bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethical climate in nursing environment: A scoping review
Authors: Koskenvuori Janika , Numminen Olivia , Suhonen Riitta
Published: June 2017

Background:

In the past two decades, interest in the concept of ethical climate and in its research has increased in healthcare. Ethical climate is viewed as a type of organizational work climate, and defined as the shared perception of ethically correct behavior, and how ethical issues should be handled in the organization. Ethical climate as an important element of nursing environment has been the focus of several studies. However, scoping reviews of ethical climate research in nursing have not been conducted to guide further research in this area.

Objective:

The purpose of this scoping review is to describe and analyze studies focusing on ethical climate in nursing environment to elicit an overall picture of the research in this field.

Methods:

A scoping review methodology guided by Arksey and O’Malley and Levac et al. was used. Studies were identified by conducting electronic searches on PubMed/MEDLINE, CINAHL, Web of Science Core Collection, PsycINFO, and Scopus and Philosophers’ Index databases. Of 1051 citations, 56 articles matched the inclusion criteria.

Ethical considerations:

This study was conducted according to good scientific guidelines.

Findings:

Ethical climate is a topical research area which has been explored with different methods and outcomes, in different environments, and has mainly been perceived positively. The focus of the studies was on finding associations between ethical climate and work-related factors such as job satisfaction, moral distress, and turnover intentions. Methodologically, research was rather homogeneous using quantitative, descriptive, and correlative research designs.

Conclusion:

Novel perspectives and more diverse methodological approaches paying attentions to issues affecting generalizability of the findings could expand our knowledge in this area.
Evaluating Cultural Competence of Pediatric Oncology Nurses at a Teaching Hospital: A Pilot Study
Authors: Eche Ijeoma Julie , Aronowitz Teri
Published: June 2017

This cross-sectional descriptive study evaluated registered nurses’ self-ratings of cultural competence on the hematology/oncology unit at a large Northeastern urban children’s hospital. The Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals was used to measure 5 constructs of cultural competence. The study findings show that there were significant correlations between the knowledge and skill subscales (ρ = .57, P < .001) and the knowledge and desire subscales (ρ = .42, P < .05). The highest mean among the 5 subscales was cultural desire (mean = 15.5), indicating that nurses were motivated to engage in the process of becoming culturally competent. The lowest mean among the 5 subscales was cultural knowledge (mean = 11.2), followed by cultural skill (mean = 11.8), indicating that nurses did not perceive themselves to be well informed in these areas. The findings from this pilot study suggest that nurses on this pediatric oncology unit are most likely to possess cultural desire and cultural awareness, but there is certainly opportunity to engage and educate the staff. Targeted interventions to improve cultural competence on this inpatient unit are being explored and a larger scale study is being planned to assess the cultural competence of nurses across the hospital.
Scoping Review of Nursing Case Management in the United States
Authors: Joo Jee Young , Huber Diane L.
Published: June 2017

The purpose of this study is to identify issues of case management (CM) interventions in the United States in recent studies and to identify implications for future research into CM. This study was guided by the following framework for a scoping review. Multiple electronic databases were searched to identify studies published between 2007 and 2016 in the United States and related to nursing CM. Five weaknesses were identified: no clear and consistent definition of CM, lack of theoretical frameworks, lack of standard guidelines in CM practice, lack of precise CM dosage and of process measures, and limited reports of explicit role of nurse case managers and role confusion by nurses. Three strengths were also identified. More rigorous and continuous efforts to develop theoretical frameworks and evaluation tools, as well as clear definitions and precise role descriptions, are required for future research and practice into CM.
Leukopenia and Hepatotoxicity
Authors: Ponte Charles D. , Decker Edward L.
Published: June 2017

A case report of a 72-year-old white female who was treated with a total of 260 mg chlorpromazine and who rapidly developed elevated serum glutamic oxalacetic transaminase, direct and total bilirubin, alkaline phosphatase, and lactic dehydrogenase and whose peripheral white blood cell count dropped to 2,500/mm3' is presented. The bone marrow was found to be hypocellular. Approximately 15 days following discontinuance of the drug, the laboratory values returned toward normal with marked clinical improvement in the patient.

The possibility of other drugs causing similar changes in this patient is discussed as are the adverse effects of phenothiazines and methods of monitoring the patient who is receiving phenothiazine therapy.
Effect of Food on Nifedipine Sustained-Release Preparation
Authors: Ueno Kazuyuki , Kawashima Syuichi , Uemoto Kiyotaka , Ikada Tomoko , Miyai Kazuyoshi , Wada Kyoichi , Yamazaki Kunio , Matsumoto Katsuyoshi , Nakata Izumi
Published: June 2017

The effect of food on the bioavailability of a nifedipine sustained-release preparation was studied. Each of seven male volunteers received a single oral 20 mg dose with 100 mL of water under two conditions, fasting and after a meal, with a crossover after a seven-day wash-out period. Blood samples were drawn at time zero (just prior to dose), and 1, 2, 3, 4, 6, 8, 10, and 12 hours after dosing. Nifedipine assays were performed by gas chromatography. The area under the serum concentration-time curve (AUC) from 0 to 12 hours and maximum serum concentration (Cmax) were significantly increased by food. Blood pressure was significantly decreased by food. The mean AUC for fasting and meal conditions were 315.0 and 411.4 ng•h/mL, and the mean Cmax were 42.6 and 86.6 μg/mL, respectively. The results indicate that food may increase the bioavailability of nifedipine sustained-release preparation.
Hostility and Hallucinations as a Consequence of Midazolam Administration
Authors: Burnakis Thomas G. , Berman David E.
Published: June 2017

A 74-year-old woman experienced an apparent psychotic reaction several hours after administration of iv midazolam as a premedicant for gastroscopy. The reaction included confusion, hallucinations, and hostility and required administration of haloperidol to calm her. The woman subsequently underwent colonoscopy with meperidine as a premedication and experienced no behavioral changes. Although other causes cannot be completely ruled out, the evidence points strongly to midazolam as the precipitating agent for the psychotic reaction.
Hemodynamic Status during Famotidine Infusion
Authors: Heiselman Darell E. , Chapman Jeff , Malik Mark , Riegnor Elaine
Published: June 2017

Histamine H2 antagonists, which reduce gastric acid secretion, are often used in the intensive care setting for the prophylaxis of stress ulcers. This double-blind, placebo-controlled study evaluated hemodynamic parameters in 11 stable, critically ill patients receiving famotidine. Repeated-measures ANOVA demonstrated that famotidine had no significant effect on baseline hemodynamic measurements and that there was no significant difference in hemodynamic values following the famotidine infusion as compared with NaCl 0.9% placebo (p>0.05).
Using Estimated Creatinine Clearance for Individualizing Drug Therapy: A Reassessment
Authors: Smith Curtis L. , Hampton Edward M.
Published: June 2017

Estimates of renal function are frequently used to design individual dosing regimens. The accuracy of these estimates naturally influences their ability to predict certain pharmacokinetic parameters and appropriate drug dosages. Creatinine clearance is the most widely used estimate of renal function. Many formulas have been developed to provide a quick, relatively accurate prediction of creatinine clearance and, supposedly, the glomerular filtration rate (GFR). However, an understanding of the limitations associated with creatinine clearance estimations raises questions concerning their reliability as an aid in individualizing drug therapy. Many factors such as disease states, age, diet, analytical variations, and drug interactions affect the relationship between estimates and measures of creatinine clearance and GFR. As a result, creatinine clearance estimates using these formulas are often poor reflections of measured creatinine clearance or GFR. Also, studies comparing measured creatinine clearance with more accurate methods of assessing renal function (i.e., inulin) reveal errors that are often exaggerated as renal function declines. Therefore, estimated creatinine clearance is twice removed from the associated pharmacokinetic parameter. Despite these limitations, no other clinically relevant and convenient assessment of renal function is available. The authors recommend that the appropriate caveats be considered when using these tools clinically. For drugs with narrow therapeutic indices, estimates of creatinine clearance should only be used to establish initial dosing regimens, with subsequent therapy based on parameters generated from concentration determinations.
Nafarelin Acetate: A Gonadotropin-Releasing Hormone Agonist for the Treatment of Endometriosis
Authors: Letassy Nancy A. , Thompson Dennis F. , Britton Mark L. , Suda Russell R.
Published: June 2017

Nafarelin acetate is a gonadotropin-releasing hormone (GnRH) agonist proven as effective as danazol in treating endometriosis. Its proposed mechanism of action is the desensitization of pituitary GnRH receptors leading to a decrease in gonadotropin release, and ovarian hormone serum concentrations similar to those achieved in postmenopausal women. Nafarelin decreases or ablates the physical symptoms associated with endometriosis, and pregnancy rates following therapy with this drug are comparable to rates observed after danazol therapy. Nafarelin is administered by nasal inhalation and has been generally well tolerated. It is associated with a high incidence of adverse effects but they are rarely severe enough to cause withdrawal from treatment, and those occurring most frequently—hot flashes, vaginal dryness, and decreased libido—are a consequence of the hypoestrogenemia induced by the drug. Increased bone turnover occurs in women on nafarelin but biochemical parameters return to pretreatment concentrations by six months after termination of treatment. This agent's place in the therapy of endometriosis will be determined as clinical experience accumulates.
Pharmacist Interventions Improve Fluid Balance in Fluid-Restricted Patients Requiring Parenteral Nutrition
Authors: Broyles Joyce E. , Brown Rex O. , Vehe Kathryn L. , Nolly Robert J. , Luther R. Wayne
Published: June 2017

Many intensive care unit (ICU) patients require parenteral nutrition (PN) and fluid restriction, making delivery of adequate nutrition difficult. We studied the effects of pharmacist interventions on fluid balance in fluid-restricted ICU patients requiring PN. Twenty patients were randomized to the treatment group (dextrose 70% injection [D70W] plus 15% amino acids for PN, 25-mL piggybacks, selected drugs added to the PN solution) or the control group (D70W plus 10% amino acids, 50- or 100-mL piggybacks). Each group contained 10 patients and they were not significantly different for age, gender, weight, hospital days, and serum albumin concentration. The duration (9.3 ± 1.2 vs. 9.7 ± 2.4 d) and doses of PN (29 ± 6.8 vs. 28.7 ± 6.9 kcal/kg/d; 1.1 ± 0.3 vs. 1.1 ± 0.4 g/kg/d protein) were similar between treatment and control groups. Mean fluid intake (3112 ± 1146 vs. 3498 ± 1111 mL/d), fluid balance (146 ± 1581 vs. 708 ± 1402 mL/d), and cumulative fluid balance (1358 vs. 6867 mL) were all significantly lower in the treatment group. Mean fluid output was similar between the two groups. Pharmacist interventions can significantly decrease intake and result in a better fluid balance in fluid-restricted ICU patients who require PN.
Delirium in an Elderly Woman Possibly Associated with Administration of Misoprostol
Authors: Morton Mark R. , Robbins Marshall E.
Published: June 2017

Misoprostol has been associated with adverse reactions, including gastrointestinal symptoms, gynecologic problems, and headache. Changes in mental status, however, have not been reported. We present a case in which an 89-year-old woman in a long-term care facility became confused after the initiation of misoprostol therapy. The patient's change in mental status was first reported nine days after the initiation of therapy. Her delirium significantly improved after misoprostol was discontinued and her mental status returned to normal within a week. Because no other factors related to this patient changed significantly, the delirium experienced by this patient possibly resulted from misoprostol therapy.
Meta-Analysis of Quinolone—Theophylline Interactions
Authors: Parent Marc , LeBel Marc
Published: June 2017

Several fluoroquinolones currently under investigation or on the market potentially interact with theophylline. In this study, meta-analysis methodology was used to evaluate the significance of findings from quinolone-theophylline interaction studies. Two major databases were searched: Index Medicus (from 1986 to March 1990) and Current Content/Clinical Medicine (from 1985 to March 1990). A total of 32 studies were retrieved; 20 of these met the inclusion criteria. With a large effect size (ES) value of 2.26, enoxacin is the strongest inhibitor of theophylline metabolism of this family. The fail-safe N value was 135, indicating that 135 studies enrolling an average of 8 patients and showing no interaction (i.e., ES = 0) would be required to lower the ES to the threshold value of 0.1, which we considered a priori to render the results nonsignificant. Other fluoroquinolones showed a degree of interaction that can be considered significant: Ciprofloxacin (ES = 0.50, fail-safe N = 26), norfloxacin (ES = 0.31, fail-safe N = 10). Ofloxacin (ES = 0.13, fail-safe N = 4), lomefloxacin (ES = 0.12, fail-safe N = 2), and fleroxacin (ES = 0.06, fail-safe N = 2) provided the weakest evidence of interaction based on effect size and power. Among the fluoroquinolones studied, ofloxacin, lomefloxacin, and fleroxacin, when available, should be the fluoroquinolones of choice when the patient also is receiving theophylline.
Parenteral Nutrient Admixtures as Drug Vehicles: Theory and Practice in the Critical Care Setting
Authors: Driscoll David F. , Baptista Richard J. , Mitrano Francis P. , Mascioli Edward A. , Blackburn George L. , Bistrian Bruce R.
Published: June 2017

Parenteral nutrient (PN) admixtures are the most complex, extemporaneously compounded formulations routinely prepared for hospitalized and home-based patients. In addition, drugs are added with increasing frequency to PN admixtures, thus presenting even greater physicochemical challenges to this highly complex pharmaceutical product. The continuous infusion of selected drugs may provide pharmacokinetic and therapeutic advantages over conventional, intermittent, bolus methods of administration. Fluid conservation, cost savings, and a possible decrease in the risk of infection through reduced catheter manipulation and simplification of therapy provide additional incentives to consider the use of PN admixtures. The many advantages of PN admixtures make them an attractive approach to cost-effective care, with special clinical benefits achieved in the critical care setting. This article reviews our clinical experience using PN admixtures as drug vehicles for selected drugs and presents some theoretical as well as actual benefits associated with this practice.
Economic Analyses in Hypertension: Applications for Healthcare Providers
Authors: Jones-Grizzle Amy J. , Draugalis JoLaine R.
Published: June 2017

Hypertension affects millions of Americans. With healthcare dollars becoming more closely scrutinized, economic studies are playing an important role in helping decision makers choose who should receive treatment and which treatments and methods of administration are most cost-effective. This article provides an overview of the different methods used in economic evaluation and demonstrates the utility of each method using studies from the hypertension literature.
Pain Assessment and Documentation — Making a Difference
Authors: Mcarthur Elizabeth , Cunliffe Mary
Published: June 2017

• Pain assessment is essential for effective pain management

• Development of structured pain assessment and documentation of the child's pain history is vital

• Involving the child and family in pain assessment is crucial for effective pain management

• Pain management requires multiprofessional commitment and involvement

• The role of the acute pain service is a vital element within a Children's Trust
Audit of computer literacy and skills
Authors: Browne Alison
Published: June 2017

• Information technology (IT) has radically changed the way that many people work and think

• This audit was designed to evaluate the IT skills and training needs of different professional groups

• Most clerical staff but only about 33% of medical and nursing staff were able to use the current patient information system

• 72% of the staff were interested in further training in information technology skills

• The local college agreed to come to the hospital to run the CLAIT (Computer Literacy and Information Technology) course on our premises
Trust in distant sources: An analytical model capturing antecedents of risk and trustworthiness as perceived by journalists
Authors: Wintterlin Florian
Published: June 2017

The trustworthiness of journalistic sources has always been a crucial element of journalistic working patterns and gained recently prominence in the public discourse about spectacular verification fails. To ensure the correctness of news, journalists have to trust their sources to deliver reliable information. This article explores trust building processes in the relationship between journalists and distant sources they access online. Sociological and psychological trust literature and research on credibility are used to develop an analytical model of reflexive trust in journalistic sources. Based on qualitative data from 12 in-depth interviews with German journalists, the model is applied to relationships between home-based journalists and sources based in crisis regions.
Programming microphysiological systems for children’s health protection
Authors: Knudsen TB , Klieforth B , Slikker W
Published: June 2017

Microphysiological systems (MPS) and computer simulation models that recapitulate the underlying biology and toxicology of critical developmental transitions are emerging tools for developmental effects assessment of drugs/chemicals. Opportunities and challenges exist for their application to alternative, more public health relevant and efficient chemical toxicity testing methods. This is especially pertinent to children’s health research and the evaluation of complex embryological and reproductive impacts of drug/chemical exposure. Scaling these technologies to higher throughput is a key challenge and drives the need for in silico models for quantitative prediction of developmental toxicity to inform safety assessments. One example is cellular agent-based models, constructed from extant embryology, that produce data useful to simulate critical developmental transitions and thereby predict phenotypic consequences of disruption in silico. Biologically inspired MPS models built from human induced pluripotent stem (iPS)-derived cells and synthetic matrices that recapitulate organ-specific physiologies and native tissue architectures are providing exciting new research opportunities to advance the assessment of developmental toxicity and offer the possibility of deriving a full ‘human on a chip’ system, or a ‘Homunculus.’

Impact statement

This ‘commentary’ summarizes research needs and opportunities for engineered MPS models for developmental and reproductive toxicity testing. Emerging concepts can be taken forward to a virtual tissue modeling framework for assessing chemical (and non-chemical) stressors on human development. These models will advance children’s health research, both basic and translational and new ways to evaluate complex embryological and reproductive impacts of drug and chemical exposures to inform safety assessments.
Prediction of pathologic femoral fractures in patients with lung cancer using machine learning algorithms: Comparison of computed tomography-based radiological features with clinical features versus without clinical features
Authors: Oh Eunsun , Seo Sung Wook , Yoon Young Cheol , Kim Dong Wook , Kwon Sunyoung , Yoon Sungroh
Published: June 2017

Purpose:

The purpose of this article is to compare the predictive power of two models trained with computed tomography (CT)-based radiological features and both CT-based radiological and clinical features for pathologic femoral fractures in patients with lung cancer using machine learning algorithms.

Methods:

Between January 2010 and December 2014, 315 lung cancer patients with metastasis to the femur were included. Among them, 84 patients who underwent CT scan and were followed up for more than 3 months were enrolled. We examined clinical and radiological risk factors affecting pathologic fracture through logistic regression. Predictive analysis was performed using five different supervised learning algorithms. The power of predictive model trained with CT-based radiological features was compared to those trained with both CT-based radiological and clinical features.

Results:

In multivariate logistic regression, female sex (odds ratio = 0.25, p = 0.0126), osteolysis (odds ratio = 7.62, p = 0.0239), and absence of radiation therapy (odds ratio = 10.25, p = 0.0258) significantly increased the risk of pathologic fracture in proximal femur. The predictive model trained with both CT-based radiological and clinical features showed the highest area under the receiver operating characteristic curve (0.80 ± 0.14, p < 0.0001) through gradient boosting algorithm.

Conclusion:

We believe that machine learning algorithms may be useful in the prediction of pathologic femoral fracture, which are multifactorial problem.
Empirical Evidence of Geographic Expansion of Sales by Small and Medium Enterprises
Authors: Funabashi Gaku
Published: June 2017

This article examines how small and medium enterprises (SMEs) expand sales markets geographically, using gross profit data from the Indonesian formal and informal firms with relatively low technology. The results from multinomial logistic estimation with four levels of domestic markets and foreign markets indicate that the critical factors for entering distance markets differ depending on the jurisdiction or geographic distance between existing and new markets. The most important factor for low-level expansion, that is, market entry in a province outside the home region or city of the SME concerned, is productivity level. On the other hand, market entry beyond the home province, including foreign markets, requires a certain size and capacity of the firm and certain relationships with business partners, but not productivity level. These findings suggest that the provision of different types of policy support to SMEs, relevant to their stage of market expansion, could be beneficial.
Supply Chain Risk Evaluation: Understanding the Technical Risks from the Perspectives of Dubai Logistics Supply Chain Companies
Authors: Purohit Harsh , Kumar Vijaya
Published: June 2017

This article evaluates the technical risks faced by Dubai based large and medium size logistics supply chain companies (LSCC). Middle East is attempting to turn itself into a multimodal trans-shipment hub for transport, as manufactured goods production has moved from West to East. Thus Dubai port has become the hub, as great freight volumes now transit this region, which has created demand for additional warehousing facilities. As supply chains have lengthened, logistics executives are increasingly responsible for anticipating and eliminating a greater number of risks. The stakes are high: in the past five years, nearly three-fourths of companies experienced significant disruptions. Also the topic is very important in current context; however, there does not seem to be much work done in this area in Dubai, a place which is dominated by the LSCC. The findings are based on risk identification and risk analysis through exploratory and empirical survey using a sample size of 50 questionnaires, 7 in-depth interviews and a focus group meeting with senior supply chain executives. The study provides insights into the applicability of technical risks faced by logistics supply chain, Dubai, with respect to severity, degree, speed, amount of forewarning associated and duration of each risk. Findings from this research will prove useful to management researchers and practitioners.
Cultural impacts on nursing unit design: A comparative study on Chinese nursing unit typologies and their U.S. counterparts using space syntax
Authors: Cai Hui , Zimring Craig
Published: June 2017

This study attempts to understand cultural impacts on nursing unit design through a comparative study on Chinese nursing unit typologies and their U.S. counterparts. The focus is to investigate whether seemingly westernized Chinese nursing units still retained certain characteristics of Chinese socio-cultural preferences; and how configurational differences of Chinese and American nursing unit design reflect the different work styles and organizational communication styles driven by national culture. This study’s contributions are twofold. Firstly, it demonstrates the impact of national culture on nursing unit design. The spatial configuration is a manifesto of culture and is congruent with culture. Secondly, from a methodological point of view, this study has translated abstract cultural schema, organizational constructs, and complex spatial relationships into quantitative spatial metrics. It makes the comparison of various building configurations from different cultures possible. The method and conceptual framework described here can be applied to understanding cultural differences in other building types as well.
A supplement to the studies of tralatitious editions of Shangshu and the character issues (II): A version comparison of Yueming
Authors: Zang Kehe
Published: June 2017

Four sources of the texts of Shangshu are referred to in this article: fragmented texts found on Chu Bamboo Slips of Warring States kept in Shanghai Museum, fragmented texts found on Bamboo Slips of Warring States kept in Tsinghua University, the transcript edition of Shangshu of the Tang Dynasty in ancient script kept in Japan, and the Gengwu edition of Shangshu kept in Korea. These editions represent, respectively, different tralatitious periods of Shangshu. The Tang transcript edition kept in Japan was written in ancient script; the Gengwu edition in Korea contains both ancient and modern scripts; the Bamboo Slips kept in Tsinghua University are regarded as a transcription of the Warring States period. Of the Yueming chapter (part one), many texts in the Bamboo Slips that are kept in Tsinghua University are not compatible with those in the tralatitious editions, or are in contradiction with historical records. Even on a single slip, the texts are often in disorder and unreadable. However, this does not mean that the readable and fluent texts in ancient transcript and print editions testify to the authenticity of the materials. From the level of document dissemination, if the bamboo slip texts are authentic, then we can conclude that there were errors, missing characters, and transcribing errors in the three parts of Yueming in the period as early as the later Warring States period. A comparative study of different editions shows the disagreement in paragraphing and characters in the Tang transcript edition kept in Japan and the Gengwu edition kept in Korea which reflects the version of Shangshu after the merging of the modern and ancient script editions.
Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk
Authors: Dobrosielski Devon A. , Papandreou Christopher , Patil Susheel P. , Salas-Salvadó Jordi
Published: June 2017

Obstructive sleep apnoea (OSA) is associated with increased cardiovascular disease (CVD) morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved (e.g.altered dietary quality) or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients.
A guide for the selection of routing protocols in WBAN for healthcare applications
Authors: Bhanumathi V. , Sangeetha C. P.
Published: June 2017

In the present scenario, the term wireless body area network (WBAN) is becoming an integral part of human day to day life due its wide variety of applications, especially in the field of healthcare systems. To design such a reliable body area network system, there are a number of factors to be considered both in hardware and software levels. One of such factors still developing is the design and the analysis of routing protocols in the network layer. Routing protocols are a set of protocols which can identify and maintain the routes in the network so that the data can be exchanged between the nodes efficiently. Hence, routing protocol plays a vital role in the wireless sensor networks for reliable communication between the sensor nodes. In this paper, different routing protocols for body area networks are surveyed and observed that they are affected by factors like energy, network topology, various quality of services (QoS) in the nodes, node temperature, transmission range of nodes, human posture, etc. An evocative taxonomy of protocols is presented such as cluster-based, cross-layered, postural movement based, QoS aware and temperature-aware routing protocols. From the survey, it is found that the selection of a routing protocol is application dependent. For example, the energy efficient protocols like reinforcement learning based routing with QoS support or wireless autonomous spanning tree protocol can be used for daily health monitoring systems due to its high packet delivery ratio. If the system is for in vivo networks, routing algorithm for network of homogeneous and Id-less biomedical sensor nodes or mobility-supporting adaptive threshold-based Thermal-aware energy-efficient multi-hop protocols are the suitable ones. For critical and emergency cases, where accuracy with little delay is the major concern, the protocols like critical data routing, reliability aware routing, data-centric multi objective QoS-aware routing protocol, etc. can be rightly chosen. This entire survey paper can be used by the researchers as a reference for studying various WBAN routing protocols, especially in the field of medical health care systems.
Participant-Reported Symptoms and Their Effect on Long-Term Adherence in the International Breast Cancer Intervention Study I (IBIS I)
Authors: Smith Samuel George , Sestak Ivana , Howell Anthony , Forbes John , Cuzick Jack
Published: June 2017

Purpose

To assess the role of participant-reported symptoms on long-term adherence to preventive therapy in the United Kingdom sample of the International Breast Cancer Intervention Study (IBIS-I). IBIS-I was a randomized controlled trial that investigated the effectiveness of tamoxifen in reducing the risk of breast cancer among women at increased risk of the disease.

Participants and Methods

Women were randomly assigned to tamoxifen versus placebo (20 mg/day; n = 4,279). After 456 exclusions, 3,823 women were included in this analysis. Adherence (< 4.5 years or ≥ 4.5 years) was calculated using data from six monthly clinical visits. Analyses were adjusted for age, Tyrer-Cuzick risk, smoking, use of hormone replacement therapy, menopausal status, baseline menopausal symptoms, and treatment.

Results

Overall, 69.7% of women were adherent for at least 4.5 years (tamoxifen: 65.2% v placebo: 74.0%; P < .001). Differences in adherence between treatment arms were observed from 12 months onward (all P < .01) and were largest at 54 months. Dropout rates were highest in the first 12 to 18 months and decreased thereafter. Women reporting nausea/vomiting were less likely to be adherent in both the tamoxifen (odds ratio [OR], 0.57; 95% CI, 0.37 to 0.86; P = .007) and placebo (OR, 0.58; 95% CI, 0.37 to 0.93; P = .023) arms. Headaches were associated with adherence only in the placebo arm (OR, 0.62; 95% CI, 0.42 to 0.91; P = .016), whereas gynecologic symptoms were significant only in the tamoxifen arm (OR, 0.77; 95% CI, 0.62 to 0.97; P = .024). Effect sizes for each symptom on adherence were not significantly different between the treatment groups ( P > .05). In both treatment arms, we observed significant trends for lower adherence with increasing severity for all symptoms ( P < .01) except headaches ( P = .054).

Conclusion

In the IBIS-I trial, experiencing predefined symptoms in the first 6 months reduced long-term adherence. Effects were similar between treatment arms, suggesting that women were attributing age-related symptoms to preventive therapy. Interventions were required to support symptom management.
Passive regeneration of glutathione: Glutathione reductase regulation from the freeze-tolerant North American wood frog, Rana sylvatica
Authors: Dawson Neal J. , Storey Kenneth B.
Published: June 2017

Wood frogs inhabit a broad range across North America, extending from the southern tip of the Appalachian Mountains to the northern boreal forest. Remarkably they can survive the winter in a frozen state, where as much as 70% of their body water is converted into ice. During the frozen state, their hearts cease to pump blood, causing their cells to experience ischemia which can dramatically increase the production of reactive oxygen species produced within the cell. To overcome this, wood frogs have elevated levels of glutathione, a primary antioxidant. We examined the regulation of glutathione reductase, the enzyme involved in recycling glutathione, in both the frozen and unfrozen state (control). Glutathione reductase activity from both the control and frozen state showed dramatic reduction in substrate specificity (Km) for oxidized glutathione (50%) when measured in the presence of glucose (300mM) and a increase (157%) when measured in the presence of levels of urea (75mM) encountered in the frozen state. However, when we tested the synergistic effect of urea and glucose simultaneously, we observed a substantial reduction in the Km for oxidized glutathione (43%) to a value similar to that of glucose alone. In fact, we found no observable differences in the kinetic and structural properties of glutathione reductase between the two states. Therefore, a significant increase in the affinity for oxidized glutathione in the presence of endogenous levels of glucose, suggests that increased glutathione recycling may result due to passive regulation of glutathione reductase by rising levels of glucose during freezing.
Effects of rearing salinity on expression and function of ion motive ATPases and ion transport across the gastric caecum of Aedes aegypti larvae
Authors: D'Silva Natalie M. , Patrick Marjorie L. , O'Donnell Michael J.
Published: June 2017

Larvae of Aedes aegypti, the yellow fever vector, inhabit a variety of aquatic habitats ranging from fresh water to brackish water. This study focuses on the gastric caecum of the larvae, an organ that has not been widely studied. We provide the first measurements of H+, K+, and Na+ fluxes at the distal and proximal gastric caecum, and have shown that they differ in the two regions, consistent with previously reported regionalization of ion transporters. Moreover we have shown that the regionalization of vacuolar H+-ATPase and Na+/K+ -ATPase is altered when larvae are reared in brackish water (30% seawater) relative to fresh water. Measurements of luminal Na+ and K+ concentrations also show a 5-fold increase in Na+/K+ ratio in the caecal lumen in larvae reared in brackish water relative to fresh water, whereas transepithelial potential and luminal pH were unchanged. Calculated electrochemical potentials reveal changes in the active accumulation of Na+ and K+ in the lumen of the gastric caecum of fresh water versus brackish water larvae. Together with the results of previous studies of the larval midgut, our results show that the caecum is functionally distinct from the adjacent anterior midgut, and may play an important role in osmoregulation as well as uptake of nutrients.
Two new polyploid species closely related to Alnus glutinosa in Europe and North Africa – An analysis based on morphometry, karyology, flow cytometry and microsatellites
Authors: Vít Petr , Douda Jan , Krak Karol , Havrdová Alena , Mandák Bohumil
Published: June 2017

In the present study, we investigate the variation of European representatives of Alnus subg. Alnus, i.e., Alnus glutinosa and A. incana, in Europe and partly North Africa. Four distinct Alnus taxa were recognized using a multidisciplinary approach based on multivariate morphometrics, karyology, flow cytometry and nuclear microsatellite analyses. Besides the long‐recognized diploid taxa (2n = 2x = 28) A. glutinosa and A. incana, we revealed the presence of morphologically, cytologically and genetically noticeably delimited tetraploid populations (2n = 4x = 56), which we consider new species. These form two geographically well‐delimited clusters located in the Iberian Peninsula and the adjacent part of North Africa, designated here as Alnus lusitanica, and in the Dinaric Alps extending south‐easterly to Greece, denominated here as Alnus rohlenae. Detailed information concerning their diagnosis and geographical distribution is presented, and photographs of type specimens are provided.
O grau de satisfação dos agricultores familiares em relação ao Programa de Aquisição de Alimentos
Authors: Teotonio Nascimento Daniel , Johann Jerry Adriani , Basso Dirceu
Published: June 2017

Este estudo teve como objetivo comprovar o grau de satisfação de 69 agricultores familiares em relação ao Programa de Aquisição de Alimentos (PAA), bem como o seu grau de satisfação em relação à gestão de uma Cooperativa do Oeste do Paraná dos quais são filiados. No desenvolvimento da pesquisa foi utilizado o Modelo de Avaliação de Satisfação (MAS), desenvolvido por Nascimento (2015), constatando-se que em geral os agricultores familiares estão satisfeitos em relação ao PAA e a gestão da Cooperativa. Entretanto, alguns produtores manifestaram insatisfação, especialmente quanto aos preços pagos por seus produtos, aos grupos prioritários, e às documentações exigidas. Quanto à gestão da Cooperativa, também foram detectados alguns indicadores negativos. Portanto, foram realizadas duas propostas de intervenção: uma direcionada aos órgãos públicos e outra aos diretores da Cooperativa.
External rotation of the femoral component increases asymmetry of the posterior condyles
Authors: Bonnin M. P. , Saffarini M. , Nover L. , van der Maas J. , Haeberle C. , Hannink G. , Victor J.
Published: June 2017

Aims

The morphometry of the distal femur was largely studied to improve bone-implant fit in total knee arthroplasty (TKA), but little is known about the asymmetry of the posterior condyles. This study aimed to investigate the dimensions of the posterior condyles and the influence of externally rotating the femoral component on potential prosthetic overhang or under-coverage.

Patients and Methods

We analysed the shape of 110 arthritic knees at the time of primary TKA using pre-operative CT scans. The height and width of each condyle were measured at the posterior femoral cut in neutral position, and in 3º and 5º of external rotation, using both central and medial referencing systems. We compared the morphological characteristics with those of 14 TKA models.

Results

In the neutral position, the dimensions of the condyles were nearly equal. Externally rotating the femoral cut by 3º and 5º with ‘central referencing’ induced width asymmetry >  3 mm in 23 (21%) and 33 (30%) knees respectively, while with ‘medial referencing’ it induced width asymmetry > 3 mm in 43 (39%) and 75 (68%) knees respectively. The asymmetries induced by rotations were not associated with gender, aetiology or varus-valgus alignment.

Conclusion

External rotation may amplify the asymmetry between the medial and lateral condyles, and exacerbate prosthetic overhang, particularly in the superolateral zone. ‘Central referencing’ guides result in less potential prosthetic overhang than ‘medial referencing’ guides. Cite this article: Bone Joint J 2017;99-B:894–903
The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy
Authors: Ogawa H. , Matsumoto K. , Akiyama H.
Published: June 2017

Aims

We aimed to investigate factors related to the technique of medial opening wedge high tibial osteotomy which might predispose to the development of a lateral hinge fracture.

Patients and Methods

A total of 71 patients with 82 osteotomies were included in the study. Their mean age was 62.9 years (37 to 80). The classification of the type of osteotomy was based on whether it extended beyond the fibular head. The level of the osteotomy was classified according to the height of its endpoint.

Results

At a mean follow-up of 20 months (6 to 52), a total of 15 lateral hinge fractures (18.3%) were identified. A sufficient osteotomy, in which both anterior and posterior tibial cortices were involved with extension into the lateral aspect of the plateau in relation to an anteroposterior line tangential to the medial edge of the fibular head in the CT axial plane, was seen in 48 knees (71.6%) in those without a lateral hinge fracture and in seven (46.7%) in those with a lateral hinge fracture. An osteotomy which ended above the level of the fibular head was seen in nine (13.4%) of the knees without a lateral hinge fracture and seven (46.7%) of the those with a lateral hinge fracture. There was a significant relationship between the absence of a lateral hinge fracture and both a sufficient osteotomy and one whose endpoint was at the level of the fibular head (p = 0.0451 and p = 0.0214, respectively).

Conclusion

A sufficient osteotomy involving both the anterior and posterior cortices, whose endpoint is at the level of the fibular head, should be performed when undertaking a medial opening wedge high tibial osteotomy if a lateral hinge fracture is to be avoided as a complication. Cite this article: Bone Joint J 2017;99-B:887–93.
Prospective randomised trial of non-operativeversusoperative management of olecranon fractures in the elderly
Authors: Duckworth A. D. , Clement N. D. , McEachan J. E. , White T. O. , Court-Brown C. M. , McQueen M. M.
Published: June 2017

Aims

The aim of this prospective randomised controlled trial was to compare non-operative and operative management for acute isolated displaced fractures of the olecranon in patients aged ≥ 75 years.

Patients and Methods

Patients were randomised to either non-operative management or operative management with either tension-band wiring or fixation with a plate. They were reviewed at six weeks, three and six months and one year after the injury. The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at one year.

Results

A total of 19 patients were randomised to non-operative (n = 8) or operative (n = 11; tension-band wiring (n = 9), plate (n = 2)) management. The trial was stopped prematurely as the rate of complications (nine out of 11, 81.8%) in the operative group was considered to be unacceptable. There was, however, no difference in the mean DASH scores between the groups at all times. The mean score was 23 (0 to 59.6) in the non-operative group and 22 (2.5 to 57.8) in the operative group, one year after the injury (p = 0.763). There was no significant difference between groups in the secondary outcome measures of the Broberg and Morrey Score or the Mayo Elbow Score at any time during the one year following injury (all p ≥ 0.05).

Conclusion

These data further support the role of primary non-operative management of isolated displaced fractures of the olecranon in the elderly. However, the non-inferiority of non-operative management cannot be proved as the trial was stopped prematurely. Cite this article: Bone Joint J 2017;99-B:964–72.
Promising early results for trabecular metal acetabular components used at revision total hip arthroplasty
Authors: Mohaddes M. , Shareghi B. , Kärrholm J.
Published: June 2017

Aims

The aim of this study was to compare the incidence of aseptic loosening after the use of a cemented acetabular component and a Trabecular Metal (TM) acetabular component (Zimmer Inc., Warsaw, Indiana) at acetabular revision with bone impaction grafting.

Patients and Methods

A total of 42 patients were included in the study. Patients were randomised to receive an all- polyethylene cemented acetabular component (n = 19) or a TM component (n = 23). Radiostereometric analysis and conventional radiographic examinations were performed regularly up to two years post-operatively or until further revision.

Results

The proximal migration was significantly higher in the cemented group. At two years, the median proximal migration was 1.45 mm and 0.25 mm in the cemented and TM groups, respectively (p = 0.02). One cemented component was revised due to dislocation. There were no revisions in the TM group.

Conclusion

Lower proximal migration in the TM group suggests that this design might be associated with a lower risk of aseptic loosening in the long term compared with an all polyethylene cemented component. Longer follow-up is required to confirm the clinical advantages of using this component at acetabular revision. Cite this article: Bone Joint J 2017;99-B:880–6.