bluuebunny/crossref_metadata_2025 huggingface dataset:
Norwegian Approach to Private Internal Investigations: An Empirical Study of Mandates for Fraud Examiners
Authors: Gottschalk Petter
Published: November 2017

This article applies principal–agent relationship theory through an empirical study of private investigators’ mandates for fraud examiners in Norway. The business of private internal investigations by external fraud examiners has grown remarkably in the recent decades. Law firms and auditing firms are hired by private and public organizations to reconstruct the past when there is suspicion of misconduct and potential financial crime. Most reports of investigation are kept secret to the public and often also to the police, even when there is evidence of financial crime by white-collar criminals. For this study, we were able to identify and retrieve a total of 49 investigation reports in Norway for the 10-year period from 2006 to 2016. Reports are studied in terms of mandates defining the motive, purpose, scope, tasks, and goals. We find that mandates are deficient, thereby opening up for opportunistic behavior by both parties in the principal–agent relationship.
Treating Moderate-to-Severe Plaque Psoriasis With Guselkumab: A Review of Phase II and Phase III Trials
Authors: Howell Seth T. , Cardwell Leah A. , Feldman Steven R.
Published: November 2017

Objective: Guselkumab, an anti-interleukin-23 monoclonal antibody was recently approved for the treatment of patients with moderate-to-severe plaque psoriasis. This article will review the available phase II and phase III guselkumab clinical trial data. Data Sources: A PubMed search was conducted using the terms guselkumab, interleukin-23, psoriasis, adalimumab, and ustekinumab (January 2014 to August 2017). Study Selection and Data Extraction: Articles detailing the results of phase II and phase III clinical trials were selected for review. Data Synthesis: In 1 phase II and 2 phase III clinical trials, guselkumab was more effective than adalimumab and placebo in reducing Physician’s Global Assessment and Investigator Global Assessment (IGA) scores in those with moderate-to-severe plaque psoriasis. In a separate phase III trial, transitioning to guselkumab treatment was more effective than continued ustekinumab use in reducing IGA scores in those who were minimally responsive to ustekinumab ( P = 0.001). Trial results did not reveal specific patterns in adverse event (AE) incidence; the most commonly reported AEs were nasopharyngitis, headache, and upper-respiratory-tract infections. No increased incidence of malignancy, tuberculosis, or serious infections were observed with the use of guselkumab. Conclusions: Guselkumab appears to be a safe and effective option for the treatment of moderate-to-severe plaque psoriasis in patients who have been screened for susceptibility to infection and are candidates for systemic treatment or phototherapy. However, long-term safety data are lacking.
Revisiting Majority-Minority Districts and Black Representation
Authors: Hicks William D. , Klarner Carl E. , McKee Seth C. , Smith Daniel A.
Published: November 2017

What is the minimum black population necessary to elect African-American state lawmakers? We offer the most comprehensive examination of the election of black state legislators in the post- Thornburg v. Gingles (1986) era. We begin by charting changes in the partisan affiliation of state legislators and the percentage of black legislators from 1971 to 2016. This descriptive assessment is undertaken according to important regional (Non-South and South) and subregional (Rim South and Deep South) contexts in American politics. We then perform multivariate analyses of the likelihood of electing black legislators across three periods following the marked increase in the creation of majority-minority districts (1993–1995, 2003–2005, 2013–2015). Because of sectional variation in the partisan strength of the major parties, the probability of achieving black representation is significantly different depending upon whether a contest occurs in the Non-South, Rim South, or Deep South, with the latter constituting of the highest threshold of black population necessary to elect an African-American. By merging an original dataset on state legislative elections with the most complete evaluation of the factors shaping the election of black lawmakers, our findings shed new light on minority representation and how sectional differences greatly affect the electoral success of African-Americans.
Disagreeable Rhetoric and the Prospect of Public Opposition: Opinion Moderation on the U.S. Supreme Court
Authors: Wedeking Justin , Zilis Michael A.
Published: November 2017

Elite rhetoric is an important aspect of democracy, and understanding why elites alter their rhetorical tone is vital to understanding the nature of public–elite interaction. In this paper, we identify the conditions under which insulated elites respond to public opinion by changing the amount of disagreeable rhetoric they emphasize. We examine Supreme Court opinions and theorize that the majority limits the use of disagreeable rhetoric—language with harsh, unpleasant, or negative connotations—in salient cases with the intention of dulling public opposition to rulings. We test our expectations on two levels, the first using a broad measure of public mood on a large sample of cases and the second using a small sample with issue-specific public opinion measures. We find that as public opinion diverges from the Court, the majority tones down its disagreeable rhetoric, but only in salient cases.
Visual Information and Candidate Evaluations: The Influence of Feminine and Masculine Images on Support for Female Candidates
Authors: Bauer Nichole M. , Carpinella Colleen
Published: November 2017

Existing research debates the extent to which feminine and masculine stereotypes affect voters’ impressions of female candidates. Current approaches identify how descriptions of female candidates as having feminine or masculine qualities lead voters to rely on stereotypes. We argue that extant scholarship overlooks a critical source of stereotypic information about female candidates—the role of visual information. This manuscript explores the conditions under which voters use feminine and masculine visuals to evaluate female candidates. Drawing on theories of information processing and stereotype reliance, we develop a framework that explains when visual information will affect how voters evaluate female and male candidates. We argue that visual information that is incongruent with stereotypes about a candidate’s sex will affect candidate evaluations while visuals congruent with stereotypes about candidate sex will not. We test these dynamics with an original survey experiment. We find that gender incongruent masculine visuals negatively affect evaluations of a female candidate’s issue competencies and electoral viability.
Performance analysis of fully explicit and fully implicit solvers within a spectral element shallow-water atmosphere model
Authors: Evans Katherine J , Archibald Richard K , Gardner David J , Norman Matthew R , Taylor Mark A , Woodward Carol S , Worley Patrick H
Published: November 2017

Explicit Runge–Kutta methods and implicit multistep methods utilizing a Newton–Krylov nonlinear solver are evaluated for a range of configurations of the shallow-water dynamical core of the spectral element community atmosphere model to evaluate their computational performance. These configurations are designed to explore the attributes of each method under different but relevant model usage scenarios including varied spectral order within an element, static regional refinement, and scaling to the largest problem sizes. This analysis is performed within the shallow-water dynamical core option of a full climate model code base to enable a wealth of simulations for study, with the aim of informing solver development within the more complete hydrostatic dynamical core used for climate research. The limitations and benefits to using explicit versus implicit methods, with different parameters and settings, are discussed in light of the trade-offs with Message Passing Interface (MPI) communication and memory and their inherent efficiency bottlenecks. Given the performance behavior across the configurations analyzed here, the recommendation for future work using the implicit solvers is conditional based on scale separation and the stiffness of the problem. For the regionally refined configurations, the implicit method has about the same efficiency as the explicit method, without considering efficiency gains from a preconditioner. The potential for improvement using a preconditioner is greatest for higher spectral order configurations, where more work is shifted to the linear solver. Initial simulations with OpenACC directives to utilize a Graphics Processing Unit (GPU) when performing function evaluations show improvements locally, and that overall gains are possible with adjustments to data exchanges.
Avoidance and Delay of Medical Care in the Young
Authors: Montagni Ilaria , Langlois Emmanuel , Koman Jason , Petropoulos Margaux , Tzourio Christophe
Published: November 2017

Prompt and appropriate health-seeking behaviour among young people is a public health priority worldwide. However, data indicate that non-health-seeking behaviour is common among young adults who are particularly likely to avoid and delay medical care. Our study investigates this phenomenon through an interdisciplinary mixed-methods approach. Quantitative and qualitative data are presented from university students from 11 higher education institutions in the city of Bordeaux, France, for a total of 16 individual interviews and a questionnaire survey of 126 students. Results show that main reasons for non-health-seeking behaviour among students are: time constraints, lack of information on available health services and economic problems. The transitional period of university studies is a further justification of students’ difficulty in managing their medical care. Providing a clear picture of avoidance and delay of medical care (ADMC) and attached reasons was intended to explore strategies for promoting health-seeking behaviour in university students.
A Comparison of the Long-term Health Related Quality of Life and Handicap of Stroke Patients in Mainland China and Hong Kong
Authors: Kwok T , Jin X , Yeung F , Cheng J , Lo RSK , Lam CLK , Yuan HJ , Woo J
Published: November 2017

Purpose

To compare health related quality of life (HRQOL) and handicap of stroke survivors in Hong Kong (HK) and Chengdu (CD) in Mainland China.

Method

Fifty-four pairs of first ever stroke patients in CD and in HK matched by age, sex and Modified Barthel Index (MBI) were interviewed using a structured questionnaire at 16–36 months after stroke. HRQOL and handicap outcomes were evaluated by the Chinese version of the Short-Form Health Survey (SF-36) and London Handicap Scale (LHS) respectively.

Results

Compared to stroke patients in CD, HK subjects reported significantly greater handicap, especially in the occupation domain. HK subjects also had significantly lower HRQOL Z scores in domains of role limitations due to emotional or physical problems, and bodily pain. CD subjects had more social support, but had more difficulties in meeting medical costs, and were less likely to have regular medical follow-up and dysphagia symptom. After adjusting for social and health related factors, the site differences in handicap and the role limitation (physical) domain of SF36 became insignificant.

Conclusions

CD stroke survivors had better scores in HRQOL and fewer handicaps than their counterparts in HK, because of social and health related factors.
Assessing the Need for a Comprehensive Acne Quality-of-Life Scale for Face and Torso Acne
Authors: McLellan Chelsea , Frey Marc Philip , Tan Jerry
Published: November 2017

Purpose:

While acne, a common condition, largely involves the face, chest, and back, current acne quality-of-life measures focus primarily on facial acne. The purpose of this study was to assess the need for a comprehensive quality-of-life measure intended for use with patients who have facial and/or torso acne.

Methods:

We evaluated the need for a comprehensive quality-of-life scale for facial and torso acne based on data from an epidemiological survey (N = 690) in which participants were grouped according to the location of their acne (face, torso, or both) and where quality of life was assessed.

Results:

Analysis of variance results revealed that participants with acne on their torso reported the highest levels of quality of life while participants with acne on their face reported the lowest levels.

Conclusions:

There is a need for a quality-of-life instrument that assesses the impact of acne on the face and torso separately. This unmet need can be addressed with a comprehensive acne quality-of-life measure that is inclusive of torso acne.
The automated states, automated government, and self-automation of the ‘smart’ appliance: three questions about refrigerators
Authors: Hay James
Published: November 2017

This essay considers the automation of the everyday through ‘smart’ domestic appliance, specifically the current regime of smart refrigerators. The essay revisits and rethinks perspectives about media by McLuhan, focusing particularly on his discussion of clothing, cars, clocks, light bulbs, and highways as ‘media’. The essay outlines a critical practice (a ‘critical refrigerator studies’), as a means of rethinking ‘media power’, through perspectives by Foucault about technologies of government and through perspectives by Otter about Liberal objects.
Automating the digital everyday: an introduction
Authors: Burgess Jean , Mitchell Peta , Highfield Tim
Published: November 2017

This Special Issue brings together a range of social science and humanities perspectives on the relationships among automation, digital media and everyday life. We have aimed to get beyond the current hype and anxieties around self-driving cars, algorithms and robotics, and to achieve a more precise and grounded understanding of exactly what might be meant by automation, how and with what effects it is becoming entangled with everyday life and how investigating these relationships also helps us in understanding processes of media change in society more broadly.
Simplifying Logistics and Avoiding the Unnecessary in Patients With Breast Cancer Undergoing Sentinel Node Biopsy. A Prospective Feasibility Trial of the Preoperative Injection of Super Paramagnetic Iron Oxide Nanoparticles
Authors: Karakatsanis A. , Olofsson H. , Stålberg P. , Bergkvist L. , Abdsaleh S. , Wärnberg F.
Published: November 2017

Purpose:

Sentinel node is routinely localized with the intraoperative use of a radioactive tracer, involving challenging logistics. Super paramagnetic iron oxide nanoparticle is a non-radioactive tracer with comparable performance that could allow for preoperative localization, would simplify the procedure, and possibly be of value in axillary mapping before neoadjuvant treatment. The current trial aimed to determine the a priori hypothesis that the injection of super paramagnetic iron oxide nanoparticles in the preoperative period for the localization of the sentinel node is feasible.

Methods:

This is a prospective feasibility trial, conducted from 9 September 2014 to 22 October 2014 at Uppsala University Hospital. In all, 12 consecutive patients with primary breast cancer planned for resection of the primary and sentinel node biopsy were recruited. Super paramagnetic iron oxide nanoparticles were injected in the preoperative visit in the outpatient clinic. The radioactive tracer (99mTc) and the blue dye were injected perioperatively in standard fashion. A volunteer was injected with super paramagnetic iron oxide nanoparticles to follow the decline in the magnetic signal in the sentinel node over time. The primary outcome was successful sentinel node detection.

Results:

Super paramagnetic iron oxide nanoparticles’ detection after preoperative injection (3–15 days) was successful in all cases (100%). In the volunteer, axillary signal was presented for 4 weeks. No adverse effects were noted.

Conclusion and relevance:

Preoperative super paramagnetic iron oxide nanoparticles’ injection is feasible and leads to successful detection of the sentinel node. That may lead to simplified logistics as well as the identification, sampling, and marking of the sentinel node in patients planned for neoadjuvant treatment.
What are the costs of violence?
Authors: Hoeffler Anke
Published: November 2017

This article presents estimates of the global cost of collective and interpersonal violence for the period of one year. This includes war, terrorism, homicides, assaults and domestic violence against women and children. The cost of conventionally defined interpersonal violence, that is, homicides and assault, are about 7.5 times higher than the cost due to war and terrorism. I also estimate the costs of non-fatal domestic violence against children and women and suggest that these costs are much higher than the combined costs of homicide, assault, terrorism and war. The main reason is that the prevalence of these types of violence is very high: possibly as many as 16 per cent of all children are punished using violent methods and about 12 per cent of all women experience intimate partner violence. Richer societies have lower levels of violence, and there is evidence that prevalence rates have been declining over time. However, it is often unclear why this is the case. Much of the evidence from violence reducing interventions comes from high-income countries, and it is uncertain whether these programs would be similarly effective in low- and middle-income countries. However, although further research is needed to examine the effectiveness of violence-reducing interventions, it appears likely that some interventions would constitute a very effective use of resources.
Dynamic response of a wedge through asymmetric free fall in 2 degrees of freedom
Authors: Ghadimi Parviz , Tavakoli Sasan , Dashtimanesh Abbas , Taghikhani Pouria
Published: November 2017

In this article, a mathematical model is presented for simulation of the coupled roll and heave motions of the asymmetric impact of a two-dimensional wedge body. This model is developed based on the added mass theory and momentum variation. To this end, new formulations are introduced which are related to the added mass caused by heave and roll motions of the wedge. These relations are developed by including the asymmetrical effects and roll speed. In addition, by considering the roll speed, a particular method is presented for the time derivative of half-wetted beam of an asymmetric wedge. Furthermore, two equations are derived for the roll and heave motions in which damping terms appear. Validity of the proposed method is verified by comparing the predicted results against available experimental data in two conditions of roll motion and no roll motion. Favorable agreement is observed between the predicted results and experimental data. The pressure and hydrodynamic load are computed, and the differences between the results associated with the considered conditions are explored. Subsequently, the effects of different physical parameters including deadrise angle, initial roll angle, and initial velocity on the dynamic response of a two-dimensional wedge section are investigated. Ultimately, time histories of hydrodynamic coefficients are determined in order to provide a better understanding of the derived equations.
A study on an up-milling rock crushing tool operation of an underwater tracked vehicle
Authors: Vu Mai The , Choi Hyeung-Sik , Ji Dae Hyeong , Jeong Sang-Ki , Kim Joon-Young
Published: November 2017

In this article, we develop the analysis of a new underwater tracked vehicle with rock crushing tool, working under the water. To design the capacity of the underwater tracked vehicle actuator and the rock crushing tool actuator, we analyze the interaction forces and torque between the rock and the rock crushing tool. Since experiments on the underwater tracked vehicle with a rock crushing tool are very difficult, costly, time-consuming, we first perform a mathematical modeling of the underwater tracked vehicle with the rock crushing tool. We analyze the mechanics of the underwater tracked vehicle system that is affected by the forces and moments of the underwater rock crushing, where the force and torque on the rock crushing tool are based on the analysis of the mechanics of an individual cutter tool. We derive a mathematical expression for the forces and moments of the combined system on the underwater tracked vehicle and the rock crushing tool for rock crushing. For this, we study the parameters that affect the mechanics of the underwater tracked vehicle system with the rock crushing tool. To apply the rock crushing tool to underwater rock excavation, we also study the hydrostatic effects to the combined underwater tracked vehicle system with the rock crushing tool. To design the capacity of the actuator of the developing underwater tracked vehicle and the rock crushing tool, we analyze the required tractive or down thrust forces, and the torque to the rotor carriage caused by the cutting system. In addition, we analyze the energy and the power for the rock crushing tool actuator related to the tool characteristics. To support the validity of the analyses, we use the derived equations to perform a number of numerical simulations.
Multiway principal component analysis contributions for structural damage localization
Authors: Ruiz Magda , Mujica Luis Eduardo , Sierra Julián , Pozo Francesc , Rodellar José
Published: November 2017

In this article, a novel methodology for damage localization is introduced. The approach is based on a multiactuator system. This means that the system itself has the ability of both exciting the specimen and measuring its response at different points in a pitch-catch mode. Once one of its actuators excites the specimen, the damage affects the normal travel of the guided wave, and this change is mainly detected by sensors in the direct route to the excitation point. In previous works by the authors, it can be observed that the progression using data-driven statistical models (multivariable analysis based on principal component analysis) of all recorded signals to determine whether the damage is present. However, the main contribution of this article is the demonstration of the possibility of localizing damages by analyzing the contribution of each sensor to this index which have detected it ( T2-statistic and Q-statistic). The proposed methodology has been applied and validated on an aircraft turbine blade. The results indicate that the presented methodology is able to accurately locate damages, analyzing the record signals from all actuation phases and giving a unique and reliable region.
‘I’d say it’s around me’: Introducing field analysis into bouncer ethnography – the case of a Czech city
Authors: Kupka Petr , Šmíd Tomáš , Walach Václav
Published: November 2017

Bouncers have recently attracted the interest of criminologists, some of whom have utilized Pierre Bourdieu’s concepts to grasp the sociocultural realities of bouncing. The present study continues this line of enquiry, aiming to demonstrate that bouncer ethnography will benefit from yet another of Bourdieu’s concepts, that of the field. A study of bouncers in a Czech city is utilized to argue that (1) field analysis is a valuable analytical framework for ethnographic research in this context, (2) it allows relationships both among bouncers and between them and other relevant agents to be explored, (3) it has the potential to investigate these relationships without criminalizing them, and (4) it provides a framework for comparative studies of bouncing in different contexts.
Management of a Rare Case With Severe Hydrofluoric Acid Burns: Important Roles of Neutralizers and Continuous Renal Replacement Therapy
Authors: Zhang Yuanhai , Wang Xingang , Liu Yuezhen , Jiang Xinhua , Ye Chunjiang , Ni Liangfang , Zhang Liping , Zhang Jianfen , Xu Bin , Han Chunmao
Published: November 2017

Hydrofluoric acid (HF), a dangerous inorganic acid, is widely used in various industries and in daily life. Chemical burns caused by HF exposure occur more frequently in some regions worldwide. It has been reported that some cases with HF burns can be lethal due to the hypertoxicity of HF. In this article, we present a case of a 24-year-old worker who suffered HF burns by 53% HF solution to his face, neck, and nasal cavity. This patient quickly developed electrolyte disturbance, that is, hypocalcemia, and hypopotassemia, and myocardial injury after exposure. Multiple measures had been taken to treat this patient, including fluid resuscitation, electrolyte replacement, timely wound treatment with neutralizers, and respiratory tract care. Moreover, continuous renal replacement therapy was also employed to remove fluoride in the circulatory system and rectify the electrolyte disturbance and acid-base imbalance. The patient smoothly pulled though and survived. High fluoride levels in the dialysate solution were confirmed, indicating that continuous renal replacement therapy is an effective and potentially lifesaving treatment for acute HF poisoning.
Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction
Authors: Bahk Sujin , Doh GyeongHyeon , Hong Ki Yong , Lim SooA , Eo SuRak
Published: November 2017

Reconstruction of soft tissue defects in the foot remains a challenge due to its specialized tissue for weightbearing and ambulation. Considering the principle of replacing “like with like,” adjacent soft tissues would be a best option for a donor site. Although several kinds of reverse-flow island flaps for the lower leg have been well described, intrinsic foot reverse flow flaps have been rarely reported. We describe 3 kinds of reverse-flow intrinsic fasciocutaneous flaps (RIFFs) for foot reconstruction. From September 2012 to August 2015, a retrospective study was done on case notes of all patients who had a RIFF for coverage of soft tissue defects within the foot following trauma or tumor ablation. A total of 7 patients were included in this study, with an average of 5 × 3.5 cm sized defects in the forefoot, second and third web space, and sole, which were reconstructed with RIFF. All flaps were well perfused and recovered excellent function of the foot with satisfactory aesthetics and minimal limitations in range of motion. However, one case showed a complication of venous congestion, due to remnant scar tissues, which resolved after medical leech application. Donor defects healed completely with split thickness skin grafting in all cases. Soft tissue defects within the foot were repaired successfully by RIFF. In spite of its technical challenges, it is a reliable one-stage procedure requiring no microsurgical anastomosis. Precise vascular evaluation of the reverse inflow has to be preceded for satisfactory outcome of RIFF.
Development of the Spanish Language Houston Pain Outcome Instrument for Spanish Speakers
Authors: McNeill Jeanette , Sherwood Gwen
Published: November 2017

Purpose:

To address reported disparities in pain management among Hispanic patients, this article reports the psychometrics of the newly developed Spanish language Houston Pain Outcome Instrument (HPOI) with postoperative Hispanic patients.

Methods:

Findings from qualitative interviews conducted with 35 self-identified Hispanics in Phase 1 of the overall project were used to generate items for a new Spanish language instrument, Cuestionario de Houston Sobre el Dolor (HPOI). The second phase tested the psychometric properties with 95 self-identified Hispanic postoperative inpatients in three Texas hospitals.

Results:

HPOI subscale reliabilities ranged from .63 to .91, with similar reliabilities for Spanish and English versions. Concurrent validity was demonstrated by moderate significant correlations with similar items on the Brief Pain Inventory. Participants reported moderate and severe worst pain in the last 24 hours; 38% were undertreated for pain according to the Pain Management Index; and 75% reported nonpharmacologic strategies including family support, prayer, and position change as highly effective in managing pain.

Conclusions:

The HPOI is a reliable instrument for addressing disparities in pain management for the rapidly growing Hispanic population in the United States. Subscales for interference with mood and physical function and patient-reported nonpharmacologic strategies facilitate a more comprehensive assessment of the pain experience.
A New Civil Rights Campaign? Policies and Practices to Support Students’ Gender Diversity
Authors: Barnard Janalee , Goodrich Kristopher M. , Borden Allison M.
Published: November 2017

Ms. Barnard is faced with a complex dilemma. The district administrator in charge of lesbian, gay, bisexual, and transgender (LGBT) initiatives and support was presented with a case of a transgender student who wished to attend an overnight field trip and share a room with other students based on her gender identity. Although the district had made previous headway in formatting district policies to fit the needs of transgender students, no procedural directive was available to respond to this new situation. In addition, the superintendent of the district was unsupportive of transgender students. The case was developed for an educational leadership course so that students can discuss the legal issues, role and value conflicts, and theoretical perspective informing policy and practice.
Research ethics, informed consent and the disempowerment of First Nation peoples
Authors: Tauri Juan M
Published: November 2017

Recently, Indigenous commentators have begun to analyse the way in which institutional Research Ethics Boards (REBs) engage with Indigenous researchers and participants, respond to Indigenous peoples’ concerns with academic research activities, and scrutinise the ethics proposals of Indigenous scholars. Of particular concern for Indigenous commentators is that the work of REBs often results in the marginalisation of Indigenous approaches to knowledge construction and dissemination, especially in relation to the vexed issue of informed consent. Based on analysis of the results of research with Indigenous researchers and research participants, this paper argues that institutionalised REBs’ preference for ‘universal’ and ‘individualised’ approaches for determining ethical research conduct marginalises Indigenous approaches to ethical research conduct. The paper concludes by calling for a decolonisation of REB processes through recognition of the validity of communal processes for attaining the informed consent of Indigenous research participants.
Overcoming ethical barriers to research
Authors: Machin Helen E , Shardlow Steven M
Published: November 2017

Researchers engaged in studies about ‘hidden social groups’ are likely to face several ethical challenges. Using a study with undocumented Chinese migrants in the UK, challenges involved in obtaining approval by a university research ethics committee are explored. General guidance about how to resolve potential research ethics issues, with particular reference to ‘hidden social groups’, prior to submission to a research ethics committee is presented.
Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study
Authors: Purvis Tara , Kilkenny Monique F , Middleton Sandy , Cadilhac Dominique A
Published: November 2017

Background

Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital.

Aim

To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units.

Methods

Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons.

Results

A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator ( N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator ( N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03).

Conclusion

Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.
Cerebral amyloid angiopathy associated with inflammation: A systematic review of clinical and imaging features and outcome
Authors: Corovic Andrej , Kelly Siobhan , Markus Hugh S
Published: November 2017

Background

Cerebral amyloid angiopathy associated with inflammation is an increasingly recognized condition, characterized by an inflammatory response to the vascular deposits of β-amyloid within the brain that are the hallmark of cerebral amyloid angiopathy. Two main patterns of this inflammatory response have been identified to date: one involving a perivascular inflammatory cell infiltrate (cerebral amyloid angiopathy-related inflammation); the other a transmural vasculitic process (A-beta related angiitis). Unlike cerebral amyloid angiopathy itself, which predisposes to intracerebral hemorrhage and has no known treatment, cerebral amyloid angiopathy associated with inflammation typically presents in diverse ways and diagnosis may be challenging and delayed.

Aims

We sought to summarize the clinical features, imaging appearances and available data on outcome and treatment responses, using information derived from a systematic review of pathologically proven cases of cerebral amyloid angiopathy associated with inflammation.

Summary of review

We identified 213 distinct pathologically proven cases of cerebral amyloid angiopathy-related inflammation/A-beta related angiitis, from 104 publications. The clinical presentation, imaging features, pathology, treatment, and outcomes of cerebral amyloid angiopathy associated with inflammation are described.

Conclusions

Cerebral amyloid angiopathy associated with inflammation is an important and increasingly recognized clinical condition, which affects the older patient population and presents most commonly with cognitive decline, seizures, and headaches. Future research is required to develop and validate diagnostic criteria and determine optimum treatment strategies.
Effects of SSRI exposure on hemorrhagic complications and outcome following thrombolysis in ischemic stroke
Authors: Schellen Christoph , Ferrari Julia , Lang Wilfried , Sykora Marek
Published: November 2017

Background

Selective serotonin reuptake inhibitors (SSRI) may interfere with platelet function, and pre-stroke SSRI treatment has been associated with increased hematoma volumes and mortality in hemorrhagic stroke patients. The effects of SSRI on the risk of hemorrhagic complications after thrombolysis in ischemic stroke patients are unclear.

Aims

To examine the effects of pre-stroke SSRI exposure on bleeding complications, functional outcome, and mortality following thrombolysis in ischemic stroke.

Methods

Data including standard demographic and clinical variables as well as baseline and follow-up stroke severity (measured by National Institutes of Health Stroke Score), functional outcome (measured by modified Rankin Scale) at 3 months, and mortality at 7 and 90 days were extracted from the Virtual International Stroke Trials Archive. Multivariable binary logistic regression was used for statistical analyses.

Results

Out of 1114 ischemic stroke patients treated with recombinant tissue-type plasminogen activator, 135 (12.1%) had previous SSRI exposure. Symptomatic intracranial hemorrhage occurred in 30 (2.7%) patients. Of those, 2 (1.5%, n = 135) were in the SSRI pretreatment group and 28 (2.9%, n = 979) were SSRI naive patients. Pre-stroke SSRI exposure in thrombolysed patients showed association with neither bleeding complications ( P = .58) nor functional outcome ( P = .38) nor mortality ( P = .65).

Conclusions

Results from this large retrospective ad hoc database cohort study indicate that pre-stroke SSRI exposure in ischemic stroke patients who receive thrombolytic treatment is not associated with bleeding complications, functional outcome, or mortality.
Gubernatorial debate sessions in Nigeria: A socio-cognitive analysis
Authors: Kupolati Oluwateniola Oluwabukola , Boluwaduro Eniola
Published: November 2017

This article adopts Benoit’s functional theory of campaign discourse and Van Dijk’s socio-cognitive theory (context models) in discussing two gubernatorial debate sessions in Nigeria. The selected debate sessions (Ondo Governorship Debate and Lagos Governorship Debate) are recovered from YouTube files and transcribed. However, only utterances from candidates in the two major political parties in Nigeria, namely, Action Congress of Nigeria (ACN) (now renamed All Progressives Congress (APC)) and the People’s Democratic Party (PDP), are subjected to content analysis. Context models in the aspects of discourse meaning and argumentation are also considered. Findings reveal that first, candidates’ utterances range from acclaims to attacks and defenses. Second, topics help to derive candidates’ ideologies which are further exemplified within the ambience of shared background knowledge (presupposition). Finally, candidates adopt legal/illegal jargons, explanations, statements of evidence, examples and illustrations to explicitly exemplify their mental dispositions and beliefs. We conclude by stating that candidates’ utterances were found to be relevant within the context of the debates and, by extension, the prevalent socio-political problems in Nigeria.
Liquifying PLDLLA Anchor Fixation in Achilles Reconstruction for Insertional Tendinopathy
Authors: Boden Stephanie A. , Boden Allison L. , Mignemi Danielle , Bariteau Jason T.
Published: November 2017

Insertional Achilles tendinopathy (IAT) is a frequent cause of posterior heel pain and is often associated with Haglund’s deformity. Surgical correction for refractory cases of IAT has been well studied; however, the method of tendon fixation to bone in these procedures remains controversial, and to date, no standard technique has been identified for tendon fixation in these surgeries. Often, after Haglund’s resection, there is large exposed cancellous surface for Achilles reattachment, which may require unique fixation to optimize outcomes. Previous studies have consistently demonstrated improved patient outcomes after Achilles tendon reconstruction with early rehabilitation with protected weight bearing, evidencing the need for a strong and stable anchoring of the Achilles tendon that allows early weight bearing without tendon morbidity. In this report, we highlight the design, biomechanics, and surgical technique of Achilles tendon reconstruction with Haglund’s deformity using a novel technique that utilizes ultrasonic energy to liquefy the suture anchor, allowing it to incorporate into surrounding bone. Biomechanical studies have demonstrated superior strength of the suture anchor utilizing this novel technique as compared with prior techniques. However, future research is needed to ensure that outcomes of this technique are favorable when compared with outcomes using traditional suture anchoring methods.

Levels of Evidence: Level V: Operative technique
Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis
Authors: Reardon David C , Thorp John M
Published: November 2017

Objectives:

Measures of pregnancy associated deaths provide important guidance for public health initiatives. Record linkage studies have significantly improved identification of deaths associated with childbirth but relatively few have also examined deaths associated with pregnancy loss even though higher rates of maternal death have been associated with the latter. Following PRISMA guidelines we undertook a systematic review of record linkage studies examining the relative mortality risks associated with pregnancy loss to develop a narrative synthesis, a meta-analysis, and to identify research opportunities.

Methods:

MEDLINE and SCOPUS were searched in July 2015 using combinations of: mortality, maternal death, record linkage, linked records, pregnancy associated mortality, and pregnancy associated death to identify papers using linkage of death certificates to independent records identifying pregnancy outcomes. Additional studies were identified by examining all citations for relevant studies.

Results:

Of 989 studies, 11 studies from three countries reported mortality rates associated with termination of pregnancy, miscarriage or failed pregnancy. Within a year of their pregnancy outcomes, women experiencing a pregnancy loss are over twice as likely to die compared to women giving birth. The heightened risk is apparent within 180 days and remains elevated for many years. There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors.

Conclusions:

Both miscarriage and termination of pregnancy are markers for reduced life expectancy. This association should inform research and new public health initiatives including screening and interventions for patients exhibiting known risk factors.
The heart matters in diabetes: 10-Year outcomes of peripheral artery disease
Authors: Mueller Thomas , Hinterreiter Franz , Poelz Werner , Haltmayer Meinhard , Dieplinger Benjamin
Published: November 2017

Objectives:

Mortality rates at 10 years are higher in diabetic patients with chronic lower extremity peripheral arterial disease than in non-diabetic peripheral arterial disease patients. We tested the hypothesis that the predictors of mortality differ between diabetic and non-diabetic peripheral arterial disease patients.

Methods:

We studied 331 consecutive patients who were <75 years of age, symptomatic for peripheral arterial disease, and admitted to a tertiary care hospital. Our cohort included 216 patients without diabetes mellitus and 115 with diabetes mellitus. The outcome measure was all-cause mortality at 10 years post-admission.

Results:

Mortality rates at 10 years were 29% among non-diabetic peripheral arterial disease patients and 58% among diabetic peripheral arterial disease patients. We identified the following independent predictors of death in the 216 peripheral arterial disease patients without diabetes: age ≥65 years (risk ratio: 2.15; 95% confidence interval: 1.28–3.59), ankle brachial index <0.60 mmHg/mmHg (risk ratio: 1.88; 95% confidence interval: 1.14–3.08), history of peripheral arterial disease-specific intervention (risk ratio: 1.81; 95% confidence interval: 1.10–2.97), and high-sensitivity C-reactive protein ≥5.0 mg/L (risk ratio: 2.11; 95% confidence interval: 1.28–3.47). For the 115 peripheral arterial disease patients with diabetes, independent predictors of mortality were as follows: age ≥65 years (risk ratio: 1.72; 95% confidence interval: 1.05–2.83) and amino-terminal pro-B-type natriuretic peptide ≥125 ng/L (risk ratio: 2.10; 95% confidence interval: 1.22–3.60).

Conclusion:

In this study, the predictors of death at 10 years differed between peripheral arterial disease patients with and without diabetes. Among the biomarkers tested, high-sensitivity C-reactive protein was independently associated with outcomes in non-diabetic patients, whereas amino-terminal pro-B-type natriuretic peptide was an independent predictor of death in patients with diabetes. Our findings suggest that in future studies, risk assessment and treatment strategies should be differentially applied to the two peripheral arterial disease subgroups.
A retrospective epidemiologic study to define risk factors, microbiology, and clinical outcomes of infective endocarditis in a large tertiary-care teaching hospital
Authors: Mostaghim Anahita S , Lo Hoi Yee Annie , Khardori Nancy
Published: November 2017

Objective:

This study aims to define risk factors as well as their association with microbiology and clinical outcomes in a large US infective endocarditis population.

Methods:

Hospital records were searched for appropriate infective endocarditis–related ICD codes from 16 July 2007 to 13 August 2015. A total of 363 cases were retrospectively identified that met definite Modified Duke Criteria for infective endocarditis and were analyzed by age group, causative organism, and associated risk factors for use of valvular surgical intervention, 30/90/180-day mortality after admission, and embolic phenomena.

Results:

Chronic hemodialysis was the most common risk factor (26.7% of cases). Of all age groups, those aged 78+ years had the lowest 30-day mortality but those aged 58–77 years had the highest mortality (p = 0.039). Staphylococcus aureus was the most prevalent causative organism. Those aged 78–97 years were more likely to have enterococcal infective endocarditis than those aged 18–27 years (p = 0.0144). Chronic hemodialysis associated infective endocarditis was more likely to be caused by coagulase-negative staphylococcus (p = 0.0121) and have a higher 30-day mortality (p = 0.141) than intravenous drug use associated infective endocarditis. Intravenous drug use and chronic hemodialysis were similarly likely to be caused by S. aureus. Intravenous drug use associated infective endocarditis was more likely to be caused by viridans group streptococci (p = 0.0001). Fungal infective endocarditis was most likely to embolize. Chronic hemodialysis patients were less likely to undergo valvular surgery (p = 0.001) and those with chronic hemodialysis who did had lower mortality than those only managed medically that did not reach statistical significance (p = 0.2991). Infective endocarditis caused by coagulase-negative staphylococci had the greatest 30-day mortality at 31.3% but did not reach statistical significance over all other causative organisms (p = 0.060).

Conclusion:

In our infective endocarditis population, S. aureus is the predominant causative organism. Chronic hemodialysis is the most common risk factor present in infective endocarditis populations and has greater association with coagulase-negative staphylococci and 30-day mortality. Intravenous drug use had the lowest mortality among risk factors with a similar proportion of S. aureus infective endocarditis compared to chronic hemodialysis but a higher proportion of viridans group streptococci infective endocarditis cases. Further study will need to be performed on prevention and treatment of infective endocarditis in chronic hemodialysis patients.