informs us whether a test is consistent in its outcome by measuring the reproducibility and discriminating ability of the test. In the long journey of assessment in surgical training, the same assessment formats are frequently being used for selection into a programme of study, job selection, progression, and certification. Although similar assessment methods are being used for different purposes in surgical training, the psychometric properties of these assessment methods have not been examined separately for each purpose. Because of the significance of these assessments for trainees and patients, their reliability and validity should be examined thoroughly in every context where the assessment method is being used.
Deleuze's Rethinking of the Notion of Sense
Authors: Voss Daniela
Published: February 2013

Drawing on Deleuze's early works of the 1960s, this article investigates the ways in which Deleuze challenges our traditional linguistic notion of sense and notion of truth. Using Frege's account of sense and truth, this article presents our common understanding of sense and truth as two separate dimensions of the proposition where sense subsists only in a formal relation to the other. It then goes on to examine the Kantian account, which makes sense the superior transcendental condition of possibility of truth. Although both accounts define sense as merely the form of possibility of truth, a huge divide cuts across a simple formal logic of sense and a transcendental logic: transcendental logic discovered a certain genetic productivity of sense, such that a proposition always has the kind of truth that it merits according to its sense. In pursuit of this genetic productivity of sense, Deleuze applies different models of explanation: a Nietzschean genealogical model of the genetic power of sense, and in The Logic of Sense a structural model combined with elements of Stoic philosophy. This article follows Deleuze in setting up a new and very complex notion of sense, which he radically distinguishes from what he terms ‘signification’, that is, an extrinsic, linguistic or logical, condition of possibility. Rather, sense has to be conceived as both the effect and the intrinsic genetic element of an extra-propositional sense-producing machine.
Fast and Sensitive Interferon-γ Assay Using Supercritical Angle Fluorescence
Authors: Winterflood Christian , Ruckstuhl Thomas , Seeger Stefan
Published: February 2013

We present an immunoassay for Interferon-γ (IFN-γ) with a limit of detection of 1.9 pM (30 pg/mL) and a linear concentration range spanning three orders of magnitude. The developed one-step assay takes only 12 min and can replace the time-consuming and labor-intensive enzyme-linked immunosorbent assay (ELISA). The solid-phase sandwich assay is performed on a new measurement system comprising single-use test tubes and a compact fluorescence reader. The polymer tubes contain an optical configuration for the detection of supercritical angle fluorescence, allowing for highly sensitive real-time binding measurements.
An Overview of the First Use of the Terms Cognition and Behavior
Authors: Chaney Daniel
Published: February 2013

Use of the terms cognition and behavior and their variants can be traced back to the middle-ages. What is not widely known is how the terms were first used in the literature. This article identifies variations of terms for cognition and behavior and traces the first use of the terms using the Oxford English Dictionary (OED). A systematic search of the OED was conducted, identifying terms in the cognition and behavior families. Terms are defined and the year the term first appeared in the literature is identified. Terms are sorted and grouped chronologically by first appearance to determine their first use in the literature as noted in the OED. Results indicated more words are related to cognition than behavior. The first term related to cognition to appear was cogitation in circa 1225; while the first term related to behavior was port, which appeared circa 1330. Each family of terms experienced tremendous growth during the first appearance of terms. The cognition family saw 60% of its terms appear in the 17th and 19th centuries. The behavior family saw nearly 75% of its terms make their first appearance during the 15th through the 17th centuries.
Entropic Forms and Related Algebras
Authors: Scarfone Antonio
Published: February 2013

Starting from a very general trace-form entropy, we introduce a pair of algebraic structures endowed by a generalized sum and a generalized product. These algebras form, respectively, two Abelian fields in the realm of the complex numbers isomorphic each other. We specify our results to several entropic forms related to distributions recurrently observed in social, economical, biological and physical systems including the stretched exponential, the power-law and the interpolating Bosons-Fermions distributions. Some potential applications in the study of complex systems are advanced.
System Identification and Integration Design of an Air/Electric Motor
Authors: Hwang Yean-Ren , Huang Shih-Yao
Published: February 2013

This paper presents an integration design and implementation of an air motor and a DC servo motor which utilizes a magnetic powder brake to integrate these two motors together. The dynamic model of the air/electric hybrid system will be derived and eventually leads to successful ECE-40 driving cycle tests with a FPGA-based speed controller. The testing results obtained by using the proposed experimental platform indicate that the total air consumption is about 256 L under air motor mode and the electric charge consumption is about 530 coulombs under DC servo motor mode. In a hybrid mode, the current reduction of the battery is about 18.5%, and then the service life of the battery can be improved. Furthermore, a prototype is built with a proportional-integral (PI) speed controller based on a field-programmable gate array (FPGA) in order to facilitate the entire analysis of the velocity switch experiment. Through the modular methodology of FPGA, the hybrid power platform can successfully operate under ECE-40 driving cycle with the PI speed controller. The experimental data shows that the chattering ranges of the air motor within ±1 km/h and ±0.2 km/h under DC servo motor drive. Therefore, the PI speed controller based on FPGA is successfully actualized.
Expression of a Functional Recombinant Human Basic Fibroblast Growth Factor from Transgenic Rice Seeds
Authors: An Na , Ou Jiquan , Jiang Daiming , Zhang Liping , Liu Jingru , Fu Kai , Dai Ying , Yang Daichang
Published: February 2013

Basic fibroblast growth factor (FGF-2) is an important member of the FGF gene family. It is widely used in clinical applications for scald and wound healing in order to stimulate cell proliferation. Further it is applied for inhibiting stem cell differentiation in cultures. Due to a shortage of plasma and low expression levels of recombinant rbFGF in conventional gene expression systems, we explored the production of recombinant rbFGF in rice grains (Oryza sativa bFGF, OsrbFGF). An expression level of up to 185.66 mg/kg in brown rice was obtained. A simple purification protocol was established with final recovery of 4.49% and resulting in a yield of OsrbFGF reaching up to 8.33 mg/kg OsrbFGF. The functional assay of OsrbFGF indicated that the stimulating cell proliferation activity on NIH/3T3 was the same as with commercialized rbFGF. Wound healing in vivo of OsrbFGF is equivalent to commercialized rbFGF. Our results indicate that rice endosperm is capable of expressing small molecular mass proteins, such as bFGF. This again demonstrates that rice endosperm is a promising system to express various biopharmaceutical proteins.
Rapid and Sensitive Determination of Timosaponin AIII in Rat Plasma by LC-MS/MS and Its Pharmacokinetic Application
Authors: Liu Yanping , Pu Yiqiong , Zhang Tong , Ding Yue , Wang Bing , Cai Zhenzhen
Published: February 2013

A rapid sensitive and selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for determination of timosaponin AIII (TA-III) in rat plasma, using ginsenoside Re as an internal standard (IS). TA-III and the IS were detected in MRM mode with a negative ionization electrospray mass spectrometer. The calibration curves were linear over the concentration ranges from 11.14 to 1114 ng/mL and the lower limit of quantification (LLOQ) was 11.14 ng/mL. Intra-day and inter-day precisions (RSD) were within 10%, and accuracy ranged from 6.4% to 9.1%. The extraction recovery at three concentrations ranged from 92.3% to 95.5%. The validated method was successfully applied to monitor the concentrations of TA-III in rat plasma after intragastric administration. The best fit pharmacokinetic model to estimate the pharmacokinetic parameters was a single compartment model with weight of 1/x2 for oral administration groups of rats for TA-III.
Exercise Therapy Downregulates the Overexpression of TLR4, TLR2, MyD88 and NF-κB after Cerebral Ischemia in Rats
Authors: Ma Yuewen , He Man , Qiang Lin
Published: February 2013

Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) are considered to mediate the inflammatory reaction of cerebral ischemia injury, and exercise can inhibit the activity of the Toll-like receptor signaling pathway in the peripheral blood of humans. Although physical exercise has been demonstrated to be neuroprotective in both clinical and laboratory settings, the underlying mechanism remains unclear. To clarify this critical issue, this study investigated the effects of treadmill training on the recovery of neurological function and the expression of TLR2 and TLR4 and their main downstream targets, nuclear factor-kappaB (NF-κB) and myeloid differentiation factor 88 (MyD88), in the ischemic rat brain after middle cerebral artery occlusion-reperfusion (MCAo/R). Rats were divided into seven groups: sham control without MCAo/R and five, nine and 16 days post-ischemic exercise or non-exercise. The neurological function and infarct volume were measured, and reverse transcription polymerase chain reaction (RT-PCR) and Western blotting were used to detect the expression of TLR2, TLR4, NF-κB and MyD88 in ischemic brain tissue. The results indicated that treadmill training promoted functional recovery and reduced the overexpression of TLR2, TLR4, NF-κB and MyD88 in rat brain tissue after ischemia, a finding that may have implications for understanding the mechanism of exercise therapy after brain ischemia and indicating new therapeutic strategies for the pharmacological modulation of TLR signaling.
Interlamellar Organization of Phase Separated Domains in Multi-Component Lipid Multilayers: Energetic Considerations
Authors: Tayebi Lobat , Parikh Atul , Vashaee Daryoosh
Published: February 2013

A recent experimental study [1] has demonstrated the alignment of phase separated domains across hundreds of bilayer units in multicomponent stacked lipid bilayers. The origin of this alignment is the interlamellar coupling of laterally phase separated domains. Here, we develop a theoretical model that presents the energetics description of this phenomenon based on the minimization of the free energy of the system. Specifically, we use solution theory to estimate the competition between energy and entropy in different stacking configurations. The model furnishes an elemental phase diagram, which maps the domain distributions in terms of the strength of the intra- and inter-layer interactions and estimates the value of inter-layer coupling for complete alignment of domains in the stacks of five and ten bilayers. The area fraction occupied by co-existing phases was calculated for the system of the minimum free energy, which showed a good agreement with experimental observations.
Hall Effect Sensors Design, Integration and Behavior Analysis
Authors: Paun Maria-Alexandra , Sallese Jean-Michel , Kayal Maher
Published: February 2013

The present paper focuses on various aspects regarding Hall Effect sensors’ design, integration, and behavior analysis. In order to assess their performance, different Hall Effect geometries were tested for Hall voltage, sensitivity, offset, and temperature drift. The residual offset was measured both with an automated measurement setup and by manual switching of the individual phases. To predict Hall sensors performance prior to integration, three-dimensional physical simulations were performed.
Do Fat Supplements Increase Physical Performance?
Authors: Macaluso Filippo , Barone Rosario , Catanese Patrizia , Carini Francesco , Rizzuto Luigi , Farina Felicia , Di Felice Valentina
Published: February 2013

Fish oil and conjugated linoleic acid (CLA) belong to a popular class of food supplements known as “fat supplements”, which are claimed to reduce muscle glycogen breakdown, reduce body mass, as well as reduce muscle damage and inflammatory responses. Sport athletes consume fish oil and CLA mainly to increase lean body mass and reduce body fat. Recent evidence indicates that this kind of supplementation may have other side-effects and a new role has been identified in steroidogenensis. Preliminary findings demonstrate that fish oil and CLA may induce a physiological increase in testosterone synthesis. The aim of this review is to describe the effects of fish oil and CLA on physical performance (endurance and resistance exercise), and highlight the new results on the effects on testosterone biosynthesis. In view of these new data, we can hypothesize that fat supplements may improve the anabolic effect of exercise.
Polyphosphazenes: Multifunctional, Biodegradable Vehicles for Drug and Gene Delivery
Authors: Teasdale Ian , Brüggemann Oliver
Published: February 2013

Poly[(organo)phosphazenes] are a unique class of extremely versatile polymers with a range of applications including tissue engineering and drug delivery, as hydrogels, shape memory polymers and as stimuli responsive materials. This review aims to divulge the basic principles of designing polyphosphazenes for drug and gene delivery and portray the huge potential of these extremely versatile materials for such applications. Polyphosphazenes offer a number of distinct advantages as carriers for bioconjugates; alongside their completely degradable backbone, to non-toxic degradation products, they possess an inherently and uniquely high functionality and, thanks to recent advances in their polymer chemistry, can be prepared with controlled molecular weights and narrow polydispersities, as well as self-assembled supra-molecular structures. Importantly, the rate of degradation/hydrolysis of the polymers can be carefully tuned to suit the desired application. In this review we detail the recent developments in the chemistry of polyphosphazenes, relevant to drug and gene delivery and describe recent investigations into their application in this field.
Frequency Noise Properties of Lasers for Interferometry in Nanometrology
Authors: Hrabina Jan , Lazar Josef , Holá Miroslava , Číp Ondřej
Published: February 2013

In this contribution we focus on laser frequency noise properties and their influence on the interferometric displacement measurements. A setup for measurement of laser frequency noise is proposed and tested together with simultaneous measurement of fluctuations in displacement in the Michelson interferometer. Several laser sources, including traditional He-Ne and solid-state lasers, and their noise properties are evaluated and compared. The contribution of the laser frequency noise to the displacement measurement is discussed in the context of other sources of uncertainty associated with the interferometric setup, such as, mechanics, resolution of analog-to-digital conversion, frequency bandwidth of the detection chain, and variations of the refractive index of air.
High-Visibility Photonic Crystal Fiber Interferometer as Multifunctional Sensor
Authors: Cárdenas-Sevilla G. , Fávero Fernando , Villatoro Joel
Published: February 2013

A photonic crystal fiber (PCF) interferometer that exhibits record fringe contrast (~40 dB) is demonstrated along with its sensing applications. The device operates in reflection mode and consists of a centimeter-long segment of properly selected PCF fusion spliced to single mode optical fibers. Two identical collapsed zones in the PCF combined with its modal properties allow high-visibility interference patterns. The interferometer is suitable for refractometric and liquid level sensing. The measuring refractive index range goes from 1.33 to 1.43 and the maximum resolution is ~1.6 × 10−5.
Welcome to Technologies—A New Open Access Journal
Authors: O'Brien Jeremy
Published: February 2013

Technologies of one sort or another have been with us for millennia; our ancestors developed solutions to their everyday problems to improve their—and subsequently our—quality of life. Over the course of history technological development has gone through periods of both gradual evolution and culture changing paradigm shifts. These leaps of progress have enabled greater communication, better generation and distribution of food and through better transportation, greater mobility. It is human nature to endeavour to build on these technological advancements, seeking to ever improve quality of life whilst minimising environmental impact. [...]
Gouverner par la parole : parlements de la rue, pratiques oratoires et subjectivation politique en Côte d'Ivoire
Authors: Cutolo Armando , Banégas Richard
Published: February 2013

Résumé La crise en Côte d’Ivoire a vu se multiplier les « agoras » et « parlements » de la rue, devenus les hauts lieux de la mobilisation patriotique. Cet article montre que les orateurs de ces espaces se sont affirmés en tant que sujets moraux et politiques par la prise de parole publique et un travail herméneutique de « dévoilement » de la vérité. Mais il souligne aussi que ce processus de subjectivation s’est opéré dans le cadre d’un dispositif contraignant de professionnalisation de la parole patriotique s’apparentant à une forme de gouvernementalité. Il s’interroge alors sur le devenir de celle-ci dans un contexte de sortie de guerre qui a vu la destruction dudit dispositif.
Ce que « parler au grin » veut dire : sociabilité urbaine, politique de la rue et reproduction sociale en Côte d'Ivoire
Authors: Vincourt Sarah , Kouyaté Souleymane
Published: February 2013

Résumé Lieux de sociabilité et de discussion au cœur d’Abidjan, les multiples « grins de thé » se sont transformés, au cours de la crise postélectorale de 2010-2011, en lieux de politisation, voire de recrutement politique en faveur du candidat Alassane Ouattara. Ces prises de position de rue sont caractéristiques de mécanismes de participation politique mais aussi de contention de la contestation inscrits dans les interactions micro-locales au sein des quartiers d’Abidjan, où les économies morales et les identités se construisent et se confrontent.
Expressions de la xénophobie en réunion publique et construction d'une identité de quartier : le cas de Yeoville, à Johannesbourg
Authors: Bénit-Gbaffou Claire , Mkwanazi Eulenda , Botiveau Raphaël
Published: February 2013

Résumé Dans les villes sud-africaines, les réunions publiques de quartier font partie de la vie populaire ordinaire. Depuis 1994 et l’élection d’un régime démocratique, elles font l’objet de fortes dynamiques d’institutionnalisation, qui en transforment les fonctionnements et les enjeux. Cet article s’appuie sur le cas de Yeoville, un quartier de Johannesbourg, et analyse le rôle crucial que joue le leadership local dans la construction, à travers ces réunions publiques, d’une identité de quartier, notamment par leur positionnement face à l’expression publique de la xénophobie.
A Review of the Role of Psychosocial Evaluation in Organ Transplant and Bariatric Surgery
Authors: Marcangelo Michael J.
Published: February 2013

CME Educational Objectives

1.

Review the evidence related to pre-transplant psychiatric evaluations and its relation to patient outcomes.

2.

Discuss the management of psychiatric disorders in organ transplant patients.

3.

Review the evidence related to psychiatric evaluations of bariatric surgery candidates and the impact it has on outcomes.

Advanced medical procedures are expensive, often risky, and pose both short- and long-term challenges for those who receive them. Psychiatric assessment prior to many procedures is often requested, either due to regulations or convention. However, the evidence in favor of these evaluations ranges from some obvious benefits to near conjecture, and while common sense and clinical judgment can lead evaluators to focus on those aspects of the patient’s life that seem relevant, evidence (where available) should guide the work. Organ transplantation and bariatric surgery are two examples of these high-stakes medical interventions that involve psychiatry and related mental health fields during the evaluation process. A review of some of the evidence and areas of uncertainty follows.
Health Reform Policy Initiatives to Promote Older Women’s Health
Authors: Brewin Dorothy , Nannini Angela
Published: February 2013

Currently, women’s health care is receiving more attention in health policy discussions. This article reviews aspects of the Patient Protection and Affordable Care Act (PPACA) that seek to improve the health and health care services for older women. Increased access to evidence-based screening assessments for women with Medicare will enhance both the prevention and treatment of acute and chronic diseases. PPACA also contains provisions to expand the gerontological nursing workforce to meet the needs of the rapidly growing population of Medicare-eligible women. Evolving models of care, such as community-based care, shared financial risks, and care coordination, are the current focus of best practice research by the Center of Medicare & Medicaid Innovation. The financing and provision of long-term care is a major issue for women, who represent the majority of adults older than 85. The overarching aim of the new PPACA Medicare changes is to create affordable, quality health care systems that meet the needs of women as they age.
Clonidine Premedication Versus Placebo: Effects on Postoperative Agitation and Recovery Time in Children Undergoing Strabismus Surgery
Authors: Heinmiller Laura J. , Nelson Leonard B. , Goldberg Marc B. , Thode Adam R.
Published: February 2013

Purpose:

Postoperative agitation is common in adults and children following the use of several anesthetics, particularly inhalation anesthetics. This behavior has detrimental effects both physically for the patient following the procedure and psychologically for the parent or guardian. The authors propose that clonidine, an alpha-2 agonist, would provide a reduction in children’s postoperative agitation and, in turn, improve parent satisfaction in children undergoing strabismus surgery.

Methods:

Fifty children were prospectively randomized to receive either clonidine or placebo in a double-blind fashion prior to surgery. The children were evaluated using preoperative and postoperative parent questionnaires and postoperative behavioral evaluation using standardized scales including the Pediatric Anesthesia Emergence Delirium and Watcha scales.

Results:

Children receiving clonidine immediately after anesthesia induction had statistically significant improvement in postoperative agitation at the 15-minute mark (
P
= .096) and last score obtained (
P
= .095) using the Watcha scale. The clonidine group spent an insignificantly longer time in the post-anesthesia care unit (average: 54 minutes) than the placebo group (average 47 minutes) (
P
= .17). Seventy-one percent of parents reported being “very satisfied” with their child’s recovery from anesthesia in the clonidine group compared to 46% in the placebo group, although this was not statistically significant (
P
= .34).

Conclusions:

Children receiving clonidine prior to undergoing strabismus surgery have a small but noticeable reduction in postoperative agitation, stay slightly longer in the post-anesthesia care unit, and have higher rates of parent satisfaction.

[J Pediatr Ophthalmol Strabismus 2013;50(3):150–154.]
El jardín de los frailes de Azaña en la novelística de internados religiosos
Authors: Ezpeleta Aguilar Fermín
Published: February 2013

El jardín de los frailes, de Manuel Azaña, absorbe los mejores valores literarios de un subgénero, como es el de la novela autobiográfica de colegio, cultivado con profusión por la generación novecentista. Por un lado, hay tratamiento flexible del modelo de novela de formación, con derivación hacia la de artista. Hay además conformación de un cuerpo pedagógico al modo del tratado o de la novela de instrucción. E, incluso, pintura de tipos y anécdotas colegiales. Todo ello bajo la responsabilidad narrativa de un «yo» que indaga, más que en otras novelas de la serie, en las claves culturales del país.
El teatro de Manuel Altolaguirre: Amor de madre
Authors: Insausti Gabriel
Published: February 2013

Durante la guerra civil española el poeta Manuel Altolaguirre se dejó atraer especialmente por el teatro. Dirigió La Barraca, la célebre compañía universitaria fundada por Lorca, así como el Teatro Español, tomó parte en el proyecto de El triunfo de las Germanías junto con José Bergamín y reescribió un drama de tema político, Entre dos públicos, que convirtió en Amor de madre, siguiendo las huellas de Gorki, quizá para adecuarlo a una ortodoxia ideológica de la que más tarde se arrepentiría.
César y los personajes de Catón, un republicano contra César, de Fernando Savater. Historia y literatura
Authors: Conde Salazar Matilde
Published: February 2013

En la obra de teatro Catón, un republicano contra César, Fernando Savater adapta con maestría muchísimas reminiscencias clásicas, sobre todo de Plutarco, para plantear una reflexión sobre política y filosofía. Mediante una excelente intervención del texto clásico, perfila a los personajes agrupados por parejas manteniendo, aunque con nueva fórmula, el esquema de las «vidas paralelas» de Plutarco. Cada personaje conserva los rasgos más peculiares de la figura histórica a la que representa, pero, gracias a una hábil recreación literaria, adquiere también nuevos papeles. César, aunque no tiene en la obra un papel dramático, deja sentir su presencia como un antagonista que personifica todos los defectos de la tiranía frente a las virtudes de la república. Los personajes van haciendo una descripción de los rasgos que le han caracterizado como personaje de referencia a lo largo de todos los tiempos, más allá de la mera inspiración clásica.
Editorial Vol.3(1)
Authors: Perera MC
Published: February 2013

DOI: http://dx.doi.org/10.4038/cjo.v3i1.5209Ceylon Journal of Otolaryngology Vol.3(1) 2013
Neck Dissections – An Adelaide Perspective
Authors: Krishnan Suren
Published: February 2013

DOI: http://dx.doi.org/10.4038/cjo.v3i1.5210 Ceylon Journal of Otolaryngology Vol.3(1) 2013 pp.1-8
The Bethesda system for reporting thyroid cytopathology: Should Sri Lanka adopt it?
Authors: De Silva Chandu
Published: February 2013

Fine needle aspiration (FNA) is a frontline investigation in the management of solitary thyroid nodules. It reduces unnecessary surgery in patients with benign nodules and helps to triage patients with malignant nodules for surgery. If FNA is to be clinically useful, the cytopathology report has to be unambiguous and should guide the referring physician to appropriate therapy. It is also essential for endocrinologists, physicians and surgeons to be familiar with the reporting format and terminology used. This article will describe the Bethesda system for reporting thyroid cytopathology (BSRTC), compare it with the existing system used in Sri Lanka and discuss why it should adopted in this country. DOI: http://dx.doi.org/10.4038/cjo.v3i1.5211 Ceylon Journal of Otolaryngology Vol.3(1) 2013 pp.9-14
Cancer in Sri Lanka: The Question of, “To Tell or Not to Tell”
Authors: Perera MC , Tennakoon TMS , Kumarasiri LA , Jayasinghe SMNC , Rathnayake RMWD , Rajapaksha RMAM
Published: February 2013

Introduction Cancer is an important cause of death in Sri lanka and revealing the truth about cancer diagnosis has become difficult due to many factors. Objectives To find the attitudes of Doctors, cancer patients and their close family members about informing the diagnosis of head and neck cancer at TH Anuradhapura. Method A descriptive, prospective study was carried on histologically diagnosed cancer patients, their first degree relatives and doctors treating them. Results Ninety three percent 93.6%(29) of the patients wanted the diagnosis of cancer to be told to them, 45.5%(12) relatives had the same view and 58.3%(21) of the doctors said that they would inform about the cancer to the patient. Conclusion Our study indicates that cancer patients in Anuradhapura have no inhibition of accepting their diagnosis of cancer and its complications. DOI: http://dx.doi.org/10.4038/cjo.v3i1.5213 Ceylon Journal of Otolaryngology Vol.3(1) 2013 pp.17-19
Paediatric Granular Cell Tumour of the Larynx: A Case Report of Laryngo fissure Resection and Buccal Mucosal Graft
Authors: Etulgama HMSB , Ratnayake RMP , Sanjeewa SGN
Published: February 2013

We present a case of a granular cell tumour (GCT) in the larynx of a 9-yaer old boy. The literacy review confirmed that this would be the youngest patient reported in Sri Lanka. The histological diagnosis of GTC is emphasized as macroscopic appearance may confuse with viral papilomatosis of the larynx. In addition, we present a method of surgical treatment of the tumour, involving the hitherto unreported technique through laryngofissure excision and buccal mucosal graft to preserve the exact function of the larynx with complete excision of the tumour. DOI: http://dx.doi.org/10.4038/cjo.v3i1.5216 Ceylon Journal of Otolaryngology Vol.3(1) 2013 pp.29-30
Regulatory T Cells Migrate to Airways via CCR4 and Attenuate the Severity of Airway Allergic Inflammation
Authors: Faustino Lucas , Fonseca Denise Morais da , Takenaka Maisa Carla , Mirotti Luciana , Florsheim Esther Borges , Guereschi Marcia Grando , Silva João Santana , Basso Alexandre Salgado , Russo Momtchilo
Published: February 2013

We have previously shown that regulatory T (Treg) cells that accumulate in the airways of allergic mice upregulate CC-chemokine receptor 4 (CCR4) expression. These Treg cells suppressed in vitro Th2 cell proliferation but not type 2 cytokine production. In the current study, using a well-established murine model of allergic lung disease or oral tolerance, we evaluated the in vivo activity of Treg cells in allergic airway inflammation with special focus on CCR4 function. We found that allergic, but not tolerant, mice treated with anti-CD25 Ab showed increased airway eosinophilia and IL-5– or IL-4–producing Th2 cells when compared with untreated mice. Notably, mice with CCR4 deficiency displayed an augmented airway allergic inflammation compared with wild-type or CCR2 knockout (KO) mice. The allergic phenotype of CCR4KO mice was similar to that observed in anti-CD25–treated mice. The exacerbated allergic inflammation of CCR4KO mice was directly associated with an impaired migration of Treg cells to airways and augmented frequency of pulmonary Th2 cells. Adoptive transfer of CD25+CD4+ T cells expressing high levels of CCR4, but not CCR4KO CD25+CD4+ T cells, attenuated the severe airway Th2 response of CCR4KO mice. Our results show that CCR4 is critically involved in the migration of Treg cells to allergic lungs that, in turn, attenuate airway Th2 activation and allergic eosinophilic inflammation.
Parenting Stress in Mothers of Premature Infants.
Authors: Hwang Hyun Sook , Kim Hee Soon , Yoo Il Young , Shin Hyun Sook
Published: February 2013

PURPOSE: The purposes of this study were to assess the parenting stress in mothers of premature infants and stress related characteristics of mothers and infants.METHODS: The methodology was a cross sectional survey study using self-report questionnaires. Participants in this study were 36 mothers of infants with corrected ages of 4 months to 12 months who were born prematurely. Data were analyzed using t-test, ANOVA, and Pearson correlation with the SPSS WIN 19.0 program.RESULTS: The mean score for parenting stress in mothers of premature infants was 74.639+/-17.570, indicating that the mothers actually experienced stress. When mothers were able to have some private time, parenting stress was statistically significantly lower. When the residential status was having one's own house and the local community provided informational support regarding child nurturing, there was a statistically significant decrease in the sub-category of particular infant temperament. There was a statistically significant positive correlation between mothers' depression and parenting stress.CONCLUSION: These results indicate that there is a need for nursing interventions to increase mothers' private time and to include informational support regarding health management of children including developmental status assessment from local communities.
Successful Medical Management of a Left Ventricular Thrombus and Aneurysm following Failed Thrombolysis in Myocardial Infarction
Authors: Oyedeji Adebayo T , Lee Christopher , Owojori Olukolade O , Ajegbomogun Olabanji J , Akintunde Adeseye A
Published: February 2013

We report the case of a patient with an extensive anterior myocardial infarction complicated by left ventricular systolic dysfunction, left ventricular apical thrombus and an apical left ventricular aneurysm following failed thrombolysis. We obtained serial two-dimensional echocardiograms at short intervals in the acute phase and also during the months of recovery and follow up. The patient was successfully and exclusively medically managed.
Umbilical Submanifolds of Sn × R
Authors: Mendonça Bruno , Tojeiro Ruy
Published: February 2013

We give a complete classification of umbilical submanifolds of arbitrary dimension and codimension of ×ℝ, extending the classification of umbilical surfaces in ×ℝ by Souam and Toubiana as well as the local description of umbilical hypersurfaces in × ℝ by Van der Veken and Vrancken. We prove that, besides small spheres in a slice, up to isometries of the ambient space they come in a two-parameter family of rotational submanifolds whose substantial codimension is either one or two and whose profile is a curve in a totally geodesic ×ℝ or ×ℝ, respectively, the former case arising in a one-parameter family. All of them are diffeomorphic to a sphere, except for a single element that is diffeomorphic to Euclidean space. We obtain explicit parametrizations of all such submanifolds. We also study more general classes of submanifolds of × R and ℍn × ℝ. In particular, we give a complete description of all submanifolds in those product spaces for which the tangent component of a unit vector field spanning the factor ℝ is an eigenvector of all shape operators. We show that surfaces with parallel mean curvature vector in ×ℝ and ℍn×ℝ having this property are rotational surfaces, and use this fact to improve some recent results by Alencar, do Carmo, and Tribuzy. We also obtain a Dajczer-type reduction of codimension theorem for submanifolds of × ℝ and ℍn × ℝ.
Prairie North: A joint civilian/military mass casualty exercise highlights the role of the National Guard in community disaster response
Authors: Vukotich, PhD George , Bayram, MD, MPH, EMDM, MEd Jamil D. , Miller, MPH, CHEC Miriam I.
Published: February 2013

In a joint military/civilian exercise conducted in June 2010, military National Guard medical and decontamination response efforts proved to be paramount in supporting hospital resources to sustain an adequate response during a simulated terrorist event. Traditionally, hospitals include local responders in their disaster preparedness but overlook other available state and federal resources such as the National Guard. Lessons learned from the exercise included the value of regular joint disaster planning and training between the military and civilian medical sectors. Additionally, military communication and medical equipment compatibility with the civilian infrastructure was identified as one of the top areas for the improvement of this joint exercise. Involving the National Guard in community disaster planning provides a valuable medical support asset that can be critical in responding to multiple casualty events. National Guard response is inherently faster than its federal counterpart. Based on the findings from our joint exercise, states are encouraged to incorporate their corresponding National Guard in civilian critical medical infrastructure disaster preparedness activities, as the National Guard can be an integral part of the disaster response efforts in real multiple casualty events.
Contribution of the administrative database and the geographical information system to disaster preparedness and regionalization
Authors: Kuwabara, MD, DPH Kazuaki , Matsuda, MD, PhD Shinya , Fushimi, MD, PhD Kiyohide , Ishikawa, PhD Koichi B. , Horiguchi, PhD Hiromasa , Fujimori, MD, PhD Kenji
Published: February 2013

Objective: Public health emergencies like earthquakes and tsunamis underscore the need for an evidence- based approach to disaster preparedness. Using the Japanese administrative database and the geographical information system (GIS), the interruption of hospital-based mechanical ventilation administration by a hypothetical disaster in three areas of the southeastern mainland (Tokai,Tonankai, and Nankai) was simulated and the repercussions on ventilator care in the prefectures adjacent to the damaged prefectures was estimated.Design, setting, and patients: Using the database of 2010 including 3,181,847 hospitalized patients among 952 hospitals, the maximum daily ventilator capacity in each hospital was calculated and the number of patients who were administered ventilation on October xx was counted.Interventions: Using GIS and patient zip code, the straight-line distances among the damaged hospitals, the hospitals in prefectures nearest to damaged prefectures, and ventilated patients’ zip codes were measured. The authors simulated that ventilated patients were transferred to the closest hospitals outside damaged prefectures.Outcomes: The increase in the ventilator operating rates in three areas was aggregated.Results: One hundred twenty-four and 236 patients were administered ventilation in the damaged hospitals and in the closest hospitals outside the damaged prefectures of Tokai, 92 and 561 of Tonankai, and 35 and 85 of Nankai, respectively. The increases in the ventilator operating rates among prefectures ranged from 1.04 to 26.33-fold in Tokai; 1.03 to 1.74-fold in Tonankai, and 1.00 to 2.67-fold in Nankai.Conclusion: Administrative databases and GIS can contribute to evidenced-based disaster preparedness and the determination of appropriate receiving hospitals with available medical resources.
The impact of alternative diagnoses on the utility of influenza-like illness case definition to detect the 2009 H1N1 pandemic
Authors: Rumoro, DO, FACEP Dino P. , Bayram, MD, MPH, EMDM, MEd Jamil D. , Silva, MD, MPH Julio C. , Shah, PhD Shital C. , Hallock, MD Marilyn M. , Gibbs, MPH Gillian S. , Waddell, MS Michael J.
Published: February 2013

Objective: To investigate the impact of excluding cases with alternative diagnoses on the sensitivity and specificity of the Centers for Disease Control and Prevention’s (CDC) influenza-like illness (ILI) case definition in detecting the 2009 H1N1 influenza, using Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification, a disease surveillance system.Design: Retrospective cross-sectional study design.Setting: Emergency department of an urban tertiary care academic medical center.Patients: 1,233 ED cases, which were tested for respiratory viruses from September 5, 2009 to May 5, 2010.Main Outcome Measure: The main outcome measures were positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of the ILI case definition (both including and excluding alternative diagnoses) to detect H1N1.Results: There was a significant decrease in sensitivity (χ2 = 9.09, p 0.001) and significant improvement in specificity (χ2 = 179, p 0.001), after excluding cases with alternative diagnoses.Conclusion: When early detection of an influenza epidemic is of prime importance, pursuing alternative diagnoses as part of CDC’s ILI case definition may not be warranted for public health reporting due to the significant decrease in sensitivity, in addition to the resources required for detecting these alternative diagnoses.
High-fidelity multiactor emergency preparedness training for patient care providers
Authors: Scott, MD Lancer A. , Maddux, BS P. Tim , Schnellmann, PhD, ELS Jennifer , Hayes, BS Lauren , Tolley, BS Jessica , Wahlquist, MS Amy E.
Published: February 2013

Background: Providing comprehensive emergency preparedness training (EPT) for patient care providers is important to the future success of emergency preparedness operations in the United States. Disasters are rare, complex events involving many patients and environmental factors that are difficult to reproduce in a training environment. Few EPT programs possess both competency-driven goals and metrics to measure life-saving performance during a multiactor simulated disaster.Methods: The development of an EPT curriculum for patient care providers—provided first to medical students, then to a group of experienced disaster medical providers—that recreates a simulated clinical disaster using a combination of up to 15 live actors and six high-fidelity human simulators is described. Specifically, the authors detail the Center for Health Professional Training and Emergency Response’s (CHPTER’s) 1-day clinical EPT course including its organization, core competency development, medical student self-evaluation, and course assessment.Results: Two 1-day courses hosted by CHPTER were conducted in a university simulation center. Students who completed the course improved their overall knowledge and comfort level with EPT skills.Conclusions: The authors believe this is the first published description of a curriculum method that combines high-fidelity, multiactor scenarios to measure the life-saving performance of patient care providers utilizing a clinical disaster scenario with 10 patients at once. A larger scale study, or preferably a multicenter trial, is needed to further study the impact of this curriculum and its potential to protect provider and patient lives.
Occupational and public health considerations for work-hour limitations policy regarding public health workers during response to natural and human-caused disasters
Authors: Berkowitz, DO, MA, MS, MPH Murray R.
Published: February 2013

This article examines the occupational health considerations that might impact the health and wellbeing of public health workers during responses to natural (eg, floods and hurricanes) and humancaused (eg, terrorism, war, and shootings) disasters. There are a number of articles in the medical literature that argue the impact of how working long hours by house staff physicians, nurses, and first-responders may pose health and safety concerns regarding the patients being treated. The question examined here is how working long hours may pose health and/or safety concerns for the public health workers themselves, as well as to those in the communities they serve. The health problems related to sleep deprivation are reviewed. Current policies and legislations regarding work-hour limitations are examined. Policy implications are discussed.
Healthcare delivery aboard US Navy hospital ships following earthquake disasters: Implications for future disaster relief missions
Authors: Sechriest II, MD V. Franklin , Wing, MS Vern , Walker, BA G. Jay , Aubuchon, BS Maureen , Lhowe, MD David W.
Published: February 2013

Objective: Since 2004, the US Navy has provided ship-borne medical assistance during three earthquake disasters. Because Navy ship deployment for disaster relief (DR) is a recent development, formal guidelines for equipping and staffing medical operations do not yet exist. The goal of this study was to inform operational planning and resource allocation for future earthquake DR missions by 1) reporting the type and volume of patient presentations, medical staff, and surgical services and 2) providing a comparative analysis of the current medical and surgical capabilities of a hospital ship and a casualty receiving and treatment ship (CRTS).Design: The following three earthquake DR operations were reviewed retrospectively: 1) USNS Mercy to Indonesia in 2004, 2) USNS Mercy to Indonesia in 2005, and 3) USNS Comfort/USS Bataan to Haiti in 2010. (The USS Bataan was a CRTS.) Mission records and surgical logs were analyzed. Descriptive and statistical analysis was performed. Comparative analysis of hospital ship and CRTS platforms was made based on firsthand observations.Results: For the three missions, 986 patient encounters were documented. Of 1,204 diagnoses, 80 percent were disaster-related injuries, more than half of which were extremity trauma. Aboard hospital ships, healthcare staff provided advanced (Echelon III) care for disaster-related injuries and various nondisaster- related conditions. Aboard the CRTS, staff provided basic (Echelon II) care for disaster-related injuries.Conclusions: Our data indicate that musculoskeletal extremity injuries in sex- and age-diverse populations comprised the majority of clinical diagnoses. Current capabilities and surgical staffing of hospital ships and CRTS platforms influenced their respective DR operations, including the volume and types of surgical care delivered.
Business continuity after catastrophic medical events: The Joplin Medical Business Continuity Report
Authors: Carlton Jr, MD, FACS Paul K. , Bringle, RN, BSN, MSHSA Dottie
Published: February 2013

On May 22, 2011, The St Johns Mercy Medical Center in Joplin,MO, was destroyed by an F-5 tornado. There were 183 patients in the building at that time in this 367-bed Medical Center. The preparation and response were superbly done and resulted in many lives saved. This report is focused on the reconstitution phase of this disaster response, which includes how to restore business continuity. As 95 percent of our medical capacity resides in the private sector in the United States, we must have a proper plan for how to restore business continuity or face the reality of the medical business failing and not providing critical medical services to the community. A tornado in 2007 destroyed a medical center in Sumter County, GA, and it took more than 365 days to restore business continuity at a cost of $18M. The plan executed by the Mercy Medical System after the disaster in Joplin restored business continuity in 88 days and cost a total of $6.6M, with all assets being reusable. The recommendation from these lessons learned is that every county, state, and Federal Emergency Management Agency region has a plan on the shelf to restore business continuity and the means to be able to do so. The hard work that the State of Missouri and the Mercy Medical System did after this disaster can serve as a model for the nation in how to quickly recover from any loss of medical capability.