bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of storage conditions on the calorific value of municipal solid waste
Authors: Nzioka Antony Mutua , Hwang Hyeon-Uk , Kim Myung-Gyun , Yan Cao Zheng , Lee Chang-Soo , Kim Young-Ju
Published: June 2017

Storage conditions are considered to be an important factor as far as waste material characteristics are concerned. This experimental investigation was conducted using municipal solid waste (MSW) with a high moisture content and varying composition of organic waste. The objective of this study was to understand the effect of storage conditions and temperature on the moisture content and calorific value of the waste. Samples were subjected to two different storage conditions and investigated at specified temperatures. The composition of sample materials investigated was varied for each storage condition and temperature respectively. Gross calorific value was determined experimentally while net calorific value was calculated using empirical formulas proposed by other researchers. Results showed minimal changes in moisture content as well as in gross and net calorific values when the samples were subjected to sealed storage conditions. Moisture content reduced due to the ventilation process and the rate of moisture removal increased with a rise in storage temperature. As expected, rate of moisture removal had a positive effect on gross and net calorific values. Net calorific values also increased at varying rates with a simultaneous decrease in moisture content. Experimental investigation showed the effectiveness of ventilation in improving the combustion characteristics of the waste.
Access to Qualified Special Educators Across Elementary Neighborhood and Exclusionary Schools
Authors: Mason-Williams Loretta , Bettini Elizabeth , Gagnon Joseph Calvin
Published: June 2017

In this study, we investigate the distribution of qualified special educators across elementary neighborhood schools and exclusionary public and private special education schools. Using the 2011–2012 Schools and Staffing Survey, we provide a descriptive analysis of measurable teacher qualifications (e.g., years of experience, preparation type, degree, formal preparation, certification) across the three settings of interest. Findings indicate that each type of school relies heavily on special educators who lack qualifications in special education. Furthermore, special educators in neighborhood schools were statistically significantly more qualified in terms of experience, degrees, and special education certification than special educators in public and private exclusionary special education schools. These findings have important implications for policy makers, school leaders, and researchers.
Medical Leeches for the Salvage of a Nipple Areola Complex
Authors: Spera Carlos
Published: June 2017

Introduction:

A breast lift combined with the insertion of breast implants is a popular surgery in the United States. The volume added by the implant increases the pressure and tension on the breast tissues. Difficulties with venous drainage of the transposed nipple areola complex (NAC) can result in the catastrophic partial or total necrosis of these structures. Draining or removing the stagnating blood from the capillary system will improve the microcirculation and avoid further complications (ie, NAC necrosis).

Materials and Methods:

A breast lift/reduction with concomitant insertion of breast implants in a 39-year-old female was performed without intraoperative complications. The patient was seen for follow-up the next morning. The left breast NAC showed a remarkable bluish discoloration. The diagnosis of venous congestion was obvious. Medicinal leeches were applied to the left NAC. Treatment with the leeches was repeated every 12 hours for 2 days.

Results:

The areola became pink and matched the color of the unaffected side. There was no tissue necrosis and healing was exactly the same as for the right breast. No treatment complications developed.

Conclusions:

NAC necrosis is not uncommon after breast surgery. This problem is undoubtedly a compromise of the venous return. If any doubt arises after this surgery, leech therapy should be performed to decrease the chances of this catastrophic complication.
Bifurcated Inferior Pedicle with a Bucket-Handle Pectoralis Flap to Enhance Superior Pole Fullness in Breast-Reduction Surgery
Authors: Sumpter Kristi , Gershenbaum Sam , Cartwright Mont J.
Published: June 2017

Introduction:

Breast-reduction surgery utilizing the inferior pedicle technique is popular among breast surgeons because of its reliable areolar neurovascular preservation qualities. Although smaller, more elevated breast mounds are achieved, one shortcoming is persistent or recurrent glandular ptosis with loss of superior pole fullness (bottoming-out). A modification of the inferior pedicle technique is presented, which enhances and maintains the aesthetically desired bulk in the superior pole of the breast.

Methods:

After creating an inferior pedicle with a generous base width, a superior portion of the pedicle is incompletely bifurcated. The superior section of bifurcated inferior pedicle is secured superiorly high on the pectoralis fascia after passing it through a bipedicle (bucket-handle) flap of pectoralis major muscle.

Result:

The support afforded by the pectoralis flap to the superior section of this bifurcated inferior pedicle helps maintain the position of the superiorly placed breast parenchyma. This provides long-term superior pole fullness.

Discussion:

The modification is safe, and surgeons who are comfortable with the inferior pedicle technique should master it easily. The technique and surgical results are presented.
Shifting Sexual Assault Forensic Examiners Orientation From Prosecutorial to Patient-Centered: The Role of Training
Authors: Patterson Debra , Pennefather Megan , Donoghue Kathleen
Published: June 2017

Sexual assault forensic examiners (SAFEs) have a complex role that entails providing health care and medical forensic evidence collection. The literature indicates that there are two orientations that guide SAFEs in this role. A patient-centered orientation emphasizes attending to emotional needs, offering options, and respecting survivors’ decisions, which has been linked to positive emotional outcomes. A prosecutorial orientation places emphasis on evidence collection and has been associated with providing fewer comprehensive services. SAFE training may play a pivotal role in guiding new SAFEs to adopt a patient-centered orientation. However, there is a paucity of research examining how training can bolster the adoption of this orientation. Thus, the current qualitative study explored if and how a national blended SAFE training influenced participants’ adoption of a patient-centered orientation. Semistructured qualitative interviews were conducted with 64 health care professionals who participated in a national SAFE training. Utilizing analytic induction, the results suggest that the majority of participants entered the training with a prosecutorial orientation but shifted to a patient-centered orientation. Multiple elements of the training influenced this shift including (a) content that dispelled misconceptions of survivors; (b) providing explanations of how attending to survivors’ well-being can lead to positive outcomes; (c) earlier placement of patient-centered content to allow instructors to explain how patient-centered care can be applied to each component of the SAFE role including the medical forensic exam; and (d) continual emphasis on patient-centered care.
A resource-oriented middleware in a prototype cyber-physical manufacturing system
Authors: Liu Chao , Jiang Pingyu , Zhang Chaoyang
Published: June 2017

The interconnection among heterogeneous sensors and data acquisition equipment in cyber-physical systems have profound significance in achieving adaptability, flexibility, and transparency. Various middlewares have been developed in cyber-physical systems to collect, aggregate, correlate, and translate system monitoring data. Existing middleware solutions are normally highly customized, which face several challenges due to the highly dynamic and harsh production environments. The data generated by sensors can only be shared by specific applications, which prevents the reusability of sensors. Moreover, the lack of uniform access to sensors causes high cost and low efficiency in application development. To address these issues, a resource-oriented middleware architecture called ROMiddleware was proposed, and three key enabling technologies including heterogeneous sensor modeling and grouping, open application programming interfaces development, and token-based access right control mechanism have been developed. Under the guidance of the key enabling technologies, a prototype of ROMiddleware was implemented and its performance was evaluated. Finally, two applications were developed to stress the significance of ROMiddleware. The results show that ROMiddleware can meet the requirements of data acquisition in cyber-physical systems.
Constellation design for responsive visiting based on ground track adjustment
Authors: Yu Xiang , Liu Kun , Chen Qifeng
Published: June 2017

Many responsive civilian or military space missions require that a certain ground site of interest be visited in a fairly short period (e.g., 12 h or less). To this end, a constellation must be utilized, since a single satellite is usually unable to fulfill such a task if the ground site is selected on the whole terrestrial surface responding to random user requirements. In this paper, the design approaches of such a constellation for responsive visiting based on ground track adjustment are investigated. By using the difference in orbit period between the maneuvered satellite and the reference satellite to make the ground track shift, reachable domain belts are generated. In terms of orbit maneuvering, two- and one-impulse maneuvers are analyzed and compared. Based on the reachable domain belts of a single satellite, two constellation design methods are proposed. The first one is an analytical method which is presented to achieve global reach and implemented by uniformly splicing together the widest belts of all satellites within the range of [0°, 180°]. The second one is an optimized method proposed to further reduce the number of satellites, by splicing together all the reachable domain belts rather than only the widest belts in the equator. A hybrid algorithm that consists of the genetic algorithm and the pattern search algorithm is proposed to minimize the number of satellites. Numerical examples are provided to illustrate the two proposed constellation design methods and validate the global reach performance.
Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy
Authors: Khuyagbaatar Batbayar , Kim Kyungsoo , Park Won Man , Lee SuKyoung , Kim Yoon Hyuk
Published: June 2017

Myelopathy in the cervical spine due to cervical ossification of the posterior longitudinal ligament could be induced by static compression and/or dynamic factors. It has been suggested that dynamic factors need to be considered when planning and performing the decompression surgery on patients with the ossification of the posterior longitudinal ligament. A finite element model of the C2–C7 cervical spine in the neutral position was developed and used to generate flexion and extension of the cervical spine. The segmental ossification of the posterior longitudinal ligament on the C5 was assumed, and laminectomy was performed on C4–C6 according to a conventional surgical technique. For various occupying ratios of the ossified ligament between 20% and 60%, von-Mises stresses, maximum principal strains in the spinal cord, and cross-sectional area of the cord were investigated in the pre-operative and laminectomy models under flexion, neutral position, and extension. The results were consistent with previous experimental and computational studies in terms of stress, strain, and cross-sectional area. Flexion leads to higher stresses and strains in the cord than the neutral position and extension, even after decompression surgery. These higher stresses and strains might be generated by residual compression occurring at the segment with the ossification of the posterior longitudinal ligament. This study provides fundamental information under different neck positions regarding biomechanical characteristics of the spinal cord in cervical ossification of the posterior longitudinal ligament.
An evaluation of the SD Bioline HIV/syphilis duo test
Authors: Holden Jeffrey , Goheen Joshua , Jett-Goheen Mary , Barnes Mathilda , Hsieh Yu-Hsiang , Gaydos Charlotte A
Published: June 2017

Many health agencies now recommend routine HIV and syphilis testing for pregnant women and most-at-risk populations such as men who have sex with men. With the increased availability of highly sensitive, low cost rapid point-of-care tests, the ability to meet those recommendations has increased, granting wider access to quick and accurate diagnoses. Using blood specimens collected from a Baltimore City Health Department (BCHD) sexually transmitted infection clinic, we evaluated the SD Bioline HIV/Syphilis Duo, a rapid test that simultaneously detects antibodies to HIV and syphilis and has the potential to further benefit clinics and patients by reducing costs, testing complexity, and patient wait times. SD DUO HIV sensitivity and specificity, when compared to BCHD results, were 91.7 and 99.5%, respectively. SD DUO syphilis sensitivity and specificity, when compared to rapid plasma reagin, were 85.7 and 96.8%, respectively, and 69.7 and 99.7%, respectively, when compared to Treponema pallidum particle agglutination (TPPA). SD DUO syphilis sensitivity and specificity, when compared to a traditional screening algorithm, improved to 92.3 and 100%, respectively, and improved to 72.9 and 99.7%, respectively, when compared to a reverse screening algorithm. The HIV component of the SD DUO performed moderately well. However, results for the SD DUO syphilis component, when compared to TPPA, support the need for further testing and assessment.
In-cylinder heat transfer and gas motion of a free-piston diesel engine generator
Authors: Yuan Chenheng , Xu Jing , Feng Huihua
Published: June 2017

The free-piston engine generator is an attractive alternative to the conventional reciprocating engine due to the feature that it moves without crankshaft system. This paper presented a simulation for the investigation on the characteristic of in-cylinder gas motion and heat transfer in a compression ignited free-piston engine generator. An operation experiment was performed to obtain the precise piston motion for the modeling of heat transfer and gas flow. The development of the multi-dimensional model was described, and simulation results were presented and showed good similarity with the experimental data. Then, the heat transfer and gas motion in the free-piston engine generator were discussed, on which the influences of piston motion were also investigated compared with a corresponding conventional reciprocating engine. The results indicated that compared with the conventional reciprocating engine, a higher level of squish and reverse squish effect was found for the free-piston engine generator due to its faster motion around top dead center, while its slower piston motion led to weaker gas turbulence in the compression process. Moreover, the free-piston engine generator and conventional reciprocating engine did not show a significant difference in heat transfer during the compression process, however, an obvious advantage of heat transfer was indicated for the free-piston engine generator in combustion and expansion processes due to its lower combustion temperature and the reduced time that is available for heat transfer caused by its faster expansion. The mechanism for such differences is that the free-piston engine generator moves with uneven equivalent speed.
Evidence of Holocene climatic change and human impact in northwestern Yunnan Province: High-resolution pollen and charcoal records from Chenghai Lake, southwestern China
Authors: Xiao Xiayun , Haberle Simon G , Li YanLing , Liu Enfeng , Shen Ji , Zhang Enlou , Yin Jianji , Wang Sumin
Published: June 2017

High-resolution pollen and charcoal records from Chenghai Lake, northwestern Yunnan Province of China, are presented in this study. These records reveal changes in climate and human activity since 8220 cal. yr BP, and the drivers of climatic change are further discussed based on spectral analysis of Tsuga and evergreen oak pollen percentages. The pollen record indicated that the climate in the low altitude area was relatively warm and moderately dry, whereas the climate in the high altitude area was relatively cool and humid during the period 8220–4670 cal. yr BP, corresponding to the Holocene climate optimum, although the seasonality of precipitation increased between 5180 and 4670 cal. yr BP. From 4670 to 3470 cal. yr BP, the temperature declined, and the precipitation and its seasonality decreased. Between 3470 and 1860 cal. yr BP, the temperature was still relatively low, and precipitation appeared to decrease further. At the same time, human activity represented by agricultural planting began to influence this study area, but the intensity of human activity was relatively weak. After 1860 cal. yr BP, the climate was gradually becoming drier and the intensity of human activity such as deforestation and slash-and-burn agriculture increased. Spectral analysis of Tsuga and evergreen oak pollen percentages shows statistically significant periodicities of ~1500 and ~200 years at the ≥95% confidence level, which suggests that insolation and feedback interactions on millennial to centennial scales are the primary forcing mechanisms of the southwest monsoon and past climatic change during the Holocene in northwestern Yunnan Province, southwestern China.
Blocking the VISTA pathway enhances disease progression in (NZB × NZW) F1 female mice
Authors: Sergent PA , Plummer SF , Pettus J , Mabaera R , DeLong JK , Pechenick DA , Burns CM , Noelle RJ , Ceeraz S
Published: June 2017

V-domain Ig suppressor of T-cell activation (VISTA) is a critical negative checkpoint molecule involved in regulating the immune response. Targeting the pathway with an antagonist anti-VISTA antibody designated 13F3 has been shown to enhance disease severity in experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis. To determine if VISTA plays a role in murine lupus, New Zealand Black × New Zealand White (BWF1) mice were treated with 13F3 or control hamster Ig and disease monitored. Onset of proteinuria was earlier and renal damage more profound in mice treated with 13F3. Cell subset analysis showed an increase of activated splenic T cells and inflammatory splenic myeloid cells, but no effect on B cells, in mice receiving 13F3. Examination of the kidney showed an increase in inflammatory myeloid cell infiltration with 13F3 treatment. This study along with previous EAE data, suggests that interventions that enhance VISTA regulatory activity may be effective for the treatment of autoimmune disease.
Renal tubular epithelial cell-derived BAFF expression mediates kidney damage and correlates with activity of proliferative lupus nephritis in mouse and men
Authors: Schwarting A , Relle M , Meineck M , Föhr B , Triantafyllias K , Weinmann A , Roth W , Weinmann-Menke J
Published: June 2017

B-cell activating factor of the tumour necrosis factor family (BAFF) is a cytokine, mainly produced by hematopoietic cells (e.g. monocytes/macrophages, dendritic cells), indispensable for B-cell maturation. The BLISS studies have demonstrated that blocking BAFF by the human monoclonal antibody belimumab is a valuable therapeutic approach in patients with clinically and serologically active systemic lupus erythematosus (SLE). However, the defined sources of BAFF, which contributes to SLE, are still unclear. Recent findings show that BAFF expression is not restricted to myeloid cells. Since lupus nephritis is the main cause of morbidity and mortality for SLE patients, the aim of this study was to investigate whether renal tubular epithelial cells (TEC) are an important source of BAFF and thus may contribute to the pathogenesis and progression of SLE. We found BAFF expression both in cultured murine and human TEC. These results could be verified with in situ data from the kidney. Moreover, BAFF expression in the kidneys of lupus-prone MRL- Faslpr mice correlated with disease activity, and BAFF expression on TEC in biopsies of patients with diffuse proliferative lupus nephritis showed a correlation with the histopathological activity index. In vitro functional assays revealed an autocrine loop of BAFF with its binding receptors on TEC, resulting in a strong induction of colony stimulating factor-1. Finally, we identified divergent effects of BAFF on TEC depending on the surrounding milieu (‘inflammatory versus non-inflammatory’).

Taken together, our findings indicate that renal-derived BAFF may play an important role in the pathophysiology of the systemic autoimmune disease SLE.
Challenge of political globalization
Authors: Cao Shixiong , Zheng Xinyi , Zhang Junze
Published: June 2017

Globalization represents an intriguing new way to increase global prosperity. However, it represents a dramatic contrast to events in previous centuries, both in the West and in China, when most unions resulted from warfare and conquest rather than from peaceful negotiations. This can be seen in the increase in military conflict and decrease in political stability in many parts of the world in recent years. Therefore, achieving a union of nations through economic methods may reduce the risk of military conflict if nations can find ways to turn conflicts into a mixture of national cooperation and healthy competition (“coopetition”), leading to the evolution of a new world political order. Unlike previous efforts to create peaceful unions, such as the Global League of Nations, the new union of nations may succeed because it emphasizes the political and economic self-interest of each member state, thereby offering the possibility of win–win solutions. Through this process, conflict can become cooperation because the union of political powers with different ideologies under a unified regime will provide a dispute resolution mechanism and mitigate the risk of conflict. To achieve that goal, it will be necessary to develop a new way of thinking that emphasizes peaceful cooperation and competition rather than warfare.
Seizing the Moment: Experiences of School Nurses Caring for Students With Overweight and Obesity
Authors: Powell Shannon Baker , Engelke Martha Keehner , Neil Janice A.
Published: June 2017

School nurses are well positioned to assess, intervene, and evaluate efforts to positively impact students who are overweight or obese. The purpose of this qualitative, descriptive study was to explore the experiences of school nurses providing care to children living with overweight and obesity. Data were collected through face-to-face, tape-recorded, in-depth, open-ended interviews with 10 school nurses from rural areas of North Carolina working with minority and low-income children in the public school setting. The text of the interviews was transcribed and analyzed into codes, categories, and themes. Three themes and eight subthemes were identified. The three themes were identified as (1) “jumping hurdles,” (2) “seize the moment,” and (3) “moral distress.” The findings of this study can be used to provide a better understanding of the experiences of school nurses caring for children with overweight and obesity that is necessary for planning successful school-based interventions.
A Total Parenteral Nutrition Protocol
Authors: Swenson John P. , Edwards Drew , Chamberlain Marv , Rault Raymond , Ivey Marianne F.
Published: June 2017

The need for guidelines on the use of concentrated nutritional solutions to achieve effective total parenteral nutrition has become very evident in our hospitals. As these are teaching hospitals, our physicians write TPN orders for short-term surgical patients, long-term patients (home TPN), burn patients, neonatal patients and selected cancer patients. This variance in patients, coupled with the rotation of the interns and resident house staff, has resulted in a need for a TPN protocol. Within the framework of this protocol, each patient can be approached.

The pharmacy's approach to this problem was to convene an Ad Hoc Committee for the purpose of developing a protocol and in early 1975 the protocol was submitted to our Pharmacy and Therapeutics Committee. The Committee approved its acceptance, and it was forwarded to the Medical Staff Advisory Committee and was approved. Since that time, new developments and the inclusion of other pertinent material have necessitated updating our protocol. The update has resulted in the following protocol.
Physiologic Implications of Mechanical Ventilation on Pharmacokinetics
Authors: Perkins Mark W. , Dasta Joseph F. , Dehaven Bryan
Published: June 2017

Numerous factors present in the critically ill patient decrease drug clearance. The contribution of one factor, mechanical ventilation, to this decrease is largely unknown and unquantified. This article attempts to review the physiologic effects of mechanical ventilation and to propose theoretical changes in the pharmacokinetics of concomitantly administered drugs. Mechanical ventilation with or without positive end-expiratory pressure is a well-documented cause of decreases in cardiac output, hepatic and renal blood flow, glomerular filtration rate, and urine flow. The mean airway pressure delivered, the pathophysiologic state of the patient, and coexisting therapeutic interventions affect the degree of hemodynamic alteration. Theoretically, these hemodynamic changes can decrease the clearance of several drugs frequently administered to critically ill patients. Decreased hepatic blood flow decreases the clearance of nonrestrictively cleared drugs. The pharmacokinetics of drugs predominantly renally cleared, by either glomerular filtration or tubular secretion, are affected by a decrease in renal blood flow or glomerular filtration rate. Also, the clearance of agents for which tubular reabsorption is important may decrease because the reduction in urine flow resulting from mechanical ventilation allows increased time for drug reabsorption. Interventions that minimize the decrease in cardiac output and organ blood flow and, theoretically, the risk of the adverse drug reactions from decreased drug clearance include expansion of intravascular volume, administering positive inotropic agents, and decreasing mean airway pressure. Monitoring serum concentration of critical and toxic agents suspected to have altered clearance in patients receiving mechanical ventilation is recommended. We hope that our article will stimulate future research in this area to give clinicians guidelines for drug dosing in patients receiving mechanical ventilation.
Hemolytic Reactions to Nitrofurantoin in Patients with Glucose-6-Phosphate Dehydrogenase Deficiency: Theory and Practice
Authors: Gait John E.
Published: June 2017

The prescribing information for nitrofurantoin states that patients with glucose-6-phosphate dehydrogenase deficiency may experience hemolysis following administration of the drug. Although there is no doubt that this statement is qualitatively correct, the degree of risk in the general population of patients has not been previously quantified. This study was designed to estimate the degree of risk of a clinically important hemolytic reaction to nitrofurantoin by means of a retrospective analysis of the Norwich Eaton adverse reaction database. Since 1953, approximately 130 million courses of nitrofurantoin therapy have been distributed in the U.S. alone. The database contained 127 reports of hemolytic reactions; a “worst-case” estimate of the incidence rate was 1 in 100 000 courses of therapy. Considering the extensive usage of nitrofurantoin, clinically important hemolytic reactions appeared to be very rare. For the cases in which outcome was recorded, complete recovery occurred in 87 percent of patients. Although nitrofurantoin is contraindicated after the onset of labor and in infants less than one month old, no well-documented cases of hemolytic reactions in neonates were identified.
Conversion of Intravenous Ranitidine to Oral Therapy
Authors: Baciewicz Anne M.
Published: June 2017

A two-phase drug program concentrating on inappropriate use of intravenous ranitidine is described at a 612-bed university teaching hospital. Phase 1 of the study was a retrospective audit of 50 randomly selected adult patients receiving iv ranitidine. The chart was reviewed for indications for therapy, rationale for iv ranitidine, median length of iv therapy, and appropriateness of iv use. Phase 2 consisted of concurrent monitoring of iv ranitidine soley to assess the appropriateness of the iv dosage form at our hospital. Staff pharmacists reviewed the patient's medication profile from the central pharmacy to determine if the patient had standing orders for any oral or nasogastric medications while concomitantly receiving iv ranitidine. An educational memo was placed in the patient's chart if the patient was concurrently receiving oral or nasogastric medications and iv ranitidine. In phase 1, iv ranitidine was inappropriate either partially or totally in 51 percent of the cases. The median length of inappropriate iv therapy was five days. During the second phase, the pharmacy staff reviewed 4301 profiles of patients receiving iv ranitidine over eight months. Educational memos were placed in 451 patient charts (11 percent) where conversion from iv to oral therapy was feasible; a favorable follow-up occurred in 275 cases (61 percent). This would result in an estimated annual cost savings of $4685. Based on our ranitidine use review, extrapolating the median length of inappropriate iv therapy to five days would result in a yearly cost savings of $23425. This project demonstrated that staff pharmacists can impact on physician education and cost savings by routinely screening patient's medication profiles from the central pharmacy.

A TWO-PHASE DRUG PROGRAM concentrating on inappropriate use of intravenous ranitidine was undertaken at a 612-bed university teaching hospital to demonstrate how pharmacists can make an impact on drug therapy both financially and clinically. Intravenous ranitidine was selected based on cost, frequent use, and potential for inappropriate use. Parenteral ranitidine offers no therapeutic advantage over oral therapy if the gastrointestinal tract is intact and functioning.1 At our hospital, the cost of daily iv ranitidine (50 mg iv q8h) is $14.50, approximately eight times that of daily oral tablets (150 mg po q12h) which cost $1.75.
Simvastatin: A Review of its Pharmacology and Clinical Use
Authors: Mauro Vincent F. , MacDonald Joanne L.
Published: June 2017

Simvastatin, a chemical derivative of lovastatin, is an antihyperlipidemic medication that inhibits hydroxymethylglutaryl coenzyme A reductase. Animal and clinical data suggest simvastatin is twice as potent as lovastatin. It lowers serum cholesterol by inhibiting hepatic synthesis of cholesterol and, more importantly, by increasing the number of low-density lipoprotein (LDL) receptors present on hepatic cellular membranes. Simvastatin, when used at doses of 40 mg/d in patients with heterozygous familial hypercholesterolemia, significantly reduces total cholesterol (>30 percent) and LDL cholesterol (35–45 percent) and tends to reduce triglycerides and raise high-density lipoprotein (HDL) cholesterol. The agent is also effective in patients with polygenic hypercholesterolemia, familial dysbetalipoproteinemia, and nephrotic syndrome. Addition of cholestyramine to simvastatin enhances the LDL cholesterol-lowering effect to approximately 55 percent. Common clinical adverse effects reported with simvastatin use include headaches and gastrointestinal complaints. Transient elevations in serum transaminases and creatine phosphokinase have also been seen. Based on data currently available, the drug's clinical activity and adverse-effect profile are similar to those of lovastatin. Therefore, there is no need for formularies to contain both medications. To choose between the two, one needs to consider the incidence of adverse effects and the daily cost of each product when used at equally effective doses. That information is now now available and, until it is, a clear recommendation cannot be made. Simvastatin, presently marketed in several countries, is investigational in the U.S. but is expected to be available soon.
Local Capital Spending in U.S. Metropolitan Areas
Authors: Haughwout Andrew F.
Published: June 2017

This article describes capital spending patterns for general purpose local governments in 36 large U.S. metropolitan areas for the period from 1987 to 1991. Capital spending by central cities dominates metropolitan area expenditures in each year. The results suggest that at least for local capital spending, central city residents provide the bulk of funds devoted to metropolitan area infrastructure provision. The primary reasons for this dominance are that city governments spend more than suburbs overall, and their spending is more heavily weighted toward capital in the most capital-intensive functions. City spending is not more concentrated in heavily capital-intensive functions. Highway and sewer aid from other levels of government favors cities but does not fully compensate them for the greater capital spending they undertake.
A Structured Review and Critical Analysis of Male Perceptions of the Penis: A Comparison between Heterosexual Men and Men Who Have Sex with Men (MSM)
Authors: Simpson Paul , Adams Julie
Published: June 2017

Current research into male body image has identified several areas of body dissatisfaction among men, including perceptions associated with the penis. This is the first article to present a structured review, synthesis, and critical analysis of research into male perceptions of the penis, the psychosocial, and sexual correlates and to provide a comparison of outcomes between men who have sex with men (MSM) and heterosexual men. Analysis of twenty-six international studies suggests that men’s accounts of the penis indicate diverse ways of negotiating normative masculinity. Key findings include that most men perceive their penis to be of an average size but would still like a larger one; and differences exist between MSM and heterosexual men in ratings of penis size, emphasis placed upon penis size, and impact of penis size upon sexual behavior. This narrative synthesis has addressed a gap in knowledge concerning how accounts of the penis by men expressing different forms of sexual identification indicate diverse ways of negotiating masculinity.
Case Series: A Kindred With Eruptive Vellus Hair Cysts and Systemic Features
Authors: Ponzo Marisa G. , Van Allen Margot I. , Armstrong Linlea , Martinka Magdalena , Dutz Jan P.
Published: June 2017

Eruptive vellus hair cysts (EVHCs) often occur on the trunk and limbs. Facial involvement is uncommon. Autosomal dominant inheritance has been described, but associated extracutaneous anomalies have not. We describe a 4-patient kindred presenting with multiple facial EVHCs and an association of preauricular pits, lipomas, joint hypermobility, and cardiac defects. Histopathologic examination confirmed the diagnosis of EVHCs in 3 affected individuals. We propose that facial EVHCs may indicate the presence of an inherited autosomal dominant disorder with extracutaneous manifestations. Extracutaneous manifestations noted in the kindred have been sporadically described in association with steatocystoma multiplex (SM), a condition occasionally noted in the presence of EVHCs, further supporting an association between these disorders.
Clinical education in paediatrics
Authors: James Elizabeth
Published: June 2017

• The clinical environment is an important factor in the student nurse's learning experience

• The literature identifies a number of key areas which form the clinical learning environment

• The reality of the ward environment and the literature demonstrate gaps between theory and practice

• Ongoing evaluation of the ward environment could increase the learning opportunities available to students
Working with parents to promote health
Authors: Williams Yvonne
Published: June 2017

• A cleft lip, with or without cleft palate, is the most common craniofacial malformation

• The issue of whether health can be attained if the person has a physical defect is discussed

• Health education can be considered as a means whereby individuals learn to maintain, restore and promote health

• Consideration is given to health promotion and the prevention of ill health in relation to infant feeding

• Skill teaching, if successfully completed, may be regarded as a fundamental cornerstone to health promotion
Politicization and the public interest: When do the elites in Brussels address public interests in EU policy debates?
Authors: De Bruycker Iskander
Published: June 2017

Contemporary European studies concur that public pressure and responsiveness have become key ingredients of the EU policy arena. Nonetheless, there is little known about when and how the elites in Brussels articulate public interests in EU policy debates. This article bridges this gap by examining the conditions under which political elites involved in EU legislative procedures address public interests in the news. It is expected that the politicization of EU policy processes stimulates elites to articulate public interests. The dataset consists of 2164 media statements in six European media outlets on a sample of 125 legislative proposals (2008–2010). The results demonstrate that elites address public interests in the media predominantly when issues are publicly salient and attract intensive mobilization by civil society groups. Elites stay silent about public interests when policy processes are crowded with business lobbyists and are of low salience to European citizens.
Respite in Dementia: An Evolutionary Concept Analysis
Authors: O’ Shea Emma , Timmons Suzanne , O’ Shea Eamon , Fox Siobhan , Irving Kate
Published: June 2017

Aim

There is a lack of conceptual clarity around ‘respite’ as it relates to people with dementia and their carers. This study provides clarification on the use and meaning of the term and considers the concept in relation to the dominant care paradigm in dementia, i.e. person-centred care.

Methods

Rodgers’ (1989) evolutionary framework was employed. A systematic search was conducted on the Pubmed/MedLine, Embase, Cinahl, PsychInfo, Scopus, Web of Science and Cochrane databases (1980–2016, English) with fixed search terms relating to ‘respite’ and ‘dementia’. Papers with primary qualitative data and literature reviews were included. This search was supplemented with snowballing techniques (back/forward searching, generic search engines). Data were analysed thematically, through an iterative process of constant comparison.

Results

Respite is understood both as a service that provides a physical break for the carer and as a psychological outcome, i.e. a mental break for the carer, which can be facilitated by formal services, under certain conditions. The conceptual model outlines how client factors (dyadic relations, recognising/accepting need, carer psychosocial issues, restorative occupation, and stigma) and service factors (model/characteristics, care quality, staff expertise, meaningful occupation for people with dementia and communication and support), interact to influence a respite outcome. The key antecedent for a positive respite experience is that the carer perceives that mutual benefit is garnered from service use.

Conclusion

The term respite can be interpreted as both a service and an outcome. However, it is clear that ‘respite’, as currently understood, acknowledges the relational experience of the carer only; it is, therefore, potentially damaging to the planning and delivery of person-centred dementia care. We suggest ‘restorative care’ as a potential alternative nomenclature to respite care, thereby highlighting the importance of providing mutual, personalised health and social care services that serve to enhance care relationships rather than diminish them.
Making Sense and Moving On
Authors: Kansky Jessica , Allen Joseph P.
Published: June 2017

This study assessed the key aspects of romantic relationship dissolution in emerging adulthood as predictors of future mental health and romantic qualities. It utilized a longitudinal, multiinformant, multimethod study of 160 participants with their romantic partners and close friends followed from ages 20–25, with a breakup assessed at age 22. Having control over initiating a breakup at age 22 predicted relative increases in peer-rated internalizing symptoms and autonomy-undermining interactions with a new partner at ages 23–25. Having a greater understanding of the reasons for a breakup predicted lower self-reported internalizing symptoms and relative decreases in partner-reported romantic conflict as well as relative increases in self-reported relationship satisfaction and peer-rated intimate relationship competence at ages 23–25. Predictions remained after accounting for numerous potential confounds including age 20–22 baseline relationship quality, social competence, internalizing symptoms, and gender. Implications for understanding links between breakup characteristics on emerging adult psychological and relationship functioning are discussed.
Anatomical shoulder arthroplasty in epileptic patients with instability arthropathy and persistent seizures
Authors: Thangarajah Tanujan , Falworth Mark , Lambert Simon M
Published: June 2017

Purpose:

Epileptic seizures can cause shoulder dislocation, recurrent instability and eventually arthritis. The purpose of this study was to report the results, complications and rate of revision surgery following anatomical shoulder arthroplasty in epileptic patients with instability arthropathy.

Methods:

A consecutive series of eight patients with epilepsy underwent anatomical shoulder arthroplasty for recurrent shoulder instability and were retrospectively reviewed after a mean of 4.7 years (range, 2–7.5 years). These included three total shoulder replacements and five humeral resurfacing hemiarthroplasty procedures.

Results:

Mean age of the cohort was 33 years (range, 17–44). All patients experienced post-operative grand mal seizures. Two patients with hemiarthroplasty required further surgery due to painful glenoid erosion. No residual cases of instability were noted. Mean active forward elevation and external rotation improved following surgery. The Oxford Shoulder Score improved from 15 pre-operatively (range, 7–22) to 26 post-operatively (range, 12–45) ( p = 0.031). This was accompanied by an increase in the mean Subjective Shoulder Value, which improved from 29 (range, 10–80) pre-operatively to 53 (range, 15–90) post-operatively ( p=0.042). Conclusions: Anatomical shoulder arthroplasty may offer a solution for the treatment of instability arthropathy in patients with epilepsy and persistent seizures.
Psychological Capital and Organisational Commitment: Nature, Structure and Relationship in an Indian Sample
Authors: Sahoo Bharat Chandra , Sia Surendra Kumar
Published: June 2017

Nowadays, researchers are expressing more concern regarding the use of scales which were not validated or standardised in the Indian context. Direct application of such scales to the Indian population is sometimes not practical due to differences in culture, belief, language and lifestyle. In order to get accurate validation and applicability, we should verify the nature and structure of original scales in the Indian context through factor analyses. Based on this need, the authors carried out factor analyses involving both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on psychological capital questionnaire by Luthans, Avolio, Avey and Norman (2007) and CFA for organisational commitment scale by Mowday, Steers and Porter (1979). The study involves a sample of 276 employees (150 male, 126 female) from three manufacturing units in India. The EFA of psychological capital suggested a three factors model instead of a four factors model. When it was estimated with CFA, the three factors measurement model was more well fitted than single factor as well as four factors models. The series of CFAs conducted for the organisational commitment scale through the measurement model reported that two factors structure is good enough to measure commitment behaviour. Internal consistencies through Cronbach’s alpha have also been checked. Structural equation modelling (SEM) analysis reports that psychological capital contributes significantly to organisational commitment. The researchers conclude this article with implications and directions for future research.
Comparison of two related lines of tauGFP transgenic mice designed for lineage tracing
Authors: Sharp Linda , Pratt Thomas , MacKay Gillian E. , Keighren Margaret A. , Flockhart Jean H. , Chandler Emma J. , Price David J. , Mason John O. , West John D.
Published: June 2017

Background

The tauGFP reporter fusion protein is produced nearly ubiquitously by the TgTP6.3 transgene in TP6.3 mice and its localisation to microtubules offers some advantages over soluble GFP as a lineage marker. However, TgTP6.3
Tg/Tg
homozygotes are not viable and TgTP6.3
Tg/−
hemizygotes are smaller than wild-type. TP6.4 mice carry the TgTP6.4 transgene, which was produced with the same construct used to generate TgTP6.3, so we investigated whether TgTP6.4 had any advantages over TgTP6.3.

Results

Although TgTP6.4
Tg/Tg
homozygotes died before weaning, TgTP6.4
Tg/−
hemizygotes were viable and fertile and only males were significantly lighter than wild-type. The TgTP6.4 transgene produced the tauGFP fusion protein by the 2-cell stage and it was widely expressed in adults but tauGFP fluorescence was weak or absent in several tissues, including some neural tissues. The TgTP6.4 transgene expression pattern changed over several years of breeding and mosaic transgene expression became increasingly common in all expressing tissues. This mosaicism was used to visualise clonal lineages in the adrenal cortex of TgTP6.4
Tg/−
hemizygotes and these were qualitatively and quantitatively comparable to lineages reported previously for other mosaic transgenic mice, X-inactivation mosaics and chimaeras. Mosaicism occurred less frequently in TP6.3 than TP6.4 mice and was only observed in the corneal epithelium and adrenal cortex.

Conclusions

Mosaic expression makes the TgTP6.4 transgene unsuitable for use as a conventional cell lineage marker but such mosaicism provides a useful system for visualising clonal lineages that arise during development or maintenance of adult tissues. Differences in the occurrence of mosaicism between related transgenic lines, such as that described for lines TP6.3 and TP6.4, might provide a useful system for investigating the mechanism of transgene silencing.