bluuebunny/crossref_metadata_2025 huggingface dataset:
Where Did All the People Go? The View From the Dean’s Office at 30,000 Feet
Authors: Stark John B.
Published: January 2019

The role of dean in a business school is, by design, more strategic than tactical. And, when the various stakeholders that a dean must interact with are considered, the ability of a dean to have much of an operating knowledge of what is going on in the teaching and learning space of a school is very limited. The problem, however, is that the dean must be an advocate for this critical function of the business school mission. To understand how these two dimensions might be reconciled, this article looks at the drivers of a dean’s perspective and the disengagement these drivers create. The article ends by suggesting ways for a dean to stay connected to this vital function of the school.
Zika and Chikungunya Virus and Risk for Venous Thromboembolism
Authors: Ramacciotti Eduardo , Agati Leandro B. , Aguiar Valéria C. R. , Wolosker Nelson , Guerra João C. , de Almeida Roque P. , Alves Juliana Cardoso , Lopes Renato D. , Wakefield Thomas W. , Comerota Anthony J. , Walenga Jeanine , Fareed Jawed
Published: January 2019

A variety of viral infections are associated with hypercoagulable states and may be linked to the development of deep venous thrombosis and pulmonary embolism. The Zika and Chikungunya viral infections spread through the South and Central American continents, moving to North America in 2016, with severe cases of polyarthralgia, fever, and Guillain-Barré syndrome leading eventually to death. A decreased trend for both infections was reported in the first quarter of 2017. In this article, we report the possible association of venous thromboembolic events associated with Zika infection. After 2 cases of deep venous thrombosis in patients with acute Zika infections, D-dimer levels were measured in 172 consecutive patients who presented to the emergency department of a university hospital in an endemic region of Brazil with either Zika or Chikungunya infections confirmed by polymerase chain reaction tests. D-dimer levels were increased in 19.4% of 31 patients with Zika and in 63.8% of 141 patients with Chikungunya infections. The mechanisms behind this association are yet to be elucidated as well as the potential for venous thromboembolism prevention strategies for in-hospital patients affected by Zika and Chikungunya infections.
Effects of Obesity on Warfarin Reversal With Vitamin K
Authors: Luc Stanley A. , Whitworth Maegan M. , King Shawna E.
Published: January 2019

Phytonadione (vitamin K1, VK) is fat soluble and may be sequestered by adipose tissue, thus potentially altering drug distribution in obese patients requiring warfarin reversal. This single-center retrospective cohort study aimed to determine the effects of obesity (defined as body mass index [BMI] ≥ 30 kg/m2) on warfarin reversal following administration of VK in adult patients. The primary outcome was complete or partial warfarin reversal (defined as an international normalized ratio [INR] ≤ 2.0) within 72 hours post-VK administration. Of 688 identified patients, 215 were included in primary INR analysis. Mean BMIs for obese (n = 84) and nonobese (n = 131) patients were 37.3 and 24.3 kg/m2 ( P < .001), and mean baseline INRs were 4.73 and 4.42 ( P = .534), respectively. Within 72 hours post-VK administration, 70% and 69% of the obese and nonobese groups, respectively, achieved complete or partial warfarin reversal ( P = .904). Multiple logistic regression determined baseline INR and concomitant fresh frozen plasma administration to be factors influencing warfarin reversal. These findings do not suggest obesity is significantly associated with a decreased likelihood of warfarin reversal within 72 hours post-VK administration.
Size-dependent Eshelby’s ellipsoidal inclusion problem based on generalized first strain gradient elasticity theory
Authors: Sidhardh Sai , Ray MC
Published: January 2019

An analytical solution of Eshelby’s ellipsoidal inclusion problem is derived in this paper using the generalized first strain gradient theory (GFSGT) of elasticity. The GFSGT employed here is a reformulation of Mindlin’s first-order strain gradient theory, retaining only three independent material length scales. The Eshelby’s tensor for an ellipsoidal inclusion embedded in a strain gradient elastic continuum is obtained from the result for an arbitrary inclusion, which is available in the literature. The fourth-order Eshelby’s tensor depicts size-dependent behaviour, and a position-dependence is noted even within the domain of the inclusion. The volume average of this position-dependent tensor is determined inside and outside the inclusion, for the evaluation of size-dependent homogenized properties of composites. As expected, the results of this study asymptotically approach those of classical elasticity when the geometric dimensions of the inclusion are increased. For inclusions having sizes on the order of the material length scale parameters, these volume averages are strongly influenced by gradient effects. A comparison of the current model based on the GFSGT with that built on the simplified theories of strain gradient elasticity is made to illustrate the complete strain gradient effects. This comparison, along with the suitability of a generalized model involving different length scales for crystals and polymers, illustrates the importance of using GFSGT for determining the effective properties of micro- and nanocomposites.
Applicability of the interface spring model for micromechanical analyses with interfacial imperfections to predict the modified exterior Eshelby tensor and effective modulus
Authors: Lee Sangryun , Kim Youngsoo , Lee Jinyeop , Ryu Seunghwa
Published: January 2019

Closed-form solutions for the modified exterior Eshelby tensor, strain concentration tensor, and effective moduli of particle-reinforced composites are presented when the interfacial damage is modeled as a linear-spring layer of vanishing thickness; the solutions are validated against finite element analyses. Based on the closed-form solutions, the applicability of the interface spring model is tested by calculating those quantities using finite element analysis augmented with a matrix–inhomogeneity non-overlapping condition. The results indicate that the interface spring model reasonably captures the characteristics of the stress distribution and effective moduli of composites, despite its well-known problem of unphysical overlapping between the matrix and inhomogeneity.
Designing for Cultural Revival: African Housing in Perspective
Authors: Ikudayisi Ayodele Emmanuel , Odeyale Timothy Oluseyi
Published: January 2019

Culture and tradition are essential components of the traditional architecture. However, in the era of globalization and modernization, traditional architecture is fast disappearing in most part of Africa due to neglect and lack of understanding of its importance. A reconsideration becomes necessary as traditional architecture can be a source of inspiration even in contemporary times. Through a systematic literature review, this article takes a critical look at how culture affects architecture in Africa with Nigeria as a case study. It explores various traditional architectural accomplishments across Africa revealing the disappearance of cultural identity and the weak connection between traditional and contemporary architecture. It then concludes with strategies toward survival and revival of indigenous African architecture with clear direction on architects’ key roles in persevering the Africans endangered culture.
The expanding party universe: Patterns of partisan engagement in Australia and the United Kingdom
Authors: Gauja Anika , Grömping Max
Published: January 2019

Although membership is declining, parties continue to perform roles central to democratic governance in modern societies. Given this seeming paradox, we suggest that partisan identification, in complementing studies of formal membership, is a promising way of assessing the strength of parties’ democratic linkage. Using data from an original survey of voters in Australia and the United Kingdom, we analyse the participatory and demographic profiles of party supporters. We show that there are significant differences between supporters and those not committed to any party, as well as between supporters based on the strength of their party identification, substantiating the idea that parties can be conceptualized as a series of concentric circles of increasing engagement but declining representativeness. Stronger supporters are more likely to engage with parties online, volunteer and donate, but are older, more likely to be male and less likely to be foreign-born. Our findings have important implications for democratic practice as parties seek to expand and rejuvenate their networks of affiliates.
Pharmacist-led telehealth disease management program for patients with diabetes and depression
Authors: Cohen Lisa B , Taveira Tracey H , Wu Wen-Chih , Pirraglia Paul A
Published: January 2019

Introduction

The aim of this study was to determine whether a pharmacist-led telehealth disease management program is superior to usual care of nurse-led telehealth in improving diabetes medication adherence, haemoglobin A1C (A1C), and depression scores in patients with concomitant diabetes and depression.

Methods

Patients with diabetes and depression were randomized to pharmacist-led or nurse-led telehealth. Veterans with type 1 or type 2 diabetes, an A1C ≥ 7.5%, diagnosis of depression, and access to a landline phone were invited to participate. Patients were randomized to usual care of nurse-led telehealth or pharmacist-led telehealth. Patients were shown how to use the telehealth equipment by the nurse or pharmacist. In the pharmacist-led group, the patients received an in-depth medication review in addition to the instruction on the telehealth equipment.

Results

After six months, the pharmacist-led telehealth arm showed significant improvements for cardiovascular medication adherence (14.0; 95% confidence interval (CI) 0.4 to 27.6), antidepressant medication adherence (26.0; 95% CI 0.9 to 51.2), and overall medication adherence combined (13.9; 95% CI 6.6 to 21.2) from baseline to six-month follow-up. There was a significant difference in A1C between each group at the six-month follow-up in the nurse-led telehealth group (6.9 ± 0.9) as compared to the pharmacist-led telehealth group (8.8 ± 2.0). There was no significance in the change in patient health questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) from baseline to follow-up in both groups.

Discussion

Pharmacist-led telehealth was efficacious in improving medication adherence for cardiovascular, antidepressants, and overall medications over a six-month period as compared to nurse-led telehealth. There was no significant improvement in overall depression scores.
How gun control policies evolve: Gun culture, ‘gunscapes’ and political contingency in post-Soviet Georgia
Authors: Light Matthew , Slonimerov Eugene
Published: January 2019

We analyse the influence of gun culture and exogenous political events on gun regulation in post-Soviet Georgia. While neighbouring states retain restrictive Soviet-era gun laws, in Georgia, state failure, armed conflict and proliferation of weapons during the 1990s all impelled recent governments towards moderate gun policies, including liberal rules on handgun ownership, strict rules on gun carriage and a national gun registry. We conceptualize gun policy as the product of relatively durable institutional legacies and underlying social attitudes—in this case, a distinctive post-communist ‘gunscape’—which constrain future policy development; and specific political conjunctures, which provide opportunities for limited policy experimentation. While Georgian gun owners desire weapons for self-defence, sport and the affirmation of masculinity, they do not seek to defy the state or replace its role in collective security, leading to a moderate ‘harm reduction’ approach to regulation that may be applicable in other post-conflict societies.
Melnikov-threshold-triggered mixed-mode oscillations in a family of amplitude-modulated forced oscillator
Authors: Wang Qianqian , Yu Yue , Zhang Zhengdi , Han Xiujing
Published: January 2019

This paper deals with the transitions through Melnikov thresholds and the corresponding fast–slow dynamics in a family of bi-parametric mechanical oscillators subjected to an amplitude modulation force both analytically and numerically. Applying Melnikov analytical method, the threshold condition for the occurrence of mixed-mode oscillations is obtained. First, the Melnikov threshold curves are drawn in different parameter space in the unperturbed system. Next, as the control variable crosses above the threshold, two states about mixed-mode oscillations can be identified: the rest state corresponding to local limit cycle from nontrivial equilibrium point and the spiking state corresponding to large amplitude cycle produced by saddle–node bifurcation of limit cycles. Such mixed-mode oscillations are created since the amplitude modulation force slowly and periodically switches between the rest states and spiking states. Furthermore, we elucidate the effect of modulation frequency on phase portraits and dynamical behaviors, and some numerical simulations are also included to illustrate the validity of our study.
Mechanisms of Disclosure: A Socio-technical Perspective on Sociality in Massively Multiplayer Online Role-playing Games
Authors: Coanda Iulia , Aupers Stef
Published: January 2019

It is a mainstay in game studies that Massively Multiplayer Online Role-Playing Games are boasting social relations and community formation. Considering games as “sociotechnical” environments, this article studies how the usage of external communication technologies in an online video game guild shapes the members’ social dynamics. Based on a one-year ethnographic study of a women’s guild in The Elder Scrolls Online (TESO), the analysis shows that the infrastructure of TESO guards anonymous interaction by default and contributes to the game as a “safe space.” The displacement of guild communication to media platforms outside the game, however, unleashed mechanisms of disclosure: a leakage of information from the private, domestic domain via TeamSpeak and the “sharing” imperative of personal information on Facebook. Such techno-induced forms of personal disclosure act as a double-edged sword: they strengthen the guild’s social bonds but, simultaneously, breed tensions, peer-to-peer surveillance, and social control within the guild.
Tensile and flexural properties of glass and carbon fibre composites reinforced with silica nanoparticles and polyethylene glycol
Authors: Selver Erdem
Published: January 2019

This paper attempts to show the effect of silica nanoparticles and polyethylene glycol mixture (shear thickening fluids) on tensile and flexural properties (3-point bending) of glass and carbon fibre-reinforced thermoset composite laminates. The shear thickening fluids were prepared by combination of silica nanoparticles and polyethylene glycol using various silica contents (10–20 wt%). A viscometer was used to evaluate the shear thickening characteristics and viscosity of shear thickening fluids increased by increasing the silica content. Shear thickening fluids were impregnated on the host of glass and carbon fabrics and subsequently converted to composite laminates using vacuum infusion method with an epoxy matrix. It was found that shear thickening fluids-treated carbon and glass fabric composites exhibited up to 10% and 12% higher tensile strength than neat composites whilst the tensile modulus increased about 24%. Shear thickening fluids-treated fabric composites exhibited slower damage propagation compared to brittle nature of untreated fabric composites. However, lower flexural strength with higher energy absorption (up to 27%) were obtained after using shear thickening fluids for both carbon and glass fibre composites.
Designing insistence-aware medium access control protocol and energy conscious routing in quality-of-service-guaranteed wireless body area network
Authors: Abdu Abdullahi Ibrahim , Bayat Oguz , Ucan Osman Nur
Published: January 2019

Wireless body area network is a type of wireless sensor network that enables efficient healthcare system. To minimize frequent sensor replacement due to resource restrictions, it is necessary to improve energy efficiency in wireless body area network. This article deals with energy efficiency and quality-of-service improvement together in novel wireless body area network architecture. A novel wireless body area network architecture is designed with dual sink nodes in order to minimize delay and energy consumption. A novel insistence-aware medium access control protocol which is aware of criticality of sensed data is presented in the proposed wireless body area network. Prior knowledge-based weighted routing algorithm is responsible to select optimal route for data transmission. In prior knowledge-based weighted routing, weight value is computed by considering significant metrics such as residual energy, link stability, distance, and delay in order to improve energy efficiency and quality of service in the network. Energy consumption is further minimized by incorporating graph-based sleep scheduling algorithm. In graph-based sleep scheduling, criticality of sensor node is also considered as major metric. In coordinator, split and map–based neural network classifier is involved to perform packet classification. After classification, packets are assigned to corresponding sink node according to packet type. Then, throughput and delay metrics are improved by frame aggregation process which is involved in sink node. Extensive simulation in OMNeT++ shows better performance in network lifetime, throughput, residual energy, dropped packets, and delay.
Tumor Ablation Using 3-Dimensional Electromagnetic-Guided Ultrasound Versus Standard Ultrasound in a Porcine Model
Authors: Krasnick Bradley Aaron , Sindram David , Simo Kerri , Goss Ryan , Bharadwaj Jeetendra , Howk Kreg , Herdina Katherine A. , Hammill Chet W.
Published: January 2019

Introduction. The objective of this study was to compare the placement of ablation needles using 3-dimensional electromagnetic-guided ultrasound (guided) to standard ultrasound guidance (standard) in both laparoscopic surgery and open surgery. Endpoints for this study included targeting accuracy and number of required needle withdrawals and reorientations. Methods. Using a porcine model, fiducial markers were placed into the kidney and liver to represent tumors. Navigation and identification of target sites was achieved using standard or guided ultrasound. Intraprocedural observations as well as the number of needle placement attempts per target were recorded. Three board-certified general surgeons performed the navigation and ablation procedures. After completion of the navigation and ablation procedures, necropsy was performed. The position of the ablation zones relative to the fiducial markers was recorded. Results. A total of 48 procedures were performed across 6 animals (50% open and 50% laparoscopic). Overall, the guided ablations required 50% fewer attempts to successfully target the marker ( P = .01). There was a 62% reduction of attempts for guided laparoscopic ablation ( P = .006). On subgroup analysis of laparoscopic ablation, the benefit remained for liver ( P = .041) ablations, but not for renal ablations ( P = .093). There was no significant difference between the groups with regard to targeting accuracy (91.3% guided vs 95.4% standard, P = .58). Conclusions. The number of targeting attempts required during laparoscopic ablation procedures was significantly less with guided than with standard ultrasound, particularly for laparoscopic ablation of liver lesions. These findings suggest that the guided ultrasound can potentially reduce complications during laparoscopic ablation procedures.
“How Can He Be So Cruel?” Examining Issues of Trust in School Improvement Efforts
Authors: Wettlaufer Jacqueline R. A. , Sider Steve R.
Published: January 2019

In this case, a high school vice-principal encounters tension and anger when she rewrites a staff member’s report card comments without his knowledge. The case narrative examines the conflict that arises when, under time constraints and pressures to produce student reports, the vice-principal acts on a decision she believes is ethically correct only to find that she incurs a significant setback with staffing relationships largely due to wavering of trust. The analysis examines how transformational leadership builds self-efficacy in all staff founded on trusting relationships. Professional reflection provides a conduit through which educational leaders can assess their own practice and implement the changes needed to sustain school improvement planning.
The commodification of mobile phone surveillance: An analysis of the consumer spyware industry
Authors: Harkin Diarmaid , Molnar Adam , Vowles Erica
Published: January 2019

This article examines the attempts of ‘spyware’ developers to commodify and market their products to a general audience. While consumers of ‘spyware’ have often been government and law enforcement (Citizen Lab, 2015), there is an increasing attempt to market, sell, and commodify ‘spyware’ for use by wider audiences. ‘Spyware’ is sold as a security product commonly aimed at businesses, parents, and intimate partners. Pursuant to calls for a “sociology of security consumption” (Goold et al., 2010: 3), this article analyzes how nine prominent spyware vendors attribute meaning to their products. Spyware vendors face particularly fraught marketing challenges as the general deployment of spyware: a) is often utilized in forms of intimate partner abuse; b) is “morally troubling” from the perspective of being corrosive to many forms of social relations (Loader et al., 2014: 469); and c) has limited contexts where it could be deployed without violating surveillance laws. More specifically, this article compares the social meaning that vendors attempt to give to spyware and contrasts this with the powers of surveillance provided by the product, the marketing messages that appear to support non-consensual use, and the lack of guidance for non-consenting spyware targets to have recourse with the vendors.
Pulp-dentin regeneration: current approaches and challenges
Authors: Jung Chanyong , Kim Sangwan , Sun Taeuk , Cho Yong-Bum , Song Minju
Published: January 2019

Regenerative endodontic procedures for immature permanent teeth with apical periodontitis confer biological advantages such as tooth homeostasis, enhanced immune defense system, and a functional pulp-dentin complex, in addition to clinical advantages such as the facilitation of root development. Currently, this procedure is recognized as a paradigm shift from restoration using materials to regenerate pulp-dentin tissues. Many studies have been conducted with regard to stem/progenitor cells, scaffolds, and biomolecules, associated with pulp tissue engineering. However, preclinical and clinical studies have evidently revealed several drawbacks in the current clinical approach to revascularization that may lead to unfavorable outcomes. Therefore, our review examines the challenges encountered under clinical conditions and summarizes current research findings in an attempt to provide direction for transition from basic research to clinical practice.
The educational gradient in premature cardiovascular mortality: Examining mediation by risk factors in cohorts born in the 1930s, 1940s and 1950s
Authors: Ariansen Inger , Strand Bjørn Heine , Kjøllesdal Marte Karoline Råberg , Steingrímsdóttir Ólöf Anna , Mortensen Laust Hvas , Stigum Hein , Graff-Iversen Sidsel , Næss Øyvind
Published: January 2019

Aims

Educational inequality in cardiovascular disease and in modifiable risk factors changes over time and between birth cohorts. We aimed to assess how cardiovascular disease risk factors mediate educational differences in premature cardiovascular disease mortality and how this varies over birth cohorts and sex.

Methods

We followed 360,008 40–45-year-olds born in the 1930s, 1940s or 1950s from Norwegian health examination surveys (1974–1997) for premature cardiovascular disease mortality. Cox proportional hazard and Aalen’s additive survival analyses provided hazard ratios and rate differences of excess deaths in participants with basic versus tertiary education.

Results

Relative educational differences in premature cardiovascular disease mortality were stable, whereas absolute differences narrowed from the 1930s to the 1950s cohorts; rate differences per 100 000 person years declined from 170 (95% confidence interval 117, 224) to 49 (36, 61) in men and from 60 (34, 85) to 23 (16, 29) in women. Cardiovascular disease risk factors attenuated rate differences by 69% in both cohorts in men, and in women by 102% in 1930s and 61% in 1950s cohorts. Smoking had the single strongest influence on the educational differences for men in all three cohorts, and for women in the two most recent cohorts.

Conclusion

Smoking appeared to be the driving force behind educational differences in premature cardiovascular disease mortality in the 1930s to 1950s birth cohorts for men and in the two recent birth cohorts for women. This suggests that strategies for smoking prevention and cessation might have the strongest impact for reducing educational inequality in premature cardiovascular disease mortality.
Tailoring in the digital era: Stimulating dialogues on health topics in collaboration with social media influencers
Authors: Lutkenhaus Roel O , Jansz Jeroen , Bouman Martine PA
Published: January 2019

In today’s media landscape, audiences increasingly turn to online communities for media consumption and to exchange information about specific niche interests such as health-related topics. This calls for a segmented approach in which interventions are targeted at online communities, tailored to their specific cultures and health-related perceptions, and leverage the dynamics of conversation and social influence in online networks. Strategies drawn from the field of influencer marketing provide interesting opportunities to reach and engage with audiences in a personally relevant manner, including with those who may disagree with an intervention’s message.

This article reflects on what health communicators might learn from influencer strategies and proposes digital methods to target and tailor health communication in the digital era. More concretely, we present methods to: (a) identify online communities engaging on a specific health issue; (b) map community specific cultures and health-related perceptions; and (c) identify influencers as potential collaboration partners. As such, we adopt a slightly different take on tailoring by putting the creative and cultural competences of social influencers central, and by aligning our methods with a media mapping protocol to create influencer strategies that are tailored to the cultures and health-related perceptions of multiple online audience segments. We illustrate the potential of these methods with a study of how vaccination is discussed among Dutch Twitter users.
On the same page: Co-designing the logic model of a telehealth service for children in rural and remote Australia
Authors: Abimbola Seye , Li Clare , Mitchell Michelle , Everett Michael , Casburn Kim , Crooks Philippa , Hammond Rebecca , Milling Holly , Ling Lydia , Reilly Alexandra , Crawford Alexandra , Cane Lindsay , Hopp Dagney , Stolp Ellen , Davies Suzanne , Martiniuk Alexandra
Published: January 2019

The value of programme logic models as a tool for planning, evaluation, and communication is well recognised. However, the value of its development process is less discussed. In this paper, we describe how we used a combination of literature review and organisational stakeholder consultations to develop a logic model for a telehealth programme for children in rural and remote Australia. Our aim was to use this process to further embed the programme within its implementing organisation, and by so doing to promote its sustainability and scale-up; a major challenge of telehealth programmes, especially those involving reorganisation of processes. Our efforts to describe the components of this complex intervention on the one-page logic model allowed for debates and discussions within the implementing organisation which then facilitated an improved cross-organisational understanding of the telehealth programme; a real time face-to-face (video-link) service which requires the reorganisation of existing service delivery platforms. The process helped to embed the telehealth programme within existing services. We conclude that stakeholder engagement in developing logic models can transform them from being only a tool that provides the picture of why and how a programme works, to one that plays a role in embedding programmes within implementing organisations.
Intraoperative manipulation for flexion contracture during total knee arthroplasty
Authors: Matsui Yoshio , Matsuura Masanori , Minoda Yukihide , Nakagawa Sigeru , Okajima Yoshiaki , Kobayashi Akio , Inori Fumiaki
Published: January 2019

Background:

Joint gap unbalancing during total knee arthroplasty (TKA) induces flexion contracture. Flexion contracture is one of the most serious complications of TKA. When flexion contracture is found during surgery, intraoperative manipulation is often empirically performed. We evaluated the effects of intraoperative manipulation on joint gap and postoperative flexion contracture.

Materials and methods:

TKA was performed for 136 knees. Intraoperative manipulation was performed for flexion contracture in 61 knees. Joint gap changes before and after manipulation were measured at six positions from extension to 120° of flexion. Manipulation was not performed for 75 knees. The extension angle was measured radiographically immediately after surgery, at 3 months, and 6 months postoperatively. Extension angles with manipulation and without manipulation were compared.

Results:

Joint gap changes (mm) before and after manipulation were 0.1, 0.0, −0.2, −0.3, −0.1, and −0.3 at 0°, 30°, 45°, 60°, 90°, and 120° of flexion, respectively, indicating that manipulation could not change joint gaps significantly. Extension angles (°) with and without manipulation were −4.0 ± 4.6 and −3.8 ± 3.9 immediately after surgery, −5.3 ± 6.7 and −5.5 ± 6.2 at 3 months postoperatively, and −2.7 ± 6.0 and −3.8 ± 5.8 at 6 months postoperatively. No statistically significant difference existed between the values with or without manipulation during all periods.

Conclusion:

Intraoperative manipulation does not enlarge the gap or resolve postoperative flexion contracture. Developing the new surgical technique is required to achieve perfect balance at TKA.
Use of smartphone to improve acetabular component positioning in total hip athroplasty: A comparative clinical study
Authors: Pongkunakorn Anuwat , Chatmaitri Swist , Diewwattanawiwat Kittipong
Published: January 2019

Background:

The position of the acetabular cup is important to the outcome of total hip athroplasty (THA). We devised an instrument that uses the level indicator application of smartphone together with a mechanical alignment guide to improve the precision of cup placement. This study aims to determine the percentage of acetabular cups positioned in the Lewinnek safe zone comparing between the conventional technique (using a mechanical alignment guide alone) and the smartphone technique (using a mechanical alignment guide combined with the devised instrument and smartphone).

Methods:

A historical controlled trial was conducted among 82 patients who underwent primary THAs through a posterolateral approach. In the conventional group, 41 cups were placed during January 2013 and December 2014, whereas 41 cups in the smartphone group were placed during January 2015 and March 2016. Inclination and anteversion angles were measured in standardized pelvic radiographs. The cup orientation was compared between groups.

Results:

The inclination angle in the smartphone group was significantly lower than in the conventional group (40.9° (SD 3.8) vs. 46.3° (SD 6.7), p < 0.001), but the anteversion angle was higher (19.6° (SD 4.4) vs. 16.5° (SD 6.1), p = 0.010). The smartphone group had more cups positioned in the Lewinnek safe zone (90.2% vs. 56.1%, p = 0.001) and longer operative times (136 (SD 27) vs. 119 (SD 23) min, p = 0.011). No significant difference was found for blood loss ( p== 0.384) or dislocation rate ( p = 0.494).

Conclusion:

Using the computerized function of smartphone could improve the precision of cup positioning. Most cups were placed within a narrow margin inside the Lewinnek safe zone.
Prevalence and distribution of air in the leg on preoperative multidetector high-resolution computed tomography in closed and low-grade open tibial shaft fractures
Authors: Suzuki Takashi , Nakayama Yuhei , Matsui Kentaro , Ishii Keisuke , Kurozumi Taketo , Shindo Masateru
Published: January 2019

Purpose:

The prevalence and distribution of air present in the leg in closed and low-grade open tibial shaft fractures are unknown on multidetector high-resolution computed tomography (CT). The purpose of this study was to determine the rate of surgical site infection (SSI) in cases where debridement was not performed in the area of air infiltration.

Methods:

Eighty-one closed and low-grade open tibial shaft fractures that underwent multidetector high-resolution CT on admission and were treated with an intramedullary nail were examined retrospectively.

Results:

Of the 36 Gustilo type I or II open fractures, all had local air around the fracture site (within 5 cm proximal and distal from the fracture center). Of these, 25 showed remote air (more than 5 cm away from the fracture center). The most frequent site of remote air was in the subcutaneous tissue, followed by the anterior compartment and deep posterior compartment. All open fractures were treated with local irrigation and debridement, regardless of the presence of remote air, followed by a reamed intramedullary nail. No SSI developed until bone union. Of the 45 closed fractures, 3 patients showed air in the leg on the CT. No debridement was performed for closed fractures. One patient who did not have air in the leg developed SSI. All fractures united eventually.

Conclusions:

In low-grade open tibial shaft fractures, air can spread far from the fracture site. Even in closed tibial shaft fractures, air can be identified in the leg. The debridement of the area of air infiltration, however, is not necessary for prevention of SSI.
Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers
Authors: Garcia Grant H. , Gowd Anirudh K. , Cabarcas Brandon C. , Liu Joseph N. , Meyer John R. , White Gregory M. , Romeo Anthony A. , Verma Nikhil N.
Published: January 2019

Background:

Repetitive pitching produces significant stress on the elbow that may result in structural abnormalities discernable on magnetic resonance imaging (MRI) without causing symptoms.

Purpose:

To determine whether there exists an association between subclinical MRI findings in asymptomatic elbows of Major League Baseball (MLB) players and future placement on the disabled list (DL) or future operative procedure.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

MRI scans of the elbows of professional-level baseball pitchers, taken during routine presigning imaging at a single organization from 2005 to 2017, were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with an injury before the earliest session of elbow MRI. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement. Binary imaging findings were related to future placement on the DL for elbow complaints and future elbow surgery.

Results:

A total of 41 pitchers had asymptomatic MRI findings with no prior DL placement. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity ( P = .021), humeral-sided partial UCL tears ( P = .031), and PM impingement ( P = .004) on preinjury MRI compared with players who remained healthy. PM impingement was related to future elbow-related surgery ( P = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage ( P < .05 for all).

Conclusion:

UCL heterogeneity, PM impingement, and humeral-sided partial tears were correlated with future DL placement for elbow-related reasons in MLB pitchers. Asymptomatic PM impingement may be a precursor to future surgery.
Effect of Cigarette Smoking on Patient-Reported Outcomes in Hip Arthroscopic Surgery: A Matched-Pair Controlled Study With a Minimum 2-Year Follow-up
Authors: Lall Ajay C. , Hammarstedt Jon E. , Gupta Asheesh G. , Laseter Joseph R. , Mohr Mitchell R. , Perets Itay , Domb Benjamin G.
Published: January 2019

Background:

The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers.

Purpose/Hypothesis:

The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers’ compensation status, and body mass index within 5 kg/m2. All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool–12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05.

Results:

A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group ( P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups.

Conclusion:

Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery.
Establishment of an Accelerated Doctor of Family Medicine Program at Unaizah College of Medicine, Qassim University, Kingdom of Saudi Arabia
Authors: Al-Shafei Ahmad , Al-Damegh Saleh , Al-Matham Fahad , Al-Mohaimeed Abdulrahman , Al-Nafeesah Abdullah , Hamad-Aldosary Ahmad , Al-Otaibi Moteb , Al Wutayd Osama , Mansour Ali , El-Gendy Ola , Fadda Walaa , El-Migdadi Fayig , Al-Qumaizi Khalid , Shaban Sami
Published: January 2019

Primary health care is well known to be the cornerstone for the health of the society. Furthermore, efficient health care at the secondary and tertiary levels is entirely dependent on effective primary health care. The Kingdom of Saudi Arabia (KSA) is currently building up a rigorous primary health care system with a large number of well-equipped primary health care centers. However, there is an acute shortage of Saudi family physicians throughout the country; both in urban and rural areas. There is no evidence in the literature supporting the relatively long 7 years’ traditional duration of medical programs in the KSA. Rather, several US and Canadian medical schools have established accelerated programs in Internal Medicine and Family Medicine with graduates comparable with those of the traditional curricula in terms of standardized tests, initial resident characteristics, and performance outcomes. In response to the challenges the KSA is facing in primary health care, Unaizah College of Medicine at Qassim University is proposing to establish an accelerated Doctor of Family Medicine Program that would run for total duration of 6 years. Herein, we describe a concise outline of this program.
Ocular Venous Air Embolism: A Report of 5 Cases
Authors: Morris Robert E. , Boyd Gwendolyn L. , Sapp Mathew R. , Oltmanns Matthew H. , Kuhn Ferenc , Albin Maurice S.
Published: January 2019

Purpose:

The purpose of this case series is to report 5 new cases of ocular venous air embolism (OVAE). We define OVAE as a precipitous drop in end-tidal carbon dioxide, a choroidal detachment, or a choroidal wound, followed by signs of impending or actual cardiovascular collapse, during vitrectomy air infusion.

Methods:

A case report series was retrospectively reviewed.

Results:

Four of the 5 OVAE cases (80%) were fatal, occurring in conjunction with repair of rhegmatogenous retinal detachment (2 cases); a large surgical wound of the choroid (1 case); and vitrectomy repair of an injured eye (1 case). One patient survived OVAE during choroidal melanoma endoresection after prompt discontinuance of air infusion by anesthesia personnel previously alerted to the OVAE risk.

Conclusions:

OVAE is a rare but usually fatal complication of air infusion into the eye during vitrectomy. Because the effective response time to avoid a fatal OVAE outcome can be less than 1 minute, use of preventive measures is critical.
Everyday life in a magnificent landscape: Making sense of the nature/culture dichotomy in the mountains of Jämtland, Sweden
Authors: Wall-Reinius Sandra , Prince Solène , Dahlberg Annika
Published: January 2019

Although the nature/culture dichotomy has been extensively criticized by scholars, it remains pervasive to our conception of the world. Discourses of nature as a pristine milieu and of culture as a realm of human dominance not only impact cognition, but also the local practices of those involved daily in such contested areas. In this study of the mountainous area of the Jämtland County, Sweden, we report on the ways local stakeholders make sense of their surrounding landscape in the wake of its magnificent character as they go about their daily lives as residents, entrepreneurs and recreationists. We turn to the notion of dwelling to frame these narratives. This ultimately becomes an exploration of the contradictions and confusions within and between the discourses of conservation, management, recreation, authenticity and tourism development that affect how local stakeholders consciously and subconsciously cope with the tensions brought about by the nature/culture dichotomy. The findings are used to propose a critical, as well as constructive, notion of dwelling that stresses the importance of opening up to new possibilities and responsibilities during negotiations over protected areas.
Bridging the gaps of headache care for underserved populations: A medication overuse headache survey among international headache society members from Latin America
Authors: Lisicki Marco , Flores Juan Antonio Castro , Bordini Carlos Alberto , Goicochea María Teresa , Peres Mario Fernando Prieto
Published: January 2019

Introduction:

Headache epidemiological studies in Latin America are scarce, and available data suggest that medication overuse headache is an existing health concern in the region.

Materials and Methods:

A survey empirically constructed to assess the management of medication overuse headache was sent to all the International Headache Society (IHS) members from Latin American countries.

Results:

We found no IHS members in 13 countries of Latin America. In countries with active members, the median number of IHS members per million inhabitants was significantly less when compared to Western Europe. Although the International Classification of Headache Disorders-3-beta (ICHD-3-beta) criterion was the most frequently used tool for medication overuse headache diagnosis, 41% of responders considered the diagnostic criterion ‘ambiguous’ and only 67% found them ‘very useful’. With respect to preferred treatment patterns, an important lack of uniformity, and a very limited usage of therapeutic approaches widely employed in other regions, characterized the responses.

Conclusion:

There is an urgent need to reach a consensus and establish region-specific strategies for the management of medication overuse headache as well as other headache disorders in this region. Development of headache specialized educational programmes, and participation of Latin American health providers in the IHS, should be incentivized.
Extending the Discussion: First Steps in Developing Band Director Self-Efficacy in a Jazz Setting
Authors: Fraile Alejandro
Published: January 2019

Based on Regier’s article, concert and marching band pedagogical strategies might not transfer to the jazz setting. Participating in jazz pedagogical workshops or graduate courses may develop director jazz pedagogy self-efficacy when possible. This “Extending the Discussion” article provides alternative suggestions for band directors to become more familiar with jazz improvisation and phrasing, thereby possibly improving self-efficacy in jazz pedagogy settings.
Public-Private Partnerships: Agency Costs in the Privatization of Social Infrastructure Financing
Authors: Solheim-Kile Espen , Lædre Ola , Lohne Jardar
Published: January 2019

Public-private partnerships (PPPs) have been subjected to considerable public debate. In particular, this debate has concerned PPP financing and its implications. Using insights from agency theory, this study aims to develop a theoretical understanding of PPP financing. The following research question is investigated: How does the privatization of financing decrease or increase agency costs in social infrastructure PPPs? A comparative case study consisting of four Norwegian PPP projects with different financial configurations is undertaken. The findings suggest that the private sector is risk averse, increasing the cost of capital. In addition, private financing does not seem to have the intended incentive effect.