bluuebunny/crossref_metadata_2025 huggingface dataset:
Modified ultrafiltration in paediatric cardiopulmonary bypass
Authors: Wang Wei , Huang Hui Ming , De Ming Zhu  , Chen Hong , Su Zhao Kang , Ding Wei Xiang
Published: January 2013

Cardiopulmonary bypass (CPB), a nonphysiological procedure, is associated with haemodilution and the inflammatory response, causing the accumulation of body water and organ dysfunction. The purpose of this study was to evaluate the efficacy of modified ultrafiltration.

Forty paediatric patients undergoing cardiac operations were randomized into a control group and a modified ultrafiltration group. Blood cells, protein and cytokine concentrations were recorded for 24 h postoperatively.

As the fluid was removed at 50 ml/min, both blood cells and protein were concentrated by modified ultrafiltration ( p < 0.001). The tumour necrosis factor (TNF)-α concentration was increased and interleukin-8 (IL-8) and endothelin (ET) concentrations were unaltered after ultrafiltration. After correction for albumin, TNF-α concentration changed little, and IL-8 and ET concentrations (36.75 ± 12.35, 42.89 ± 15.54) were decreased significantly (21.47 ± 13.87, 26.06 ± 12.54) after ultrafiltration.

Modified ultrafiltration is an effective method for removing excess tissue fluid and concentrating blood after CPB. This technique can also filter out some cytokines.
Effects of the combinations propofol/alfentanil and midazolam/fentanyl on blood pressure and contact phase system during coronary surgery
Authors: Schulze Hans-Joachim , Wendel Hans Peter , Kleinhans Martin , Oehmichen Siegfried , Guggenberger Herbert , Heller Wolfgang , Hoffmeister Hans-Eberhard
Published: January 2013

Perioperative haemodynamic changes leading to severe circulatory problems during open-heart surgery still represent dreaded complications. The aim of this study was to examine the relationship between the use of applied anaesthetic agents and alterations of the contact phase of the intrinsic blood-clotting system, as changes within the kallikrein-kinin system can lead to a fall in blood pressure.

In a randomized study, parameters of the kallikrein-kinin system, coagulation and fibrinolysis were determined for 36 patients with aortocoronary bypass operations. The patients had been given either midazolam/fentanyl or propofol/alfentanil to maintain anaesthesia. Perioperative blood pressure values were registered at seven fixed points.

The measured values of the factor XIIa-like activity and the kallikrein-like activity suggested a higher activation of the contact phase, when propofol/alfentanil was given. From the start of the extracorporeal circulation (ECC) to the end of the operation, the kallikrein-like activities in the propofol/alfentanil group were significantly higher than those of the midazolam/fentanyl group. Also, the results of the kallikrein inhibition capacity and the indicators of fibrinolysis (t-PA and D-dimers) indicate a stronger activation of the contact phase - at least at the beginning of recirculation - and as a result of it, a stronger fibrinolysis within the propofol/alfentanil group. In addition, the hypotensive side-effects differed significantly between the two groups. Patients receiving propofol/alfentanil needed the triple amount of anti-hypotonicum to maintain the mean arterial blood pressure above 75 mmHg.

With the results of this study, a correlation between the application of propofol/alfentanil, contact phase activation, with activation of the kallikrein-kinin-bradykinin system and the observed hypotension, can be presumed.
Venous saturation monitoring: reliability of the Bentley SM-0200 OxySAT with and without use of a cuvette
Authors: Bellaiche Anne Louise , Christensen Thomas Decker
Published: January 2013

In-line venous saturation monitoring is a useful method of quality management during extracorporeal circulation (ECC). The Bentley SM-0200 OxySAT® meter was tested with and without the use of the recommended cuvette. The study consisted of an in vitro part, where extremely low saturations could be safely measured, and an in vivo part, carried out under routine ECC conditions. The results show that the OxySAT® may be used with or without a cuvette, and that it needs calibration for optimal accuracy in either case.
Effect of surface coating on platelet count drop during cardiopulmonary bypass
Authors: Palanzo David A , Zarro Debra L , Manley Norman J , Montesano Ralph M , Quinn Michael , Gustafson Patricia A
Published: January 2013

This study was designed to investigate the effect of surface coating on platelet count drop during cardiopulmonary bypass (CPB). Sixty patients undergoing open-heart surgery were randomly divided into three groups each receiving a different type of coated hollow-fiber membrane oxygenator. The patients were given either an uncoated oxygenator (noncoated group), an oxygenator coated with Carmeda® (Carmeda group) or an uncoated oxygenator with albumin in the priming solution (albumin group). Comparisons were made in platelet count pre-CPB, on bypass (15-25 min) and during the warming period. Calculations were used to account for the effect of hemodilution. The albumin group had significantly lower platelet count drops (-4.8 ± 7.1%) than the Carmeda group (11.0 ± 8.3%) and the noncoated group (20.3 ± 14.5%). Carmeda surface coating demonstrated some beneficial effects, but to a lesser degree than the albumin.
Gabexate mesilate and antithrombin III for intraoperative anticoagulation in heparin pretreated patients
Authors: Ranucci M , Cazzaniga A , Isgrò G , Ditta A , Boncilli A , Cotza M , Brozzi S
Published: January 2013

Thirty patients scheduled for elective myocardial revascularization and having undergone preoperative heparin treatment have been admitted to this prospective, randomized study. The aim of the study was to test two different strategies for preserving circulating antithrombin III (AT-III) during cardiopulmonary bypass. Patients in the control group (group C, n = 10) were treated with a standard heparinization (300 IU/kg). Patients in group A ( n = 10) received the same management plus two doses of purified antithrombin III (1000 IU each). Patients in group GA received 200 IU/kg heparin and a continuous infusion of heparin (100 IU/kg/h) and gabexate mesilate (2 mg/kg/h) plus the same dose of antithrombin III as group A. Both group A and group GA demonstrated a preservation of circulating AT-III when compared to group C; this effect was more pronounced in group GA. The total heparin dosage was less in group GA than in groups A and C. Purified AT-III administration is recommended in heparin pretreated patients; the addition of gabexate mesilate to this protocol decreases the heparin requirement and increases the AT-III preservation.
A new bladder allows kinetic venous augmentation with a roller pump
Authors: Tamari Yehuda , Lee-Sensiba Kerri , Ganju Rik , Chan Richard , Hall Michael H
Published: January 2013

Augmented venous drainage improves venous return during minimally invasive cardiac surgery. Two systems to augment drainage are common: in one, a centrifugal pump draws blood from the venous site and pumps it into a venous reservoir. In the other, suction is applied directly to a hard-shell venous reservoir. Both systems overcome the high resistance of the venous cannula when gravity alone is insufficient to provide adequate drainage. Both systems also have shortcomings: in the first approach, the centrifugal pump head can entrap large bubbles, reducing flow and requiring pump stoppage to remove them. Air from the venous line also can be broken up by the centrifugal pump into small bubbles that can pass through the pump head. The direct suction system in the second approach cannot use a closed-bag reservoir, and has the potential to introduce air into the arterial line.

We have developed a new venous augmentation system for a closed venous reservoir that provides excellent suction control without the potential to introduce air into the arterial line. Our system replaces the centrifugal pump of the first approach with a roller pump controlled by the Better-Bladder™, a new device with FDA 510(k) clearance for long-term pumping. The Better-Bladder is a length of medical tubing, processed to form a thin-walled, enlarged bladder that is sealed within a clear rigid housing. It acts as an in-line reservoir that provides compliance in the venous line and a noninvasive means to measure blood pressure at the pump inlet. The bladder housing can maintain a negative pressure set by the user that controls the degree of gravity drainage. Tests have shown that the Better-Bladder allows for safe, smooth pump control using a roller pump in the venous line.
Ex vivo testing of the Quart® arterial line filter
Authors: Mueller Xavier M , Tevaearai Hendrick T , Jegger David , Augstburger Monique , Burki Marco , von Segesser Ludwig K
Published: January 2013

Arterial line filters are now routinely used in cardiac surgery in order to decrease the microemboli load to the patient. The Quart® filter (Jostra, Hirrlingen, Germany) with a new planar construction design, an easy de-airing system and an integrated bypass, was tested for air filtration capacity and resistance to blood path in a standardized setting with surviving animals.

Three calves (mean body weight: 71 ± 3.4 kg) were connected to a standard cardiopulmonary bypass (CPB) circuit by jugular venous and carotid arterial cannulation with a mean flow rate of 3.5 l/min. The arterial line filter was challenged with upstream injections of boluses of air of 5, 10 and 15 ml, respectively. A Doppler ultrasound was positioned downstream on the arterial line to measure bubble count and size. The pressure drop through the filter was monitored at flow rates of between 1 and 6 l/min. At the end of the procedure the animals were weaned from the CPB and, thereafter, from the ventilator. After 7 days, the animals were sacrificed electively.

This study shows that important quantities of air can be injected into the arterial line upstream of the filter with small volumes of small sized bubbles recorded downstream. With the 5 ml air bolus injection, mean values of 0.3 ± 0.6 bubbles of 30 and 40 μm were detected, whereas with the 20 ml bolus, 32.6 ± 8.7 bubbles of 10 μm, 3.7 ± 1.1 bubbles of 30 μm, 3.3 ± 0.6 bubbles of 40 μm and 0.7 ± 1.1 bubbles of 50 μm were recorded. The blood path resistance at different blood flow rates was well within the acceptable range with a pressure drop of 20 ± 0 and 26.6 ± 5.7 mmHg at flow rates of 4 and 5 l/min, respectively.

With its planar concept, the Quart filter offers good air filtering capacity both in terms of bubble count and size after injection of large boluses of air, without any increase of resistance to the blood path. Moreover, it offers a venting function and an integrated bypass system.
Differences in Knee Joint Stabilization Between Children and Adults and Between the Sexes
Authors: Tagesson Sofi , Witvrouw Erik , Kvist Joanna
Published: January 2013

Background:

Differences in knee joint stabilization between children and adults and between the sexes are not fully understood.

Purpose:

To compare the knee laxity and the dynamic tibial translation between (1) children and adults, (2) girls and boys, and (3) women and men.

Study Design:

Controlled laboratory study.

Methods:

Sixty-seven children (aged 8-13 years) and 63 adults (aged 18-30 years) without previous knee injuries participated. Sagittal tibial translation was measured during the instrumented Lachman test at 90 N and 134 N (knee laxity) and during gait (dynamic translation). Tibial translation was recorded with an electrogoniometer.

Results:

Knee laxity was greater in children than in adults (Lachman test at 90 N: 9.1 ± 2.9 vs 7.3 ± 2.7, respectively; P < .001). In contrast, dynamic tibial translation during gait did not differ between children and adults. Girls and boys did not differ in knee laxity or maximum anterior tibial translation during gait, and men and women did not differ in knee laxity. Women had greater dynamic tibial translation during gait than men (7.8 ± 2.7 vs 5.7 ± 3.0, respectively; P = .004).

Conclusion:

Children had greater knee laxity than adults, whereas the dynamic tibial translation did not differ. In adults, knee laxity did not differ between the sexes, but dynamic tibial translation was greater in women.

Clinical Relevance:

Children and men had less dynamic tibial translation during gait in proportion to their maximum knee laxity. The observed less dynamic tibial translation in children and adult men might be related to their reduced risk of sustaining an anterior cruciate ligament injury.
The Many Faces of Glut1 Deficiency Syndrome
Authors: Tzadok Michal , Nissenkorn Andreea , Porper Keren , Matot Israel , Marcu Shai , Anikster Yair , Menascu Shay , Bercovich Dani , Zeev Bruria Ben
Published: January 2013

Glucose transporter protein type 1 deficiency syndrome is a metabolic disorder manifesting as cognitive impairment, acquired microcephaly, epilepsy, and/or movement disorder caused by mutations in the SLC2A1 gene. We describe a cohort of isolated and familial cases of glucose transporter protein type 1 deficiency syndrome, emphasizing seizure semiology, electroencephalographic (EEG) features, treatment response and mutation pathogenicity. SLC2A1 mutations were detected in 3 sporadic and 4 familial cases. In addition, mutations were identified in 9 clinically unaffected family members in 2 families. The phenotypic spectrum of glucose transporter protein type 1 deficiency is wider than previously recognized, with considerable intra-familial variation. Diagnosis requires either hypoglycorrachia followed by SLC2A1 sequencing or direct gene sequencing. A ketogenic diet should be the first line of treatment, but more flexible diets, like the Atkins modified diet, can also be followed. Carbonic anhydrase inhibitors, such as acetazolamide or zonisamide, can be effective for seizure control.
Impediments of Labor Contracts on Prison Administrators’ Response to Staff–Inmate Sexual Misconduct
Authors: Armstrong Gaylene S. , Longmire Dennis , Dretke Doug J. , Steinmetz Kevin
Published: January 2013

Sexual violence in adult correctional facilities led to the enactment of the 2003 Prison Rape Elimination Act as one approach to reducing this form of institutional violence. The current study examined collective bargaining agreements governing correctional agencies to identify impediments that may impact administrators’ responses to sexual violence, specifically in instances of allegations of staff–inmate sexual misconduct. In addition, structured interviews and focus groups with correctional administrators and labor representatives were used to develop policy recommendations. Contract language and interview participants demonstrated that a myriad of cultural and structural characteristics of prisons as well as pragmatic considerations may serve to inhibit the implementation of some policy changes. Interview participants identified several insights about contemporary prison settings and modifications that may aid in reducing some forms of institutional violence.
Impact of Pharmacy Technician-Centered Medication Reconciliation on Optimization of Antiretroviral Therapy and Opportunistic Infection Prophylaxis in Hospitalized Patients With HIV/AIDS
Authors: Siemianowski Laura A. , Sen Sanchita , George Jomy M.
Published: January 2013

Purpose: This study aimed to examine the role of a pharmacy technician-centered medication reconciliation (PTMR) program in optimization of medication therapy in hospitalized patients with HIV/AIDS. Methods: A chart review was conducted for all inpatients that had a medication reconciliation performed by the PTMR program. Adult patients with HIV and antiretroviral therapy (ART) and/or the opportunistic infection (OI) prophylaxis listed on the medication reconciliation form were included. The primary objective is to describe the (1) number and types of medication errors and (2) the percentage of patients who received appropriate ART. The secondary objective is a comparison of the number of medication errors between standard mediation reconciliation and a pharmacy-led program. Results: In the PTMR period, 55 admissions were evaluated. In all, 50% of the patients received appropriate ART. In 27of the 55 admissions, there were 49 combined ART and OI-related errors. The most common ART-related errors were drug–drug interactions. The incidence of ART-related medication errors that included drug–drug interactions and renal dosing adjustments were similar between the pre-PTMR and PTMR groups ( P = .0868). Of the 49 errors in the PTMR group, 18 were intervened by a medication reconciliation pharmacist. Conclusion: A PTMR program has a positive impact on optimizing ART and OI prophylaxis in patients with HIV/AIDS.
Classifier fusion of vibration and acoustic signals for fault diagnosis and classification of planetary gears based on Dempster–Shafer evidence theory
Authors: Khazaee Meghdad , Ahmadi Hojat , Omid Mahmoud , Moosavian Ashkan , Khazaee Majid
Published: January 2013

Nowadays, the ever increasing need for higher accuracy, reliability and security in modern industries has given rise intensively to the use of multi-sensor data fusion method in fault diagnosis of industrial equipment. In this article, an effective and powerful method for precise fault diagnosis of planetary gearbox based on fusion of vibration and acoustic data using the Dempster–Shafer theory is presented. For this purpose, the vibration and acoustic signals in different modes of the gears were first received simultaneously by two separate sensors and then were transmitted from time domain to time–frequency domain using wavelet analysis. After signal processing, each sensor's data were transferred to a local classifier for primary fault diagnosis. Local classification was performed by artificial neural network classifier. The outputs of the local classification were used as the inputs into Dempster–Shafer rules for fusion of classifiers and achieving the final accuracy of the classification. In primary fault diagnosis, the accuracy of fault classification based on vibration and acoustic signals was obtained as 86% and 88%, respectively. After incorporating the outcomes of two sensors, the final accuracy of the classification was calculated as 98% which indicates a 10% jump compared to single-sensor mode. These results indicate the effectiveness of the data fusion method in condition monitoring and fault diagnosis of the equipment. Moreover, in this article, the capability of Dempster–Shafer theory in the fusion of uncertain data and the increase of accuracy in the classification was demonstrated to a quiet acceptable level.
4E analysis and multi-objective optimization of CCHP using MOPSOA
Authors: Sanaye Sepehr , Hajabdollahi Hassan
Published: January 2013

Thermal modeling and optimal design of combined cooling, heating, and power generation system are presented in this article. Selecting the type and number of prime movers, their nominal power and operational strategy, the heating capacity of backup boiler and storage tank, the cooling capacity of electrical and absorption chillers as well as electric cooling ratio (the ratio of electrical chiller capacity to the demand cooling capacity) were considered as nine design parameters. Three types of prime movers including gas turbine, diesel engine, and gas engine were studied in this article. Multi-objective particle swarm optimization algorithm was applied to obtain the maximum actual annual benefit and exergy efficiency simultaneously. Actual annual benefit included the energy, economy, and environmental parameters, therefore with adding exergy parameters, 4  E analysis of combined cooling, heating, and power system was performed. The combined cooling, heating, and power system could run in two operation modes, named economical and electricity tracking modes. In the former case, it was allowed to sell the excess electricity to the network and in the latter, it was not allowed to sell the excess electricity to the grid. It was observed that actual annual benefit for the gas engine was higher than two other cases in economical mode. In electricity tracking mode, the gas engine and gas turbine were more profitable. In addition, the trends of optimum values of design parameters versus actual annual benefit and exergy efficiency in economical mode were investigated and the results were presented. Finally, the results of applying the assumptions of constant and variable running load of prime movers during a year were compared.
Social workers’ perceptions of the causes of poverty in the Nordic countries
Authors: Blomberg Helena , Kroll Christian , Kallio Johanna , Erola Jani
Published: January 2013

Street-level bureaucrats have been given an increasing role in the implementation of policies aimed at the poor. The article analyses: (1) how social workers in the Nordic countries explain the causes of poverty and whether there are variations between countries in social workers’ perceptions; and (2) the nature of the impact, if any, of various individual- and municipal-level factors on social workers’ perceptions of the causes of poverty. Survey data gathered from social workers in four countries are analysed and combined with data from the municipalities in which the respondents work. The results illustrate that social workers display a surprisingly large variation in perceptions: there are differences between countries and also differences related to individual-level factors, while municipality-level factors do not appear to influence the perceptions of social workers in an obvious way.
Resource utilization and direct medical costs in adult systemic lupus erythematosus patients from a commercially insured population
Authors: Furst DE , Clarke A , Fernandes AW , Bancroft T , Gajria K , Greth W , Iorga SR
Published: January 2013

Objective

Our aim was to estimate annual health care resource use and medical costs associated with systemic lupus erythematosus (SLE) in a large US managed care health plan.

Methods

Subjects at least 18 years of age and with claims-based evidence of SLE (ICD-9-CM 710.0x) were identified from a health plan database. Subjects were matched on the basis of demographic and clinical characteristics to unaffected controls. Resource use and costs were determined during a fixed 12-month period. A generalized linear model (GLM) was used to adjust costs for demographic and clinical characteristics.

Results

In total, 1278 newly diagnosed SLE subjects were matched to 3834 controls, and 10,152 subjects with existing SLE were matched to 30,456 controls. Health care resource use was significantly higher among SLE subjects than matched controls, including average annual numbers of ambulatory visits, specialist visits, and inpatient hospital stays (all p < 0.001). SLE subjects had significantly higher overall mean annual medical costs than matched controls (newly diagnosed: $19,178 vs. $4909; existing: $15,487 vs. $5156; both p < 0.001). Evidence of specific organ involvement including renal failure and central nervous system complications, were each associated with increased costs (both p < 0.001).

Conclusions

Subjects with SLE have high resource use and medical costs relative to controls.
Decentralization and Interventions in the Health Sector
Authors: Rajesh K. , Thomas M. Benson
Published: January 2013

The democratic decentralization process was launched in Kerala with the Peoples Planning Campaign in 1996 followed by the 73rd and 74th Amendments to the Constitution of India and the passing of the Kerala Panchayat Raj Nagara Palika Act. One of the major objectives of the decentralization process in Kerala was to strengthen the public health care network and improve the quality of public health service delivery. This article attempts to analyze the transition in the health care sector during the last two decades linking it to the interventions of Local Self Governments (LSGs). It was found that decentralization improved infrastructure facilities and equipment in primary and secondary health care institutions and widened health care delivery. It succeeded in providing safe drinking water and sanitation facilities to the local people. The accountability of the public health care system was also enhanced. However, it could not address the issues of nutritional imbalance, old age care, lifestyle diseases and the changing morbidity pattern in the state. This article calls for a comprehensive health policy to ensure functional autonomy for LSGs to address the emerging health care needs in Kerala.
‘We are Textbook Badnekais!’: A Bernsteinian Analysis of Textbook Culture in Science Classrooms
Authors: Vijaysimha Indira
Published: January 2013

This article is an empirical study of science teaching practices using a Bernsteinian framework. It provides a comparative analysis through ethnographic examination of pedagogic recontextualisation in different school types—government, private unaided and international. Bernstein drew attention to the process of pedagogic recontextualisation and pointed out two interacting fields within it—the official recontextualisation field (ORF) and the pedagogic recontextualisation field (PRF). This article examines the textbook culture that is found in most of the schools and argues that it arises from the PRF. The differences in the pedagogic discourse within science classrooms are shown to arise from the interactions between the ORF, the PRF and the school context. The relative strengths of classification and framing within the pedagogic discourse is one of the key variants across the different types of schools. Control over students was highest in government schools, present to a lesser extent in the private school and least visible in the international school, indicating that poor children were perceived as requiring more disciplining. Poor children were also constructed as passive and probably unwilling/undeserving recipients of worthwhile knowledge, whereas affluent children were seen as capable of discursively constructing this knowledge. The knowledge to be transmitted within the government schools was kept distinct from everyday knowledge, thus indicating strong classification between knowledge to be learnt within the school and knowledge outside school. The pedagogic discourse experienced by students from government schools in conjunction with systemic problems results in creating an educational disadvantage for these students.
Pakistan’s Strategic Obsession and the Road to Catastrophe: Is There a Way Out?
Authors: Meher Jagmohan
Published: January 2013

Pakistan’s obsession of searching for a ‘strategic depth’ across the Durand Line in Afghanistan and a ‘Muslim Space’ in the Indian state of Jammu and Kashmir has proved to be a devastating policy for the country in pursuit of which its military-intelligence establishment implanted the seeds of Islamism, extremism and state-sponsored terrorism on both sides of their borders. This strategic overstretch, though driven by a strong military sense of geo-politics among its largely military rulers, is embedded in the country’s unrealistic yearnings, out of place perceptions and false grievances. The army outsourced its ill-conceived strategy to jihadi organisations and religious institutions and allowed local militias, terrorist groups, guerrilla armies and other non-state actors to emerge in different parts of the country who afterwards claim political and religious authority. Rawalpindi (army headquarters) supported these terrorists as a cheap way to keep India and Afghanistan off balance. But over the years, they have metamorphosed into a menace and the more powerful terrorist groups—which are also the more radical ones—have outgrown their handlers; fatally weakening the political institutions, declining the role of the state and creating monsters that threaten to devour Pakistani society. In the process, the failure of the state apparatus is creating a culture of impunity and ultimately leading to the breakdown of the rule of law in the country. Clearly, ongoing fragility appears to be a prelude to a failed state. Thus, the extremists’ growth and power in Pakistani society are a direct result of its policy towards India and Afghanistan. What is required is a four-dimensional approach to promote liberal democracy, to reduce the role of military, to reform madrassah, and to emphasise on economic development through cross-border trade with India and Afghanistan . The Pakistani strategic obsession has large-scale security implications both for its neighbours and the international community at large, and hence, requires closer scrutiny and analysis.
Social Network Legitimacy and Property Right Loopholes: Evidences from an Infrastructural Water Project in Pakistan
Authors: Magsi Habibullah , Torre André
Published: January 2013

Little attention has been devoted to the role of social networks and property rights in infrastructural projects. We use the Chotiari water reservoir project data from Pakistan, to explore the social network of actors on land use and property right violation, which create a dissimilar power distribution and significant land use conflicts. Results indicate that public officials with their alien stakeholders have pressurised the local population to displace, where institutional inconsistency towards justice has led them to mistrust and project opposition. In Pakistan, the non-existence of a national resettlement policy is germinating land use conflicts and human and property rights violations since five decades. Therefore, attention to such conflicts, their resolution and prevention are important for research and policy development.
Regionalising Infrastructure for Deepening Market Integration: The Case of East Africa
Authors: Kessides Ioannis N.
Published: January 2013

The East African Community has long recognised that regional economic integration can yield significant welfare gains to its member states. To that end, the community has been making steady progress towards the removal of tariffs and quantitative restrictions to trade. Moreover, in recent years, there has been an increasing recognition that (a) even greater welfare gains could be realised through deeper forms of regional integration which entail harmonisation of legal, regulatory and institutional frameworks; and (b) reforms that reduce cross-border transaction costs and improve the performance of ‘backbone’ infrastructure services are arguably even more important for the creation of an open, unified regional economic space than trade policy reforms narrowly defined. Disparities of regulatory treatment across borders can introduce distortions that hinder both cross-border trade and the aggregate flows of investment on a regional basis. Regulatory harmonisation and infrastructure regionalisation could make a significant contribution to the region’s economic development by promoting a more efficient utilisation of its human and physical resources, enhancing connectivity, reducing the costs of trade and facilitating the integration of the continent with the global economy.
Spatial Modelling of Urban Growth and Urban Influence
Authors: Ali Md. Julfikar , Varshney Deepika
Published: January 2013

Urbanization and regional development are closely associated. Allocation of higher and lower order facilities and specialization of business influence urban growth, which diffuses its benefits to the surrounding countryside. Subsequently, socio-economic development of the region comes into being. The continuous increase of urban size cannot be sustained; rather declining growth will certainly set in the long run. Optimum level of its growth depends on the capacity of an urban centre to provide required facilities to the people in fair manner. Hierarchical growth of urban centres in association with location of civic amenities induces regional development in hierarchical dimension, which is the common problem in developing economy. Subsequently, few of the urban centres are having large number of facilities while others are lacking corresponding to their population size. Formulation of pragmatic planning model is the rescue of wiping out such problems.

It is an attempt to analyze the hierarchical growth of urban centres associated with their functional potentiality and diffusion of urban developmental impulses to the surrounding rural part. Further, it proposes a model for developing economy like India to solve the problem of regional variations of development. Besides, it examines the adequacy and inadequacy of facilities in the urban centres and puts forward planning recommendations, so that a balanced regional development would be achieved by not leaving any rural part out of the zone of functional influence of urban centre.
Land Use Dynamics and Peri-urban Growth Characteristics
Authors: Dutta Venkatesh
Published: January 2013

The importance of urban transition is recognized in the literature, but largely underexplored in developing world cities. There are no actual relationships between projections and discussions of spatial growth with urban and regional reality. This paper attempts to fill this gap by assessing the spatio-temporal patterns of land use dynamics in urban and peri-urban areas of Lucknow, which is the capital city of India’s largest State, Uttar Pradesh. It also evaluates to what extent the Master Plan 2021 deviates from the actual reality. The finding shows that patterns of urban growth do not follow Master Plan and even Master Plan deviates profoundly from the preferred land suitability. The multi-temporal land use change statistics reveal two major land transformation trends between 1997 and 2010: ( i) Intensification of urbanization in the central core areas where a few remaining open areas and water bodies were occupied and landfilled to accommodate residential developments. ( ii) Urban expansion in peri-urban/suburban areas through edge expansion and envelopment, where the extension of urban core increased at the cost of permanent crops and pastures.

The results indicate that substantial Class I agricultural land was lost due to urban growth during 1997—2010, with an average annual rate of 13 per cent. Around 77 per cent of the available land in the peri-urban areas has weak or very weak suitability for future urban development primarily because of the high conservation and agriculture suitability and incompatibility of physical land use to enable infrastructure. The case is similar to any other developing city and transition country of the global south and may provide useful policy lessons.
The Social Practices of Governing
Authors: Zimmer Anna , Sakdapolrak Patrick
Published: January 2013

Delhi’s slums face recurrent and disturbing waste water-related problems: overflowing drains, stagnation of sewerage near or within houses, and subsequent mosquito breeding cause difficulties for everyday life and serious health hazards. The question arises for the affected people as well as administration, how to deal with this tremendous challenge? Governance is defined as ‘exercise of authority, control, management, power of government’ (World Bank, 1992, p. 3) and is used to explain differential outcomes of development interventions. It is widely recognized to be the task of the state, the private sector and civil society conjunctly (UNDP, 1997). Yet, the development debate is suggestive of a rather organized process of governance; of negotiations that lead to the identification of a common goal; and of a rational, technical, and somewhat apolitical management of means of reaching this goal. From this perspective, the waste water situation in Delhi’s slums presents a clear case of governance failure. This article aims at shedding these assumptions and the conclusion they point at, and rather expose the scattered, piece-meal and conflict-ridden character of governance practices and outcomes in the urban everyday. It therefore takes a bottom-up perspective on governance, starting from the empirical evidence of waste water governance in one slum cluster in west Delhi.
Pragmatic Municipal Finance Reform in India
Authors: Sahasranaman Anand
Published: January 2013

The 74th Constitutional Amendment Act (CAA) enacted in 1993 gave urban local governments constitutional status and aimed to strengthen municipal governance. Municipalities were to be given greater responsibilities in the provision of basic infrastructure and social services and financial power was also to be devolved. Now, seventeen years since the passage of this constitutional amendment, the promise held out by decentralization has remained largely unrealized. In this context, the intention of this paper is to recommend specific policy initiatives for municipal governance reform in India. In drawing up these recommendations, the paper analyses two broad sources, namely the policy environments for local government in post-Apartheid South Africa and post-democracy Brazil. South Africa and Brazil are instructive case studies because they too, like India, are trying to address the issues of widespread poverty and inequality in a democratic framework. Additionally, they are widely recognized as having innovated in many aspects of the policy framework for local government and service delivery.

Based on our analysis, we recommend pragmatic changes in aspects of property tax, municipal finance, community involvement and models of service delivery as the levers to improve urban governance and service delivery.
Development of a Chinese Childbearing Attitude Questionnaire for Infertile Women Receiving In Vitro Fertilization Treatment
Authors: Lee Shu-Hsin , Kuo Ching-Pyng , Hsiao Chiu-Yueh , Lu Yen-Chiao , Hsu Ming-Yi , Kuo Pi-Chao , Lee Maw-Shen , Lee Meng-Chih
Published: January 2013

The purpose of this study was to report the second phase of instrument development, a culturally sensitive questionnaire of childbearing attitudes to assess the psychosocial responses of infertile women. Using a nonexperimental quantitative design, we investigated 238 women who are undergoing in vitro fertilization treatment. Data collection and relevant planning occurred in two phases: in-depth interviews of women to generate items for the questionnaire and establishing the questionnaire’s content and construct validity. Through factor analysis, five factors were extracted from the “attitude toward childbearing questionnaire”: gender identification with self and society, insurance of marriage and inheritance, happy family life, spiritual investment, and continuing the family line and procreation. The total variance of these five factors was 64.31%. Cronbach’s α and test–retest reliability were between .72 and .87 and between .60 and .76, respectively, demonstrating acceptable internal consistency and stability. The information obtained through the questionnaire could be used to provide infertile women with personal counseling and appropriate psychological support during and after assisted reproductive technology.
Awareness of Palliative Care and End-of-Life Options Among African Canadians in Nova Scotia
Authors: Maddalena Victor , Bernard Wanda Thomas , Davis-Murdoch Sharon , Smith Donna
Published: January 2013

Purpose: To assess, using qualitative methods, the knowledge African Canadians living in Nova Scotia have regarding their options for palliative and end-of-life (EOL) care. Design: This project engaged caregivers in a Black community in Nova Scotia, Canada, in an exploration of palliative and EOL care. A group of six caregivers who cared for someone who had died were recruited through purposive sampling. The caregivers met three times to (1) discuss their experiences, (2) receive a presentation from the palliative care service, and (3) discuss whether those services would be beneficial. This was followed by a community meeting to discuss the findings. Findings: Knowledge of options for palliative care services is limited. Family centered care may be a reason why “system” is generally not aware of the EOL experiences of African Nova Scotians. Discussion: Information about palliative care services is not filtering down to the community in a way that is meaningful to families. Families tend to self-select services that assist them in providing care in the home setting. There is a need to engage Black communities and palliative care services in developing culturally appropriate services.
The Experiences of Suffering of Palliative Care Informal Caregivers in Malaysia
Authors: Beng Tan Seng , Guan Ng Chong , Seang Lim Kheng , Pathmawathi Subramaniam , Ming Moy Foong , Jane Lim Ee , Chin Loh Ee , Loong Lam Chee
Published: January 2013

A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering in 15 palliative care informal caregivers in University Malaya Medical Centre. The data were thematically analyzed. Seven basic themes were generated (1) empathic suffering, (2) anticipatory grief, (3) obsessive–compulsive suffering, (4) helpless–powerless suffering, (5) obligatory suffering, (6) impedimental suffering, and (7) repercussion suffering. A model of compassion suffering was conceptualized from the analysis. This model may serve as a guide in the assessment and management of suffering in palliative care informal caregivers.
Posterior Pilon Fractures
Authors: Klammer Georg , Kadakia Anish R. , Joos David A. , Seybold Jeffrey D. , Espinosa Norman
Published: January 2013

Background:

Posterior malleolus fractures occur in 7% to 44% of ankle fractures and are associated with worse clinical outcomes. Fractures that involve the posteromedial plafond extending to the medial malleolus have been described previously in small case series. Failure to identify this fracture pattern has led to poor clinical outcomes and persistent talar subluxation. The purpose of this study was to report our outcomes following fixation of this posterior pilon fracture and to describe a novel classification system to help guide operative planning and fixation.

Methods:

Eleven patients were identified following fixation of a posterior pilon fracture over a 4-year span; 7 returned at minimum 1-year follow-up to complete a physical examination, radiographs, and RAND-36 (health-related quality of life score developed at RAND [Research and Development Corporation] as part of the Medical Outcomes Study) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot questionnaires. Patient records were reviewed to evaluate for secondary complications or operative procedures.

Results:

Our mean postoperative AOFAS ankle/hindfoot score was 82. Anatomical reduction of the plafond was noted radiographically in 7 of 11 patients, with the remainder demonstrating less than 2 mm of articular incongruity. Five of 7 patients demonstrated ankle and hindfoot range of motion within 5 degrees of the uninvolved extremity. Four complications required operative intervention; 2 patients reported continued pain secondary to development of CRPS.

Conclusion:

The posterior pilon fracture is a challenging fracture pattern to treat, and it has unique characteristics that require careful attention to operative technique. Our results following fixation of this fracture pattern are comparable with results in the literature. In addition, a novel classification scheme is described to guide recognition and treatment of this fracture pattern.

Level of Evidence:

Level IV, retrospective case series.
Enhancing gamma-aminobutyric acid content in germinated brown rice by repeated treatment of soaking and incubation
Authors: Thitinunsomboon Somboon , Keeratipibul Suwimon , Boonsiriwit Athip
Published: January 2013

Gamma-aminobutyric acid (GABA), commonly produced by germination of brown rice grain, is a free amino acid which could help relieving or preventing non-communicable diseases in human. Several research works have been conducted on GABA production from germinated brown rice. However, the yielded GABA (10.1–69.2 mg/100 g germinated brown rice) was comparatively low; thus the amount was insufficient to be used as active ingredients in functional foods. The objective of this study was to explore alternative methods in order to gain higher yield of GABA. A new process of repeated soaking (in tap water at 35 °C, 3 h) and incubation (at 37 °C, 21 h) during germination was developed. The amount of GABA produced was highest at 116.88 ± 9.24 mg/100 g germinated brown rice (dry basis). However, an unpleasant odour was generated by some microorganisms during long germination. Lactic acid was applied at soaking step to overcome this problem; whereby 0.5% lactic acid solution (vol./vol.) could effectively control the microorganisms without impairing GABA producing ability and sensory qualities.
Application of finite element method to analysis of tribological properties of aluminum oxide nano-layers
Authors: Kubica M , Skoneczny W , Jedrzejczyk D
Published: January 2013

This article describes the research findings achieved by the application of Al2O3 nano-layers coated on aluminum alloys by an electrolytic method. With tribological applications, mainly thin and hard anti-wear coatings were used. Oxide Al2O3 nano-layers created by electrolytic method on aluminum alloys have very good tribological properties when pairing them with plastics and low friction composites. Self-lubricating coatings are a mixture of binding and lubricating agents, which after a putting on sliding surfaces create the coating being characterized by a low friction coefficient that enables a mutual movement of the rubbing areas without the need to apply an extra lubrication media. On the other hand, binding materials – polymers – guarantee the presence of the cohesive force which hold components of the layers together, as well as adhesive forces binding the layer with the base. Practically all polymers can be applied as a matrix for production of polymer composites, but because of excellent friction properties and chemical inertness polytetrafluoroethylene is the most attractive. The structure of the investigated nano-layers was described by the computer image analysis that enables its modeling. Analyzed nano-layers were tribological tested in pair with composites on the basis of polytetrafluoroethylene. In the course of examinations tribological properties were measured that described the quality of sliding pairs, i.e. friction coefficient and abrasive wear. The registered parameters were compared to these measured in other tribological pairs. The differences were analyzed and justified. For predicting stresses and strains generated during the experiment a finite element method was used. The achieved results are similar to the measured real values. Applied computer analysis with finite element method as the calculation method of the cube-plate sliding matching with reciprocating motion and simulation of real forces condition that affect the system, allowed to achieve the following maximal stresses: TG15 (3.02726 MPa), TGK20/5 (3.02732 MPa), TMP12 (4.25076 MPa), and strains: TG15 (0.0045573), TGK20/5 (0.0047507), TMP12 (0.0065434). The stress distributions indicate that the highest values appear in the contact cube-plate area and at the lower cube edges especially in the places being in accordance with the movement direction irrespective of the kind of material used. Material modification results in the change of achieved stresses and strain values according Hooke’s law.