bluuebunny/crossref_metadata_2025 huggingface dataset:
An examination of the effectiveness of Handwriting Without Tears® instruction
Authors: Roberts Gwenyth I. , Derkach-Ferguson Alanna F. , Siever Jodi E. , Rose M. Sarah
Published: April 2014

Background.

Handwriting is an important childhood occupation, and implications of poor handwriting may have significant long-term effects.

Purpose.

The purpose of this study was to determine the effectiveness of Handwriting Without Tears® (HWT) on Grade 1 students’ handwriting and perception of skills.

Methods.

A cross-over design was used. Repeated measures, at three points, included the Minnesota Handwriting Assessment (MHA) and performance rating scales.

Findings.

Eighty-three boys and 66 girls with an average age of 6.2 years participated in the study. Students receiving HWT achieved significantly higher improvements compared to students with teacher-designed instruction in MHA Total Test Score and in MHA components of form, size, space, and alignment (all p < .05). Students had higher average performance ratings when receiving HWT in the first half of the school year.

Implications.

Instruction using HWT improves students’ perception and skill in handwriting performance.
African American Students, Retention, and Team-Based Learning
Authors: Hunn Vanessa
Published: April 2014

This article reviews the literature on retention of African American students at predominately White institutions (PWIs). A focus on current trends in Kentucky colleges and universities outlines regional retention characteristics. With the popularity of team-based learning pedagogy, the author addresses the need for research using team-based learning with African American students attending PWIs. Research suggests retention of African American students can be undermined with pedagogy that is void of cultural sensitivity. The challenges of using team-based learning with African American students attending PWIs are outlined including feelings of isolation of African American students in White team-based learning groups, omission of African American students from relevant group work, discomfort of students with students of differing race/ethnicity, and the effect on group educational experience as a result of student discomfort. Last, recommendations are made for the use of team-based learning with African American students attending PWIs.
Toward a Better Understanding of the Relationship Between Transformational Leadership, Public Service Motivation, Mission Valence, and Employee Performance
Authors: Caillier James Gerard
Published: April 2014

The direct and indirect impact of transformational leadership on individual performance has often been studied. Yet scholars have failed to fully explore the degree to which two motivators (i.e., public service motivation [PSM] and mission valence) interact with this leadership practice to influence employee performance. To close this lacuna in the literature, a nationwide survey was administered to federal, state, and local government employees in the United States. The findings revealed that transformational leadership and PSM had a direct, positive effect on employee evaluations. They also revealed that mission valence strengthened the positive relationship between transformational leadership and performance. However, PSM did not have the same influence on the association between transformational leadership and performance. The implications these findings have for theory and practice are discussed in the article.
Causes and Consequences of Interrupted Enteral Nutrition
Authors: Peev Miroslav P. , Yeh D. Dante , Quraishi Sadeq A. , Osler Polina , Chang Yuchiao , Gillis Erin , Albano Caitlin E. , Darak Sharon , Velmahos George C.
Published: April 2014

Background: Malnutrition and underfeeding are major challenges in caring for critically ill patients. Our goal was to characterize interruptions in enteral nutrition (EN) delivery and their impact on caloric debt in the surgical intensive care unit (ICU). Materials and Methods: We performed a prospective, observational study of adults admitted to surgical ICUs at a Boston teaching hospital (March–December 2012). We categorized EN interruptions as “unavoidable” vs “avoidable” and compared caloric deficit between patients with ≥1 EN interruption (group 1) vs those without interruptions (group 2). Multivariable logistic regression was used to investigate the association of EN interruption with the risk of underfeeding. Poisson regression was used to investigate the association of EN interruption with length of stay (LOS) and mortality. Results: Ninety‐four patients comprised the analytic cohort. Twenty‐six percent of interruptions were deemed “avoidable.” Group 1 (n = 64) had a significantly higher mean daily and cumulative caloric deficit vs group 2 (n = 30). Patients in group 1 were at a 3‐fold increased risk of being underfed (adjusted odds ratio, 2.89; 95% confidence interval [CI], 1.03–8.11), had a 30% higher risk of prolonged ICU LOS (adjusted incident risk ratio [IRR], 1.27; 95% CI, 1.14–1.42), and had a 50% higher risk of prolonged hospital LOS (adjusted IRR, 1.53; 95% CI, 1.41–1.67) vs group 2. Conclusions: In our cohort of critically ill surgical patients, EN interruption was frequent, largely “unavoidable,” and associated with undesirable outcomes. Future efforts to optimize nutrition in the surgical ICU may benefit from considering strategies that maximize nutrient delivery before and after clinically appropriate EN interruptions.
Endovenous surgery for recurrent varicose veins with a one-year follow up in a patient with Ehlers Danlos syndrome type IV
Authors: Whiteley Mark S , Holdstock Judith M
Published: April 2014

We present a woman with severe symptomatic recurrent varicose veins who was treated with endovenous laser ablation and transluminal occlusion of perforator with attempted phlebectomies for extensive varices. The phlebectomies turned out to be near impossible due to friability of the veins. Her treatment was completed with post-operative ultrasound guided foam sclerotherapy seven months later. She was subsequently diagnosed as Ehlers Danlos syndrome type IV. A duplex ultrasound scan 18 months post-endovenous laser ablation and transluminal occlusion of perforator and 11 months after ultrasound guided foam sclerotherapy confirmed successful closure with virtual atrophy of all treated veins. She was found to be reflux free and only showed a few scattered cosmetic reticular veins. Open varicose vein surgery has been reported as being hazardous in the past in a patient with Ehlers Danlos syndrome type IV. Our experience has shown that endovenous laser ablation, transluminal occlusion of perforator and ultrasound guided foam sclerotherapy appear to be effective in treating this patient with Ehlers Danlos syndrome type IV, although phlebectomies were technically impossible.
Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology
Authors: Baldwin David S , Anderson Ian M , Nutt David J , Allgulander Christer , Bandelow Borwin , den Boer Johan A , Christmas David M , Davies Simon , Fineberg Naomi , Lidbetter Nicky , Malizia Andrea , McCrone Paul , Nabarro Daniel , O’Neill Catherine , Scott Jan , van der Wee Nic , Wittchen Hans-Ulrich
Published: April 2014

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.
“It’s Valid and Reliable” Is Not Enough
Authors: Sepucha Karen R. , Matlock Daniel D. , Wills Celia E. , Ropka Mary , Joseph-Williams Natalie , Stacey Dawn , Ng ChirkJenn , Levin Carrie , Lally Joanne , Borkhoff Cornelia M. , Thomson Richard
Published: April 2014

Background. This review systematically appraises the quality of reporting of measures used in trials to evaluate the effectiveness of patient decision aids (PtDAs) and presents recommendations for minimum reporting standards. Methods. We reviewed measures of decision quality and decision process in 86 randomized controlled trials (RCTs) from the 2011 Cochrane Collaboration systematic review of PtDAs. Data on development of the measures, reliability, validity, responsiveness, precision, interpretability, feasibility, and acceptability were independently abstracted by 2 reviewers. Results. Information from 178 instances of use of measures was abstracted. Very few studies reported data on the performance of measures, with reliability (21%) and validity (16%) being the most common. Studies using new measures were less likely to include information about their psychometric performance. The review was limited to reporting of measures in studies included in the Cochrane review and did not consult prior publications. Conclusions. Very little is reported about the development or performance of measures used to evaluate the effectiveness of PtDAs in published trials. Minimum reporting standards are proposed to enable authors to prepare study reports, editors and reviewers to evaluate submitted papers, and readers to appraise published studies.
Matrix-Applied Characterized Autologous Cultured Chondrocytes Versus Microfracture
Authors: Saris Daniel , Price Andrew , Widuchowski Wojciech , Bertrand-Marchand Marion , Caron Jacob , Drogset Jon Olav , Emans Pieter , Podskubka Ales , Tsuchida Anika , Kili Sven , Levine David , Brittberg Mats ,   on behalf of the SUMMIT study group, Paša Libor , Trc Tomas , Slynarski Konrad , Sanson Bernd-Jan , Bezuidenhoudt Mauritz
Published: April 2014

Background:

Randomized controlled trials studying the efficacy and safety of matrix-applied characterized autologous cultured chondrocytes (MACI) versus microfracture (MFX) for treating cartilage defects are limited.

Purpose:

To compare the clinical efficacy and safety of MACI versus MFX in the treatment of patients with symptomatic cartilage defects of the knee.

Study Design:

Randomized controlled clinical trial; Level of evidence, 1.

Methods:

Patients enrolled in the SUMMIT (Demonstrate the Superiority of MACI implant to Microfracture Treatment) trial had ≥1 symptomatic focal cartilage defect (Outerbridge grade III or IV; ≥3 cm2) of the femoral condyles or trochlea, with a baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) pain value <55. The co–primary efficacy endpoint was the change in the KOOS pain and function subscores from baseline to 2 years. Histological evaluation and magnetic resonance imaging (MRI) assessments of structural repair tissue, treatment failure, the remaining 3 KOOS subscales, and safety were also assessed.

Results:

Of the 144 patients treated, 137 (95%) completed the 2-year assessment. Patients had a mean age of 33.8 years and a mean lesion size of 4.8 cm2. The mean KOOS pain and function subscores from baseline to 2 years were significantly more improved with MACI than with MFX (pain: MACI, 37.0 to 82.5 vs MFX, 35.5 to 70.9; function: MACI, 14.9 to 60.9 vs MFX, 12.6 to 48.7; P = .001). A significant improvement in scores was also observed on the KOOS subscales of activities of daily living (MACI, 43.5 to 87.2 vs MFX, 42.6 to 75.8; P < .001), knee-related quality of life (MACI, 18.8 to 56.2 vs MFX, 17.2 to 47.3; P = .029), and other symptoms (MACI, 48.3 to 83.7 vs MFX, 44.4 to 72.2; P < .001) for patients treated with MACI compared with MFX. Repair tissue quality was good as assessed by histology/MRI, but no difference was shown between treatments. A low number of treatment failures (nonresponders: MACI, 12.5% vs MFX, 31.9%; P = .016) and no unexpected safety findings were reported.

Conclusion:

The treatment of symptomatic cartilage knee defects ≥3 cm2 in size using MACI was clinically and statistically significantly better than with MFX, with similar structural repair tissue and safety, in this heterogeneous patient population. Moreover, MACI offers a more efficacious alternative than MFX with a similar safety profile for the treatment of symptomatic articular cartilage defects of the knee.
An investigation into the performance of composite hat stringers incorporating nanocomposites using a multiscale framework
Authors: Hasan Zeaid , Chattopadhyay Aditi , Liu Yingtao
Published: April 2014

In this paper, an effort has been made to investigate the incorporation of carbon nanotubes in structural composites in order to improve damage characteristics, such as delamination. The nanocomposite material is introduced in the damage-prone regions of complex aerospace stiffener sections; the methodology proposed is an alternative to traditional approaches used to suppress delamination in composites, such as the use of metallic fittings. Numerical simulations are conducted using a multiscale modeling framework. The effective properties of the nancomposites are computed using a micromechanics-based approach and the results are compared with those obtained using a Kalman filter algorithm. The information is then used to analyze the structural response of a hat stringer using detailed finite element models. The stringer is analyzed under different loading conditions and varying levels of defects in the structure. Results obtained indicate that the use of nanocomposites improves the structural performance by improving the initial failure load. It is anticipated that the use of carbon nanotubes during the manufacturing process will help delay the onset of initial damage and damage growth, which can ultimately lead to a more robust structural design with enhanced performance against unique composite failure modes.
Glass fiber-reinforced polymer composites – a review
Authors: Sathishkumar TP , Satheeshkumar S , Naveen J
Published: April 2014

Glass fibers reinforced polymer composites have been prepared by various manufacturing technology and are widely used for various applications. Initially, ancient Egyptians made containers by glass fibers drawn from heat softened glass. Continues glass fibers were first manufactured in the 1930s for high-temperature electrical application. Nowadays, it has been used in electronics, aviation and automobile application etc. Glass fibers are having excellent properties like high strength, flexibility, stiffness and resistance to chemical harm. It may be in the form of roving’s, chopped strand, yarns, fabrics and mats. Each type of glass fibers have unique properties and are used for various applications in the form of polymer composites. The mechanical, tribological, thermal, water absorption and vibrational properties of various glass fiber reinforced polymer composites were reported.
Linking Loneliness, Shyness, Smartphone Addiction Symptoms, and Patterns of Smartphone Use to Social Capital
Authors: Bian Mengwei , Leung Louis
Published: April 2014

The purpose of this study is to explore the roles of psychological attributes (such as shyness and loneliness) and smartphone usage patterns in predicting smartphone addiction symptoms and social capital. Data were gathered from a sample of 414 university students using online survey in Mainland China. Results from exploratory factor analysis identified five smartphone addiction symptoms: disregard of harmful consequences, preoccupation, inability to control craving, productivity loss, and feeling anxious and lost, which formed the Smartphone Addiction Scale. Results show that the higher one scored in loneliness and shyness, the higher the likelihood one would be addicted to smartphone. Furthermore, this study shows the most powerful predictor inversely affecting both bonding and bridging social capital was loneliness. Moreover, this study presents clear evidence that the use of smartphones for different purposes (especially for information seeking, sociability, and utility) and the exhibition of different addiction symptoms (such as preoccupation and feeling anxious and lost) significantly impacted social capital building. The significant links between smartphone addiction and smartphone usage, loneliness, and shyness have clear implications for treatment and intervention for parents, educators, and policy makers. Suggestions for future research are discussed.
The mental test as a boundary object in early-20th-century Russian child science
Authors: Byford Andy
Published: April 2014

This article charts the history of mental testing in the context of the rise and fall of Russian child science between the 1890s and the 1930s. Tracing the genealogy of testing in scientific experimentation, scholastic assessment, medical diagnostics and bureaucratic accounting, it follows the displacements of this technology along and across the boundaries of the child science movement. The article focuses on three domains of expertise – psychology, pedagogy and psychiatry, examining the key guises that mental testing assumed in them – namely, the experiment, the exam and the diagnosis. It then analyses the failed state-bureaucratic harnessing of mental testing in early Soviet attempts to manage mass education, discussing the peculiar dynamics of the (de)legitimation of testing, as it swung between black-boxing and instrumentalization, on the one hand, and scandal and controversy, on the other. The article argues that mental testing thrived in Russia as a strategically ambiguous and flexibly interpreted ‘boundary object’, which interconnected a highly heterogeneous field, enabling the coexistence and cooperation of diverse occupational agendas and normative regimes.
Rail grinding for the 21st century – taking a lead from the aerospace industry
Authors: Singleton Roger , Marshall Matthew B , Lewis Roger , Evans Gareth
Published: April 2014

Rail grinding is a key maintenance activity for Network Rail. It is performed at night through possession of the track, so process speed is critical. Increasing the metal removal rate (MRR) of the rail grinding operations would be a way to improve the time taken for this operation. The aerospace industry has recently seen advances in grinding technologies that have increased MRR. This work was aimed at assessing their best practice and its application to rail grinding operations.

Current Network Rail grinding operations include preventative and corrective re-profiling of the rail head. The majority of work performed in the UK is preventative re-profiling with current train speeds ranging from 1 to 10 mile/h. Opportunities exist to increase train speed and improve the productivity of this operation through the use of more advanced grinding technologies.

The most relevant aerospace technology is high efficiency deep grinding (HEDG). This approach uses: a high surface speed of the grinding wheel, superabrasive tooling, and high workpiece feed rates to remove material quickly from the cut-zone. Productivity improvements were identified by applying theory on power requirements (by assessing the specific grinding energy) and chip thickness of the grinding process. Computer CAD/CAM modelling was also performed to assess the effect of changing grinding techniques on potential gouging of the track infrastructure and/or interference with example trackside obstructions.

The work concluded that opportunities do exist to improve the current productivity of grinding operations. Utilizing HEDG technology theoretically provides a 100% train speed increase (utilizing the same power available with the current setup) for preventative re-profiling. This requires the application of high surface speeds of the grinding wheel and superabrasive technology. Further increases in train speed require increased spindle power. The chip thickness experienced by grinding grains is reduced for a peripheral grinding setup and high wheel surface speeds that is beneficial for wheel wear. The application of HEDG technology cutting on the periphery of the wheel provided optimum conditions during CAD/CAM simulation to avoid rail gouging, and any potential collision of the grinding stone with modelled trackside obstructions.
Numerical calculation of the slipstream generated by a CRH2 high-speed train
Authors: Huang Sha , Hemida Hassan , Yang Mingzhi
Published: April 2014

Slipstreams caused by high-speed train movement through the atmosphere pose a safety risk to passengers, trackside workers and track infrastructure. The improved delayed detached eddy simulation (IDDES) approach, an improved version of the detached eddy simulation method, is adopted in this paper to calculate the slipstream of a four-coach 1/25th-scale model of the CRH2 high-speed train. Slipstream velocities and pressures at various lateral distances from the centre of rail (COR) position and vertical distances from the top of rail (TOR) position at trackside are calculated. Numerical results are compared with measurements obtained in a full-scale test and good agreement is obtained, which verifies the effectiveness and potential of the less costly IDDES method. It is found that the velocity and pressure distributions are similar to those obtained using different train types but with different peak values related to the difference in shapes. The peak velocities in the slipstream along the length of the train are found at the tail and in the near wake region. The magnitude of the peak decreases with an increasing distance from the COR and shows a relatively high value at about two thirds of the train height from the TOR. The maximum pressure coefficients are found in the upstream and nose regions. The results show that the value of these coefficients decreases with an increasing distance from the COR and TOR. Based on the suggested safe slipstream velocity in China, the IDDES results show that for a CRH2 high-speed train at a speed of 350 km/h, the safe standing distance should be greater than 3.4 m in the lower part of the train’s slipstream (up to about half of the train height from the ground) and 2.4 m for the top part of the train’s slipstream (above half the height of the train from the ground).
An investigation of the dynamic behaviour of track transition zones using discrete element modelling
Authors: Chen Cheng , McDowell Glenn R
Published: April 2014

Previous investigations have shown that an abrupt stiffness change in track support is often associated with accelerated rates of deterioration of track geometry, high maintenance demand and poor ride quality. However, at present, there is no detailed understanding of the mechanisms of the deterioration of track geometry at transition zones. This paper aims to use the discrete element method to investigate transition zones from a micromechanical perspective. A simple track transition model with dimensions 2.1 m × 0.3 m × 0.45 m was simulated by using PFC3D. In order to identify and evaluate appropriate mitigation methods, two kinds of transition patterns, including a single step change and a multi step-by-step change for subgrade stiffness distribution were tested. The influence of train direction, speed and axle load on the transition was also investigated. In addition, geogrid was used in the ballast layer to examine the effects of geogrid reinforcement. This paper provides insight into the factors that can cause or accelerate track degradation at the transition zones, in order to identify and evaluate appropriate mitigation design.
Track deflection and stiffness measurements from a track recording car
Authors: Berggren Eric G , Nissen Arne , Paulsson Björn S
Published: April 2014

A new innovative method for track deflection and track stiffness measurement is described and used on the iron-ore line in Sweden. The method uses two different measurement systems of longitudinal level on one axle, and by comparing them in a new way it is possible to extract the unloaded level and the effect of the loading from the loaded longitudinal level. Displacement due to loading can also be interpreted as a track stiffness value if the wheel load is simulated or measured. With this method, a new approach to condition monitoring of track is created due to the possibility of monitoring stiffness and longitudinal level at the same time using a track recording car. The method has been used in an extensive measurement campaign on the iron-ore line in the north of Sweden. Many examples are given in this paper to illustrate different track defects on ordinary track, mainly on track section (bandel) 118. Hanging sleepers and mud-pumping places have been successfully located using the new method. The method has been used in both winter and summer conditions. We have found that the track stiffness/deflection level does not vary considerably with change of season. This result is explained by the design decision in the 1980s to use soft fastener pads, which seems to have been a very good decision.
Study on the mechanism of the formation of polygon-shaped wheels on subway vehicles
Authors: Ma Weihua , Song Rongrong , Luo Shihui
Published: April 2014

This paper discusses the mechanism responsible for the formation of polygon-shaped wheels; the aim is to solve the problem of their occurrence on subway vehicles. This phenomenon occurs mainly as a result of wheel/rail vertical forces created by the vibration of the wheelset over several complete revolutions of the wheel. In addition, a relationship linking the phase angle between two adjacent vertices, the main vibration frequency and running speed of the polygonal wheel is derived. Then, considering a subway vehicle that is powered by a linear induction motor and applying the multi-body system dynamics model, the main frequency of the wheel/rail vertical force under various running speeds is investigated. Analysis of the speed and main frequency value of a subway vehicle covered in this study revealed that a polygonal wheel with nine vertices can be generated in the speed range 72 to 80 km/h.
Performance characteristics and optimisation of a geared intercooled reversed flow core engine
Authors: Camilleri William , Anselmi Eduardo , Sethi Vishal , Laskaridis Panagiotis , Rolt Andrew , Cobas Pedro
Published: April 2014

Intercooled turbofan cycles allow higher overall pressure ratios to be reached, which gives rise to improved thermal efficiency. In addition, intercooling allows for the size, weight and exhaust jet velocity of the core to be reduced. For an optimum jet velocity ratio and fixed thrust, the fan pressure ratio and specific thrust are also reduced, which benefits propulsive efficiency. A new intercooled core concept is proposed in this paper, which promises to alleviate limitations identified in previous intercooled turbofan designs. This concept facilitates the installation of the intercooler and reduces core losses at high overall pressure ratios. This engine concept takes advantage of intercooling and the arrangement of the high pressure spool to reach and exceed overall pressure ratios of 80. In addition, given the reduction in core size, bypass ratios beyond 14 have been considered. In order to identify efficiency gains and performance characteristics which are due to the novel arrangement alone, the geared intercooled reversed flow core engine has been compared with a geared intercooled engine with a more conventional core. Finally an optimisation exercise has been carried out to identify the best configuration for both the geared intercooled reversed flow core concept and the conventional core concept. In this paper, it is demonstrated that the geared intercooled reversed flow core concept allows for a 2.3% reduction in block fuel burn. The reductions are due to the improved core efficiency, higher overall pressure ratio as well as efficiency gains from the use of a mixed exhaust. The sensitivity analysis shows that the improvements are highly dependent on pressure losses in the core and bypass stream and that careful design of the mixer chutes and intercooler headers to achieve low losses is essential if the concept gains are to be realised.
A model for pilot control behavior in analyzing potential loss-of-control events
Authors: Hess Ronald A
Published: April 2014

An adaptive model of the human pilot engaged in pursuit tracking tasks that was previously introduced in the literature is modified and applied to the analysis of piloted control of a realistic transport aircraft model. As described, the pilot model requires no guesswork on the part of the analyst as regards initial parameter settings. By means of computer simulation, the adaptive pilot model is shown to exhibit superior performance to its non-adaptive counterpart in a series of configuration changes associated with the vehicle model. The overall validity of the post-adaptive pilot model is assessed by examining the resulting open-loop pilot vehicle dynamics in comparison to that predicted by the crossover model of the human pilot. The pilot modeling approach is proposed as a preliminary analytical tool to be used in the assessment of robust flight control system designs subject to faults or system failures with an eye toward potential loss-of-control.
Analysis of a rotary task following total knee arthroplasty: Stair descent with a cross-over turn
Authors: Denney Linda M , Ferris Lauren A , Dai Hongying , Maletsky Lorin P
Published: April 2014

Leg loading and knee angle differences have been reported in total knee replacement individuals during straight gait; however, little is known about the impact on the knee during turning. Rotary motions may be difficult following total knee replacement surgery; therefore, some individuals may develop strategies or utilize pre-surgical strategies in order to maintain function. The primary aim of this study was to identify differences in individuals with a total knee replacement as compared to their healthy counterparts during stair descent followed by a cross-over turn. Ground reaction force, knee angle and moments were recorded on 10 total knee replacement and 12 healthy individuals during stair descent followed by a turn and compared to walking straight. Variables were analyzed for the affected, unaffected and healthy knees during the gait cycle. On initial contact, the total knee replacement group had less ground reaction force on the affected leg compared to the unaffected leg (p = 0.021) and had delayed contact (p = 0.044) and a slower loading rate (p = 0.020) compared to healthy group. During mid-stance, the affected leg had less ground reaction force compared to the healthy leg (p = 0.049). The affected stance leg had less knee flexion during mid-stance in both the straight trial (p = 0.002) and turn (p = 0.010). Moment differed between straight and turn trials but not between groups. Stair descent with or without a turn was approached in a precautionary manner by individuals with a total knee replacement. Slow approach, reduced impact and weight-bearing with a more extended knee on the affected leg may suggest a protective strategy to avoid risk of fall.
Prevalence of antibodies against Treponema pallidum among HIV-positive patients in a tertiary care hospital in Mexico
Authors: Mata-Marín José Antonio , Sandoval-Sánchez Juan Joel , Huerta-García Gloria , Arroyo-Anduiza Carla Ileana , Alcalá-Martínez Enrique , Mata-Marín Luis Alberto , Sandoval-Ramirez Jorge Luis , Gaytán-Martínez Jesús
Published: April 2014

Our objective was to determine the seroprevalence of syphilis among HIV-infected patients in a tertiary care hospital in Mexico City. A cross-sectional study was developed, and 318 HIV-positive patients were evaluated from January to February 2013 at Hospital de Infectología, National Medical Center ‘La Raza’ (a tertiary care hospital specialising in infectious diseases in Mexico City). Laboratory data were screened for the detection of antibodies against Treponema pallidum. Patients completed a questionnaire relating to socio-demographic data and factors associated with syphilis. Of the 318 patients, 83% were men. The mean age ± SD was 36 ± 11 years; 52% were men who have sex with men and 47% had undertaken higher education. The overall seroprevalence of syphilis among these patients was 25% (95% confidence interval 21%, 30%). Men who have sex with men had a significantly higher seroprevalence (30% vs. 15%, p = 0.009). We conclude that, in Mexico, there is a high seroprevalence of syphilis antibodies in HIV-infected patients and that men who have sex with men are the group most affected.
Clinical research should be a priority in the NHS – but what do genito-urinary medicine clinic staff think?
Authors: Roberts Rosa , Perry Nicky , Phillips Alan , Richardson Daniel , Soni Suneeta
Published: April 2014

Clinical research improves patient care and is a government priority. We sought the opinions of genito-urinary medicine clinic staff regarding undertaking research, any barriers they perceived, and methods to optimise study recruitment. Questionnaires were offered to everyone working in the genito-urinary medicine clinic over a one-week period. In addition, four focus groups were held with genito-urinary medicine clinic staff. Forty-three questionnaires were completed. All respondents stated that research was important; however, 14.0% worried that it affected patient care and 16.3% would rather see patients without having to consider research. Doctors were more likely to enjoy discussing studies than other healthcare staff ( p = 0.029) and were less likely to think that too many studies were being conducted at one time ( p = 0.027). Forty staff attended the focus groups. Time, knowledge of studies, difficulty in broaching the topic of research and patient factors were cited as barriers to recruitment. Suggestions to improve recruitment included: greater multi-disciplinary team involvement; improving staff research knowledge; streamlining the research process; and patient education. Reasons for different attitudes between staff disciplines towards research included different training pathways and incentives to conduct research. The recommendations staff have made to help drive recruitment should be implemented in the genito-urinary medicine clinic.
Contribution of ethics education to the ethical competence of nursing students
Authors: Cannaerts Nancy , Gastmans Chris , Casterlé Bernadette Dierckx de
Published: April 2014

Aims:

To review the literature on perceptions of nursing students and/or educators on the contribution of ethics education to ethical competence in nursing students.

Background:

Nurses do not always demonstrate the competencies necessary to engage in ethical practice. Educators continue to debate about the best ways to teach ethics to nurses so that they can develop ethical competencies.

Data sources:

MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science.

Review methods:

A total of 15 articles with a quantitative, qualitative, or mixed-methods design published between January 1992 and March 2012 were analyzed.

Results:

According to students and educators, ethics education increases ethical perception of nursing students and the development of reflective and analytical skills. However, its contribution to the development of ethical behavior was barely mentioned. The accounts of students and educators revealed essential features of effective ethics education: active involvement of students in case study discussions and use of ethical frameworks. The use of activating educational strategies requires a safe learning environment where students can openly reflect on values at stake in their care practice.

Conclusion:

A better understanding of how students learn to develop ethical skills and of influencing factors can guide educators to develop ethics courses for nursing curriculum. Future research needs to focus on the methodological accuracy of sampling and measuring instruments.
Moral distress in the resuscitation of extremely premature infants
Authors: Molloy Jennifer , Evans Marilyn , Coughlin Kevin
Published: April 2014

Objective:

To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature.

Design:

A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants.

Setting:

A regional, tertiary academic referral hospital in Ontario offering a perinatal program.

Participants:

A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants.

Methods:

Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants.

Ethical considerations:

Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis.

Results:

Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses’ perceived lack of power and influence in the neonatal resuscitation decision-making process.

Conclusion:

Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration.
Exploring the adequacy and validity of ‘sport’: Reflections on a contested and open concept
Authors: Lagaert Susan , Roose Henk
Published: April 2014

In this paper we explore whether and how ‘sport’ can be an adequate and valid sociological concept considering the multitude of contested meanings and definitions attached to ‘sport’ by different stakeholders in the sports field. Firstly, we argue that essentialist definitions of ‘sport’ too often one-sidedly focus on physical exertion and neglect the socially distinguishing nature of sportive practices as part of a lifestyle. Secondly, survey questions reflect this physical definition of ‘sport’ and assume that ‘sport’ has an obviously similar meaning to respondents. However, reflecting the struggle to define ‘sport’ in the sports field, people with different socio-demographic backgrounds differ in their understanding of the concept. Because current measurement of ‘sport’ does not adequately deal with the open and contested nature of the concept, suggestions on how to collect survey data on sport participation are presented.
Extravasation of Noncytotoxic Drugs
Authors: Le Ann , Patel Samit
Published: April 2014

Objective: Extravasation is a potential complication associated with intravenous therapy administration. Inadvertent leakage of medications with vesicant properties can cause severe tissue necrosis, which can lead to devastating long-term consequences. Recognizing potential agents is an essential step in mitigating the risk of extravasation. Data Source: A literature search was carried out using PubMed with the following key words: extravasation, soft tissue injury, phlebitis, and infiltration, from January 1961 through January 2014. Study Selection and Data Extraction: The publications were screened manually and reviewed to identify reports for medications that included synonyms of the International Nonproprietary Name, while excluding antineoplastic agents, radiographic contrast material, investigational or nonmarketed drugs, and animal data, to yield 70 articles. Furthermore, reference citations from publications were also reviewed for relevance and yielded 4 articles. Data Synthesis: We discovered 232 cases of extravasation involving 37 agents (in order of frequency): phenytoin, parenteral nutrition, calcium gluconate, potassium chloride, calcium chloride, dopamine, dextrose solutions, epinephrine, sodium bicarbonate, nafcillin, propofol, norepinephrine, mannitol, arginine, promethazine, vancomycin, tetracycline, dobutamine, vasopressin, sodium thiopental, acyclovir, amphotericin, ampicillin, cloxacillin, gentamicin, metronidazole, oxacillin, penicillin, amiodarone, albumin, furosemide, lipids, lorazepam, immunoglobulin, morphine, and sodium valproate. Potential properties contributing to extravasation include the following: pH, osmolarity, diluent, vasoactive properties, and inactive ingredients. Antidotes and supportive care agents used in the management of these cases of extravasation include hyaluronidase, phentolamine, terbutaline, topical anesthetics (such as lidocaine and prilocaine cream), topical antimicrobials (such as silver sulfadiazine and chlorhexidine), topical debridement agents (collagenase ointment), topical steroids, and topical vasodilators (nitroglycerin). Conclusion: Data on the management of noncytotoxic extravasations is sparse, consisting primarily of case reports and anecdotal evidence. Fortunately, this adverse outcome is preventable and identification of vesicant agents plays a pivotal role. The intent of this review is to provide a reference identifying noncytotoxic vesicants and the management of extravasations associated with specific agents.
Effects of outside air temperature on the preparation of antineoplastic drug solutions in biological safety cabinets
Authors: Umemura Masayuki , Itoh Akio , Ando Yuichi , Yamada Kiyofumi , Wakiya Yoshifumi , Nabeshima Toshitaka
Published: April 2014

Purpose

In Japan, biological safety cabinets are commonly used by medical staff to prepare antineoplastic agents. At the Division of Chemotherapy for Outpatients, Nagoya University Hospital, a class II B2 biological safety cabinet is used. The temperature inside this biological safety cabinet decreases in winter. In this study, we investigated the effect of low outside air temperature on the biological safety cabinet temperature, time required to admix antineoplastic agents, and accuracy of epirubicin weight measurement.

Methods

Studies were conducted from 1 January to 31 March 2008 (winter). The outside air temperature near the biological safety cabinet intake nozzle was compared with the biological safety cabinet temperature. The correlation between the outside air temperature and the biological safety cabinet temperature, time for cyclophosphamide and gemcitabine solubilization, and accuracy of epirubicin weight measurement were investigated at low and high biological safety cabinet temperatures.

Result

The biological safety cabinet temperature correlated with the outside air temperature of 5–20℃ ( p < 0.0001). Compared to cyclophosphamide and gemcitabine solubilization in the biological safety cabinet at 25℃, solubilization at 10℃ was significantly delayed ( p < 0.01 and p < 0.0001, respectively). Measurement of epirubicin weight by using a syringe lacked accuracy because of epirubicin’s high viscosity at low temperatures ( p < 0.01).

Conclusion

These results suggest that the biological safety cabinet temperature decreases when cool winter air is drawn into the biological safety cabinet, affecting the solubilization of antineoplastic agents. We suggest that a decrease in biological safety cabinet temperature may increase the time required to admix antineoplastic agents, thereby increasing the time for which outpatients must wait for chemotherapy.
‘My Car is the Best Thing That Ever Happened to Me’
Authors: Collin-Lange Virgile
Published: April 2014

A survey submitted to Icelandic novice drivers and the author’s personal experience of obtaining the drivers licence constitute the ground basis for this article. In their responses, many of the young people who answered the survey pointed out that their car use was an adaptation to the conditions in which they found themselves: a pervasively car-oriented transport system. Their car use is also symptomatic of how they approach their own automobility and spatiality. The present article concurs with current discussions of automobility and approaches it as a regime. The author argues, however, that one’s integration into the regime of automobility is an expression of human territoriality. This article also shows that automobility should be considered as a phase during which one’s individual motility is maximized according to the structural and social environments in which the individual finds himself or herself. Finally this article calls for greater considerations about youth within the field of mobilities.
Young People Negotiating the Stigma Around their Depression
Authors: Issakainen Mervi
Published: April 2014

This study explored how young people negotiated the stigma associated with depression. The study methodology involved collecting written narratives, as well as conducting asynchronous online group discussions and online individual interviews with young Finnish people who self-identified as being depressed. Theoretical insights of the study were drawn from dialogicality and symbolic interactionism. Examining patterns in the participants’ experiences and perceptions revealed their reliance on two stigmatizing cultural conceptions—’depression as a mental illness’ and ‘depression as a matter of pulling oneself together’—to account for why they were perceived as abnormal, and for the absence of empathy for their distress. To cope with these stigmatizing conceptions, they resorted to reframing their experience of ‘depression as a normal but serious affliction’. The study’s results highlight the importance of information dissemination (in schools, through media, etc.) regarding harmful as well as helpful ways to give meaning and respond to depressive experiences.
Dwelling in the place of devastation: Transcendence and the everyday in recovery from trauma
Authors: Conrad Keziah
Published: April 2014

In this essay, I critically evaluate Veena Das's assertion that recovery from trauma takes place through ‘descent into the everyday’ rather than ‘ascent into the transcendent’ (2007). This article unpacks Das's contributions to the understanding of ‘the everyday’ as a complex intersubjective achievement, but also uses ethnographic examples to look more carefully at the interplay between transcendence and the everyday in healing. With a case study of a community choir reconciliation project in Sarajevo, Bosnia, the author describes a group of people tacking back and forth between modes of everyday engagement and transcendence as they reach toward healing for themselves and their audiences. The article argues that locally-relevant forms of ‘ascent into the transcendent’ are ways of moving beyond the everyday, but are also firmly embedded in everyday life. It calls for more careful attention to the relationship between transcendence and the everyday, and the role each can play in recovery from trauma.
Anthropology, the indigenous and human rights: Which billiard balls matter most?
Authors: Clemmer Richard O
Published: April 2014

Anthropology is uniquely positioned to open a new dimension of critical human rights discourse based on engaging indigenous rights. Moving toward a critical anthropology of human rights begins from the UN Declaration on the Rights of Indigenous Peoples. The charge that this document reifies ‘indigenous’ and ‘rights’ is examined in light of reifications such as ‘primitive’ and ‘tribe’, referencing Eric Wolf’s assertion that cultures, societies and nations should not be treated as if they were bounded ‘billiard balls’. In reframing rights, Marx’s (1844) and others’ insights on human collectivity are useful. This reframing perforce questions the ipso facto legitimacy of nation-statism.