bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Small Beautiful? The Quasi-experimental Analysis of the Impact of Territorial Fragmentation on Costs in Polish Local Governments
Authors: Swianiewicz Pawel , Łukomska Julita
Published: December 2017

Debates on the impact of size of subnational jurisdiction on the costs of public-service delivery have a very long tradition, but results are still far from conclusive. This article applies a quasi-experimental scheme of the synthetic control method for Polish municipal fragmentation to analyze the impact of territorial reform on administrative spending as well as on the operating surplus of the budget. Earlier studies using similar methods focused on amalgamation reforms, so the study of territorial fragmentation is an important new contribution to knowledge on scale effects. The analysis clearly confirms the existence of economy of scale in administrative services. The result for the operating surplus is less clear and more ambiguous. Results of the study are to a large extent a mirror of earlier analysis of territorial amalgamation consequences, which confirms the importance of scale for administrative costs, but not necessarily for costs of other local services.
Development of a flowchart for risk assessment and allocation of preparation of monoclonal antibodies
Authors: Bauters Tiene , Vandenbroucke Johan
Published: December 2017

Monoclonal antibodies have expanded as a novel class of therapeutic agents. In contrast to appropriate guidelines for safe handling of cytotoxics, there are no real standards for the safe handling of monoclonal antibodies. Many questions have arisen whether monoclonal antibodies have to be prepared under controlled circumstances or can be prepared on the ward. We developed a flowchart which provides recommendations for the classification of monoclonal antibodies according to their toxicity profile and takes practical and financial issues into account. It allows oncology pharmacists worldwide to define which monoclonal antibodies can/must be prepared in pharmacy aseptic facilities and which monoclonal antibodies can be prepared on the ward.
Composition of legume soaking water and emulsifying properties in gluten-free bread
Authors: Huang San , Liu Yuling , Zhang Weihan , Dale Kylie J , Liu Silu , Zhu Jingnan , Serventi Luca
Published: December 2017

Soaking of legumes results in the loss of macronutrients, micronutrients and phytochemicals. Fibre, protein and phytochemicals found in legumes exert emulsifying activity that may improve the structure and texture of gluten-free bread. The legume soaking water of haricot beans, garbanzo chickpeas, whole green lentils, split yellow peas and yellow soybeans were tested in this study for functional properties and use as food ingredients. Composition, physicochemical properties and effect on the quality of gluten-free bread were determined for each legume soaking water. Haricot beans and split yellow peas released the highest amount of solids in the legume soaking water: 1.89 and 2.38 g/100 g, respectively. Insoluble fibre was the main constituent of haricot beans legume soaking water, while water-soluble carbohydrates and protein were the major fraction of split yellow peas. High quantities of phenolics (∼400 µg/g) and saponins (∼3 mg/g) were found in the legume soaking water of haricot beans, whole green lentils and split yellow peas. High emulsifying activity (46 and 50%) was found for the legume soaking water of garbanzo chickpeas and split yellow peas, probably due to their protein content and high ratio of water-soluble carbohydrates to dry matter. Such activity resulted in softer texture of the gluten-free bread. A homogeneous structure of crumb pores was found for split yellow peas, opposing that of whole green lentils. A balance between the contents of yeast nutrients and antinutrients was the likely basis of the different appearances.
Sexual Violence Victimization Among Youth Presenting to an Urban Emergency Department: The Role of Violence Exposure in Predicting Risk
Authors: Eisman Andria B. , Ngo Quyen M. , Kusunoki Yasamin Y. , Bonar Erin E. , Zimmerman Marc A. , Cunningham Rebecca M. , Walton Maureen A.
Published: December 2017

Sexual violence (SV) is a widespread public health problem among adolescents and emerging adults with significant short- and long-term consequences. Young people living in urban, disadvantaged communities with high rates of violence may be especially at risk for SV victimization. Understanding interconnections between different forms of violence is critical to reducing SV risk among youth. Participants were youth ( N = 599) ages 14 to 24 years ( M = 20.05, SD = 2.42) presenting to an urban emergency department with a Level 1 trauma designation as part of a prospective cohort study and followed-up for 24 months. We used logistic regression to examine the probability of reporting SV during the 24-month follow-up based on baseline reports of community and peer violence exposure, accounting for previous SV victimization, substance use, and sociodemographic characteristics. Among youth presenting to an urban emergency department, 22% of youth not seeking care for a sexual assault reported any lifetime SV (forced and/or substance-induced sexual intercourse) at baseline. During the 24-month follow-up, 12% reported SV victimization. We found high community violence exposure (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.01, 8.68]) and peer violence exposure (OR = 1.58, 95% CI [1.19, 2.08]) were associated with increased odds of reporting SV during follow-up in addition to previous SV victimization (OR = 2.71, 95% CI [1.45, 5.09]). Sex, age, parent education, and alcohol or other drug use at baseline were not associated with odds of SV during follow-up. Investigating interconnections between SV victimization and other forms of violence across socioecological levels provides an opportunity to advance SV research and identify promising avenues for prevention based on other violence prevention research. Future strategies for SV prevention that incorporate community and peer components as well as SV-specific content may help reduce SV victimization among youth living in urban, disadvantaged communities.
Mechanical and tribological properties of Cr/Cr2O3 multilayer films
Authors: Wang Feifei , He Nairu , Li Hongxuan , Ji Li , Liu Xiaohong , Ye Yinping , Zhou Huidi , Chen Jianmin
Published: December 2017

Cr/Cr2O3 multilayer and single-layer films were deposited through multiple arc ion plating technique. The influence of modulation ratio on the mechanical and tribological properties was also investigated. Results show that the multilayer design of Cr/Cr2O3 films could improve the toughness of films, but a certain degree of hardness loss is also observed. The hardness and adherence strength are improved with the increase of Cr2O3 layer thickness. Furthermore, alternating layers of ductile soft metals and hard ceramics could suppress the propagation of microcracks and brittle fracture. However, the decrease of modulation ratio could causes a decline in the mechanical properties. The film with appropriate modulation ratio (Cr2O3:Cr ratio 10:1) exhibits better comprehensive properties than other films, this film also exhibits an excellent wear resistance with a high load of 10 N. Consequently, the wear life is improved from 6 m of the single-layer Cr2O3 film to 835 m of the multilayer film.
Pedagogical suitability of data-driven learning in EFL grammar classes: A case study of Taiwanese students
Authors: Lin Ming Huei , Lee Jia-Ying
Published: December 2017

This study of 52 undergraduates of English as a foreign language (EFL) involves an empirical assessment of the pedagogical suitability of data-driven learning (DDL) in three Taiwanese grammar classes. One class (16 students) was taught using a traditional deductive approach (TDA), and the others (one of 17 and one of 19 students) were taught using blends of DDL and TDA. The participants’ performance in grammar and their judgments of the teaching effects of DDL were both collected for analysis. Using a covariance analysis, the study results indicate no significant differences between the three classes in grammar proficiency, although paired-sample t-tests reveal significant gains for each class. However, the results of quantifying participants’ perceptions of the treatments over time show clear changes as the experiment proceeded; there was a growing preference for DDL-integrated treatments but a disinclination towards the TDA. Although it seems premature to claim DDL’s pedagogical suitability here, the overall results lend support to the legitimacy of practicing DDL in different educational areas. This is particularly notable for Taiwan’s EFL context, given that most of its grammar classrooms are still employing conventional approaches, including the Grammar Translation method, even if they are not inclined towards them. The article concludes with a discussion of DDL’s effects on future EFL grammar classes and possible avenues for further studies.
Elimination of mother-to-child transmission of syphilis: Is it a reality in Nigeria by 2020?
Authors: Adeyinka Daniel A. , Olakunde Babayemi O. , Ozigbu Chamberline E. , Agogo Emmanuel A. , Morka Mercy , Atoba Temitope , Obanubi Chris , Okorie Gideon , Davies Abiola , Oladimeji Olanrewaju
Published: December 2017

Background: Congenital syphilis is a global health problem, yet it has received little attention in recent years. Despite cost-effective syphilis screening and treatment, it continues to contribute hugely to perinatal morbidity and mortality worldwide. Aims: To determine the prevalence and treatment coverage trend for syphilis among pregnant women in the national prevention of mother-to-child transmission programme in Nigeria and to evaluate progress towards the elimination of congenital syphilis in the country. Methods: A retrospective analysis of validated national health sector performance data on pregnant women attending antenatal care at prevention of mother-to-child transmission clinics from 2013 to 2016 in Nigeria. Results: The proportion of new antenatal care attendees who annually received serological testing for syphilis increased from 12.2% in 2013 to 16.3% in 2016 (p-trend<0.0001). Although the prevalence of maternal syphilis decreased from 3.2% in 2013 to 1.4% in 2016 (p-trend<0.0001), the syphilis treatment coverage during pregnancy has decreased from 71.3% in 2013 to 54.9% in 2016 (p-trend<0.0001). Conclusions: Maternal syphilis screening and treatment in Nigeria are inadequate to meet the elimination aspirations. A rapid scale-up of antenatal care syphilis screening and treatment are crucial to averting an epidemic in Nigeria by 2020.
In LeBron James’ promotional skin: Self-branded athletes and fans’ immaterial labour
Authors: Fresco Estee
Published: December 2017

Using the LeBron James brand as a case study, this article adds insight into the phenomenon of self-branding by demonstrating that sports fans play an essential role in building the value of athletes’ personal brands. Drawing on Hearn’s theory of self-branding and Arvidsson’s concept of ‘ethical surplus’, it argues that audience members participated in the immaterial labour required to build (and re-build) the value of the LeBron James and Nike brands. By considering this immaterial labour within the neo-liberal context in which it occurs, this article highlights a central tension between the individual and the group that lies at the heart of athletes’ self-branding practices.
What does that shirt mean to you? Thrift-store consumption as cultural capital
Authors: Steward Shelly
Published: December 2017

Recent work shows cultural capital taking increasingly vague and embodied forms. Attitudes and understandings of “creativity” and “authenticity,” for example, hold more symbolic value than any particular objects. How are these culturally valuable understandings defined and transmitted? This project examines thrift-store shopping to show how symbolic meanings are defined and employed as a form of embodied cultural capital. Ethnographic observation and interviews with shoppers at thrift stores in Portland, Oregon, reveal competing symbolic understandings among two groups of consumers. One group, the “thrift-seekers,” is motivated by a desire to find bargains. Members of this group describe their consumption as a game in which they are able to compete with other consumers. The other group, the “creativists,” comes from a more privileged background and is motivated by a rejection of conventional stores. They describe their consumption as an exercise of creativity through which they establish superiority over other consumers. Each group implicates the other as it constructs its narrative of consumption. Outside of the thrift store, the creativists employ their narratives of creativity as a form of cultural capital, giving them status in relation to similarly privileged peers. This project illustrates the embodied nature of contemporary cultural capital and shows how classes implicate one another in definitions of it. Furthermore, it demonstrates how thrift stores hold particular significance as sites in which embodied cultural capital is defined.
Determination of railway track longitudinal profile using measured inertial response of an in-service railway vehicle
Authors: OBrien Eugene J , Quirke Paraic , Bowe Cathal , Cantero Daniel
Published: December 2017

The use of sensors fixed to in-service trains has the potential to provide real-time track condition monitoring to inform maintenance planning. An Irish Rail intercity train was instrumented for a period of 1 month so that a numerical method developed to find track longitudinal profile from measured vehicle inertial responses could be experimentally tested. A bogie-mounted accelerometer and gyrometer measured vertical acceleration and angular velocity as the train made regular service operations between Dublin and Belfast on the island of Ireland. Cross entropy optimisation is used to find a track longitudinal profile that generates a numerical inertial response that best fits the measured response. Tolerance limits are used to inject variance where required to ensure a good match between measured and modelled signals. A section of track with known track settlement history is selected as a case study. A level survey was undertaken during the measurement campaign to characterise the longitudinal profile through the test section. Bandpass filters are used to compare inferred profiles and the surveyed profile. Good agreement is found between the two profiles although improvements in accuracy and reproducibility are required before conformance with current standards is achieved.
The Silver Screen and Authoritarianism: How Popular Films Activate Latent Personality Dispositions and Affect American Political Attitudes
Authors: Glas Jeffrey M. , Taylor J. Benjamin
Published: December 2017

Do popular films activate authoritarianism? We theorize that, because of the willing suspension of disbelief, films encourage social learning, which primes viewers to respond to messages activating latent personality traits such as authoritarianism. This activation then affects citizens’ political attitudes. To test our theory, we use a 1 × 3 posttest experimental design where treatment groups watch feature-length films. As treatments, subjects watch 300 and V for Vendetta, and the control film is 21 Jump Street. Consistent with our hypotheses, we find that 300 activates authoritarianism while V for Vendetta activates antiauthoritarianism. As expected, 21 Jump Street has no effect. In addition, we show that the activation of authoritarianism produces significant differences in attitudes on U.S. primacy, rights of protestors, immigration, and military service. This research demonstrates how the causal mechanism between entertainment media and latent personality activation affects political attitudes, which advances both the American political behavior and media politics literature.
Wnt3a promotes pro-angiogenic features in macrophages in vitro: Implications for stroke pathology
Authors: Fuster-Matanzo Almudena , Manferrari Giulia , Marchetti Bianca , Pluchino Stefano
Published: December 2017

Wnt3a is implicated in several key cellular processes and its expression has been reported in different cell types. Here, we report a novel function for Wnt3a in macrophages, whose exposure to this ligand shifts them towards a pro-angiogenic phenotype capable, under oxygen and glucose deprivation, of inducing in vitro tubular pattern structures in endothelial cells resembling capillary-like vasculature. These newly acquired angiogenetic features also include increased proliferation and migration and surprisingly, an increase in cell death. This work provides a new link between Wnt3a and macrophage-mediated angiogenesis under glucose and oxygen deprivation in vitro, which are worth further investigation in pathological conditions including stroke, where the stimulation of the angiogenic process might help to recovery after tissue injury

Impact statement

This work provides a new link between Wnt3a and macrophage-mediated angiogenesis under glucose and oxygen deprivation in vitro. Our results reveal how Wnt3a shifts macrophages towards a pro-angiogenic phenotype, which is able–in absence of both glucose and oxygen–of inducing angiogenesis in vitro, thus pointing to a synergy between the activation of the pathway and the hypoxia scenario. This work also demonstrates that modulation of cell death is key in order to explain the observed angiogenic effects. We consider all these findings of significant importance, since no connection between Wnt3a, macrophages, and angiogenesis has been established so far. Furthermore, we do believe that this work provides new and interesting results, with Wnt signaling pathway emerging as an interesting target mediating beneficial outcomes during the inflammatory response undoubtedly linked to stroke pathology, where angiogenesis has been already proposed as a potential mechanism to promote recovery after the injury.
Risk Factors for 30-Day Complications After Thumb CMC Joint Arthroplasty: An American College of Surgeons National Surgery Quality Improvement Program Study
Authors: Shah Kalpit N. , Defroda Steven F. , Wang Bo , Weiss Arnold-Peter C.
Published: December 2017

Background: The first carpometacarpal (CMC) joint is a common site of osteoarthritis, with arthroplasty being a common procedure to provide pain relief and improve function with low complications. However, little is known about risk factors that may predispose a patient for postoperative complications. Methods: All CMC joint arthroplasty from 2005 to 2015 in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database were identified. Bivariate testing and multiple logistic regressions were performed to determine which patient demographics, surgical variables and medical comorbidities were significant predictors for complications. These included wound related, cardiopulmonary, neurological and renal complications, return to the operating room (OR) and readmission. Results: A total of 3344 patients were identified from the database. Of those, 45 patients (1.3%) experienced a complication including wound issues (0.66%), return to the OR (0.15%) and readmission (0.27%) amongst others. When performing bivariate analysis, age over 65, American Society of Anesthesiologists (ASA) Class, diabetes and renal dialysis were significant risk factors. Multiple logistic regression after adjusting for confounding factors demonstrated that insulin-dependent diabetes and ASA Class 4 had a strong trend while renal dialysis was a significant risk factor. Conclusions: CMC arthroplasty has a very low overall complication rate of 1.3% and wound complication rate of 0.66%. Diabetes requiring insulin and ASA Class 4 trended towards significance while renal dialysis was found to be a significant risk factors in logistic regression. This information may be useful for preoperative counseling and discussion with patients who have these risk factors.
Management of a rare case of posterior condylar canal dural arteriovenous fistula presenting with subarachnoid haemorrhage: A case report and review of literature
Authors: Shambanduram Somorendra Singh , Devarajan Sebastian Leve Joseph , Jain Nishchint , Garg Ajay , Gaikwad Shailesh B
Published: December 2017

Posterior condylar canal dural arteriovenous fistula (PCC dAVF) is a rare entity with only three cases having been reported so far in the English literature. We describe the clinical presentation, imaging, and endovascular management of an elderly man with left PCC dAVF presenting with subarachnoid haemorrhage (SAH). Endovascular management of such cases requires thorough understanding of the vascular anatomy around the craniovertebral junction (CVJ) and variable bridging vein draining patterns. The fistula in our case was fed by the posterior meningeal branch of the left vertebral artery and was draining through a dilated and tortuous medullary bridging vein into the antero-lateral pontomedullary venous system. Transarterial glue embolisation was performed with complete exclusion of the fistula and venous pouches. The patient developed intractable hiccough and left-sided facial pain on the second post-procedural day, and MRI showed focal diffusion restriction in the left dorso-lateral medulla. He recovered completely after a short course of steroids.
Waiting for Godot: Eight major problems in the odd field of leadership studies
Authors: Alvesson Mats
Published: December 2017

This paper identifies eight significant shortcomings in leadership studies. The field is large, divergent and fragmented, making it difficult to make broad generalizations, but the majority of all research suffer from most of what may be referred to as the Hollywood, Disneyland, closed system, two kinds of people, bees and the honeypot, reification, tautology and hyperreality problems. The paper suggests ways of reducing these problems.
The Sense of Being Watched Is Modulated by Arousal and Duration of the Perceptual Episode
Authors: Hesslinger Vera M. , Carbon Claus-Christian , Hecht Heiko
Published: December 2017

The mere presence of a depiction of eyes can elicit a sense of being watched in the perceiver. To this date, the factors affecting the intensity of this sense of being watched, however, have not been investigated. In the present experiment, we tested the impact of two potentially relevant variables: arousal (manipulated using specific musical pieces) and duration of the perceptual episode (manipulated using presentation times of 200 ms and 10 s, respectively). We asked participants to report how intensely they felt being watched while we exposed them to various observation cues ranging from human eyes to surveillance cameras. We found that, on average, reported intensities were higher if participants were in a state of relatively higher arousal and if the perceptual episode during which the respective observation cues were presented lasted long enough (10 s) to allow more than a first glance. Scientific and practical implications are briefly discussed.
Embryonal tumor with multilayered rosettes, C19MC-altered: Report of an extremely rare malignant pediatric central nervous system neoplasm
Authors: Tariq Muhammad Usman , Ahmad Zubair , Minhas Muhammad Khurram , Memon Aisha , Mushtaq Noreen , Hawkins Cynthia
Published: December 2017

The 2016 update of the WHO Classification of Tumours of the Central Nervous System has redefined a number of tumors. Embryonal tumor with multilayered rosettes, C19MC-altered is one such tumor entity which has been newly defined on the basis of a characteristic molecular alteration. We report, to our knowledge, the first case of this rare pediatric brain neoplasm in the Pakistani population. An 8-month-old girl was presented with vomiting and left-sided ptosis, and magnetic resonance imaging scan showed a cerebellar tumor. Histologically, a highly cellular population of primitive cells was seen alternating with hypocellular neuropil-rich regions containing multilayered true rosettes and cells with glial and neuronal differentiation. Amplification of 19q13. 42 chromosome region on fluorescence in situ hybridization analysis confirmed the diagnosis. Post-operative radiological examination revealed widespread central nervous system involvement. Adjuvant treatment was not offered due to complications. Patient expired a week after diagnosis.
Delayed severe anaphylactoid reaction following retrograde pyelogram: A case report
Authors: Pooli Aydin , Brush Thomas , Belle Joshua D , LaGrange Chad A
Published: December 2017

Retrograde pyelography is used to evaluate upper collecting system in patients with hematuria who have contrast allergy. Reported here is a patient who developed severe, late-onset anaphylactoid reaction after retrograde pyelography. Premedication is commonly used to reduce risk of allergic reaction but has limited evidence to support its efficacy. Caution should be used when evaluating microhematuria with retrograde pyelography in patients with prior anaphylactoid reaction to intravenous contrast.
Changes needed to medicine in the UK before senior UK-trained doctors, working outside the UK, will return: questionnaire surveys undertaken between 2004 and 2015
Authors: Lambert Trevor W , Smith Fay , Goldacre Michael J
Published: December 2017

Objective

To report the changes to UK medicine which doctors who have emigrated tell us would increase their likelihood of returning to a career in UK medicine.

Design

Questionnaire survey.

Setting

UK-trained medical graduates.

Participants

Questionnaires were sent 11 years after graduation to 7158 doctors who qualified in 1993 and 1996 in the UK: 4763 questionnaires were returned. Questionnaires were sent 17 and 19 years after graduation to the same cohorts: 4554 questionnaires were returned.

Main outcome measures

Comments from doctors working abroad about changes needed to UK medicine before they would return.

Results

Eleven years after graduation, 290 (6%) of respondents were working in medicine abroad; 277 (6%) were doing so 17/19 years after graduation. Eleven years after graduation, 53% of doctors working abroad indicated that they did not intend to return, and 71% did so 17/19 years after graduation. These respondents reported a number of changes which would need to be made to UK medicine in order to increase the likelihood of them returning. The most frequently mentioned changes cited concerned ‘politics/management/funding’, ‘pay/pension’, ‘posts/security/opportunities’, ‘working conditions/hours’, and ‘factors outside medicine’.

Conclusions

Policy attention to factors including funding, pay, management and particularly the clinical–political interface, working hours, and work–life balance may pay dividends for all, both in terms of persuading some established doctors to return and, perhaps more importantly, encouraging other, younger doctors to believe that the UK and the National Health Service can offer them a satisfying and rewarding career.
Biomechanical Comparison of Single- Versus Double-Row Capsulolabral Repair for Shoulder Instability: A Review
Authors: Yousif Matthew John , Bicos James
Published: December 2017

Background:

The glenohumeral joint is the most commonly dislocated joint in the body. Failure rates of capsulolabral repair have been reported to be approximately 8%. Recent focus has been on restoration of the capsulolabral complex by a double-row capsulolabral repair technique in an effort to decrease redislocation rates after arthroscopic capsulolabral repair.

Purpose:

To present a review of the biomechanical literature comparing single- versus double-row capsulolabral repairs and discuss the previous case series of double-row fixation.

Study Design:

Narrative review.

Methods:

A simple review of the literature was performed by PubMed search. Only biomechanical studies comparing single- versus double-row capsulolabral repair were included for review. Only those case series and descriptive techniques with clinical results for double-row repair were included in the discussion.

Results:

Biomechanical comparisons evaluating the native footprint of the labrum demonstrated significantly superior restoration of the footprint through double-row capsulolabral repair compared with single-row repair. Biomechanical comparisons of contact pressure at the repair interface, fracture displacement in bony Bankart lesion, load to failure, and decreased external rotation (suggestive of increased load to failure) were also significantly in favor of double- versus single-row repair. Recent descriptive techniques and case series of double-row fixation have demonstrated good clinical outcomes; however, no comparative clinical studies between single- and double-row repair have assessed functional outcomes.

Conclusion:

The superiority of double-row capsulolabral repair versus single-row repair remains uncertain because comparative studies assessing clinical outcomes have yet to be performed.
Official Frames and the Tulsa Race Riot of 1921: The Struggle for Reparations
Authors: Messer Chris M. , Shriver Thomas E. , Beamon Krystal K.
Published: December 2017

Movements that seek reparations against racial injustices must confront historic narratives of events and patterns of repression. These injustices are often legitimated through official narratives that discredit and vilify racial groups. This paper analyzes elite official frames in the case of the Tulsa Race Riot of 1921, in which an economically thriving African American neighborhood was destroyed. Our research examines the official frames that were promulgated by white elites in defending the violent repression and analyzes the ongoing efforts by reparations proponents to seek redress. We delineate the discursive mechanisms used by proponents to challenge the dominant white narrative of the riot and to campaign for reparations. We conclude by discussing the implications of our research for future research on racial injustices and reparations movements.
A Decentralised Approach to Wastewater Management in the Urbanising Region: The Case of Jakarta, Indonesia
Authors: Putri Prathiwi Widyatmi
Published: December 2017

State-led and market-oriented approaches to sanitation development in Jakarta have favoured the construction of large-scale centralised sewerage systems. This development approach is not always suitable because the principles of modern infrastructure underlying the technological systems are not applicable in informal settlements scattered over the metropolis. Due to spatial fragmentation within the built environment, diverse socio-economic and fragile geo-ecological conditions in different settlements and the city as a whole, Jakarta needs to adopt a decentralised approach to wastewater management. This article examines governmental dynamics in Jakarta and analyses a sanitation project to introduce improved septic tanks and community sludge-hauling enterprises. The presence of (international) NGOs and civil society organisations is often vital to help communities enrich their technical knowledge of environmental problems and expand their sociopolitical networks. Nevertheless, local initiatives provide a limited response to community sanitation needs and sanitation problems beyond the neighbourhood level. This article argues that the introduction of decentralised sanitation systems requires a new form of state-led infrastructure provision, which involves the (transformative) participation of local actors. In doing so, it extends the notion of decentralised wastewater management beyond purely technological concerns.
Discharge and Readmission Rates with Atypical Antipsychotic Agents
Authors: Goren Jessica L , Levin Gary M
Published: December 2017

Objective

Newer atypical antipsychotic agents offer many advantages over conventional antipsychotic agents, including a decreased adverse effect burden, improved compliance, and superior efficacy. However, the atypical antipsychotic agents are considerably more expensive than conventional agents. We conducted a retrospective review to determine whether one atypical antipsychotic agent provided a significant advantage with regard to discharge or readmission rates in the inpatient population of a state psychiatric facility. In addition, we assessed whether one atypical antipsychotic agent was associated with an increased use of concomitant medications.

Methods

All records for patients started on clozapine, risperidone, or olanzapine at any time during 1997 were reviewed. Each inpatient started on a study medication had his or her records reviewed for 1 full year after the medication start date. Each record was assessed for discharge status and concomitant psychotropic medication use. For those patients discharged, the readmission status was followed.

Results

Patients treated with clozapine had the highest discharge rate (54%) and lowest readmission rate (16%) compared with risperidone (39% and 26%, respectively; p = 0.75) and olanzapine (39% and 26%, respectively; p = 0.88).

Conclusions

The highest discharge rate was seen in patients receiving clozapine. Treatment with risperidone was associated with the highest readmission rate and concomitant psychotropic use. Although the results are limited because of a small sample size, these findings provide some insight into the long-term efficacy of atypical antipsychotics and some potential differences in recidivism rates. These findings also suggest the need and importance of further study in this area.
Atrial Fibrillation Induced by Oral Methylprednisolone
Authors: Juni Samuel , Kerstein Moshe
Published: December 2017

Objective

To report a case of atrial fibrillation (AF) due to oral methylprednisolone.

Case Summary

A 45-year-old white man with chronic intermittent paroxysmal supraventricular tachycardia (PSVT) reacted to oral methylprednisolone by developing a PSVT episode that elicited an 18-hour episode of AF. AF was resolved by discontinuing methylprednisolone and administering oral nadolol, and no recurrence was reported for 6 years.

Discussion

This appears to be the first published report linking AF to oral methylprednisolone. Based on an analysis of the literature, it is suggested that AF may be triggered by any autonomic paroxysmal event in some individuals. Accepting the clinical evidence linking methylprednisolone to PSVT, the case is elaborated as having involved an initial atrial paroxysmal reaction to the drug, which then triggered AF.

Conclusions

Clinicians may wish to consider history of arrhythmias, and to monitor them, when prescribing oral methylprednisololne.
The Management of Dog Bites
Authors: McDermitt Beth A , Romanchak Nancy L , Ponte Charles D
Published: December 2017

Objective

To review the contemporary management of dog bites with an emphasis on clinical presentation, wound care, microbiology, antimicrobial prophylaxis, and treatment.

Data Sources

The published literature was searched by use of MEDLINE (1990-December 2000) and bibliographic reviews of relevant textbooks and review articles.

Data Selection and Extraction

Review articles, case reports, appropriate meta-analyses, and relevant textbook chapters dealing with mammalian bites and their management were evaluated. All pertinent information was synthesized and incorporated into the present review.

Data Synthesis

The incidence of serious and fatal dog bites has increased because of the acquisition of larger, more aggressive breeds. School-age children and young adults are at the highest risk. Most bites occur on the upper extremities, although head and neck bites are also common. The risk of infection is greatest for crush injuries, puncture wounds, and hand wounds. Infection tends to develop within 24–36 hours of the injury. Complications include osteomyelitis, septic arthritis, tenosynovitis, and septicemia. Most infections are polymicrobial and involve organisms isolated from the skin of the patient and the indigenous oral flora of the dog. Bites should be initially managed under accepted wound care protocols. Wound closure remains controversial and should be reserved for facial and head wounds. Immobilization and elevation are essential for therapeutic success. Prophylactic antibiotics should be reserved for bites at high risk for infection and the immunocompromised host. Whether for prophylaxis or treatment, empiric antimicrobial therapy should be directed against the most common bacteria: Pasteurella spp., streptococci, staphylococci, and anaerobes. Duration and route are dependent on the location and severity of the wound.

Conclusions

Dogs remain the major cause of mammalian bites in the US. It is important for clinicians to have an understanding of the contemporary management of dog bites. Good wound care is central to the prevention and treatment of complications. Appropriate antimicrobial therapy should be directed against both aerobic and anaerobic flora. Careful monitoring is imperative, and antibiotic changes should be made based on clinical response and, if appropriate, the results of culture and sensitivity reports.
The Role of Leukotriene Modifiers in the Management of Exercise-Induced Bronchoconstriction
Authors: Kelly Charles B , Rodgers Philip T
Published: December 2017

Objective

To review the use of leukotriene modifiers in exercise-induced bronchoconstriction (EIB).

Data Source

A MEDLINE search (1966–March 2001) identified pertinent English-language publications on EIB in humans.

Study Selection

Selection of prospective clinical studies was limited to those that focused on prevention of EIB with leukotriene modifiers, including both leukotriene receptor antagonists and 5-lipoxygenase inhibitors.

Data Synthesis

Leukotriene modifiers have been shown to attenuate EIB in patients with mild to intermittent, stable asthma from exacerbations after exercise, especially those with a predicted forced expiratory volume in 1 second (FEV1) >80% and who did not require corticosteroids. Extrapolation to patients with more severe forms of asthma cannot be made because of the lack of currently available data in these types of patients. Children may benefit from the oral dosage forms of leukotriene modifiers if they have difficulty using a metered-dose inhaler. The current literature supports a lack of a tolerance effect with leukotriene modifiers, as opposed to tachyphylaxis seen with beta2-adrenergic drugs after repeated dosing. As many as 25% of EIB patients will not respond to therapy with leukotriene modifiers. Montelukast has the greatest volume of data and the most positive benefits of the available leukotriene modifiers.

Conclusions

Evidence supports the use of leukotriene modifiers for protection of EIB in patients with stable, mild to intermittent asthma with a predicted FEV1 ≥80% if beta-agonists are intolerable or ineffective. Potential benefits include the lack of a tolerance effect, the long duration of action exhibited by some leukotriene modifiers, and the availability of a tablet form. Beta2-adrenergic drugs should remain the first-line therapy for EIB; however, leukotriene modifiers may provide a valuable alternative in those few who cannot use short-acting beta-agonists. Long-term safety studies of leukotriene modifiers in children and the elderly with EIB are necessary before widespread use can be advocated in the pediatric and geriatric populations.
Adverse Reactions to Metoclopramide in Young Children: A 6-Year Retrospective Study and Review of the Literature
Authors: Lifshitz Matityahu , Gavrilov Vladimir
Published: December 2017

Objective

To report our experience with children admitted to the emergency department between the years 1994 and 1999 for adverse reactions to metoclopramide.

Patients and Methods

The medical records of 52 children admitted for adverse reactions to metoclopramide were analyzed retrospectively. All the patients had been prescribed metoclopramide for the treatment of nausea and vomiting.

Results

The patients' ages ranged from 1.5 to 4.5 years (median 2.4 y). All had manifested various dystonic symptoms that occurred several hours after ingestion of 1 or 2, rarely more, doses of metoclopramide. Thirty-two patients had received metoclopramide 0.1 mg/kg/dose, 11 children 0.2 mg/kg/dose, 7 pateints 0.3 mg/kg/dose; for the remaining 2 children, the dosage was not known. The prominent clinical sign in all the children was oculogyric crisis. All the patients who had received a two- to threefold overdose, as well as those infants for whom the dosage was not known, experienced drowsiness. All 52 children were treated intravenously with a single dose of procyclidine hydrochloride 0.1 mg/kg. Extrapyramidal symptoms were abolished 15–30 minutes after treatment, and the children were discharged home 2–3 hours after treatment, free of symptoms.

Conclusions

Young children are especially susceptible to adverse reactions from metoclopramide, particularly oculogyric crisis. Therefore, physicians should use this drug with great caution. Our study indicates that it is fairly safe to treat oculogyric crisis in children with a single intravenous injection of procyclidine hydrochloride 0.1 mg/kg.
Use of Digoxin Monitoring in a Hospital Setting as an Essential Tool in Optimizing Therapy
Authors: Mayan Haim , Bloom Einat , Hoffman Amnon
Published: December 2017

Objective

To determine what triggers the use of digoxin therapeutic drug monitoring (TDM) that adheres to established indications and the change in digoxin dosage after the result of monitoring is obtained.

Methods

This prospective study included 86 patients admitted to 6 medicine wards and 2 intensive cardiac care unit wards in a tertiary-care center. Data on patients' demographics, drug therapy, serum chemistry values, indications for digoxin therapy, indications for ordering the drug assay, timing of the blood sample relative to administration of the last dose, and physicians' decisions after attaining serum digoxin concentrations were collected.

Results

Eighty-six digoxin assays were evaluated. Indications for the use of a digoxin assay were mostly routine without a clear indication (66%); in only 22% of the assays were orders considered clinically justified. Eleven patients had concentrations >2 ng/mL, but only 8 patients had digoxin intoxication. In only 31% of patients did the medical staff respond to the results. In only 21% of patients with subtherapeutic drug concentrations was there a change in digoxin dose.

Conclusions

Although there are clear indications for the use of digoxin TDM, physicians seem to routinely order these blood tests. The clinicians did not adequately use the digoxin concentration data to optimize therapy. The assistance of a clinical pharmacist or pharmacologist is warranted for use of the assays, to optimize digoxin therapy.
Impact of Clozapine versus Haloperidol on Conditional Release Time and Rates of Revocation in a Forensic Psychiatric Population
Authors: Stoner Steven C , Lea Jessica S Wehner , Dubisar Beth M , Roebuck-Colgan Kathleen , Vlach David M
Published: December 2017

Background

Clozapine remains the cornerstone of treatment for treatment refractory schizophrenia. Clozapine has been shown to improve quality of life and cognitive functioning and to reduce hospital days in psychiatric patients. The impact of clozapine in a forensic population of psychiatric patients has not been studied.

Methods

This study is a naturalistic, retrospective database analysis of forensic patients hospitalized at the Northwest Missouri Psychiatric Rehabilitation Center from January 1, 1990 to August 1, 1999 who were treated with clozapine or haloperidol. Patients were either court ordered for hospitalization as having been found not guilty by reason of insanity or as incompetent to proceed to trial.

Results

Data from 84 patients (69 male, 15 female) were included in the analysis. The primary Axis I diagnoses were substance abuse (n = 61) and schizophrenia (n = 46). Patients had been treated with haloperidol (n = 78) and clozapine (n = 21), and some had received each agent as monotherapy during their course of treatment (n = 15). Assault (n = 22), armed criminal action (n = 18), and burglary (n = 18) were the primary forensic reasons for admission. Of those eligible to obtain a conditional release, 33% of haloperidol-treated patients and 38% of clozapine-treated patients obtained their conditional release on those medications. Haloperidol-treated patients were more likely to have their conditional release revoked (58.8%) versus those treated with clozapine (0%). Clozapine-treated patients were also more likely to stay on conditional release for longer periods of time. Global Assessment of Functioning (GAF) scores improved in both treatment groups; however, of 15 patients converted from haloperidol to clozapine, 93% (n = 14) saw improvements in GAP scores.

Conclusions

Clozapine and haloperidol effectively reduce psychosis and aggression. In our study, clozapine-treated patients were more likely to obtain a conditional release and stayed on conditional release for longer periods of time. Although the need exists to study this patient population more closely from a longitudinal standpoint, one may suspect that these findings represent a potential decrease in healthcare costs for the treatment of forensic psychiatric patients.
Liposomal Amphotericin B for Visceral Leishmaniasis in a Kidney Allograft Patient
Authors: Valente Marina , Marroni Massimo , Sfara Claudio , Francisci Daniela , Malincarne Lisa , Gubbiotti Giampiero , Cozzari Massimo , Tordini Giacinta , Stagni Giuliano
Published: December 2017

Objective

To report a case of visceral leishmaniasis treated with liposomal amphotericin B (LAB) after probable failure with amphotericin B lipid complex (ABLC).

Case Summary

A 62-year-old white renal transplant recipient was admitted for pyrexia, hepato-splenomegaly, and pancytopenia. Leishmania amastigotes were detected from bone marrow aspirate and in circulating blood monocytes and neutrophils. The patient, who weighed 56 kg, received ABLC at a starting dose of 200 mg/d (3.6 mg/kg of body weight per day) for 13 days, achieving a total dose of 2,600 mg (46 mg/kg) without clinical improvement. The patient was switched to 100 mg/d (1.8 mg/kg) of LAB for 10 days, after which a dose of 250 mg (4.5 mg/kg) was repeated on days 17,24,31, and 38. Twenty-four hours after the first dose of LAB, the patient showed an excellent clinical response. On the following days, there was a progressive increase in hemoglobin concentration and leukocyte and platelet counts. Three months later, the patient was asymptomatic.

Discussion

Although treatment with ABLC appears to be effective for the treatment of Indian patients with visceral leishmaniasis, experience with immunocompromised patients is limited. This is the first case of a renal transplant recipient in which ABLC was used to treat visceral leishmaniasis without remarkable efficacy, but with infusion-related adverse effects perhaps due to the use of higher doses.

Conclusions

A randomized comparative trial is needed to compare LAB with ABLC in the treatment of visceral leishmaniasis in patients who have received kidney allografts.