bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomic Evaluation of Percutaneous Achilles Tendon Lengthening
Authors: Phillips Sierra , Shah Ashish , Staggers Jackson Rucker , Pinto Martim , Godoy-Santos Alexandre Leme , Naranje Sameer , de Cesar Netto Cesar
Published: December 2017

Background:

The objective of the study was to evaluate the accuracy of percutaneous Achilles tendon lengthening (TAL) using a triple hemisection technique and the improvement in ankle dorsiflexion.

Methods:

Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of the Achilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Following forced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper.

Results:

The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3% ± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendon excursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm for the distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion data analysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degrees postprocedure. The dorsiflexion angle significantly increased ( P < .0001) at an average of 19.5 ± 5.0 degrees following TAL.

Conclusion:

Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accurate technique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures are possible complications.

Clinical Relevance:

Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.
Fatigue Bending Strength of Jones Fracture Specific Screw Fixation
Authors: Jastifer James , McCullough Kirk A.
Published: December 2017

Background:

Intramedullary screw fixation is a common method of treating proximal metadiaphyseal fifth metatarsal (ie, Jones) fractures. Fatigue failure is a complication of this fixation. There are many screw designs available, including Jones fracture specific fixation, but the optimal choice of screw design is unknown. The purpose of this study was to compare the fatigue strength of Jones fracture specific screw designs as well as other commonly used screw designs. Our hypothesis was that there would be no difference in fatigue strength for Jones fracture specific screw designs at similar screw diameters.

Methods:

A study was performed to determine the fatigue bending strength of 5 different screw designs including Jones fracture specific screw designs at 3 different screw diameters. Six screws of each size and design underwent cyclic fatigue testing, and a median fatigue limit (MFL) was determined for each screw design and size.

Results:

The Stryker Asnis JFX solid 4.0-mm, 5.0-mm, and 6.0-mm screws had a higher MFL than all other screws with similar diameter tested (all P < .0001). Both Jones fracture specific screw designs (Stryker Asnis JFX solid screws and Charlotte Carolina Jones screws) had higher MFLs than the other screw designs tested.

Conclusion:

This study provides comparative fatigue strength data on larger screw diameters, which have not been previously reported. There was a statistically significant difference in screw fatigue properties at the screw diameters tested.

Clinical Relevance:

The clinical significance of this study is that it provides surgeons with fatigue strength data to aid in screw selection for Jones fracture fixation.
Salt microspheres and potassium chloride usage for sodium reduction: Case study with sushi
Authors: Đorđević Đani , Buchtová Hana , Macharáčková Blanka
Published: December 2017

The aim of the study was to estimate possibilities of salt substitutes usage in the preparation of two sushi types (nigiri and maki) prepared with different seafood (salmon: Salmo salar, tuna: Thunnus albacares, and shrimp: Pleoticus muelleri). Potassium chloride (Mary samples), Soda-Lo (hollowed microsphere of regular salt crystals), and regular salt (sodium chloride) were used in the experiment. Sushi samples (n = 1960) were evaluated by 40 trained panelists who noticed that maki shrimp samples prepared with Mary salt had higher bitterness (21.48 ± 28.01) in comparison with 2% sodium chloride (7.91 ± 8.80). The saltiness was lower in nigiri tuna prepared with Mary (49.59 ± 17.47) than 2% sodium chloride (61.11 ± 15.75). The study clearly showed the possibility of lowering sodium content in sushi meal with the usage of salt substitutes, with emphasis that Soda-Lo should be considered as a better option due to the retention of sensory properties in sushi samples prepared with this salt substitute.
Confirmatory Latent Class Analysis
Authors: Schmiege Sarah J. , Masyn Katherine E. , Bryan Angela D.
Published: December 2017

Most applications of person-centered methodologies have relied on data-driven approaches to class enumeration. As person-centered analyses grow in popularity within organizational research, confirmatory approaches may be sought to provide more stringent theoretical tests and to formalize replication efforts. Confirmatory latent class analysis (LCA) is achieved through placement of modeling constraints, yet there is variation in the types of potential constraints and a lack of standardization in evaluating model fit in published work. This article provides a comprehensive framework for operationalizing model constraints and demonstrates confirmatory LCA via two illustrations: (a) a dual sample approach ( n = 1,366 and n = 1,367 in exploratory and validation samples, respectively) and (b) confirmatory testing of a hypothesized latent class structure ( n = 1,483). We depict operationalization of threshold boundary and/or equality constraints under both illustrations to generate a confirmatory latent class structure, and explain methods of model evaluation and comparison to alternative models. The confirmatory model was well supported under the dual sample approach, and partially supported under the hypothesis-driven approach. We discuss decision making at various points of model estimation and end with future methodological developments.
Universal School-Based Implementation of Screening Brief Intervention and Referral to Treatment to Reduce and Prevent Alcohol, Marijuana, Tobacco, and Other Drug Use: Process and Feasibility
Authors: Maslowsky Julie , Whelan Capell Julie , Moberg D Paul , Brown Richard L
Published: December 2017

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to reducing substance use in adolescents. An emerging literature shows the promise of school-based SBIRT. However, most school-based SBIRT has only targeted substance-using adolescents and used school-based health clinics, which most schools lack. This project aimed to describe the following: a model for implementing universal SBIRT in high schools without school-based clinics, reasons students most commonly endorsed for reducing or avoiding substance use, students’ perceptions of SBIRT, and students’ intentions to change substance use or remain abstinent following SBIRT. Participants were N = 2513, 9th to 10th grade students in 10 high schools. Students rated SBIRT positively and indicated substantial intentions to reduce or delay substance use following SBIRT. Results support SBIRT’s potential to delay substance use among current abstainers in addition to reducing substance use among current users. This project demonstrates SBIRT’s feasibility as a universal method in high schools without in-school clinics.
Trade, investment and the global economy: Are we entering a new era for health?
Authors: Labonté Ronald , Ruckert Arne , Schram Ashley
Published: December 2017

Although officially dead due to US withdrawal from agreement, the Trans-Pacific Partnership agreement (TPP) is now in a ‘zombie’ state being resurrected in different ways by most of its remaining 11 member countries. This renders the analysis of its health implications both current and timely. This article, drawing on our own health impact assessment of the TPP and other analyses and commentaries, critically reviews some of the major ways in which the TPP, as a representative of so-called 21st-century regional trade agreements, poses a threat to global health equity. Four specific ways are identified and reviewed: (1) It increases restrictions on public health regulations (despite the tobacco partial carve-out) specifically through changes in the Technical barriers to Trade (TBT) and Sanitary and Phytosanitary Measures (SPS) chapters, and its new Regulatory Chapter. (2) Its flawed Investor–State Dispute Settlement (ISDS) system (with several cases affecting health services/insurance and indirectly health through cases challenging environmental protection) continues to benefit investor over public health and sustainability. (3) Its labour and environmental chapters are largely hortatory and concerned with ensuring increased trade by TPP rules, and not stronger labour rights or environmental protection per se. (4) There is little aggregate economic benefit, but disequalizing income distributions, and no accounting for public costs (e.g. trade adjustment compensation for negatively affected economic sectors, increased patent drug costs).The article concludes by locating the content and implementation of agreements as the TPP as a form of international law that entrenches a discredited neoliberal economic model of enormous benefit to capital and limited benefit to most of the world’s peoples.
Exploring the Occupational Context of Independent Male Escorts Who Seek Male Clients: The Case of Job Success
Authors: Kumar Navin , Grov Christian
Published: December 2017

Male sex work (MSW) research has been generally limited to the examination of “social problems.” Although there have been studies on occupational aspects, pointed examinations of the occupational environment, detailing the contemporary nature of the field, are rare. Research on nuances of the occupational context of MSW, providing insight on the rapidly changing face of the field, is wanting. Semistructured interviews were conducted with 20 escorts in Brisbane, Australia. This study explored job success, indicating that success in the field was well articulated, possibly highlighting that male independent escorting is becoming a professionalized occupation, with a shift away from current stigmatized understandings.
Exploring the knowledge and attitude of medical and pharmacy students about generic medicine in Lahore, Pakistan
Authors: Asif Usama , Saleem Zikria , Yousaf Mahrukh , Saeed Hamid , Hashmi Furqan Khurshid , Hassali Mohamed Azmi
Published: December 2017

Background

The age of out-of-pocket health-care expenditures demands the practice of generic medicine. Our objective was to evaluate the knowledge and attitude about generic medicine among medical and pharmacy students of Lahore, Pakistan.

Methods

A cross-sectional study was performed among calculated sample size (via online Raosoft calculator) of 295 students including 185 pharmacy and 110 medical students from third, fourth, and final year of studies using convenient sampling approach. A pre-validated questionnaire was used to assess the knowledge of students regarding generic medicine. Data were analyzed using SPSS version 20.

Results

We found that a majority of both pharmacy and medical students were aware of the meaning of brand and generic medicine where 86 (29.7%) students believed that generic medicine is bioequivalent to brand name product and 108 (36.5%) students agreed that cost burden will be reduced with the use of generics. There were concerns about quality (P ≤ 0.05) and side effects (P ≤ 0.005) of generic medicine as compared to brands. Significant associations were found between the knowledge of medical and pharmacy students (P ≤ 0.005).

Conclusion

Educational interventions and policies regarding generic medicine practices are strongly needed to overcome the knowledge deficits among pharmacy and medical students.
Caroline Bartlett Crane and Municipalsanitation: Applied Sociology in the Progressive Era
Authors: Rynbrandt Linda
Published: December 2017

Applied Sociology occupies contested territory between academic sociology and social activism. An examination of applied sociology at the turn of the 20th century, as practiced by Caroline Bartlett Crane, Unitarian minister and Progressive Era social reformer, provides an excellent case study of these disciplinary debates. This article examines Crane's efforts to utilize the new discipline of sociology to improve society through municipal sanitation. Sociology and community social reform were often closely linked in the Progressive Era. Early reformers and applied sociologists involved in sociology at the turn of the 20th century would likely be puzzled by the academic focus of the field today and dismayed by the privileged position of scholarship over social reform in contemporary sociology. One can only question how sociology's mission and message might differ today if the legacy of early, community-based sociology was more widely known within the discipline.
Contemporary Developments in Applied Demography within the United States
Authors: Swanson David A. , Pol Louis G.
Published: December 2017

Changes in technology and methodological developments have significantly changed the field of applied demography in the U.S. over the last decade. These have been accompanied by alterations in perceptions of how the demographic perspective contributes to addressing public and private sector issues. This paper focuses on contemporary developments with the goal of identifying areas of future direction. Following a brief history of applied demography, recent developments are placed into five categories: training, including programs; courses and course materials; institutional structures such as the Population Association of America, the Southern Demographic Association and funding agencies; career opportunities in government, educational institutions and the private sector; technological developments in communication and data storage and retrieval; and methodological developments, such as GIS, that allow researchers to extract additional information from data. These developments provide an overall picture of applied demography in the U.S. early in the twenty-first century and provide ideas about the state of the art in applied demography in the near future.
The Possibility of Healthy Organizations: Toward a New Framework for Organizational Theory and Practice
Authors: Schuyler Kathryn Goldman
Published: December 2017

The fields of organizational sociology and organizational development contain considerable literature dealing with organizational effectiveness, but little that focuses explicitly on organizational health. This paper clarifies the notion of “healthy organizations” and describes how it needs to be fed by practice, so that social scientists do not build theories that are unrelated to the reality that people experience in organizations today. This delineation of “organizational health” as an arena of inquiry is built on the definition of health developed by the World Health Organization, and on the writing of behavioral scientists (Argyris, Bruhn, Cooley, Etzioni, Kilburg, Levinson, Sorokin, and Whyte) and non-traditional thinkers and practitioners (G.I. Gurdjieff, Oscar Ichazo, Charles G. Krone, Moshe Feldenkrais, and Tenzin Gyatso, the 14th Dalai Lama). Sociological practice can contribute significantly to the creation of “organizations of the future” (Argyris, 1973) in which a state of reciprocal maintenance (Bennett, 1976) exists between individuals and organizations. “Reciprocal maintenance” means that neither partner seeks to take advantage of the other: the organizations are designed to enable the growth and development of their members or workers (in the broadest sense, including managers) and the individuals do their best to enhance the organization's long-term viability. I define as “healthy” those organizations that foster such reciprocal maintenance while creating an organizational culture in which people have more influence and control over the decisions that affect their lives.
Changes in Awareness of Shaken Baby Syndrome in the San Antonio Metropolitan Statistical Area: 2001–2002
Authors: Norton Darla Rae , Firestone Juanita M. , Vega Arturo
Published: December 2017

This research reports the results from random probability surveys conducted in Bexar County, Texas during June 2001 and October 2002. Data were gathered as part of an evaluation of the Any Baby Can organization's efforts to push Shaken Baby Syndrome (SBS) into the center of the public's attention. Shaken Baby Syndrome is a term used to describe the constellation of signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child (The National Center for SBS 2003:2). Any Baby Can (ABC) started its SBS campaign in 1996 with a grant from Children's Trust Fund of Texas, an organization heavily involved in the prevention of child abuse. Survey results are mixed. On the one hand, findings suggest that groups, like Any Baby Can, can provide a valuable service to the community relative to SBS, evidenced by the very high percentage of respondents across all demographic categories that disagreed with the view that “a mild shaking of a child” is as an acceptable form of disciplining a child and the improved knowledge in the community of SBS. On the other hand, despite these improvements, analyses also suggest there is more work to be done. Many people still need to know that SBS can be caused by “even mildly shaking a baby.” Notable percentages of respondents (15%-25%, depending on demographic group) perceived “a mild shaking” of a child as an acceptable manner of discipline. Furthermore, the SBS message should be transmitted in Spanish as well as in English, especially in communities where portions of their populations are from Mexico or other Spanish-speaking countries.
The Effect of Female-Headed Households on Educational Attainment: A Comparative Analysis of White and Black Respondents
Authors: Wang Guang-Zhen , Buffalo M. Doug , Bakr Shawn , Spataro Lucian P.
Published: December 2017

The study presents an analysis of the relationship between living in female-headed households and educational attainment among White and Black respondents. A statistically significant relationship is found for the White respondents. For the Black respondents, the relationship is not statistically significant. The empirical findings cast doubt on the “pathology of matriarchy” hypothesis that the breakdown of the Black family has placed Black children at a distinct disadvantage in obtaining education and social well-being. The results point instead to the importance of the social and economic resources within the family. The proposition that growing up in a female-headed household is more devastating for males than for females in terms of educational attainment is not supported. The data used for this study came from the General Social Survey (GSS) of the National Opinion Research Center (NORC). The analysis was conducted from the 1970s, 1980s, 1990s, and the year 2000 data.
Identifying the Face of Hate
Authors: Valeri Robin , Borgeson Kevin
Published: December 2017

Previous research by Borgeson and Valeri (2004) suggests that individuals may not recognize the intolerance of hate web sites. The present study examines the impact of content-warning notices on both an individual's ability to detect the intolerance of a hate site and the specific target of a hate site.
“Abortion Culture” in Russia: Its Origins, Scope, and Challenge to Social Development
Authors: Karpov Vyacheslav , Kääriäinen Kimmo
Published: December 2017

This paper focuses on one aspect of Russia's critical demographic condition: its extraordinarily high rate of abortion. We show that much in the current crisis may be attributed to the persistent cultural legacies of the Soviet past. Using survey data collected in Russia in 2002 along with the 1998 ISSP Religion II data, historical accounts, and statistics on abortion, we suggest that the “abortion culture” that emerged in Russia under communism has had a lasting impact on Russians' perceptions of this issue. This “culture” manifests itself in the widespread and deep-seated view that abortion is a “normal” way of dealing with medical and socioeconomic hardships in personal and family life. These beliefs may account for the fact that Russia's abortion rate is still among the highest in the world, despite generational replacement in the at-risk age group, dramatically improved access to modern contraceptives, and greater openness of public discussion of sexual and reproductive issues. The theoretical importance of this study, in our view, transcends its empirical boundaries: it points to powerful limitations that the informal, unofficial and mundane institutions that had emerged under communism impose on social development and social policy in post-communist societies.
Evaluation of a School and Peer Based Anti-Smoking Program Targeting Southwest Louisiana Grade School Students
Authors: Campbell Carol , Weeber Stan
Published: December 2017

Evidence suggests that anti-smoking programs that target school-aged children can be effective and that they can assist in reducing tobacco use among peers. This article presents an evaluation of a peer and school based mentoring program offered by Big Brothers/Big Sisters of Southwest Louisiana in conjunction with local elementary schools. The program matches high school mentors with elementary school children believed to be at a high risk for smoking, as well as for alcohol and drug abuse. The results of the evaluation were mixed. Teachers and mentors praised the program. Participation in the program was also associated with a reduction in peer use of alcohol and tobacco. However, there was no significant difference between experimental and control groups with respect to how the grade school subjects recognized the harm that alcohol can produce for children. Further, there was no significant difference in how experimental and control groups viewed the damage to children that could be done by a combination of alcohol, tobacco, and street drugs. The mixed results demonstrate the program's promise and its potential usefulness as a strategy to prevent teen smoking. At the same time, the results underscore the complex interplay of factors that may contribute to the success or failure of such innovative programs.
Social Support and Risky Sexual Behavior among Adolescents: The Protective Role of Parents and Best Friends
Authors: Majumdar Debarun
Published: December 2017

Parents and best friends provide social support to adolescents that can protect them from risky sexual behaviors. Although past research has examined various factors related to parents, the benefits of parental involvement in an adolescent's life as it relates to risky sexual activities have not been examined. Past studies have also examined peer influence on adolescent behaviors, but have largely ignored the effect of best friends. The National Longitudinal Study of Adolescent Health (1995) reports that higher levels of family involvement and best friend interaction were related to lowering the odds of engaging in risky sexual activities. Higher levels of family involvement and best friend interaction increased the likelihood of using contraception during intercourse and early sexual activity among adolescents. The effects varied by gender. Programs that are intended to reduce the chances of sexual risk can potentially encourage activities with parents and close friends. Also, programs might focus on best friends, not necessarily peers, as a possible deterrent to behavior among adolescents.
Environmental Press, Aging in Place, and Residential Satisfaction of Urban Older Adults
Authors: Byrnes Mary , Lichtenberg Peter A. , Lysack Cathy
Published: December 2017

Sociologists who study and work with older adults often use the term “aging in place” when discussing older adults' residential environments. Aging in place suggests that what is best for older people (and society at large) is to remain in the residential environment (e.g. home and neighborhood) in which they have lived most of their lives. The goal of this study was to utilize the theory of environmental press in a sample of older adults living in the central city of Detroit to begin to understand their levels of satisfaction with their residential environment, and to examine potential limitations in the theory of aging in place.

A random telephone survey was used in a sample of older adults (n = 604) living in the central city of Detroit, Michigan. Hierarchical logistic regression was used to test residential satisfaction using demographics, home hazards, neighborhood hazards, personal competencies, geographic location, and interaction variables. Home hazards, neighborhood hazards, geographic location, and interaction press measures predicted housing satisfaction (Nagelkerke R2=40.2 percent) and neighborhood satisfaction (Nagelkerke R2=50.5 percent). The environmental press and residential satisfaction of the highest and lowest mentally and physically functioning older adults were also investigated. Respondents who reported the lowest levels of mental and physical functioning also reported the lowest levels of residential satisfaction and faced the greatest environmental challenges. The results suggest that older adults occupying disadvantaged social locations may be overlooked in current practice definitions of aging in place.
Multiplanar computed tomography reconstruction to aid in recognition of the middle cerebral artery “Dot” sign: The sagittal string sign
Authors: Mannel Robert K , Sandhu Sukwinder J , Silliman Scott L
Published: December 2017

While non-contrast head computed tomography is effective in detecting blood, it is not sensitive in diagnosing hyperacute ischemic stroke. One neuroradiologic marker for early thromboembolic occlusion of the distal middle cerebral artery is the middle cerebral artery “dot” sign. The “dot” seen on the typical axial plane represents a hyperdensity of the middle cerebral artery in the Sylvian fissure. A review of medical literature was conducted via PubMed utilizing search phrases “MCA,” “dot,” and “sign.” The review was limited to the intravenous tissue-type plasminogen activator era, 1996 and on. Articles were analyzed to determine the use of the sagittal plane of non-contrast head computed tomography to locate the middle cerebral artery “dot” sign. The search terms yielded 11 results which revealed that computed tomography reconstruction and sagittal planes were not used for detection of the middle cerebral artery “dot” signs. Our patient had no known past medical history. The initial non-contrast head computed tomography was read as having a hypodensity in the right insular region and a middle cerebral artery “dot” sign. Multiplanar reconstruction of the computed tomography demonstrated a hyperdense sagittal string-like appearance of the middle cerebral artery along the Sylvian fissure. Computed tomography angiography confirmed the M2 occlusion. This is the first report of using the head computed tomography sagittal plane for diagnosis of the middle cerebral artery “dot” sign. Incorporating multiplanar reconstruction and producing the sagittal plane may lead to a higher sensitivity of the middle cerebral artery “dot” sign. Further studies incorporating a patient cohort will be needed to determine how much the sagittal plane view augments predictive value of the middle cerebral artery “dot” sign.
Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy
Authors: Witiw Christopher D. , Mathieu Francois , Nouri Aria , Fehlings Michael G.
Published: December 2017

Study Design:

Narrative review with commentary.

Objectives:

The growing use of magnetic resonance imaging (MRI) often leaves clinicians faced with scenarios where imaging findings are inconsistent with the clinical picture. This is particularly relevant for degenerative cervical spinal cord compression (CSCC). In this article, we provide a focused narrative literature review to address whether (1) surgery should be offered to asymptomatic patients with CSCC and (2) should MRI spinal cord signal changes influence clinical decisions for a patient with mild myelopathy from CSCC?

Methods:

Illustrative cases are presented with expert commentary which is supplemented by a focused literature review.

Results:

The literature suggests that CSCC from degenerative pathology is a common incidental radiographic finding. For those without symptoms of myelopathy, the short-term risk of progression is low. There is a lack of evidence to support surgery for asymptomatic individuals with CSCC who have no risk factors for progression. For these patients, the authors suggest non-operative management that includes education on the symptoms of myelopathy, clinical follow-up within 6 to 12 months, and avoidance of high-risk activities. Conversely, symptomatic patients have a notable risk of progression. Surgical intervention improves neurological function and quality of life regardless of severity. The authors support surgery as an option for all patients with mild myelopathy who are appropriate operative candidates. Intramedullary signal change on MRI has not been shown to reliably predict progression.

Conclusions:

While MRI technologies are under evolution, we advise that surgical decisions for patients with CSCC should rely on clinical assessment and not imaging findings.
Electoral politics and democracy in Africa: A critical review of Lindberg’s thesis
Authors: Appiah-Thompson Christopher
Published: December 2017

This article critically reviews, assesses and refines Lindberg’s theoretical proposition that African states will become more democratic if they simply keep holding elections, irrespective of the degree of ‘freeness and fairness of the elections’, by using new empirical evidence from Ghana. Specifically, it highlights three fundamental challenges to Lindberg’s thesis on theoretical, methodological and empirical grounds. To achieve the objectives of this article, first, a systematic and logical approach will be employed to assess the theoretical and methodological justifications underpinning Lindberg’s argument and some contributions to the debate from his critics. Second, it introduces new empirical evidence from Ghana, which clearly ‘deviates’ from Lindberg’s theoretical expectations in the long run, thus, calling for theoretical refinement and elaboration of the latter’s initial thesis. Finally, it draws from the analysis some conclusions and implications for the study of democratization in Africa in the future.
ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children
Authors: Kaditis Athanasios G. , Alonso Alvarez Maria Luz , Boudewyns An , Abel Francois , Alexopoulos Emmanouel I. , Ersu Refika , Joosten Koen , Larramona Helena , Miano Silvia , Narang Indra , Tan Hui-Leng , Trang Ha , Tsaoussoglou Marina , Vandenbussche Nele , Villa Maria Pia , Van Waardenburg Dick , Weber Silke , Verhulst Stijn
Published: December 2017

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1–23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g.snoring) and/or conditions predisposing to SDB (e.g.mandibular hypoplasia) as well as children with SDB and complex conditions (e.g.Down syndrome, Prader–Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g.supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1–23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
A simple algorithm for the identification of clinical COPD phenotypes
Authors: Burgel Pierre-Régis , Paillasseur Jean-Louis , Janssens Wim , Piquet Jacques , ter Riet Gerben , Garcia-Aymerich Judith , Cosio Borja , Bakke Per , Puhan Milo A. , Langhammer Arnulf , Alfageme Inmaculada , Almagro Pere , Ancochea Julio , Celli Bartolome R. , Casanova Ciro , de-Torres Juan P. , Decramer Marc , Echazarreta Andrés , Esteban Cristobal , Gomez Punter Rosa Mar , Han MeiLan K. , Johannessen Ane , Kaiser Bernhard , Lamprecht Bernd , Lange Peter , Leivseth Linda , Marin Jose M. , Martin Francis , Martinez-Camblor Pablo , Miravitlles Marc , Oga Toru , Sofia Ramírez Ana , Sin Don D. , Sobradillo Patricia , Soler-Cataluña Juan J. , Turner Alice M. , Verdu Rivera Francisco Javier , Soriano Joan B. , Roche Nicolas
Published: December 2017

This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.

Data from 2409 COPD patients of French/Belgian COPD cohorts were analysed using cluster analysis resulting in the identification of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative International Assessment (3CIA) initiative.

Cluster analysis identified five subgroups of COPD patients with different clinical characteristics (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated that the variables relevant for patient grouping differed markedly between patients with isolated respiratory disease (FEV1, dyspnoea grade) and those with multi-morbidity (dyspnoea grade, age, FEV1and body mass index). Application of this algorithm to the 3CIA cohorts confirmed that it identified subgroups of patients with different clinical characteristics, mortality rates (median, from 4% to 27%) and age at death (median, from 68 to 76 years).

A simple algorithm, integrating respiratory characteristics and comorbidities, allowed the identification of clinically relevant COPD phenotypes.
Multiple imputation using linked proxy outcome data resulted in important bias reduction and efficiency gains: a simulation study
Authors: Cornish R. P. , Macleod J. , Carpenter J. R. , Tilling K.
Published: December 2017

Background

When an outcome variable is missing not at random (MNAR: probability of missingness depends on outcome values), estimates of the effect of an exposure on this outcome are often biased. We investigated the extent of this bias and examined whether the bias can be reduced through incorporating proxy outcomes obtained through linkage to administrative data as auxiliary variables in multiple imputation (MI).

Methods

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) we estimated the association between breastfeeding and IQ (continuous outcome), incorporating linked attainment data (proxies for IQ) as auxiliary variables in MI models. Simulation studies explored the impact of varying the proportion of missing data (from 20 to 80%), the correlation between the outcome and its proxy (0.1–0.9), the strength of the missing data mechanism, and having a proxy variable that was incomplete.

Results

Incorporating a linked proxy for the missing outcome as an auxiliary variable reduced bias and increased efficiency in all scenarios, even when 80% of the outcome was missing. Using an incomplete proxy was similarly beneficial. High correlations (> 0.5) between the outcome and its proxy substantially reduced the missing information. Consistent with this, ALSPAC analysis showed inclusion of a proxy reduced bias and improved efficiency. Gains with additional proxies were modest.

Conclusions

In longitudinal studies with loss to follow-up, incorporating proxies for this study outcome obtained via linkage to external sources of data as auxiliary variables in MI models can give practically important bias reduction and efficiency gains when the study outcome is MNAR.
Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross‐sectional retrospective case‐control study
Authors: Tehan Peta Ellen , Barwick Alex Louise , Sebastian Mathew , Chuter Vivienne Helaine
Published: December 2017

Background

The resting systolic toe pressure (TP) is a measure of small arterial function in the periphery. TP is used in addition to the ankle‐brachial index when screening for peripheral arterial disease (PAD) of the lower limb in those with diabetes, particularly in the presence of lower limb medial arterial calcification. It may be used as an adjunct assessment of lower limb vascular function and as a predictor of wound healing. The aim of this study was to determine the diagnostic accuracy of TP for detecting PAD in people with and without diabetes.

Methods

This was a retrospective case‐control study. Two researchers extracted information from consecutive patient records, including TP measurements, colour Duplex ultrasound results, demographic information, and medical history. Measures of diagnostic accuracy were determined by receiver operating curve (ROC) analysis, and calculation of sensitivity, specificity, and positive and negative likelihood ratios.

Results

Three hundred and nintey‐four participants with suspected PAD were included. In the diabetes group (n = 176), ROC analysis of TP for detecting PAD was 0.78 (95%CI: 0.69 to 0.84). In the control group (n = 218), the ROC of TP was 0.73 (95%CI: 0.70 to 0.80). TP had highest sensitivity when anatomical distribution of disease was both proximal and distal (diabetes group: 79.49%, the control group: 82.61%). TP yielded highest sensitivity in mild disease (50–75% stenosis) in diabetes group, (81.82%) and moderate disease (>75% stenosis) in control group (80.77%).

Conclusions

Our findings indicate that TPs are useful to assist in diagnosing PAD in clinical practice, however, results should be interpreted with caution due to the small probability of PAD being present with a negative test.
Modifiable and Nonmodifiable Factors Associated With Perioperative Failure of Extraglottic Airway Devices
Authors: Vannucci Andrea , Rossi Isabella T. , Prifti Kevin , Kallogjeri Dorina , Rangrass Govind , DeCresce David , Brenner Daniel , Lakshman Neel , Helsten Daniel L. , Cavallone Laura F.
Published: December 2017

BACKGROUND:

Extraglottic airway device (EGA) failure can be associated with severe complications and adverse patient outcomes. Prior research has identified patient- and procedure-related predictors of EGA failure. In this retrospective study, we assessed the incidence of perioperative EGA failure at our institution and identified modifiable factors associated with this complication that may be the target of preventative or mitigating interventions.

METHODS:

We performed a 5-year retrospective analysis of adult general anesthesia cases managed with EGAs in a single academic center. Univariable and multivariable logistic regressions were used to identify clinically modifiable and nonmodifiable factors significantly associated with 3 different types of perioperative EGA failure: (1) “EGA placement failure,” (2) “EGA failure before procedure start,” and (3) “EGA failure after procedure start.”

RESULTS:

A total of 19,693 cases involving an EGA were included in the analysis dataset. EGA failure occurred in 383 (1.9%) of the cases. EGA placement failure occurred in 222 (1.13%) of the cases. EGA failure before procedure start occurred in 76 (0.39%) of the cases. EGA failure after procedure start occurred in 85 (0.43%) of the cases. Factors significantly associated with each type of failure and controllable by the anesthesia team were as follows: (1) EGA placement failure: use of desflurane (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.23–2.25) and EGA size 4 or 5 vs 2 or 3 (OR, 0.07; 95% CI, 0.05–0.10); (2) EGA failure before procedure start: use of desflurane (OR, 2.05; 95% CI, 1.23–3.40) and 3 or more placement attempts (OR, 4.69; 95% CI, 2.57–8.56); and (3) EGA failure after procedure start: 3 or more placement attempts (OR, 2.06; 95% CI, 1.02–4.16) and increasing anesthesia time (OR, 1.35; 95% CI, 1.17–1.55).

CONCLUSIONS:

The overall incidence of EGA failure was 1.9%, and EGA placement failure was the most common type of failure. We also found that use of desflurane and use of smaller EGA sizes in adult patients were factors under the direct control of anesthesia clinicians associated with EGA failure. An increasing number of attempts at EGA placement was associated with later device failures. Our findings also confirm the association of EGA failure with previously identified patient- and procedure-related factors such as increased body mass index, male sex, and position other than supine.
Differential Effects of Anesthetics and Opioid Receptor Activation on Cardioprotection Elicited by Reactive Oxygen Species–Mediated Postconditioning in Sprague-Dawley Rat Hearts
Authors: Lucchinetti Eliana , Lou Phing-How , Gandhi Manoj , Clanachan Alexander S. , Zaugg Michael
Published: December 2017

BACKGROUND:

Despite an array of cardioprotective interventions identified in preclinical models of ischemia–reperfusion (IR) injury, successful clinical translation has not been achieved. This study investigated whether drugs routinely used in clinical anesthesia influence cardioprotective effectiveness by reducing effects of reactive oxygen species (ROS), upstream triggers of cardioprotective signaling. Effects of propofol, sevoflurane, or remifentanil were compared on postischemic functional recovery induced by ROS-mediated postconditioning with Intralipid.

METHODS:

Recovery of left ventricular (LV) work, an index of IR injury, was measured in isolated Sprague-Dawley rat hearts subjected to global ischemia (20 minutes) and reperfusion (30 minutes). Hearts were either untreated or were treated with postconditioning with Intralipid (1%, throughout reperfusion). Propofol (10 μM), sevoflurane (2 vol%), remifentanil (3 nM), or combinations thereof were administered peri-ischemically (before and during IR). The effects of anesthetics on ROS production were measured in LV cardiac fibers by Amplex Red assay under phosphorylating and nonphosphorylating conditions.

RESULTS:

Recovery of LV work (expressed as percentage of the preischemic value ± standard deviation) in untreated hearts was poor (20% ± 7%) and was improved by Intralipid postconditioning (58% ± 8%, P = .001). In the absence of Intralipid postconditioning, recovery of LV work was enhanced by propofol (28% ± 9%, P = .049), sevoflurane (49% ± 5%, P < .001), and remifentanil (51% ± 6%, P < .001). The benefit of Intralipid postconditioning was abolished by propofol (33% ± 10%, P < .001), but enhanced by sevoflurane (80% ± 7%, P < .001) or remifentanil (80% ± 9%, P < .001). ROS signaling in LV fibers was abolished by propofol, but unaffected by sevoflurane or remifentanil. We conclude that propofol abolishes ROS-mediated Intralipid postconditioning by acting as a ROS scavenger. Sevoflurane and remifentanil are protective per se and provide additive cardioprotection to ROS-mediated cardioprotection.

CONCLUSIONS:

These divergent effects of routinely used drugs in clinical anesthesia may influence the translatability of cardioprotective therapies such as Intralipid postconditioning.
Macintosh Blade Videolaryngoscopy Combined With Rigid Bonfils Intubation Endoscope Offers a Suitable Alternative for Patients With Difficult Airways
Authors: Pieters Barbe M. , Theunissen Maurice , van Zundert Andre A.
Published: December 2017

BACKGROUND:

In the armamentarium of an anesthesiologist, videolaryngoscopy is a valuable addition to secure the airway. However, when the videolaryngoscope (VLS) offers no solution, few options remain. Earlier, we presented an intubation technique combining Macintosh blade VLS and Bonfils intubation endoscope (BIE) for a patient with a history of very difficult intubation. In the present study, we evaluated this technique to establish whether it is a valuable alternative.

METHODS:

In this single-blinded nonrandomized study, 38 patients with a history of difficult intubation or 1 or more predictors of difficult intubation, scoring a Cormack & Lehane (C&L) grade III or IV using Macintosh blade VLS, were included. Patients were intubated combining the VLS with the BIE. The C&L grade was scored 3 times during (1) direct laryngoscopy; (2) indirect videolaryngoscopy; and (3) using the combined technique (VLS + BIE). Afterward, 2 blinded anesthesiologists assessed the C&L grade using the pictures taken during the procedure.

RESULTS:

Data of 38 patients were analyzed. An improvement of the C&L grade with the combined technique occurred in 33 of 38 patients (86.8%; 95% confidence interval, 71.9%–95.6%). Reviewer 1 reported an improvement of the C&L grade with the combined technique in 37 of 38 patients. Reviewer 2 reported improvement in 33 and deterioration in 2 of the patients. No complications occurred.

CONCLUSIONS:

The combined use of a VLS with Macintosh blade and BIE gives the anesthesiologist a valuable alternative intubation option in patients with extremely difficult airways.