bluuebunny/crossref_metadata_2025 huggingface dataset:
Injury and medical expenditure in emergency department visits of older veterans
Authors: Wang Fu‐Ting , Chang Yuhsuan , Chien Wu‐Chien , Li Hung‐Hui
Published: October 2015

Aim

The purpose of the present study was to investigate the injury types and medical utilization profiles of veterans in emergency department visits by using big data from the National Health Insurance program in Taiwan.

Method

We used the outpatient prescriptions and treatment records between 1997 and 2010 of veterans aged ≥65 years in the National Health Insurance Research Database. The International Classification of Diseases, Ninth Revision, Clinical Modification codes 800–999 (i.e. injuries) were selected, and the emergency medical treatment and the medical institutions' basic profile were recorded.

Results

A total of 287 113 veterans were selected for this study. The average age was 77.4 years, and most participants were men (71.2%). The total medical expenses were US$46.0 million (an average of US$160.00 per person). Contusions/abrasions, open wounds, and fractures comprised 29.2%, 26.6% and 16.3% of the injuries, respectively. In addition, contusions/abrasions, open wounds, and fractures comprised 23.8%, 21.5% and 19.8%, respectively, of the total medical expenses. The highest charges for a single injury episode were for spinal cord and nerve injuries (an average of US$349.00 per person). Regarding sex differences, women mainly experienced fractures and contusions/abrasions, whereas men experienced open wounds.

Conclusions

The injury rate of veterans was reported higher than the non‐veterans. Preventive methods are proposed to decrease the occurrences of injury, number of emergency visits and medical expenses. Geriatr Gerontol Int 2016; 16: 1254–1262.
New Negroes on Campus: St. Clair Drake and the Culture of Education, Reform, and Rebellion at Hampton Institute
Authors: Rosa Andrew J.
Published: October 2015

As the New Century began… more blacks and whites than ever before had lost faith in one another… The South, everyone could see, had changed enormously over the last quarter century. Everyone could see, too, that the new order came with heavy costs. Edward Ayers

The Negro race needs colleges. We need them today as never before; but we do not need colleges so much that we can sacrifice the manhood and womanhood of our children to the thoughtlessness of the North or the prejudice of the South. W. E. B. Du Bois

My experiences as a student at Hampton Institute in Virginia moved me to want to study, understand, and change the odd world of Jim Crow. St. Clair Drake.
Risk factors and common contact allergens in facial allergic contact dermatitis patients
Authors: Kasemsarn Pranee , Iamphonrat Thanawan , Boonchai Waranya
Published: October 2015

Background

Facial dermatitis is commonly encountered in dermatologic practice. It is sometimes difficult to manage because its causative factors may be multiple and difficult to diagnose.

Objectives

This study was designed to identify the characteristics, patch test results, and final diagnoses of facial dermatitis patients who were referred to a contact dermatitis clinic and to identify factors associated with facial allergic contact dermatitis (ACD).

Methods

We retrospectively reviewed case records of facial dermatitis patients who underwent patch testing at the clinic during the period from July 2006 to June 2011.

Results

Of the 891 patients patch‐tested, 244 (27.4%) had facial dermatitis. Female patients were 9.1 times more predominant than male patients. The mean ± standard deviation age of patients was 37.3 ± 14.8 years. A total of 199 (81.6%) patients demonstrated at least one positive reaction to a patch test, 66.7% of which were clinically relevant. Allergic contact dermatitis was diagnosed in 45.5% of patients. Independent factors predisposing towards facial dermatitis were female sex, having a previous history of cosmetic allergy, a positive patch test reaction to hairdressing product‐related allergens, and a positive allergic reaction to preservative allergens.

Conclusions

The prevalence of facial dermatitis was 27.4%. Almost half of all patients with facial dermatitis demonstrated ACD. Factors associated with facial ACD were female gender, a history of cosmetic allergy, and positive patch test reactions to hairdressing product‐related allergens and preservatives.
Dermoscopic features of acral pigmented lesions in Egyptian patients: a descriptive study
Authors: Elwan Nagwa M. , Eltatawy Rania A. , Elfar Nashwa N. , Elsakka Omnia M.
Published: October 2015

Background

Dermoscopy is a non‐invasive technique allowing rapid and magnified in vivo observation of the skin. The anatomical structure of acral volar skin results in unique dermoscopic features in this location.

Objective

To describe and analyze the characteristic dermoscopic features of various kinds of acral pigmented lesions and emphasize the diagnostic value of the dermoscope in early melanoma at this anatomic site in a sample of Egyptians.

Patients and methods

This study included 200 patients with 224 acral pigmented lesions. Dermoscopic examination was done to evaluate different dermoscopic patterns of these lesions. Clinically and dermoscopically suspicious lesions for malignancy were selected for more evaluation by histopathological examination by hematoxylin–eosin staining.

Results

The most frequent dermoscopic pattern was the parallel furrow pattern, (66.1%), followed by the lattice‐like (8.9%), homogeneous (7.6%), fibrillar (6.3%), non‐typical (5.4%), and then parallel ridge (2.2%). The least commonly reported patterns in our cases were the reticular and globular patterns (1.8% each). There was one case of acral lentiginous melanoma of the palm with a multicomponent dermoscopic pattern.

Conclusion

The recognition of different dermoscopic patterns is essential for diagnosis of various types of acral pigmented lesions. In addition, dermoscopy is useful in discriminating between acral nevi and early acral melanoma and narrows down the number of biopsies needed.
The effects of audiovisual distraction on children's pain during laceration repair
Authors: Ha Young Ok , Kim Hee Soon
Published: October 2015

This study aimed to determine the effects of audiovisual distraction on pain in children during laceration repair in emergency room settings. This study was designed as a randomized controlled trial. Eighty‐four children aged 3–10 years were randomized to either the experimental group or the control group. Pain response was assessed by the Faces Pain Rating Scale, a visual analogue scale and the Procedure Behaviour Checklist. We measured salivary cortisol levels as a physiological pain response. The results showed that the sensory and affective pain responses were significantly lower in magnitude in the experimental group than in the control group. There was no statistically significant difference in physiological pain responses between the two groups. Audiovisual distraction might be a helpful method to reduce children's pain during laceration repair in emergency room settings.
Factors associated with stress of conscience among emergency medical technicians in China
Authors: Zhang Hong , Wang Kang , Liu Yu , Chan Darius K‐S
Published: October 2015

The current study was designed to investigate factors related to stress of conscience among emergency medical technicians in China. One hundred and seventy‐five doctors and nurses from emergency departments completed questionnaires measuring demographic information, two personality traits (i.e. responsibility and logical‐affective orientation), stress of conscience and colleagues' stress of conscience. Important findings include the following: (i) Stress of conscience varied as a function of age, years of work, and marital status; (ii) Participants' stress of conscience was highly associated with colleagues' stress of conscience; and (iii) Both responsibility and a logical orientation were negatively associated with stress of conscience.
Behaviour of pregnant women towards the use of prenatal care services: A comparative study between China and the Democratic Republic of Congo
Authors: Sabine Kabuyaya K , Li Wentao , Wambale Jose Mulwahali
Published: October 2015

The present study aims to highlight and describe the elements of difference and/or similarity between China (Changchun) and the Democratic Republic of Congo (Kinshasa) concerning the behaviour of pregnant women in the use of prenatal care services. A cross‐sectional investigation with a self‐designed survey was carried out from September 2011 to March 2012 among pregnant women attending antenatal visits in Changchun and Kinshasa. Sixty pregnant women of childbearing age, with an uncomplicated pregnancy, attending prenatal visits in two hospitals and two community care centres were eligible for the study. Data were analysed using SPSS 13.0 software. Kinshasa 86.6% vs. Changchun 26.6% of pregnant women attended prenatal health education. In Changchun none of the responders (0%) have received tetanus vaccine, whereas in Kinshasa 90% were vaccinated against tetanus. Kinshasa 73.3% vs. Changchun 23.3% of pregnant women confirmed that they have performed the HIV test. The elements of difference found in our results were statistically significant P < 0.05. Prenatal health education can help pregnant women to have an appropriate awareness and improve their behaviour in the use of prenatal care services.
Why Immigrant Background Matters for University Participation: A Comparison of Switzerland and Canada
Authors: Picot Garnett , Hou Feng
Published: October 2015

This article extends our understanding of the difference in university participation between students with and without immigrant backgrounds by contrasting outcomes in Switzerland and Canada and by the use of new longitudinal data that are comparable between the countries. The research includes family socio-demographic characteristics, family aspirations regarding university education, and the student's secondary school performance as explanatory variables of university attendance patterns. In Switzerland, compared with students with Swiss-born parents, those with immigrant backgrounds are disadvantaged regarding university participation, primarily due to poor academic performance in secondary school. In comparison, students with immigrant backgrounds in Canada display a significant advantage regarding university attendance, even among some who performed poorly in secondary school. The included explanatory variables can only partly account for this advantage, but family aspirations regarding university attendance play a significant role, while traditional variables such as parental educational attainment are less important. In both countries, source region background is important. Possible reasons for the cross-country differences are discussed.
Missional Church: A Historical and Theological Analysis of an Ecclesiological Tradition
Authors: Nikolajsen Jeppe Bach
Published: October 2015

This article argues that an understanding of the development of a missional ecclesiology requires we recognize three closely connected and significant matters in 20th‐century mission history: first, the increasing appreciation of the interconnection of church and mission evinced at major ecumenical conferences in the mid‐20th century; second, the contributions of influential missiologistLesslieNewbigin and his theological integration of mission and church; and third, the breakthrough of the phrase “missional church” with the 1998 publication of the bookMissional Church. This article traces this three‐part development through both historical and theological analyses.
Self‐reported antenatal adherence to medical treatment among pregnant women with Crohn’s disease
Authors: Nielsen M. J. , Nørgaard M. , Holland‐Fisher P. , Christensen L. A.
Published: October 2015

Aliment Pharmacol Ther 2010; 32: 49–58

Background  Adherence to medical treatment among women with Crohn’s disease (CD) prior to and during pregnancy has never been reported.

Aim  To examine both the predictors and prevalence rates of non‐adherence to maintenance medical treatment among women with CD prior to and during pregnancy

Methods  Among a population of 1.6 million inhabitants, we identified a total of 132 women with CD who had given birth during 2000–2005. Questionnaires were used to investigate predictors and extent of adherence. The validity of self‐reported use of medication was assessed using data from the Danish Prescription Database. We used logistic regression to estimate prevalence odds ratios for non‐adherence according to smoking status and other predictors.

Results  Eighty percent of the patients returned the questionnaire. A total of 58 (54%) women reported to have been on medical treatment, 50 of whom had fulfilled a prescription on relevant medication. Adherence to medical treatment was 72%. Fear of a negative effect on fertility/foetus was a reason for non‐adherence by 18.8% prior to, and by 45.5% during, pregnancy. Among smokers, 30.8% were non‐adherent compared with 11.5% among nonsmokers (prevalence odds ratio 3.41, 95% CI 0.8–14.7).

Conclusions  Despite fear of a negative effect on fertility/foetus, adherence to medical treatment is high in women with CD. There is no substantial variation in adherence prior to and during pregnancy. Smoking prior to pregnancy is a predictor of non‐adherence.
Expanding the role of umbilical cord blood transplantation
Authors: Brunstein Claudio G. , Setubal Daniela C. , Wagner John E.
Published: October 2015

Umbilical cord blood has become a valuable alternative source of haematopoietic stem cells for allogeneic transplantation. However, largely because of the impact of cell dose on engraftment, risk of transplant‐related mortality and survival, progress in the field has been largely restricted to children. Nevertheless, substantial clinical experience with umbilical cord blood transplantation clearly establishes its safety and effectiveness in young patients with a variety of malignant and non‐malignant diseases. Although less well established in adults, new strategies are now being explored to address the obstacle of cell dose. This article reviews the state of the art and future directions with umbilical cord blood as a source of haematopoietic stem cells for transplantation in both children and adults.
Low expression of Granzyme B in colorectal cancer is associated with signs of early metastastic invasion
Authors: Salama Paul , Phillips Michael , Platell Cameron , Iacopetta Barry
Published: October 2015

Salama P, Phillips M, Platell C & Iacopetta B (2011) Histopathology59, 207–215

Low expression of Granzyme B in colorectal cancer is associated with signs of early metastastic invasion

Aims:  Tumour‐infiltrating forkhead box P3 (FoxP3+) regulatory T cells (Tregs) have stronger prognostic significance than cytotoxic CD8+ T cells in colorectal cancer (CRC). Because there is evidence that some tumour‐infiltrating CD8+ T cells may be inactive, the present study aimed to investigate the prognostic significance of Granzyme B, one of the major effector molecules of T cells.

Methods and results:  A tissue microarray containing 963 CRCs was stained immunohistochemically for Granzyme B and the level of expression quantified by digital image analysis. Granzyme B expression was higher in tumours with microsatellite instability (P < 0.0001), a dense lymphocytic infiltrate (P < 0.0001) and location in the proximal colon (P = 0.009), but lower in tumours with vascular invasion (P = 0.007), perineural invasion (P =0.041) and positive nodal status (P < 0.001). Elevated expression of Granzyme B was associated with improved survival on univariate analysis (hazard ratio = 0.65; 95% confidence interval 0.51–0.84; P = 0.001), but not in a multivariate model that included stage, vascular invasion and FoxP3+ Treg cell density.

Conclusions:  Low expression of Granzyme B was associated with early signs of metastasis in CRC. The stronger prognostic significance of FoxP3+ Tregs is in keeping with animal models that suggest these cells act as gatekeepers for the release of Granzyme B from CD8+ T cells.
Loss of dystroglycan function in oesophageal cancer
Authors: Parberry‐Clark Charlotte , Bury Jonathan P , Cross Simon S , Winder Steve J
Published: October 2015

Parberry‐Clark C, Bury J P, Cross S S & Winder S J  (2011) Histopathology59, 180–187

Loss of dystroglycan function in oesophageal cancer

Aims:  Oesophageal cancer is an increasingly common human malignancy, with its incidence in the West rapidly rising. It is associated with a very poor prognosis, and its exact pathogenesis is uncertain. Dystroglycan and E‐cadherin are cell adhesion molecules, the loss of which is often related to tumour differentiation, aggressiveness and invasiveness. The aim was therefore to evaluate their roles in oesophageal carcinogenesis.

Methods and results:  mRNA and protein levels of dystroglycan and E‐cadherin were examined in oesophageal normal and tumour tissue samples, and in FLO‐1 oesophageal adenocarcinoma cells, using immunohistochemistry, western blotting and reverse transcription polymerase chain reaction. E‐cadherin,α‐dystroglycan and β‐dystroglycan levels were decreased in the oesophageal primary tumour samples, despite the presence of normal levels of dystroglycan mRNA. In FLO‐1 cells, increasing cell density caused a decrease in protein levels of β‐dystroglycan over time, despite the persistent presence of dystroglycan mRNA. Re‐expression of dystroglycan in FLO‐1 cells reduced the numbers and size of colonies formed in soft agar, indicative of a role for dystroglycan in suppressing the tumour phenotype.

Conclusions:  The adenocarcinoma cells mirrored the in vivo situation with respect to dystroglycan function, making this a useful model of oesophageal carcinogenesis; moreover, loss of dystroglycan protein, despite the presence of dystroglycan mRNA, points to a post‐translational mechanism of dystroglycan loss.
No non‐sentinel node involvement in melanoma patients with limited Breslow thickness and low sentinel node tumour load
Authors: Bogenrieder Thomas , van Dijk Marijke R , Blokx Willeke A M , Ramrath Katrin , Seldenrijk Kees , Stolz Wilhelm , van Diest Paul J
Published: October 2015

Bogenrieder T, van Dijk M R, Blokx W A M, Ramrath K, Seldenrijk K, Stolz W & van Diest P J (2011) Histopathology59, 318–326

No non‐sentinel node involvement in melanoma patients with limited Breslow thickness and low sentinel node tumour load

Aims:  Most melanoma patients with a positive sentinel node (SN) undergo completion lymph node dissection and frequently experience associated morbidity. However, only 10–30% of SN‐positive patients have further lymph node metastases. The aim of the present study was to predict the absence of non‐SN metastases in a multicentre study of patients with a positive SN based on primary melanoma features and SN tumour load.

Methods and results:  Of 70 SN positive patients, 18 had non‐SN metastases. Penetrative depth of metastatic cells into the SN and SN tumour load was assessed by morphometry. None of the 14 patients (20%) with a Breslow thickness <2.0 mm and an SN tumour load <0.2 mm2 had non‐SN metastases. Similarly, none of the 15 patients (21%) with a Breslow thickness <2.0 mm and SN penetrative depth <600 μm had non‐SN metastases. Lastly, none of the 14 patients (20%) with a Breslow thickness <2.0 mm and a diameter of the largest SN deposit <500 μm had non‐SN metastases.

Conclusions:  A combination of limited Breslow thickness and low SN tumour load predicts absence of non‐SN metastases in melanoma patients with a positive SN with high accuracy. We propose that this subgroup may be spared completion lymph node dissection.
Analysis of miR‐376 RNA cluster members in the mouse inner ear
Authors: Yan Denise , Xing Yazhi , Ouyang Xiaomei , Zhu Juhong , Chen Zheng‐yi , Lang Hainan , Liu Xue Z.
Published: October 2015

Mutations in phosphoribosyl pyrophosphate synthetase 1 (PRPS1) are associated with a spectrum of non‐syndromic to syndromic hearing loss. PRPS1 transcript levels have been shown to be regulated by the microRNA‐376 genes. The long primary RNA transcript of the miR‐376 RNA cluster members undergo extensive and simultaneous A → I editing at one or both of two specific sites (+4 and +44) in particular human and mouse tissues. The PRPS1 gene, which contains target sites for the edited version of miR‐376a‐5p within its 3′UTR, has been shown to be repressed in a tissue‐specific manner. To investigate whether the transcription of Prps1 is regulated by miR‐376 cluster members in the mouse inner ear, we first quantified the expression of the mature miR‐376 RNAs by quantitative real‐time‐PCR. The spatio‐temporal patterns of miR‐376 expression were assessed by in situ hybridization. Finally, we examined whether A →I editing of pri‐miR‐376 RNAs occurs in mouse inner ear by direct sequencing. Our data showed that the miR‐376a‐3p, b‐3p, c‐3p are present in mouse embryonic inner ears and intensive expression of miR‐376a‐3p/b‐3p was detected in the sensory epithelia and ganglia of both auditory and vestibular portions of the inner ear. In adult inner ear, the expression of miR‐376a‐3p/b‐3p is restricted within ganglion neurons of auditory and vestibular systems as well as the cells in the stria vascularis. Only unedited pri‐miR‐376 RNAs were detected in the cochlea suggesting that the activity of PRPS1 in the inner ear may not be regulated through the editing of miR‐376 cluster.
Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence
Authors: Leeman Jennifer , Chang Yun Kyung , Lee Eun Jeong , Voils Corrine I. , Crandell Jamie , Sandelowski Margarete
Published: October 2015

leeman j., chang y.k., lee e.j., voils c.i., crandell j. & sandelowski m. (2010)
 Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence. Journal of Advanced Nursing 66(9), 1915–1930.

Aim.  This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy.

Background.  Evidence on efficacy must be supplemented with evidence on how interventions were implemented in practice and on how that implementation varied across populations and settings.

Data sources.  Sixty‐one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Fifty‐two reports were included in the final analysis: 37 reporting the effects of interventions and 15 reporting intervention feasibility, acceptability, or fidelity.

Review methods.  An adaptation of Pawson’s realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. This model is successively refined to the point at which it best explains empirical findings from the reports reviewed.

Results.  The final explanatory model suggests that individuals with HIV will be more likely to enrol in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one‐to‐one relationship with the intervener. Participants who have limited prior experience with antiretroviral therapy will be more likely to continue with an intervention than those who are more experienced. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand‐alone interventions.

Conclusion.  The explanatory model developed in this study is intended to provide guidance to clinicians and researchers on the points in the implementation chain that require strengthening.
W(h)ither complexity? The emperor's new toolkit? Or elucidating the evolution of health systems knowledge?
Authors: Martin Carmel M. , Félix‐Bortolotti Margot
Published: October 2015

Rationale The outputs from vastly expanding health research and knowledge industry with a broadening range of approaches to the synthesis of knowledge provide an impetus to develop complex science and theory‐informed knowledge management in health care.

Aims To stimulate debate in order to assist health care decision makers to move beyond framing certainty and evidence in purely reductionist terms.

Objectives To locate health, health care and health knowledge systems research using a complex adaptive systems theory framework.

Methods An conceptual analysis of pervading methodologies and ways of knowing in health systems research to elucidate a framework in order to inform health care decision making.

Findings A living Tree of (Research) Knowledge is proposed, with theoretic and operational frameworks. Branches of the tree are linked to differing evolutionary and developmental processes in order to assist researchers in the ongoing self‐organizing of taxonomies, multiple methods and types of knowledge, recognizing the ‘lived’, developing and adaptive nature of our understandings.

Conclusions It is challenging to determine whither the directions ‘knowledge’ creation and management should take in complex health systems, beyond a total reliance on reductionism. Yet quality will wither, if knowledge does not pertain to real world contexts.
Power law relationships between health care utilization and symptom assessment among people with panic attacks
Authors: Katerndahl David
Published: October 2015

Rationale  Although people with panic attacks are high utilizers of health care, the role of symptom assessment in care‐seeking is unclear. Previous studies suggest that symptom perceptions are linearly related to utilization but panic appraisal is not. The purpose of this study was to determine whether the relationships between symptom assessment and utilization are non‐linear, displaying power law distributions.

Methods  This community‐based study of 97 subjects with panic attacks assessed utilization of family doctor offices, total ambulatory utilization, and hospitalizations as well as symptom perceptions and panic appraisals. Matrices of symptom assessment versus utilization were created, and log–log plots were constructed. To minimize the risk of overestimation of power law distributions, linear, quadratic and cubic regression models were computed.

Results  None of the utilization versus symptom perceptions displayed power law distributions. However, all three measures of utilization showed power law relationships with panic appraisals, but in unique patterns.

Conclusions  Although power law relationships were not found between symptom perceptions and utilization, unique patterns of power laws were identified between panic appraisals and all three measures of utilization.
Medical education accreditation in Mexico and the Philippines: impact on student outcomes
Authors: van Zanten Marta , McKinley Danette , Durante Montiel Irene , Pijano Concepcion V
Published: October 2015

Medical Education 2012: 46:586–592

Context  Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status.

Methods  The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi‐squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant.

Results  For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification.

Conclusions  These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.
The process of feedback in workplace‐based assessment: organisation, delivery, continuity
Authors: Pelgrim Elisabeth A M , Kramer Anneke W M , Mokkink Henk G A , van der Vleuten Cees P M
Published: October 2015

Medical Education 2012: 46:604–612

Objectives  Feedback in workplace‐based clinical settings often relies on expert trainers’ judgements of directly observed trainee performance. There is ample literature on effective feedback, but in practice trainees in workplace‐based training are not regularly observed. We aimed to examine external conditions that impact feedback in observational workplace‐based assessment (WBA).

Methods  Interviews were conducted and the resulting data analysed using a qualitative, phenomenological approach. Between October 2009 and January 2010, we interviewed 22 postgraduate general practice trainees at two institutions in the Netherlands. Three researchers analysed the transcripts of the interviews.

Results  A three‐step scheme emerged from the data. Feedback as part of WBA is of greater benefit to trainees if: (i) observation and feedback are planned by the trainee and trainer; (ii) the content and delivery of the feedback are adequate, and (iii) the trainee uses the feedback to guide his or her learning by linking it to learning goals. Negative emotions reported by almost all trainees in relation to observation and feedback led to different responses. Some trainees avoided observation, whereas others overcame their apprehension and actively sought observation and feedback. Active trainers were able to help trainees overcome their fears. Four types of trainer–trainee pairs were distinguished according to their engagement in observation and feedback. External requirements set by training institutions may stimulate inactive trainers and trainees.

Conclusions  In line with the literature, our results emphasise the importance of the content of feedback and the way it is provided, as well as the importance of its incorporation in trainees’ learning. Moreover, we highlight the step before the actual feedback itself. The way arrangements for feedback are made appears to be important to feedback in formative WBA. Finally, we outline several factors that influence the success or failure of feedback but precede the process of observation and feedback.
Skin diseases in the Peruvian Amazonia
Authors: Gutierrez Ericson L. , Galarza Carlos , Ramos Willy , Tello Mercedes , Jiménez Gerardo , Ronceros Gerardo , Chía Humberto , Hurtado Jorge , Ortega‐Loayza Alex G.
Published: October 2015

Background  Dermatologic diseases vary widely as a result of geographic location and may be influenced by environmental factors.

Aim  To determine the epidemiology of dermatological diseases in the Peruvian Amazonia.

Methods  Transversal and multicentric study, which were carried out during February of 2006, 2007, and 2008 in three regional hospitals in the Peruvian Amazonia. All new patients who were looking for dermatological consultation were included. Univariate/bivariate analysis, chi square, and multinomial logistic regression were used with a confidence level of 95%.

Results  A total of 1602 patients were included. The infectious and parasitic dermatoses were the most prevalent (31.5%). There was a statiscally significant association between infections of the skin and subcutaneous tissue in children (P < 0.001). The parasitic dermatoses such as scabiosis, pediculosis, and myiasis were associated with an altitude less than 700 meters above sea level (m.a.s.l.) (P = 0.003, OR = 3.1, CI: 1.5–6.7). On the other hand, radiation‐related disorders of the skin and subcutaneous tissue were associated with more than 700 m.a.s.l. (P < 0.01, OR = 2.9, CI: 1.7–4.9).

Conclusions  Infectious dermatological diseases were the most common diagnoses in the Peruvian Amazonia. In addition, radiation‐related disorders of the skin should be addressed for people living/traveling in the rainforest area. These findings may assist in the training of general doctors in diagnosis and treatment of the most common dermatoses in tropical areas. Moreover, this study would be helpful for physicians from developed countries when giving medical advice/attention to travelers or immigrants of tropical areas.
Proteasome inhibitor therapy for antibody‐mediated rejection
Authors: Woodle E. S. , Walsh R. C. , Alloway R. R. , Girnita A. , Brailey P.
Published: October 2015

Woodle ES, Walsh RC, Alloway RR, Girnita A, Brailey P. Proteasome inhibitor therapy for antibody‐mediated rejection. Pediatr Transplantation 2011: 15: 548–556. © 2011 John Wiley & Sons A/S.

Abstract:  AMR is being recognized with increasing efficiency, but continues to present a significant threat to renal allograft survival. Traditional therapies for AMR (IVIG, plasmapheresis, rituximab, and antilymphocyte preparations) in general have provided inconsistent results and do not deplete the source of antibody production, viz., the mature plasma cell. Recently, the first plasma cell–targeted therapy in humans has been developed using bortezomib (a first in class PI) for AMR treatment in kidney transplant recipients. Initial experience with bortezomib involved treatment of refractory AMR. Subsequently, the efficacy of bortezomib in primary therapy for AMR was demonstrated. In a multicenter collaborative effort, the initial results with bortezomib in AMR have been confirmed and expanded to pediatric and adult heart transplant recipients. More recently, results from a prospective, staged desensitization trial has shown that bortezomib alone can substantially reduce anti‐HLA antibody levels. These results demonstrate the significant potential of proteasome inhibition in addressing humoral barriers. However, the major advantage of proteasome inhibition lies in the numerous potential strategies for achieving synergy.
Volume kinetics of acetated Ringer's solution during experimental spinal anaesthesia
Authors: HAHN R. G. , LINDAHL C. C. , DROBIN D.
Published: October 2015

Background

General anaesthesia lowers the clearance of crystalloid fluid, but the volume kinetics of such fluid throughout the duration of spinal anaesthesia has not been studied.

Methods

Ten female volunteers (mean age 29 years) received an intravenous infusion of 25 ml/kg of acetated Ringer's solution with and without spinal anaesthesia. A volume kinetic model was fitted to serial measurements of the haemoglobin concentration over 240 min based on arterial, cubital vein, and femoral vein blood. The measured urine flow was compared to the model‐predicted elimination.

Results

The arterial pressure remained stable, although the block reached to Th3‐Th5 in half of the volunteers. There were no differences in fluid kinetics between the spinal anaesthesia and the control experiments. The administered volume was well confined to the kinetic system, which consisted of two communicating fluid spaces that were 2.8 l and approximately 7 l in size at baseline. The arteriovenous difference in plasma dilution remained positive for 30 min post‐infusion in those having analgesia reaching to Th3‐Th5, which differed significantly from low‐level analgesia (Th12‐L2, P < 0.03) when venous plasma was sampled from the leg. The urinary excretion averaged 1.13 l and 1.01 l for the spinal and control experiments, respectively. Volume kinetics predicted the urinary excretion at 5‐ to 10‐min intervals with an overall bias of 52 ml.

Conclusion

Acetated Ringer's solution showed the same kinetics during experimental spinal anaesthesia as when the fluid was infused alone. Hence, spinal anaesthesia is not associated with the reduced fluid clearance reported for general anaesthesia.
Enzymatic interactions between Gremmeniella abietina var. abietina, European race, and two resistant hosts, Pinus banksiana and P. contorta
Authors: Simard M. , Laflamme G. , Rioux D.
Published: October 2015

Ultrastructural observations showed that the European race of Gremmeniella abietina var. abietina can secrete several cell wall–degrading enzymes that help the invasion of Pinus banksiana and P. contorta shoot tip tissues. Alterations in the content or distribution of cellulose were obvious, indicating that colonization might be achieved primarily through the action of glucanases. Polygalacturonases seemed more abundant in the cortex and the phloem of the stem, suggesting they are among the first enzymes secreted by the pathogen during infection. Production of laccases and peroxidases was also revealed but always close to fungal cells or in areas where host wall degradation was obvious. In places where there was an accumulation of phenolic compounds in the infected zones of the shoot, particularly in or near the transition zone, immunolocalization of both enzymes was limited or absent. Laccases and polygalacturonases were regularly detected over the extracellular sheath of G. abietina, and this indicates that the sheath could play a significant role during host wall degradation. Finally, examination of G. abietina wall constituents, such as chitin and β‐1,3‐glucans, suggests that the composition of the pathogen wall changes during the infection process. This change may be associated with the secretion of fungal enzymes but could also be linked to host reactions altering the integrity of pathogen cell walls.
Palliative care for patients with chronic obstructive pulmonary disease: exploring the landscape
Authors: Philip J. , Lowe A. , Gold M. , Brand C. , Miller B. , Douglass J. , Sundararajan V.
Published: October 2015

Patients with chronic obstructive pulmonary disease experience a substantial symptom burden, high levels of psychosocial need and significant mortality. This epidemiological study reveals that the majority of patients are cared for in the public hospital system (64%) and generally die in hospital (72%) with a number of identifiable predictors of 6‐month mortality. Our results suggest that palliative care services need to be redirected from a community‐based admission focus to a model that is responsive to emergency and acute care hospital systems.
Referral to specialist palliative care
Authors: Broom A. , Kirby E. , Good P.
Published: October 2015

Recent literature has suggested that earlier referral to palliative care can improve quality of life and prognosis. The decision to refer to palliative care is a complex process that can involve an interplay of interpersonal, subjective and institutional factors. Negotiating this referral process can be challenging to a medical specialist from a professional and personal viewpoint. What remains unknown is what actually influences the individual clinician to refer a patient to palliative care.
Sustainable Development of the Learning City
Authors: JUCEVICIENE PALMIRA
Published: October 2015

Kaunas is the second largest city in Lithuania and has strong links with its large rural hinterland. Working from the ideas and examples in ‘Learning Cities for a Learning Century, (Longworth, 1999) and through contact with other cities that have already implemented lifelong learning concepts, the city has, since 2001, started out on the journey to become a ‘sustainable learning city.’ The process is a long, and not always a smooth, one, but the partnership between university, city administration, the learning providers and the citizens has provided insights whereby economic, social and environmental capital can grow when these stakeholders work together to improve the learning of both organisations and people. This article is the story of that journey so far, the rationale for making it, the actions the city has undertaken, the results of the research that has been carried out and the benefits that have so far accrued. The voyage is by no means over—indeed it is constantly continuing, much in the same way that a learning organisation can never stop learning lest it ceases to be one and loses its dynamic. But we believe that it is the right one for Kaunas and sets an example for others.
A Web of Learning Opportunities
Authors: ANDERSEN BRITT , REE GUNNAR , SANDAKER INGUNN
Published: October 2015

For at least two decades, politicians, academics and other stakeholders have advocated cooperation across sectors, administrative layers and other institutionalised boundaries to achieve objectives of what are called ‘learning regions’ and the ‘lifelong learning perspective’. Boundaries between geographical, institutional and sectors are becoming more porous. Regions and cities may be seen as complex adaptive systems (CAS), and hence do not necessarily follow the logic of formal institutions. While formal institutions have innate interests in regulating interaction and communication between their members, networks develop according to evolutionary or selectionist dynamics, in that the processes of change can be seen as analogous to natural (Darwinian) selection.

Networks may be seen as the architecture of complex systems. Research on networks has been relatively extensive in the last 20 to 30 years in mathematics, sociology, anthropology, and biology. There is an emerging science of networks that studies the structure and function of systems. There is also substantial research on the features in the interconnectedness or interdependencies within the system that contribute to explaining the functionality of that system. In this perspective, we may view a learning region as a web of learning opportunities.
Quality and Quality Assurance in Vocational Education and Training in the Mediterranean Countries: lessons from the European approach
Authors: MASSON JEAN‐RAYMOND , BAATI MOUNIR , SEYFRIED ERWIN
Published: October 2015

This article reflects on the development of the European approach towards quality and quality assurance in vocational education and training (VET) and its relevance for VET reforms in the European Training Foundation (ETF) partner countries. The analysis is based on an ETF project conducted in 2007‐2008 in the Mediterranean partner countries to promote exchanges of information and experience between the decision makers and experts of the countries concerned and within the EU. More precisely, it aims to analyse how quality assurance (QA) initiatives could promote the quality of systems and support best practices already established in the EU and in the Mediterranean region in order to lay the foundations for specific actions at national and regional level.

The authors of the article found out that: the tools developed by the EU to quality assure VET systems are relevant for the Mediterranean region. They can serve as a guideline for identifying strategic priorities. However, they do not provide a well‐delimited concept to be implemented in the short term. Moreover, these EU tools reflect a new model of governance based on decentralization of responsibilities, autonomy of providers and accountability that may be difficult to implement in Mediterranean countries where VET systems remain very centralised and compartimentalised.
WITH PURPOSE
Authors: Crainer Stuart
Published: October 2015

Kleinwort Benson Bank CEO, Sally Tennant, talks with purpose to Stuart Crainer on taking over as a leader and building momentum.
COMPLEXITIES, UNCERTAINTIES AND FINANCE
Authors: Crainer Stuart
Published: October 2015

Over the last 50 years the world of finance has been revolutionised. In no other discipline is theory and practice so intimately related. In the wake of the worldwide financial crisis, how best can we make sense of how far the world of finance has come and where it will likely go in the future?Richard Brealey offers a unique perspective. The Emeritus Professor of Finance at London Business School is a Fellow of the British Academy and co‐author of the definitive textbook on corporate finance, Principles of Corporate Finance. He reviewed the financial world past, present and future with Business Strategy Review.
FACE VALUES: MINING SUCCESS
Authors: Crainer Stuart
Published: October 2015

Knowing what you want to do and overcoming any obstacles that prevent you from doing it are the traits of successful people. Those who achieve remarkable success usually have the ability to change direction in response to outside forces as well as the courage to decide when to take risks. Mick Davis has those qualities in abundance, qualities he has displayed in the decade he has spent building Xstrata, a small mining firm, into a world leader. Davis talks to Stuart Crainer.
THINK AGAIN: SIX RULES TO BECOME SIMPLY BETTER
Authors: Barwise Patrick , Meehan Seán
Published: October 2015

Instead of trying to offer uniqueness, Patrick Barwise and Seán Meehan suggest that companies should channel their energies into being simply better than the competition. This classic article from Business Strategy Review was originally published in a longer form in the Autumn 2004 issue, but the authors' observations and advice are timeless.
EXECUTIVE SUMMARY: THE POWER OF TRANSPARENCY
Authors: Ioannou Ioannis , Serafeim George
Published: October 2015

Ioannis Ioannou and George Serafeim, ‘The consequences of mandatory corporate sustainability reporting’, Working Paper, 30 March 2011.
EXECUTIVE SUMMARY: BEATING A BEHEMOTH
Authors: Mukherji Prokriti , Sorescu Alina , Prabhu Jaideep C , Chandy Rajesh
Published: October 2015

Prokriti Mukherji, Alina Sorescu, Jaideep C Prabhu and Rajesh Chandy, ‘Behemoths at the gate: How incumbents take on acquisitive entrants (and why some do better than others)’, Journal of Marketing, September 2011.
EXECUTIVE SUMMARY: THE RIGHT WORDS AT THE RIGHT TIME
Authors: Lambrecht Anja , Tucker Catherine
Published: October 2015

Anja Lambrecht and Catherine Tucker, ‘When does Retargeting Work? Timing Information Specificity’, Working Paper, April 2011.
740. STAUNTONIA HEXAPHYLLA
Authors: Christenhusz Maarten J. M.
Published: October 2015

Stauntonia hexaphylla (Thunb.) Decne. is described and illustrated from plants cultivated at the Royal Botanic Gardens, Kew. Its uses in Japan are discussed and the history of introduction of the species to Europe is described.
743. STAUNTONIA BRACHYANDRA
Authors: Christenhusz Maarten J. M.
Published: October 2015

Stauntonia brachyandra (H.N.Qin) Christenh., was collected in Vietnam in 2003, a new record for the country. This Stauntonia has the largest flowers known in the genus and was previously only known from just across the Vietnamese‐Chinese border in Yunnan. It is described and illustrated here based on material from Crûg Farm Plants.
744. STAUNTONIA ANGUSTIFOLIA
Authors: Cullen James
Published: October 2015

Stauntonia angustifolia (Wall.) Wall. ex Christenh., formerly Holboellia angustifolia Wall. is described and illustrated. Its recent history in cultivation in Cambridge is discussed.