bluuebunny/crossref_metadata_2025 huggingface dataset:
The re-emergence of antigen-specific tolerance as a potential therapy for MS
Authors: Steinman Lawrence
Published: April 2015

Ideal therapy for inflammatory disease in the nervous system would preserve normal immune function, while suppressing only the pathologic immune responses that damage tissue and allowing for repair. In principle, antigen-specific therapy would eradicate unwanted adaptive immune responses—antibody and T-cell mediated—while preserving the integrity of other adaptive responses to infectious agents and retaining the ability to fight malignancy. However, at this time, for multiple sclerosis (MS) we do not have compelling evidence that would support any particular dominant immune response to any specific antigen or even a limited group of antigens. In fact, there are adaptive immune responses to a wide swathe of proteins and lipids found on neurons and myelin in MS. Unless controlling a few of the known immune responses is sufficient, antigen-specific therapy in MS may not have enough of an impact to modulate clinical outcome. However, in other neuroinflammatory conditions, such as neuromyelitis optica, the adaptive immune response is highly focused. Trials of antigen-specific therapy for neuroinflammatory disease might first be tested in diseases with a more limited adaptive immune response like neuromyelitis optica. The likelihood of a significant success for this therapeutic strategy might then ensue.
The impact of service learning on the training of pre-service teachers
Authors: Gil-Gómez Jesús , Chiva-Bartoll Óscar , Martí-Puig Manuel
Published: April 2015

This paper discusses the effects of the use of service learning in pre-service teachers (PSTs). This methodology has been applied for two academic years at a Spanish university, providing a direct service for children with special educational needs (SEN) through motor and expressive games. We used Butin’s model for the analysis of data collected through written reflections. The results show significant academic and personal learning, especially in areas useful for future teachers. The paper also proposes an extension (subcategories) of the original explanatory model.
The emotions and action tendencies associated with viewing online cancer information among patients’ loved ones
Authors: Lauckner Carolyn
Published: April 2015

Loved ones of cancer patients are vulnerable, often reporting psychological distress and inadequate information provision. This research examined the use and emotional and behavioral effects of online cancer information. Compassion and fear were the strongest emotions elicited by online content, and respondents reported several cognitive, communicative, and helping behaviors. Multiple relationships between emotions and behaviors were found, including between hope and helping behaviors, anger and problem-solving, fear and seeking comfort, and sadness and a decreased likelihood of engaging in cancer prevention and detection. This study extends research on emotions and action tendencies and provides guidance for developing future online resources.
People-friendly lighting controls – User performance and feedback on different interfaces
Authors: Yılmaz FS , Ticleanu C , Howlett G , King S , Littlefair PJ
Published: April 2015

This study aimed to investigate user reactions to lighting controls and to develop guidance on achieving people-friendly user interfaces. An experimental study was conducted in the Building Research Establishment (BRE) lighting laboratory. A total of 24 participants were brought in and asked to control the lighting in a room in various ways. Their success and any causes of confusion or failure were noted; a questionnaire was completed for each participant. In general, participants preferred simple and familiar control types, although they did appreciate being able to change the lighting colour. Controls needed to respond quickly and give visual feedback to the user. Users preferred slide dimmers which allowed them to set their preferred level. Pre-set levels or ‘scenes’ were less popular. Lighting controls needed to be recognisable to avoid unnecessary detail and duplication.
Reliability and Responsiveness of Upper Limb Motor Assessments for Children With Central Neuromotor Disorders
Authors: Gerber Corinna N. , Labruyère Rob , van Hedel Hubertus J. A.
Published: April 2015

Background. To investigate the effectiveness of upper limb rehabilitation, sound measures of upper limb function, capacity, and performance are paramount. Objectives. This systematic review investigates reliability and responsiveness of upper limb measurement tools used in pediatric neurorehabilitation. Methods. A 2-tiered search was conducted up to July 2014. The first search identified upper limb motor assessments for 1- to 18-year-old children with neuromotor disorders. The second search examined the psychometric properties of the tools. Methodological quality was rated according to COSMIN guidelines, and results for each tool were assembled in a “best evidence synthesis.” Furthermore, we delineated whether tools were unimanual or bimanual tests and if they measured recovery or did not distinguish between physiological and compensatory movements. Results. The first search delivered 2546 hits. Of these, 110 articles on 51 upper limb assessment tools were included. The second search resulted in 58 studies on reliability, 11 on measurement error, and 10 on responsiveness. Best evidence synthesis revealed only 2 assessments with moderate positive evidence for reliability, whereas no evidence on measurement error and responsiveness was found. The Melbourne Assessment showed moderate positive evidence for interrater and a fair positive level of evidence for intrarater reliability. The Pediatric Motor Activity Log Revised revealed moderate positive evidence for test–retest reliability. Conclusions. There is a lack of high-quality studies about psychometric properties of upper limb measurement tools in children with neuromotor disorders. To date, upper limb rehabilitation trials in children and adolescents risk being biased by insensitive measurement tools lacking reliability.
Inadvertent Detachment of a Retrievable Intracranial Stent: Review of Manufacturer and User Facility Device Experience
Authors: Yub Lee Sang , Won Youn Sung , Kyun Kim Ho , Rok Do Young
Published: April 2015

Few systematic surveys have dealt with the potential procedural risks associated with the use of retrievable intracranial stents [Solitaire Flow Restoration (Solitaire FR)], which have become effective tools for recanalizing acutely occluded cerebral arteries. The aim of this study was to present the real-world experiences of Solitaire-FR-related adverse events by reviewing the MAUDE (Manufacturer and User Facility Device Experience) as published on the United States Food and Drug Administration website. In total, 85 adverse events related to the use of the Solitaire FR stent were reported between March 2012 and October 2014. In 80 patients these adverse events were attributable to inadvertent detachment of the device. Thirteen of these 80 patients (16%) died after the procedure. Morbidity data were available in 62 patients, among whom 11 (18%) had suffered a procedure-related injury. Detachment occurred at the first, second, and third pass in nine (21%), 21 (49%), and 13 (30%) of the 43 patients for whom this information was available, respectively. Resistance was perceived by the physician during retrieval of the device in 12 patients, and lesion characteristics were noted in 13. A rescue maneuver was reported in 20 (25%) of the 80 patients in whom the adverse event was attributable to detachment of the device, resulting in flow reestablishment in 13 (65%). The risk of inadvertent detachment during stent retrieval cannot be overemphasized in real-world scenarios, and careful consideration of the “dos and don’ts” is essential for the achievement of a safe procedure.
Are we ready to predict percutaneous nephrolithotomy (PCNL) stone-free failure?
Authors: Gadzhiev Nariman , Brovkin Sergei , Grigoryev Vladislav , Dmitriev Vladimir , Baketin Pyotr , Obidnyak Vladimir , Pisarev Aleksei , Shkarupa Dmitry , Tagirov Nair , Korol Valeriy , Petrov Sergei
Published: April 2015

Objective:

To develop a tool, both simple and reliable, for postoperative percutaneous nephrolithotomy (PCNL) stone-free failure prediction.

Materials and methods:

We analysed a sample of 116 patients, who underwent conventional PCNL from 2011 to 2014. Cases with residual stones ⩽ 4 mm in size were regarded as clinically insignificant and ‘stone-free’.

Results:

According to the low-dose computed tomography (CT) scan performed within 24 hours after operation, the patients were stratified as follows: 72 stone-free and 44 with residual stones. Among the analysed variables, three were derived as most important for prediction purposes: an additional stone in a calyx with an acute angle (⩽ 45°), represented by ‘A’; an additional stone in a long calyx (⩾ 10 mm) with a narrow infundibulum (⩽ 8mm), represented by ‘C’; and a stone size that is > 24 mm, represented by ‘S’. These were abbreviated as the ‘ACS’ score. Depending on the absence or presence of each of these three variables, a score of 0 or 1 was assigned. If the ACS score is 0, then the probability of being a stone-free patient was about 88%; however, when the ACS score is 3, then the probability of being stone free was just 8%.

Conclusion:

Use of the ACS score seemed to be a simple and reliable tool for PCNL stone-free failure prediction.
Distal Radioulnar Joint Instability
Authors: Mirghasemi Ali R. , Lee Daniel J. , Rahimi Narges , Rashidinia Shervin , Elfar John C.
Published: April 2015

Distal radioulnar joint (DRUJ) instability is a common clinical condition but a frequently missed diagnosis. Both surgical and nonsurgical treatments are possible for chronic cases of DRUJ instability. Nonsurgical treatment can be considered as the primary therapy in less active patients, while surgery should be considered to recover bone and ligament injuries if nonsurgical treatment fails to restore forearm stability and function. The appropriate choice of treatment depends on the individual patient and specific derangement of the DRUJ
Making Sense of Mobile Technology
Authors: Pauleen David , Campbell John , Harmer Brian , Intezari Ali
Published: April 2015

Mobile technologies have facilitated a radical shift in work and private life. In this article, we seek to better understand how individual mobile technology users have made sense of these changes and adapted to them. We have used narrative enquiry and sensemaking to collect and analyze the data. The findings show that mobile technology use blurs the boundaries between work and private life, making traditional time and place distinctions less relevant. Furthermore, work and private life can be integrated in ways that may be either competitive or complementary. We also observed an effect rarely discussed in the literature—the way personal and professional aspirations affect how work and private life are integrated. Implications include the need for researchers and organizations to understand the wider consequences that arise from the integration of work and private life roles.
The Ethnonym Geordie in North East England
Authors: Pearce Michael
Published: April 2015

AbstractWhat are the origins and history of the ethnonym Geordie in North East England? How does this history — which according to some authorities has never adequately been explained — help us to understand its current usage and meanings? I attempt to answer these questions by drawing on evidence from a range of sources (including newly available material in the British Newspaper Archive).
Approaches to Research in Toponymy
Authors: Tent Jan
Published: April 2015

AbstractThere are two basic ways to conduct toponymic research — one concentrating on the etymology, meaning, and origin of toponyms, and one focusing on the toponyms of a region and examining patterns of these names. Usually, this distinction is not explicitly recognized. This paper considers the differences between the two approaches and proposes guidelines for their use.
Meniscus repair using mesenchymal stem cells – a comprehensive review
Authors: Yu Hana , Adesida Adetola B , Jomha Nadr M
Published: April 2015

The menisci are a pair of semilunar fibrocartilage structures that play an essential role in maintaining normal knee function. Injury to the menisci can disrupt joint stability and lead to debilitating results. Because natural meniscal healing is limited, an efficient method of repair is necessary. Tissue engineering (TE) combines the principles of life sciences and engineering to restore the unique architecture of the native meniscus. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential both in vitro and in vivo. This comprehensive review examines the English literature identified through a database search using Medline, Embase, Engineering Village, and SPORTDiscus. The search results were classified based on MSC type, animal model, and method of MSC delivery/culture. A variety of MSC types, including bone marrow-derived, synovium-derived, adipose-derived, and meniscus-derived MSCs, has been examined. Research results were categorized into and discussed by the different animal models used; namely murine, leporine, porcine, caprine, bovine, ovine, canine, equine, and human models of meniscus defect/repair. Within each animal model, studies were categorized further according to MSC delivery/culture techniques. These techniques included direct application, fibrin glue/gel/clot, intra-articular injection, scaffold, tissue-engineered construct, meniscus tissue, pellets/aggregates, and hydrogel. The purpose of this review is to inform the reader about the current state and advances in meniscus TE using MSCs. Future directions of MSC-based meniscus TE are also suggested to help guide prospective research.
Effects of blended e-Learning: a case study in higher education tax learning setting
Authors: Lee Li-Tze , Hung Jason C
Published: April 2015

This article has two main objectives. First, we describe the design of an e-learning system for a University Income Tax Law course. Second, we analyze and explore learning results in terms of students’ learning satisfaction and learning achievement. Learning achievement was examined by questions derived from the course content while learning satisfaction was analyzed based on an adaptation of the Technology Acceptance Model (TAM).

Results indicate that neither gender nor the school system affect students’ e-learning system satisfaction. Since students’ knowledge and exposure to computers are equal regardless of gender or educational background this reduces the significance of both these variables. Participating samples are divided into three groups: traditional, fully on-line and blended learning. We find, however, a statistically significant difference existed in learning achievement among groups. The blended learning group, combining on- line learning with paper-and-pencil testing, has the best learning achievement among the three groups.
Introduction
Authors: Currah Paisley , Stryker Susan
Published: April 2015

In this introduction to the special issue of TSQ: Transgender Studies Quarterly on the theme “making transgender count,” the authors delineate the senses in which trans people can count. On one hand, one makes trans count (in the sense of having its importance recognized) by counting it (making it visible through quantification). On the other hand, one makes (i.e., compels) trans count by forcing atypical configurations of identity into categories into which they do not quite fit—the proverbial square peg in a round hole. In this way, the imperative to be counted becomes another kind of normativizing violence that trans subjects can encounter and hence another problematic to be critically interrogated by the field of transgender studies. The tensions among what to count, whom to count, how to count, why to count, or whether to count or be counted at all are explored in this issue's articles. What makes the notion of trans* such a fecund point of departure for work in transgender studies is that the definitional lines of the concept are moving targets. That very instability frustrates the project of fixing embodied identities in time and space—a requisite operation for the potentially life-enhancing project of counting trans populations and better addressing their needs as well as for the necropolitical project of selecting certain members of the population for categorical exclusion as dysgenic. The essays in this issue do not resolve the tension between efforts to refine techniques of governmental reason and strategies of resistance, between attempts to sedentarize trans identities and movements that refuse such settling, or between universalizing imperatives to classify and local demands to reject incorporation into a global schematics of gender difference organized by male/female, man/woman, cis-/trans-, trans-/homo-, or white/color dichotomies. Some attempt to do both, while all ultimately fall on one side or the other of various problematics. Our goal in curating this issue has been less to gather a collection of articles that definitively settle these vexed questions than to stage a conversation in which the stakes of the game are made visible.
Solvent Effect on Fluorescence Properties of Stilbene Dendrimer Surrounded by Benzyl-Ether Dendrons
Authors: Nakazato Satoshi , Arai Tatsuo
Published: April 2015

The fluorescence maximum of the fourth generation of stilbene-cored dendrimer (trans-G4) was affected by solvent polarity. These results indicated that the core of even higher generation dendrimer was not isolated from solvent molecules and the environment of the dendrimer core is constructed by both surrounding dendron groups and penetrated solvent molecules.
Reforming LIBOR and Other Financial Market Benchmarks
Authors: Duffie Darrell , Stein Jeremy C.
Published: April 2015

LIBOR is the London Interbank Offered Rate: a measure of the interest rate at which large banks can borrow from one another on an unsecured basis. LIBOR is often used as a benchmark rate— meaning that the interest rates that consumers and businesses pay on trillions of dollars in loans adjust up and down contractually based on movements in LIBOR. Investors also rely on the difference between LIBOR and various risk-free interest rates as a gauge of stress in the banking system. Benchmarks such as LIBOR therefore play a central role in modern financial markets. Thus, news reports in 2008 revealing widespread manipulation of LIBOR threatened the integrity of this benchmark and lowered trust in financial markets. We begin with a discussion of the economic role of benchmarks in reducing market frictions. We explain how manipulation occurs in practice, and illustrate how benchmark definitions and fixing methods can mitigate manipulation. We then turn to an overall policy approach for reducing the susceptibility of LIBOR to manipulation before focusing on the practical problem of how to make an orderly transition to alternative reference rates without raising undue legal risks.
The ACCE method: an approach for obtaining quantitative or qualitative estimates of residual confounding that includes unmeasured confounding
Authors: Smith Eric G.
Published: April 2015

Background:  Nonrandomized studies typically cannot account for confounding from unmeasured factors. 

Method:  A method is presented that exploits the recently-identified phenomenon of  “confounding amplification” to produce, in principle, a quantitative estimate of total residual confounding resulting from both measured and unmeasured factors.  Two nested propensity score models are constructed that differ only in the deliberate introduction of an additional variable(s) that substantially predicts treatment exposure.  Residual confounding is then estimated by dividing the change in treatment effect estimate between models by the degree of confounding amplification estimated to occur, adjusting for any association between the additional variable(s) and outcome.

Results:  Several hypothetical examples are provided to illustrate how the method produces a quantitative estimate of residual confounding if the method’s requirements and assumptions are met.  Previously published data is used to illustrate that, whether or not the method routinely provides precise quantitative estimates of residual confounding, the method appears to produce a valuable qualitative estimate of the likely direction and general size of residual confounding.

Limitations:  Uncertainties exist, including identifying the best approaches for: 1) predicting the amount of confounding amplification, 2) minimizing changes between the nested models unrelated to confounding amplification, 3) adjusting for the association of the introduced variable(s) with outcome, and 4) deriving confidence intervals for the method’s estimates (although bootstrapping is one plausible approach).

Conclusions:  To this author’s knowledge, it has not been previously suggested that the phenomenon of confounding amplification, if such amplification is as predictable as suggested by a recent simulation, provides a logical basis for estimating total residual confounding. The method's basic approach is straightforward.  The method's routine usefulness, however, has not yet been established, nor has the method been fully validated. Rapid further investigation of this novel method is clearly indicated, given the potential value of its quantitative or qualitative output.
Laryngeal mask placement in a teaching institution: analysis of difficult placements
Authors: Katsiampoura Anastasia D , Killoran Peter V , Corso Ruggero M , Cai Chunyan , Hagberg Carin A , Cattano Davide
Published: April 2015

Background: Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program.

Methods: This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved.

Results: Sixty-nine unique Laryngeal Mask Airways (uLMAs) were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%.

Conclusion: In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.
Subject of Law: Sociologist’s Opinion
Authors: Khlopaeva Natalya
Published: April 2015

This article reviews the behavioral aspect of law as one of core factors of laws’ efficiency. In order to overcome gaps between law-making, legal consciousness and law enforcement, the author suggests investigating motives of the subject’s choice of this or that strategy for its legal status’ enforcement. On the basis of general scientific cognitive methods such as comparison method, historical method, analysis and synthesis methods, the author offers her own model typology through which the subject of law enforces its status. Factors of efficient enforcement of a government employee’s status are considered in the context of the administrative reform, as well as the global tendency to transition to the concept of a service-oriented state. The author identifies ways of overcoming restrictions in the process of assimilation of management concepts and technologies from business into the state management sphere. The author suggests expanding the list of government employees’ performance indicators through the inclusion of qualitative criteria, as well as through implementation of relevant educational programs.
On Economic Analysis Theory in Fiscal Law (Conceptual Framework)
Authors: Khavanova Inna
Published: April 2015

The article is devoted to economic analysis’ conceptual framework in the tax law. The author examines modern aspects of the correlation between Law and Economics, the content of the principle of the economic basis for tax, expresses her opinion on the matter of the possibility to verify the economic feasibility of taxes and fees in the context of constitutional proceedings. Special attention is attributed to the issues of application of economic analysis’ methodological tools in tax law. In 2012, while considering tax disputes arbitration courts focused on the application of economic analysis. Based on the analysis of law enforcement practice, the author identifies problematic issues in the use of economic analysis in the tax law interpretation, defines the scope of economic analysis and its specific features. The article introduces concepts of “economic and legal impact area” and “economic and legal impact coverage area”, identifies their characteristics and specific features of a regulatory nature.
Spontaneously Developed Bisphosphonate Related Osteonecrosis of the Jaws: Three Cases
Authors: Ates Ufuk , Gulsahi Ayse
Published: April 2015

Aim: The aim of this case report is to present the clinical and radiologic diagnose of the spontaneously developed bisphosphonate-related osteonecrosis of the jaws in the edentulous patients. 
Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a common side effect of long term bisphosphonate therapy. It is characterized with the presence of exposed necrotic bone appearing in the jaws of patients treated bisphosphonates never irradiated in the head and neck area. BRONJ lesions may occur spontaneously or at the site of a dentoalveolar procedure. Clinically evident lesions are confirmed through radiographs showing poorly defined radiolucent- radiopaque lesions. At present, no predictable remedy is available for BRONJ. 
Case Description: Three edentulous male patients were referred to our clinic for non-healing defect in the posterior region of the mandible. Medical anamnesis revealed prostate carcinoma and the use of zoledronate (Zometa). Clinical examinations showed oval shaped defect or exposed necrotic bone. Digital panoramic radiographs revealed destructive radiolucent area. Biopsy was performed for the exclusion of the metastic disease and revealed inflammation consistent with osteomyelitis. Treatment protocol included systemic antibiotic therapy and conservative surgical treatment. 
Clinical Significance: BRONJ should be mentioned that presence of exposed necrotic bone or non-healing oral mucosa in patients with a history of bisphosphonate use without a history of dentoalveolar procedures.
Primary Anorectal Melanoma-Uncommon Entity and Rare Presentation
Authors: Malhotra Parveen , Malhotra Naveen , Malhotra Vani , Chugh Ajay , Dahiya Abhisekh Hemant
Published: April 2015

Background: Malignant melanomas of the gastrointestinal (GI) tract are usually metastatic. Primary malignant melanoma of the GI tract is rare and occurs mainly in the anorectum and esophagus, but can also involve stomach rarely.  Case: We report a case of 65-year-old female who presented with short duration of anemia but on detailed evaluation had primary Anorectal melanoma (ARM) with extensive metastasis.  Conclusion: An evaluation of short duration of anemia led to unexpected widely metastasized primary anorectal melanoma. Hence anemia presenting at old age should be evaluated in detail including endoscopy of whole gastro-intestinal tract to rule out malignancy.
Inferior epigastric artery pseudoaneurysms
Authors: Edwards KJ , Avula SK , Babu BDH , England RA
Published: April 2015

Introduction

Inferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication.

Methods

We describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000.

Findings

The main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique.

Conclusions

The incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.
Human factors in decision making in major trauma in Camp Bastion, Afghanistan
Authors: Arul GS , Pugh HEJ , Mercer SJ , Midwinter MJ
Published: April 2015

Introduction

The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements.

Methods

We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR–DCS). This system identifies four key stages: ‘command huddle’, ‘snap brief’, ‘sit-reps’ (situation reports) and ‘sign-out/debrief’. The attitude of staff to communication and decision making is also evaluated.

Results

Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff were collected. All patients were haemodynamically shocked with a median pH of 7.25 (range: 6.83–7.40) and a median of 18 units of mixed red cells and plasma were transfused. In 89% of instances, theatre staff were aware of what was required of them at the beginning of the case, 86% felt there were regular updates and 93% understood what was required of them as the case progressed.

Conclusions

The evolution of the hospital at Camp Bastion has been a unique learning experience in the field of major trauma. The Defence Medical Services have responded with continuous innovation to optimise DCR–DCS for seriously injured patients. Together with the improvements in clinical care, a communication and decision making matrix was developed. Staff evaluation showed a high degree of satisfaction with the quality of communication.
Port site metastases following laparoscopic liver resection for hepatocellular carcinoma
Authors: Maarschalk J , Robinson SM , White SA
Published: April 2015

A laparoscopic approach is being used increasingly in specialist centres for the resection of hepatocellular carcinomas and compares favourably with the traditional open approach, in terms of perioperative morbidity and mortality as well as long-term survival. We present a case of port site recurrence in a patient who underwent a laparoscopic left lateral segmentectomy for a hepatocellular carcinoma diagnosed during investigation of symptomatic gallstones. Nearly three years following surgery, surveillance computed tomography demonstrated a suspicious lesion at the site of one of the laparoscopic ports. Further resection was carried out and the lesion was confirmed histologically to be an isolated recurrence of the primary hepatocellular carcinoma, involving peritoneum and adominal wall. This case demonstrates that it is possible to encounter port site metastasis following laparoscopic resection of primary liver tumours although the incidence is very rare.
Recurrent Warthin’s tumour of the larynx
Authors: Hilton A , Pankhania M , Jose J
Published: April 2015

Warthin’s tumours, or adenolymphomas, present commonly as masses of the parotid glands and salivary tissue. However, in the existing literature, few cases of laryngeal adenolymphomas are described. We report the case of a 60-year-old woman with a recurrent right-sided laryngeal adenolymphoma, and discuss the difficulties in diagnosis and management.
Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis
Authors: Bokhari S , Kulendran M , Liasis L , Qurashi K , Sen M , Gould S
Published: April 2015

Introduction

Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP).

Methods

A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed.

Results

Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001).

Conclusions

A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP.
Radiological considerations and surgical planning in the treatment of giant parathyroid adenomas
Authors: Garas G , Poulasouchidou M , Dimoulas A , Hytiroglou P , Kita M , Zacharakis E
Published: April 2015

Giant parathyroid adenomas constitute a rare clinical entity, particularly in the developed world. We report the case of a 53-year-old woman where the initial ultrasonography significantly underestimated the size of the lesion. The subsequent size and weight of the adenoma (7cm diameter, 27g) combined with the severity of the hypercalcaemia raised the suspicion for the presence of a parathyroid carcinoma. This was later disproven by the surgical and histological findings. Giant parathyroid adenomas are encountered infrequently among patients with primary hyperparathyroidism, and appear to have distinct clinical and biochemical features related to specific genomic alterations. Cross-sectional imaging is mandated in the investigation of parathyroid adenomas presenting with severe hypercalcaemia as ultrasonography alone can underestimate their size and extent. This is important since it can impact on preoperative preparation and planning as well as the consent process as a thoracic approach may prove necessary for certain cases.
Why authors have to use a rigid format for their journal articles
Authors: Heseltine E
Published: April 2015

‘Proper words in proper places make the true definition of style.’

Jonathan Swift

Medical writing is a creative process. It combines rhetoric and science to produce a piece of work that connects the scientific community with the general public. However, despite pressure to publish, many researchers dread the thought of medical writing. It can be an intimidating journey and hard work – and after all, where does one learn how to write a good science paper? Is there a recipe for success?

The answer lies in the IMRaD (Introduction, Methods, Results and Discussion) structure. This allows authors to organise and structure their work in an effective manner, which maintains the emphasis on the matter of good science.

Some may think applying such a structure is too formulaic and breeds mediocrity. Others may believe IMRaD allows authors to organise thoughts and ideas as well as helping them to remember to convey critical elements. That it makes evaluation of a manuscript easier for editors and reviewers and also allows readers to locate specific information without going through the entire article is less contentious.

Although the IMRaD structure may not reflect the order of scientific enquiry and activities, most journals continue to apply it to medical articles. It appears that having such a discipline to writing opens the doors to those who have not yet overcome their writer’s block.

In the third article of the publishing series, Elisabeth Heseltine informs readers ‘how to write’. Elisabeth became a scientific editor through science rather than language. She has worked as a researcher on the BBC science programme Horizon, as a proof-reader and then as a copy-writer. She is head of publications at the World Health Organization International Agency for Research on Cancer, in Lyon, France. She has edited many documents for other United Nations agencies and for research institutes around the world. She also runs workshops in scientific communication in over 30 countries.

JYOTI SHAH

Commissioning Editor
Increase in Bcl2 expression of penile and prostate cells of Sprague Dawley male rats following treatment with buceng (combination of Pimpinella alpina molk with Eurycoma longifolia Jack)
Authors: Nasihun Taufiqurrachman
Published: April 2015

Background: Treatment with buceng combination of Eurycoma longifolia Jack and Pimpinella alpine Molk has been proven to increase testosterone level, decrease apoptosis and caspase3 expression. Bcl2 is an antiapoptotic protein found in cytoplasm which inhibits cells apoptosis. This study was aimed to investigate the effect of buceng on Bcl2 expression on penile and prostate tissues of the rats. Methods: In this experimental study, 24 male Sprague Dawley rats of 90 days old, weighing ± 300 grams, were randomly assigned into four groups. Group A, normal rats. Group B, castrated rats and treated with buceng 100 mg/day, per oral (Cast-Bcg); Group C, castrated rats and treated with 2 ml of water as placebo against buceng (Cast-Plac). Group D, castrated rats, treated with mesterolone 6.75 mg/day, per oral, as exogenous testosterone (Cast-Mest). All rats were treated for 30 days. Manova test was used to analyze the different expression of Bcl2 among groups with significance level at p ≤ 0.05. Results: Castration was associated with significant decrease of Bcl2 expression in the penile and prostate tissues (53.0 and 50.9%, respectively) compared to normal rats (82.6 and 84.2%, respectively, p < 0.001). Treatment with mesterolone reversed Bcl2 expression (77.1 and 78.1%) to a near normal level. The same level of Bcl2 expression was also observed with buceng treatment (73.8 and 78.2%).Conclusion: The treatment with buceng could enhance Bcl2 expression in penile and prostate tissues, comparable to normal rats and mesterolone treated rats.
Correlation between peripapillary retinal nerve fiber layer thickness and visual function changes in patients receiving ethambutol
Authors: Dialika Dialika , Sidik Muhammad , Nusanti Syntia , Kekalih Aria
Published: April 2015

Background: Recent animal studies revealed the decreased amount of retinal ganglion cells after treatment with ethambutol. The aim of this study was to evaluate the changes of peripapillary retinal nerve fiber layer (RNFL) thickness in patients receiving ethambutol therapy, as well as to know the correlation of RNFL thickness changes with the changes of visual function.Methods: This was a cohort study on 29 subjects at one tuberculosis treatment center, Jakarta. Subjects underwent RNFL thickness measurement using optical coherence tomography (OCT) and several visual function parameters (visual acuity, contrast sensitivity, color sensitivity and visual field) before and two-months following ethambutol therapy. Statistical comparison between pre- and post- ethambutol measurements were done using either paired T-test or Wilcoxon test. Correlations between anatomical and functional changes were assessed with Spearman correlation test. Results: There were significant changes of peripapillary RNFL thickness in superior (147 and 141 μm, p = 0.001), nasal (92 and 88 μm, p = 0.045) quadrants and average RNFL thickness (116.77 and 112.65 μm, p = 0.001). No significant correlation between RNFL thickness changes and the changes of visual function parameters (p > 0.05).Conclusion: Ethambutol consumption for two months in recommended dose is still considered safe to human retina and visual status.
Optimizations of expression and purification of recombinant HIV-1 CRF01_AE p24 protein in Escherichia coli for development of immunodiagnostic assay
Authors: Simaremare Ade P.R. , Bela Budiman , Yasmon Andi , Ibrahim Fera
Published: April 2015

Background: Conventional method for confirmation of HIV infection is Western blot. However, it has limitations because of contamination by human cellular antigen and genetic diversity among the HIV-1 subtypes that show indeterminate result and inaccuracy for the diagnosis of different strains. Most of Western blot developed are based on HIV-1 B subtype. In Indonesia HIV-1 CRF01_AE subtype is dominantly circulated. Therefore, we optimized the expression, purification of the recombinant HIV-1 CRF01_AE p24 protein for development of immunodiagnostic assay.Methods: Optimization of protein expression in Escherichia coli strain BL21CP was performed including induction time, isopropyl-1-thio-d-galactopyranoside (IPTG) and immidazole consentrations, and induction temperature. Purification of the recombinant p24 protein was used by using Ni-NTA (Qiagen) purification system in native condition. Results: Expression and purification of HIV-1 CRF01_AE p24 protein have been performed. Confirmation of the recombinant protein by Western blot showed the expression and purification of recombinant p24 protein has been optimized well and reactive with sera of patients with HIV-1 CRF01_AE subtype positive.Conclusion: The recombinant HIV-1 CRF01_AE p24 protein has been expressed and purified successfully, and it is potential to be used as antigen for immunodiagnostic assay.
Palmaris longus absence in six largest Indonesian ethnicities and its relationship with gender, ethnicity, and hand dominance
Authors: Hadi Syaiful A. , Masri Dody P.
Published: April 2015

Background: Palmaris longus (PL) tendon is often used as graft in tendon or ligament reconstruction. PL absence is a normal variation in human body. Its prevalence was different in various population. Serbian population had an absence rate of 42.4%, but in the Korean population it was only 4.0%. This study aimed to determine the prevalence of PL absence in various ethnic of Indonesian population and its relationship with gender and side of hand dominance. Methods: We conducted a cross-sectional study in 1230 people from six ethnicities in Indonesia. The absence of PL was determined by Schaeffer test and confirmed with Mishra and Thompson test. Data collection was performed by a single examiner in various cities in Indonesia. The relationship between PL absence with ethnicity, gender, and hand dominance were determined by Chi-square test. Results: Prevalence of PL absence in overall Indonesian population was 10.4% (bilateral 37.5% and unilateral 62.5%). The highest were in Batak and Madura ethnicities (15.5%), followed by Sunda (11.8%), Java (10.0%), Betawi (6.0%), and the lowest was Minang ethnicity (4.1%) (p = 0.008). Prevalence of PL absence in female and male were 10.7% 10.2%, respectively, p > 0.05).Conclusion: Compared to range of prevalence in other countries in the world, prevalence of PL absence in Indonesian population was moderate (10.4%). There was significant difference found between ethnicity, but not in gender. Surgeon should consider this data when planning for reconstruction procedures using PL graft in Indonesian population.
Earthshipak: Bideragarriak al dira hornidura-sareetara konektatzea behar ez duten etxebizitza ekologikoak Euskal Autonomia Erkidegoan?
Authors: Zarrabeitia Enara , Alvarez Izaskun
Published: April 2015

Earthshipek eraikuntza konbentzionalaren eredua erabat eraldatu dute.Azken urteotan, hain zuzen, bioeraikuntzaren oinarriak aplikatuz hainbat etxebizitza mota eraiki dira, baina haien artean earthshipak izan dira etxebizitza konbentzionalekiko haustura nabarmenena ekarri dutenak. Hala, gaur egun praktikan dagoen eraikuntza-ereduak eraldaketa bat igaro behar duela esateak ez digu ekarpen berririk egiten, jakina baita, eredu horrek ez duela helburu gisa jendartearen eta ingurumenaren oreka. Gure ingurua etengabe urratzen duen eraikuntza-ereduak muga jo du edo joko du. Kontu horri erreparatzen dio, hain zuzen, earthship filosofiak: inguruaren eta gizakien arteko oreka erabatekoa helburu modura duen eraikuntza-eredua. Lehenengo earthshipa Taosen (Mexiko Berrian) eraiki zen orain dela berrogei bat urte, eta gaur egun, mundu osoan zehar 3.000 baino gehiago daude, baina Euskal Autonomia Erkidegoan guztiz ezezaguna da eraikuntza mota hori. Horregatik, ikerlan honetan aztertuko da earthshipak zer diren, berauen oinarriak zein diren, eta Euskal Autonomia Erkidegoan ere bideragarriak ote diren.
Is a coherence theory of understanding possible?
Authors: Gijsbers Victor
Published: April 2015

Coherence is a measure of how much our beliefs hang together. Understanding is achieved when we see that something is not just a brute, isolated fact. This suggests that it might be possible to develop a coherence theory of understanding, which is what we attempt to do in this article using several formal measures of coherence. However, it turns out that a coherence theory runs into trouble with the asymmetry of understanding. We identify four difficulties and give suggestions for how they could be solved. These solutions all point away from coherence and towards a rather different notion, unification, which casts some (though not conclusive) doubt on the possibility of a coherence theory of understanding.
Causality and Unification: How Causality Unifies Statistical Regularities
Authors: Schurz Gerhard
Published: April 2015

Two key ideas of scientific explanation - explanations as causal information and explanation as unification - have frequently been set into mutual opposition.  This paper proposes a "dialectical solution" to this conflict, by arguing that causal explanations are preferable to non-causal explanations because they lead to a higher degree of unification at the level of the explanation of statistical regularities. The core axioms of the theory of causal nets (TC) are justified because they give the best if not the only unifying explanation of two statistical phenomena: screening off and linking up. Alternative explanation attempts are discussed and it is shown why they don't work. It is demonstrated that not the core of TC but extended versions of TC have empirical content, by means of which they can generate independently testable predictions.