bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Defend and extend’: British business strategy, EU employment policy and the emerging politics of Brexit
Authors: Lavery Scott
Published: August 2017

As the British government embarks upon the process of exiting the European Union (EU), it will have to navigate the preferences of powerful business interest groups. However, the British politics and political economy literatures have tended to neglect the question of business agency in general and its relation to EU integration in particular. This article analyses British business strategy in relation to EU employment policy between 2010 and 2016. Through a document analysis of business responses to the Balance of Competences Review on EU Employment Policy and Confederation of British Industry (CBI) policy documents, the article argues that British business has attempted to ‘defend and extend’ a liberalising agenda within the EU in the recent past. Brexit fundamentally undermines this strategic orientation. The article accordingly outlines some of the key strategic dilemmas which the ‘Leave’ vote generates for British capital within the emerging politics of Brexit.
Convergent validation of a questionnaire to assess the mode and frequency of commuting to and from school
Authors: Chillón Palma , Herrador-Colmenero Manuel , Migueles Jairo H. , Cabanas-Sánchez Verónica , Fernández-Santos Jorge R. , Veiga Óscar L. , Castro-Piñero Jose , Marcos Ascensión , Marcos Ascensión , Veiga Oscar L. , Castro-Piñero José , Bandrés Fernando , Martínez-Gómez David , Ruiz Jonatan R. , Carbonell-Baeza Ana , Gomez-Martinez Sonia , Santiago Catalina , Marcos Ascensión , Gómez-Martínez Sonia , Nova Esther , Díaz Esperanza L. , Zapatera Belén , Veses Ana M. , Mujico Jorge R. , Gheorghe Alina , Veiga Oscar L. , Villagra H. Ariel , del-Campo Juan , Cordente Carlos , Díaz Mario , Tejero Carlos M. , Acha Aitor , Moya Jose M. , Sanz Alberto , Martínez-Gómez David , Cabanas-Sánchez Verónica , Rodríguez-Romo Gabriel , Izquierdo-Gómez Rocío , Garcia-Cervantes Laura , Esteban-Cornejo. Irene , Castro-Piñero José , Mora-Vicente Jesús , Montesinos José L. González , Conde-Caveda Julio , Ortega Francisco B. , Ruiz Jonatan R. , Padilla Moledo Carmen , Carbonell Baeza Ana , Chillón Palma , del Rosario Fernández Jorge , González Galo Ana , Bellvís Guerra Gonzalo , Alfonso Álvaro Delgado , Parrilla Fernando , Gómez Roque , Gavala Juan , Bandrés Fernando , Lucia Alejandro , Santiago Catalina , Gómez-Gallego Félix
Published: August 2017

Aims: The purposes of this research were to study the convergent validity of the Mode and Frequency of Commuting To and From School Questionnaire using objectively assessed steps and time spent in different physical activity intensities and to compare the self-reported versus objective journey time in Spanish youths. Methods: Three hundred and eighty-nine Spanish youth aged 7–19 years were asked to complete the questionnaire and wore an accelerometer for five days. The objective commuting distance and time from home to school were estimated using Google MapsTM. Results: There were significant differences between passive and walking participants on step numbers, sedentary time and physical activity levels (except for vigorous physical activity in children). For children, a mean difference of −4.03 minutes between objective measured and self-reported journey time was found (95% limits of agreement were 13.55 and −21.60 minutes). For adolescents, the mean difference was −1.39 minutes (95% limits of agreement were 15.23 and −18.02 minutes). Conclusions: The findings indicated that the Mode of Commuting To and From School Questionnaire showed a convergent validity to assess this behaviour in Spanish youths. Self-reported journey time for walking is comparable to Google MapsTM in adolescents but not in children.
Employment status five years after a randomised controlled trial comparing multidisciplinary and brief intervention in employees on sick leave due to low back pain
Authors: Pedersen Pernille , Nielsen Claus Vinther , Jensen Ole Kudsk , Jensen Chris , Labriola Merete
Published: August 2017

Aims: To evaluate differences in employment status, during a five-year follow-up period in patients on sick leave due to low back pain who had participated in a trial comparing a brief and a multidisciplinary intervention. Methods: From 2004 to 2008, 535 patients were referred to the Spine Centre at the Regional Hospital in Silkeborg if they had been on sick leave for 3–16 weeks due to low back pain. All patients underwent a clinical examination by a rehabilitation physician and a physiotherapist, and were randomised to either the brief intervention or the multidisciplinary intervention. The outcome was employment status from randomisation to five years of follow-up and was measured by the mean number of weeks in four different groups of employment status (sequence analysis) and a fraction of the number of weeks working (work participation score) that were accumulated over the years. Results: A total of 231 patients were randomised to the brief intervention and 233 patients to the multidisciplinary intervention. No statistically significant differences in the mean weeks spent within the different employment statuses were found between the two intervention groups. After five years of follow-up, participants in the multidisciplinary intervention had a 19% higher risk of not having a work participation score above 75% compared to participants in the brief intervention. Conclusions: After five years of follow-up no differences in employment status were found between participants in the brief and the multidisciplinary intervention.
Women’s expectations and experiences regarding e-health treatment: A systematic review
Authors: Verhoeks Carmen , Teunissen Doreth , van der Stelt-Steenbergen Anke , Lagro-Janssen Antoine
Published: August 2017

There is a gap in knowledge of women’s perceptions of e-health treatment. This review aims to investigate women’s expectations and experiences regarding e-health. A search was conducted in MEDLINE, EMBASE, CINAHL and PsycInfo in March 2016. We included articles published between 2000 and March 2016, reporting on e-health interventions. The initial search yielded 2987 articles. Eventually, 16 articles reporting on 16 studies were included. Barriers to e-health treatment were lower for women than barriers to face-to-face treatment, such as feelings of shame and time constraints. Women were able to develop an online therapeutic relationship. As reduced feelings of obligation and lack of motivation were women’s greatest challenges in completing e-health treatment, they expressed a wish for more support during e-health treatment, preferably blended care. e-Health lowers the threshold for women to seek healthcare. Combining e-health interventions with face-to-face sessions may enhance women’s motivation to complete treatment.
Making touch analog: The prospects and perils of a haptic media studies
Authors: Parisi David , Archer Jason Edward
Published: August 2017

In this article, we argue for the urgency of establishing a coherent tradition of haptic media studies, suggesting that the fields of visual culture studies and sound studies provide analogs, however imperfect, for modeling a new touch-oriented approach to media. This call to make touch like the senses of seeing and hearing echoes previous movements in touch’s discursive and institutional history, as investigators in prior generations similarly aspired to transform tactility through the development of new institutionally grounded research programs. Furthermore, we outline one possible genealogy of haptic media that attends specifically to the power relations expressed through the technoscientific harnessing of touch by haptics. We close with a programmatic set of suggestions for operationalizing haptic media studies.
Intimacy and touch: Closeness, separation and family life in Kulob, southern Tajikistan
Authors: Ibañez Tirado Diana
Published: August 2017

This article examines the emotional, embodied and sensuous aspects of intimacy within and between two families from Kulob, southern Tajikistan, as it is embedded in imminent or/and impending conflict. It focuses on touch and its importance to the fashioning of family life that is also informed by government policies and Muslim subjectivities. The ethnography highlights bodily sensations such as shaking chills, and visceral episodes such as vomiting, fainting, or sensuously-dreaming because they materialize the narrative, experience and performativity of the qualities of touch. The article advances the notion that touch pertains not only to both physical immediacy and intimate closeness, but also to processes of physical separation and estrangement between two or more intimates.
Pose overshoot analysis of the marine spherical double plugging in twisting process
Authors: Wang Wenming , Liu Xu , Wang Hao , Fan Jinchao , Zhu Xiaoxiao
Published: August 2017

Marine spherical double plugging is a novel plugging device, which can achieve the initiative plugging in the oil and gas pipeline. In order to ensure that the plugging head will not collide with the pipeline wall and not be scratched by the drill cuttings, the analysis of twisting process is necessary to assure reliable operation. In this article, we designed the overall scheme of marine spherical double plugging and established the mathematic model of spherical double plugging. Through studying the twisting algorithm of plugging head and trajectory algorithm of plugging head contour, four dangerous points were obtained. The multi-body dynamic of the structure was built using ADAMS, and the twisting process and motion analysis of four points were analyzed. The twisting error of the plugging head between the four points and the inner wall of the pipeline was analyzed in overshoot states to obtain the maximum allowable overshoot of inserting hydraulic cylinder and twisting hydraulic cylinder. Simulation results show that overshoot of inserting hydraulic cylinder needs to be controlled within 11.5 mm and overshoot of twisting hydraulic cylinder needs to be controlled within 5.3 mm to avoid the unpredictable danger. This article will provide theoretical and technical support for the optimization design of control system and the plugging head.
Indirect monitoring of vortex-induced vibration of suspension bridge hangers
Authors: Cantero Daniel , Øiseth Ole , Rønnquist Anders
Published: August 2017

Wind loading of large suspension bridges produces a variety of structural responses, including the vortex-induced vibrations of the hangers. Because it is impractical to monitor each hanger, this study explores the possibility of assessing the presence of these vibrations indirectly by analyzing the responses elsewhere on the structure. To account for the time-varying nature of the wind velocity, it is necessary to use appropriate time–frequency analysis tools. The continuous wavelet transform and the short-term Fourier transform are used here to obtain clear correlations between the vortex shedding frequency and the energy content of the Hardanger Bridge responses. The analysis of recorded signals from a permanent monitoring system installed on the deck and a temporary system installed on some of the hangers shows that it is possible to indirectly detect hanger-related vortex-induced vibrations from the deck response. Furthermore, this study elaborates on the detection of the two types of vortex-induced vibrations (cross-flow and in-line), the spatial variability of the results, and a possibility to automate the detection process. The ideas reported can be implemented readily in existing structural health monitoring systems for large cable-supported structures not only to identify vortex-induced vibrations but also to gain a better understanding of their structural response.
Of Bricks and Bats: New Stadiums, Talent Supply, and Team Performance in Major League Baseball
Authors: Rockerbie Duane W. , Easton Stephen T.
Published: August 2017

This article considers whether publicly financed new facility investments encourage professional sports team owners to increase their investments in costly talent. We develop a model of a sports league that incorporates publicly financed facility investments, the unique characteristics of the talent market, and revenue sharing to explore the complementarity between new facility amenities, the team budget decision, and team performance. Our empirical results suggest that publicly financed new stadiums do little to improve team performance, not due to restrictions in the talent market, but rather due to a lack of fan response.
Endovascular Management for Symptomatic Chronic Mesenteric Ischemia: A Single-Center Experience
Authors: Guo Baolei , Guo Daqiao , Xu Xin , Chen Bin , Jiang Junhao , Yang Jue , Shi Zhenyu , Fu Weiguo
Published: August 2017

Background:

Chronic mesenteric ischemia (CMI) is an uncommon condition encountered by clinicians. Presentation may vary from asymptomatic to classical intestinal ischemia, although a clear pathophysiology has yet to be elucidated. Here, we have presented our institution’s experience in the management of symptomatic CMI.

Methods:

From February 2007 to February 2016, a retrospective study was performed of all consecutive patients with symptomatic CMI managed by endovascular treatment (ET). We reviewed these patients’ demographics, comorbidities, clinical presentations, and treatment modalities. Perioperative and midterm outcomes included technical success, clinical symptom relief, complications, symptomatic recurrence, mortality, restenosis, and reintervention.

Results:

Thirty-five mesenteric arteries (74.3% stenotic/25.7% occluded) identified in 32 patients (12 females, 20 males) were treated with endovascular procedures. There were no 30-day deaths; the perioperative complication rate was 12.5%. Overall, the median postprocedural time to symptom relief was 7.6 days (range: 1-30 days). Twenty-two (68.8%) had complete remission of symptom, whereas 7 (21.9%) had partial improvement in symptom after ET. After a mean follow-up of 35.4 (25.9) months, 5 (15.6%) patients developed recurrent symptoms, with 4 requiring reinterventions. The primary patency was 93.7%, 82.6%, and 73.1% at 12, 24, and 36 months, respectively, and the freedom from symptomatic recurrence was 90.6%, 84.0%, 84.0%, and 84.0% at 6, 12, 24, and 36 months, respectively.

Conclusions:

Endovascular treatment for patients with CMI had a high technical success rate and satisfactory clinical outcomes. Symptomatic recurrence was not frequent but found mainly within 12 months following the initial procedure.
Rare Post–Tonsillectomy Internal Carotid Artery Pseudoaneurysm: Management by Parent Artery Occlusion Using Detachable Balloons
Authors: Sharma Arun , Kumar Sanjeev , Devarajan S. Leve Joseph , Agarwal Himanshu
Published: August 2017

Iatrogenic cervical internal carotid artery pseudoaneurysm is a rare and potentially lethal complication following tonsillectomy. It can be complicated by thromboembolism, mass effect and eventually may rupture leading to death. Various endovascular treatment options are available for the management of these pseudoaneurysms, including coil embolization, detachable balloon occlusion, or stent graft placement. Parent artery occlusion using detachable balloons can be a therapeutic option in a subset of patients. However, evaluation of cross circulation with preprocedure balloon test occlusion is imperative in such cases.
Robot motion synthesis using ground reaction forces pattern
Authors: Luxman Ramamoorthy , Zielinska Teresa
Published: August 2017

Gait generation in its realization stage in majority of bipeds involves inverse dynamics model with the need of pre-determined joint trajectories and the zero moment point method for final postural stability adjustments. This requires generation of such joint trajectories, where the zero moment point criterion is fulfilled and the human-like posture is kept. Such task is complex and still misses the universal solution. Preserving natural (human-like) and stable body posture under acting disturbances is an issue too. High computational costs, problem with disturbances rejection and controller complexity are the major disadvantages associated with such approaches. This article presents a method for motion control with forward dynamics model and ground reaction forces as the reference values. The ground reaction forces measured during real human walking are utilized here. A MATLAB/Simulink framework is used for testing the proposed synthesis of bipedal locomotion. The ground reaction forces recorded during the walk with different footwear are applied as the references. The obtained motion patterns and postures are compared with those of the human. Obtained results were satisfactory and justified the proposed approach.
Cabozantinib in metastatic renal cell carcinoma: latest findings and clinical potential
Authors: Bersanelli Melissa , Buti Sebastiano
Published: August 2017

Since the advent of immunotherapy revolutionized the treatment of metastatic renal cell carcinoma (mRCC), the attention of oncologists has been unavoidably shifted from tyrosine kinase inhibitors (TKIs) to immune checkpoint blockade, with the associated risk of listing cabozantinib as just one of many available TKIs. On the contrary, we think that cabozantinib represents a very good option for mRCC treatment, with outstanding outcomes in terms of response rate, progression-free survival, overall survival and quick time to treatment response. Its safety profile is acceptable and its discontinuation rate, due to toxicity, is similar to those of other TKIs. It is still not clear if the effectiveness of this drug is justified by its wide spectrum of multikinase activity, extended to the MET and AXL kinases, or by the simple maintenance of a ‘vascular endothelial growth factor receptor pressure’ after another previous TKI. Early-phase studies are currently ongoing to investigate the potential activity and safety of cabozantinib in association with immunotherapy, albeit with the risk of an overly toxic combination. Thus, future opportunities to improve the clinical use of this drug will probably be represented by a smart treatment sequence.
MBA Coaching Program: Best Practices for Success With Limited Resources
Authors: Steiner Susan , Dixon Deirdre P. , Watson Mary Anne
Published: August 2017

Professional coaching has been touted as a highly effective approach to helping executives and managers enhance their organizational acumen and interpersonal skills. In the past several years, a number of prestigious, top-ranked MBA programs have established one-on-one coaching programs to attract students by offering “executive treatment before the title.” Coaching, however, does not have to be the purview of larger, prestigious, resource-rich universities. We offer robust coaching services to students with limited university resources. From its modest beginnings 15 years ago, our MBA Coaching Program recently received national recognition. This article highlights the challenges and decisions that those wishing to undertake a coaching program should consider.
Spatial consequences of urban densification policy: Floor-to-area ratio policy in Tehran, Iran
Authors: Ghadami Mostafa , Newman Peter
Published: August 2017

The purpose of this paper is to investigate the effect of the urban densification policies made after the Islamic Revolution on the urban spatial structure of Tehran as the most important metropolis in Iran. The Hot Spot approach based on the Getis Ord Local G statistical test and Arc GIS 10.2 software was employed in this study. The advantage of the Geo-statistic technique used in this study is that this model does not require the exact location of the city centre to map and determine its spatial structure. The results show that the spatial structure of Tehran was affected by the non-spatial densification policies for 30 years (until Tehran’s Master Plan in 2007). Furthermore, these policies were greatly dependent on the financial benefits from the sale of the FAR permission and fines related to the ignorance of the lawful regulations. There is a spatial imbalance between the population and activity distribution patterns in the structure of Tehran. However, the negative spatial consequences of the densification policies are declining capacity of the city centre and the inner wards in retaining the population, and growing population density in the northern outer wards of Tehran.
Successful AP Music Theory Instruction: A Case Study
Authors: Buonviri Nathan O.
Published: August 2017

The purpose of this case study was to examine the instructional approach of a highly successful Advanced Placement Music Theory teacher. I visited the participant’s class twice a week for 14 weeks, taking field notes, conducting interviews, and collecting instructional artifacts. Analysis of qualitative data revealed three main themes: classroom atmosphere, instructional strategies, and the Advanced Placement exam. The participant’s classroom atmosphere was built on effective pacing, student rapport, and an active, open learning environment. His instructional strategies included offering individual attention to students, asking questions to model thinking, and connecting sight to sound. He used the Advanced Placement exam as both an instructional guidepost and motivational tool. Implications for music educators include the need to focus on specific approaches conducive to successful theory teaching, which may share both similarities and differences with approaches they use when directing ensembles.
Quantitative seismic characterization of CO2 at the Sleipner storage site, North Sea
Authors: Dupuy Bastien , Romdhane Anouar , Eliasson Peder , Querendez Etor , Yan Hong , Torres Verónica A. , Ghaderi Amir
Published: August 2017

Reliable quantification of carbon dioxide ([Formula: see text]) properties and saturation is crucial in the monitoring of [Formula: see text] underground storage projects. We have focused on quantitative seismic characterization of [Formula: see text] at the Sleipner storage pilot site. We evaluate a methodology combining high-resolution seismic waveform tomography, with uncertainty quantification and rock physics inversion. We use full-waveform inversion (FWI) to provide high-resolution estimates of P-wave velocity [Formula: see text] and perform an evaluation of the reliability of the derived model based on posterior covariance matrix analysis. To get realistic estimates of [Formula: see text] saturation, we implement advanced rock physics models taking into account effective fluid phase theory and patchy saturation. We determine through sensitivity tests that the estimation of [Formula: see text] saturation is possible even when using only the P-wave velocity as input. After a characterization of rock frame properties based on log data prior to the [Formula: see text] injection at Sleipner, we apply our two-step methodology. The FWI result provides clear indications of the injected [Formula: see text] plume being observed as low-velocity zones corresponding to thin [Formula: see text] filled layers. Several tests, varying the rock physics model and [Formula: see text] properties, are then performed to estimate [Formula: see text] saturation. The results suggest saturations reaching 30%–35% in the thin sand layers and up to 75% when patchy mixing is considered. We have carried out a joint estimation of saturation with distribution type and, even if the inversion is not well-constrained due to limited input data, we conclude that the [Formula: see text] has an intermediate pattern between uniform and patchy mixing, which leads to saturation levels of approximately [Formula: see text]. It is worth noting that the 2D section used in this work is located 533 m east of the injection point. We also conclude that the joint estimation of [Formula: see text] properties with saturation is not crucial and consequently that knowing the pressure and temperature state of the reservoir does not prevent reliable estimation of [Formula: see text] saturation.
Arsenic Trioxide Consolidation Allows Anthracycline Dose Reduction for Pediatric Patients With Acute Promyelocytic Leukemia: Report From the Children's Oncology Group Phase III Historically Controlled Trial AAML0631
Authors: Kutny Matthew A. , Alonzo Todd A. , Gerbing Robert B. , Wang Yi-Cheng , Raimondi Susana C. , Hirsch Betsy A. , Fu Cecilia H. , Meshinchi Soheil , Gamis Alan S. , Feusner James H. , Gregory John J.
Published: August 2017

Purpose

The Children’s Oncology Group AAML0631 trial for newly diagnosed pediatric acute promyelocytic leukemia (APL) was a phase III historically controlled trial to determine the survival of patients receiving arsenic trioxide (ATO) consolidation and reduced doses of anthracyclines.

Patients and Methods

Patients age 2 to 21 years with de novo APL confirmed by PML-RARα polymerase chain reaction were stratified as standard risk (SR) or high risk (HR) on the basis of diagnostic WBC count. All patients received all-trans retinoic acid (ATRA) during induction, each consolidation course, and maintenance. All patients received two cycles of ATO therapy during consolidation 1, an additional two (SR) or three (HR) consolidation courses that included high-dose cytarabine and anthracycline, and maintenance therapy comprising ATRA, oral methotrexate, and mercaptopurine.

Results

One hundred one patients (66 SR and 35 HR) were evaluable for outcome. The 3-year overall survival was 94%, and event-free survival (EFS) was 91%. For SR and HR patients with APL, the overall survival was 98% versus 86% ( P = .003), and EFS was 95% versus 83% ( P = .03), respectively. The EFS for SR patients in AAML0631 was noninferior to that of patients in the AIDA 0493 historical control, which used a significantly higher anthracycline dose and did not include ATO consolidation. Relapse risk for patients in AAML0631 from end consolidation 1 (after ATO treatment) was only 4% at 3 years and did not differ significantly between SR and HR patients.

Conclusion

ATO consolidation cycles were well tolerated in pediatric patients with APL and allowed significant reduction in cumulative anthracycline doses while maintaining excellent survival and a low relapse risk for both SR and HR patients with APL.
Hydrogen Sulfide and Sulfate Prebiotic Stimulates the Secretion of GLP-1 and Improves Glycemia in Male Mice
Authors: Pichette Jennifer , Fynn-Sackey Nancy , Gagnon Jeffrey
Published: August 2017

Recently, the gastrointestinal microbiome, and its metabolites, has emerged as a potential regulator of host metabolism. However, to date little is known on the precise mechanisms of how this regulation occurs. Hydrogen sulfide (H2S) is abundantly produced in the colon by sulfate-reducing bacteria (SRB). H2S is a bioactive gas that plays regulatory roles in many systems, including metabolic hormone regulation. This gas metabolite is produced in close proximity to the glucagonlike peptide-1 (GLP-1)–secreting cells in the gut epithelium. GLP-1 is a peptide hormone that plays pivotal roles in both glucose homeostasis and appetite regulation. We hypothesized that H2S can directly regulate GLP-1 secretion. We demonstrated that H2S donors (NaHS and GYY4137) directly stimulate GLP-1 secretion in murine L-cells (GLUTag) and that this occurs through p38 mitogen-activated protein kinase without affecting cell viability. We then increased SRB in mice by supplementing the diet with a prebiotic chondroitin sulfate for 4 weeks. Mice treated with chondroitin sulfate had elevated Desulfovibrio piger levels in the feces and increased colonic and fecal H2S concentration. These animals also had enhanced GLP-1 and insulin secretion, improved oral glucose tolerance, and reduced food consumption. These results indicate that H2S plays a stimulatory role in GLP-1 secretion and that sulfate prebiotics can enhance GLP-1 release and its downstream metabolic actions.
Trade Policy of the Eurasian Economic Union (Theoretical and Methodological Aspect)
Authors: Быстров Г. , Bystrov G.
Published: August 2017

The article at theoretical and methodological level gives the estimation of the institutional environment of the organization of trade policy as a source of possible conflicts of interests of the states — participants of economic integration. The attention is focused on the problem of providing a flexible institutional environment for stability and development of economic integration.
State Innovation Program Budgetingfrom Extra-Budgetary Sources
Authors: Восканян Роза , Voskanyan Roza
Published: August 2017

Timely implementation of the state innovation programs requires a large financial investment on account of private sector investment of the economy. In this regard, the present article is devoted to the study of public-private partnerships as a source of extra-budgetary funding for the state innovation programs in Russia. The author analyzed the possibility of involvement of various extra-budgetary sources to finance public innovation programs, which allowed to conclude that the public-private partnership is one of the most effective mechanisms of financing the implementation of government programs. The article considers the characteristic features of public-private partnerships, and identified key issues of implementation of public-private partnership in the Russian Federation. Based on the conducted research the author developed a complex of measures which implementation may contribute to increasing the attractiveness of the mechanism of public-private partnerships to Finance public innovation programs.
Information Relaxation Bounds for Infinite Horizon Markov Decision Processes
Authors: Brown David B. , Haugh Martin B.
Published: August 2017

We consider the information relaxation approach for calculating performance bounds for stochastic dynamic programs (DPs), following Brown et al. [Brown DB, Smith JE, Sun P (2010) Information relaxations and duality in stochastic dynamic programs. Oper. Res. 58(4, Part 1):785–801]. This approach generates performance bounds by solving problems with relaxed nonanticipativity constraints and a penalty that punishes violations of these constraints. In this paper, we study infinite horizon DPs with discounted costs and consider applying information relaxations to reformulations of the DP. These reformulations use different state transition functions and correct for the change in state transition probabilities by multiplying by likelihood ratio factors. These reformulations can greatly simplify solutions of the information relaxations, both in leading to finite horizon subproblems and by reducing the number of states that need to be considered in these subproblems. We show that any reformulation leads to a lower bound on the optimal cost of the DP when used with an information relaxation and a penalty built from a broad class of approximate value functions. We refer to this class of approximate value functions as subsolutions, and this includes approximate value functions based on Lagrangian relaxations as well as those based on approximate linear programs. We show that the information relaxation approach, in theory, recovers a tight lower bound using any reformulation and is guaranteed to improve on the lower bounds from subsolutions. Finally, we apply information relaxations to an inventory control application with an autoregressive demand process, as well as dynamic service allocation in a multiclass queue. In our examples, we find that the information relaxation lower bounds are easy to calculate and are very close to the expected cost using simple heuristic policies, thereby showing that these heuristic policies are nearly optimal.
Research Roundup
Authors: Cowan Helen
Published: August 2017

Helen Cowan presents a selection of recently published articles of interest to nurses working in cardiovascular nursing. The aim of this roundup is to provide a brief overview of the research papers selected. A full reference is provided for those who wish to take a look at the research in further detail
The Mental Capacity Act: ‘Best interests’—a review of the literature
Authors: Marshall Helen , Sprung Sally
Published: August 2017

The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 in order to provide a consistent, robust framework with the aim to protect and empower people to make decisions themselves. However, an assessment as per the MCA may demonstrate that a person is lacking mental capacity and therefore unable to make an autonomous decision at the time it needs to be made. In this case, a ‘best interests’ decision may be made on their behalf, ensuring their wishes and beliefs are at the centre of the decision-making process. When making a best interests decision, a health practitioner must follow the guidance as set out in the MCA legislation to ensure fair and consistent approaches to safeguard and provide assurance that the outcome is truly the best decision for the individual. This review of the literature supports the findings of a 2014 post-legislative review by the House of Lords, which concluded the principles of the MCA are not sufficiently embedded into the practice of all health practitioners, due to a lack of knowledge, awareness and understanding. However, the evidence base also appreciates making a decision on behalf of another person can be a stressful, complex and intricate process when further support may be required from the wider multidisciplinary team, including potentially seeking legal advice.
Young carer awareness, identification and referral
Authors: Sprung Sally , Laing Michelle
Published: August 2017

Young carers often provide care because they have always done so for the people they care about, and because they believe that the care recipient could not manage without them. For many young carers, looking after their own health, combining caring with schoolwork, getting access to training or having time off from carer duties can be a major challenge ( Department of Health [DH], 2008 ). This paper presents evidence from a literature review that builds a substantial body of knowledge to suggest that community nursing teams must develop supportive approaches towards increasing an awareness of young carers' needs. Identification of young carers by community nurses will encourage referral to appropriate services and agencies. The aim of this study was to appraise, for the Queen's Nursing Institute, the published evidence base to explore young carers' needs and how community nurses could support young carers' needs in England. Databases were systematically searched. Title and abstract reviews found 606 potential studies (see Figure 1 ), which were identified around topics corresponding to the headings of three distinct categories: mental health and wellbeing; education needs and resilience; and development of coping strategies. Full-text review resulted in 26 publications that met the study's inclusion criteria. The results of this work show that there is a scarcity of publications around the community nursing needs of young carers. However, studies consistently report young carers are hidden from view and have a significant requirement for support and information. Therefore, effective ways of delivering community nursing support and information to young carers needs to be developed by service providers as a matter of priority, and implemented to give the support that young carers need.
Evaluating the results of mentorship training for community midwives in Sindh, Pakistan
Authors: Sayani Amber Hussain , Jan Rafat , Lennox Susan , Mohammad Yasmin Jan , Awan Safia
Published: August 2017

Aims

The aim of the study was to measure the impact of the mentorship training on the community midwives' knowledge, perceptions, and willingness to mentor.

Methods

A quasi-experimental pre- and post-design was used. A total of 50 community midwives were educated about mentorship, and data were collected through pre- and post-test questionnaires, and a 3-month follow-up.

Findings

There was a significant improvement in the knowledge of community midwives about mentorship (P=<0.001) and their willingness to mentor (P=<0.001). Their perceptions about the cost versus benefit of mentoring had improved (P=<0.001). During the follow-up, the majority of participants reported that they had begun working as a mentor.

Conclusions

Mentorship training was found to be effective in improving the knowledge, perceptions, and willingness of community midwives to mentor. A larger study in a different area of Pakistan is also recommended using a similar scheme.
Coping with end-of-year assessments: a survival guide for pre-registration midwives
Authors: Power Alison , Murray Jonathan
Published: August 2017

The midwifery preregistration programme of study is a demanding undertaking that prepares students for the stressors and complexities of the role of the qualified midwife. Additionally, there are ‘pinch points’ during each academic year, where the pressures of theory and practice assessments can lead to students feeling overwhelmed and unable to cope. While multiple submissions due on or around the same time may seem excessive, as students cannot be assessed on what they have not learned, this inevitably leads to a heavy assessment schedule towards the end of each academic year. This article will complement existing literature by suggesting self-help techniques such as relaxation, exercise and making use of existing support networks, along with signposting to useful online resources for students to access during particularly stressful times of their training.
The new world of clinical supervision
Authors: Hawes Katherine
Published: August 2017

Katherine Hawes, newly appointed Deputy Regional Maternity Lead for Midlands and East, reflects on saying goodbye to statutory supervision and plans for the future in her new appointment
A midwife's experience of stillbirth
Authors: McDowell Indie
Published: August 2017

After being asked by a mother of a stillborn baby in Ethiopia whether the experience also affects clinicians, Indie McDowell discusses the many emotions that midwives may feel
To whom it may concern
Authors: Dawkins Kelly
Published: August 2017

Coming to the end of her midwifery training, Kelly Dawkins writes to students past and present about the realities of midwifery education, and how student midwives may feel
Durham and Cleveland police firearms unit tactical team medics: lessons from the first six years
Authors: Carr Gavin , Doyle Pete , Wheatley Sean , Kyle Tony , Mellor Adrian
Published: August 2017

Background.

Since 2007 Durham and Cleveland Firearms Police have trained a small number of firearms police officers to an enhanced level of first aid qualification. This article reviews the history of this programme, the patient report forms submitted during the period 2013-2016 and analyses the types of incidents attended.

Methods:

66 PRFS were interrogated and analysed from a four-year period between Jan 2013 and Dec 2016. There was a marked increase in PRFs submitted during that time. Over half the casualties were male, resulting from assault (15) 21%), road traffic collisions (14)19%) and deliberate self-harm (14)19%). The most frequent medical interventions were wound dressing and direct pressure, airway manoeuvres and Oxygen therapy. On-scene times with patients prior to handover to NHS staff ranged from 0->60 mins. 0-20 minutes (22), 20-40 minutes (15), 40-60 minutes (10) and >60 minutes (1).

Discussion:

This data shows that the TTMs provide a useful medical response often arriving before other medical provision is on scene. Despite the primary role being to respond to firearms trauma, officers have dealt with a range of medical scenarios and provided a range of interventions.
Ocular management for CS gas exposure: exploring treatment in the pre-hospital setting
Authors: McIntosh John
Published: August 2017

Problem: The use of CS gas has increased dramatically in recent years yet how to implement optimal management is still a matter of debate. A lack of a sandardised approach to care has left a vacuum in which various treatments have been proposed, some with no evidence base. Whilst some of these treatments may simply not work, others will increase the pain and time taken to recover. Approach: This paper looks, specifically at the ocular management of exposure to CS gas as the eyes are often the most severely affected of organs and therefore the focus of the first aider's efforts. Suggested ocular treatments proposed by the general public were explored alongside existing professional guidelines and available academic literature. Conclusions: Recommending best practice remains difficult and treatment will often have to be adapted to the local environment. Adherence to commonly agreed principles is essential and includes preventing secondary effects by use of personal protective equipment, removing those affected into a well ventilated area, removing contaminated clothing and offering reassurance.
Which factors influence the rate of failure following metal-on-metal hip arthroplasty revision surgery performed for adverse reactions to metal debris?
Authors: Matharu G. S. , Judge A. , Pandit H. G. , Murray D. W.
Published: August 2017

Aims

To determine the outcomes following revision surgery of metal-on-metal hip arthroplasties (MoMHA) performed for adverse reactions to metal debris (ARMD), and to identify factors predictive of re-revision.

Patients and Methods

We performed a retrospective observational study using National Joint Registry (NJR) data on 2535 MoMHAs undergoing revision surgery for ARMD between 2008 and 2014. The outcomes studied following revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using competing-risk regression modelling.

Results

Intra-operative complications occurred in 40 revisions (1.6%). The cumulative five-year patient survival rate was 95.9% (95% confidence intervals (CI) 92.3 to 97.8). Re-revision surgery was performed in 192 hips (7.6%). The cumulative five-year implant survival rate was 89.5% (95% CI 87.3 to 91.3). Predictors of re-revision were high body mass index at revision (subhazard ratio (SHR) 1.06 per kg/m2 increase, 95% CI 1.02 to 1.09), modular component only revisions (head and liner with or without taper adapter; SHR 2.01, 95% CI 1.19 to 3.38), ceramic-on-ceramic revision bearings (SHR 1.86, 95% CI 1.23 to 2.80), and acetabular bone grafting (SHR 2.10, 95% CI 1.43 to 3.07). These four factors remained predictive of re-revision when the missing data were imputed.

Conclusion

The short-term risk of re-revision following MoMHA revision surgery performed for ARMD was comparable with that reported in the NJR following all-cause non-MoMHA revision surgery. However, the factors predictive of re-revision included those which could be modified by the surgeon, suggesting that rates of failure following ARMD revision may be reduced further. Cite this article: Bone Joint J 2017;99-B:1020–7.
The correlation between Salter’s criteria for avascular necrosis of the femoral head and Kalamchi’s prognostic classification following the treatment of developmental dysplasia of the hip
Authors: Tsukagoshi Y. , Kamegaya M. , Kamada H. , Saisu T. , Morita M. , Kakizaki J. , Tomaru Y. , Yamazaki M.
Published: August 2017

Aims

The aim of this study was to evaluate the correlation between Salter’s criteria and Kalamchi’s classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH).

Patients and Methods

The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter’s criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis.

Results

S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 + S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis. A CHDD ≥ 10% and a D-shaped metaphysis were also predictive of a poor prognosis.

Conclusion

The Salter criteria were predictive of the Kalamchi grade of avascular necrosis in patients with DDH aged ten or more years after reduction of the hip. Cite this article: Bone Joint J 2017;99-B:1115–20.
The colonisation of the glenohumeral joint by Propionibacterium acnes is not associated with frozen shoulder but is more likely to occur after an injection into the joint
Authors: Booker S. J. , Boyd M. , Gallacher S. , Evans J. P. , Auckland C. , Kitson J. , Thomas W. , Smith C. D.
Published: August 2017

Aims

Our aim was to investigate the prevalence of Propionibacterium (P.) acnes in the subcutaneous fat and capsule of patients undergoing shoulder surgery for frozen shoulder or instability.

Patients and Methods

A total of 46 patients undergoing either an arthroscopic capsular release or stabilisation had biopsies taken from the subcutaneous fat and capsule of the shoulder at the time of surgery. These samples were sent for culture in enrichment, and also for Nucleic Acid Amplification testing. The prevalence of P. acnes and other microbes was recorded. Fisher's exact test of binary variables was used to calculate the association with significance set at p < 0.05. Assessment of influence of independent variables including a pre-operative glenohumeral injection, fat colonisation and gender, was undertaken using binary linear regression.

Results

A total of 25 patients (53%) had P. acnes in one or more tissue samples and 35 (74%) had other bacterial species. The same microbe was found in the subcutaneous fat and the capsule in 13 patients (28%). There was no statistically significant association between the surgical pathology and capsular colonisation with P. acnes (p = 0.18) or mixed identified bacterial species (p = 0.77). Male gender was significantly associated with an increased capsular colonisation of P. acnes (odds ratio (OR) 12.38, 95% confidence interval (CI) 1.43 to 106.77, p = 0.02). A pre-operative glenohumeral injection was significantly associated with capsular P. acnes colonisation (OR 5.63, 95% CI 1.07 to 29.61, p = 0.04. Positive fat colonisation with P. acnes was significantly associated with capsular P. acnes (OR 363, 95% CI 20.90 to 6304.19, p < 0.01). Regression models pseudo R2 found fat colonisation with P. acnes to explain 70% of the variance of the model. Patients who had a pre-operative glenohumeral injection who were found intra-operatively to have fat colonisation with P. acnes had a statistically significant association with colonisation of their capsule with P. acnes (OR 165, 95% CI 13.51 to 2015.24, p < 0.01).

Conclusion

These results show a statistically significant association between subcutaneous skin P. acnes culture and P. acnes capsular culture, especially when the patient has undergone a previous injection. The results refute the hypothesis that P. acnes causes frozen shoulder. Cite this article: Bone Joint J 2017;99-B:1067–72.