bluuebunny/crossref_metadata_2025 huggingface dataset:
Adherence with capecitabine: A population-based analysis based on prescription refill data
Authors: Kovacic Laurel , de Haan Neil , de Lemos Mário L , Schaff Kimberly , Walisser Susan
Published: November 2016

Background

Patient adherence is important with the increasing use of oral anticancer drugs. Recent studies reported different capecitabine adherence rates based on self-reporting and microelectronic monitoring of the medication bottle. Patient’s awareness of being monitored may confound these results. Prescription records provide a larger and more objective dataset for adherence investigation. We report the use of computer algorithm and manual review of prescription and medical documentation to determine the rate of capecitabine adherence.

Methods

Two years of capecitabine prescription records from five ambulatory cancer centres were reviewed. Prescription data were extracted using a custom Java-based software tool to compare the predicted vs. actual dispensing date. The difference between the dates was the primary adherence measure (altered treatment date incident) and estimated using a computer algorithm and by manual review of medical charts.

Results

Of 4412 refill prescriptions, 45.2% was associated with an altered treatment date incident based on the initial computer algorithm. This was reduced to 29.5% after adjusting for clinic scheduling processes and 10.2% after manual chart review to adjust for valid reasons for delay. The reasons for altered treatment date incident were not identified in 52.2% of prescriptions.

Conclusions

Adherence rate of capecitabine based on refill data seem to be high and consistent with other findings based on patient self-report. Population analysis of prescription data with custom computer algorithm may identify trends in capecitabine adherence with some efficiency. Manual review would likely be required to verify these results. The accuracy of using altered prescription refill dates as an adherence measure requires further studies.
Multicenter study of environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in 48 Canadian hospitals
Authors: Poupeau Céline , Tanguay Cynthia , Caron Nicolas J , Bussières Jean-François
Published: November 2016

Context

Oncology workers are occupationally exposed to antineoplastic drugs. This exposure can induce adverse health effects. In order to reduce their exposure, contamination on surfaces should be kept as low as possible.

Objectives

To monitor environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in oncology pharmacy and patient care areas in Canadian hospitals. To describe the impact of some factors that may limit contamination.

Methods

This is a descriptive study. Twelve standardized sites were sampled in each participating center (six in the pharmacy and six in patient care areas). Samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by ultra-performance liquid chromatography tandem mass spectrometry technology. Descriptive statistical analyses were done and results were compared with a Kolmogorov–Smirnov test for independent samples.

Results

In 2015, 48 hospitals participated in this study (48/202, 24%). Overall, 34% (181/525) of the samples were positive for cyclophosphamide, 8% (41/525) for ifosfamide, and 6% (31/525) for methotrexate. The 75th percentile value of cyclophosphamide surface concentration was 6.9 pg/cm2. For ifosfamide and methotrexate, they were lower than the limit of detection. Centers who prepared more antineoplastic drugs per year and centers who used more cyclophosphamide per year showed significantly higher surface contamination ( p < 0.0001). Over the years, we observed a reduction in surface contamination.

Conclusion

In comparison with other multicenter studies that were conducted in Canada, the concentration of antineoplastic drugs measured on surfaces is decreasing. Regular environmental monitoring is a good practice in order to maintain contamination as low as reasonably achievable.
Novel association between bone mineral density scores and the prevalence of peripheral artery disease in both sexes
Authors: Baldwin Melissa J , Policha Aleksandra , Maldonado Thomas , Hiramoto Jade S , Honig Stephen , Conte Michael S , Berger Jeffrey , Rockman Caron B
Published: November 2016

The purpose of the current study was to investigate the association between bone mineral density (BMD) scores and the prevalence of peripheral artery disease (PAD) in a large cohort of subjects who underwent arterial Doppler assessments and calcaneal bone densitometry. The study was performed using data obtained from Life Line Screening Inc. Subjects were self-selected and paid for screening tests. The prevalence of PAD was significantly higher in men with osteopenia (4.5%) and osteoporosis (10.9%) compared to men with normal BMD (3.0%) ( p<0.001). Osteopenia (odds ratio (OR) 1.3) and osteoporosis (OR 2.3) were found to be independent risk factors for the presence of PAD in men. The prevalence of PAD was significantly higher in women with osteopenia (4.8%) and osteoporosis (11.8%) compared to women with normal BMD (3.3%) ( p<0.001). Osteopenia (OR 1.15) and osteoporosis (OR 1.8) were found to be independent risk factors for the presence of PAD in women. The current study reports a strong association of abnormal BMD analysis with the prevalence of PAD, which persists even when controlling for age and associated atherosclerotic risk factors. Although the mechanism by which these two disease processes is related is not completely elucidated, the presence of osteoporosis should make clinicians aware of the possibility of occult PAD or associated atherosclerotic disease in appropriate patients.
Public health implications and risks for children and families resettled after exposure to armed conflict and displacement
Authors: Calam Rachel
Published: November 2016

Early adverse experiences can precede long-term negative effects on physical health. Children experiencing armed conflict, flight and displacement, and refugee life may be at enhanced risk. Recent psychobiological models integrating knowledge about perinatal and childhood stress with susceptibility to chronic illnesses in later life make clear the pressing need for protective provision for war-affected children, who experience multiple traumas and continuing stressors. There is increasing recognition of the mechanisms linking physical and mental health with adult diseases seen as developmental disorders with origins early in life. Biological embedding models propose links between early adversity and increased vulnerability to later disease and premature death. Threat is central for children and families whose lives are changed by war and displacement, and may activate biological and behavioural systems that could increase the risk of long-term ill-health. Applying these models to understanding the experiences of refugees and the translation of these into the care provided and ways of monitoring and protecting long-term population health could potentially promote interventions to reduce longer term and secondary harms.
Isolated punctuate hippocampal infarction and transient global amnesia are indistinguishable by means of MRI
Authors: Förster A , Al-Zghloul M , Wenz H , Böhme J , Groden C , Neumaier-Probst E
Published: November 2016

Background

Small punctuate lesions in the hippocampus on diffusion-weighted images are a typical finding in transient global amnesia. Consequently, it has been suggested that diffusion-weighted images findings might corroborate the diagnosis of transient global amnesia. However, isolated punctuate hippocampal infarction might be a differential diagnosis of transient global amnesia.

Aim

Evaluation of isolated punctuate hippocampal infarction frequency and comparison of its clinical presentation and MRI findings to transient global amnesia.

Methods

From an MRI database, we identified 10 patients with isolated punctuate hippocampal infarction and compared these to 12 patients with transient global amnesia with diffusion-weighted images lesion with regard to clinical symptoms and MRI findings.

Results

Disorientation and memory deficits were more common in transient global amnesia patients, whereas dysphasia/aphasia and vertigo were more common in hippocampal infarction patients. MRI findings in isolated punctuate hippocampal infarction and transient global amnesia did not differ significantly, neither regarding the affected hemisphere, lesion distribution, size, nor relative ADC values.

Conclusions

Differentiation of isolated punctuate hippocampal infarction and transient global amnesia based on neuroimaging findings is not possible. Thus, in the case of isolated punctuate hippocampal diffusion-weighted images lesions the final diagnosis of hippocampal infarction or transient global amnesia should be based on the clinical presentation.
Impact of stroke education on middle school students and their parents: A cluster randomized trial
Authors: Marto João Pedro , Borbinha Cláudia , Filipe Rita , Calado Sofia , Viana-Baptista Miguel
Published: November 2016

Background

School students are an attractive target for stroke education due to the potential impact on stroke prevention and recognition. Additionally, these students can drive behavioral changes in their families.

Aim

To evaluate the impact of stroke education on school students, in terms of students’ and parents’ acquired stroke knowledge.

Methods

A structured questionnaire on knowledge of stroke was filled out by eighth-grade students and one of their parents in seven public schools. In four of these schools, students attended a stroke lecture; educational flyers and magnetic posters were distributed and parent education was encouraged. Students and parents of the other three schools were included in a control group. Students and parents, of both intervention and control groups, were resubmitted to the initial structured questionnaire within one week of the stroke lecture and three months later.

Results

We included 764 students and 344 parents, 383 (50.1%) and 210 (61.0%) in the intervention group. Correct test scores for students before, within one week, and three months after the intervention were 54.49% versus 55.03% (p = 0.418), 98.69% versus 60.89% (p < 0.001), and 95.58% versus 75.7% (p < 0.001) in the intervention and control groups, respectively. Correct test scores for parents at the same time points were 68.78% versus 64.47% (p = 0.107), 96.89% versus 71.42% (p < 0.001), and 94.58% versus 76.54% (p < 0.001) in the intervention and control groups, respectively.

Conclusions

School-based interventions may improve stroke knowledge in middle school students and their parents.
Patient Throughput in a Sports Medicine Clinic With the Implementation of an Athletic Trainer
Authors: Nicolello Timothy S. , Pecha Forrest Q. , Omdal Reed L. , Nilsson Kurt J. , Homaechevarria Alejandro A.
Published: November 2016

Background:

Orthopaedic clinics have acquired a multitude of health professionals to improve clinic efficiency. More recently, athletic trainers (ATs) have been utilized to improve clinical efficiency and patient care because of their extensive background in musculoskeletal injuries and anatomy. Improved clinical efficiency allows for increased patient visits, potentially enhancing patient access and downstream revenue via relative value units (RVUs).

Hypothesis:

The addition of an AT into a sports medicine physician’s clinic will increase total patient throughput and overall RVU production.

Study Design:

Retrospective analysis.

Level of Evidence:

Level 4.

Methods:

Patients seen by each of the 2 primary care sports medicine physicians at St Luke’s Sports Medicine for a 2-year period were retrospectively evaluated. The initial clinic model included the physician and a medical assistant; during the second year of analysis an AT was added to the clinic staffing model. Two-tailed t tests were used to determine significant differences in patient volume between the 2 periods of data collection.

Results:

Through the implementation of an AT, patient throughput increased by 0.7 patients per hour over 2 half-day clinics, a 25% increase ( P < 0.01). Physician B patient visits increased by 21%, or 3.8 patients per 6.5-hour clinic day ( P < 0.01). Additionally, RVU production increased by 3.23 per half-day and 4.3 per full day for physicians A and B, respectively.

Conclusion:

Clinical efficiency was improved with the addition of an AT. Total physician RVUs improved, thereby raising the potential revenue of both the physician and health care institution. Employing ATs in a sports medicine clinic may improve clinical productivity and financial stability, thereby validating the incorporation of ATs into the established clinical model.

Clinical Relevance:

Limited research exists measuring patient throughput with an AT in a sports medicine clinic. This study investigates patient throughput and the subsequent increase in work-based RVUs.
Navigating In and Out of Romantic Relationships From Adolescence to Emerging Adulthood
Authors: Boisvert Stéphanie , Poulin François
Published: November 2016

This study examines how romantic relationship patterns (i.e., based on the number of different partners and the number of years in a relationship) from adolescence to emerging adulthood (1) are associated with independence at age 25 and (2) are related to the characteristics of one’s romantic relationship and parental status at age 25. A sample of 274 youth (61.3% girls) identified their romantic partners each year between the ages of 16 and 24 and completed a series of questionnaires at age 25 concerning their level of independence and the characteristics of their current romantic relationship and parental status. Results show that patterns were associated with the pace at which youth accomplished tasks associated with emerging adulthood, in particular, gaining independence and becoming parents themselves. However, characteristics of the youth’s romantic relationships at age 25 did not vary as a function of these patterns.
Leading by Tweeting
Authors: Naidoo Jefrey , Dulek Ronald
Published: November 2016

This study examines the extent to which the leaders of business schools engage with Twitter to reach diverse audiences, the possible links between Twitter usage and the ranking of the Dean’s respective business college, and the linguistic/stylistic approaches adopted. We employed sentiment analysis to examine the linguistic approaches among the various tweets from the Dean’s account. The findings of the study suggest speaking at stakeholders from a public microblog may not be the most effective way to connect with them. Notwithstanding, biological and cognitive constraints limit the economy of attention and relationships in an online world.
Leadership Construction in Intra-Asian English as Lingua Franca Decision-Making Meetings
Authors: Du-Babcock Bertha , Tanaka Hiromasa
Published: November 2016

In Asia, the English language serves as a lingua franca to connect people from various backgrounds for managerial synergy. In this study, we investigate leadership in a setting where English as lingua franca is used among Asian business professionals. Employing the notion of discourse, we use quantitative and qualitative analyses to identify how leadership emerges in meetings with multicultural participants, and how different types of leadership affect these decision-making meetings. We conclude that linguistic and contextual factors discursively construct different styles of leadership, and that these leadership styles lead to starkly different team outcomes. The overall result indicates that a business meeting is not a logical process leading to a rational decision, but rather an organic mix of contextual, linguistic, and leadership factors when English as lingua franca is used in multicultural participants.
Understanding Each Other: Strategies for Accommodation in a Virtual Business Team Project Based in China
Authors: Lockwood Jane , Song Ying
Published: November 2016

The use of accommodation strategies between native and nonnative interlocutors of English in the rapidly increased virtual and global work contexts remains underresearched. Contextualized in a Chinese IT outsourcing company where English is used as a lingua franca, this study focuses on how accommodation strategies are used by both on- and offshore team project members in their virtual meeting exchanges. The article argues that the actual linguistic exchange appears to be scaffolded and facilitated by a series of what the authors call “extratextual accommodation strategies” such as the use of detailed minutes of tasks set and completed, and an agreed meeting format. While “intratextual accommodation strategies,” that is, those relating to specific linguistic behaviors in English in the exchanges are also used by interlocutors to accommodate to each other’s speech; the article argues, therefore, that both extra- and intratextual accommodation strategies appear to work in a symbiotic way to ensure successful exchange in business virtual meeting contexts.
Invited commentary … On poverty, politics and psychology
Authors: Parry Glenys , McCrone Paul
Published: November 2016

Associations between deprivation and mental health have long been known. This commentary discusses recent work examining this in relation to the uptake, delivery and outcomes of psychological therapies in England. These associations are complex but it is clear that implementation of evidence-based interventions should consider area-level characteristics.
Scoring System for Identifying Impending Complete Fractures in Incomplete Atypical Femoral Fractures
Authors: Min Byung-Woo , Koo Kyung-Hoi , Park Youn-Soo , Oh Chang-Wug , Lim Seung-Jae , Kim Joon-Woo , Lee Kyung-Jae , Lee Young-Kyun
Published: November 2016

Context:

Although impending incomplete atypical femoral fractures (AFFs) require prophylactic fixation, there is still a lack of study on predicting complete fracture among the incomplete AFFs.

Objective:

Our purposes are to develop a scoring system to predict progression into complete fracture and to evaluate its reliability and validity.

Design, Setting, and Patients:

We reviewed 46 incomplete AFFs in 44 patients who did not undergo prophylactic fixation. A weighted scoring system, including four identified risk factors (the site, severity of pain, status of the contralateral femur, and the extent of radiolucent line), was developed. We evaluated its interobserver reliability by using intraclass correlation coefficiency (ICC) and its accuracy using receiver operator characteristic (ROC) curve. The validity of the scoring system was tested in a different cohort.

Intervention:

Observational study.

Main Outcome Measure:

Progression to complete fracture within 6 months.

Results:

Among 46 incomplete fractures, 13 developed a complete fracture within 6 months. The probability of complete fracture increased abruptly when the score was 8 points or more. The proposed scoring system showed an almost perfect reliability (ICC, 0.997; 95% confidence interval, 0.995 to 0.998) and higher accuracy than any single risk factor in ROC curve. In the different series, the positive predictive value was 100% and the sensitivity was 75%, when cutoff value was 8 points.

Conclusion:

The progression to complete fracture could be predicted by using our scoring system. Incomplete AFF with scores <8 points can be treated conservatively, whereas lesions with scores ≥8 require prophylactic fixation.
The Participation of a Northern New Jersey Korean American Community in Local and National Language Variation
Authors: Lee Jinsok
Published: November 2016

This study investigates the variable patterning of two English phonemes, /ɔ/ and /æ/, in the speech of 24 second- and 1.5-generation Korean Americans from Bergen County, New Jersey, which borders New York City and contains the most densely populated Korean American community in the United States. Detailed acoustic phonetic analysis reveals that in general Bergen County Korean Americans produce a raised /ɔ/ nucleus, in accordance with New York City English, and tense /æ/ in prenasal environments, in accordance with General American English. Positive correlations between speaker age and the frontness of /ɔ/ and distance in vowel space between /ɔ/ and /ɑ/ suggest a change in apparent time toward fronting of /ɔ/ and shortening of the distance between two vowels (and hence possibly movement toward a low back merger). Speaker sex patterns are also apparent, with female speakers showing a closer distance and more overlap between /ɔ/ and /ɑ/ than male speakers, and females showing a clearer split between tense /æ/ in prenasal environments and lax /æ/ elsewhere. In general, the patterning of variation for /æ/ among Bergen County Korean Americans shows an alignment to the general American norm, while the patterning for /ɔ/ suggests that Korean Americans are adopting the local norm. Future research will be needed to corroborate these patterns across a wider range of speaker ages.
Post-transcriptional modifications in development and stem cells
Authors: Frye Michaela , Blanco Sandra
Published: November 2016

Cells adapt to their environment by linking external stimuli to an intricate network of transcriptional, post-transcriptional and translational processes. Among these, mechanisms that couple environmental cues to the regulation of protein translation are not well understood. Chemical modifications of RNA allow rapid cellular responses to external stimuli by modulating a wide range of fundamental biochemical properties and processes, including the stability, splicing and translation of messenger RNA. In this Review, we focus on the occurrence of N6-methyladenosine (m6A), 5-methylcytosine (m5C) and pseudouridine (Ψ) in RNA, and describe how these RNA modifications are implicated in regulating pluripotency, stem cell self-renewal and fate specification. Both post-transcriptional modifications and the enzymes that catalyse them modulate stem cell differentiation pathways and are essential for normal development.
Development of the neurons controlling fertility in humans: new insights from 3D imaging and transparent fetal brains
Authors: Casoni Filippo , Malone Samuel A. , Belle Morgane , Luzzati Federico , Collier Francis , Allet Cecile , Hrabovszky Erik , Rasika Sowmyalakshmi , Prevot Vincent , Chédotal Alain , Giacobini Paolo
Published: November 2016

Fertility in mammals is controlled by hypothalamic neurons that secrete gonadotropin-releasing hormone (GnRH). These neurons differentiate in the olfactory placodes during embryogenesis and migrate from the nose to the hypothalamus before birth. Information regarding this process in humans is sparse. Here, we adapted new tissue-clearing and whole-mount immunohistochemical techniques to entire human embryos/fetuses to meticulously study this system during the first trimester of gestation in the largest series of human fetuses examined to date. Combining these cutting-edge techniques with conventional immunohistochemistry, we provide the first chronological and quantitative analysis of GnRH neuron origins, differentiation and migration, as well as a 3D atlas of their distribution in the fetal brain. We reveal not only that the number of GnRH-immunoreactive neurons in humans is significantly higher than previously thought, but that GnRH cells migrate into several extrahypothalamic brain regions in addition to the hypothalamus. Their presence in these areas raises the possibility that GnRH has non-reproductive roles, creating new avenues for research on GnRH functions in cognitive, behavioral and physiological processes.
Rebuilding a broken heart: lessons from developmental and regenerative biology
Authors: Kuyumcu-Martinez Muge N. , Bressan Michael C.
Published: November 2016

In May 2016, the annual Weinstein Cardiovascular Development and Regeneration Conference was held in Durham, North Carolina, USA. The meeting assembled leading investigators, junior scientists and trainees from around the world to discuss developmental and regenerative biological approaches to understanding the etiology of congenital heart defects and the repair of diseased cardiac tissue. In this Meeting Review, we present several of the major themes that were discussed throughout the meeting and highlight the depth and range of research currently being performed to uncover the causes of human cardiac diseases and develop potential therapies.
An interview with Paola Arlotta
Authors: Vicente Catarina
Published: November 2016

Paola Arlotta is a neurodevelopmental biologist based at the Harvard Department of Stem Cell and Regenerative Biology in Boston, MA, USA. Her lab studies the birth, differentiation and assembly of neuronal circuits in the cerebral cortex with the aim of developing novel therapies for degenerative and neuropsychiatric diseases. Paola has recently become an editor for Development, and we asked her about her research and career, and her recent efforts to support women in science.
The integrin adhesome network at a glance
Authors: Horton Edward R. , Humphries Jonathan D. , James Jenny , Jones Matthew C. , Askari Janet A. , Humphries Martin J.
Published: November 2016

The adhesion nexus is the site at which integrin receptors bridge intracellular cytoskeletal and extracellular matrix networks. The connection between integrins and the cytoskeleton is mediated by a dynamic integrin adhesion complex (IAC), the components of which transduce chemical and mechanical signals to control a multitude of cellular functions. In this Cell Science at a Glance article and the accompanying poster, we integrate the consensus adhesome, a set of 60 proteins that have been most commonly identified in isolated IAC proteomes, with the literature-curated adhesome, a theoretical network that has been assembled through scholarly analysis of proteins that localise to IACs. The resulting IAC network, which comprises four broad signalling and actin-bridging axes, provides a platform for future studies of the regulation and function of the adhesion nexus in health and disease.
Mechanisms and functions of lysosome positioning
Authors: Pu Jing , Guardia Carlos M. , Keren-Kaplan Tal , Bonifacino Juan S.
Published: November 2016

Lysosomes have been classically considered terminal degradative organelles, but in recent years they have been found to participate in many other cellular processes, including killing of intracellular pathogens, antigen presentation, plasma membrane repair, cell adhesion and migration, tumor invasion and metastasis, apoptotic cell death, metabolic signaling and gene regulation. In addition, lysosome dysfunction has been shown to underlie not only rare lysosome storage disorders but also more common diseases, such as cancer and neurodegeneration. The involvement of lysosomes in most of these processes is now known to depend on the ability of lysosomes to move throughout the cytoplasm. Here, we review recent findings on the mechanisms that mediate the motility and positioning of lysosomes, and the importance of lysosome dynamics for cell physiology and pathology.
Workers' Spending Response to the 2011 Payroll Tax Cuts
Authors: Graziani Grant , van der Klaauw Wilbert , Zafar Basit
Published: November 2016

This paper investigates workers' spending response to the 2011 payroll tax cuts. Respondents were surveyed at the beginning and end of 2011, which allows the comparison of ex ante and ex post reported use of the extra income. While workers on average intended to spend 14 percent of their tax cut income, they ex post reported spending 36 percent of the funds. This pattern of higher spending ex post is shared across all demographic groups. Differences across workers in this shift to greater ex post spending are largely unexplained by differences in either present bias or unanticipated shocks, so in the end the upward revision in spending remains a puzzle. (JEL D12, D91, E21, H24, H31)
The Effects of Tobacco Control Policies on Tobacco Products, Tar, and Nicotine Purchases among Adults: Evidence from Household Panel Data
Authors: Cotti Chad , Nesson Erik , Tefft Nathan
Published: November 2016

We analyze the Nielsen Household Consumer Panel to estimate the effects of tobacco policies on tobacco-related purchases using within-household variation. We also match purchases to cigarette contents from NHANES. Higher cigarette taxes reduce cigarette purchases and increase smoking cessation product purchases, while estimates of smoking ban effects are less precisely estimated. Smokeless tobacco (SLT) taxes lead to reductions in SLT use but also lead to substitution among SLT products. We find evidence that cigarette taxes induce purchases of cigarettes with higher tar, nicotine, and carbon monoxide contents, but this compensatory behavior is overwhelmed by the reduction in cigarettes purchased. (JEL D12, H25, H31, I18, L66)
Interdicting Structured Combinatorial Optimization Problems with {0, 1}-Objectives
Authors: Chestnut Stephen R. , Zenklusen Rico
Published: November 2016

Interdiction problems ask about the worst-case impact of a limited change to an underlying optimization problem. They are a natural way to measure the robustness of a system or to identify its weakest spots. Interdiction problems have been studied for a wide variety of classical combinatorial optimization problems. Most interdiction problems are NP-hard, and furthermore, even designing efficient approximation algorithms that allow for estimating the order of magnitude of a worst-case impact has turned out to be very difficult. Not very surprisingly, the few known approximation algorithms are heavily tailored for specific problems.

Inspired by previous approaches to network flow interdiction we suggest a general method to obtain pseudoapproximations for many interdiction problems. More precisely, for any α > 0, our algorithm will return either a (1 + α)-approximation or a solution that may overrun the interdiction budget by a factor of at most 1 + 1/α but is also at least as good as the optimal solution that respects the budget. Furthermore, our approach can handle submodular interdiction costs when the underlying problem is to find a maximum weight independent set in a matroid. Additionally, our approach can sometimes be refined by exploiting additional structural properties of the underlying optimization problem to obtain stronger results. We demonstrate this by presenting a polynomial-time approximation scheme for interdicting b-stable sets in bipartite graphs.
Whistleblowing: protecting our children from abuse
Authors: Gouldsboro Julia
Published: November 2016

The health, safety, happiness, and wellbeing of young children should be the number one priority of everyone working in the early years, and we must all know how to act when this is not the case.
Physical activity helps to shape early brain structure
Authors: Preedy Pat , Duncombe Rebecca
Published: November 2016

Children's early experiences and movements shape the growing brain, creating the structures necessary for learning and personal development, which is why physical activity is so important.
Prepare children for the unknown world of tomorrow
Authors: Smith Kimberley
Published: November 2016

This article is based on a case study about project-based learning in a reception class, exploring factors that contribute to them making accelerated progress during their first year of schooling.
Applying learning theory to staff, children and parents
Authors: Francis Jo
Published: November 2016

The range of skills needed to work and, especially, lead in an early years setting seems to grow every year, but how do we gain our knowledge? Do we use learning theories, and if so, what do they tell us?
Let's start with the child
Authors: Allingham Sue
Published: November 2016

What exactly does developmentally appropriate practice in the early years look like, and how do we get there? This is the question a range of experts answered at the Early Years 2016 conference.
Safeguarding in the widest sense
Authors: Webb Penny
Published: November 2016

We are duty bound in the early years to provide children with a safe and secure environment in which to learn and develop, and to fulfil their potential, but government directives still fall short on mental health.
The lines of communication
Authors: Chalmers Debbie
Published: November 2016

Babies and toddlers must learn to communicate effectively with the adults who care for them, to express their wishes and feelings, and to develop their early verbal and non-verbal language skills.
Experiences and needs of older people with end stage renal disease: bereaved carers perspective
Authors: Pungchompoo Wanicha , Richardson Alison , Brindle Lucy A
Published: November 2016

Background:

There is a growing population of older patients with End Stage Renal Disease (ESRD) managed without dialysis in Thailand, and services have yet to be developed to specifically respond to the needs of this group. As a consequence this population are likely to have unmet needs with respect to health care and suffer from symptoms that could be better managed.

Objective:

This qualitative study explored experiences and health care needs during the last year of life among older people with ESRD, managed without dialysis, from the perspective of bereaved carers.

Methods:

A retrospective post-bereavement approach was adopted to collect qualitative interview data. Purposive sampling was used to select 12 bereaved relatives of older patients with ESRD, managed without dialysis, who had died in the previous 5–10 months. Semi-structured interviews were conducted. Data were digitally recorded, transcribed and analysed through framework analysis.

Results:

Four main themes were identified: symptom experiences, impacts of being managed without dialysis, symptom management, and health care needs and utilisation of services.

Conclusions:

Findings confirmed patients' needs were not being met and identified the need to develop approaches to symptom management at home, health education, and psychological and spiritual support at the end of life.
The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip
Authors: Sprowson† A. P. , Jensen C. , Chambers S. , Parsons N. R. , Aradhyula N. M. , Carluke I. , Inman D. , Reed M. R.
Published: November 2016

Aims

A fracture of the hip is the most common serious orthopaedic injury, and surgical site infection (SSI) is one of the most significant complications, resulting in increased mortality, prolonged hospital stay and often the need for further surgery. Our aim was to determine whether high dose dual antibiotic impregnated bone cement decreases the rate of infection.

Patients and Methods

A quasi-randomised study of 848 patients with an intracapsular fracture of the hip was conducted in one large teaching hospital on two sites. All were treated with a hemiarthroplasty. A total of 448 patients received low dose single-antibiotic impregnated cement (control group) and 400 patients received high dose dual-antibiotic impregnated cement (intervention group). The primary outcome measure was deep SSI at one year after surgery.

Results

The rate of deep SSI was 3.5% in the control group and 1.1% in the intervention group (p = 0.041; logistic regression adjusting for age and gender). The overall rate of non-infective surgical complications did not differ between the two groups (unadjusted chi-squared test; p > 0.999).

Conclusion

The use of high dose dual-antibiotic impregnated cement in these patients significantly reduces the rate of SSI compared with standard low dose single antibiotic loaded bone cement. Cite this article: Bone Joint J 2016;98-B:1534–1541.
A quantitative assessment of the functional recovery of flexion of the elbow after nerve transfer in patients with a brachial plexus injury
Authors: Quick T. J. , Singh A. K. , Fox M. , Sinisi M. , MacQuillan A.
Published: November 2016

Aims

Improvements in the evaluation of outcome after nerve transfers are required. The assessment of force using the Medical Research Council (MRC) grades (0 to 5) is not suitable for this purpose. A ceiling effect is encountered within MRC grade 4/5 rendering this tool insensitive. Our aim was to show how the strength of flexion of the elbow could be assessed in patients who have undergone a re-innervation procedure using a continuous measurement scale.

Methods

A total of 26 patients, 23 men and three women, with a mean age of 37.3 years (16 to 66), at the time of presentation, attended for review from a cohort of 52 patients who had undergone surgery to restore flexion of the elbow after a brachial plexus injury and were included in this retrospective study. The mean follow-up after nerve transfer was 56 months (28 to 101, standard deviation (sd) 20.79). The strength of flexion of the elbow was measured in a standard outpatient environment with a static dynamometer.

Results

In total, 21 patients (81%) gained MRC grade 4 strength of flexion of the elbow. The mean force of flexion was 7.2 kgf (3 to 15.5, sd 3.3).

Conclusion

This study establishes that the dynamometer may be used for assessing the strength of flexion of the elbow in the outpatient department after nerve reconstructive surgery. Cite this article: Bone Joint J 2016;98-B:1517–20.
The Exeter Universal cemented femoral stem at 20 to 25 years
Authors: Petheram T. G. , Whitehouse S. L. , Kazi H. A. , Hubble M. J. W. , Timperley A. J. , Wilson M. J. , Howell J. R.
Published: November 2016

Aims

We present a minimum 20-year follow-up study of 382 cemented Exeter Universal total hip arthroplasties (350 patients) operated on at a mean age of 66.3 years (17 to 94).

Patients and Methods

All patients received the same design of femoral component, regardless of the original diagnosis. Previous surgery had been undertaken for 33 hips (8.6%). During the study period 218 patients with 236 hips (62%) died, 42 hips (11%) were revised and 110 hips (29%) in 96 patients were available for review. The acetabular components were varied and some designs are now obsolete, however they were all cemented.

Results

With an endpoint of revision for aseptic loosening or lysis, survivorship of the stem at 22.8 years was 99.0% (95% confidence interval (CI) 97.0 to 100). One stem was revised 21 years post-operatively in a patient with Gaucher’s disease and proximal femoral osteolysis. Survivorship with aseptic loosening or lysis of the acetabular component or stem as the endpoint at 22.8 years was 89.3% (95% CI 84.8 to 93.8). With an endpoint of revision for any reason, overall survivorship was 82.9% (95% CI 77.4 to 88.4) at 22.8 years. Radiological review showed excellent preservation of bone stock at 20 to 25 years, and no impending failures of the stem.

Conclusion

The Exeter femoral stem continues to perform well beyond 20 years. Cite this article: Bone Joint J 2016;98-B:1441–9.
Surveillance of intramedullary cartilage tumours in long bones
Authors: Sampath Kumar V. , Tyrrell P. N. M. , Singh J. , Gregory J. , Cribb G. L. , Cool P.
Published: November 2016

Aims

The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate.

Patients and Methods

A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a total of 384 scans. Patients with radiological follow-up of more than three years (46 patients) were divided into two groups: an active group (11 patients) and a latent group (35 patients).

Results

Active lesions had a total growth in all three planes that was > 6 mm, whilst latent lesions had < 6 mm of growth. Most latent lesions were heavily calcified: active lesions were calcified less than 50% (p = 0.025).

Conclusion

Clinico-radiological surveillance can identify growing cartilage lesions: MRI is the surveillance modality of choice. A CT scan is recommended, in addition, at presentation to assess the amount of calcification within the lesion. A first follow-up MRI is suggested one year from diagnosis. If the total growth in the cartilage lesion is > 6 mm, surgical treatment should be considered. Otherwise, a second surveillance scan can be performed at three years to determine further management. Cite this article: Bone Joint J 2016;98-B:1542–7.
Can blood metal ion levels be used to identify patients with bilateral Birmingham Hip Resurfacings who are at risk of adverse reactions to metal debris?
Authors: Matharu G. S. , Berryman F. , Brash L. , Pynsent P. B. , Dunlop D. J. , Treacy R. B. C.
Published: November 2016

Aims

We investigated whether blood metal ion levels could effectively identify patients with bilateral Birmingham Hip Resurfacing (BHR) implants who have adverse reactions to metal debris (ARMD).

Patients and Methods

Metal ion levels in whole blood were measured in 185 patients with bilateral BHRs. Patients were divided into those with ARMD who either had undergone a revision for ARMD or had ARMD on imaging (n = 30), and those without ARMD (n = 155). Receiver operating characteristic analysis was used to determine the optimal thresholds of blood metal ion levels for identifying patients with ARMD.

Results

The maximum level of cobalt or chromium ions in the blood was the parameter which produced the highest area under the curve (91.0%). The optimal threshold for distinguishing between patients with and without ARMD was 5.5 µg/l (83.3% sensitivity, 88.4% specificity, 58.1% positive and 96.5% negative predictive values). Similar results were obtained in a subgroup of 111 patients who all underwent cross-sectional imaging. Between 3.2% and 4.3% of patients with ARMD were missed if United Kingdom (7 µg/l) and United States (10 µg/l) authority thresholds were used respectively, compared with 2.7% if our implant specific threshold was used, though these differences did not reach statistical significance (p ≥ 0.248).

Conclusion

Patients with bilateral BHRs who have blood metal ion levels below our implant specific threshold were at low-risk of having ARMD. Cite this article: Bone Joint J 2016;98-B:1455–62.
The monitoring of activity at home after total hip arthroplasty
Authors: Toogood P. A. , Abdel M. P. , Spear J. A. , Cook S. M. , Cook D. J. , Taunton M. J.
Published: November 2016

Aims

Total hip arthroplasty (THA) has well known subjective benefits, but little is known objectively about the recovery of mobility in the early post-operative period.

Patients and Methods

A total of 33 patients aged > 60 years who underwent elective primary THA had their activity monitored for 30 days post-operatively using an at-home (Fitbit) ankle accelerometer. Their mean age was 70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance and the mean level of activity were determined. Comparisons between subgroups based on age, body mass index (BMI), surgical approach, and the destination of the patients when discharged were also performed.

Results

The mean compliance over the 30 days was 26.7 days (16 to 30; 89%) of use. The mean number of steps increased from 235 (5 to 1152) to 2563 (87 to 7280) (p < 0.001) between the first and the 30th post-operative day. Age < 70 years and an anterior surgical approach were significantly associated with higher levels of activity (1600 to 2400 (p = 0.016 to 0.031) and 1000 to 1800 (p = 0.017 to 0.037) more steps per day, respectively) between the second and the fourth week post-operatively. There was also a trend towards higher levels of activity in those who were discharged to their home rather than to a nursing facility (a mean of 1500 more steps per day, p = 0.02). BMI greater or less than 30 kg/m2was not predictive of activity (p = 0.45 to 0.98).

Conclusion

At-home remote mobility monitoring using existing commercially available technology is feasible in patients who have undergone THA. It showed a clear trend towards increased activity with the passage of time. Additionally, the remote device was able to detect differences in levels of activity clearly between patients in relation to variables of interest including age, BMI, surgical approach, and the destination of the patient at the time of discharge from hospital. Such monitoring may allow for the early identification and targeted intervention in patients who recover slowly. Cite this article: Bone Joint J 2016;98-B:1450–4.
Randomised sham-controlled double-blind multicentre clinical trial to ascertain the effect of percutaneous radiofrequency treatment for lumbar facet joint pain
Authors: van Tilburg C. W. J. , Stronks D. L. , Groeneweg J. G. , Huygen F. J. P. M.
Published: November 2016

Aims

The aim of this study was to compare the effect of a percutaneous radiofrequency heat lesion at the medial branch of the primary dorsal ramus with a sham procedure, for the treatment of lumbar facet joint pain.

Patients and Methods

A randomised sham-controlled double blind multicentre trial was carried out at the multidisciplinary pain centres of two hospitals. A total of 60 patients aged > 18 years with a history and physical examination suggestive of facet joint pain and a decrease of ≥ 2 on a numerical rating scale (NRS 0 to 10) after a diagnostic facet joint test block were included. In the treatment group, a percutaneous radiofrequency heat lesion (80oC during 60 seconds per level) was applied to the medial branch of the primary dorsal ramus. In the sham group, the same procedure was undertaken without for the radiofrequency lesion. Both groups also received a graded activity physiotherapy programme. The primary outcome measure was decrease in pain. A secondary outcome measure was the Global Perceived Effect scale (GPE).

Results

There was a statistically significant effect on the level of pain in the factor Period (T0-T1). However, there was no statistically significant difference with the passage of time between the groups (Group × Period) or in the factor Group. In the crossover group, 11 of 19 patients had a decrease in NRS of ≥ 2 at one month crossover (p = 0.65). There was no statistically significant difference in satisfaction with the passage of time between the groups (Group × Period). The independent factors Group and Period also showed no statistically significant difference. There was no statistically significant Group × Period effect for recovery, neither an effect of Group or of Period.

Conclusion

The null hypothesis of no difference in the decrease in pain and in GPE between the treatment and sham groups cannot be rejected. Post hoc analysis revealed that the age of the patients and the severity of the initial pain significantly predicted a positive outcome. Cite this article: Bone Joint J 2016;98-B:1526–33.
Shy of retiring?
Authors: Winter George F
Published: November 2016

George F Winter wonders when is the right time to hang up your scalpel and take up a hobby.
What you need to know your NHS Pension
Authors: Wright Neil
Published: November 2016

There have been significant changes to the NHS pension scheme in the past decade. Neil Wright explains how the changes may affect you.
Interview: Sir Muir Gray
Authors: Ghabina Sarah
Published: November 2016

We ask the NHS Chief Knowledge Officer and seemingly indefatigable author of Sod 70 about ageing, outcomes and what he’s been up to since he stopped being a surgeon. Quite a lot, it turns out.
Lessons in leadership from… Admiral Sir Trevor Soar
Authors: Shah Jyoti
Published: November 2016

Our series on leadership this month continues with the former Commander-in-Chief Fleet of the Royal Navy.
US observership: an educational opportunity to improve emergency surgery and trauma services in the UK
Authors: Pearce L
Published: November 2016

With no dedicated training in EGS in the UK, trainees may have to look abroad.
Flora da Bahia: Hypoxidaceae
Authors: Santana Karoline Coutinho , Oliveira Reyjane Patricia de , Giulietti Ana Maria
Published: November 2016

The taxonomic treatment of the Hypoxidaceae from Bahia, Brazil, is presented here. Hypoxis decumbens is the only species found in the state. Descriptions, illustrations, comments and a geographic distribution map of the species in Bahia are presented.