bluuebunny/crossref_metadata_2025 huggingface dataset:
Authorial Atonement in Ian McEwan’s Atonement and Sweet Tooth
Authors: Pastoor Charles Cornelius
Published: December 2018

Ian’s McEwan’s 2001 novel Atonement ends with a question: “how can a novelist achieve atonement when, with her absolute power of deciding outcomes, she is also God?” (350). And it concludes, in response to this question, that there “There is … No atonement for God, or novelists, even if they are atheists” (350–51). I consider in the first part of this article what leads Briony Tallis, the novel’s fictive author, to this bleak conclusion. In the second part I consider how McEwan takes up the question again in his 2012 novel Sweet Tooth and how he arrives at a more hopeful answer.
Adsorption of congo red dye from aqueous solutions by prepared activated carbon with oxygen-containing functional groups and its regeneration
Authors: Lafi Ridha , Montasser Imed , Hafiane Amor
Published: December 2018

This study investigates the potential use of activated carbon prepared from coffee waste (CW) as an adsorbent for the removal of congo red dye from aqueous solution. The oxygen-containing groups of activated carbon prepared from CW play an important role in dyes ions adsorption onto activated carbon prepared from CW. The activated carbon is characterized by scanning electron microscopy and Fourier transform infrared (FTIR) spectroscopy. Adsorption experiments were carried out as batch studies at different contact time, pH, and initial dye concentration. The dye adsorption equilibrium was attained after 120 min of contact time. Removal of dye in acidic solutions was better than in basic solutions. The adsorption of dye increased with increasing initial dye concentration. The equilibrium data were revealed that Langmuir model was more suitable to describe the congo red adsorption and demonstrated excellent reusability potential with desorption greater than 90% throughout six consecutive adsorption–desorption cycles. Experimental data founded that kinetics followed a pseudo-second-order equation. Thermodynamic study showed that the adsorption was a spontaneous and exothermic process. According to the FTIR analyses, hydrogen bonding and electrostatic interactions between dyes and oxygen-containing functional groups on activated carbon prepared from CW are dominant mechanisms for dye adsorption.
A spatial testimony: The politics of do-it-yourself aerial photography in East Jerusalem
Authors: Keysar Hagit
Published: December 2018

In this paper, I examine the kind of testimony enabled by do-it-yourself aerial photography with kites or balloons in situations of political and spatial conflict, and how this plays on the surface of proliferating uses of geospatial technologies in a human rights context. The case study presented here concerns the use of do-it-yourself aerial photography in the context of discriminatory urban planning policies and practices against the Palestinian population of East Jerusalem. Its analysis shows that the political potentials of do-it-yourself aerial photography go further than just enabling the independent production of high-resolution aerial evidence in near real-time settings. It brings forth a distinctive kind of testimony, which I term a “spatial testimony,” that pushes against a certain threshold of participation in human rights truth production and sheds light on the political role embodiment may play in such processes. The “spatial testimony” denotes not only the visual image or the speech act related to the testimony but also the whole process of experimentation with a self-built instrument that unsettles and reconfigures the political space of relations between human rights, human bodies, and technoscientific objects.
Transactional Sex Among Women Accessing Antiretroviral Care in Sagamu, Nigeria: A Descriptive Survey
Authors: Animasahun Victor Jide , Sholeye Oluwafolahan O. , Oyewole Bankole K.
Published: December 2018

HIV prevalence and transmission is still of public health concern in low-resource climes like Nigeria. Transactional sex is a well-known risk factor for HIV transmission. This study therefore assessed the prevalence of transactional sex and associated factors among women attending the antiretroviral clinic in Sagamu, Nigeria. A cross-sectional study was carried out among 204 women attending antiretroviral treatment center in Sagamu, Ogun State, Nigeria, selected via total population recruitment. Data were collected using a validated, semistructured questionnaire. Respondents’ written informed consent was obtained. The mean age of respondents was 38.3 ± 9.0 years. Two thirds (66%) were in monogamous marriages. About two thirds (64.2%) had at least secondary education. Almost 50% spent more than half of their income on food. About 90% had commenced antiretroviral therapy. The prevalence of transactional sex was 7.4%. Household size ( p = .031), marital status ( p = .015), reduction of food ration ( p = .010), skipping of medication ( p = .001), and starving for a whole day ( p = .044) were associated with transactional sex. Food assistance programs, socioeconomic empowerment schemes, and targeted counseling should be given to people living with HIV to halt HIV transmission.
Conservationland: Toward the anthropology of professionals in global nature conservation
Authors: Kiik Laur
Published: December 2018

When reading anthropological writings on global nature conservation, one may wonder: Where are the conservationists? Anthropologists have written nuanced ethnographies of how native people encounter and are dispossessed by transnational environmental NGOs and conservation policies. Yet, anthropologists have neglected the other side of those worldwide encounters: the conservation practitioners. Instead, conservationists are sometimes misrepresented as homogenous, impersonal and voiceless. This is surprising, considering anthropologists’ increasing interest in cultures of expertise, including that of professionals in international development. This paper contributes to building the anthropology of professionals in global biodiversity conservation. It locates and reviews disparate material on conservationists from across the ethnographic literature. It argues for attending to the perspectives and diversity of conservation professionals and institutions, their transnational social worlds, naturalist worldviews and emotional lives. A section discusses the key contradictory positionality of the Global South’s local-national professionals. Lastly, the paper reflects on practical challenges to fieldwork in ‘Conservationland’.
On financialization and its future
Authors: Ioannou Stefanos , Wójcik Dariusz
Published: December 2018

Born as a term with a critical connotation towards finance, financialization has been widely employed in social sciences, despite the vagueness often surrounding it. In this article we discuss the concept of financialization with a focus on three dimensions. First, we highlight the crucial role of theory in shaping the depth of one’s understanding of the term. Second, we discuss the merits and limitations of the term as a means for bringing together researchers from different communities. Third, we reflect on its future. We argue in particular that the various phenomena associated with financialization involve different boundaries and temporalities. These differences are important, first for appreciating the openness of possible outcomes, and second, for anticipating potential convergences in scholarly perceptions of financialization that might occur in the near future.
Public Employee Speech Rights: Survey of Recent Trends
Authors: Mead Joseph
Published: December 2018

Public employees have the right to free speech in their personal capacities, but that right is tempered in many instances by the interests of their governmental employers. This piece provides an overview of the speech rights of public employees, highlighting approaches taken in recent appellate decisions. The piece ends with practical suggestions for public employers.
Coping With Conflict: Examining the Influence of PSM on Perceptions of Workplace Stressors
Authors: Davis Randall S. , Stazyk Edmund C. , Kochenour Allysha , Neuhoff Emily
Published: December 2018

While the presence and degree of workplace stress poses a significant problem for organizations in all sectors, scholarship frequently acknowledges that responses to workplace stress vary significantly across individuals. However, public sector human resource management (HRM) research, relative to generic HRM research, invests comparatively less attention toward understanding individual differences in response to perceived stressors. We employ the relational model of stress developed by Matteson and Ivancevich and Lazarus to examine how one dispositional characteristic commonly examined in public sector HRM research, public service motivation (PSM), influences the stress process. Results obtained using data from the 2010 U.S. Merit Principles Survey reveal that individuals with higher than average PSM experience more pronounced negative emotions when they perceive heightened workplace conflict, which subsequently increases their intent to separate from the organization.
Understanding Social Media Competence in Higher Education: Development and Validation of an Instrument
Authors: Zhu Sha , Hao Yang Harrison , Xu Shun , MacLeod Jason
Published: December 2018

The rapid integration of social media into personal, professional, and educational settings has catalyzed the need to assess social media competence. This study provides the rationale for developing an instrument to conduct such an assessment, and the research illustrates evidence of validity and reliability in assessing social media competence in the field of higher education. The instrument includes 28 items and 4 dimensions: technical usability, content interpretation, content generation, and anticipatory reflection. Data were collected from a sample of 622 college students. Exploratory and confirmatory factor analyses were conducted, and this study finds that the instrument shows no signs of deficiency in its validity or reliability when measuring social media competence. Accordingly, the instrument could be used to evaluate and improve levels of social media competence in higher education.
Relationships: Discipleship that Promotes Another Kind of Life
Authors: Hudson Trevor
Published: December 2018

The acid test of the authentic Christ-following life is linked to a steady growth in compassionate caring validated by the way Christians care and value the ones closest to them. Ministers of spiritual formation need a practical theology for becoming Christ-like in compassionate caring thus announcing salvation offered by Christ as another kind of life, especially in its relational aspects, which generates a lasting transformation that lets go of deception and, with the guidance of the Holy Spirit, fosters the growth of authentic beings from the inside out.
Testing and evaluation of adhesive bonded joints of unreinforced and glass fiber–reinforced polyoxymethylene treated with low-pressure plasma
Authors: Anagreh Nabil , Dweiri Radwan , Al-Ajlony Al-Montaser Bellah
Published: December 2018

The effect of surface treatment of polyoxymethylene (POM) using low-pressure plasma (LPP) on its adhesive bonding was investigated. Three different types of adhesives were used. Examinations of single lap shear, scanning electron microscopy, contact angle measurements, and energy dispersive X-ray analysis were carried out. The results showed that the adhesion strength was apparently enhanced when treating surfaces by LPP using argon or oxygen plasma which increased with the treatment time. This increase was also dependent on the adhesive type. Moreover, glass fiber–reinforced POM showed better adhesion strength compared to that of unreinforced POM. An increase in the surface free energy exceeding 50 mN/m was observed after 600-s treatment time compared to untreated samples (39 mN/m), where the increase in polar component was more predominant. Surface topography observations showed a significant increase in the surface roughness with increasing the treatment time, mainly when using oxygen plasma. Finally, an increase in polarity and wettability due to changes in the chemical composition of the surface was also reported.
Green composites: A review of processing technologies and recent applications
Authors: Mann Guravtar Singh , Singh Lakhwinder Pal , Kumar Pramod , Singh Sunpreet
Published: December 2018

Biocomposites are considered as the next-generation materials as these can be made using natural/green ingredients to offer sustainability, eco-efficiency, and green chemistry. Nowadays, biocomposites are being utilized by numerous sectors, which include automobile, biomedical, energy, toys, sports, and so on. In this review article, an effort has been made to provide a comprehensive assessment of the available green composites and their commonly used processing technologies for the sake of materials’ capabilities to meet up with demands of the present and forthcoming future. Various types of natural fibers have been investigated with polymer matrixes for the production of composite materials that are at par with the synthetic fiber composite. This review article also highlights the requirements of the green composites in various applications with a view point of variability of fibers available and their processing techniques. This review is specially done to strengthen the knowledge bank of the young researchers working in this field.
Decoupled linear model and S-shaped curve motion trajectory for load sway reduction control in overhead cranes with double-pendulum effect
Authors: Ouyang Huimin , Hu Jinxin , Zhang Guangming , Mei Lei , Deng Xin
Published: December 2018

Overhead cranes with double-pendulum effect seem more practical than those with single-pendulum effect. However, in this case, it is difficult to find an applicable controller for such systems. Hence, a linearized and decoupled double-pendulum overhead crane dynamic model is derived by adopting a disturbance observer and modal analysis technique. The S-shaped trajectory is planned by solving algebraic equations, and the stability of the system is confirmed by the Routh–Hurwitz stability theory. Experimental results and simulations demonstrate the effectiveness of the proposed method. It could be realized to operate the crane accurately without sensor systems for measuring load sways by using the proposed method.
Influence map: Determining the actuators’ influence in kinematic chains for mechanism design
Authors: Hideki Murai Estevan , Simoni Roberto , Martins Daniel
Published: December 2018

This paper introduces the concepts of influence matrix and influence map for actuated kinematic chains. The influence matrix and influence map are defined to provide the designer with methods to identify and map actuators dependency. After the definitions are presented, the algorithms to calculate these structural characteristics are proposed together with an algorithm to calculate the actuated degree-of-control. Then, two case studies are presented, showing how the influence matrix and influence map can be used to select reference and output links.
Leveraging endogenous climate resilience: urban adaptation in Pacific Small Island Developing States
Authors: Trundle Alexei , Barth Bernhard , Mcevoy Darryn
Published: December 2018

Pacific Small Island Developing States are often referred to as the “frontline” of climate change, facing an array of worsening climate-related shocks and stressors. However, despite their underlying exposure to climate change impacts, the role of Pacific Island cities as both an avenue for adaptation and sites of climate vulnerability is often overlooked. This paper reflects on two ongoing participatory action research projects conducted by UN-Habitat and research partners from Australian universities in Honiara, Solomon Islands, and Port Vila, Vanuatu. Findings from community consultations across 16 communities in these settings demonstrate the critical role of endogenous modes of resilience, as well as the strong correlation between these spaces and sub-city climate vulnerability. Cross-scale integration with climate resilience planning processes is then used to examine points of conflict between stakeholder interpretations of core functions within socioecological systems, demonstrating the importance of considering values and conflict within urban climate adaptation.
Urban development-induced displacement and quality of life in Kolkata
Authors: Shaw Annapurna , Saharan Tara
Published: December 2018

This paper draws together issues of urban development-induced displacement and resettlement and the quality of life of the affected population over the longer term. It reviews settlement strategies related to the Kolkata Environmental Improvement Project, exploring residents’ recollection of the relocation process and comparing and contrasting the situation over time of two groups of low-income households: those who refused a resettlement package and chose to continue to reside in their canalside huts; and those who accepted the package and moved into new flats provided by the government. The paper highlights issues of livelihoods, social cohesion and sanitation among both sets of households to find out whether those who were resettled experienced improvement in these aspects of their lives. Findings point to resettled households’ overall satisfaction with sanitation despite periodic lapses in functioning, and a modicum of social support, but significant livelihood problems among the poorest households, and dissatisfaction with the small size of units.
A review of prewhirl regulation by inlet guide vanes for compressor and pump
Authors: Liu Ming , Tan Lei , Cao Shuliang
Published: December 2018

To achieve the energy conservation and sustainable development, the prewhirl regulation by inlet guide vanes is proposed and rapidly developed for the compressor and pump. The inlet guide vanes change the flow pattern at the impeller inlet especially the velocity circulation, and then influence the performance of compressor and pump. This paper presents and discusses researches on the prewhirl regulation by inlet guide vanes. Researches include mechanism analysis of prewhirl regulation, experimental and numerical studies on the flow field, performance of compressor and pump with inlet guide vanes, influence of geometric parameters on performance of inlet guide vanes, and failure mode analysis and corresponding flow control methods.
The modified homotopy perturbation method with an auxiliary term for the nonlinear oscillator with discontinuity
Authors: Pasha Syed Ahmed , Nawaz Yasir , Arif Muhammad Shoaib
Published: December 2018

Recently, a modified homotopy perturbation method with an auxiliary term was proposed for obtaining an analytical approximate solution of a nonlinear equation. The auxiliary term involves a tuning parameter that gives the modified homotopy perturbation method an additional degree-of-freedom to construct the approximate solution. In this paper, we present a systematic approach for choosing the auxiliary parameter and furthermore show that an optimal value of the parameter yields significant improvement in the approximate solution compared to the standard homotopy perturbation method. We consider the nonlinear oscillator with a discontinuity to illustrate the proposed approach.
Efficient estimation of a linear transformation model for current status data via penalized splines
Authors: Lu Minggen , Liu Yan , Li Chin-Shang
Published: December 2018

We propose a flexible and computationally efficient penalized estimation method for a semi-parametric linear transformation model with current status data. To facilitate model fitting, the unknown monotone function is approximated by monotone B-splines, and a computationally efficient hybrid algorithm involving the Fisher scoring algorithm and the isotonic regression is developed. A goodness-of-fit test and model diagnostics are also considered. The asymptotic properties of the penalized estimators are established, including the optimal rate of convergence for the function estimator and the semi-parametric efficiency for the regression parameter estimators. An extensive numerical experiment is conducted to evaluate the finite-sample properties of the penalized estimators, and the methodology is further illustrated with two real studies.
Fracture and long-term aging characteristics of GFRP clamping plates for improved movable weirs
Authors: Oh Ri-On , Park Chan-Gi
Published: December 2018

In this study, the durability of movable weirs was improved by replacing steel clamping plates with glass fiber-reinforced polymer (GFRP) material. Because the clamping plates of movable weirs are always in contact with water, the service life of weirs is reduced due to corrosion. Other environmental conditions also degrade movable weirs, such as exposure to continuous inundation, dry environments, repeated dry and wet conditions, and chemical environments. This study evaluated the absorption, fracture, and long-term aging properties of GFRP clamping plates for improved movable weirs. Absorption increased with immersion time in 60°C tap water, sodium sulfate (Na2SO4) solution, or calcium chloride (CaCl2) solution. However, the total absorption for 50 days and 100 days exposure was low, less than 0.50% and 0.62%, respectively. In fracture load tests, the GFRP clamping plates showed the largest reduction in strength after exposure to the CaCl2 solution; 70% and 67% of the control load were retained for exposures of 50 days and 100 days, respectively. After exposure to both tap water and the Na2SO4 solution, the GFRP clamping plates showed residual strengths of 77% and 69% after 50 days and 100 days exposure, respectively. The GFRP clamping plates showed 74% and 71% residual strength after exposure to repeated freeze–thaw environments for 50 days and 100 days, respectively, and 80% residual strength after exposure to all other environments for 50 days or 100 days. Both vertical and horizontal cracks were generated before fracture after exposure to an environment involving direct contact with moisture. Without moisture, only horizontal cracks were generated before fracture.
The curing behaviour and thermo-mechanical properties of core–shell rubber-modified epoxy nanocomposites
Authors: Quan Dong , Ivankovic Alojz
Published: December 2018

This work investigates the effects of core–shell rubber (CSR) nanoparticles on the curing behaviour and thermo-mechanical properties of an epoxy using differential scanning calorimetry and dynamic mechanical thermal analysis approaches. Interaction between CSR nanoparticles and epoxy matrix is detected at a temperature of approximately 97°C in the curing process. This results in an increase in the glass transition temperature ( Tg) of the cured nanocomposites. Given the semi-dynamic curing schedule, the curing process of all the epoxy nanocomposites consists of an abrupt onset stage followed by a slow diffusion-controlled stage. Higher temperature is required to initiate the curing for the epoxy nanocomposites with higher loading of CSR nanoparticles. This is attributed to the physical changes caused by the addition of CSR nanoparticles, such as the increase in the viscosity and the reduction in the density of the reactive groups. The storage modulus of the epoxy decreases in the glassy region but remains constant in the rubbery region due to the incorporation of CSR nanoparticles.
Effect of surface treatment and stacking sequence on mechanical properties of basalt/glass epoxy composites
Authors: Raajeshkrishna CR , Chandramohan P , Saravanan D
Published: December 2018

In the present work, sandwich hybrid composites have been fabricated using hand layup technique followed by compression molding process. Glass and basalt fabrics were used with epoxy resin to fabricate the sandwich composites. The fabrics were used in both untreated and treated conditions using hydrochloric acid and sodium hydroxide solutions. The Fourier transform infrared study conducted on the fabrics before and after the surface treatment shows the effectual impregnation of acid and base on the fabric by the formation of ions on the surfaces. The tensile and hardness tests were conducted as per the ASTM D638-10 and ASTM D2240 standards. The results show that hybridization and surface treatment improve tensile strength and hardness in all the composites. In particular, the hydrochloric acid–treated sandwich composites with basalt fabric as core and glass fabric as skin have recorded the highest tensile strength of 356.39 MPa. The experimental values have been validated using the simulation results of finite element analysis in ANSYS 15.0 with a minimum deviation of 0.47%.
Moral distress of undergraduate nursing students in community health nursing
Authors: Escolar Chua Rowena L , Magpantay Jaclyn Charmaine J
Published: December 2018

Background:

Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.

Aim:

To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.

Research design:

A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led them to have moral distress.

Participants and research context:

The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.

Ethical considerations:

Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.

Findings:

Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.

Conclusion:

This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested.
The Impact of Marijuana Legalization on Law Enforcement in States Surrounding Colorado
Authors: Ward Kyle C. , Lucas Paul A. , Murphy Alexandra
Published: December 2018

Since the legalization of recreational marijuana occurred in Colorado, politicians, academics, and the public have been paying close attention to what impact, if any, the legalization of recreational marijuana has on crime, substance use and abuse, and state revenue gains. However, research has not identified the potential impact that marijuana legalization has had on law enforcement officers in neighboring states. This study used survey methodology to explore how the legalization of recreational marijuana in Colorado has affected law enforcement officers and their duties in states that border Colorado. Using multistage cluster sampling, municipal police departments and sheriff’s offices in Kansas, Nebraska, and Wyoming were selected for inclusion in this study based off their proximity to Colorado and because none had legalized either medical or recreational marijuana at the time of this study. Results indicate that law enforcement officers view Colorado’s legalization of recreational marijuana as having a negative impact on their enforcement duties. Respondents note an increase in potency, perceived juvenile use, and strain on their resources as major issues they are now having to deal with. Analysis indicates that departments further away from Colorado perceive less of an impact than counties closer to Colorado’s border. Compared with Nebraska and Kansas, respondents from Wyoming perceived a larger impact on enforcement, but these differences were diminished when controlling for personal perceptions of marijuana.
Experimental study on the high-velocity impact behavior of sandwich structures with an emphasis on the layering effects of foam core
Authors: Abbasi Mohammad , Alavi Nia Ali , Abolfathi Mostafa
Published: December 2018

In this study, the effects of the core layering of sandwich structures, as well as arrangements of these layers on the ballistic resistance of the structures under high-velocity impact, were investigated. Sandwich structures consist of aluminum face-sheets (AL-1050) and polyurethane foam core with different densities. Three sandwich structures with a single-layer core of different core densities and four sandwich structures with a four-layer core of different layers arrangements were constructed. Cylindrical steel projectiles with hemispherical nose, 8 mm diameter and 20 mm length were used. The projectile impact velocity range was chosen from 180 to 320 m/s. Considering constant mass and total thickness for the core, the results of the study showed that the core layering increases the ballistic limit velocity of the sandwich structures. The ballistic limit velocity of the panels with a four-layer core of different arrangements, compared to the panel with the single-layer core, is higher from 5% to 8%. Also, for the single-layer core structure, by increasing the core density, the ballistic limit velocity was increased. Different failure mechanisms such as plugging, petaling and dishing occurred for the back face-sheet. The dishing area diameter of back face-sheets was proportional to the ballistic resistance of each sandwich structure.
Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up
Authors: Perticarini Loris , Mosconi Mario , Medetti Marta , Caliogna Laura , Benazzo Francesco M
Published: December 2018

Background:

The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal.

Aim:

The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem.

Methods:

61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years.

Results:

The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm.

Conclusions:

Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.
Metal ion trend in patients with metal-on-metal total hip arthroplasty: a 10-year prospective study
Authors: Sangaletti Rudy , Spreafico Andrea , Barbieri Flavio , Ferrari Roberto , Castelli Claudio Carlo
Published: December 2018

Introduction:

There have been reported adverse reactions in patients with large head metal-on-metal hip arthroplasty, therefore metal particle debris are a cause for concern. The aim of this study was to evaluate the release trend of metal ions and the correlated variables.

Methods:

54 patients were prospectively enrolled into the study from 2004 to 2006. All patients had 36-mm metal head, Pinnacle acetabular component, Summit stem and Ultamet CoCr alloy liner (Depuy Inc.), and underwent clinical and radiological management. The haematic concentration of Cr-Co at 0, 6, 12, 24, 60 and 120 months after the implantation was analysed in a sub-cohort of 34 patients.

Results:

10-year revision rate for each case was 8.9%. The average concentration of Co at 120 months was 3.12 μg/L (median 2.20) with 53% values >2 μg/L and 1 >7 μg/L. After 6 months the median levels of Cr and Co were higher than time 0 ( p < 0.0001); no significant differences were found between 6 and 24 months; while Co had significant increase between 60 and 120 months ( p = 0.002). Overweight, University of California at Los Angeles (UCLA) >9 and <50 years old patients have significantly higher circulating metal ions.

Discussion:

This is 1 of the few prospective studies on the argument. The revision rate is conforming to records. Our data shows ionic concentration is not predictive of revision or adverse reaction to metals. We described a 3-phase trend for Co probably due to the loss of integrity of the surfaces.
Surgical prevention of femoral neck fractures in elderly osteoporotic patients: a randomised controlled study on the prevention nail system device
Authors: Giannini Sandro , Chiarello Eugenio , Mazzotti Antonio , Tedesco Guiseppe , Faldini Cesare
Published: December 2018

Introduction:

Hip fractures represent an enormous challenge for our health care system. The aim of this randomised controlled trial was to assess both efficacy and safety of a novel device called Prevention Nail System (PNS) and developed for the surgical prevention of a contralateral femoral neck fracture (FNF) in elderly osteoporotic patients.

Methods:

Primary outcome was to evaluate, in patients suffering from osteoporotic FNF, the effectiveness of PNS in reducing the incidence of a contralateral hip fracture. Secondary outcome was to evaluate the safety of this device therefore intra- and postoperative complications were recorded.

Results:

72 patients, with an age ⩾65 years old, were enrolled (38 study group (group A) and 34 control group (group B). 3 and 5 contralateral FNF were recorded respectively in group A and B. An interim analysis showed a non-effectiveness of the device therefore enrollment was suspended.

Discussion:

In all group A failures a difficult positioning of the PNS was recorded: surgical techniques errors may have affected the result. Nevertheless, it is improbable to hypothesise that, without substantial modifications to the PNS design, this could significantly reduce the incidence of FNF. Considering that current pharmacological approach can achieve, at best, a marginal reduction in FNF especially in patients at high risk, complementary approaches to provide immediate prevention of hip fractures may need to be developed.

Clinical Trial Protocol:

N° 263. 03 June 2008.
Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity
Authors: Loppini Mattia , Schiavi Paolo , Rocca Antonello Della , Traverso Francesco , Rocca Federico Della , Mazziotta Giuseppe , Astore Franco , Grappiolo Guido
Published: December 2018

Introduction:

Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity.

Methods:

A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs.

Results:

Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason.

Conclusion:

The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.
Tension-free closure with capsular lengthening in mini posterior total hip replacement
Authors: Santori Nicola
Published: December 2018

Purpose:

Choice of the best mini invasive surgical approach for total hip replacement remains a controversial topic. The posterior approach is traditionally associated with a higher dislocation rate and the obligation of postoperative restrictions. Soft tissue repair reduces the risk of dislocation yet, posterior closure it is often challenging because of capsular and external rotator contractures. In this article, an original procedure of capsular lengthening and tension-free closure is described and the results of a retrospective single surgeon series of minimally invasive posterior total hip replacement (THR) with capsular repair are presented.

Methods:

A total of 925 mini posterior total hip replacements performed between 2009 and 2015 were retrospectively reviewed. 2 original types of capsulorrhaphy to decrease tension of the repaired tissues were employed. Absence of posterior envelope stretch during flexion and internal rotation was confirmed intraoperatively with a dynamic test. No postoperative restrictions were used.

Results:

Capsular lengthening with 1 of the described techniques was required in over 50% of cases for a tension-free closure. 3 patients dislocated in the 867 reviewed procedures (0.35%), 1 requiring revision for instability (0.11%).

Conclusions:

This soft tissue repair technique after mini posterior approach THR is technically easy, provides a tension-free closure and a low dislocation rate.
A minimum 20-year outcome of 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon
Authors: Solarino Giuseppe , Piazzolla Andrea , Moretti Lorenzo , Vicenti Giovanni , Moretti Biagio
Published: December 2018

Background:

Ceramic-on-ceramic (CoC) is currently a viable bearing combination in primary total hip arthroplasty (THA) and, due to its mechanical properties, it can be used in young patients requiring a long-lasting implant. The aim of this study is to report the results of a series of CoC THAs at a minimum 20 years follow-up.

Methods:

A retrospective study was conducted on the 1st 100 consecutive alumina-on-alumina arthroplasties performed by a single surgeon on 51 females and 40 males with an average age of 60.7 years. The mean preoperative Harris Hip Score was 35. The press-fit cup consisted of a pure titanium core with a titanium alloy mesh. Both the inlay and the head were made of dense polycrystalline surgical-grade alumina. The 32-mm femoral head was anchored on 3 different femoral components.

Results:

19 patients with 22 THAs were died or lost, 2 anatomic cementless stems were revised due to sinking, 1 THA was revised for periprosthetic infection. 2 patients sustained a Vancouver B1 periprosthetic femoral fracture. None of the 78 THAs eligible for this study were revised for wear, breakage, noise of the ceramic components. None of the cups, none of the cemented stems, none of the cementless straight stems failed. HHS raised up to a mean value of 95.

Conclusions:

The present report demonstrates that CoC coupling offers minimal wear at a long-term follow-up. Further studies are needed to evaluate whether the modern ceramic composites will confirm such excellent results in total hip replacement.
MRI findings, metal ion levels and clinical outcome of a complete series of large metal on metal THA: what’s really going on?
Authors: Marchica Daniele , Gallazzi Enrico , Materazzi Giovanni , Battaglia Giulio A , Zagra Luigi
Published: December 2018

Introduction:

Metal-on-metal (MoM) large head total hip arthroplasties (THAs) were discontinued early after their introduction because of the high number of failures due to adverse reaction to metal debris (ARMD). Aim of this study is to report the clinical outcome at a mid-term follow-up (FU) of a series of large-head MoM THA.

Methods:

In this prospective study, 25 hips (24 patients, 3 males, 21 females, mean age 62.44 years) who have undergone primary THA with large head (diameter ⩾36 mm) MoM prosthesis were evaluated. Each patient underwent a standard follow-up after surgery, that included blood tests with metal ion levels (Co and Cr), x-ray of the pelvis, metal artifact reduction sequence magnetic resonance imaging (MARS-MRI) and clinical evaluation.

Results:

At an average follow-up of 7.3 years, 4 hips have been surgically reviewed: 2 for causes not related to ARMD (1 heterotopic ossification and 1 periprosthetic fracture); the other 2 on the same patient (bilateral) with ARMD, who was eventually found to be allergic to nickel. Increased metal ions, osteolysis and severe MRI alterations were found in patients with ARMD. Asymptomatic alterations at MRI were found in 8 patients. Harris Hip Score improved after surgery from a mean of 51 points to a mean of 90 points ( p < 0.01).

Conclusions:

The findings of this study show that not all the patients with MoM THA will develop clear symptoms of ARMD at mid-term follow-up. Patients should be closely monitored following protocols such as that proposed in the European Consensus Statement.
Survey of non-tunneled temporary hemodialysis catheter clinical practice and training
Authors: Yuan Christina M , Oliver James D , Little Dustin J , Narayan Rajeev , Prince Lisa K , Raghavan Rajeev , Nee Robert ,   (for the Nephrology Education Research and Development Consortium—NERDC)
Published: December 2018

Background:

Nephrologists are placing fewer non-tunneled temporary hemodialysis catheters. Requiring competence for nephrology fellow graduation is controversial.

Methods:

Anonymous, online survey of all graduates from a single, military nephrology training program (n = 81; 1985–2017) and all US Nephrology program directors (n = 150).

Results:

Graduate response and completion rates were 59% and 100%, respectively; 93% agreed they had been adequately trained; 58% (26/45) place non-tunneled temporary hemodialysis catheters, independent of academic practice or time in practice, but 12/26 did ⩽5/year and 23/26 referred some or all. The most common reason for continuing non-tunneled temporary hemodialysis catheter placement was that it is an essential emergency procedure (92%). The single most significant barrier was time to do the procedure (49%). Program director response and completion rates were 50% and 79%, respectively. The single most important barrier to fellow competence was busyness of the service (36%), followed by disinterest (21%); 55% believed that non-tunneled temporary hemodialysis catheter insertion competence should be required, with 81% indicating it was an essential emergency procedure. The majority of graduates and program directors agreed that simulation training was valuable; 76% of programs employ simulation. Graduates who had simulation training and program directors with ⩽20 years of practice were significantly more likely to agree that simulation training was necessary.

Conclusion:

Of the graduate respondents from a single training program, 58% continue to place non-tunneled temporary hemodialysis catheters; 55% of program directors believe non-tunneled temporary hemodialysis catheter procedural competence should be required. Graduates who had non-tunneled temporary hemodialysis catheter simulation training and younger program directors consider simulation training necessary. These findings should be considered in the discussion of non-tunneled temporary hemodialysis catheter curriculum requirements.
Health-care use and information needs of children with neonatal brachial plexus palsy: A cross-sectional survey among 465 Dutch patients
Authors: van der Holst Menno , Steenbeek Duco , Pondaag Willem , Nelissen Rob GHH , Vlieland Thea PM Vliet
Published: December 2018

To investigate health-care use (HCU) and information needs of children aged 0–18 years with neonatal brachial plexus palsy (NBPP), a cross-sectional study was performed. Patients and/or parents seen in our NBPP clinic were invited to complete a survey comprising questions on HCU due to NBPP and current information needs. Outcomes were described for three age-groups (0–1/2–9/10–18 years), based on follow-up status (early/late/no-discharge). Four hundred sixty-five parents/patients participated (59 in the 0–1, 226 in the 2–9, and 180 in the 10–18-year group). Two hundred ninety-three patients had C5–C6 lesions, 193 were discharged from follow-up, 83 of whom categorized as ‘early discharged’ (<1 year of age). Over the past year, 198 patients had contact with the expert team (49 in the 0–1, 81 in the 2–9, and 68 in the 10–18-year group) and 288 with at least one other health-care professional (53 in the 0–1, 133 in the 2–9, and 102 in the 10–18-year group). Of the 83 patients discharged early, 34 reported health-care use. Two hundred twenty-eight participants reported current information needs of whom 23 were discharged early. HCU and information needs of Dutch children with NBPP remains considerable even in children who were discharged. Stricter follow-up and information provision for these patients is needed.
“Everybody’s responsibility”: Conceptualization of youth mental health in Kenya
Authors: Tamburrino Inge , Getanda Elijah , O’Reilly Michelle , Vostanis Panos
Published: December 2018

There is increasing interest in providing resilience-building interventions in low- and middle-income countries (LMIC), but limited evidence on how young people and their carers process mental health and related supports. The aim of this study was to establish stakeholders’ conceptualization of youth mental health in a disadvantaged area of Kenya through focus groups with 7 young people aged 14–17 years and their parents, 9 teachers and 11 practitioners or community leads. The four identified themes related to definitions of both mental well-being and mental health problems; a range of contributing factors related to identity resolution, parenting, poverty and social media; attribution of responsibility at different socio-ecological levels; and required awareness, supports and interventions at these levels. Stakeholders, notably young people, are thus essential in the development and planning of user-led and culturally appropriate interventions in LMIC.