bluuebunny/crossref_metadata_2025 huggingface dataset:
Simplifying Piperacillin/Tazobactam Dosing: Pharmacodynamics of Utilizing Only 4.5 or 3.375 g Doses for Patients With Normal and Impaired Renal Function
Authors: Thabit Abrar K. , Grupper Mordechai , Nicolau David P. , Kuti Joseph L.
Published: November 2017

Objectives:

To evaluate the pharmacodynamic exposure of piperacillin/tazobactam across the renal function range using 4.5 or 3.375 g dosing regimens.

Methods:

A 5000-patient Monte Carlo simulation was conducted to determine the probability of achieving 50% free time above the minimum inhibitory concentration ( fT > MIC) for piperacillin. Proposed regimens, using solely 4.5 or 3.375 g strengths, were compared with regimens listed in piperacillin/tazobactam prescribing information over creatinine clearance (CrCl) ranges of 120 mL/min to hemodialysis. The probability of target attainment (PTA) at MICs ≤ 16 μg/mL was compared between proposed and standard regimens.

Results:

At CrCl 41 to 120 mL/min, prolonged infusions of 4.5 g (3 hours) and 3.375 g (4 hours) every 6 hours resulted in ≥95% PTA versus ≥76% for standard regimens (0.5 hour). At CrCl 20 to 40 mL/min, 4.5 and 3.375 g every 8 hours as prolonged infusions achieved slightly higher PTA (≥98%) versus standard regimens (≥93%). Similarly, PTA achieved with prolonged infusions of 4.5 and 3.375 g every 12 hours (≥93%) was comparable with those of standard regimens (≥91%) at CrCl 1 to 19 mL/min. In hemodialysis, 100% PTA was achieved with prolonged infusion regimens.

Conclusion:

Piperacillin/tazobactam regimens designed around the 4.5 or 3.375 g dose and prolonged infusions provided similar or better PTA at MICs ≤ 16 μg/mL compared with standard regimens. These observations may support the stocking and use of a single piperacillin/tazobactam strength to simplify dosing.
Exceptional Sexual Harms
Authors: Gleeson Kate
Published: November 2017

Questioning of Catholic Church leaders in the Australian Royal Commission into Institutional Responses to Child Sexual Abuse has revealed a distinct sense of immunity and lack of responsibility for the crimes of church personnel, which has resulted in stymied justice for complainants in sexual abuse lawsuits. In this article, I explore this immunity by examining it in the context of treatments of sexual harms in other areas of private law, particularly religious exceptions to discrimination law, by which religious organizations are granted immunity from the modern rationale of the harms of discrimination on the grounds of sex and sexual orientation. In situating child sexual abuse claims in the broader sphere of private law, I aim to reveal law’s incoherent logic of sexual harms, and its implications for justice. The example of religious exceptions illustrates an incoherent problematization of sexual harm and responsibility in contemporary legal and political systems that aim to uphold modern values of equality and dignity while sustaining incompatible doctrines of religious autonomy.
The use of ocular ultrasound for the diagnosis of retinal detachment in a local accident and emergency department
Authors: Chu Ho Cheung , Chan Ming Yin , Chau Cheuk Wai Jeffrey , Wong Chi Pang , Chan Hok Hang , Wong Tai Wai
Published: November 2017

Objectives:

This study aimed to assess the accuracy of ocular ultrasound performed by emergency physicians for diagnosis of retinal detachment.

Methods:

This was a prospective single-center observational study conducted between September 2013 and February 2015. All adult patients presenting to the emergency department with acute onset of visual changes were eligible to participate. Patients who met one of the following criteria were excluded: a diagnosis of retinal detachment had already been made by an ophthalmologist prior to attendance; pre-existing retinal detachment currently under treatment; hemodynamically unstable; suspected rupture eyeball; and unable to give consent. Six emergency physicians performed emergency ocular ultrasound using a linear 10-MHz ultrasound probe. An abnormal lifting of the retina or the presence of a retinal flap was considered diagnostic of retinal detachment. The final diagnosis of the ophthalmologist who was blinded to the study was used as the gold standard.

Results:

Among the 139 patients evaluated, 16 (12%) had retinal detachments and 14 of them were correctly identified (true positives). Of the 123 patients (88%) without retinal detachment, 107 patients were correctly identified (true negatives). The sensitivity and specificity of emergency ocular ultrasound for retinal detachment were 88% (95% confidence interval = 60 to 98) and 87% (95% confidence interval = 79 to 92), respectively.

Conclusion:

Emergency ocular ultrasound is a useful adjunct for the diagnosis of retinal detachment.
Simulated workplace protection factors for respirators with N95 or higher filters for health care providers in an emergency medical centre: A randomized crossover study
Authors: Lee Sanghyun , Kim Hongjung , Lim Taeho , Oh Jaehoon , Kang Hyunggoo , Ahn Chiwon , Song Yeongtak , Lee Juncheol , Shin Hyungoo
Published: November 2017

Introduction:

Health care providers in emergency medical centres often encounter infected sources during medical procedures; these sources can generate droplets. Wearing respirators could help to protect against infection risk. However, to the best of our knowledge, no previous study has reported the efficacy of N95 or higher respirators for health care providers in emergency medical centres.

Methods:

A randomized, crossover study of 26 health care providers was conducted to examine the protective performance of respirators. Quantitative fit tests with three types of respirators (cup type, fold type without valve and fold type with valve) were performed using seven exercises. Primary outcomes were the fit factors. Secondary outcomes included the percentage of fit factors above 100 and respirator preference.

Results:

After excluding one participant, data for 25 participants were analysed. The fit factors and the percentage of fit factors above 100 were higher when participants wore a fold-type respirator (200 fit factors [38.6–200], 100% [0–100]) relative to those for the cup-type respirator (114.0 fit factors [16.0–185.2], 60% [0–100]) and valve-type respirator (84.9 fit factors [14.2–170.8], 23.8 % [0–100]) in normal respiration. There was no clear preference regarding the type of respirator.

Conclusion:

The type of respirator could influence protective performance for health care providers. Health care providers in emergency medical centres should be aware of and wear the type of respirator that is well-fitted for them in advance.
Whose Fault Is It Anyway? Guilt, Blame, and Death Attribution by Mothers After Stillbirth or Infant Death
Authors: Gold Katherine J. , Sen Ananda , Leon Irving
Published: November 2017

Parents who experience stillbirth or infant death often struggle with postpartum guilt. This may be an adaptive response or can become chronic and maladaptive. We surveyed bereaved mothers in Michigan with perinatal death 15 months after loss to evaluate guilt, blame, and potential covariates. Self-report information was linked with data from State of Michigan vital records of births and deaths. Respondents included 311 mothers. Most reported guilt or self-blame at 15 months. In multinomial logistic analysis, depression and interpersonal violence predicted greater guilt. Nearly half of women blamed their medical team for the loss, and about a fifth reported feeling blamed by others. Both of these attributions were associated with greater guilt. The majority of mothers report persistent guilt after perinatal loss. Depression at either 9 or 15 months was a strong predictor of greater guilt.
Further Investigations of the Effects of Anti-β2GP1 Antibodies on Collagen-Induced Platelet Aggregation
Authors: Ho Yik C. , Ahuja Kiran D. K. , Adams Murray J.
Published: November 2017

Anti-beta-2-glycoprotein 1 (anti-β2GP1) antibodies are associated with increased thrombotic risk in patients with autoimmune disease. There is conflicting evidence on the effects of anti-β2GP1 antibodies on platelets, with both enhanced and inhibited aggregation previously reported. However, previous studies did not include isotype antibodies to ensure the observed effects were due to anti-β2GP1 antibodies. The aims of this study were to (1) investigate the effects of anti-β2GP1 antibodies on collagen-induced platelet aggregation in parallel with negative control (buffer normal saline) and isotype control antibodies and (2) determine the lupus anticoagulant (LA) activity of anti-β2GP1 antibodies used. Three animal-derived anti-human-β2GP1 antibodies (1.25, 2.5, and 5 μg/mL) incubated with healthy platelet-rich plasma were activated by collagen (2.5 μg/mL). Each anti-β2GP1 antibody demonstrated the inhibition of aggregation compared to negative control, but not to isotype control. No anti-β2GP1 antibody demonstrated LA activity, suggesting they were probably nonpathological. This study highlights both negative and isotype control markers are important to validate the effects of anti-β2GP1 antibodies. Assays to measure anti-domain I-β2GP1 antibodies are recommended to be used in conjunction with functional measures to further investigate the effects of anti-β2GP1 antibodies.
An Aesthetic of Relationality: Embodiment, Imagination, and the Necessity of Playing the Fool in Research-Informed Theater
Authors: Gray Julia , Kontos Pia
Published: November 2017

Research-informed theater is often informed by an assumed linear trajectory between research findings and performance, overlooking the multiple embodied perspectives that are implicated in the development of research-informed theater. To challenge this assumption, we explore how artist-researchers draw on their own embodiment and imagination as ways to understand the research findings, how they conceptualize the intended audience, and how those understandings shape the creative process of the research-informed play. Using the case study of the research-informed play Cracked: New Light on Dementia, we focus on three interrelated modes of practice: playful extending, foolish disrupting, and inventive disrupting. We argue that these modes of practice create an aesthetic of relationality, what we define as an aesthetic space within which the embodied interpretive work of artist-researchers is extended into spatial, relational contexts. We discuss implications of this theoretical framework for a new critical inquiry.
Psychosocial Benefits of Cooking Interventions: A Systematic Review
Authors: Farmer Nicole , Touchton-Leonard Katherine , Ross Alyson
Published: November 2017

Objectives. Cooking interventions are used in therapeutic and rehabilitative settings; however, little is known about the influence of these interventions on psychosocial outcomes. This systematic review examines the research evidence regarding the influence of cooking interventions on psychosocial outcomes. Methods. A systematic review of the literature examined peer-reviewed research using Embase, PubMed, CINALH Plus, and PsychInfo with the following search terms: cooking, culinary, baking, food preparation, cookery, occupational therapy, mental health, mood, psychosocial, affect, confidence, self-confidence, self-esteem, socialization, and rehabilitation. Inclusion criteria were the following: adults, English, influence of cooking interventions on psychosocial outcomes. PRISMA guidelines were used. Results. The search yielded 377 articles; and 11 ultimately met inclusion criteria and were reviewed. Generally, the quality of the research was weak due to nonrandomization, unvalidated research tools, and small sample sizes. However, inpatient and community-based cooking interventions yielded positive influences on socialization, self-esteem, quality of life, and affect. Conclusions. Finding benefits to cooking that extend beyond nutritional may be helpful in increasing motivation and frequency of cooking. This review suggests that cooking interventions may positively influence psychosocial outcomes, although this evidence is preliminary and limited. Further qualitative and rigorous quantitative research are needed to identify mechanisms by which cooking interventions may improve psychosocial outcomes.
Recipes for Change? Patriarchal and Progressive Masculinities in Cookbooks for Men
Authors: Nolen Jason A.
Published: November 2017

In this article, representations of culinary masculinities are analyzed. Through a textual analysis of two sets of twenty-first-century cookbooks—those targeted to “men” and those targeted to “dads”—I show that two contrasting hybridizations of hegemonic masculinity are represented. The men’s cookbooks present a patriarchal masculinity that supports men’s structural dominance over women by framing men’s cooking as distinct from routine care work. This is achieved by portraying men’s cooking as an instrumental strategy for gaining sexual or romantic access to women, as a way of elevating the esteem in which others (usually nonfamily members) hold the male cook, and as an irregular activity that is performed on special occasions or due to special circumstances. The dads’ cookbooks present a progressive masculinity that challenges men’s dominance by framing men’s cooking as a form of routine care work. This is achieved by portraying men’s cooking as a daily endeavor, as an activity that is attentive to the nutritional and emotional needs of children, and as an aspect of a larger parenting project that encompasses household management and children’s social development. This analysis contributes to the debate over whether hybridizations of hegemonic masculinity perpetuate or challenge men’s dominance by suggesting that the multiplicity of hybrid masculinities provides for the dual possibility of a movement toward gender equality or a retrenchment of patriarchal power.
Evaluation Practice
Authors: Grob George F.
Published: November 2017

This article is the fifth in a series on the relationship of evaluation theory and practice. It was commissioned by the Eastern Evaluation Research Society and the American Evaluation Association as part of The Chelimsky Forum, launched in 2013 to honor Eleanor Chelimsky, one of the most influential and respected program evaluators of our era, and the former director of the Program Evaluation and Methodology Division of the U.S. Government Accountability Office. Supported by the Robert Wood Johnson Foundation, the forum is aimed at discussing challenges in the fit between theory and practice and strategies for addressing them. This article focuses on the relationships between evaluators and their users, especially policy makers. It tries to see things through the eyes of these users, recognizing their values and concepts related to evidence, proof, and “the truth” as they see it. It therefore tries to come to grips with the common core of evaluation thinking among a host of such clients, aiming to speak to them in their own language, but without sacrificing evaluator independence. It also recognizes the modern world of electronic reports and the possibility of both widespread and targeted dissemination of evaluation results. Finally, it offers some hints about evaluator development in this modern world, especially in the volatile world of policy and politics.
Place-Making and Communication Practice: Everyday Precarity in a Night Market in Hong Kong
Authors: Chan Ngai Keung
Published: November 2017

Drawing insights from the literature around cultural discourse theory, urban informality, and precarity, this article explores how a group of unlicensed hawkers in Hong Kong engage in a place-making process of precarity. Existing research on precarity has examined the structural change in the labor market in advanced economies and labor unions’ collective resistance. Few empirical studies, however, have explicated how informal workers experience precarity in their everyday life. To contribute to this literature, therefore, this study examines how hawkers in Hong Kong constitute their class identities and the meanings of place while facing legal and spatial ambiguities on a daily basis. While interlocutors articulate different class identities, they constitute themselves as precarious beings through spatial practice. Rather than engaging in collective resistance against precarity, hawkers develop culturally distinctive practices to adapt to the power structure in which they operate. This article highlights the dialectical relationship between spatial practice and precarity as contextualizing precarity in developing Asia.
Manual engagement and automation in amateur photography
Authors: Ploderer Bernd , Leong Tuck Wah
Published: November 2017

Automation has been central to the development of modern photography and, in the age of digital and smartphone photography, now largely defines everyday experience of the photographic process. In this article, we question the acceptance of automation as the default position for photography, arguing that discussions of automation need to move beyond binary concerns of whether to automate or not and, instead, to consider what is being automated and the degree of automation couched within the particularities of people’s practices. We base this upon findings from ethnographic fieldwork with people engaging manually with film-based photography. While automation liberates people from having to interact with various processes of photography, participants in our study reported a greater sense of control, richer experiences and opportunities for experimentation when they were able to engage manually with photographic processes.
‘Keep it to yourself’: Shame and female masturbation in American independent cinema
Authors: Clayton Wickham , Humphreys Georgia
Published: November 2017

This article considers four films released in American independent cinema since 2000 that contain examples of female masturbation as linked with shame within the character constructs: Mulholland Dr. (2001; dir. Lynch), Secretary (2002; dir. Shainberg), Margot at the Wedding (2007; dir. Baumbach), and Black Swan (2010; dir. Aronofsky). Utilising formalist analysis of the relevant masturbation sequences in the films, along with psychoanalytic theory in relation to both masturbation and the concept of shame, this article aims to demonstrate how these films frame masturbation as negative and transgressive, and link autoerotic behaviour to the concept of shame within the development of the characters.
Pharmaceutical intimacy: Managing female sexuality through Addyi
Authors: Flore Jacinthe
Published: November 2017

In August 2015, the US Food and Drug Administration approved the production of Addyi (flibanserin), a pharmaceutical tablet for premenopausal women distressed by a lack of sexual desire. During clinical trials, reports from research participants revealed minimal efficacy: an estimated 0.8 increase in ‘satisfying sexual events’ per month. This article explores the emergence of Addyi as a case study of how this technique produces a particular subject of pharmaceutical knowledge. It examines the pharmaceutical tablet as a technique for the management of sexual appetite. I consider the significance of the act of pharmaceutical ingestion on the embodied subjectivity of the consumer and the chemical constitution of the human body.
Which computer-use behaviours are most indicative of cognitive decline? Insights from an expert reference group
Authors: Couth Samuel , Stringer Gemma , Leroi Iracema , Sutcliffe Alistair G , Gledson Ann , Bruno Davide , McDonald Kathryn R , Montaldi Daniela , Poliakoff Ellen , Rust Jonathan , Thompson Jennifer C , Brown Laura JE
Published: November 2017

Computer use is becoming ubiquitous among older adults. As computer use depends on complex cognitive functions, measuring individuals’ computer-use behaviours over time may provide a way to detect changes in their cognitive functioning. However, it is uncertain which computer-use behaviour changes are most likely to be associated with declines of particular cognitive functions. To address this, we convened six experts from clinical and cognitive neurosciences to take part in two workshops and a follow-up survey to gain consensus on which computer-use behaviours would likely be the strongest indicators of cognitive decline. This resulted in a list of 21 computer-use behaviours that the majority of experts agreed would offer a ‘strong indication’ of decline in a specific cognitive function, across Memory, Executive function, Language and Perception and Action domains. This list enables a hypothesis-driven approach to analysing computer-use behaviours predicted to be markers of cognitive decline.
Three-dimensional computational fluid dynamics engine knock prediction and evaluation based on detailed chemistry and detonation theory
Authors: Netzer Corinna , Seidel Lars , Pasternak Michal , Lehtiniemi Harry , Perlman Cathleen , Ravet Frédéric , Mauss Fabian
Published: November 2017

Engine knock is an important phenomenon that needs consideration in the development of gasoline-fueled engines. In our days, this development is supported using numerical simulation tools to further understand and predict in-cylinder processes. In this work, a model tool chain which uses a detailed chemical reaction scheme is proposed to predict the auto-ignition behavior of fuels with different octane ratings and to evaluate the transition from harmless auto-ignitive deflagration to knocking combustion. In our method, the auto-ignition characteristics and the emissions are calculated using a gasoline surrogate reaction scheme containing pathways for oxidation of ethanol, toluene, n-heptane, iso-octane and their mixtures. The combustion is predicted using a combination of the G-equation based flame propagation model utilizing tabulated laminar flame speeds and well-stirred reactors in the burned and unburned zone in three-dimensional Reynolds-averaged Navier–Stokes. Based on the detonation theory by Bradley et al., the character and the severity of the auto-ignition event are evaluated. Using the suggested tool chain, the impact of fuel properties can be efficiently studied, the transition from harmless deflagration to knocking combustion can be illustrated and the severity of the auto-ignition event can be quantified.
Theory adrift: The matter of archaeological theorizing
Authors: Pétursdóttir Þóra , Olsen Bjørnar
Published: November 2017

At a possible transition towards a ‘flat’, post-human or new-materialist environment, many have suggested that archaeological theory and theorizing is changing course; turning to metaphysics; leaning towards the sciences; or, even is declared dead. Resonating with these concerns, and drawing on our fieldwork on a northern driftwood beach, this article suggests the need to rethink fundamental notions of what theory is – its morphological being – and how it behaves and takes form. Like drift matter on an Arctic shore, theories are adrift. They are not natives of any particular territory, but nomads in a mixed world. While they are themselves of certain weight and figure, it matters what things they bump into, become entangled with, and moved by. Based on this, we argue that theories come unfinished and fragile. Much like things stranding on a beach they don’t simply ‘add up’ but can become detached, fragmented, turned and transfigured. Rather than seeing this drift as rendering them redundant and out of place, it is this nomadism and ‘weakness’ that sustains them and keeps them alive.
Does Family Policy Influence Women’s Employment?: Reviewing the Evidence in the Field
Authors: Ferragina Emanuele
Published: November 2017

During the past two decades, the debate over the relation between family policy and women’s employment in high-income countries has grown in prominence. Nevertheless, the evidence proposed in different disciplines – sociology, politics, economics and demography – remains scattered and fragmented. This article addresses this gap, discussing whether family policy regimes are converging and how different policies influence women’s employment outcomes in high-income countries. The main findings can be summarized as follows: family policy regimes (‘Primary Caregiver Strategy’, ‘Choice Strategy’, ‘Primary Earner Strategy’, ‘Earning Carer Strategy’, ‘Mediterranean Model’) continues to shape women’s employment outcomes despite some process of convergence towards the Earning Carer Strategy; the shortage of childcare and the absence of maternal leave curtail women’s employment; long parental leave seems to put a brake to women’s employment; unconditional child benefits and joint couple’s taxation negatively influence women’s employment but support horizontal redistribution; policies and collective attitudes interact, influencing women’s behaviour in the labour market; and the effect of policies is moderated/magnified by individual socioeconomic characteristics, that is, skills, class, education, income, ethnicity and marital status. The article concludes by suggesting avenues for future research.
Bifurcated Stent Technique: A Viable Option for Treatment of Patients With Unusual Anatomy Presenting With Combined Chronic Mesenteric Ischemia and Diffuse Ischemic Gastric Ulcers
Authors: Manunga Jesse
Published: November 2017

Treatment of chronic mesenteric ischemia has evolved over the last two decades. Endovascular therapy is now the treatment of choice for patients with lesions amenable to such an approach. Open revascularization remains the standard of care but is frequently being reserved for lesions containing intraluminal thrombus or severe calcification. In most cases, celiac axis (CA) stenting is not needed since revascularization of the superior mesenteric artery (SMA) alone results in symptomatic resolution. This report describes a case of a patient with chronic mesenteric ischemia and diffuse gastric ulcers found to have a common origin of the SMA and CA that was treated endovascularly using a bifurcated stent technique.
Prophylactic Inferior Vena Cava Filter Utilization and Risk Factors for Nonretrieval
Authors: Stern Jordan R. , Cafasso Danielle E. , Meltzer Andrew J. , Schneider Darren B. , Ellozy Sharif H. , Connolly Peter H.
Published: November 2017

Purpose:

Inferior vena cava filters (IVCFs) are often placed for prophylactic indications. We sought to better define the range of practice indications for placement of prophylactic IVCFs, as well as the specific retrieval rate and risk factors for nonretrieval.

Methods:

A retrospective, single-institution review of patients undergoing IVCF placement over a 2-year period was performed. Patients undergoing prophylactic IVCF placement were selected from a prospectively collected database. Risk factors for nonretrieval were identified using a multivariate logistic regression model.

Results:

Of 615 IVCFs placed, 256 were retrievable filters placed for prophylactic indications and comprised the study cohort. The most common indications were a history of venous thromboembolic disease (43.7%), malignancy (35.1%), bleeding risk precluding anticoagulation (33.9%), and trauma (22.6%). One hundred sixty-three (63.6%) were placed preoperatively. Placement was performed in 70.3% by interventional radiology, 21.4% by vascular surgery, and 8.2% by cardiology. The most common requesting services were orthopedics (67%), general surgery (11%), neurosurgery (9%), and bariatric surgery (7%). Of all, 67.6% were placed in the inpatient setting and 32.4% in outpatients. Seventy-one (27.7%) of the 256 prophylactic filters were retrieved, with a mean indwelling time of 92 ± 74 days. Inpatients were significantly less likely to have their IVCF removed (32.4% vs 57.8%; P < .001), as were preoperative patients.

Conclusions:

This study helps define current practice trends for the placement of prophylactic IVCFs. Importantly, the specific retrieval rate for prophylactic filters is low. This suggests that prophylactic IVCF usage is suboptimal and efforts should be taken to increase retrieval, especially among inpatients and perioperative patients.
#BlackGirlsMatter: A Case Study Examining the Intersectionality of Race, Gender, and School Discipline
Authors: Kemp-Graham Kriss Y.
Published: November 2017

Nationwide, African American girls have the highest suspension rates among all racial and ethnic groups. Furthermore, they are the most severely, disproportionately affected by school discipline policies and practices when compared with other girls. This case study was developed for use in education leadership programs to critically analyze school discipline policies and practices that disproportionately affect African American girls.
Trends in Upper Extremity Injuries Presenting to US Emergency Departments
Authors: Wenzinger Eric , Rivera-Barrios Angel , Gonzalez Gil , Herrera Fernando
Published: November 2017

Background: The purpose of this study was to identify the incidence of upper extremity injuries presenting to emergency departments (EDs) nationally. Methods: The Nationwide Emergency Department Sample (NEDS) database was queried using International Classification of Diseases, Ninth Revision (ICD-9) codes specific for hand/wrist injuries to identify national estimates of ED visits. The incidence, mean age, gender, payer mix, hospital type, location (metropolitan vs nonmetropolitan), and geographic region were recorded. Results: In total, 2 791 257 patients with upper extremity injuries and infections were treated at an ED in 2010. In total, 7.4% resulted in hospital admission; 57% of patients were male. Most common age group affected was 18 to 44 years (44%), followed by those less than 17 years (24%) and 45 to 64 years (21%). The 3 most common injury classifications were soft tissue contusions (37%), fractures (27%), and infections (17%). Thirty-seven percent of patients had private insurance, 21% had Medicaid, 19% were uninsured, 13% Medicare, and 10% other. In total, 63% of visits were seen in nonteaching EDs, 80% were seen in metropolitan cities, and 65% of visits were seen at non–trauma-designated hospitals. Geographically, 37% of visits were in the South, 25% Midwest, 20% Northeast, and 18% in the West. Conclusions: Soft tissue contusion was the most frequent diagnosis. More than half of the patients were male, while the majority of patients were under the age of 44. Ninety-three percent of patients did not require hospital admission. Half had private insurance and the two-thirds of these patients were seen at nonteaching facilities.
Wingspan stent delivery catheter fracture and the TRAP technique for endovascular salvage
Authors: Jagani Manoj , Do Huy M , Heit Jeremy J
Published: November 2017

Background

Intracranial atherosclerotic disease may result in ischemic infarction and has a high rate of recurrent ischemic strokes despite medical therapy. Patients who fail medical therapy may undergo endovascular treatment with cerebral artery angioplasty and possible Wingspan stent placement. We present a unique case of Wingspan delivery microcatheter fracture that resulted in a retained foreign body and an endovascular salvage maneuver.

Case description

An elderly patient presented with an acute ischemic stroke due to a severe stenosis in the proximal left middle cerebral artery (MCA). The patient failed non-invasive medical treatment and underwent endovascular treatment with angioplasty and Wingspan stent placement. Following Wingspan stent deployment, the stent delivery catheter fractured, and the retained catheter fragment resulted in MCA occlusion. The foreign body was retrieved by balloon catheter inflation within an intermediate catheter adjacent to the proximal end of the fractured catheter and removal of the entire construct (TRAP technique).

Conclusions

Wingspan delivery microcatheter fracture is a rare event. The TRAP technique may be used for successful retrieval of a retained foreign body.
Thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms
Authors: Nomura Motohiro , Mori Kentaro , Tamase Akira , Kamide Tomoya , Seki Syunsuke , Iida Yu , Shirokane Kazutaka , Baba Eiichi , Tsuchiya Atsushi , Shima Hiroshi
Published: November 2017

Background

In cases of subarachnoid hemorrhage due to aneurysm rupture, the administration of an anticoagulant or antiplatelet agent involves the risk of rebleeding from the aneurysm. There is a possibility of inducing thromboembolic events during the endovascular embolization of ruptured cerebral aneurysms.

Patients and methods

From April 2006 to March 2017, we treated a total of 70 patients with ruptured cerebral aneurysms with an endovascular technique. Among them, five patients (7.1%) showed intra-arterial thrombus formation. The aneurysms were located at the anterior communicating artery and basilar artery in two patients each, and on the internal carotid artery at the bifurcation of the anterior choroidal artery (AChoA) in one. In these patients, the clinical course, radiological findings, and management were retrospectively reviewed.

Results

Thrombus formation was observed in the posterior cerebral artery, anterior cerebral artery (A2), AChoA, and middle cerebral artery. The timing of thrombus formation was during coil delivery in four cases, and guiding catheter advancement in one. As for thrombus management, for all patients, administrations of heparin and antiplatelet agents were performed. For four patients, urokinase injection into the affected arteries was added after the completion of embolization. Cerebral infarction was postoperatively identified in two patients, but no hemorrhage was noted.

Conclusion

Administrations of heparin and antiplatelet drugs should be performed appropriately during procedures, and close observation of the arterial condition on angiography is necessary. Once thromboembolism occurs during the endovascular embolization of ruptured cerebral aneurysms, adequate heparinization, and antiplatelet therapy should first be performed.
Choroid plexus AVM with anomalous origin of the capsulothalamic artery: A case report
Authors: Yamauchi Shigeru , Kawakami Taichiro , Murata Keiji , Ishiguro Tomoya , Ikeda Hidetoshi , Nishio Akimasa
Published: November 2017

Background and importance

Traditionally, it has been believed that the plexal segment of the anterior choroidal artery (AChoA) can be sacrificed safely. Here, we present a case of choroid plexus arteriovenous malformation (AVM) in which the capsulothalamic artery originated from distal plexal segment of the AChoA.

Clinical presentation

A 45-year-old man was diagnosed with arteriovenous malformation involving the left inferior horn in screening MRI. Preceding stereotactic radiosurgery, transarterial target embolization was performed. In this procedure, 20% n-butyl-2-cyanoacrylate (NBCA) was successfully injected from the lateral plexal branch of the AChoA. After embolization, right homonymous hemianopsia developed due to cerebral infarction on the left optic radiation. This infarction was considered to be within the territory of the capsulothalamic artery.

Conclusion

This anomalous capsulothalamic artery might be formed by hemodynamic compromise of the brain surrounding AVM in early gestation. We must be aware of this unusual anatomical variation to avoid ischemic complication in embolization of the AChoA.
Leadership and school success: Barriers to leadership in Botswana primary and secondary schools
Authors: Moswela Bernard , Kgosidialwa Keonyatse
Published: November 2017

This paper explored two issues as follows: the influence school leaders have on school performances and factors that hinder school leaders’ efforts to achieve school success in Botswana secondary and primary schools. The subjects of the study were 199 teachers and 21 members of the senior management team in primary and secondary schools in Botswana. The participants were to analyse, through semi-structured interviews and a closed-ended questionnaire, the leadership patterns of their leaders and the barriers to effective leadership in schools. The findings revealed that, generally, leaders in Botswana schools practise democratic leadership although not without barriers. Chief among the barriers are the imposition of policies through numerous directives from the Ministry of Education and drug abuse by students supplied by some adults in society. The study ends with a conclusion that draws from the discussion of the findings and relevant studies to the subject being discussed.
One size fits not quite all: Universal research ethics with diversity
Authors: Msoroka Mohamed S , Amundsen Diana
Published: November 2017

For researchers in Aotearoa New Zealand who intend to conduct research with people, it is common practice to first ensure that their proposals are approved by a Human Research Ethics Committee (HREC). HRECs take the role of reviewing, approving or rejecting research proposals and deciding on whether the intended research will be completed in the ‘right’, rather than the ‘wrong’ way. Such decisions are based upon a system which is guided by universal ethical principles – principles that assume there is universal agreement about the ethically right way to conduct research. Increasingly, Aotearoa New Zealand is becoming more culturally diverse. Actions that are assumed as ‘right’ in reference to ethical norms endorsed in one culture or society may not always be considered ‘right’ in reference to ethical norms in another culture or society. In this article we first set out what is already known in the literature about the origins and applications of universal ethics in a research context. Next, we analyse how cultural values and beliefs bear influence on the process of ethical deliberation. Two case studies illustrate our own examples of how conducting ethical research projects following universal principles with cultural diversity operated in practice. We conclude that one size fits not quite all. Lastly, we propose that Aotearoa New Zealand HRECs may need to consider expanding their approach from universal ethical principles to include a more diverse interpretation of what is ‘ethical research conduct’. Rather than advocating a radical approach, i.e. either universality or diversity, it is time for HRECs to consider a hybrid approach of universality with diversity that permits partial detour from universal principles when considering ethics application proposals.
Strategic Foresight and Futures Studies in Mexico: The Master’s Degree in Strategic Foresight at Tecnológico de Monterrey
Authors: Rincón Guillermina Benavides
Published: November 2017

The aim of this article is to provide a brief overview of the different approaches for conducting a foresight process to be able to position the key competencies developed by the Master’s Degree in Strategic Foresight offered at Tecnológico de Monterrey. There are few graduate degree programs about futures studies worldwide. There is also consensus that futures studies is more a practice-based field than an established academic discipline; this stresses the importance of having a clear understanding of what contents and skills these programs are trying to teach.
Melanotic neuroectodermal tumour of infancy: A case report and differential diagnosis
Authors: Tan A P , Jacques Thomas S , Mankad Kshitij , James Gregory , Jeelani Owase , Slater Olga , D’Arco Felice
Published: November 2017

Melanotic neuroectodermal tumour of infancy is an uncommon pigmented neoplasm of neural crest origin. It was first described in 1918 by Krompecher, known as congenital melanocarcinoma at that time. Although it is generally agreed upon that it is a benign entity, it is locally aggressive and has a significant recurrent risk, reported to be between 10–15%. There have also been prior reports of malignant behaviour in these tumours, although extremely rare. The majority of cases of this tumour (about 70%) arise from the maxilla and its occurrence in the cranial vault represents approximately 15.6% of cases. We describe a rare case of melanotic neuroectodermal tumour of infancy, with simultaneous involvement of the cranial vault and petrous temporal bone, in a four-month-old child, complicated by post-surgical pseudo-meningocele. This case illustrates the diagnostic dilemma in differentiating reactive osseous sclerosis from direct tumour infiltration, both of which can occur in the context of melanotic neuroectodermal tumour of infancy. The discussion places emphasis on differential diagnoses and useful radiological features to assist in clinching the diagnosis of melanotic neuroectodermal tumour of infancy.
Digital health now and in the future: Findings from a participatory design stakeholder workshop
Authors: Lupton Deborah
Published: November 2017

Objectives

While digital health technologies hold potential for improving healthcare and the generation and dissemination of health information, there are many issues to be resolved in facilitating their provision and efficacy and ensuring ethical management of personal health data. In the face of high-stakes digital health initiatives, debates and controversies, eliciting the views and experiences of the diverse constituents in the digital health ecosystem is important.

Methods

A digital health stakeholder workshop was held in Canberra, Australia, to address two key questions: 1) What is currently working and not working in digital health? and 2) Where should digital health go in the future? As part of a living lab approach, the 25 workshop participants from research, industry, patient and other healthcare consumer groups and government, engaged in participatory design activities directed at stimulating ideas and discussion. The design artefacts and videos generated during the workshop were thematically analysed.

Results

Digital health technologies offer valuable ways for healthcare consumers, providers, community groups and health industries to create and share information about health, medicine and healthcare. However, members of some social groups are currently excluded from full participation in the digital health ecosystem. Mechanisms for facilitating further consultation between the various stakeholders involved in digital health, including patients and carers, need to be established. The rights and responsibilities of the different stakeholders involved in connected digital health also need to be better identified and highlighted. At the same time, personal data privacy and security need protection.

Conclusion

Establishing the effective and responsible delivery of digital health technologies and collection, protection and sharing of health data is highly complex. Infrastructure, ethical and social issues need to be considered.
The use of mobile devices for physical activity tracking in older adults’ everyday life
Authors: Seifert Alexander , Schlomann Anna , Rietz Christian , Schelling Hans Rudolf
Published: November 2017

Objective

The tracking of one’s own physical activity with mobile devices is a way of monitoring and motivating oneself to remain healthy. Older adults’ general use of mobile devices for physical activity tracking has not yet been examined systematically. The study aimed to describe the use of physical activity trackers, smartwatches and smartphones, or tablets for tracking physical activity and to examine the reasons for the use of these technologies.

Methods

Participants aged ≥50 years ( N = 1013) living in Switzerland were interviewed in a telephone survey. To address the research questions, we calculated descriptive frequency distributions, tested for differences between groups, and performed logistic regression analyses.

Results

Descriptive and multivariate analyses showed that (a) 20.5% of participants used mobile devices for physical activity tracking; (b) men, younger individuals, those with a strong interest in new technology, and those who frequently exercised had a higher likelihood of using mobile devices for physical activity tracking; and (c) participants more often agreed with reasons for use relating to tracking physical activity and motivating oneself to remain healthy than they did with reasons relating to social factors.

Conclusions

The study presented representative data about the actual use of mobile tracking technology in persons over 50 years of age. Today, mainly active and younger elderly (mostly men) with a high interest in technology are using tracking technologies. Results indicate a need for further studies on motivational and usability aspects regarding the use of mobile health tracking devices by older adults.
The effectiveness of text message-based self-management interventions for poorly-controlled diabetes: A systematic review
Authors: Dobson Rosie , Whittaker Robyn , Pfaeffli Dale Leila , Maddison Ralph
Published: November 2017

Background

Poorly controlled diabetes leads to debilitating complications at a significant cost to health systems. Text messaging is an ideal platform for the delivery of self-management interventions to patients with poorly controlled diabetes due to the ubiquity of mobile phones, and the ability of text messaging to reach people in their everyday lives when self-management of the condition is vital. This systematic review aimed to assess the effectiveness of short message service-based diabetes self-management interventions on glycaemic control in adults with poorly controlled diabetes.

Methods/design

MEDLINE, PubMed, EMBASE, The Cochrane Library and PsychINFO were searched from inception through to 23 January 2017 for randomised controlled trials investigating the use of text messaging based self-management interventions on haemoglobin A1c for patients with poorly controlled diabetes.

Results

Seven studies met the inclusion criteria and were included in the review. Three of the studies reported a significant decrease in haemoglobin A1c from baseline to follow-up in the intervention group compared to the control group. No clear relationship between positive outcomes and intervention dose, content and functionality was seen.

Discussion

Evidence supporting text messaging for improvements in glycaemic control in people with poorly controlled diabetes is mixed. Previous reviews have reported positive impacts on glycaemic control for short message service interventions in patients with diabetes; however, when limited to those with poorly controlled diabetes the evidence is less clear. Large-scale studies with robust methodology and longer-term follow-up are needed to further understand the impact of text-messaging-based self-management interventions for people with poorly controlled diabetes.
Medial collateral ligament calcification: a rare knee pain entity with literature review
Authors: Siddiq Md Abu Bakar , Jahan Israt
Published: November 2017

Medial knee pain can originate from both osseous and non-osseous soft tissue structures including medial collateral ligament (MCL), creating a raft for patients’ sufferings. Previously published works demonstrated MCL calcification as a rare medial knee pain entity. Alongside physical examination, radio-imaging techniques, namely conventional X-ray, CT/MRI scanning, etc. have been reported to be useful in recognizing MCL calcification. The present study demonstrates MCL calcification in a 60-year-old Asian-Bangladeshi woman, using high frequency diagnostic ultrasonogram and is the first reported study in the literature. To have available literature review, PubMed, Cochrane, Embase, and Scopus databases were used.
Retroesophageal Infracardiac Total Anomalous Pulmonary Venous Drainage
Authors: Rodriguez Maria L. , Caldarone Christopher A. , Toeg Hadi , Maharajh Gyaandeo
Published: November 2017

This case report describes the management of a term baby, born cyanotic, who was preoperatively diagnosed to have an obstructed total anomalous pulmonary venous drainage (TAPVD) in association with a functionally univentricular heart. An urgent repair of the anomalous pulmonary venous drainage was done, and a modified Blalock-Taussig shunt was constructed. Intraoperative difficulties were encountered when the pulmonary venous confluence was not seen in the usual location in the posterior mediastinal space, anterior to the esophagus. This report describes the rare finding of infracardiac TAPVD that is located in the retroesophageal space.