bluuebunny/crossref_metadata_2025 huggingface dataset:
A 10-year follow-up of the European multicenter trial of interferon β-1b in secondary-progressive multiple sclerosis
Authors: Kuhle J , Hardmeier M , Disanto G , Gugleta K , Ecsedi M , Lienert C , Amato MP , Baum K , Buttmann M , Bayas A , Brassat D , Brochet B , Confavreux C , Edan G , Färkkilä M , Fredrikson S , Frontoni M , D’Hooghe M , Hutchinson M , De Keyser J , Kieseier BC , Kümpfel T , Rio J , Polman C , Roullet E , Stolz C , Vass K , Wandinger KP , Kappos L ,   the European Long-term Follow-up Study Group in Interferon β-1b in Secondary-progressive Multiple Sclerosis
Published: September 2015

Objectives:

To explore long-term effects of treatment and prognostic relevance of variables assessed at baseline and during the European secondary progressive multiple sclerosis (SPMS) trial of interferon beta 1b (IFNB-1b).

Methods:

We assessed 362 patients (60% female; median age 41 years; Expanded Disability Status Scale (EDSS): 5.5; 51% randomized to IFNB-1b) for their EDSS and treatment history after 10 years. Non-parametric analysis of covariance (ANCOVA) and multivariate linear regression models were applied.

Results:

Median EDSS was 6.0 at the end of the randomized controlled trial (RCT), in the IFNB-1b and placebo groups, and 7.0 in long-term follow-up patients (those receiving IFNB-1b in the RCT were 6.5 and those receiving placebo in the RCT were 7.0; p = 0.086). 24 patients (6.6%) were deceased. The EDSS at baseline and the EDSS change during the RCT were the most important predictors of the EDSS 10 years later (partial R2: 0.47). The ability to predict changes in EDSS 10 years after the RCT was limited ( R2: 0.12). Magnetic resonance imaging (MRI) measures remained in the predictive models, but explained < 5% of the variability.

Conclusions:

The results from this analysis did not provide convincing evidence to support a favorable long-term outcome in those patients allocated IFNB-1b during the RCT, in our SPMS cohort. The progressive stage of the disease remains largely unpredictable by clinical and conventional MRI measures, so better prognostic markers are needed.
Retinal ganglion cell layer thinning within one month of presentation for optic neuritis
Authors: Kupersmith Mark J , Garvin Mona K , Wang Jui-Kai , Durbin Mary , Kardon Randy
Published: September 2015

Background:

Spectral domain optical coherence tomography (SD-OCT) reveals retinal ganglion cell layer plus inner plexiform layer (GCL+IPL) and peripapillary retinal nerve fiber layer (pRNFL) thinning in chronic optic nerve injury. At presentation, swelling of the pRNFL confounds evaluation of early axon loss.

Objective:

We studied whether the GCL+IPL thins before the pRNFL, the trajectory of GCL+IPL loss and relationship to vision.

Methods:

We prospectively evaluated 33 eyes (study) with new optic neuritis, using perimetry and SD-OCT with investigative three-dimensional layer segmentation and commercial two-dimensional segmentation to compute the GCL+IPL and pRNFL thickness.

Results:

At presentation, GCL+IPL thickness (82.4±8.8 µm) did not differ from unaffected fellow eyes (81.2±6.7 µm), via the three-dimensional method, while the two-dimensional method failed in 9% of study eyes. At 1–2 months, there was thinning of the pRNFL in 10% and of the GCL+IPL in 93% of study eyes. GCL+IPL reduction was greatest during the first 2 months. GCL+IPL thinning at 1–2 months correlated with GCL+IPL thinning at 6 months ( r=0.84, P=0.01) and presentation visual acuity ( r=0.48, P=0.006) and perimetric mean deviation ( r=0.52, P=0.003).

Conclusion:

GGL+IPL is an early biomarker of structural injury in optic neuritis as thinning develops within 1–2 months of onset, prior to pRNFL thinning.
Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression
Authors: Moccia Marcello , Lanzillo Roberta , Palladino Raffaele , Chang Kiara Chu-Mei , Costabile Teresa , Russo Cinzia , De Rosa Anna , Carotenuto Antonio , Saccà Francesco , Maniscalco Giorgia Teresa , Brescia Morra Vincenzo
Published: September 2015

Background:

Cognitive impairment occurs from the early phases of multiple sclerosis (MS), and more frequently affects secondary progressive (SP) subjects than relapsing–remitting (RR).

Objective:

To investigate relationships between cognitive dysfunctions in newly diagnosed RRMS, and long-term MS-related outcomes.

Methods:

The present 10-year retrospective longitudinal study included 155 RRMS subjects, tested with the Rao Brief Repeatable Battery at MS diagnosis. The reaching of Expanded Disability Status Scale (EDSS) 4.0, and the SP conversion were recorded.

Results:

67 subjects (43.2%) reached EDSS 4.0, and 34 subjects (21.9%) converted to SP during a follow-up period of 10.0±1.8 years. Subjects with cognitive impairment at diagnosis had a rate of reaching EDSS 4.0 more than three times greater ( p<0.001; HR=3.183), and a rate of SP conversion more than two times greater, as compared to cognitively preserved subjects ( p=0.008; HR=2.535). In particular, better scores in the Selective Reminding Test-Delayed Recall and in the Symbol Digit Modalities Test at baseline were associated with lower SP conversion rates during the follow-up period ( p=0.018; HR=0.835; and p=0.001; HR=0.941, respectively).

Conclusion:

Cognitive impairment, with particular involvement of processing speed and memory, predicts disability progression and SP conversion in newly diagnosed RRMS, highlighting the importance of cognitive assessment from the beginning of MS.
Efficacy of rituximab in refractory neuromyelitis optica
Authors: Collongues N , Brassat D , Maillart E , Labauge P , Ouallet JC , Carra-Dalliere C , Moreau T , Bourre B , Papeix C , Brochet B , Audoin B , Vukusic S , de Seze J , Marignier R ,   on behalf of the OFSEP and CFSEP
Published: September 2015

Background:

Despite a growing use of rituximab (RTX) in neuromyelitis optica (NMO), data are lacking in patients with refractory NMO (RNMO), defined as cases with at least one relapse during immunosuppressive therapy.

Objective:

The purpose of this study was to assess RTX as a maintenance therapy in RNMO.

Methods:

Out of a total of 305 NMO cases from a population-based cohort, 21 RNMO patients received RTX during a mean follow-up period of 31 months.

Results:

After RTX, 11 patients (52.3%) were relapse free, meaning that 47.7% were refractory to RTX. The mean annualized relapse rate decreased from 1.3 to 0.4 ( p<0.001) and median EDSS from 5 to 3 ( p=0.02). Body mass index (BMI) was predictive of EDSS worsening.

Conclusions:

RTX is an effective and well-tolerated treatment in RNMO. BMI could be a predictive factor for efficacy.
Genetic analysis of the isolated Faroe Islands reveals SORCS3 as a potential multiple sclerosis risk gene
Authors: Binzer S , Stenager E , Binzer M , Kyvik KO , Hillert J , Imrell K
Published: September 2015

Background:

In search of the missing heritability in multiple sclerosis (MS), additional approaches adding to the genetic discoveries of large genome-wide association studies are warranted.

Objective:

The objective of this research paper is to search for rare genetic MS risk variants in the genetically homogenous population of the isolated Faroe Islands.

Methods:

Twenty-nine Faroese MS cases and 28 controls were genotyped with the HumanOmniExpressExome-chip. The individuals make up 1596 pair-combinations in which we searched for identical-by-descent shared segments using the PLINK-program.

Results:

A segment spanning 63 SNPs with excess case-case-pair sharing was identified (0.00173 < p > 0.00212). A haplotype consisting of 42 of the 63 identified SNPs which spanned the entire the Sortilin-related vacuolar protein sorting 10 domain containing receptor 3 ( SORCS3) gene had a carrier frequency of 0.34 in cases but was not present in any controls ( p = 0.0008).

Conclusion:

This study revealed an oversharing in case-case-pairs of a segment spanning 63 SNPs and the entire SORCS3. While not previously associated with MS, SORCS3 appears to be important in neuronal plasticity through its binding of neurotrophin factors and involvement in glutamate homeostasis. Although additional work is needed to scrutinise the genetic effect of the SORCS3-covering haplotype, this study suggests that SORCS3 may also be important in MS pathogenesis.
Body mass index during adolescence, rather than childhood, is critical in determining MS risk
Authors: Hedström AK , Olsson T , Alfredsson L
Published: September 2015

Objective:

Obesity in childhood and during adolescence has repeatedly been associated with increased risk of developing multiple sclerosis (MS). We aimed to investigate whether the most critical period occurs during childhood or later, during adolescence.

Methods:

Using a population-based case-control study (1586 cases and 2800 controls), individuals with different body sizes at age 10 and different body mass indices at age 20 were compared regarding MS risk, by calculating odds ratios with 95% confidence intervals. Potential interactions between HLA-DRB1*15 and absence of HLA-A*02, respectively, and both childhood and adolescent obesity were evaluated by calculating the attributable proportion due to interaction.

Results:

Regardless of body size at age 10, individuals with adolescent obesity had a 90% increased risk of MS. Among participants who were not obese at age 20, no association was observed between body size at age 10 and subsequent MS risk. An interaction was observed between the HLA MS risk genes and adolescent, but not childhood, obesity.

Conclusions:

Our results suggest that BMI during adolescence, rather than childhood, is critical in determining MS risk.
Tumefactive demyelinating lesions: Characteristics of individual lesions, individual patients, or a unique disease entity?
Authors: Weinshenker Brian G
Published: September 2015

Whether or not recurrent tumefactive demyelinating lesions are a unique form of CNS demyelinating disease or part of the continuum of multiple sclerosis is a question raised by the case report on which this commentary is based. Detailed review and immunopathologic study of biopsy material may not only confirm or refute a diagnosis of demyelinating disease, but potentially uncover unique features that may assist in understanding pathophysiology and nosology of rare cases with recurrent tumefactive demyelination.
Effect of fingolimod on cardiac autonomic regulation in patients with multiple sclerosis
Authors: Simula Sakari , Laitinen Tomi , Laitinen Tiina M , Tarkiainen Tuula , Hartikainen Päivi , Hartikainen Juha EK
Published: September 2015

Background:

Fingolimod modulates sphingosine-1-phosphate receptors that are also found in cardiovascular tissue.

Objective:

To investigate the effects of fingolimod on cardiac autonomic regulation prospectively.

Methods:

Twenty-seven relapsing–remitting multiple sclerosis patients underwent 24-hour electrocardiogram recording before, at the first day of fingolimod treatment (1d) and after three months of continuous dosing (3mo). The time interval between two consecutive R-peaks (RR-interval) was measured. Cardiac autonomic regulation was assessed by the various parameters of heart rate variability. Parasympathetic stimulation prolongs the RR-interval and increases heart rate variability while the effects of sympathetic stimulation are mainly the opposite. The low frequency/high frequency ratio reflects sympathovagal balance.

Results:

From baseline to 1d, a prolongation of the RR-interval ( P<0.001), an increase in the values of various heart rate variability parameters ( P<0.05 to P<0.001) and a decrease in the low frequency/high frequency ratio ( P<0.05) were demonstrated. At 3mo, although the RR-interval remained longer ( P<0.01), the values of various heart rate variability parameters were lower ( P<0.01 to P<0.001) as compared to baseline. At 3mo, the low frequency/high frequency ratio ( P<0.05) was higher in men than in women although no such difference was found at baseline or at 1d.

Conclusions:

After an initial increase in parasympathetic regulation, continuous fingolimod dosing shifts cardiac autonomic regulation towards sympathetic predominance, especially in men. Careful follow-up of fingolimod-treated relapsing–remitting multiple sclerosis patients is warranted as sympathetic predominance associates generally with impaired outcome. ClinicalTrials.cov: NCT01704183
Epistemic (un)certainty in times of crisis: The role of coherence as a social convention in the European Neighbourhood Policy after the Arab Spring
Authors: Natorski Michal
Published: September 2015

Academic wisdom assumes that crises precipitate institutional and policy changes in domestic and international politics. However, the relation between crises and policy outcomes is under-theorised. This article conceptualises epistemic coherence as a factor that links crises and their consequences through policy continuity. Crises expose contradictions and inconsistencies, which create uncertainty. Therefore, actors seek to recover the epistemic certainty provided by coherence, which tacitly informs, structures and simplifies actors’ interpretation of reality, even during crisis. For this reason, the role of coherence in policy ideas and institutional rules remains essential to understanding policy continuity. This article illustrates the role of coherence in the policy continuity of the European Neighbourhood Policy in the context of the Arab Spring and the changes in the institutional architecture of European Union foreign policy during 2010–2011.
Damage identification for composite structures using a cross-correlation reverse-time migration technique
Authors: He Jiaze , Yuan Fuh-Gwo
Published: September 2015

This article presents a reverse-time migration technique to image damage by cross-correlating forward and backward propagating wavefields in composite structures using flexural wave signals. First, theory and procedures are presented for damage imaging for composite plates using a zero-lag cross-correlation imaging condition for reverse-time migration, briefly called cross-correlation-based reverse-time migration. The zero-lag cross-correlation was calculated between the forward wavefield and the backward wavefield. The forward wavefield is formed by the excitation from the actuator using a finite difference method, and the backward wavefield is generated by back-propagating the time-reversed scattered wavefield using the same finite difference method. Simulation studies were first examined to verify the capability of using the proposed zero-lag cross-correlation imaging condition to image single and multiple sites of damage. Two experiments were conducted where either the surface-mounted piezoelectric wafers or non-contact laser Doppler vibrometer was used for receiving the scattered wave signals along a linear array. The scattered wave signals were extrapolated in reverse-time to generate backward propagating wavefields. The experimental studies demonstrated that the cross-correlation-based reverse-time migration can accurately locate and image multiple sites of damage with improved resolution and higher efficiency in comparison with classical pre-stack reverse-time migration.
Epithelial-mesenchymal transition: An emerging target in tissue fibrosis
Authors: Li Meirong , Luan Fuxin , Zhao Yali , Hao Haojie , Zhou Yong , Han Weidong , Fu Xiaobing
Published: September 2015

Epithelial-mesenchymal transition (EMT) is involved in a variety of tissue fibroses. Fibroblasts/myofibroblasts derived from epithelial cells contribute to the excessive accumulation of fibrous connective tissue in damaged tissue, which can lead to permanent scarring or organ malfunction. Therefore, EMT-related fibrosis cannot be neglected. This review highlights the findings that demonstrate the EMT to be a direct contributor to the fibroblast/myofibroblast population in the development of tissue fibrosis and helps to elucidate EMT-related anti-fibrotic strategies, which may enable the development of therapeutic interventions to suppress EMT and potentially reverse organ fibrosis.
Keeping up with the Joneses
Authors: Eissa Gabi , Wyland Rebecca
Published: September 2015

In this study, we draw on concepts within the abusive supervision literature, the moral exclusion literature, and the broader unethical behavior literature to develop and test a model that explains how and when envious employees engage in social undermining in the workplace. Our results from multisource field data suggest that relationship conflict mediates the relationship between envy and social undermining, while job performance moderates the indirect effect of envy on social undermining (via relationship conflict). Thus, a moderated-mediation model is proposed. Our findings provide general support to our hypotheses. Implications for theory and practice as well as future research avenues are also discussed.
Much ado about acquiescence: The relative validity and reliability of construct-specific and agree–disagree questions
Authors: Lelkes Yphtach , Weiss Rebecca
Published: September 2015

Acquiescence response bias, or the tendency to agree with questions regardless of content, is a prominent concern in survey design. An often proposed solution, and one that was recently implemented in the American National Election Study, is to rewrite response options so that they tap directly into the dimensions of the construct of interest. However, there is little evidence that this solution improves data quality. We present a study in which we employ two waves of the 2012 American National Election Study in order to compare the reliability and concurrent validity of political efficacy questions in both the agree–disagree and construct-specific formats. Construct-specific questions were not only as reliable and valid as agree–disagree questions generally, they were also as valid among respondents that were most likely to acquiesce. This suggests two possible outcomes: Either agree–disagree questions do not negatively impact data quality or that construct-specific questions are not a panacea for acquiescence response bias.
“Who are these people?” Evaluating the demographic characteristics and political preferences of MTurk survey respondents
Authors: Huff Connor , Tingley Dustin
Published: September 2015

As Amazon’s Mechanical Turk (MTurk) has surged in popularity throughout political science, scholars have increasingly challenged the external validity of inferences made drawing upon MTurk samples. At workshops and conferences experimental and survey-based researchers hear questions about the demographic characteristics, political preferences, occupation, and geographic location of MTurk respondents. In this paper we answer these questions and present a number of novel results. By introducing a new benchmark comparison for MTurk surveys, the Cooperative Congressional Election Survey, we compare the joint distributions of age, gender, and race among MTurk respondents within the United States. In addition, we compare political, occupational, and geographical information about respondents from MTurk and CCES. Throughout the paper we show several ways that political scientists can use the strengths of MTurk to attract respondents with specific characteristics of interest to best answer their substantive research questions.
The Role of Chiropractic Care in the Treatment of Dizziness or Balance Disorders
Authors: Ndetan Harrison , Hawk Cheryl , Sekhon Vishaldeep Ka , Chiusano Miguel
Published: September 2015

The purpose of this study was to explore the role of chiropractic in the treatment of dizziness or balance disorders through an analysis of data from the 2008 National Health Interview Survey. Odds ratios and 95% confidence intervals (CIs) were used to assess the likelihood that respondents with dizziness or balance problems perceived that they were helped by specified practitioners. Eleven percent of respondents reported having had a balance or dizziness problem; more than 35% were aged 65 years and older. The odds ratio for perceiving being helped by a chiropractor was 4.36 (95% CI, 1.17-16.31) for respondents aged 65 years or older; 9.5 (95% CI, 7.92-11.40) for respondents reporting head or neck trauma; and 13.78 (95% CI, 5.59-33.99) for those reporting neurological or muscular conditions as the cause of their balance or dizziness.
A randomized controlled proof-of-concept trial of early sedation management using Responsiveness Index monitoring in mechanically ventilated critically ill patients
Authors: Kaila Markus , Everingham Kirsty , Lapinlampi Petteri , Peltola Petra , Särkelä Mika O K , Uutela Kimmo , Walsh Timothy S.
Published: September 2015

Introduction

Deep sedation is associated with adverse patient outcomes. We recently described a novel sedation-monitoring technology, the Responsiveness Index (RI), which quantifies patient arousal using processed frontal facial EMG data. We explored the potential effectiveness and safety of continuous RI monitoring during early intensive care unit (ICU) care as a nurse decision-support tool.

Methods

In a parallel-group controlled single centre proof of concept trial, patients requiring mechanical ventilation and sedation were randomized via sequential sealed envelopes following ICU admission. Control group patients received hourly clinical sedation assessment and daily sedation holds; the RI monitor was connected but data were concealed from clinical staff. The intervention group received control group care, but RI monitoring was visible and nurses were asked to adjust sedation to maintain patients with an RI>20 whenever possible. Traffic-light colour coding (RI<20, Red; 20–40, Amber; >40, Green) simplified decision-making. The intervention lasted up to 48 hours. Sixteen nurses were interviewed to explore their views of the novel technology.

Results

We analysed 74 patients treated per protocol (36 intervention; 38 control). The proportion of patients with RI<20 was identical at the start of monitoring (54 % both groups). Overall, the proportion of time with RI<20 trended to lower values for the intervention group (median 16 % (1–3rd quartile 8–30 %) versus 33 % (10–54 %); P = 0.08); sedation and analgesic use was similar. A post hoc analysis restricted to patients with RI<20 when monitoring started, found intervention patients spent less time with low RI value (16 % (11–45 %) versus 51 % (33–72 %); P = 0.02), cumulative propofol use trended to lower values (median 1090 mg versus 2390 mg; P = 0.14), and cumulative alfentanil use was lower (21.2 mg versus 32.3 mg; P = 0.01). RASS scores were similar for both groups. Sedation related adverse event rates were similar (7/36 versus 5/38). Similar proportions of patients had sedation holds (83 % versus 87 %) and were extubated (47 % versus 44 %) during the intervention period. Nurses valued the objective visible data trends and simple colour prompts, and found RI monitoring a useful adjunct to existing practice.

Conclusions

RI monitoring was safe and acceptable. Data suggested potential to modify sedation decision-making. Larger trials are justified to explore effects on patient-centred outcomes.

Trial registration

NCT01361230 (registered April 19, 2010)
Splicing promotes the nuclear export of β-globin mRNA by overcoming nuclear retention elements
Authors: Akef Abdalla , Lee Eliza S. , Palazzo Alexander F.
Published: September 2015

Most current models of mRNA nuclear export in vertebrate cells assume that an mRNA must have specialized signals in order to be exported from the nucleus. Under such a scenario, mRNAs that lack these specialized signals would be shunted into a default pathway where they are retained in the nucleus and eventually degraded. These ideas were based on the selective use of model mRNA reporters. For example, it has been shown that splicing promotes the nuclear export of certain model mRNAs, such as human β-globin, and that in the absence of splicing, the cDNA-derived mRNA is retained in the nucleus and degraded. Here we provide evidence that β-globin mRNA contains an element that actively retains it in the nucleus and degrades it. Interestingly, this nuclear retention activity can be overcome by increasing the length of the mRNA or by splicing. Our results suggest that contrary to many current models, the default pathway for most intronless RNAs is to be exported from the nucleus, unless the RNA contains elements that actively promote its nuclear retention.
How HCAs and APs contribute to postoperative care
Authors: Peate Ian
Published: September 2015

The typical surgical care journey concludes with postoperative care. While this is the last phase of the journey or surgical pathway, for the patient the impact of surgery may not end here. For the patient, the journey may continue and they may have to endure other interventions that aim to return them to full health, or to as near full health as possible.

This article provides insight into and understanding of some of the key issues that are associated with postoperative care. If the healthcare assistant and assistant practitioner (HCA and AP) understand these issues, then it can help them offer care that is safe, effective and patient-centred.
1/3. Hope and despair: the community health assistant role in Zambia
Authors: Zulu Joseph Mumba , Michelo Charles , Kinsman John , Hurtig Anna-Karin , Zulu Joseph Mumba
Published: September 2015

Background:

In order to address the challenges facing the community-based health workforce in Zambia, its Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called ‘community health assistants’ (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.

Methods:

A phenomenological approach was used to examine CHAs' experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district, Zambia, and observations were analysed using a thematic analysis approach.

Results:

Personal characteristics, such as previous experience and knowledge, passion to serve the community and a desire to improve skills, motivated people to become CHAs. Health systems characteristics, such as an inclusive work culture in some health posts, motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure that constrained CHAs' ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs' ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected some CHAs' self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs, which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers, due to their exclusion from the government payroll, inhibited CHAs' ability to deliver services.

Conclusions:

Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.
Antibiotic prescribing in wound care
Authors: Brown Annemarie
Published: September 2015

There is uncertainty on antibiotic prescribing in wound infection ( Gürgen, 2012 ); this article, therefore, is aimed at nurse prescribers caring for patients with wounds in primary care, and presents up-to-date evidence-based recommendations on managing infection, and appropriate antibiotic prescribing in chronic and acute wounds. In addition, the use of topical antiseptics and antimicrobial wound dressings, which can be used as an adjunct strategy in managing wound infection, will be discussed.
Making sense of hormone replacement therapy
Authors: Abernethy Kathy
Published: September 2015

Hormone replacement therapy (HRT) remains the most effective treatment for the relief of menopausal symptoms and is an essential part of the management of women with premature ovarian failure. Over recent months, media coverage of HRT has left women anxious over its safety, and some prescribers may be unclear of the current evidence. This article summarizes the current evidence so prescribers may be confident in offering this treatment for menopause, based on individualized risk.
Making the right choice in stoma appliance
Authors: Black Pat
Published: September 2015

Health-care professionals may experience a resident with a stoma living in a care home. Pat Black suggests that it is essential that nurses and carers understand how to care for the stoma and which appliances are most appropriate to use
Hand dysfunction and managing daily living activities
Authors: Swann Julie
Published: September 2015

In the third part of a series, Julie Swann describes how hand dysfunction affects a resident's level of independence and dignity. She discusses how care staff can help a resident maintain their independence and improve hand function
Things happen: putting in place a business continuity plan
Authors: Bernstein Adam
Published: September 2015

It may be hard to imagine, say, a freak hurricane ruining your business. But that's exactly what happened all over the UK in the Great Storm of 1987. Stuff happens, warns Adam Bernstein. So make sure you've planned for the worst, however unlikely it may seem
Walkable scores for selected three east Texas counties: physical activity and policy implications
Authors: Njororai Simiyu Wycliffe W. , Njororai Fletcher , Jivetti Billystrom Aronya
Published: September 2015

Introduction: Physical activity has become an important intervention against overweight and obesity cases in the USA and worldwide. One key aspect of physical activity is walking, which has been identified as a component that can easily be incorporated into one’s lifestyle. Recent studies on physical activity have focused on promoting walking as a health enhancing endeavor. In 2010, the proportion of Texas adults who reported no participation in leisure time activity (26.7%) was significantly higher than the national average (24.4%). However, many Texans, like most Americans, are sedentary.

Purpose: This study examined the walkability of the environments in selected counties in east Texas including Wood, Van Zandt and Smith counties.

Methods and material: The data was drawn from the Walkscore.com and was based on all the zip codes in the three counties in east Texas. The community capitals were used a framework for analysis. 

Results: Only three (8.82%) zip codes had walkable scores between 70 and 89; five (14.71%) had scores between 50 and 69; four (11.76%) between 25 and 49 and 22 (64.71%) had a score below 24.

Discussion: The vast majority (26, 76.47%) of zip codes are highly dependent on vehicle transport.

Conclusions and recommendations: Stakeholders need therefore to focus on causes for the minimal walkability so that practical interventions are generated to enhance the physical activity friendly infrastructure so as to enhance the well-being of the residents in these three east Texas counties.
New type of fluxgate magnetometer for the heart’s magnetic fields detection
Authors: Rybalko Ruslan , Haueisen Jens , Hofmann Christian
Published: September 2015

The application area of fluxgate sensors is limited by their sensitivity. Medical researches create high demand on the magnetometers with the characteristics of high accuracy and sensibility for measuring weak magnetic fields produced by the human body, such as the heart‘s magnetic field. Due to the insufficient sensitivity of fluxgate sensors, superconducting magnetometers (SQUID) take the dominant position for the cardiomagnetic measurements. They have to be cooled by liquefied gases and it leads to high service costs. Therefore an idea of creating a high sensitive sensor based on fluxgate principles and known methods of measurement is attractive and up to date. This paper is dedicated to the modified flux-gate sensors based on Racetrack technology with a new approach of signal demodulation. The improved fluxgate sensor system provides detection of the heart‘s magnetic field without additional expenditures for use.
Development of a new homecare sleep monitor using body sounds and motion tracking
Authors: Kalkbrenner Christoph , Eichenlaub Manuel , Brucher Rainer
Published: September 2015

This paper presents the development of a sleep monitor to provide a comfortable way of detecting sleep-related breathing disorders like the obstructive sleep apnea syndrome (OSAS). OSAS is traditionally diagnosed using polysomnography, which requires a whole night stay at the sleep laboratory of a hospital with multiple electrodes and sensors attached to the patient’s body. However, body sound and motion tracking also provide extensive information about sleep course. A unique recording device offering a good body sound extraction, noise suppression and a small size is developed. Using this device a reliable detection of breathing and heart beat is possible. In addition sleeping positions and the activity of the patient will be evaluated using an inertial measurement unit (IMU). The device is easy to set up and offers the possibility to use it independently at home.

Initial experiments have shown that volunteers were able to set up the device on their own. Furthermore several overnight recordings revealed the capability to monitor breathing, heart rate, sleeping position as well as movements of the patient.
Separating the effect of respiration from the heart rate variability for cases of constant harmonic breathing
Authors: Kircher Michael , Lenis Gustavo , Dössel Olaf
Published: September 2015

Heart Rate Variability studies are a known measure for the autonomous control of the heart rate. In special situations, its interpretation can be ambiguous, since the respiration has a major influence on the heart rate variability. For this reason it has often been proposed to measure Heart Rate Variability, while the subjects are breathing at a constant respiration rate. That way the spectral influence of the respiration is known. In this work we propose to remove this constant respiratory influence from the heart rate and the Heart Rate Variability parameters to gain respiration free autonomous controlled heart rate signal. The spectral respiratory component in the heart rate signal is detected and characterized. Subsequently the respiratory effect on Heart Rate Variability is removed using spectral filtering approaches, such as the Notch filter or the Raised Cosine filter. As a result new decoupled Heart Variability parameters are gained, which could lead to new additional interpretations of the autonomous control of the heart rate.
Processing of membranes for oxygenation using the Bellhouse-effect
Authors: Neußer C. , Bach C. , Doeringer J. , Jockenhoevel S.
Published: September 2015

State-of-the-art lung support systems are limited to short time application because of a lack of long term hemocompatibility and protein absorption on the membrane surfaces. In a highly interdisciplinary project at RWTH Aachen University a biohybrid lung assist system with endothelialised gas exchange flat membranes is developed to improve long term compatibility of oxygenators. To increase the gas exchange performance of flat membranes hollows are imprinted in the membrane surfaces. This approach is based on the research of B. J. Bell-house et al. [1], who discovered this effect, now known as Bellhouse-effect, around 1960. In this paper a processes to manufacture membrane assemblies for oxygenation with imprinted hollows on the flat membrane surfaces is reviewed.
“Hands free for intervention”, a new approach for transoral endoscopic surgery
Authors: Boese A. , Detert M. , Stibbe Chr. , Thiele M. , Arens Chr.
Published: September 2015

A standard method for transoral diagnostic and dissection of tumour is the endoscopic examination plus microscopic and laser supported surgery. For endoscopic examination a set of rigid endoscopes with different angles of view are on the market and in use. To simplify the diagnostic examination, a first idea was to use an endoscope with flexible angles of view. A further step of this approach is the electrical angulation of the endoscopic view to enable an adaption on the surgery site without using the hands. Thus the hands are free for intervention. This paper shows a first implementation of a prototype of an electrical operated endoscope for a free hand imaging in transoral interventions.
Using smart glasses for ultrasound diagnostics
Authors: Maas Stefan , Ingler Marvin , Overhoff Heinrich Martin
Published: September 2015

Ultrasound has been established as a diagnostic tool in a wide range of applications. Especially for beginners, the alignment of sectional images to patient’s spatial anatomy can be cumbersome. A direct view onto the patient’s anatomy while regarding ultrasound images may help to overcome unergonomic examination.

To solve these issues an affordable augmented reality system using smart glasses was created, that displays a (virtual) ultrasound image beneath a (real) ultrasound transducer.
Automated high-throughput analysis of B cell spreading on immobilized antibodies with whole slide imaging
Authors: Wiesmann Veit , Reimer Dorothea , Franz Daniela , Hüttmayer Hanna , Mielenz Dirk , Wittenberg Thomas
Published: September 2015

Automated image processing methods enable objective, reproducible and high quality analysis of fluorescent cell images in a reasonable amount of time. Therefore, we propose the application of image processing pipelines based on established segmentation algorithms which can handle massive amounts of whole slide imaging data of multiple fluorescent labeled cells. After automated parameter adaption the segmentation pipelines provide high quality cell delineations revealing significant differences in the spreading of B cells: LPS-activated B cells spread significantly less on anti CD19 mAb than on anti BCR mAb and both processes could be inhibited by the F-actin destabilizing drug Cytochalasin D. Moreover, anti CD19 mAb induce a more symmetrical spreading than anti BCR mAb as reflected by the higher cell circularity.
Three-dimensional anisotropic regularization for limited angle tomography
Authors: Isernhagen C. F. , Schäfer D. , Grass M. , Buzug T. M.
Published: September 2015

Limited angle tomography is a challenging task in medical imaging. Due to practical limitations during the image acquisition, the sinogram is recorded incompletely and thus the quality of the reconstruction is deteriorated by streak artifacts. These artifacts are characterized by fast changes of the local intensity gradients and increase the total variation (TV). Generally, an energy functional is optimized which leads to a minimized Total Variation Minimization (TVM). As an outcome, noise and artifacts are reduced while edges are preserved. Anyway, often the orientation of the streak artifacts is not considered at all. Therefore, anisotropic regularization is used to reduce noise and distortions under specific directions.
US-tracked steered FUS in a respiratory ex vivo ovine liver phantom
Authors: Strehlow Jan , Xiao Xu , Domschke Markus , Schwenke Michael , Karakitsios Ioannis , Mihcin Senay , Schwaab Julia , Levy Yoav , Preusser Tobias , Melzer Andreas
Published: September 2015

Organ motion is a major problem for Focused Ultrasound Surgery (FUS) of liver tumors. We present a liver phantom mimicking human respiratory motion (20 mm range, 3 − 7 s/cycle) and the evaluation of an ultrasound-tracked steered FUS system on that phantom. Temperature curves are recorded while sonicating in moving and static phantom. The temperature curves correlate well and show the ability of the system to compensate breathing like motion.
Influence of short-term fixation with mixed formalin or ethanol solution on the mechanical properties of human cortical bone
Authors: Mick E. , Steinke H. , Wolfskämpf T. , Wieding J. , Hammer N. , Schulze M. , Souffrant R. , Bader R.
Published: September 2015

Bone specimens obtained for biomechanical experiments are fresh-frozen for storage to slow down tissue degradation and autolysis in long-term storage. Alternatively, due to infectious risks related to the fresh tissues, fixative agents are commonly used. However, fixatives will likely change the mechanical properties of bone. Existing studies on this issue gave controversial results that are hardly comparable due to a variety of measurement approaches. For this reason, the influence of ethanol and a formalin-based fixative agent was evaluated on the mechanical properties of human cortical bone specimens by means of four-point-bending tests. 127 prismatic specimens with rectangular cross sections (2.5 x 2.5 x 20 mm3) were obtained from different regions of two fresh human femora (medial, lateral, dorsal, ventral). Specimens were either fixed in ethanol or in a mixed formalin solution or frozen following a given scheme. After two weeks of storage the samples were re-hydrated in isotonic saline and subsequently tested mechanically. The elastic bending modulus and ultimate bending strength were computed considering the actual dimensions of each specific specimen. For statistical analysis a one-way-ANOVA and an LSD post-hoc-test were performed. For ultimate bending strength no significant differences due to formalin or ethanol fixation, as compared to unfixed-fresh bone specimens could be found. And only for few cases significant differences in elastic bending modulus were observed when the two bones were evaluated separately. Since more differences of significant level due to the anatomical region of the samples were determined, the original location seems to have more influence on the evaluated mechanical properties than the method of (chemical) fixation. Consequently, ethanol and the mixed formalin solution can be recommended as a fixation agent for samples in biomechanical testing, if these samples are rinsed in isotonic saline prior to static mechanical testing.
FPGA controlled artificial vascular system
Authors: Laqua D. , Brieskorn C. , Koch J. H. , Rothmayer M. , Zeiske S. , Böttrich M. , Ley S. , Husar P.
Published: September 2015

Monitoring the oxygen saturation of an unborn child is an invasive procedure, so far. Transabdominal fetal pulse oximetry is a promising method under research, used to estimate the oxygen saturation of a fetus noninvasively. Due to the nature of the method, the fetal information needs to be extracted from a mixed signal. To properly evaluate signal processing algorithms, a phantom modeling fetal and maternal blood circuits and tissue layers is necessary. This paper presents an improved hardware concept for an artificial vascular system, utilizing an FPGA based CompactRIO System from National Instruments. The experimental model to simulate the maternal and fetal blood pressure curve consists of two identical hydraulic circuits. Each of these circuits consists of a pre-pressure system and an artificial vascular system. Pulse curves are generated by proportional valves, separating these two systems. The dilation of the fetal and maternal artificial vessels in tissue substitutes is measured by transmissive and reflective photoplethysmography. The measurement results from the pressure sensors and the transmissive optical sensors are visualized to show the functionality of the pulse generating systems. The trigger frequency for the maternal valve was set to 1 per second, the fetal valve was actuated at 0.7 per second for validation. The reflective curve, capturing pulsations of the fetal and maternal circuit, was obtained with a high power LED (905 nm) as light source. The results show that the system generates pulse curves, similar to its physiological equivalent. Further, the acquired reflective optical signal is modulated by the alternating diameter of the tubes of both circuits, allowing for tests of signal processing algorithms.
Use cases and usability challenges for head-mounted displays in healthcare
Authors: Mentler T. , Wolters C. , Herczeg M.
Published: September 2015

In the healthcare domain, head-mounted displays (HMDs) with augmented reality (AR) modalities have been reconsidered for application as a result of commercially available products and the needs for using computers in mobile context. Within a user-centered design approach, interviews were conducted with physicians, nursing staff and members of emergency medical services. Additionally practitioners were involved in evaluating two different head-mounted displays. Based on these measures, use cases and usability considerations according to interaction design and information visualization were derived and are described in this contribution.
Device- and service profiles for integrated or systems based on open standards
Authors: Mildner Alexander , Janß Armin , Dell’Anna-Pudlik Jasmin , Merz Paul , Leucker Martin , Radermacher Klaus
Published: September 2015

Integrated OR systems nowadays are closed and proprietary, so that the interconnection of components from third-party vendors is only possible with high time and cost effort. An integrated operating theatre with open interfaces, giving clinical operators the opportunity to choose individual medical devices from different manufacturers, is currently being developed in the framework of the BMBF (Federal Ministry of Education and Research) funded project OR.NET [1]. Actual standards and concepts regarding technical feasibility and accreditation process do not cope with the requirements for modular integration based on an open standard. Therefore, strategies as well as service and device profiles to enable a procedure for risk management and certifiability are in the focus of the project work. Amongst others, a concept for User Interface Profiles (UI-Profiles) has been conceived in order to describe medical device functions and the entire user interface regarding Human-Machine-Interaction (HMI) characteristics with the aim to identify human-induced risks of central user interfaces. The use of standardized device and service profiles shall allow the manufacturers to integrate their medical devices in the OR.NET network, without disclosing the medical devices’ risk analysis and related confidential knowledge or proprietary information.
The role of self-leadership in service leadership
Authors: Shek Daniel T.L. , Ma Cecilia M.S. , Liu Ting Ting , Siu Andrew M.H.
Published: September 2015

One of the core beliefs of the service leadership curriculum proposed by the Hong Kong Institute of Service Leadership and Management is that ‘Every day, every human occupies a position of leadership and possesses the potential to improve his leadership quality and effectiveness’. This core belief is in sharp contrast to some of the mainstream leadership theories that only a few people and elites can be leaders. In this paper, a lecture plan regarding the nature of self-leadership with reference to service leadership is presented. The topics include definitions and concepts of self-leadership, relationships between self-leadership and service leadership, ways to promote self-leadership, and conclusions and reflections. During the lecture, students are also encouraged to reflect on how well they lead their lives, with reference to the concepts of self-management, self-monitoring, and self-improvement.