bluuebunny/crossref_metadata_2025 huggingface dataset:
On the Soul of Technical Objects: Commentary on Simondon’s ‘Technics and Eschatology’ (1972)
Authors: Hui Yuk
Published: March 2018

This article comments on a paper titled ‘Technique et eschatologie: le devenir des objets techniques’ that Gilbert Simondon presented in 1972. For Simondon, eschatology consists of a basic presupposition, which is the duality between the immortal soul and the corruptible body. The eschatology of technical objects can be seen as the object’s becoming against time. Simondon suggests that in the epoch of artisans, the product through its perfection searches for the ‘immortality of his producer’, while in the industrial epoch standardization becomes the key mover, in the sense that different parts of the object can be replaced. This analysis of Simondon on the relation between technics and eschatology allows a speculation on the soul of technical objects by tracing his earlier works. This conception of the soul, as this article tries to show, allows Simondon to address the alienation of technical objects in juxtaposition to a Marxist critique of alienation.
Mobile manipulator planning under uncertainty in unknown environments
Authors: Pilania Vinay , Gupta Kamal
Published: March 2018

We present a sampling-based mobile manipulator planner that considers the base pose uncertainty and the effects of this uncertainty on manipulator motions. The overall planner has three distinct and novel features: (i) it uses the Hierarchical and Adaptive Mobile Manipulator Planner (HAMP) that plans for both the base and the arm in a judicious manner; (ii) it uses localization-aware sampling and connection strategies to consider only those nodes and edges which contribute toward better localization; (iii) it incorporates base pose uncertainty along the edges (where arm remains static) and the effects of this uncertainty are considered on arm motion. We call this overall planner HAMP-BUA, where BUA denotes “Base pose Uncertainty and its propagation to Arm motions.” First we evaluate our planner in known static environments and show that it finds a safer path as compared with other variants where uncertainty is not considered at different levels as mentioned above. Next, we incorporate our planner within an integrated and fully autonomous system for mobile pick-and-place tasks in unknown static environments. A key aspect of our integrated system is that the planner works in tandem with base and arm exploration modules that explore the unknown environment. Our system is implemented both in simulation and on the actual Simon Fraser University (SFU) mobile manipulator and we present the corresponding results. It demonstrates a level of competency in exploring unknown environments for carrying out pick-and-place tasks that has not been demonstrated previously.
New methodology for the characterization of failure by fracture in bulk forming
Authors: Magrinho Joao P , Silva Maria Beatriz , Alves Luis M , Atkins AG , Martins Paulo AF
Published: March 2018

This article is focused on the formability limits by fracture obtained from standard bulk metal forming tests performed with cylindrical, tapered and flanged specimens. A total of two novel features are presented: the use of digital image correlation to determine strain paths and immersion of steel specimens in liquid nitrogen after the onset of crack formation to reveal the mode of fracture. A new methodology to determine the fracture loci in principal strain space is proposed based on the combination of experimental force–displacement evolutions with in-plane strain measurements. The experimental work is performed in cold-drawn steel AISI 1045 and two new formability tests with different values of stress triaxiality are proposed for obtaining strains at fracture in regions of principal strain space that are not sufficiently well covered by standard bulk metal forming tests.
Toward a Population Revolution? The Threat of Extinction and Family Policy in Czechoslovakia 1930s–1950s
Authors: Rákosník Jakub , Šustrová Radka
Published: March 2018

The 1930s and 1940s were a formative period in the development of family policy as a relatively independent branch of the state’s social policy in the Bohemian lands. During this time, several political regimes followed one another (liberal democracy, a conservative authoritative regime, the national socialism of the occupation, and postwar people’s democracy). Despite these political changes, family policy was determined by the discourse of the waning Western industrial society and intensifying nationalism throughout the period in question. The articulation of the national threat created the conditions necessary for active state intervention in the sphere of marital cohabitation and managed support of population growth. This entailed compensating families for preserving the nation as a whole by giving birth to a populous new generation. These efforts were often in conflict with the movement for equality among men and women and increased women’s participation in the labor market. The first part of this article describes the discourse of the nation under threat and its political consequences. The second half focuses on the formation of the social reform consensus during the Second World War and after peace was restored. The third part confronts experts’ proposals with political practice: despite the low number of positive legislative measures, this analysis reveals the evident continuity of efforts to create a conceptual, state-led family policy regardless of the vastly different ideologies of the political regimes mentioned.
Cavopulmonary mechanical circulatory support in Fontan patients and the need for physiologic control: A computational study with a closed-loop exercise model
Authors: Granegger Marcus , Schweiger Martin , Schmid Daners Marianne , Meboldt Mirko , Hübler Michael
Published: March 2018

Purpose:

Rotary blood pumps are a promising treatment approach for patients with a total cavopulmonary connection and a failing cardiovascular system. The aim of this study was to investigate the hemodynamic effects of cavopulmonary support using a numerical model with closed-loop baroreflex and exercise mechanisms.

Methods:

A numerical model of the univentricular cardiovascular system was developed, mimicking the hemodynamics during rest and exercise. Rotary blood pumps with different hydraulic pump characteristics (flat vs steep pressure-flow relationships) were investigated in the cavopulmonary position. Furthermore, two support modes—a constant speed setting and a physiologically controlled speed—were examined.

Results:

Hemodynamics without rotary blood pumps were achieved with less than 10% deviation from reported values during rest and exercise. Rotary blood pumps at constant speed improve the hemodynamics at rest, however, they constitute a hydraulic resistance during light (steep characteristics) or moderate (flat characteristics) exercise. In contrast, physiologic control increases cardiac output (moderate exercise: 8.2 vs 7.4 L/min) and reduces sympathetic activation (heart rate at moderate exercise: 111 vs 123 bpm).

Conclusion:

In this simulation study, the necessity of an automatically controlled rotary blood pump in the cavopulmonary position was shown. A pump at constant speed might constitute an additional resistance to venous return during physical activity. Therefore, a physiologic control algorithm based on the pressure difference between the caval veins and the atrial pressure is proposed to improve hemodynamics, especially during physical activity.
The Top Ten Websites in Critical Care Medicine Education Today
Authors: Wolbrink Traci A. , Rubin Lucy , Burns Jeffrey P. , Markovitz Barry
Published: March 2018

Introduction:

The number of websites for the critical care provider is rapidly growing, including websites that are part of the Free Open Access Med(ical ed)ucation (FOAM) movement. With this rapidly expanding number of websites, critical appraisal is needed to identify quality websites. The last major review of critical care websites was published in 2011, and thus a new review of the websites relevant to the critical care clinician is necessary.

Methods:

A new assessment tool for evaluating critical care medicine education websites, the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET), was modified from existing tools. A PubMed and Startpage search from 2007 to 2017 was conducted to identify websites relevant to critical care medicine education. These websites were scored based on the CCMEWQET.

Results:

Ninety-seven websites relevant for critical care medicine education were identified and scored, and the top ten websites were described in detail. Common types of resources available on these websites included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes. Almost one quarter of websites (n = 22) classified themselves as FOAM websites. The top ten websites most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning.

Conclusion:

Many excellent online resources for critical care medicine education currently exist, and the number is likely to continue to increase. Opportunities for improvement in many websites include more active engagement of learners, upgrading navigation abilities, incorporating an editorial process, and providing appropriate attribution for graphics and media.
Knowledge, Attitudes, and Beliefs of Physicians and Other Health Care Providers Regarding Artificial Nutrition and Hydration at the End of Life
Authors: Heuberger Roschelle , Wong Helen
Published: March 2018

Objective: Despite the growing evidence against artificial nutrition and hydration (ANH) use among patients with advanced dementia, little is known about the perspectives of the health care team. This study examined the knowledge, attitudes, and beliefs of physicians and other health care providers regarding the use of ANH at the end of life (EOL). Methods: A cross-sectional survey explored the provision of EOL care using a hypothetical case scenario of a patient with advanced dementia and dysphagia. Questionnaire items were analyzed using parametric and nonparametric approaches. Results: In this sample of 323 respondents, statistical significance was found between physicians and other health care providers’ views on ANH and its related beneficial effects or health outcomes in EOL care. Discussion: Results indicate knowledge deficits in physicians and other health care professionals and highlight the need for comprehensive continuing education programs on EOL topics. Conclusion: Differences in knowledge, attitudes and beliefs regarding ANH in EOL among healthcare providers were observed and education regarding evidence based clinical guidelines are necessary.
Measuring the value of placements to employers
Authors: Wond Tracey , Rambukwella Shan
Published: March 2018

This article explores the concept and measurement of placement value, underexplored in theory and practice to date. The article makes a theoretical contribution to the placement value discourse by examining and articulating the placement value concept. It also offers a practical contribution by exploring a piloted tool to evaluate employer placement value, developed as part of a project funded by the Higher Education Funding Council for England. It examines the immaturity of the placement value concept against contemporary value discourse, including service- and goods-dominant logic frameworks (exploring value-in-use and value-in-exchange) and calls for greater attention to be paid to placement value to support the sustainable provision of placements.
Two high-efficient DOPO-based phosphonamidate flame retardants for transparent epoxy resin
Authors: Wang Peilong , Fu Xianling , Kan Yongchun , Wang Xin , Hu Yuan
Published: March 2018

In this work, two kinds of 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO)-based phosphonamidate flame retardants named 4,4′-diamino-diphenyl methane (DDM)-DOPO and morpholine (MPL)-DOPO are successfully synthesized by the classic Atherton–Todd reaction, and their chemical structures are characterized by Fourier transform infrared spectroscopy (FTIR) and nuclear magnetic resonance (NMR). Epoxy composites containing DDM-DOPO or MPL-DOPO are prepared, which still retain relatively high transparency compared with pure epoxy resin (EP). Its fire behavior is studied in terms of vertical burning test (UL-94), limiting oxygen index (LOI), and cone calorimeter tests. The LOI values can achieve 30% and UL-94 test past V-0 rating for DDM-DOPO-modified epoxy composites with 0.25 wt% phosphorus content. The cone calorimeter results indicate that the modified epoxy composites can release less heat and smoke compared with pure EP. Also, thermal degradation behavior and flame-retardant mechanism of epoxy composites are investigated by thermogravimetric analysis and thermogravimetric analysis/infrared spectrometry. The results indicate that two DOPO-based phosphonamidates show a significant gaseous-phase effect on reducing the release of combustible volatiles.
Neural control and coordination of decentralized transportation robots
Authors: Martínez-García Edgar A , Torres-Córdoba Rafael , Carrillo-Saucedo Victor M , López-González Elifalet
Published: March 2018

This work presents the modeling, control architecture and simulation of a decentralized multi-robot system for transporting material in a warehouse. Each robot has a task scheduler comprising two different neural networks for task allocation and fault tolerance. The path planner consists of a first-order dynamical state equation to control the robot’s four-wheel asynchronous driving and steering, as well as a partial differential equation to coordinate speeds and arrival times. The task allocation and motion coordination combine the robot’s kinematic control law with a one-layer artificial neural network that classifies five-dimensional symbolic logical equations that define the state transitions between asynchronous events. These events include carry and fetch, material supply, robots stop, obstacle avoidance and battery state. Another multilayer artificial neural network reads the same state inputs for fault detection and recovery. The two neural systems feed forward a navigation planner, which uses a partial differential equation to coordinate the robot’s speed and its relaxation time with respect to the robot in front of it. The energy cost is measured by a Lagrangian function. The proposed planning control scheme was computationally validated through parallel computing simulations. The system is shown to be consistent, reliable and feasible, and it allows for fast navigational tasks.
Hans Enoch and vivicillin
Authors: Shama Gilbert
Published: March 2018

Hans Emmanuel Enoch (1896–1991) was born in Hamburg, the son of a manufacturer of sera and vaccines. Upon his father’s death, he took charge of the Hamburg Serum Werke. Following the rise of Hitler, he came to be pilloried in the Nazi press for allegedly having poisoned the population of Hamburg and was imprisoned for a time. He immigrated to England in 1935 where he had secured a position with the International Serum Company in Norwich. Following the outbreak of war, he was interned as an enemy alien, eventually ending up in Canada. In 1941, he was permitted to return to England, but wartime conditions prevented him from continuing to manufacture sera. At about this time, penicillin was making the headlines, and coupled with accounts of its miraculous properties, was the news that all production was reserved exclusively for the armed forces. Enoch decided to meet the public clamour for penicillin by producing a crude version which he termed ‘vivicillin.’ News of this spread globally, and he came to incur the disdain of Howard Florey for the attendant publicity. Notwithstanding this, vivicillin was to prove itself effective and its use led to the saving of lives.
E-Cigarettes: Implications for Health Promotion in the Asian Pacific Region
Authors: Jancey Jonine , Maycock Bruce , McCausland Kahlia , Howat Peter
Published: March 2018

Since their introduction to the United States in 2007, electronic cigarettes (e-cigarettes) use has grown exponentially. This rapid growth in e-cigarette use has been heralded by some as a potential important public health measure that could ultimately replace tobacco cigarettes, while others recommend a cautionary approach until there is clear evidence they will not become “new tobacco” bringing a possible myriad of other problems. E-cigarettes may have real benefits, however they do expose users and those nearby to organic compounds, solvents and particulate matter, with there being limited data relating to their health impact. It is unclear as to whether this relatively new device has the potential to exacerbate nicotine addictions, or play a part in reducing harm and smoking cessation. The fundamental requirement of public health practice is to do no harm and from the inconclusive evidence we have to date on e-cigarettes, it appears a cautious approach is warranted. This commentary reviews evidence that supports a cautious approach to e-cigarette availability in Australia and the Asian Pacific region.
Reporting Maltreatment to Child Protective Services in the Context of Intimate Partner Violence Research
Authors: Rizo Cynthia Fraga , O’Brien Jennifer , Macy Rebecca , Ermentrout Dania , Lanier Paul
Published: March 2018

Given the overlap between intimate partner violence (IPV) and child maltreatment, IPV-exposed child participants in research might disclose instances of child maltreatment. Such disclosures might require researchers to report the maltreatment to child protective services (CPS). However, the literature provides minimal guidance on how to navigate the complex challenges and ethical dilemmas around reporting in the context of research. To help address this gap and stimulate discussion regarding protocols and policies for reporting child maltreatment, this article presents a CPS reporting protocol developed as part of a community-engaged research project evaluating a parenting intervention for system-involved mothers experiencing IPV.
The collective dimension of federal anti-discrimination proceedings in Australia
Authors: MacDermott Therese
Published: March 2018

The burden of pursuing federal anti-discrimination proceedings in Australia is essentially an individual one, with little regard to the collective dimension of such claims. This is reflected in the narrow approach to standing for organizations with established interests in areas affected by such claims, the scarcity of representative proceedings for breaches of federal anti-discrimination law legislation, and the lack of capacity on the part of the national human rights agency to pursue test case litigation or provide advice or support to individual complainants. In exploring these three key areas, this article highlights the shortcomings of the Australian regulatory approach and its failure to provide adequate mechanisms for redress that recognize the broader community concern in ensuring that discriminatory practices are identified and addressed.
Effects of increasing the degree of reasoning and the number of elements on L2 argumentative writing
Authors: Rahimi Muhammad
Published: March 2018

The impacts of task characteristics on second language (L2) writing require further exploration. This study examined the effects of increasing task complexity on L2 argumentative writing. Upper-intermediate L2 learners performed two writing tasks with varying degrees of complexity in relation to the number of elements and the degree of reasoning. The learners’ writing was measured in terms of syntactic complexity, accuracy, lexical complexity, organization, content, and overall text quality. Increasing task complexity effected a significant desirable change in one dimension of syntactic complexity (notably the amount of subordination) and one dimension of lexical complexity (notably academic vocabulary use), had a significant adverse effect on accuracy, and led to the enhancement of content, organization, and writing quality. These findings lend support to the Trade-off Hypothesis, the Cognition Hypothesis, and the central tenet of Kellogg’s writing model. Methodological and pedagogical implications of the study are also discussed.
Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals
Authors: Salahuddin Lizawati , Ismail Zuraini , Hashim Ummi Rabaah , Raja Ikram Raja Rina , Ismail Nor Haslinda , Naim @ Mohayat Mohd Hariz
Published: March 2018

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.
Taming the ‘trolls’: How journalists negotiate the boundaries of journalism and online comments
Authors: Wolfgang J David
Published: March 2018

The relationship between online commenters and journalists has been challenged as frustrated journalists pull back on commenting and introduce rules to make it more difficult to participate. As new rules and policies emerge, journalists engage in a public campaign to change how commenting and journalism are perceived. This study seeks to understand how journalists attempt to frame commenting and its role alongside journalism. Boundary work was used to consider how journalists use public statements about commenting to establish appropriate roles for both the journalist and the commenter. But these statements also represent philosophies about strategies, policies, and practices related to commenting. Journalists take three philosophical approaches to online comments based on whether they willingly welcome commenters, see the commenter as a threat, but recognize their role, or take action to keep the audience at a distance. Along with these three roles, strategies and professional responses to commenting are also discussed.
Ritual, narrative and time: Bridging between Durkheim and Ricoeur
Authors: McKinnon Andrew
Published: March 2018

Paul Ricoeur’s theory of the narrative constitution of time and Emile Durkheim’s conception of the ritual construction of time seem, at least on first examination, incommensurable. While their important and influential theories of the social constitution of time are not easily harmonised, it is possible to construct several bridges between the two, such that they may, at least, be brought into conversation with one another (a dialogue Ricoeur himself seemed keen to avoid). While the two theories may be mutually exclusive, if we look at the relationship between ritual and narrative, we find unexpected points of possible convergence where bridges may be built. We find that ritual and narrative are themselves not entirely distinct from one another and even sometimes difficult to disentangle. Furthermore, narratives of the past require the calendar (itself owing much to its ritual heritage) to provide a structure for, and a way of marking, the flow of time. Conversely, ritual practices often act as carriers of narrative, assisting the transmission of narratives from generation to generation.
Annoyance and frustration: Emotional responses to being assessed in higher education
Authors: Wass Rob , Timmermans Julie , Harland Tony , McLean Angela
Published: March 2018

Despite many articles written about assessment in higher education, surprisingly few have examined students’ emotional responses to assessment and their perceptions of this impact on their learning experiences and well-being. This article reports on a study using in-depth interviews with 40 undergraduate students who were frequently graded. A range of emotions was reported. However, responses were overwhelmingly negative and included annoyance, frustration and disappointment. These emotions were often a response to the assessment practices, such as the timing and weighting of assessments rather than to the assessment itself. When assessment loads were too high, students reported making sacrifices with respect to learning and student life. Students also reported negative emotions when assessment was perceived as meaningless, or recognised as detrimental to learning. We argue that when considering assessment practices, educators should ask questions about the emotional impact of assessment to ensure learning while also taking into account the importance of student well-being.
70-20-10 and the Dominance of Informal Learning: A Fact in Search of Evidence
Authors: Clardy Alan
Published: March 2018

It is now widely accepted that informal learning plays a critical role in all workplace learning. Five different literature traditions examined here seemingly converge on the claim that 70% or more of work-based learning occurs informally. Referred to here as the 70% rule, that rule is now seen as a basic fact in the field. Yet a detailed examination of this literature finds that the evidential basis for the 70% rule is weak; human resource development (HRD) policies relying upon that claim are likely to be misleading. The research and scholarship cited in these traditions are critiqued in terms of sloppy scholarship, inconsistent conceptualizations, and fundamental research protocol problems. The implications from this review suggest that the 70% rule of informal learning needs to be set aside. The conclusions to this research offer propositions for redefining the focus of formal and informal work-based learning along with revising the role of HRD in organizations.
BMPR2 mutations and endothelial dysfunction in pulmonary arterial hypertension (2017 Grover Conference Series)
Authors: Frump Andrea , Prewitt Allison , de Caestecker Mark P.
Published: March 2018

Despite the discovery more than 15 years ago that patients with hereditary pulmonary arterial hypertension (HPAH) inherit BMP type 2 receptor (BMPR2) mutations, it is still unclear how these mutations cause disease. In part, this is attributable to the rarity of HPAH and difficulty obtaining tissue samples from patients with early disease. However, in addition, limitations to the approaches used to study the effects of BMPR2 mutations on the pulmonary vasculature have restricted our ability to determine how individual mutations give rise to progressive pulmonary vascular pathology in HPAH. The importance of understanding the mechanisms by which BMPR2 mutations cause disease in patients with HPAH is underscored by evidence that there is reduced BMPR2 expression in patients with other, more common, non‐hereditary form of PAH, and that restoration of BMPR2 expression reverses established disease in experimental models of pulmonary hypertension. In this paper, we focus on the effects on endothelial function. We discuss some of the controversies and challenges that have faced investigators exploring the role of BMPR2 mutations in HPAH, focusing specifically on the effects different BMPR2 mutation have on endothelial function, and whether there are qualitative differences between different BMPR2 mutations. We discuss evidence that BMPR2 signaling regulates a number of responses that may account for endothelial abnormalities in HPAH and summarize limitations of the models that are used to study these effects. Finally, we discuss evidence that BMPR2‐dependent effects on endothelial metabolism provides a unifying explanation for the many of the BMPR2 mutation‐dependent effects that have been described in patients with HPAH.
Difficulties in modelling ARDS (2017 Grover Conference Series)
Authors: Uhlig Stefan , Kuebler Wolfgang M.
Published: March 2018

Fifty years after the first description of acute respiratory distress syndrome (ARDS), none of the many positive drug studies in animal models have been confirmed in clinical trials and translated into clinical practice. This bleak outcome of so many animal experiments shows how difficult it is to model ARDS. Lungs from patients are characterized by hyperinflammation, permeability edema, and hypoxemia; accordingly, this is what most models aim to reproduce. However, in animal models it is very easy to cause inflammation in the lungs, but difficult to cause hypoxemia. Often – and not unlike in patients – models with hypoxemia are accompanied by cardiovascular failure that necessitates fluid support and ventilation, raising the question as to the role of intensive care measures in models of ARDS. In our opinion, there are two major arguments in favor of modelling intensive care medicine in models of ARDS: (1) preventing death from shock; and (2) modelling ventilation and other ICU measures as a second hit. The preferable predictive endpoints in any model of ARDS remain unclear. At present, the best recommendation is to use endpoints that can be compared across studies (i.e. PaO2/FiO2 ratio, compliance, wet‐to‐dry weight ratio) rather than percentage data. Another important and often overlooked issue is the fact that the thermoneutral environmental temperatures for mice and rats are 30℃ and 28℃, respectively; thus, at room temperature (20–22℃) they suffer from cold stress with the associated significant metabolic changes. While, by definition, any model is an abstraction, we suggest that clinically relevant models of ARDS will have to closer recapitulate important properties of the disease while taking into account species‐specific confounders.
The infection risk scan (IRIS): standardization and transparency in infection control and antimicrobial use
Authors: Willemsen Ina , Kluytmans Jan
Published: March 2018

Background

Infection control needs user-friendly standardized instruments to measure the compliance to guidelines and to implement targeted improvement actions. This abstract describes a tool to measure the quality of infection control and antimicrobial use, the Infection Risk Scan (IRIS). It has been applied in a hospital, several nursing homes and a rehabilitation clinic in the Netherlands.

Method

The IRIS consists of a set of objective reproducible measurements, combining patient- and healthcare related variables, such as: hand hygiene compliance, environmental contamination using ATP measurements, prevalence of resistant microorganisms by active screening, availability of infection control preconditions, personal hygiene of healthcare workers, appropriate use of indwelling medical devices and appropriate use of antimicrobials. Results are visualized in a spider plot using traffic light colors to facilitate the interpretation.

Results

The IRIS provided ward specific results within the hospital that were the basis for targeted improvement programs resulting in measurable improvements. Hand hygiene compliance increased from 43% to 66% (more than 1000 observations per IRIS, p < 0.000) and ATP levels were significantly reduced (p < 0.000). In the nursing homes, large differences were observed with environmental contamination as common denominator. Most remarkable were the difference in Extended Spectrum Beta-Lactamase Enterobacteriaceae (ESBL-E) prevalence (mean 11%, range 0–21%).

Conclusion

The bundle approach and visualization of the IRIS makes it a useful infection prevention tool providing standardization and transparency. Targeted interventions can be started based on the results of the improvement plot and repeated IRIS can show the effect of interventions. In that way, a quality control cycle with continuous improvement can be achieved.
Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana
Authors: Agyepong Nicholas , Govinden Usha , Owusu-Ofori Alex , Essack Sabiha Yusuf
Published: March 2018

Background

Multidrug-resistant Gram-negative bacteria have emerged as major clinical and therapeutic dilemma in hospitals in Ghana.

To describe the prevalence and profile of infections attributable to multidrug-resistant Gram-negative bacteria among patients at the Komfo Anokye Teaching Hospital in the Ashanti region of Ghana.

Methods

Bacterial cultures were randomly selected from the microbiology laboratory from February to August, 2015. Bacterial identification and minimum inhibitory concentrations were conducted using standard microbiological techniques and the Vitek-2 automated system. Patient information was retrieved from the hospital data.

Results

Of the 200 isolates, consisting of K. pneumoniae, A. baumannii, P. aeruginosa, Enterobacter spp., E. coli, Yersinia spp., Proteus mirabilis, Pasteurella spp., Chromobacterium violaceum, Salmomella enterica, Vibrio spp., Citrobacter koseri, Pantoea spp., Serratia spp., Providencia rettgeri Burkholderia cepacia, Aeromonas spp., Cadecea lapagei and Sphingomonas paucimobilis, 101 (50.5%) and 99 (49.5%) recovered from male and female patients respectively The largest proportion of patients were from age-group ≥60 years (24.5%) followed by < 10 years (24.0%) and least 10–19 years (9.5%) with a mean patient age of 35.95 ± 27.11 (0.2–91) years. The decreasing order of specimen source was urine 97 (48.5%), wound swabs 47 (23.5%), sputum 22 (11.0%) bronchial lavage, nasal and pleural swabs 1 (0.50%). Urinary tract infection was diagnosed in 34.5% of patients, sepsis in 14.5%, wound infections (surgical and chronic wounds) in 11.0%, pulmonary tuberculosis in 9.0% and appendicitis, bacteremia and cystitis in 0.50%. The isolates showed high resistance to ampicillin (94.4%), trimethoprim/sulfamethoxazole (84.5%), cefuroxime (79.0%) and cefotaxime (71.3%) but low resistance to ertapenem (1.5%), meropenem (3%) and amikacin (11%). The average multi-drug resistance was 89.5%, and ranged from 53.8% in Enterobacter spp. to 100.0% in Acinetobacter spp. and P. aeruginosa.

Conclusion

Bacterial infections caused by multi-drug resistant (isolates resistant to at least one agent in three or more antibiotic classes) Gram-negative pathogens among patients at Komfo Anokye Teaching Hospital in Kumasi, Ghana are rife and interventions are necessary for their containment.
Effectiveness of healthcare worker screening in hospital outbreaks with gram-negative pathogens: a systematic review
Authors: Ulrich Nikos , Gastmeier Petra , Vonberg Ralf-Peter
Published: March 2018

Background

Identifying the source of an outbreak is the most crucial aspect of any outbreak investigation. In this review, we address the frequently discussed question of whether (rectal) screening of health care workers (HCWs) should be carried out when dealing with outbreaks caused by gram negative bacteria (GNB).

A systematic search of the medical literature was performed, including the Worldwide Outbreak Database and PubMed. Outbreaks got included if a HCW was the source of the outbreak and the causative pathogen was an Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia spp., Pseudomonas aeruginosa, or Acinetobacter baumannii.

This was true for 25 articles in which there were 1196 (2.1%) outbreaks due to GNB, thereof 14 HCWs who were permanently colonized by the outbreak strain. Rectal screening of HCWs was helpful in only 2 of the 1196 (0.2%) outbreaks. Instead, the hands of HCWs served as a reservoir for the outbreak strain in at least 7 articles – especially when they suffered from onychomycosis or used artificial fingernails or rings.

Conclusion

Due to very weak evidence, we do not recommend rectal screening of HCWs in an outbreak situation with GNB. However, besides a critical review of hand hygiene habits, it might be useful to examine the hands of staff carefully. This measure is cheap, quick to perform, and seems to be quite effective.
US Food and Drug Administration Pooled Analysis to Assess the Impact of Bone-Only Metastatic Breast Cancer on Clinical Trial Outcomes and Radiographic Assessments
Authors: Wedam Suparna B. , Beaver Julia A. , Amiri-Kordestani Laleh , Bloomquist Erik , Tang Shenghui , Goldberg Kirsten B. , Sridhara Rajeshwari , Ibrahim Amna , Kim Geoffrey , Kluetz Paul , McKee Amy , Pazdur Richard
Published: March 2018

Purpose

The outcome and proportion of patients with bone-only (BO) metastatic breast cancer (MBC) has not been well described. We sought to describe the differential outcomes of patients with BO MBC in clinical trials and explore whether there was a discrepancy in radiographic reads between investigator and blinded independent central review.

Methods

We pooled and analyzed data on 10,521 patients from 13 prospective trials submitted for MBC treatment in initial or supplemental New Drug or Biologics License Applications from 2005. Three subsets were evaluated: BO, bone with other metastases (BWO), and no bone metastases (NBM). Early discordance rate and late discordance rate were calculated from 3,733 and 2,813 patients subject to a blinded independent central review, respectively.

Results

Bone metastases were identified in 49% (range: 42% to 73%) of patients across trials. BO disease was present in 12.5% (range: 4% to 26%), dependent on subtype. Investigator-assessed progression-free survival (PFS) and overall survival (OS) for the pooled trials demonstrated improved outcomes for the BO subgroup compared with other subgroups (BO v BWO PFS hazard ratio [HR], 0.64; 95% CI, 0.591 to 0.696; BO v NBM PFS HR, 0.70; 95% CI, 0.65 to 0.76; BO v BWO OS HR, 0.56; 95% CI, 0.50 to 0.61; BO v NBM OS HR, 0.68; 95% CI, 0.61 to 0.76). The BO subgroup has a higher early discordance rate and lower late discordance rate than the BWO and NBM subgroups.

Conclusion

To our knowledge, this review is the largest analysis to date of the BO subgroup of MBC and suggests this subgroup may have a distinct natural history. There also seems to be a difference in how the local investigators assessed progression events in the BO subgroup when compared with the other two groups.
Quality of Life During Treatment With Chemohormonal Therapy: Analysis of E3805 Chemohormonal Androgen Ablation Randomized Trial in Prostate Cancer
Authors: Morgans Alicia K. , Chen Yu-Hui , Sweeney Christopher J. , Jarrard David F. , Plimack Elizabeth R. , Gartrell Benjamin A. , Carducci Michael A. , Hussain Maha , Garcia Jorge A. , Cella David , DiPaola Robert S. , Patrick-Miller Linda J.
Published: March 2018

Purpose

Chemohormonal therapy with docetaxel and androgen deprivation therapy (ADT+D) for metastatic hormone-sensitive prostate cancer improves overall survival as compared with androgen deprivation therapy (ADT) alone. We compared the quality of life (QOL) between patients with metastatic hormone-sensitive prostate cancer who were treated with ADT+D and those who were treated with ADT alone.

Methods

Men were randomly assigned to ADT+ D (six cycles) or to ADT alone. QOL was assessed by Functional Assessment of Cancer Therapy-Prostate (FACT-P), FACT-Taxane, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Brief Pain Inventory at baseline and at 3, 6, 9, and 12 months. The Wilcoxon signed rank test was used to examine changes over time. Mixed-effect models compared the QOL between arms at each time point.

Results

Seven hundred ninety men were randomly assigned (ADT+D [n = 397] and ADT[ n = 393]) and completed FACT-P (90% at baseline, 86% at 3 months, 83% at 6 months, 78% at 9 months, and 77% at 12 months). ADT+D patients reported a statistically significant decline in FACT-P at 3 months ( P < .001) but FACT-P did not differ significantly between baseline and 12 months ( P = .38). ADT+D FACT-P scores were significantly lower at 3 months ( P = .02) but significantly higher at 12 months ( P = .04) when compared with ADT FACT-P scores. Differences did not exceed the minimal clinically important difference at any time point. ADT+D patients reported significantly lower Functional Assessment of Chronic Illness Therapy-Fatigue scores at 3 months than did ADT patients ( P < .001). Over time, both arms reported significantly poorer FACT-Taxane scores ( P < .001) when compared with baseline. Brief Pain Inventory scores were similar between arms.

Conclusion

Although ADT+D was associated with statistically worse QOL at 3 months, QOL was better at 12 months for ADT+D patients than for ADT patients. Both arms reported a similar minimally changed QOL over time, suggesting that ADT+D is not associated with a greater long-term negative impact on QOL.
Clinical Value of RNA Sequencing–Based Classifiers for Prediction of the Five Conventional Breast Cancer Biomarkers: A Report From the Population-Based Multicenter Sweden Cancerome Analysis Network—Breast Initiative
Authors: Brueffer Christian , Vallon-Christersson Johan , Grabau Dorthe , Ehinger Anna , Häkkinen Jari , Hegardt Cecilia , Malina Janne , Chen Yilun , Bendahl Pär-Ola , Manjer Jonas , Malmberg Martin , Larsson Christer , Loman Niklas , Rydén Lisa , Borg Åke , Saal Lao H.
Published: March 2018

Purpose

In early breast cancer (BC), five conventional biomarkers—estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), Ki67, and Nottingham histologic grade (NHG)—are used to determine prognosis and treatment. We aimed to develop classifiers for these biomarkers that were based on tumor mRNA sequencing (RNA-seq), compare classification performance, and test whether such predictors could add value for risk stratification.

Methods

In total, 3,678 patients with BC were studied. For 405 tumors, a comprehensive multi-rater histopathologic evaluation was performed. Using RNA-seq data, single-gene classifiers and multigene classifiers (MGCs) were trained on consensus histopathology labels. Trained classifiers were tested on a prospective population-based series of 3,273 BCs that included a median follow-up of 52 months (Sweden Cancerome Analysis Network—Breast [SCAN-B], ClinicalTrials.gov identifier: NCT02306096), and results were evaluated by agreement statistics and Kaplan-Meier and Cox survival analyses.

Results

Pathologist concordance was high for ER, PgR, and HER2 (average κ, 0.920, 0.891, and 0.899, respectively) but moderate for Ki67 and NHG (average κ, 0.734 and 0.581). Concordance between RNA-seq classifiers and histopathology for the independent cohort of 3,273 was similar to interpathologist concordance. Patients with discordant classifications, predicted as hormone responsive by histopathology but non–hormone responsive by MGC, had significantly inferior overall survival compared with patients who had concordant results. This extended to patients who received no adjuvant therapy (hazard ratio [HR], 3.19; 95% CI, 1.19 to 8.57), or endocrine therapy alone (HR, 2.64; 95% CI, 1.55 to 4.51). For cases identified as hormone responsive by histopathology and who received endocrine therapy alone, the MGC hormone-responsive classifier remained significant after multivariable adjustment (HR, 2.45; 95% CI, 1.39 to 4.34).

Conclusion

Classification error rates for RNA-seq–based classifiers for the five key BC biomarkers generally were equivalent to conventional histopathology. However, RNA-seq classifiers provided added clinical value in particular for tumors determined by histopathology to be hormone responsive but by RNA-seq to be hormone insensitive.
Cruising Baghdad
Authors: Olsen Pelle Valentin
Published: March 2018

This article uses a queer lens to examine two short stories by the Iraqi communist, teacher, and prose writer Dhu al-Nun Ayyub (1908–88), “The Eagles’ Anthem” and “How I Found a Guy,” published in his collection Sadiqi (1938). Scholars have avoided analysis of the homoerotic and heterotopic aspects of Ayyub’s writings, even if they mention his depictions of physical attraction between men. Rather than read these fictional texts as sociological studies of sexual sensibilities, the article assumes that they tapped into and reflected psychological and social dynamics in interwar Baghdad. The Ayyub stories, which render homoerotic masculine sexualities as commonplace and a positive aspect of city spaces, are thus distinguished from most Iraqi writings during this period. The stories stage homoeroticism and love between men as democratic critique and affirmation of heterogeneity and vitality in a nationalist, militarist, and heteronormalizing setting that increasingly associated homosexuality with moral dissolution and backwardness.
Grateful Nation
Authors: Moore Ellen
Published: March 2018

In today's volunteer military many recruits enlist for the educational benefits, yet a significant number of veterans struggle in the classroom, and many drop out. The difficulties faced by student veterans have been attributed to various factors: poor academic preparation, PTSD and other postwar ailments, and allegedly antimilitary sentiments on college campuses. In Grateful Nation Ellen Moore challenges these narratives by tracing the experiences of Iraq and Afghanistan war veterans at two California college campuses. Drawing on interviews with dozens of veterans, classroom observations, and assessments of the work of veteran support organizations, Moore finds that veterans' academic struggles result from their military training and combat experience, which complicate their ability to function in civilian schools. While there is little evidence of antimilitary bias on college campuses, Moore demonstrates the ways in which college programs that conflate support for veterans with support for the institutional military lead to suppression of campus debate about the wars, discourage antiwar activism, and encourage a growing militarization.
Chest Trauma in Athletic Medicine
Authors: Phillips Nicholas R. , Kunz Derek E.
Published: March 2018

While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax. Basic field-side management should be rapid and focused, using the standardized approach of Advanced Traumatic Life Support protocol. Early and appropriate diagnosis and management can help allow safe and enjoyable sports participation.
Sob nova direção [entrevistado por Eduardo Diniz, Carlos Osmar Bertero e Aline Lilian dos Santos]
Authors: Brito Luiz Artur Ledur
Published: March 2018

A GV-executivo convidou Luiz Artur Ledur Brito para uma conversa logo depois de sua posse como diretor da FGV-EAESP. Durante a entrevista, ele falou sobre sua história pessoal, trajetória profissional e visão sobre o ensino de Administração no Brasil.Veja, a seguir, de que forma esse engenheiro químico, formado aos 21 anos no Rio Grande do Sul, acabou se tornando professor da EAESP e quais os seus planos à frente da direção da Escola, já que, como declarou em seu discurso de posse, está “animadíssimo” com essa nova fase em sua carreira.
Valor emocional: o cliente sempre tem razão?
Authors: Pin Shyrlei Guitério Calmon Du
Published: March 2018

No intuito de fidelizar os clientes, muitas empresas são tentadas a adotar cegamente o princípio de que eles sempre têm razão. Isso, contudo, pode ser uma armadilha. É possível ser mais crítico em relação às demandas, sem descuidar dos vínculos emocionais.