bluuebunny/crossref_metadata_2025 huggingface dataset:
The subjective, human experience of groove: A phenomenological investigation
Authors: Hosken Fred
Published: August 2018

This phenomenological study investigates what it means for listeners to experience groove. A purposeful sample of 14 participants listened to stimuli featuring manipulations that have been identified in the groove literature and answered: “Does this groove? Why? Describe the groove.” Firstly, no single definition of what groove is, no one-to-one mappings of music detail (participatory discrepancy, tempo, or timbre) to experience of groove can be found within the results, nor is there any consensus as to whether a specific track “has groove” or not. Secondly, thematic analysis of statements shows five emergent themes: Pleasure, Movement/Energy, Tension/Relaxation, Expectation/Surprise, and Technical Language. Through discussion of examples, these categories are shown to be interconnected and may have some causal links. The aim of this study is to complement empirical groove research by emphasizing and advocating for the qualitative, phenomenological experience of listeners.
Strategic Planning and Prospects of Rail-Bound Demand Responsive Transit
Authors: Cats Oded , Haverkamp Jesper
Published: August 2018

Fully automated services allow for greater flexibility in operations and lower marginal operational costs. In this study we examined the strategic planning implications of a novel service concept – an automated rail demand responsive transit (DRT) system that offers a direct non-stop service. The objective of this study was to determine the capacity requirements of the envisaged service and discuss its prospects and feasibility. A cost minimization approach for determining the optimal track and station platform capacities for a rail-DRT system so that passenger, infrastructure, and operational costs are minimized is described. The macroscopic model allows for studying the underlying relations between technological, operational and demand parameters, optimal capacity settings, and the obtained cost components. The model was applied to a series of numerical experiments to test its implications for different network structures and demand distributions. The results of the numerical experiments indicate that – unlike conventional rail systems in which stations often are capacity bottlenecks – link capacity properties are more critical for the performance of automated rail-DRT systems than station capacity. A series of sensitivity analyses was performed to test the consequences of various cost and capacity specifications, as well as the characteristics of future automated rail-DRT systems.
Evaluation of Healing After Medial Meniscal Root Repair Using Second-Look Arthroscopy, Clinical, and Radiological Criteria
Authors: Lee Sung-Sahn , Ahn Jin Hwan , Kim Jun Ho , Kyung Bong Soo , Wang Joon Ho
Published: August 2018

Background:

Previous studies have reported various healing rates (0%-100%) as evaluated by second-look arthroscopy after repair of medial meniscal root tears (MMRTs). Such variable results might provoke suspicion of the necessity for repair. Furthermore, the effect of meniscal healing on the clinical outcomes has not been reported.

Purpose:

To more precisely determine the healing rate of MMRTs repaired through the transseptal portal, which could provide objective visualization of the healed meniscus, and to identify the effect of meniscal healing on the clinical and radiological outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

Between June 2010 and April 2015, 56 patients underwent pullout suture for MMRT. Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, medial joint space height, and Kellgren-Lawrence (K-L) grade were evaluated. Thirty-three patients underwent second-look arthroscopy and were divided into a “stable healed group” and “unhealed group” according to their healing status, as evaluated through the transseptal portal. The intraoperative, clinical, and radiological outcomes of the 2 groups were compared.

Results:

All other clinical outcomes improved. However, medial joint space became significantly narrower ( P < .001), and 23 patients (41%) showed K-L grade progression. On the basis of second-look arthroscopy, 23 patients (69.7%) were classified into a stable healed group and 10 (30.3%) into a unhealed group. The stable healed group showed a higher Hospital for Special Surgery score ( P = .023), International Knee Documentation Committee subjective score ( P = .031), and successful microfracture rate ( P = .023), with less progression of medial joint space narrowing ( P < .001) and K-L grade ( P < .001).

Conclusion:

Despite degenerative change progression, clinical outcomes were improved. The successful healing rate was 69.7% after repair of MMRTs. Compared with the unhealed group, the stable healed group showed better clinical outcomes and less degenerative change progression.
Organizational Directors’ Perceptions About Awareness of Services Among Their Employees and the Older Adults They Serve
Authors: Teixeira-Poit Stephanie M. , Napier Ariana , Carr Christine , Williams Jessica , Pulliam Paul
Published: August 2018

Objectives: This study explores the extent to which directors of organizations perceive that (a) older adults are aware of and interested in using services, and (b) their employees are aware of complementary services in the community and are willing to coordinate care or refer older adults to these services. Method: We conducted 41 qualitative semistructured interviews with organizational directors who provide services to older adults. Results: Directors perceived that not only older adults but also some providers were unaware of services in the community. Directors reported that some older adults felt stigmatized and were unwilling to use services, but services providers implemented strategies to overcome these barriers. Discussion: Understanding the perceptions of organizational directors may help identify opportunities for older adults to learn about community services and for providers to better coordinate care.
Effective diversity, equity, and inclusion practices
Authors: Gill Gurwinder Kaur , McNally Mary Jane , Berman Vin
Published: August 2018

Demographics in Canada, and the workplace, are changing. These include population changes due to race, ethnicity, religion/faith, immigration status, gender, sexual identity and orientation, disability, income, educational background, socioeconomic status, and literacy. While this rich diversity can present challenges for patient experiences/outcomes and working environments, it can also present opportunities for positive transformation. For successful transformation to take place, strategies should focus on “Diversity, Equity, and Inclusion” (DEI) versus “diversity” alone and on creating inclusive team environments for positive staff experiences/engagement. There is a growing understanding of the relationship between the providers’ work environments, patient outcomes, and organizational performance. This article leverages the principle of improving the healthcare provider’s experience based on Health Quality Ontario’s Quadruple Aim (“people caring for people”). Based on learnings/experiences, the top three successful practices from the organization’s DEI strategy have been outlined in this article.
Congenital syphilis presenting with liver lesions
Authors: Deall Heather , Faust Saul N , Pelosi Emanuela , Fairhurst Joanna , Elliott Kirsten , Patel Sanjay
Published: August 2018

Congenital syphilis is a prevalent infection in much of the world but rare in contexts where antenatal screening and treatment are available. In the UK in 2016, three cases of congenital syphilis were reported in babies born to women who were seronegative at the time of booking and hence a high degree of clinical vigilance is required in the unwell infant. We present the case of a seven-week-old baby girl with congenital syphilis with the unusual finding of discrete liver lesions. This baby was successfully treated with intravenous ceftriaxone.
Rectal Trichomonas vaginalis infection in South African men who have sex with men
Authors: Hoffman Charlotte M , Fritz Lise , Radebe Oscar , Dubbink Jan Henk , McIntyre James A , Kock Marleen M , Peters Remco PH
Published: August 2018

This study from South Africa highlights the importance of rectal Trichomonas vaginalis infection as a sexually transmitted infection among men who have sex with men (MSM). We report seven MSM presenting with rectal T. vaginalis infection. Two men presented with symptoms of proctitis; 5/7 had urethral coinfection with T. vaginalis. Rectal T. vaginalis infection should be considered in MSM in areas where genital infection is endemic.
Introduction: Pow Meng Yap and the culture-bound syndromes
Authors: Crozier Ivan
Published: August 2018

PM Yap’s most significant intellectual achievement was his development of the concept of the culture-bound syndrome, which synthesized years of research into transcultural psychiatry, and situated this work within this field by drawing on elaborated nosological schema that challenged some of the ethnocentric assumptions made by previous psychiatrists who had tried to understand mental illnesses that presented in non-western cultures. This introduction to Yap’s 1951 paper emphasizes that Yap needs to be understood as working within the western tradition of transcultural psychiatry, and argues that his English training and his continual engagement with western psychiatric and philosophical frameworks is the best way to conceive of his contributions to this field. Yap’s paper, republished below as the Classic Text, was his first foray into comparative transcultural psychiatry.
Assessing the quality, reliability and readability of online health information regarding systemic lupus erythematosus
Authors: Reynolds M , Hoi A , Buchanan R R C
Published: August 2018

Introduction

Systemic lupus erythematosus (SLE) has complex pathophysiology and treatments, and patients often use the internet to better understand their condition. This report systematically assesses the quality, reliability and readability of online information.

Methods

The search term ‘systemic lupus erythematosus’ was used with Google™, Bing™ and Yahoo™ search engines sequentially. The first 25 websites returned (‘hits’) for each search engine (total 75 websites) were compiled. The search terms ‘SLE’ and ‘lupus’ were used in separate Google searches to assess for commonality. After removal of excluded hits, websites were assessed using the DISCERN instrument, Journal of the American Medical Association benchmarks and Gunning Fog Index for quality, reliability and readability and presence of ‘Health on the Net Code’ (HoN) standardisation recorded.

Results

There was a large degree of commonality among hits from the three different search engines using the search term ‘systemic lupus erythematosus’, as well as hits returned for the three different search terms using Google. The mean DISCERN score was 47.7 (SD 13.2) for ‘systemic lupus erythematosus’, 46.4 (SD 14.2) for ‘SLE’ and 45.2 (SD 10.1) for ‘lupus’, with no statistically significant difference. The mean number of JAMA benchmarks (maximum four) present for the ‘systemic lupus erythematosus’, ‘SLE’ and ‘lupus’ searches was 1.3 (SD 1.2), 1.4 (SD 1.3) and 1.2 (SD 1.0), respectively, with no statistically significance difference. The average readability of hits for the three different search terms was 9.3 (SD 3.4), 10.0 (SD 3.1) and 11.1 (SD 2.7), with no statistically significant difference.

Conclusion

There was a large degree of commonality of hits among the different search engines and the utilised search terms but they are not synonymous. Regardless of search term, the overall quality of websites was fair, whilst reliability was poor. Websites appearing higher in searches did not score better. Presence of the HoN did not represent better quality. Readability was higher than recommended for near-universal understanding. There was no difference in quality, reliability or readability of websites using the search terms ‘systemic lupus erythematosus’, ‘SLE’ or ‘lupus’, with some high-scoring websites appearing in only one search term result. This study reminds clinicians to direct patients to high-quality websites rather than rely on search engines.
Functional Outcomes of Local Pedicle Graft Interpositional Arthroplasty in Adults With Severe Freiberg’s Disease
Authors: Abdul Wahid , Hickey Ben , Perera Anthony
Published: August 2018

Background:

Conservative treatment or debridement is generally sufficient for Freiberg’s disease grades I and II but operative intervention for the late stages of the disease process (III-V) is more challenging. Debridement alone is not sufficient and various forms of arthroplasty have been put forward. We have evaluated the outcomes of patients treated with an interpositional arthroplasty technique using a pedicle graft of periosteum and fat made into a “Rollmop” spacer for severe Freiberg’s disease. No results have previously been reported for this technique.

Methods:

Twenty-five consecutive cases (23 patients) were performed from February 2009 to September 2016 (20 females, 5 males). Mean age at surgery was 52.6 years (range 19-70.5 years) with 92% affecting the second metatarsal. Twenty-three were primary cases and 2 were revision cases. Five cases were stage III, 12 were stage IV, and 8 were stage V. All patients underwent interpositional arthroplasty using a periosteum and fat pedicle graft from the affected metatarsal shaft as described by Myerson. Patients were evaluated using Manchester-Oxford Foot Questionnaire (MOXFQ) and American Orthopaedic Foot & Ankle Society Questionnaire (AOFAS). Mean follow-up was 3.5 years (0.6-7.6 years). Paired 2-tailed Student t tests were used to assess clinical significance.

Results:

Surgery allowed 8 patients to return to normal footwear, 10 patients returned to fashion footwear/heels, and 5 returned to sports. Nineteen cases (17 patients) were assessed with patient-reported outcome measures and all showed a clinically and statistically significant improvement in their scores. Mean pre- and postoperative VAS pain scores were 6.2 (range 4-9) and 1.8 (range 0-6) ( P < .05). Mean perioperative AOFAS scores were 45.6 (range 15-73) and 82.7 (range 57-100) ( P < .05). Mean perioperative MOXFQ scores were 60.0 (range 23-89) and 18.1 (range 0-80) ( P < .05).

Conclusion:

This novel interpositional arthroplasty technique using a “rollmop” of periosteum and fat for severe Freiberg’s disease produced significant improvements in pain, functional outcome, and patient satisfaction without donor site morbidity. Furthermore, it allowed patients to return to desired footwear and sporting activities. The functional outcome and joint range of motion was superior after a K-wire was no longer placed across the joint, and we believe it is essential to avoid this to permit early range-of-motion exercises.

Level of Evidence:

Level IV, retrospective case series.
Are Self-Efficacy and Weight Perception Associated With Physical Activity and Sedentary Behavior in Hispanic Adolescents?
Authors: Alert Marissa D. , Saab Patrice G. , Llabre Maria M. , McCalla Judith R.
Published: August 2018

Little is known about the correlates of physical activity and sedentary behavior in Hispanic adolescents. This study examined at baseline and 2-year follow-up: (1) the relationship between self-efficacy for physical activity and physical activity, (2) the association of weight perception with physical activity and sedentary behavior, and (3) whether sex moderated these associations. Hispanic adolescents ( N = 483 at baseline; age 15-17 years; 55.1% girls) completed questionnaires that assessed their self-efficacy for physical activity, weight perception, and time spent in physical activity and sedentary behavior. Multiple-group path analyses were conducted to examine the proposed relationships and determine whether they were moderated by sex. Models controlled for body mass index, weight loss intention, participation on a sports team, language spoken at home, parental education, and country of birth. Self-efficacy was related to time spent in physical activity in boys ( b = .35, p < .001) and girls ( b = .41, p < .001) at baseline, but not 2 years later. No association was found for weight perception and time spent in physical activity and sedentary behavior. Post hoc analyses for overweight participants at baseline showed that weight perception was associated with time spent watching television. Overall, the findings suggest that self-efficacy is an important correlate, but not a predictor, of physical activity among Hispanic adolescents. Including strategies to address and enhance self-efficacy for physical activity in lifestyle interventions may increase adherence to physical activity recommendations and help reduce the high prevalence of obesity in this population.
Those who only know of social psychology know not social psychology: A tribute to Gustav Jahoda’s historical approach
Authors: Billig Michael
Published: August 2018

This article examines Gustav Jahoda’s late work, focussing on his historical writings which have tended to be somewhat overlooked. In many respects this later work, which needs to be understood as a whole, parallels his earlier work into culture. In his later writings, Jahoda wrote about the history of social psychology but his history served a critical purpose: he was arguing that social psychology was essentially historical. If behaviour was primarily determined by culture then culture was itself historical and, in this regard, social psychological relations were, thus, historical. Because social psychologists need to think historically, as well as culturally, Jahoda considered that it was important that they should not be constrained by artificial disciplinary boundaries. Jahoda’s advocacy of non-disciplinary thinking was not confined to social psychologists. Just as social psychologists should think historically, so sometimes historians need to think social psychologically. As such, C.L.R. James’s famous cricketing motto can be adapted to fit Jahoda’s historical approach to social psychology.
Questionnaire survey on the summer air-conditioning use behaviour of occupants in residences and office buildings of China
Authors: Meng Xi , Gao Yanna , Hou Chaoping , Yuan Fen
Published: August 2018

Although occupants play a critical role in a building’s energy consumption, their air-conditioning use behaviour is often ignored, with it usually approximated as being a continuous operation. This in turn leads to a large difference between the actual and expected levels of energy consumption, raising the need to study air-conditioning use behaviour of building occupants. In this survey, 3083 questionnaires dealing with air-conditioning use behaviour were received from 34 cities distributed throughout China. The results show occupancy rates of 20% to 75% in residences and around 80% in office buildings during the period of 8:00–18:00. Air-conditioning use behaviour only meets a liveable requirement in residences and reaches a comfortable level in office buildings. This leads to daily air-conditioning operation times of between 0.85 and 4.31 hours in residences, and between 1.67 and 7.22 hours in office buildings, indicating most air-conditioning systems do not run continuously but intermittently, and that the assumption of continuous operation is far removed from reality. Based on these survey results, the large differences between the realistic (intermittent) and assumed (continuous) use of air-conditioning are employed to reveal the weaknesses in the present standards and to examine the optimization of building energy efficiency.
The on-board carbon dioxide concentrations and ventilation performance in passenger cabins of US domestic flights
Authors: Cao Xiaodong , Zevitas Christopher D. , Spengler John D. , Coull Brent , McNeely Eileen , Jones Byron , Loo Sin Ming , MacNaughton Piers , Allen Joseph G.
Published: August 2018

Billions of people travel on airplanes every year, making the aircraft cabin a critical environment to understand with regard to public health. The main control over indoor environmental quality in the cabin is ventilation; therefore, maintaining sufficient ventilation rates on-board is essential for creating healthy and comfortable cabin environments. We measured real-time CO2 concentrations, an indicator of ventilation rates, and cabin pressure in the passenger cabins of 179 US domestic flights from boarding through deplaning. The average CO2 concentrations were 1353 ± 290 ppmv (mean ± SD) and the estimated outside airflow rates were 5.77 ± 2.09 L/s/p across all flights. The results indicated that 96% of observations met the minimum recommended outside airflow rates for acceptable air quality (3.5 L/s/p), but only 73% met the rate required in FAA design requirements (4.7 L/s/p), during flying phases. The CO2 levels on all flights were well below the occupational exposure limit of 5000 ppmv. Statistical analysis indicated that the ventilation rates during boarding phases were significantly lower than the others. The findings are of particular interest because low ventilation in other settings has been associated with increased rates of disease transmission, increased upper respiratory symptoms, and worse performance on cognitive function tests. Verification of ventilation performance rather than reliance on design estimates for determining compliance with ventilation standards is recommended.
Culture, an excuse?—A critical analysis of essentialist assumptions in cross-cultural management research and practice
Authors: Långstedt Johnny
Published: August 2018

The essentialist cross-cultural management paradigm legitimizes a discourse that undermines the agency of people with different cultural backgrounds. The assumptions that underlie the essentialist conceptualization of culture are investigated from an attribution theory perspective. The assumptions are largely based on making culture a valid predictor of action at the expense of the actor’s agency. The manifestation of the essentialist discourse in an international management context is investigated through an attribution theory framework on project professionals’ accounts of intercultural encounters in large-scale construction projects. The analysis shows that culture is used as the cause of actions but also as a means to excuse that actor for his actions. The analysis further shows how the essentialist conceptualization of culture creates a framework for using culture as both a cause of actions and an excuse. The article provides a nonessentialist conceptualization of culture and shows how the assumptions it rests on undermine the assumption that culture is a valid predictor of action. The essentialist assumption of culture can shroud the issues that underlie the challenges currently attributed to culture. Therefore, managers are encouraged to move from an essentialist conceptualization to a nonessentialist conceptualization of culture.
The Process Density Index as a Measure of Phonological Development: Data From Dutch
Authors: van Borsel John , D’haeseleer Lien
Published: August 2018

The Process Density Index (PDI), originally developed by Edwards, is a potentially useful metric for assessing phonological development that is based on the average number of phonological process applications per word in a speech sample. The purpose of the present study was to gather PDI reference data for Dutch-speaking children. Speech samples were collected and the PDI values were determined in 120 Dutch-speaking children aged between 2;6 and 5;6 years of both genders. Boys showed a higher PDI than girls, and there was a strong negative relationship between age and PDI. The presence of a history of otitis media, socioeconomic status, and sibling status, however, were of no influence. The results confirm trends seen in previous studies on phonological development of typically developing children using other metrics. This suggests that the PDI is a valid measure to assess phonological acquisition.
The multi-attribute topological graph method and its application on power flow analysis in closed planetary gear trains
Authors: Cui Yahui , Gao Jing , Ji Xiaomin , Zhou Xintao , Yan Haitao
Published: August 2018

The concept of multi-attribute topological graph is proposed in this article to represent the characteristics of both structure and state for typical one-degree-of-freedom planar spur closed planetary gear trains. This method is well applied in power flow analysis and provides a graphical view for the types, values, directions, and transmission relationship of power flow, especially for the recirculation power representation. Furthermore, a template model of multi-attribute topological graph for closed planetary gear trains is also presented, which would be helpful to the multi-attribute topological graph generation for some certain types of closed planetary gear trains just by changing symbols in the template model. A corresponding software is also developed to make the analysis process more convenient. By inputting different parameters, the different visual results can be obtained automatically, thus benefiting engineers in conceptual design.
Collision modeling and two-echelon collaborative control of non-contact ultra-quiet Stewart spacecraft
Authors: Liao He , Wu Xiande , Xu Yufei , Sun Xinzhu , Wang Zhipeng
Published: August 2018

This article presents the collision modeling and two-echelon collaborative control of a novel non-contact ultra-quiet Stewart spacecraft. It has internal instability because of its non-contact configuration. To overcome the instability, the equivalent modeling of repetitive collision process with small releasing velocity is established at first. Then, a two-echelon collaborative control is developed to guarantee both collision rejection and stability performance. Finally, the numerical simulation is conducted to demonstrate the validity and effectiveness of the proposed design.
Astromimetics
Authors: Uskoković Vuk , Wu Victoria M
Published: August 2018

Composite, multifunctional fine particles are likely to be at the frontier of materials science in the foreseeable future. Here we present a submicron composite particle that mimics the stratified structure of the Earth by having a zero-valent iron core, a silicate/silicide mantle, and a thin carbonaceous crust resembling the biosphere and its biotic deposits. Particles were formulated in a stable colloidal form and made to interact with various types of healthy and cancer cells in vitro. A selective anticancer activity was observed, promising from the point of view of the intended use of the particles for tumor targeting across the blood–brain barrier. As an extension of the idea underlying the fabrication of a particle mimicking the planet Earth, we propose a new field of mimetics within materials science: astromimetics. The astromimetic approach in the context of materials science consists of the design of particles after the structure of celestial bodies. With Earth being the most chemically diverse and fertile out of all the astral bodies known, it is anticipated that the great majority of astromimetic material models will fall in the domain of geo-inspired ones.
The Merits of Goal Support as a Self-Control Strategy
Authors: Nielsen Kristian Steensen , Bauer Jan Michael
Published: August 2018

In the present study, we investigated the influence of the presence of others and goal support on the performance of goal-directed behavior across different levels of self-control. Our analysis included survey data from 3,972 respondents across four countries. The results of the analysis revealed four important findings. First, high goal support increased the performance of goal-directed behavior when in the presence of others during decision-making. Second, self-control had a positive effect on goal-directed behavior only when individuals were by themselves. Third, while the effect of goal support significantly increased goal-directed behavior independent of self-control ability, people with low self-control reaped the most benefits from having goal support. Finally, we observed that although people with low self-control gained the most benefits from goal support, they were also less likely to be positioned in goal-supportive environments.
The liver sinusoidal endothelial cell damage in rats caused by heatstroke
Authors: Zhang Xingqin , Chen Yi , Tang Liqun , Zhang Yunhai , Duan Pengkai , Su Lei , Tong Huasheng
Published: August 2018

This study was designed to explore whether liver sinusoidal endothelial cells (SECs) play a pathological role in liver injury of heatstroke (HS) in rats. An HS rat model was prepared in a pre-warmed incubator. Rats were randomized into four groups: HS-sham group (SHAM group), the 39°C group, the 42°C group, and the HS group. The serum concentrations of SEC injury biomarkers including hyaluronic acid (HA), von Willebrand factor (vWF), thrombomodulin (TM), were measured. Plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities and endothelium-derived vasoactive substances including endothelin-1 (ET-1) and nitric oxide (NO) were determined using a commercially available kit. Hepatic tissues were obtained for histopathological examination, electron microscopy examination, immunohistochemistry, and reverse transcription polymerase chain reaction (PCR) analysis. Our study team found increased levels of plasma ALT/AST during the course of HS. We were also able to detect microcirculation changes and inflammatory injury of the liver (especially in the sinusoidal areas). In addition, markers of SEC injury were significantly elevated. Thrombosis-related markers including vWF and TF expression levels were significantly upregulated and TM levels downregulated. Furthermore, imbalance between ET-1 and NO levels were detected. In conclusion, damage of SECs could result in microcirculation disturbances and pro-inflammatory injury in the liver during HS, which could prove to be a potential pathogenic mechanism of liver injury in HS.
Operating management system for high reliability: Leadership, accountability, learning and innovation in healthcare
Authors: Day Richard M , Demski Renee J , Pronovost Peter J , Sutcliffe Kathleen M , Kasda Eileen M , Maragakis Lisa L , Paine Lori , Sawyer Melinda D , Winner Laura
Published: August 2018

The healthcare industry is on the journey toward high reliability. The industry works diligently to improve safety and quality, adopting some vitally important high reliability organization practices. While positive steps forward, these practices tend to be discrete initiatives to address specific challenges, and high reliability remains elusive. The journey taught us to view quality and safety not as a project, or even a portfolio of projects, but as an integrated operating management system. We are learning from industries that are further along on the high reliability organization journey, especially those compelled by widely publicized mishaps. These industries developed international consensus standards for integrated management systems to assure operational safety, quality, and reliability. Healthcare needs to evolve accordingly. Our work is informed by advanced systems engineering and mission assurance methodology, and research in high reliability organizing. The operating management system fosters two fundamental ways of working. First, it organizes processes and practices using a systems engineering approach to anticipate and reduce risks, mindfully standardizing work to prevent mishaps and improve performance. Second, it creates a culture of systems thinking and collaboration, building resiliency to recover from mishaps, when they occur, and promote mindful variation to deal effectively with unexpected situations. We share our motivation and approach to developing the operating management system, implementation examples and results achieved. While there is currently a large gap between idealized, highly reliable operations and current practice in healthcare, our experience demonstrates the benefits of this integrated systems management approach to address contemporary challenges and advance on the journey toward high reliability.
When can I drive? Advising patients when to drive after general surgical procedures
Authors: Dixon Steven , Woodcock Sean
Published: August 2018

Introduction

Advising patients when they are medically fit to drive following general surgical procedures is crucial to minimise risk to patients, the general public as road user’s and pedestrians and also avoid negligence claims against medical practitioners. Historically, in the UK, this advice has come from a number of sources including surgeons, general practitioners, insurers and the Driver and Vehicle Licensing Agency (DVLA). The aim of this study was to review how current surgical teams distribute this advice and what this advice is based upon.

Materials and methods

An online survey was devised and distributed to all consultant general surgeons and trainees in the North East of England via email. Leading vehicle insurance companies and the DVLA were contacted to assess what advice they gave for specific procedures (ventral hernia, appendicectomy, cholecystectomy, fundoplication).

Results

A total of 135 surveys were distributed, 56 were returned, with a response rate of 41.5%. Twenty-two (39.3%) of respondents were consultants, 30 (53.6%) were speciality trainees (ST3-8) and 4 (7.1%) were core surgical trainees (CT1-2). Some (14.2%) gave driving advice to every patient, 39.3% gave advice to most patients; 42.9% gave advice pre-operatively in clinic, 39.3% gave the advice pre-operatively on the day of surgery, and 96.4% of responders based their advice on traditional teaching. Discussion and conclusions: There is variation in the content and timing of advice regarding driving after general surgical procedures. This inconsistency will undoubtedly lead to incorrect information being distributed to patients and will impact post-operative patient safety. We suggest formulating consistent advice in a written format, standardising the process which in turn will protect patients and surgeons.
Deleterious Pulmonary Surfactant System Gene Mutations in Lung Adenocarcinomas Associated With Usual Interstitial Pneumonia
Authors: Honda Takayuki , Sakashita Hiroyuki , Masai Kyohei , Totsuka Hirohiko , Motoi Noriko , Kobayashi Masashi , Akashi Takumi , Mimaki Sachiyo , Tsuchihara Katsuya , Chiku Suenori , Shiraishi Kouya , Shimada Yoko , Otsuka Ayaka , Kanai Yae , Okubo Kenichi , Watanabe Shun-ichi , Tsuta Koji , Inase Naohiko , Kohno Takashi
Published: August 2018

Purpose

Usual interstitial pneumonia (UIP) is a risk factor for lung carcinogenesis. This study was performed to characterize mutagenesis and mutational target genes underlying lung carcinogenesis in patients with UIP.

Patients and Methods

A cohort of 691 Japanese patients with lung adenocarcinoma (LADC), of whom 54 had UIP and 637 did not, was studied for driver oncogene aberrations. Whole-exome analysis was performed for 296 cases, including 51 with UIP, to deduce mutagenic processes and identify commonly affected genes. Logistic regression analysis was used to detect associations of gene aberrations with clinicopathological factors.

Results

The EGFR mutation was markedly less prevalent in patients with LADC with UIP than in those without (1.9% [one of 54] v. 49.9% [318 of 637]; P < .001), even in heavy smokers (25.3% [38 of 150] of patients with > 40 pack-years; P < .001). Mutational signature analysis indicated that UIP-positive LADCs develop through accumulation of single-nucleotide and indel mutations caused by smoking. Pulmonary surfactant system genes (PSSGs) NKX2-1/TTF1, SFTPA1, SFTPA2, SFTPB, and SFTPC were identified as targets for mutations (preferentially indels), and mutations were specifically associated with shorter overall survival of patients with UIP-positive LADC, independent of pathologic stage (hazard ratio, 4.9; 95% CI, 1.7 to 14.4; P = .0037).

Conclusion

LADCs with UIP develop through mutational events caused by smoking, independently of EGFR mutation. PSSGs were identified as a mutational target and as a novel prognostic factor in UIP-positive LADC. PSSG deficiency might increase the malignancy of tumor cells by increasing the tumor-promoting effects of UIP.
Radioactive Iodine–Related Clonal Hematopoiesis in Thyroid Cancer Is Common and Associated With Decreased Survival
Authors: Boucai Laura , Falcone John , Ukena Jenny , Coombs Catherine C , Zehir Ahmet , Ptashkin Ryan , Berger Michael F , Levine Ross L , Fagin James A
Published: August 2018

Context

Radioactive iodine (RAI) has been epidemiologically associated with the development of hematologic malignancies. Clonal hematopoiesis (CH) is a precursor clonal state that confers increased risk of leukemia and occurs at an elevated rate in patients with thyroid cancer relative to other solid tumors.

Objective

We explore if the high prevalence of CH may be a result of RAI exposure and whether CH may be a surrogate in the association between RAI and leukemia.

Design

CH, CH-potential driver (CH-PD), and overall survival were evaluated in 279 patients with advanced thyroid carcinoma.

Results

The prevalence of CH in patients with thyroid cancer was 37%, and that of CH-PD was 5.2%. Age was the strongest predictor of CH and CH-PD. For every year increase in age, there was a 5% and 13% increase in the odds of CH and CH-PD, respectively. RAI dose was significantly associated with CH and CH-PD, even after adjustment for age, external beam radiation therapy, and chemotherapy. For every 10 mCi increase in the dose of RAI administered, there was a 2% and 4% increase in the odds of CH and CH-PD, respectively. Patients with CH-PD previously exposed to RAI had a significantly poorer survival, even when stratified by age (heart rate = 3.75, 95% CI = 1.23 to 11.5, P = 0.02).

Conclusions

RAI was associated with a high prevalence of CH, and CH is a precursor state of hematologic malignancies. The implications of this study may favor identification of CH in patients where the risks might outweigh the benefits of receiving RAI therapy for thyroid cancer.
Risk of Meningioma in European Patients Treated With Growth Hormone in Childhood: Results From the SAGhE Cohort
Authors: Swerdlow Anthony J , Cooke Rosie , Beckers Dominique , Butler Gary , Carel Jean-Claude , Cianfarani Stefano , Clayton Peter , Coste Joël , Deodati Annalisa , Ecosse Emmanuel , Hokken-Koelega Anita C S , Khan Aysha J , Kiess Wieland , Kuehni Claudia E , Flück Christa E , Pfaffle Roland , Sävendahl Lars , Sommer Grit , Thomas Muriel , Tidblad Anders , Tollerfield Sally , Zandwijken Gladys R J
Published: August 2018

Context

There has been concern that GH treatment of children might increase meningioma risk. Results of published studies have been inconsistent and limited.

Objective

To examine meningioma risks in relation to GH treatment.

Design

Cohort study with follow-up via cancer registries and other registers.

Setting

Population-based.

Patients

A cohort of 10,403 patients treated in childhood with recombinant GH in five European countries since this treatment was first used in 1984. Expected rates from national cancer registration statistics.

Main Outcome Measures

Risk of meningioma incidence.

Results

During follow-up, 38 meningiomas occurred. Meningioma risk was greatly raised in the cohort overall [standardized incidence ratio (SIR) = 75.4; 95% CI: 54.9 to 103.6], as a consequence of high risk in subjects who had received radiotherapy for underlying malignancy (SIR = 658.4; 95% CI: 460.4 to 941.7). Risk was not significantly raised in patients who did not receive radiotherapy. Risk in radiotherapy-treated patients was not significantly related to mean daily dose of GH, duration of GH treatment, or cumulative dose of GH.

Conclusions

Our data add to evidence of very high risk of meningioma in patients treated in childhood with GH after cranial radiotherapy, but suggest that GH may not affect radiotherapy-related risk, and that there is no material raised risk of meningioma in GH-treated patients who did not receive radiotherapy.
Using different methods to process forced expiratory volume in one second (FEV1) data can impact on the interpretation of FEV1 as an outcome measure to understand the performance of an adult cystic fibrosis centre: A retrospective chart review
Authors: Hoo Zhe Hui , El-Gheryani Muhaned S.A. , Curley Rachael , Wildman Martin J.
Published: August 2018

Background: Forced expiratory volume in one second (FEV1) is an important cystic fibrosis (CF) prognostic marker and an established endpoint for CF clinical trials. FEV1 is also used in observation studies, e.g. to compare different centre’s outcomes. We wished to evaluate whether different methods of processing FEV1 data can impact on centre outcome.

Methods: This is a single-centre retrospective analysis of routinely collected data from 2013-2016 among 208 adults. Year-to-year %FEV1 change was calculated by subtracting best %FEV1 at Year 1 from Year 2 (i.e. negative values indicate fall in %FEV1), and compared using Friedman test. Three methods were used to process %FEV1 data. First, %FEV1 calculated with Knudson equation was extracted directly from spirometer machines. Second, FEV1 volume were extracted then converted to %FEV1 using clean height data and Knudson equation. Third, FEV1 volume were extracted then converted to %FEV1 using clean height data and GLI equation. In addition, year-to-year variation in %FEV1 calculated using GLI equation was adjusted for baseline %FEV1 to understand the impact of case-mix adjustment.

Results: Year-to-year fall in %FEV1 reduced with all three data processing methods but the magnitude of this change differed. Median change in %FEV1 for 2013-2014, 2014-2015 and 2015-2016 was –2.0, –1.0 and 0.0 respectively using %FEV1 in Knudson equation whereas the median change was –1.1, –0.9 and –0.3 respectively using %FEV1 in the GLI equation. A statistically significant p-value (0.016) was only obtained when using %FEV1 in Knudson equation extracted directly from spirometer machines.

Conclusions: Although the trend of reduced year-to-year fall in %FEV1 was robust, different data processing methods yielded varying results when year-to-year variation in %FEV1 was compared using a standard related group non-parametric statistical test. Observational studies with year-to-year variation in %FEV1 as an outcome measure should carefully consider and clearly specify the data processing methods used.
Mathematical model and analysis of hepatitis B virus transmission dynamics
Authors: Emerenini Blessing O. , Inyama Simeon C.
Published: August 2018

Hepatitis B is a liver infection induced by the hepatitis B virus (HBV). In this paper, the dynamics involved in the transmission of HBV is mathematically formulated with considerations of different populations of individuals. The role of HBV vaccination of new born babies and the treatment of infected individuals in controlling the transmission are factored into the model. The model in this study is based on the standard SEIR model.
Milestones achieved in response to drought stress through reverse genetic approaches
Authors: Singh Baljeet , Kukreja Sarvjeet , Goutam Umesh
Published: August 2018

Drought stress is the most important abiotic stress that constrains crop production and reduces yield drastically. The germplasm of most of the cultivated crops possesses numerous unknown drought stress tolerant genes. Moreover, there are many reports suggesting that the wild species of most of the modern cultivars have abiotic stress tolerant genes. Due to climate change and population booms, food security has become a global issue. To develop drought tolerant crop varieties knowledge of various genes involved in drought stress is required. Different reverse genetic approaches such as virus-induced gene silencing (VIGS), clustered regularly interspace short palindromic repeat (CRISPR), targeting induced local lesions in genomes (TILLING) and expressed sequence tags (ESTs) have been used extensively to study the functionality of different genes involved in response to drought stress. In this review, we described the contributions of different techniques of functional genomics in the study of drought tolerant genes.
Timing the origin and past connections between Andean and Atlantic Seasonally Dry Tropical Forests in South America: Insights from the biogeographical history of Amorimia (Malpighiaceae)
Authors: Felipe de Almeida Rafael , Marcio Araújo Amorim André , van den Berg Cássio
Published: August 2018

We investigated the timing of origin and past connections between Andean and Atlantic Seasonally Dry Tropical Forests in South America based on the biogeographical history of Amorimia, a genus of Malpighiaceae restricted to South America. We used a time–calibrated phylogenetic tree based on three cpDNA (ndhF, rpl16, trnQ–rps16) and two nrDNA (ETS, ITS) regions including all currently accepted species in Amorimia for ancestral area reconstructions. Our results show that: (1) the ancestor of Amorimia originated in Atlantic dry forests around 22 Ma; (2) ancestors of both Amorimia subgenera arose in southern Brazilian dry forests from 18 to 14 Ma; (3) the remaining lineages in the genera diversified from mid–Miocene to the late–Pliocene; and (4) a history of two expansion events during early and middle Miocene, besides several colonization events in different nuclei of dry forests in South America is suggested.
No incidence of glenohumeral joint dislocation in a review of 220 paediatric proximal humerus fractures
Authors: Nelson G. , Brown C. , Liu R. W.
Published: August 2018

Purpose

Proximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation.

Methods

We retrospectively reviewed 220 proximal humerus fractures in 218 total children. Imaging and follow-up clinic notes were reviewed for potential glenohumeral dislocation.

Results

Average patient age was 9.8 years SD 3.8 with 55% of the patients male and a wide variety of mechanisms of injury. None of the 220 fractures evaluated showed radiographic evidence of a shoulder dislocation, and all 218 children had a follow-up appointment at least 21 days after the injury without any clinical concern of a missed shoulder dislocation.

Conclusion

No paediatric patients presenting with proximal humerus fractures had a corresponding glenohumeral joint dislocation in our relatively large series. We recommend obtaining this additional imaging only in cases with higher energy mechanisms, if there is suspicion of subluxation or dislocation on anteroposterior and scapular-Y views or if there is clinical concern.

Level of Evidence

Level III Diagnostic
La educación superior en Colombia: situación actual y análisis de eficiencia
Authors: Melo-Becerra Ligia Alba , Ramos-Forero Jorge Enrique , Hernández-Santamaría Pedro Oswaldo
Published: August 2018

The aim of this paper is to examine the state of higher education in Colombia and estimate the efficiency of different academic programs from institutions of higher education in the country. To estimate efficiency measures, we use stochastic frontier techniques and the results of the Saber Pro test. Estimations evaluate the effect of variables associated with the teaching staff and infrastructure of institutions, and environmental factors that are not directly under the control institutions, such as the family income and parental education. Results highlight the importance of environmental factors, suggesting that while many institutions have margin to improve their efficiency, many of them are restricted by the influence of students’ socioeconomic factors.