bluuebunny/crossref_metadata_2025 huggingface dataset:
Explosion and Fire in the Expiratory Limb of a Fisher and Paykel “Three in One” Respiratory Care System
Authors: Gowardman J. R. , Moriarty B.
Published: January 2019

We report an incident involving a Fisher and Paykel “Three in One Respiratory Care System” (Fisher and Paykel Healthcare, Auckland, New Zealand). This is a new ventilator circuit designed to be adaptable to the needs of ventilator, intubated CPAP, and mask therapies. In this case the patient had received eight hours of CPAP therapy overnight, during which time the “Three in One” circuit had been broken down to the CPAP configuration. The expiratory limb heater element, normally disconnected, was inadvertently left connected to the heater base. Under the extreme conditions of heating under “no gas flow” mode, the heater element malfunctioned. As a result when the circuit was reconfigured to provide pressure-supported ventilation, in the high oxygen environment of the expiratory limb (FiO2 0.5), ignition and combustion of the respiratory circuit occurred. The case is reported because of the potentially serious consequences and because the incident prompted the manufacturer to redesign and change componentry in parts of the circuit implicated.
Clonidine and Cardiac Surgery: Haemodynamic and Metabolic Effects, Myocardial Ischaemia and Recovery
Authors: Myles P. S. , Hunt J. O. , Holdgaard H. O. , McRae R. , Buckland M. R. , Moloney J. , Hall J. , Bujor M. A. , Esmore D. S. , Davis B. B. , Morgan D. J.
Published: January 2019

Clonidine may have beneficial effects in patients undergoing major surgery. We enrolled 156 patients having elective CABG surgery in a double-blind, randomized trial. Patients were randomized to receive either two doses of placebo (Group PP) or clonidine 5 μg/kg (Group CC). Perioperative measurements included haemodynamics, anaesthetic and analgesic drug usage, creatinine clearance, cortisol excretion, recovery times and quality of life (SF-36) after surgery. Overall, there was no significant difference with time to tracheal extubation (median [10–90 centile]): CC 7.1(3.4–18)h vs PP 8.0(4.3–17) h, P=0.70; but there was a higher proportion of patients extubated within four hours: CC 20% vs. PP 8%, P=0.038. Clonidine resulted in a number of significant (P<0.05) haemodynamic changes, particularly pre-CPB: less tachycardia and hypertension, more bradycardia and hypotension. Clonidine was associated with a significant (P<0.05) reduction in anaesthetic drug usage, higher creatinine clearance, lower cortisol excretion and improvement in some aspects of quality of life. This study lends support to consideration of clonidine therapy in patients undergoing CABG surgery.
Epidural 0.2% Ropivacaine for Labour Analgesia: Parturient-Controlled or Continuous Infusion?
Authors: Sia A. T. , Chong J. L.
Published: January 2019

In this randomized, open study, we compared the incidence of lower limb motor block associated with epidural labour analgesia provided by parturient-controlled method (PCEA) with continuous infusion (CIEA) using 0.2% ropivacaine. The PCEA group (n=20) received a demand-only regimen (bolus 5 ml, lockout 15 minutes). The rate of infusion of the CIEA group (n=20) was 8 ml/h. We found that pain relief was not significantly different between the two groups, although the PCEA group had a higher satisfaction score (P<0.05). Fewer parturients in the PCEA group had lower limb motor block (6 vs 14, P<0.05). The total volume of ropivacaine used per hour was also lower in the PCEA group (median 8.75 vs 10.5 ml, P<0.05). No difference in the maternal or fetal outcome was detected. We conclude that PCEA with ropivacaine is an effective mode of analgesia which is dose-sparing and produces less motor block in comparison with CIEA.
Sub-Tenon's Block: The Effect of Hyaluronidase on Speed of Onset and Block Quality
Authors: Guise P. , Laurent S.
Published: January 2019

The role of hyaluronidase on the onset time and quality of single quadrant sub-Tenon's block was studied in a prospective, randomized, double-blind controlled manner. One hundred and twenty consecutive patients undergoing cataract surgery under local anaesthesia received a sub-Tenon's block with either of two local anaesthetic solutions. One consisted of 2% plain lignocaine 3 ml with 0.5% plain bupivacaine 2 ml. The other consisted of 2% lignocaine 1 ml containing 150 IU per ml of hyaluronidase with 2% plain lignocaine 2 ml and 0.5% plain bupivacaine 2 ml. The development of akinesia and the resulting block quality were assessed. Akinesia scores were lower at all time intervals and were significantly lower (P<0.05) up to 9 minutes after block in the hyaluronidase group. However, block quality as assessed by the surgeon was not significantly different between the groups. The addition of 150 IU hyaluronidase significantly speeds up the onset of surgical anaesthesia produced by a sub-Tenon's block.
Validation of Tu's Cardiac Surgical Risk Prediction Index in a Western Australian Population
Authors: Leonard R. C. , van Heerden P. V. , Power B. M. , Cameron P. D.
Published: January 2019

Tu's cardiac surgical risk prediction index for a Western Australian population was examined in a prospective observational cohort study. Risk score and outcome data were collected for 367 consecutive patients. Logistic regression analysis for Tu score prediction of hospital mortality and linear regression analysis for prediction of ICU and hospital stays were performed. The Tu index accurately predicted mortality rates (P=0.002, odds ratio 1.46). The linear regression analyses of Tu score on ICU and hospital stays showed an excellent fit (P=0.0001). The area under the receiver-operating characteristic curve for prolonged ICU stay was 0.75. The Tu risk index is valid for a Western Australian cardiac surgical population and practice.
An Audit of Deaths Occurring in Hospital after Discharge from the Intensive Care Unit
Authors: Lawrence A. , Havill J. H.
Published: January 2019

The aim of the study was to conduct an audit of patients who died in the ward after discharge from the intensive care unit (ICU). Clinical records of those who died in the ward following discharge between 1991 and 1997 were reviewed. Patients were retrospectively grouped according to whether death was expected, unexpected or likely to die within one year. The causes of death, times in ICU and hospital, demographics, and APACHE II scores were compared.

Ninety-nine patients were studied, of whom 60 were triaged to the ward expected to die at the time of ICU discharge. Five of the patients were classified as not expected to die. Of the remaining 34 patients, 65% were debilitated with more than one organ disease and 62% eventually had some treatment withdrawn on the ward. After discharge from ICU, no obvious ward treatment deficiencies were found to contribute to death. However, of those who were admitted to the ICU from the ward and who later died when back in the ward, there seemed to be avoidable events pre-ICU admission in eight (36%) patients, some of which may have contributed to the later death of the patient.
Subsequent General Anaesthesia in Patients with a History of Previous Anaphylactoid/Anaphlactic Reaction to Muscle Relaxant
Authors: Thacker M. A. , Davis F. M.
Published: January 2019

Of 151 patients with a possible anaphylactoid/anaphylactic reaction to a muscle relaxant investigated over a 20-year period, follow-up for any subsequent general anaesthesia was complete in 145 (96%). One hundred and twenty-two anaesthetics in 72 patients were documented. There were no anaesthetic-related deaths. No subsequent reactions were seen if muscle relaxants were not used in the subsequent anaesthetic, nor were they in patients with severe reactions if the original intradermal test had been equivocal or negative. In the patients with a severe reaction and a positive intradermal test to one or more muscle relaxants, six out of 40 later anaesthetics using muscle relaxants were associated with clinical problems, three being probable anaphylactic reactions, whilst three were minor. Intradermal testing should be performed prior to surgery in this group of patients for the muscle relaxant(s) planned, or an anaesthetic technique which avoids relaxants should be used. This review should encourage other centres to undertake similar follow-up.
Prone Ventilation—It's Time
Authors: Tobin A. , Kelly W.
Published: January 2019

Prone positioning to improve oxygenation in acute lung injury was first reported over 20 years ago. Although this and several subsequent studies have shown that prone positioning improved oxygenation in the majority of patients, it has failed to become common practice in intensive care units. This paper reviews the mechanism by which prone positioning improves oxygenation and the clinical studies of its use to date.
An “Enigmatic” Cause of Back Pain following Regional Anaesthesia for Caesarean Section: Septic Pelvic Thrombophlebitis
Authors: French R. A. , Cole C.
Published: January 2019

A case of septic pelvic thrombophlebitis is reported. This presented as back pain and leg weakness 18 days after regional anaesthesia for caesarean section. The patient was referred to the Department of Anaesthesia. Obstetric review of the patient at the request of the anaesthetist led to a CT scan that demonstrated the diagnosis. This condition may lead to fatal “on-table” pulmonary embolus if the thrombosed vein is handled during an exploratory laparotomy. Treatment should be conservative with antibiotics and anticoagulation. This case illustrates the need for awareness amongst anaesthetists of possible surgical causes for morbidity that may initially appear anaesthetic-related.
Subcutaneous Nodules with Pseudomas Septicaemia in an Immunocompetent Patient
Authors: Asumang A. , Goldsmith A. L. , Dryden M.
Published: January 2019

Pseudomonas septicaemia presenting with subcutaneous nodules, though rare, is well described in immuno-compromized populations. It is, however, very uncommon in immunocompetent patients. We describe a case of a 42-year-old woman who presented with community-acquired Pseudomonas aeruginosa septicaemia and subcutaneous nodules. No precipitating cause or immune dysfunction was found. She was successfully treated with appropriate antibiotics, respiratory and cardiovascular support in the Intensive Care Unit. The difficulty in eradicating the organism from the skin lesion and the need for investigating the immune function of septicaemia patients are discussed.
The Effects of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) on Postoperative Renal Function: A Meta-Analysis
Authors: Lee A. , Cooper M. G. , Craig J. C. , Knight J. F. , Keneally J. P.
Published: January 2019

The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function. Eight randomized placebo-controlled double-blinded trials (n=345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95%CI) were calculated by a weighted mean difference analysis using a random-effects model. The NSAIDs (diclofenac, ketorolac, indomethacin, ibuprofen) were used for up to three days after surgery. There were no reported cases of postoperative renal failure requiring dialysis. NSAIDs reduced creatinine clearance by 22 ml.min−1 (95%CI: 7 to 37), sodium output by 54 mmol.day−1 (95%CI: 5 to 103) and potassium output by 38 mmol.day−1 (95%CI: 19 to 56) on Day 1 but not on Day 2. Serum creatinine increased on Day 2 by 15μmol.l−1 (95%CI: 2 to 28). Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.
Measurement of Cardiac Output by Transoesophageal Echocardiography: A Comparison of Two Doppler Methods with Thermodilution
Authors: Royse C. F. , Royse A. G. , Blake D. W. , Grigg L. E.
Published: January 2019

This study assessed the agreement between three methods of cardiac output (CO) measurement, thermodilution, the current clinical standard, and two transoesophageal echocardiographic techniques. Measurements were performed in 37 patients using thermodilution, continuous wave Doppler across the aortic valve and pulsed wave Doppler positioned in the left ventricular outflow tract. The aortic valve area was measured by direct planimetry, and the left ventricular outflow tract area was calculated from its diameter. Weighted least products regression analysis was employed to detect bias, and standard deviation of the difference (SDdiff) was calculated. There was no fixed bias but there was proportional bias between continuous wave Doppler and thermodilution methods (SDdiff 0.92 l/min). There was fixed bias but not proportional bias between pulsed wave and thermodilution methods (SDdiff 1.1 l/min). There was neither fixed nor proportional bias between pulsed wave and continuous wave Doppler methods (SDdiff 1.1 l/min). The transoesophageal Doppler methods described can be clinical alternatives to thermodilution cardiac output measurement.
Pharmacokinetics of Paracetamol in Adults after Cardiac Surgery
Authors: Schuitmaker M. , Anderson B. J. , Holford N. H. G. , Woollard G. A.
Published: January 2019

The pharmacokinetics of paracetamol in adults after cardiac surgery have not been described. Twenty patients were randomized to receive either paracetamol 2 g through a nasogastric tube and as a suppository eight hours later or vice versa. Arterial blood samples were taken at 0.5, one, two, four, six and eight hours after dosing. Each patient was studied for 16 h. There were 16 males and three females. One patient was excluded because of sampling errors. The mean age was 59 (SD 8) years and the mean weight 84kg (16).

The time-concentration profiles for each individual were used to estimate pharmacokinetic parameters using a non-linear mixed effects model (NONMEM). Population parameter estimates with coefficient of variation (CV%), standardized to a 70 kg person, for a one-compartment model with first order input, lag time and first order elimination were volume of distribution 127 l (28) and clearance 26.4 l/h (29) Rectal paracetamol had an absorption half-life (Tabs) of 2.02 h (31) with a lag time of 0.28h. The absorption half-life for the oral preparation was 1.49h (81) with a lag time of 0.17h. The relative bioavailability of the rectal compared to the oral formulation was 0.98 (18).

Concentrations after either nasogastric or rectal paracetamol 2g were below a target concentration of 10 mg/l, which is associated with analgesia. Absorption after nasogastric administration was slow compared to healthy adults (Tabs 0.06 to 0.7h) and the bioavailability was half that expected, due to nasogastric loss. Parameter estimates had large variability. Paracetamol is unlikely to have useful clinical impact in the majority of patients when standard doses (6 g/day) are given on day 1 after cardiac surgery.
Complement Activation by Propofol and its Effect during Propofol Anaesthesia
Authors: Ohmizo H. , Iwama H. , Sugita T.
Published: January 2019

We have examined whether propofol activates complement. In the first study, blood was mixed with saline, propofol or the lipid solvent for propofol, and the activated complement 3 (C3a) and 4 (C4a) concentrations in the supernatant were assayed. In the second study, blood and propofol were mixed with various levels of nafamostat mesilate (anti-complement agent) up to 0.3 mmol/l and the C3a was assayed. In the third study, the time course of plasma C3a concentration in patients during propofol anaesthesia was examined. The results showed that the lipid solvent activated complement and produced similar levels of C3a to propofol, probably via both the classical and alternative pathways. This activation was not inhibited by any of the nafamostat concentrations used. There was no significant change in plasma C3a concentration during propofol anaesthesia. These results suggest that C3a is generated by the lipid solvent, but its accumulation during propofol anaesthesia is minimal.
Neurological Recovery after Prolonged Verapamil-Induced Cardiac Arrest
Authors: Evans J. S. M. , Oram M. P.
Published: January 2019

A 15-year-old female survived a total of 65 minutes cardiac arrest following ingestion of verapamil and selective serotonin re-uptake inhibitors. We consider that the lack of neurological damage, despite evidence of significant renal and myocardial injury, may be related to the possible neuroprotective effect of a large dose of verapamil
Humidification Difficulties in Two Tracheostomized Children
Authors: Edwards E. A. , Byrnes C. A.
Published: January 2019

Effective humidification is sometimes difficult to achieve in children when normal mechanisms are bypassed by having a tracheostomy in situ. The humidification options available in the paediatric population are heat and moisture exchangers (HMEs) and heated humidifiers, both of which are reviewed and discussed. In some circumstances the humidification achieved with HMEs is inadequate. We outline the hospital and subsequent home management of two infants, both with tracheostomies in situ, who unsuccessfully trialed HMEs and subsequently achieved effective humidification with heated humidifiers. We propose that heated humidifiers would help more tracheostomized infants who are suffering from similar problems.
Skew Superelevation Edge Rounding Design Improving Riding Comfort on Freeways
Authors: Apostoleris Konstantinos , Psarianos Basil , Choupas Ioannis-Alexandros , Matragos Vassilios
Published: January 2019

Skew superelevation has proven to be an efficient pavement constructional measure to address hydroplaning phenomena under specific critical superelevation runoff designs. However, this technique has raised concerns about user’s comfort when driving over the skewed edge of the pavement, especially for heavy vehicles and when the traveling speed is higher than the design speed. This paper aims to evaluate the driving comfort outcome on an improved skew superelevation design, where a rounding of the skew edge has been applied. This is achieved through the use of a simulation program which examines the vehicle and driver behavior when passing over it. The simulation program estimates many parameters including the lateral and vertical accelerations ( Gy and Gz) imposed on both elements, the vehicle and the driver. This evaluation is made for different alignment designs provided in the freeway design and for a broad range of especially high velocities ranging from 80 to 160 km/h (50–100 mph), as well as for different types of heavy vehicles. Also, the influence on the above parameters has been investigated in respect of the distance between two consecutive skew superelevations, concerning cases of entering and exiting a simple, low-length curve. The outcomes are classified in order to evaluate their variability as affected by each parameter change (speed, geometry, vehicle). Simulation results are compared with thresholds, as provided in the international literature, to ensure driver comfort and a high level of road safety.
Clinical Outcomes of Isolated Revision Anterior Cruciate Ligament Reconstruction or in Combination With Anatomic Anterolateral Ligament Reconstruction
Authors: Lee Dhong Won , Kim Jin Goo , Cho Seung Ik , Kim Du Han
Published: January 2019

Background:

Although the cause of rotational instability after revision anterior cruciate ligament reconstruction (ACLR) is multifactorial, the rationale of adding an extra-articular procedure is based on its ability to restrict rotational instability.

Purpose:

To assess the effect of anterolateral ligament (ALL) reconstruction on revision ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 87 patients who underwent revision ACLR between March 2011 and July 2014 with a follow-up of more than 3 years were included in this retrospective study. Patients were divided into the isolated revision ACLR group (group I, n = 45, from March 2011 to January 2013) or the revision ACLR in combination with ALL reconstruction group (group C, n = 42, from February 2013 to July 2014). Subjective knee assessments including the subjective International Knee Documentation Committee (IKDC) form, Lysholm score, Tegner activity scale, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale were used. Clinical and functional tests were performed before surgery and at ≥6 months after surgery. All tests were usually completed at 36 months of follow-up.

Results:

The mean follow-up duration for groups I and C were 41.5 ± 8.2 and 38.2 ± 6.9 months, respectively ( P = .451). The subjective IKDC score, Tegner score, and ACL-RSI score were significantly better in group C compared with those in group I at the last follow-up (84.3 ± 18.5 vs 75.9 ± 19.2, 7.0 ± 0.8 vs 6.3 ± 0.7, and 69.5 ± 25.4 vs 51.9 ± 23.1, respectively), although they were not significantly different between the 2 groups at 12 months after surgery (79.2 ± 18.8 vs 76.7 ± 17.2, 6.7 ± 0.7 vs 6.5 ± 0.9, and 50.2 ± 24.6 vs 49.9 ± 25.1, respectively). There were no significant differences in KT-2000 arthrometer, isokinetic extensor strength, single-legged hop for distance, co-contraction test, or carioca test results between the 2 groups at the last follow-up ( P = .304, .068, .125, .056, and .066, respectively). Preoperatively, 43 (95.6%) patients in group I and 40 (95.2%) patients in group C had a grade 2 or 3 pivot shift ( P = .387). Postoperatively, 23 (53.5%) patients in group I and 38 (90.5%) patients in group C had a negative pivot shift ( P < .001). Group C showed a higher rate of return to the same level of sports activity than group I (57.1% vs 25.6%, respectively; P = .008), although there was no significant difference in the rate of return to any sports activity at the last follow-up (88.4% in group I vs 88.1% in group C; P = .713).

Conclusion:

Revision ACLR in combination with ALL reconstruction significantly reduced rotational laxity and showed a higher rate of return to the same level of sports activity than revision ACLR alone, although there were no significant differences in anterior laxity or functional test results between the 2 groups.
Posterior Tibial Slope and Risk of Posterior Cruciate Ligament Injury
Authors: Bernhardson Andrew S. , DePhillipo Nicholas N. , Daney Blake T. , Kennedy Mitchell I. , Aman Zachary S. , LaPrade Robert F.
Published: January 2019

Background:

Recent biomechanical studies have identified sagittal plane posterior tibial slope as a potential risk factor for posterior cruciate ligament (PCL) injury because of its effects on the kinematics of the native and surgically treated knee. However, the literature lacks clinical correlation between primary PCL injuries and decreased posterior tibial slope.

Purpose/Hypothesis:

The purpose of this study was to retrospectively compare the amount of posterior tibial slope between patients with PCL injuries and age/sex-matched controls with intact PCLs. It was hypothesized that patients with PCL injuries would have a significantly decreased amount of posterior tibial slope when compared with patients without PCL injuries.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Patients who underwent primary PCL reconstruction without anterior cruciate ligament injury between 2010 and 2017 by a single surgeon were retrospectively analyzed. Measurements of posterior tibial slope were performed with lateral radiographs of PCL-injured knees and matched controls without clinical or magnetic resonance imaging evidence of ligamentous injury. Mean values of posterior tibial slope were compared between the groups. Inter- and intrarater agreement was assessed for the tibial slope measurement technique via a 2-way random effects model to calculate the intraclass correlation coefficient (ICC).

Results:

In sum, 104 patients with PCL tears met the inclusion criteria, and 104 controls were matched according to age and sex. There were no significant differences in age ( P = .166), sex ( P = .345), or body mass index ( P = .424) between the PCL-injured and control groups. Of the PCL tear cohort, 91 patients (87.5%) sustained a contact mechanism of injury, while 13 (12.5%) reported a noncontact mechanism of injury. The mean ± SD posterior tibial slopes were 5.7°± 2.1° (95% CI, 5.3°-6.1°) and 8.6°± 2.2° (95% CI, 8.1°-9.0°) for the PCL-injured and matched control groups, respectively ( P < .0001). Subgroup analysis of the PCL-injured knees according to mechanism of injury demonstrated significant differences in posterior tibial slope between noncontact (4.6°± 1.8°) and contact (6.2°± 2.2°) injuries for all patients with PCL tears ( P = .013) and among patients with isolated PCL tears ( P = .003). The tibial slope measurement technique was highly reliable, with an ICC of 0.852 for interrater reliability and an ICC of 0.872 for intrarater reliability.

Conclusion:

A decreased posterior tibial slope was associated with patients with PCL tears as compared with age- and sex-matched controls with intact PCLs. Decreased tibial slope appears to be a risk factor for primary PCL injury. However, further clinical research is needed to assess if decreased posterior tibial slope affects posterior knee stability and outcomes after PCL reconstruction.
Antibody-mediated rejection after cardiac transplant: Treatment with immunoadsorption, intravenous immunoglobulin, and anti-thymocyte globulin
Authors: Sipahi Nihat Firat , Saeed Diyar , Makimoto Hisaki , Mehdiani Arash , Akhyari Payam , Dalyanoglu Hannan , Reinecke Petra , Lichtenberg Artur , Boeken Udo
Published: January 2019

Antibody-mediated rejection of allograft is a poorly understood problem after cardiac transplantation that complicates the postoperative course and impairs the graft function and overall survival. Although plasmapheresis and intravenous immunoglobulins have been used as standard therapies for years, there is no consensus about antibody-mediated rejection therapy and most transplantation centers have their own protocols. We describe herein a successful treatment for an acute antibody-mediated rejection of cardiac allograft combining immunoadsorption, intravenous immunoglobulins, and anti-thymocyte globulin, which manifested with polymorphic ventricular tachycardia and right ventricular dysfunction.
‘Short is Better’. Evaluating the Attentiveness of Online Respondents Through Screener Questions in a Real Survey Environment
Authors: Mancosu Moreno , Ladini Riccardo , Vezzoni Cristiano
Published: January 2019

In online surveys, the control of respondents is almost absent: for this reason, the use of screener questions or “screeners” has been suggested to evaluate respondent attention. Screeners ask respondents to follow a certain number of instructions described in a text that contains a varying amount of misleading information. Previous work focused on ad-hoc experimental designs composed of a few questions, generally administered to small samples. Using an experiment inserted into an Italian National Election Study survey (N=3,000), we show that short screeners – namely, questions with a reduced amount of misleading information – should be preferred to longer screeners in evaluating the attentiveness of respondents. We also show there is no effect of screener questions in activating respondent attention.
The Typological Paragon: A Methodological Proposal of Mixed Designs
Authors: Lozano Vanessa Alcaide , Fachelli Sandra , López-Roldán Pedro
Published: January 2019

This article presents a reflection and a methodological proposal on the use of the typological paragon in mixed sequential designs. The paragon is defined as the average or individual profile of a particular cluster that is obtained through multivariate techniques (correspondences analysis and cluster analysis). Here we propose four applications of the typological paragon: first, as a descriptive element, which aims to account for the content; second, as an element of sampling; third, as a link or connecting element between databases with the aim of facilitating matching; and finally, as an element that allows the convergence of results. Two studies provide the empirical basis of this innovative procedure and show the practical implementation of the four uses of paragon. The first deals with the analysis of the social stratification of households in Argentina (Fachelli, 2009). The second focuses on the study and identification of employment trajectories and their mutual influence with social capital in Spain and Catalonia (Alcaide, 2013). The four uses of the paragon that derive from both investigations allow us to reflect on the potentialities and limitations of the proposed model, the typological paragon.
Optimal perturbation guidance with constraints on terminal flight-path angle and angle of attack
Authors: Zhao Penglei , Chen Wanchun , Yu Wenbin
Published: January 2019

This paper presents the design of a singular-perturbation-based optimal guidance with constraints on terminal flight-path angle and angle of attack. By modeling the flight-control system dynamics as a first-order system, the angle of attack is introduced into the performance index as a state variable. To solve the resulting high-order optimal guidance problem analytically, the posed optimal guidance problem is divided into two sub-problems by utilizing the singular perturbation method according to two time scales: range, altitude, and flight-path angle are the slow time-scale variables while the angle of attack is the fast time-scale variable. The outer solutions are the optimal control of the slow-scale subsystem. Thereafter, by applying the stretching transformation, the fast-scale subsystem establishes the relationships between the outer solutions and acceleration command. Then, the optimal command can be obtained by solving the fast-scale subsystem also using the optimal control theory. The proposed guidance can achieve a near-zero terminal acceleration as well as a small miss distance. The superior performance of the guidance is demonstrated by adequate trajectory simulations.
Design and stiffness analysis of an overconstrained landing gear retraction mechanism with four side-stays
Authors: Parat Camille , Li Zu-Yun , Zhao Jing-Shan
Published: January 2019

It is the first mission for a landing gear retraction system to extend the structure during the phases of take-off and landing of the flight. Besides, the structure should be available to improve the reliability, strength and stability of the system while reducing the influence of the landing gear on the total drag. However, a large number of airplane accidents are due to the malfunctions or failures of the landing gear retraction system. In this paper, a novel design of retraction system is proposed. Instead of having only one side-stay to execute the desired motion, this new design proposed an over-constrained mechanism with four side-stays, which augments the structural strength and stability of the landing gear system with six over constraints. With such configuration, a second actuating motor to retract the landing gear can be inserted regardless of the first actuator to augment the reliability on the execution of the mechanism. Analyses on the properties of the landing gear retraction system with four side-stays show that the landing gear strut has a vertical motion, which decreases the working and storage spaces used for the system. Finally, this paper examines the statics and the stiffness coefficients of the retraction system with respect to its structure parameters. This provides the optimum structure for the landing gear system in terms of strength and reliability.
Beyond autonomy: Care ethics for midwifery and the humanization of birth
Authors: Newnham Elizabeth , Kirkham Mavis
Published: January 2019

The bioethical principle of respect for a person’s bodily autonomy is central to biomedical and healthcare ethics. In this article, we argue that this concept of autonomy is often annulled in the maternity field, due to the maternal two-in-one body (and the obstetric focus on the foetus over the woman) and the history of medical paternalism in Western medicine and obstetrics. The principle of respect for autonomy has therefore become largely rhetorical, yet can hide all manner of unethical practice. We propose that large institutions that prioritize a midwife–institution relationship over a midwife–woman relationship are in themselves unethical and inimical to the midwifery philosophy of care. We suggest that a focus on care ethics has the potential to remedy these problems, by making power relationships visible and by prioritizing the relationship above abstract ethical principles.
Development and validation of a Dignity in Care Scale for Nurses
Authors: Lin Yea-Pyng , Tsai Yun-Fang
Published: January 2019

Background:

Maintaining patient dignity is an important aspect of nursing care. No instrument is currently available to measure nurses’ behaviours for maintaining patient dignity in clinical care.

Objectives:

To develop and test an instrument to measure activities nurses perform to maintain patient dignity in clinical care settings, guided by the literature and face-to-face interviews.

Research design:

A quantitative cross-sectional descriptive survey collected data from the developed scale, which was analysed by descriptive statistics and factor analysis.

Participants and research context:

Convenience samples of nurses participated in the interviews (n = 40) and examined face validity of the scale (n = 20). A purposive sample of 610 nurses was recruited from four regional hospitals in the northern, southern and eastern areas of Taiwan to test the developed scale.

Ethical considerations:

Research was approved by the Institutional Review Board of the study hospital. Information about the study was provided to nurses and those willing to participate provided written informed consent prior to data collection.

Findings:

The 36-item Dignity in Care Scale for Nurses had acceptable content and face validity. Factor analysis identified six factors necessary for maintaining dignity of patient care: communication skills, confidentiality of patient information, prompt response to patient needs, respect for patient’s autonomy, providing a safe environment and protecting the patient’s well-being. The reliability coefficient for the total scale was 0.93; alpha coefficients for the subscales ranged from 0.70 to 0.94.

Discussion:

The Dignity in Care Scale for Nurses was demonstrated to be a reliable and valid tool for assessing how nurses maintain dignity in care for patients in the clinical setting. The questionnaire can be used to provide feedback to nurses regarding patient dignity.

Conclusion:

Data gained from this instrument could be used to design nursing education programmes to help nurses enhance their abilities for maintaining patient dignity in clinical practice.
International Connectivity Initiatives by China and India: For the Developing Countries
Authors: Das Khanindra Ch.
Published: January 2019

China’s One Belt, One Road (OBOR) has prompted the emergence of alternate regional connectivity projects such as the Asia Africa Growth Corridor (AAGC). The emergence of alternative projects has been driven by both strategic and economic considerations. The article contrasts OBOR and AAGC and assesses the initiatives’ likely contribution towards promoting the larger goal of economic development and stability across developing countries in Asia and Africa. While the developing countries have the choice of integrating with the projects under either or both the initiatives, the participating countries need to weigh economic and strategic benefits and challenges so that the achievement of country-level developmental goals can be fostered.
Book Review: Arndt Graf and Azirah Hashim, African–Asian Encounters: New Co-operations and New Dependencies
Authors: Rajwar Sushmita
Published: January 2019

Arndt Graf and Azirah Hashim, African–Asian Encounters: New Co-operations and New Dependencies. The Netherlands: Amsterdam University Press, 2017, 245 pp, ISBN 9789462984288.
Switching on an Environmentally Friendly and Affordable Light in Africa: Evaluation of the Role of Natural Gas
Authors: Ackah Ishmael , Opoku Freda , Anang Sarah
Published: January 2019

The purpose of this article is to review the dynamics of natural gas resources in Africa and evaluate how it can help solve the power challenges of the continent. This article develops from a descriptive analysis and desk review on natural gas and power. The key finding is that despite the increased discovery of natural gas in Africa, it has had minimal impact on power production. This study provides a descriptive overview and is limited to only natural gas. It does not consider how other energy sources can contribute to solving Africa’s power challenges. This article draws the attention of both policymakers and the investment community to the opportunities in the ‘natural gas-power’ value chain and the need to invest in gas infrastructure. An overview of the power challenges and natural gas potential of Africa is provided.
Attitudes to ageing: an overview of Australian perspectives of health support systems for the older person
Authors: Jeyasingam Neil
Published: January 2019

Objectives:

Older adults utilise health care systems to a higher frequency than younger groups, and are more vulnerable to system bias regarding ageing and expectations of old age. This narrative review attempts to outline the available literature regarding how various health support systems perceive the older adult, with an Australian focus.

Conclusions:

Perspectives on ageing are generally negative regardless of health industry. Possible contributors to this include elements of death anxiety, inadequate education and inadequate occupational exposure during training.
Serum indirect immunofluorescence assay and real-time PCR results in dogs affected by Leishmania infantum: evaluation before and after treatment at different clinical stages
Authors: Bruno Barbara , Romano Angelo , Zanatta Renato , Spina Simona , Mignone Walter , Ingravalle Francesco , Barzanti Paola , Ceccarelli Lara , Goria Maria
Published: January 2019

We compared results of a serum immunofluorescence assay (IFA) and lymph node quantitative PCR (qPCR) in dogs classified as exposed, infected, or sick because of leishmaniasis. We also determined how IFA or qPCR results changed in response to treatment and reflected different clinical and clinicopathologic improvement of dogs. We included 108 dogs in our retrospective study: 12 exposed, 25 infected, and 71 sick, as classified according to Canine Leishmaniasis Working Group standards. Between-group comparison showed higher IFA values ( p < 0.01) for sick dogs; qPCR values were higher for sick than infected dogs ( p < 0.01). A novel clinical and clinicopathologic score was created and applied to 50 sick dogs. Using this score, 41 were reclassified as partially recovered (PR) within 3 mo, and 37 as totally recovered (TR) 3–6 mo after presentation. Statistically significant differences in IFA values were found between the sick and TR dogs ( p < 0.01), but not between sick and PR dogs ( p = 0.98). During follow-up, qPCR revealed a progressive decrease in parasite load, with a statistically significant difference in sick versus PR ( p < 0.01), sick versus TR ( p < 0.01), and PR versus TR ( p < 0.01) dogs. A decrease of 1 point in the clinical score corresponded to 1.3 Leishmania/μL qPCR decrease ( p < 0.01) and decrease of 1:42 in IFA ( p < 0.01). Our findings confirm that the clinical status of dogs affected by leishmaniasis is closely related to parasite load and antibody level, both before and after treatment.
Serologic investigation of exposure to influenza A virus H3N2 infection in dogs and cats in the United States
Authors: Gutman Sarah N. , Guptill Lynn F. , Moore George E. , Pogranichniy Roman M.
Published: January 2019

We investigated, in a cross-sectional study, the prevalence of antibodies against canine influenza A virus (CIV) H3N2 in serum samples collected from dogs and cats using a commercial ELISA and a hemagglutination inhibition (HI) test. Samples were obtained from 519 cats and dogs from 13 states within the United States. Data were analyzed for potential risk factors with positive sera (vs. negative sera) by logistic regression. Odds ratios and their 95% confidence intervals (CIs) were calculated by exponentiation of the regression coefficients. Ten dogs (2.21%; 95% CI: 1.05–3.98%) and 6 cats (8.96%; 95% CI: 3.36–18.48%) tested seropositive for CIV H3N2 by HI. One feline sample (1.49%; 95% CI: 0.04–8.04%) and 16 canine samples (3.53%; 95% CI: 2.01–5.61%) tested seropositive by ELISA for influenza A virus. There were no apparent associations between seropositivity and putative risk factors. All positive animals were from Indiana or Illinois; however, CIV H3N2 seroprevalence was not common in Illinois and Indiana.
Attempts to Limit Opioid Prescribing in Critically Ill Patients: Not So Easy, Not So Fast
Authors: Erstad Brian L.
Published: January 2019

Objective: To discuss why opioids have been considered the long-standing first-line therapy for treating acute, severe nociceptive pain in critically ill patients and discuss considerations for limiting opioid overuse in the intensive care unit setting. Data Sources: Articles were identified through searches of PubMed and EMBASE from database inception until December 2018. Additional references were located through a review of the bibliographies of articles and clinical practice guidelines. Study Selection and Data Extraction: Original research articles excluding case reports were included if they concerned nonopioid agents for pain management in critically ill patients. The focus was on studies not included in the most recent pain management guidelines. Data Synthesis: Ten studies were retrieved. Nonopioid therapies or opioid-sparing therapies have been touted as possible alternatives for critically ill patients, but they have particular adverse effects concerns in critically ill patients, often lack parenteral dosage forms, and frequently require dose adjustment or avoidance in patients with renal or hepatic dysfunction. Relevance to Patient Care and Clinical Practice: There is a well-recognized opioid epidemic that has been the subject of much discussion. Attempts to control the epidemic have focused on limiting opioid prescribing and using nonopioid alternatives, but there are special considerations when treating severe pain in critically ill patients that often preclude nonopioid analgesics. Conclusions: There continues to be an unmet need for medications that are as effective as opioids for severe nociceptive pain in critically ill patients but without the adverse effect and abuse concerns. Until such medications are available, clinicians need to optimize prescribing of opioid and nonopioid analgesics.
Writing differently
Authors: Gilmore Sarah , Harding Nancy , Helin Jenny , Pullen Alison
Published: January 2019

This special issue of Management Learning on ‘Writing Differently’ builds on a groundswell of resistance to ‘scientific’ norms of academic writing. These norms are restrictive, inhibit the development of knowledge and excise much of what it is to be human from our learning, teaching and research. Contributors to the special issue explore how, released from these restrictions, it is possible to touch vulnerable flesh and invoke new political and ethical practices. Through changing our norms of writing, we explore different modes of learning and change how and what we teach. By bringing the previously excised vast hinterlands of life and lives to the fore, we create the intellectual space to engender new ideas as well as more collaborative forms of learning. In so doing, we foster alternative conversations as to how we might constitute new, highly ethical and humanitarian organisations.
Beyond Rules and Mechanics: A Different Approach for Ludology
Authors: Vargas-Iglesias Juan J. , Navarrete-Cardero Luis
Published: January 2019

Due to its affiliation with formalism, ludology, the scientific perspective prioritized in game studies, considers the rule–mechanic binomial to be an essential principle of any scholarly approach to video games. Nevertheless, the limitation of the game system order implies that, as a fundamental part of this epistemological approach, the empirical validity of its methodology is already being rejected. As such, this article attempts to shift the focus away from the rule–mechanic relation, and from a cybersemiotic perspective, to refocus it on a conceptualization of the human–machine relationship. In order to do so, the concept of convolution regarding said relation is defined, including both parts of the video game system in terms of signal processing. Likewise, this model is contrasted with a randomized total sample of 1,200 games ( N = 1,200, n = 300) in order to arrive at a set of conclusions about the behavior of the distinct video game genres in the indicated terms.
Eating Disorders and Over-Exercise: How Should Campus Recreation Respond?
Authors: Miller Karen S. , Scheele Kenda , Horacek Tonya , Dodge Ashley , Cox Norma
Published: January 2019

Little research has been done in the area of eating disordered behavior exhibited in recreation facilities on college campuses, however several studies have examined exercise behavior and reasoning. The literature states that for young women, the college subculture seems to be a breeding ground for eating disorders. A logical thesis therefore would be to presume that a recreation facility on a college campus would be a place for primary and secondary prevention of eating disorders. At one midwestern state college, students in academic and non-credit classes offered through the campus recreation department were surveyed using the EAT 26. Nearly 12% of those surveyed indicated symptoms of anorexia nervosa; and another 24% were labeled “at risk.” Four distinct groups emerged. The groups were identified as those at low weight with a desire to lose more weight; those wanting to bulk up; those who were medically obese with a desire to lose weight; and those of normal weight wanting to lose weight. Chronological steps can be taken to aid in the primary and secondary prevention of eating disorders. These steps include: identifying the problem; educating all staff; working with other campus entities in the prevention and intervention process; developing a policy; presenting the policy to affected departments and if necessary obtaining legal approval. It is also important to identify specifically how intervention will take place if it becomes necessary. Legal considerations need to be given attention. Eating disorders are multi-faceted and multidimensional It is important to have qualified professional staff able and willing to work in the prevention and early intervention of eating disordered behavior.
Marketing and Promoting Intramurals: A Comparison of Four University Approaches
Authors: Taylor W. T. , Wood Armando , Hutton Chris , Wood Ceasar , Huck John , Smith Dave
Published: January 2019

Intramurals has a long history in recreational sports. In managing intramural sports programs, the programmer needs a variety of methods to “get the word out. “It is important to consider promotion, publicity, advertising, sponsorship, and public relations. While these are important to all aspects of recreational sports, intramurals is typically the “backbone” of programming. With this in mind, it is essential that the intramural programmer be concerned with reaching all the students possible. This article discusses and compares the methods utilized by four different universities. They are Middle Tennessee State University in Murfreesboro, Tennessee, Wake Forest University in Winston Salem, North Carolina, Southern Methodist University in Dallas, Texas, and Georgia Southern University in Statesboro, Georgia.

It is believed that these four universities represent a variety of types of institutions including a small private university in a medium sized town, a combination of traditional and commuter on the edge of a metropolitan area, a traditional private institution in a major metropolitan area, and a traditional state university in a smaller community. It is very important to get the word out, regardless of the type of institution. The greater the variety of approaches used the better the chances to reach all students.