bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Hallux Valgus Deformity Using a Suture Button Device
Authors: Gonzalez Tyler , Smith Jeremy , Ready Lauren , Chiodo Christopher
Published: September 2018

Category:

Bunion

Introduction/Purpose:

Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomies. Despite good correction, these procedures bear inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis (AVN). Suture button fixation has been used as another form of HV treatment that avoids the use of corrective osteotomies and maintains reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation.

Methods:

Twenty-two patients underwent HV correction utilizing a distal soft tissue correction and proximal fixation with the Mini TightRope (Arthrex, Inc, Naples, Florida) device. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate post-operative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative Visual Analog Scale (VAS) scores, complications, and any additional surgical procedures performed were also recorded.

Results:

Mean follow-up was 27.7 months.The mean preoperative IMA and HVA were 16.9 and 32.6 degrees.The mean immediate postoperative IMA was 5.2 degrees(p<.0001)and the mean HVA was 9.8 degrees(p<.0001).At final follow-up, the mean IMA was 8.2 degrees(p<.0001)and the mean HVA was 16.7 degrees(p<.0001).Sesamoid station assessment at two-week follow-up showed that 22 patients(100%)were in the normal position group;at final follow-up,17 patients(77%)were in the normal position group and five patients(23%)were in the displacement group.Asymptomatic radiographic recurrence was noted in 5 patients(23%)who had a final HVA>20degrees.All components of the FAAM and SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant.The average final postoperative VAS was11.05.Of the 22 cases, three experienced complications, including an intra-operative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis(DVT).

Conclusion:

The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy and with minimal risk of complications.
Arthroplasty or Arthrodesis in the CJR Era
Authors: Hogan MaCalus , Chambers Monique , Kromka Joseph , Carney Dwayne , Yan Alan , Porter Jake
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Ankle arthritis can be a debilitating disease that results in decreased daily activity and chronic morbidity. Many patients elect for surgical intervention to minimize pain and improve function. To curb costs associated with the increasing demand for total joint arthroplasty (TJA) in the growing elderly Medicare population, CMS announced the Comprehensive Care for Joint Replacement (CJR) model, which included total ankle arthroplasty. To provide continued quality care and cost containment, it is necessary to determine the optimal surgical intervention for patients that could fall within the CJR program. Therefore, we sought to determine the impact of surgical fixation on functional outcomes, systemic utilization, and medical expenditures for patients with ankle arthritis.

Methods:

We reviewed a prospectively collected and maintained database to identify all patients who underwent a total joint replacement from April 2016 to September 2017. Patients were identified based on DRG codes for primary arthritis of a lower extremity joint, then specifically for foot and ankle, as well as CPT codes for ankle arthroplasty (27702) or ankle arthrodesis (27870/28725). Functional outcomes were assessed based on insurance type. The cohorts were matched for age, comorbidities, and gender. Statistical analysis was performed using chi-squared and paired t-test to assess for differences in patient reported outcomes. Descriptive statistical analysis was used to assess for differences in cost between the cohorts.

Results:

A total of 573 patients were included.There were 48 replacements and 47 fusions. Arthrodesis procedures costs approximately $6,500 less per case than the system costs for patients who underwent arthroplasty procedures. The average length of stay for patients who underwent total ankle arthroplasty was 1.6 days compared to outpatient surgical centers utilized for most arthrodesis patients. Overall, patients reported improved pain and a 30.96 increase in FAAM scores. Most patients had a global rate of change that was “very much better” or “much better” (68%). Based on insurance type, patients who underwent a total ankle replacement in the CJR program had improved outcomes and lower cost than patients commercially insured.

Conclusion:

With the CJR, there is greater emphasis on the optimal intervention for elective operations. There should be coordinated efforts to optimize quality care, while minimizing financial waste within the healthcare system. The price differential suggests an annual potential for financial savings as high as $325,000 for a system that supports intervention for ~50 cases per year. As such, these results suggest that arthroplasty may be optimal for patients with severe symptomatic ankle arthritis, while most patients have adequate relief with an ankle fusion. More importantly, quality improvement efforts should focus on the impact of surgical intervention on functional activity.
Anatomy of the Insertion of the Posterior Inferior Tibiofibular Ligament and the Posterior Malleolar Fracture
Authors: Mason Lyndon , Jayatilaka Lara , Fisher Andrew , Fisher Lauren , Molloy Andrew
Published: September 2018

Category:

Ankle

Introduction/Purpose:

The treatment of posterior malleolar fractures is developing. Our previous study on the anatomy of the posterior malleolar fracture identified only 49% of rotational push off fractures of the posterior malleolus had syndesmotic instabilities. This was against general thinking that fixation of such a fragment would stabilize the syndesmosis. Our aim in this study was to identify the extent of the posterior inferior tibiofibular ligament insertion on the posterior tibia and its relation to push off fractures.

Methods:

We examined 10 cadaveric lower limbs that had been preserved for dissection at the Human Anatomy and Resource Centre at Liverpool University in a solution of formaldehyde. The lower limbs were carefully dissected to identify the ligamentous structures on the posterior aspect of the ankle.

Results:

In all specimens, the tibial insertion of the PITFL encompassed 1/3 of the distal posterior tibia. In addition, the posterior intermalleolar ligament inserted onto the posterior tibia just medial to the tibialis posterior groove. Thus a rotational push off fracture would only cause syndesmotic injury if greater than a 3 rd of the posterior tibia was injured or occurred in combination with a ligamentous injury. This is in keeping with the clinical findings of only 49% syndesmotic instabilities with Haraguchi type 1 posterior malleolar fractures.

Conclusion:

Haraguchi type 1 posterior malleolar fractures (less than a 3 rd of the width of the posterior tibia) are unlikely to cause syndesmotic instabilities without the addition of a ligamentous injury.
Associated Joint Pain with Controlled Ankle Movement (CAM) Walker Boot Wear
Authors: Ready Lauren V. , Fisk Erica , Ciurylo William , Chiodo Christopher P. , Bluman Eric M. , Smith Jeremy T.
Published: September 2018

Category:

Ankle

Introduction/Purpose:

A controlled ankle movement (CAM) walker boot is often prescribed for patients with a lower extremity injury or disorder. CAM boot wear, however, may cause gait alterations and leg-length discrepancy, which are commonly associated with joint pain. This study evaluates the location, frequency and duration of secondary site pain relating to immobilization in a CAM walker boot.

Methods:

Patients wearing a CAM walker boot for treatment of a foot or ankle injury were prospectively enrolled and evaluated for new or worsened secondary site pain. Surveys at four time points were completed to evaluate the presence of secondary site pain, its severity, and its impact on overall function.

Results:

The final study population included 46 patients (mean age 49 years). At transition out of the boot (mean, 4.2 weeks), 31 patients (67%) reported secondary site pain either new or worse than baseline with an average of 1.6 secondary pain sites. The secondary sites most susceptible to pain were the lower back, contralateral hip, and ipsilateral knee. A majority (84%) of these pains began within the first two weeks of boot wear. Secondary site pain was less common after transition out of the boot: 18 patients (39%) at 1 month, 15 patients (33%) at 3 months. The mean VAS for secondary site pains at transition out of boot was 51.2. Statistical significance was found correlating secondary site pain and a history of chronic pain (P=.04).

Conclusion:

Secondary site pain after CAM walker boot wear was common. The frequency and severity of pain lessened with time after transition out of the boot. Yet, one-third of patients still had new or worsened secondary site pain three months after cessation of boot wear.
Clinical and Radiographic Outcomes of Tibiotalocalcaneal or Pantalar Arthrodesis Using a Novel Lateral Locking Plate
Authors: Rutherford Tyler , Campbell John , Cerrato Rebecca , Jeng Clifford
Published: September 2018

Category:

Ankle

Introduction/Purpose:

For patients suffering from severe ankle and hindfoot arthritis or deformity, tibiotalocalcaneal (TTC) or pantalar arthrodesis may be the best option to achieve a plantigrade and painless foot. These fusions are typically fixed with a retrograde intramedullary nail, a lateral side plate, or screws alone. Theoretically, the advantages of a lateral side plate applied via a trans-fibular approach include the use and the multiple points of fixation available in the tibia, talus, and calcaneus. The results of a novel side plate construct with a unique screw hole that extends underneath the calcaneus are presented in this study. A large diameter screw can be inserted retrograde through this inferior hole to engage the medial tibial cortex and provide axial compression across the ankle and subtalar joints.

Methods:

This study retrospectively evaluated 39 patients that underwent a tibiotalocalcaneal (TTC) or pantalar arthrodesis using this novel lateral plate fixation technique by one of three fellowship trained surgeons at a tertiary referral center. Patients with less than a one year follow up were excluded. Thirty-nine patients were identified between 2012 and 2016. Two patients were deceased from other causes, 2 had a below the knee amputation due to chronic pain, and 9 were lost to follow up. Pre- and postoperative General Health and Wellness (SF-12) and Revised Foot Function Index scores were obtained. Study subjects were seen for a clinical evaluation and final post-operative x-rays. The Shapiro-Wilk test was used to test for normality. The paired student’s t-test was used to compare pre- and post-surgical outcome measures.

Results:

Twenty-six patients were included in the study group. Mean follow up time was 34.42 ± 12.94 months. The SF-12 score was 32.2 ± 10.22 (physical) and 54.8 ± 10.7 (mental) before surgery, and 41.35 ± 9.21 (p < 0.01) and 56.5 ± 7.47 (p = 0.73) at final follow-up, respectively. The FFI score was 106 ± 32.69 before surgery and 53.94 ± 24.14 after surgery (p = 0.06). Eighteen patients were satisfied or very satisfied with the outcome of the surgery (70%). CT confirmation of joint fusion was obtained in all 26 patients. Twenty out of the 26 patients demonstrated fusion of all joints (77%). There were 2 ankle, 1 subtalar, and 1 talonavicular nonunions. In total, 44 of 48 total joints were fused (91%).

Conclusion:

Tibiotalocalcanceal and pantalar arthrodesis using a novel lateral plate for the treatment of complex deformity and severe osteoarthritis demonstrated acceptable fusion rates considering the number of patients with high risk factors for nonunion in this study group. Complications included fractures at the proximal end of the plate construct and persistent neurapraxia which was well tolerated. Patients reported significant improvements in SF-12 clinical scores at final 34 month follow-up.
Chronic Symptomatic Ankle Avulsion Fracture
Authors: Wang Bibo
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Persistent pain and instability following inversion or eversion injuries of the ankle is not rare. Besides injury of lateral or medial ligaments, avulsion fracture of lateral or medial malleolus could be found in some cases. The avulsion fracture may result in nonunion and/or ligamentous laxity which could lead to chronic ankle pain. The purpose of this study was to evaluate the intraoperative findings and long-term outcomes of patients of symptomatic ankle avulsion fracture.

Methods:

23 patients of ankle avulsion fracture along with chronic ankle pain and instability were studied. Tenderness and swollen at lateral and/or medial gutter were found and radiographic images were taken for the diagnosis. After at least 6 months of unsuccessful non-operative treatment, all patients underwent surgery of osseous fragments excision and anatomic ankle ligaments reconstruction. AOFAS-AH and VAS Score were given to assess the outcomes of surgery.

Results:

There were 21 males and 9 females among the patients. The average age of the patients was 24.6 years (range, 18-45 years) at the time of injury and 27.3 years (range, 18-46) at the time of surgery, indicating a mean delay in diagnosis and/or treatment of 2.7 years. At a mean follow-up of 2.6 years (range, 1 to 5.2 years), the average AOFAS-AH Score increased from 72.5 to 93.2 out of 100 (P<0.05), the average VAS score decreased from 6.2 to 1.2 (P<0.05).

Conclusion:

For those patients of ankle avulsion fracture presenting with chronic ankle pain and instability, surgical excision of the bony fragment combined with reconstruction of ankle ligaments were effective in eliminating pain, restoring ankle stability, and helping return to the pre-injury functional level.
What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement
Authors: Kim Victor , Aaron Shawn D.
Published: September 2018

Chronic obstructive pulmonary disease (COPD) is a chronic illness that can be periodically punctuated by exacerbations, characterised by acute worsening of symptoms, including increased dyspnoea, cough, sputum production and sputum purulence. COPD exacerbations are common and have important clinical and economic consequences, including lost work productivity, increased utilisation of healthcare resources, temporary or permanent reductions in lung function and exercise capacity, hospitalisation, and sometimes death. Over the past two decades, clinicians and researchers have broadened their treatment goals for COPD to extend beyond improving lung function and symptoms, and have begun to address the importance of preventing and reducing exacerbations. However, despite the best efforts of clinicians and guideline committees, current definitions of COPD exacerbations are imperfect and fraught with problems. The cardinal symptoms of a COPD exacerbation are nonspecific and can result from acute cardiorespiratory illnesses other than COPD. A proposed definition, which may be more specific than current definitions, suggests that COPD exacerbation be defined as an acute or subacute worsening of dyspnoea (≥5 on a visual analogue scale that ranges from 0 to 10) sometimes but not necessarily accompanied by increased cough, sputum volume and/or sputum purulence. Necessary laboratory criteria for an exacerbation include oxygen desaturation ≤4% below that of stable state, elevated levels of circulating blood neutrophils or eosinophils (≥9000 neutrophils·mm−3or ≥2% blood eosinophils) and elevated C-reactive protein (≥3 mg·L−1), without evidence of pneumonia or pulmonary oedema on chest radiography and with negative laboratory test results for other aetiologies. Herein, we discuss the current state of the art with respect to how we define COPD exacerbations, associated pitfalls and challenges, and opportunities for improvement.
Can We Link Thyroid Status, Energy Expenditure, and Body Composition to Management of Subclinical Thyroid Dysfunction?
Authors: Ylli Dorina , Wartofsky Leonard
Published: September 2018

We discuss the study of Samuels et al., focusing on the effect that levothyroxine treatment has on energy expenditure and body composition in subclinical hypothyroidism.
A synthetic promoter for multi-stage expression to probe complementary functions of Plasmodium adhesins
Authors: Klug Dennis , Kehrer Jessica , Frischknecht Friedrich , Singer Mirko
Published: September 2018

Gene expression of malaria parasites is mediated by the apicomplexan Apetala2 (ApiAP2) transcription factor family. Different ApiAP2s control gene expression at distinct stages in the complex life cycle of the parasite, ensuring timely expression of stage-specific genes. ApiAP2s recognize short cis-regulatory elements that are enriched in the upstream/promoter region of their target genes. This should, in principle, allow the generation of ‘synthetic’ promoters that drive gene expression at desired stages of the Plasmodium life cycle. Here we test this concept by combining cis-regulatory elements of two genes expressed successively within the mosquito part of the life cycle. Our tailored ‘synthetic’ promoters, named Spooki 1.0 and Spooki 2.0, activate gene expression in early and late mosquito stages, as shown by the expression of a fluorescent reporter. We used these promoters to address the specific functionality of two related adhesins that are exclusively expressed either during the early or late mosquito stage. By modifying the expression profile of both adhesins in absence of their counterpart we were able to test for complementary functions in gliding and invasion. We discuss the possible advantages and drawbacks of our approach.

This article has an associated First Person interview with the first author of the paper.
Unified platform for multimodal voxel-based analysis to evaluate tumour perfusion and diffusion characteristics before and after radiation treatment evaluated in metastatic brain cancer
Authors: Coolens Catherine , Driscoll Brandon , Foltz Warren , Svistoun Igor , Sinno Noha , Chung Caroline
Published: September 2018

Objective:

Early changes in tumour behaviour following stereotactic radiosurgery) are potential biomarkers of response. To-date quantitative model-based measures of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI parameters have shown widely variable findings, which may be attributable to variability in image acquisition, post-processing and analysis. Big data analytic approaches are needed for the automation of computationally intensive modelling calculations for every voxel, independent of observer interpretation.

Methods:

This unified platform is a voxel-based, multimodality architecture that brings complimentary solute transport processes such as perfusion and diffusion into a common framework. The methodology was tested on synthetic data and digital reference objects and consequently evaluated in patients who underwent volumetric DCE-CT, DCE-MRI and DWI-MRI scans before and after treatment. Three-dimensional pharmacokinetic parameter maps from both modalities were compared as well as the correlation between apparent diffusion coefficient (ADC) values and the extravascular, extracellular volume (Ve). Comparison of histogram parameters was done via Bland–Altman analysis, as well as Student’s t-test and Pearson’s correlation using two-sided analysis.

Results:

System testing on synthetic Tofts model data and digital reference objects recovered the ground truth parameters with mean relative percent error of 1.07 × 10−7 and 5.60 × 10−4 respectively. Direct voxel-to-voxel Pearson’s analysis showed statistically significant correlations between CT and MR which peaked at Day 7 for Ktrans (R = 0.74, p <= 0.0001). Statistically significant correlations were also present between ADC and Ve derived from both DCE-MRI and DCE-CT with highest median correlations found at Day 3 between median ADC and Ve,MRI values (R = 0.6, p < 0.01) The strongest correlation to DCE-CT measurements was found with DCE-MRI analysis using voxelwise T10 maps (R = 0.575, p < 0.001) instead of assigning a fixed T10 value.

Conclusion:

The unified implementation of multiparametric transport modelling allowed for more robust and timely observer-independent data analytics. Utility of a common analysis platform has shown higher correlations between pharmacokinetic parameters obtained from different modalities than has previously been reported.

Advances in knowledge:

Utility of a common analysis platform has shown statistically higher correlations between pharmacokinetic parameters obtained from different modalities than has previously been reported.
State Regulation of Development of Agrarian Territories
Authors: Зинчук Г. , Zinchuk G. , Макекадырова А. , Makekadyrova A.
Published: September 2018

The article considers methodological approaches to the concept of development of agrarian territories, gives recommendations on improving the organizational and economic mechanism of state influence on the processes of formation and functioning of agrarian territories, determining strategic guidelines for their development. The substantive essence and possibilities of the state support of development of agrarian territories are analyzed. The article analyzes the possibilities for the formation and development of the potential of agrarian territories, the state and prospects for the development of agricultural production using the model of indicative planning, taking into account the specifics of the Russian economy. The approach to the selection of the quantitative and qualitative content of the forecasts for the development of agrarian territories is disclosed. Current problems of forecasting resource support for the formation and development of agrarian territories are outlined. Recommendations are given on the possibility of using planning documents for an integrated approach to planning and regulating the development of the country’s agrarian territories.
Analysis of the Development of Network Forms of Organization of Project Training in the Interaction of Organizations of General and Vocational Education
Authors: Коваль Е. , Koval' E. , Монина А. , Monina A.
Published: September 2018

The authors consider one of the most important tasks of modernization, both general and secondary vocational education, namely the comprehensive development of project forms of education in the framework of network forms of interaction of organizations of General and vocational education. The purpose of the network project training is to create conditions for self-motivated acquisition of missing knowledge by students from different sources; training skills of using the acquired knowledge to solve real cognitive and practical problems; acquisition of communication skills, work in groups; development of project skills and system thinking. The authors show that the educational project makes it possible to organize educational activities, keeping a balance between theory and practice. It stimulates the true teachings of the students themselves, and easily fits into the learning process. Within the framework of network project activity, project competence is formed as the ability and readiness of students to productive educational, research and implementation work, focus on self-education and self-improvement, integration of research and practical training activities into an inseparable whole, the transition from exclusively performing to exclusively creative, creative activity. Project competence is an interconnected complex of several components (a combination of knowledge, ability, skills, actions, experience in the field of educational research and solution of practical issues and problems of implementation).
Informational Structure of Person As Pedagogical Category
Authors: Андреев А. , Andreev A.
Published: September 2018

The article suggests a new look at the information structure of a human. And in this connection here are defined the functions of such concepts as the individual, personality, psyche, consciousness, intellect, mind. Also here are justified the prospects of applying the proposed version of the information structure of the individual in terms of the pedagogical approach. The proposed interpretation of the personality is carried out in the vein of the concept of personality-centeredness.
The Art World of the University Town (the Example of Lawrence, Kansas)
Authors: Егорова А. , Egorova A. , Викторук Елена , Viktoruk Elena
Published: September 2018

This paper is devoted to art scene of provincial towns. The object is investigated on the example of the artistic life of the city of Lawrence, Kansas, USA. On the one hand the art scene of this local space can be described as something typical for American town (underlining of local originality and a prevalence of production of local and regional authors; prices available to representatives of middle class). On the other hand, the variety, activity and freedom of Lawrence's art life contrast with conservatism of the main territory of Kansas. The reasons of this feature were established as a result of the research.
Decision Support for the Physician Scheduling Process at a German Hospital
Authors: Schoenfelder Jan , Pfefferlen Christian
Published: September 2018

The process of manually constructing monthly working schedules for physicians in medium-sized and large departments at hospitals is a very time-consuming and error-prone task. The scheduler, typically a senior physician, is an expensive resource and oftentimes almost irreplaceable because of his acquired expertise in the scheduling process. We develop a mathematical model that formalizes every rule and regulation necessary to generate lawful schedules in the anesthesiology department of a 626-bed hospital in Berlin, Germany. We embed our detailed and complex mixed-integer programming formulation, which generates schedules superior to the ones currently in use, in an Excel environment to ensure ease of use, maximum flexibility with respect to changing all relevant inputs, and a visual output representation for practitioners. The presented approach reduces the workload for the scheduler dramatically, thereby increasing his availability for medical services. Our generated schedules outperform manually created schedules by significantly reducing the number of rule and regulation violations, while also improving key performance measures such as assigned overtime, granted employee-preferred shifts, and fairness considerations. Our approach also highlights important aspects in modeling the physician scheduling problem for practical implementation that have been widely ignored in the existing literature.
A Stochastic Game Analysis of Incentives and Behavioral Barriers in Chronic Disease Management
Authors: Zhang Hui , Wernz Christian , Hughes Danny R.
Published: September 2018

Chronic diseases can be prevented or mitigated by changing the behavior of patients and physicians. Incentives are one of the mechanisms to motivate such change. We present a two-player, multiperiod stochastic game model in which patients and primary care physicians jointly decide on chronic disease management activities. The model accounts for the decisions of patients regarding primary care engagement and lifestyle, as well as physicians’ choice of effort spent in clinical encounters. We capture the behavioral aspects of patients’ decisions by incorporating the health belief model. The physician-patient interaction is modeled as a general-sum stochastic game with switching control structure. A nonlinear programming (NLP) approach is used to find the agents’ optimal strategies. Using data on coronary heart disease, we provide a numerical example that quantifies how behavioral barriers and incentives affect patients’ and physicians’ decisions. Our results provide insights for health policy makers on how to design incentive mechanisms that contribute to more effective chronic disease management.
Stochastic Appointment Scheduling in a Team Primary Care Practice with Two Flexible Nurses and Two Dedicated Providers
Authors: Alvarez-Oh Hyun-Jung , Balasubramanian Hari , Koker Ekin , Muriel Ana
Published: September 2018

Waiting is common in appointment-based outpatient care: patients experience delays before seeing a nurse and then in the examination room before seeing the doctor. Given that service times are uncertain, the challenge for outpatient practices is to control the spacing between successive appointments to minimize waiting time while ensuring the doctor is not idle for too long. Whereas scheduling in single-doctor practices is well studied, team practice, in which one of two nurses can flexibly see the patient before the patient consults with one of two assigned doctors, is not. Optimal scheduling in a team practice is far more challenging from a computational viewpoint because the order in which patient appointments are scheduled need not be the order in which they see their doctors (i.e., patients may be allowed to crossover). In this article the authors propose a model that can solve realistic instances of this problem optimally. On the basis of analyses, the results show that (1) empty slots (which function as slack to alleviate waiting) alternate in the two doctors’ schedules and do not occur simultaneously, and (2) allowing nurse flexibility and patient crossovers produces greater benefits when service time variation is high.
A Data-Driven Procedure of Providing a Health Promotion Program for Hypertension Prevention
Authors: Lee Junghye , Kwon Ryeok-Hwan , Kim Hyung Woo , Kang Sung-Hong , Kim Kwang-Jae , Jun Chi-Hyuck
Published: September 2018

How can service providers efficiently and effectively implement a health promotion program to prevent hypertension? In this article, the authors propose a two-step procedure based on data analytics using (1) a prediction model to identify people who are at risk for developing hypertension and (2) four methods to create an index that represents the importance of specific intervention programs for eliminating risk factors for individuals. The authors use the national sample cohort database of South Korea to offer a case study of the implementation of the proposed procedure. The constructed prediction model using logistic regression has adequate accuracy, and the proposed index has results similar to those of a doctor. The insight for hypertension prevention program implementation: This two-step procedure, which relies on automatic modeling based on data, can provide informative and personalized results based on individual health records.
Patient preferences for involvement in health service development
Authors: Finn Vincent , Stephenson John , Astin Felicity
Published: September 2018

Background:

patient involvement in the design, planning and delivery of health services is acknowledged to be a local and national priority.

Aims:

to improve service quality through a quality improvement initiative to explore patient preferences for involvement in health services design, planning and delivery.

Methods:

a questionnaire was developed to: assess patient preferences for involvement in hospital service development; and explore differences in responses between patient subgroups.

Findings:

162 patients were recruited. Most were positive about being engaged in all service developments, not just those used personally. Involvement through questionnaires with infrequent email communication was favoured over attendance at public meetings. Time was a greater barrier to being involved than distance or remuneration. Conclusion’ Patients valued involvement in health service development, but finding free time during working hours was difficult. There were no differences in preferences for involvement between subgroups defined by gender, ethnicity, home situation or health.
Belonging and loss in the transition to newly qualified nursing
Authors: Hamilton Duncan
Published: September 2018

Duncan Hamilton, at the time of writing a final year adult nursing student at the University of Surrey, considers an unexpected sense of melancholy at the end of his course
Supreme Court ruling on the withdrawal of life-sustaining nutrition
Authors: Griffith Richard
Published: September 2018

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the Supreme Court's decision on the need to bring cases concerning the withdrawing of clinically assisted nutrition to court
Reducing the risks of surgical site infection: the importance of the multidisciplinary team
Authors: Burden Mel , Thornton Melanie
Published: September 2018

Surgical site infection (SSI), which can range from superficial infection to life-threatening problems, puts extra strain on healthcare resources and can have a significant impact on patient quality of life. The majority of SSIs are preventable, with different members of the multidisciplinary team (MDT) playing their part at every stage of the patient journey from preoperative assessment to post-discharge follow up. Effective communication and cooperation between members of the MDT is key. This article provides an overview of the input at different stages along the patient journey.
Oxygen therapy in adult patients. Part 2: promoting safe and effective practice in patients' care and management
Authors: Rolfe Sandy , Paul Fiona
Published: September 2018

The assessment, care and management of patients requiring oxygen therapy are key aspects of a nurse's role. Although oxygen therapy is an important treatment for many clinical conditions, it carries risks and complications; therefore, nurses and other health professionals have a responsibility to ensure safe and effective practice along with maintaining and developing their knowledge and skills in this therapy. The relevant aspects of physiology and pathophysiology were explored and discussed in part one of this article ( Rolfe and Paul, 2018 ). The aims of the second part are to discuss: (1) the indications for oxygen therapy; (2) the principles of assessment, care and management of adult patients requiring oxygen therapy; and (3) recommendations for the safe and effective use of oxygen devices, along with the potential complications.
A DECISION SUPPORT TOOL FOR BUSINESS MODEL ANALYSIS
Authors: Latora Antonio Giuseppe , Compagno Lucio , Trapani Natalia
Published: September 2018

The business model (BM) concept which has emerged in the scientific literature and business world over the past fifteen years is a new management concept that, although characterised by fuzzy boundaries, can be synthesized as “the rationale of how an organisation creates, delivers and captures value”. Many authors see the BM as an excellent tool for the strategic evaluation of business ideas, but the literature review shows a lack of efficient quali-quantitative tools for evaluating potential BM alternatives and selecting the best BM solution from among them. In this paper, we propose a Business Model Decision Support Tool (BM-DST) based on a quali-quantitative methodology of Multiple Criteria Decision Analysis (MCDA) called Analytic Hierarchy Process (AHP) and specifically based on a modified AHP procedure called Value-Analytic Hierarchy Process (V-AHP). A case study with a numerical example was carried out in the field of industrial plants, specifically in the context of the Industrial Product-Service Systems, in order to select the best BM solution from among three potential BM alternatives usually taken into account by an Original Equipment Manufacturer (OEM) and Engineering-Procurement- Construction (EPC) company: Transactional Project Deliveries, Project Led Solutions and Life-Cycle Solutions.
SPACE MISSION DEFINITION BASED ON ANALYTICAL HIERARCHY PROCESS (AHP) METHOD
Authors: Naseh Hassan
Published: September 2018

Generally, missions of remote sensing satellites are divided into three types:  monitoring missions, recognition missions and surveillance missions. These missions need the Sun Synchronous Orbits (SSOs) or Multi-Sun Synchronous Orbits (MSSOs) in order to perform the operations. These SSOs and MSSOs have many requirements that make deciding the best type a multi-criteria decision problem. To this end, the Analytical Hierarchy Process (AHP) methodology is utilized to decide the orbit type in the remote sensing satellites missions. Therefore, the objective in the above methodology is to reach the orbit in the minimum amount of time and with the minimum cost (SSOs or MSSOs). The criterions are remote sensing missions, and the alternatives in the AHP methodology are the SSOs and MSSOs. In the conclusion, the results of methodology are presented and evaluated.
Mental illness media and the paradox of ‘productivity’ in Elementary and Limitless
Authors: Brayton Sean
Published: September 2018

This article examines representations of mental illness in North American network television. It is particularly drawn to the CBS police procedurals Elementary (2012–present) and Limitless (2015) as distinct but overlapping stories of mental illness, addiction and intellectual labour. Though depression, drug addiction and anxiety disorders are treated differently in each series, Elementary and Limitless offer complementary narratives of occupational therapy that equate work with mental well-being. While they seem to present a positive image of mentally ill characters with meaningful jobs, Elementary and Limitless measure mental fitness by one’s capacity to work in the same industries often linked to mental illnesses in the first place, resulting in a paradox of productivity. Here the television programmes, much like occupational therapy, tend to overlook critical questions about the socio-economic underpinnings of psychological disorders and encourage viewers to understand the links between mental illness and work in rather myopic ways.
Transgression – identification – interaction: Blu-ray bonus features and Supernatural’s cult status
Authors: Fuchs Michael
Published: September 2018

Being ‘cultish’ is not a feature which is inherent in a given media text. Rather, this quality is attributed to the text in question over time, usually due to the development of a passionate fan community around it. Nevertheless, media producers are well aware of means which help increase – or in some cases even produce – the cult status of their products. This article dissects the role the bonus features included in Supernatural’s Blu-ray releases play in the cultification of the series. As this article demonstrates these special features primarily function as a means of tightening the bond between the fan community and the show’s creative team.
The road to Negan: Governance and power in The Walking Dead
Authors: Howe Andrew , Evans Sean
Published: September 2018

In Robert Kirkman’s graphic novel The Walking Dead (2003–present), a zombie apocalypse serves as the backdrop against which the survivors make the practical and moral decisions that will determine their fate. The struggle is less about combating the undead than maintaining a civilized, moral imperative and reformulating a micro-society from the ashes of previous civilization. Leadership and decisionmaking become critical in situations where the wrong choice can result in destruction. The television adaptation offers a rare glimpse into a world where some of the fundamental features of civilization – government, kinship, culture – are simultaneously and completely enveloped in chaos. In the midst of a complete breakdown of structure, power vacuums occur and are inevitably filled, most notably in the early parts of the series by Rick Grimes and Shane Walsh, friends and former law enforcement officers who model very different visions of power and governance. This article explores power structures and hierarchy in The Walking Dead from two disciplinary perspectives – historical/cultural and psychological – and focuses upon the clash of competing hierarchal structures and leadership styles that develop as the survivors band together and begin to seek out islands of safety from zombies and other humans alike. The zombie apocalypse is thus a backdrop against which to project the real story: the power dynamics within a micro-society undergoing tremendous stress, and what these dynamics indicate about the conflicted nature of power and identity.
From ambivalence to acceptance: Representations of trans embodiment on American television
Authors: Lafrance Marc , Manicom Jay , Bardwell Geoff
Published: September 2018

Boasting some of the highest ratings in American cable television history, FX’s six-season dramatic series Nip/Tuck (2003–10) features more trans characters than any other show of its kind. Focusing on its regularly recurring trans woman character, Ava Moore, we argue that Nip/Tuck’s representations of trans embodiment are complex, contradictory and, above all, ambivalent. More specifically, we claim that the show portrays medically-assisted transition not only as a large-scale crisis in the order of things but also as a path to personal prosperity and success. In doing so, we demonstrate that the former is articulated through themes of incest, infertility, fraudulence and monstrosity while the latter is articulated through themes of beauty, intelligence, resilience and social mobility. Having presented our analysis of how Nip/Tuck represents sex reassignment and those who undergo it, we then turn to a critical consideration of how a more recent dramatic series, Orange is the New Black (2013–present), portrays the trans trajectory. Widely understood to represent a kind of ‘transgender tipping point’, Orange is the New Black can be seen as a useful index of how trans people are portrayed in present-day televisual culture. Through our consideration of these portrayals, we think critically about whether popular media representations of sex reassignment have changed since Nip/Tuck and, if so, in what ways.
From ‘pop’ nostalgia to millennial modernity: Bugs as an ‘Avengers for the 1990s’
Authors: Oldham Joseph
Published: September 2018

This article examines the 1990s adventure series Bugs (1995–99), whilst also exploring broader transformations in British television thrillers and nostalgic programming. First, I position the series’ origin as a response to the popularity of 1960s adventure series repeats on the BBC in the 1990s. I argue, that the nostalgic impulse of Bugs itself did not manifest in visual terms, as in more conventional 1960s pastiches, but was instead at a narrative level. The series dispensed with contemporaneous trends towards more psychologised characters and serialised narratives in favour of a self-consciously ‘retro’ rejection of ‘depth’. Yet I also explore other ways in which it adapted the adventure series for the 1990s. These included reworking the spy agency as a small business enterprise for the ‘dotcom’ age, reinventing alienating surveillance technology as the user-friendly gadget, glamorizing neo-liberalism through exoticizing London’s redeveloped Docklands, and presenting terrorism as a leading existential threat for the post-Cold War era. I argue that whilst Bugs represented a dead end for an ‘innocent’ model of nostalgic drama, through many of the latter characteristics it stands as an unacknowledged influence on a later generation of stylish, issue-led ‘War on Terror’ thriller series.
In flag-rante: Julia Gillard and the infamous ‘flag scene’ in ABC’s At Home with Julia
Authors: Stevenson Ana
Published: September 2018

In 2011, the Australian Broadcasting Corporation financed and produced a controversial sitcom based on the life, characteristics, and politics of incumbent Prime Minister Julia Gillard. At Home with Julia (2011) examined Gillard’s private life by fictionalizing her de facto relationship with partner Tim Mathieson. Before, during, and after it aired, the series became a media spectacle as print, digital and broadcast journalists debated the propriety of the parody/satire. Media hype peaked in response to a fleeting scene in which the main characters appear cuddling under the Australian flag. Drawing on scholarship about postfeminism, this article examines the representation of single/unmarried women in popular culture and the characterization of political women in television dramas. The media commentary surrounding At Home with Julia denounced the ‘flag scene’ in the strongest terms, yet this reportage also conveyed an underlying unease towards the series’ candid depiction of sexuality. Most significantly, journalists collectively failed to adequately distinguish between Gillard, the prime minister, and ‘Julia’, the fictional character. Such a failure, this article suggests, enabled and excused the media’s subsequent and far more visceral sexualization of Australia’s first female prime minister. Although the public clearly understood the fictional premise of At Home with Julia, the Australian media fabricated a ‘sex’ scandal that came to be read onto the body of Gillard herself.
Conference Report
Authors: Shaw Caitlin
Published: September 2018

At Home with Horror? Terror on the Small Screen, University of Kent, 27–29 October 2017
Seeking academic help: A case study of peer brokering interactions
Authors: Lee Sherrie
Published: September 2018

The literature often depicts international students as deficient due to poor English language skills and limited participation in class, thus positioning them as lacking in agency or habitually weak. This article reframes international students as resourceful learners by focusing on their academic learning through brokering, that is, help-seeking social interactions. Understood as part of informal learning practices, brokering interactions take place when students seek assistance with unfamiliar academic texts and practices from brokers, that is, those who are able to bridge cultural and knowledge gaps. The article reports on research that investigated brokering practices among ten international English as an Additional Language (EAL) students in their initial semester of study at a New Zealand university. In particular, the article examines the brokering interactions between two participants, Linda, a first-year student, and her broker Emily, a fellow Mainland Chinese student who provided information and advice about various academic tasks and situations. A conversation analytic approach that views brokering as asymmetrical knowledge positions is used to analyse twelve episodes of brokering interactions in Chinese that took place through WeChat, a mobile phone application. Initial analysis reveals that the dynamics of brokering interactions between Linda and Emily were characterized by a display of social solidarity, even as seeker and broker negotiated their knowledge positions over information or advice offered by the broker. The article concludes that peer brokering between same language speakers provides a collegial space in which students exercise agency by utilizing sociolinguistic resources. Thus educational institutions should recognise the importance of international students’ informal academic learning and increase opportunities for EAL students to build and enhance their social connections with peers as part of a holistic approach towards academic support.