bluuebunny/crossref_metadata_2025 huggingface dataset:
Albumin/Hetastarch Drug Utilization Review in an Operating Room Pharmacy
Authors: Donnelly Andrew J.
Published: May 2016

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12 346.00 could be realized by the Department of Pharmacy.
Population Pharmacokinetics: Development of a Medical Intensive Care Unit-Specific Gentamicin Dosing Nomogram
Authors: Watling Sharon M. , Kisor David F.
Published: May 2016

Objective

This study was designed to develop a population-specific dosing nomogram for gentamicin in medical intensive care unit (MICU) patients using the population pharmacokinetic program nonparametric expectation maximization (NPEM).

Design

Observational clinical gentamicin dosing data were collected, entered into the USC*PACK database program PASTRX, and downloaded into the population pharmacokinetic program NPEM. NPEM generated population pharmacokinetic parameter values that were used to develop a gentamicin dosing nomogram. The nomogram was tested in the next 15 patients admitted to MICU to determine accuracy. Doses given per the MICU and the Hull-Sarubbi nomograms were compared with doses based on actual patient-specific pharmacokinetic parameter values. Reliability coefficients (intraclass correlation coefficients) were calculated to assess the agreement between observations.

Setting

Data were gathered from patients receiving gentamicin therapy in the MICU, Presbyterian University Hospital, Pittsburgh.

Patients

Baseline population pharmacokinetic parameter values were determined in 36 MICU patients receiving gentamicin therapy. Patients with renal failure receiving hemodialysis or another mechanical method of blood clearance or fluid removal were excluded. The population parameter values in the form of a dosing nomogram were then used prospectively to dose gentamicin in 15 patients.

Results

NPEM generated population parameter values similar to those previously published using the Sawchuk-Zaske method in ICU patients. The mean volume of distribution generated using NPEM was 0.34 ± 0.12 L/kg. The relationship between creatinine clearance (Clcr) and elimination rate constant (Ke) was: Ke = 0.00218 x Clcr + 0.007. The nomogram-derived doses correlated with doses determined by using actual patient-specific pharmacokinetic values (p<0.05). The Hull-Sarubbi derived doses, however, did not correlate with patient-specific doses (p>0.05). Only one patient had a peak concentration <6 mg/L. Two of 15 patients had trough concentrations prior to the first maintenance dose >2 mg/L.

Conclusions

The use of NPEM to generate population-specific pharmacokinetic parameter values has been previously described. Application of population-specific dosing nomograms can improve initial dosing regimens such that conventional therapeutic concentrations can be achieved early in therapy. This nomogram, however, does not preclude follow-up patient-specific pharmacokinetic analysis.
Inappropriate Use of High-Dose Glyburide to Treat Uncontrolled Type 2 Diabetes Mellitus
Authors: Rae Charlesworth E. , Ewing Robert C. , Cook Dee Dee
Published: May 2016

Objective

To report a case of chronic glyburide overdose.

Case Summary

A patient with noninsulin-dependent diabetes mellitus (NIDDM) who had previously developed secondary failure while taking a maximal dosage of glipizide was switched to glyburide 5 mg/d. The patient initially experienced adequate glycemic control while taking glyburide, but subsequently experienced deterioration in glycemic control. This necessitated gradual increases in the dosage of glyburide until the maximum dosage of 20 mg/d was reached. Because the patient's diabetic control did not improve with this dosage of glyburide, she decided independently to increase the dosage further. She ingested an average daily dose of 37.7 mg of glyburide over the 18 days that preceded her clinic visit without experiencing any glyburide-related adverse effects.

Discussion

Progression of NIDDM may be responsible for the development of secondary sulfonylurea failure in NIDDM patients treated with oral sulfonylurea drugs. Consequently, these patients should be treated as patients dependent on insulin.

Conclusions

NIDDM patients treated with oral sulfonylurea drugs require long-term blood glucose monitoring to detect the development of secondary sulfonylurea failure. Patients who experience secondary failure to a particular sulfonylurea drug do not appear to develop long-term blood glucose control when switched to a different oral sulfonylurea drug. These patients should be treated with insulin therapy.
Suspected Nafcillin-Induced Interstitial Nephritis
Authors: Guharoy Sudip Roy , Kar Sheila , Mcgalliard James
Published: May 2016

Objective

To present a case of nafcillin-induced interstitial nephritis.

Methodology

Case report and literature review.

Setting

Hospital.

Results

Three days following initiation of nafcillin therapy for staphylococcal pneumonia, an 80-year-old woman developed allergic manifestations and progressive renal impairment suggestive of acute allergic interstitial nephritis. These manifestations were completely reversed within 96 hours of cessation of nafcillin therapy.

Conclusions

In the clinical setting of acute renal failure in a patient on nafcillin therapy, acute interstitial nephritis should be considered. Prompt cessation of nafcillin therapy has generally been associated with reversal of symptoms and an improvement in renal function.
Retroperitoneal Abscess Caused by Mycobacterium Chelonae and Treatment
Authors: Idemyor Vincent , Cherubin Charles E.
Published: May 2016

Objective

To report a case of retroperitoneal abscess caused by Mycobacterium chelonae and treatment.

Design

Case report.

Setting

Private community teaching hospital.

Patients

A patient was admitted to the hospital following a gunshot to the flank. The bullet passed through the iliac crest and lodged in the abdomen.

Intervention

The patient was treated with cefazolin, trimethoprim/sulfamethoxazole, and amikacin at different times.

Outcome

The patient responded well to pharmacologic treatment and at 18-month follow-up, he is disease free.

Conclusions

Antimicrobial agents with in vitro activity against M. chelonae, especially amikacin-containing regimens, are recommended for treating M. chelonae infection.
Labetalol: Response and Safety in Critically Ill Hemorrhagic Stroke Patients
Authors: Patel Rakesh V. , Kertland Heather R. , Jahns Brian E. , Zarowitz Barbara J. , Mlynarek Mark E. , Fagan Susan C.
Published: May 2016

Objective

To observe and characterize the blood pressure (BP)-lowering and adverse hemodynamic and/or central nervous system effects of intravenous bolus doses of labetalol in hemorrhagic stroke patients.

Design

Observational, prospective, pilot survey conducted over an eight-week period.

Setting

Surgical intensive care unit.

Participants

Patients admitted with an intracerebral or subarachnoid hemorrhage.

Main Outcome Parameters

Absolute decline in systolic BP (SBP) and diastolic BP (DBP), time to peak reduction in SBP and DBP, and adverse hemodynamic and mental status changes.

Results

Labetalol at doses between 5 and 25 mg lowered SBP by 6–19 percent (baseline 152–184 mm Hg) and DBP by 3–26 percent (baseline 50–99 mm Hg). Adverse hemodynamic or mental status changes were not detected following labetalol administration.

Conclusions

Small (≤25 mg) intravenous bolus doses of labetalol produce mild decreases in BP in hemorrhagic stroke patients.
Use of Clonidine to Treat Hot Flashes Secondary to Leuprolide or Goserelin
Authors: Bressler Linda R. , Murphy Christine M. , Shevrin Daniel H. , Warren Richard F.
Published: May 2016

Objective

To determine the effects of clonidine, a centrally acting adrenergic agonist, in abating symptoms of hot flashes in men receiving either leuprolide or goserelin for prostate cancer.

Design

Patients were administered transdermal or oral clonidine 0.1–0.2 mg/d. Dosages were increased in increments of 0.1–0.3 mg/d every two to four weeks if symptoms persisted or until adverse effects developed.

Setting

Medical oncology clinic at the University of Illinois and the hypertension clinic at the Veterans Affairs West Side Medical Center.

Participants

Consenting male patients were eligible for the study if they were receiving leuprolide or goserelin for prostate cancer and were experiencing hot flashes. Exclusion criteria included diastolic blood pressure of 75 mm Hg or below or a history of adverse reactions to clonidine.

Main Outcome Measures

Effectiveness of clonidine was determined by questioning patients about frequency, severity, and duration of hot flashes at baseline and at two- to four-week intervals.

Results

All four patients receiving clonidine experienced a partial response within two weeks of starting treatment. No dose-dependent response was observed. Adverse effects were noted in one patient but did not result in discontinuation.

Conclusions

Our results document the first report of the use of clonidine to treat hot flashes secondary to leuprolide or goserelin therapy. Symptomatic improvement was noted in all four patients. Further evaluation of clonidine as well as other centrally acting adrenergic agonists is needed.
Vigabatrin
Authors: Connelly Julie Faulkner
Published: May 2016

Objective

To introduce the reader to the use of a new agent, vigabatrin, in the treatment of refractory complex partial seizures. Clinical trials and pharmacokinetic data are reviewed, as well as neuropathology, adverse effects, drug interactions, and dosage guidelines.

Data Sources

A MEDLINE search through March 1992 was used to identify pertinent English-language literature, including clinical trials, reviews, abstracts, and conference proceedings. Indexing terms included vigabatrin and anticonvulsants.

Study Selection

All clinical trials (total of 21) were reviewed, as were all pharmacokinetic studies (total of 8). Selected studies highlighting chemistry, pharmacology, neuropathology, and adverse effects were also reviewed.

Data Extraction

Performed subjectively by the author. Trials were assessed by design, sample size, types of seizures of the subjects, and clinical response.

Data Synthesis

Vigabatrin represents the first of a new class of antiepileptic drugs (AEDs)—the gamma-aminobutyric acid transaminase (GABA-T) inhibitors. Vigabatrin works by selective, irreversible inhibition of GABA-T, thus preventing the breakdown of GABA. It has been shown to produce dose-dependent increases in cerebrospinal fluid GABA concentrations, and decreases in GABA-T activity. Vigabatrin may also cause a decrease in excitation-related amino acids. It is well absorbed, is not protein bound, and is eliminated by glomerular filtration. However, even with a short half-life (5–7 h), vigabatrin may be given once or twice daily because of its mechanism of action. Few drug interactions have been reported with this agent, although decreases in phenytoin concentration may reach clinical significance. Concern over neuropathologic findings (microvacuolization of white matter) in animals caused trials of vigabatrin to be halted in 1983, but trials have now resumed as there is no evidence of toxicity in humans. Clinical efficacy of vigabatrin has been evaluated in controlled trials and appears to be most effective in complex partial seizures, producing a 50 percent or greater reduction in seizure frequency in approximately 50 percent of the adult patients studied. Efficacy in children with partial seizures also appears promising, and one uncontrolled study suggests that further study of vigabatrin in infantile spasms may be warranted.

Conclusions

Vigabatrin appears to be effective in treating refractory complex partial seizures in adults and refractory partial seizures in children. Its relatively benign adverse-effect profile and few known drug interactions may give this agent an advantage over existing anticonvulsants. However, definitive conclusions about the role of vigabatrin in epilepsy treatment should await the completion of ongoing Phase II and Phase III trials.
Renal Functional Alterations Induced by Angiotensin-Converting Enzyme Inhibitors in Heart Failure
Authors: Munger Mark A.
Published: May 2016

Objective

To review the effects of angiotensin-converting enzyme (ACE) inhibitors on renal pathophysiology and the compensatory mechanisms involved in heart failure. A clinical application of the use of these agents in the setting of concomitant heart failure and renal insufficiency also is presented.

Data Sources

A MEDLINE search was conducted using the terms heart failure, congestive; renal insufficiency; and angiotensin-converting enzyme inhibitors.

Study Selection

All applicable animal and human trials were reviewed.

Data Synthesis

Advances in the management of heart failure have led to new insights into the complex pathophysiology of this condition, particularly the favorable clinical effects noted with the ACE inhibitors. The net effect of ACE inhibitors on the renin-angiotensin system in patients with heart failure is to augment renal blood flow to a greater extent than cardiac output. Glomerular filtration rate is either unchanged or decreased by ACE inhibition. Sodium excretion is augmented primarily by alterations in glomerular hemodynamic parameters. ACE inhibitors may alter renal tubular function, both directly and indirectly, leading to increased diuresis and natriuresis.

Conclusions

Although ACE inhibitors exert beneficial pharmacodynamic effects on the renal bed in patients with heart failure, clinical consideration of volume and neurohormonal status prior to institution of therapy is prudent.
Use of Trans-Retinoic Acid in the Treatment of Acute Promyelocytic Leukemia
Authors: Dulaney Alice M. , Murgatroyd Rebecca J.
Published: May 2016

Objective

To discuss acute promyelocytic leukemia (APL) and review the literature concerning differentiation treatment of APL with trans-retinoic acid (t-RA).

Data Sources

English-language articles concerning APL or its treatment with t-RA were identified with a MEDLINE search.

Study Selection

All studies available at the time of article preparation, which addressed t-RA treatment in APL, were selected.

Data Extraction

Data extraction and assessment were performed subjectively by the authors. An extensive discussion of specific study details is included in the article.

Data Synthesis

APL is a unique subset of acute myelogenous leukemia and is typified by an accumulation of malignant promyelocytes in the bone marrow. Within the granulocyte cell cycle of a patient with APL, differentiation has been halted at the level of the promyelocyte, preventing formation of mature granulocytes. Upon treatment with traditional cytotoxic chemotherapy, complete remission rates of approximately 70 percent, with a five-year survival ranging from 25 to 40 percent have been achieved. In most patients with APL, a characteristic chromosomal t(15q+;17q-) translocation has been found, which may be responsible for the production of an aberrant retinoic acid receptor-alpha. Therefore, t-RA induction therapy has been investigated and has produced promising results. Administration of t-RA in dosages of 45–100 mg/m2/d has induced complete remissions. The apparent mechanism of t-RA is the induction of promyelocyte differentiation and maturation. The most common adverse effects noted have been dry skin, cheilitis, and headaches.

Conclusions

Upon consideration of the initial trials, t-RA appears to be a promising and unique treatment for APL.
Assessing the Quality of Pharmaceutical Care II. Application of Concepts of Quality Assessment from Medical Care
Authors: Farris Karen B. , Kirking Duane M.
Published: May 2016

Objective

To present a framework that facilitates quality assessment of pharmaceutical care (PC) so that the profession and the public may identify pharmacists in ambulatory settings who provide quality care in all aspects of their practices.

Data Sources

A MEDLINE search augmented by a review of International Pharmacy Abstracts was used to identify pertinent quality assessment and pharmacy practice literature; indexing terms included quality assurance, healthcare, pharmacists, community pharmacy services, ambulatory, pharmacy, and process and outcome assessment.

Study Selection

All identified quality assessments of community pharmacy practice were considered. Studies that documented the effectiveness of specific pharmacist activities and patient satisfaction were also included.

Data Extraction

The literature was independently reviewed by the primary author.

Data Synthesis

The structure–process–outcome paradigm is presented as a framework for quality assessment of PC. Structure should be assessed at periodic intervals because it identifies the potential for the provision of quality care. Process, the care that pharmacists provide, must be documented and linked to outcomes before either structure or process can be used to make inferences about the quality of PC. Technical and interpersonal processes should be examined. Outcomes require an interdisciplinary approach that not only considers other medical care inputs but also recognizes the psychologic, economic, and social factors that affect health status and quality of life. Process and outcome must both be assessed to distinguish the contribution of pharmacists from that of other healthcare providers. Examples of criteria are provided and a model to integrate PC within the healthcare system is discussed.

Conclusions

It is pharmacists’ duty to ensure that patients receive an acceptable level of PC. The structure-process-outcome paradigm provides a framework to identify and link pharmacists’ processes with patients’ outcomes.
Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program
Authors: Rao Sandhya K. , Carballo Victoria , Cummings Brian M. , Millham Frederick , Jacobson Joseph O.
Published: May 2016

Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.
Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis
Authors: Hongmou Zhao , Xiaojun Liang , Yi Li , Hongliang Liu , Junhu Wang , Cheng Liu
Published: May 2016

Background:

Supramalleolar osteotomy (SMOT) is an alternative operative procedure for the management of early and midstage varus ankle arthritis. However, whether fibular osteotomy is needed is controversial. The purpose of the current study was to evaluate the functional and radiologic outcomes of pre- and postoperative SMOT, and to compare the outcomes between patients with and without fibular osteotomy.

Methods:

Forty-one Takakura stage 2 and 3 varus ankle osteoarthritis patients treated with SMOT were included. Fourteen males and 27 females with a mean age of 50.7 (range, 32-71) years were followed with a mean of 36.6 (range, 17-61) months. There were 22 cases with fibular osteotomy and 19 without. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Maryland foot score, and Ankle Osteoarthritis Score (AOS) were used for pre- and postoperative functional evaluation. The tibial articular surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre- and postoperatively.

Results:

At the last follow-up, the mean AOFAS score (from 50.8 to 83.1 points) and Maryland score (from 58.3 to 81.6 points) in overall were improved ( P < .01); the mean AOS pain (from 42.6 to 26.1 points) and function (from 53.4 to 36.8 points) scores were decreased ( P < .01). For radiologic evaluation, all the included parameters were improved ( P < .05) except TLS. The mean Takakura stage was decreased ( P < .01). No significant difference could be detected in comparing the functional outcomes between those with and without fibular osteotomy. However, in the fibular osteotomy group, TT was decreased ( P < .05) and TC was improved ( P < .01) significantly.

Conclusion:

SMOT was promising, with substantial functional improvement and malalignment correction for varus ankle arthritis. Fibular osteotomy may be necessary in cases with large TT and small TC angles.

Level of Evidence:

Level III, retrospective comparative study.
Radiographic and CT Assessment of Reduction of Calcaneus Fractures Using a Limited Sinus Tarsi Incision
Authors: Scott Aaron T. , Pacholke David A. , Hamid Kamran S.
Published: May 2016

Background:

The lateral extensile incision for fixation of displaced intra-articular calcaneus fractures allows for fracture reduction but has been associated with high rates of soft tissue complications. This has prompted a search for less invasive methods of fracture fixation. The purpose of the present study was to determine the adequacy of reduction and rate of complications associated with operative fixation of calcaneal fractures using a limited sinus tarsi approach.

Methods:

A limited sinus tarsi incision with plate fixation was utilized for treatment of 39 displaced intra-articular calcaneal fractures in 35 consecutive patients as part of a single surgeon series. Imaging assessment of previously described fracture displacement measures was undertaken in preoperative and postoperative radiographs and CT. A retrospective chart review was conducted to identify postoperative complications.

Results:

Mean preoperative Bohler angle measurement was 7.7 (range, –26.0 to 30.0) degrees and the mean final postoperative standing Bohler angle was 25.5 (range, 12.3 to 37.7) degrees. Postoperative CT demonstrated that subtalar articular reduction was within 2 mm of anatomic in 91% of patients. There were 2 instances of superficial wound dehiscence (5.1%) and 1 deep infection (2.6%) that required debridement and complete hardware removal. Visual analog score (VAS) for pain averaged 3 of 10 in the 32 available patients at 1-year follow-up. Eight of these patients (25%) reported no pain (0/10) at final follow-up.

Conclusion:

Operative fixation of displaced intra-articular calcaneal fractures utilizing the limited sinus tarsi approach resulted in acceptable fracture reduction and a low rate of complications.

Level of Evidence:

Level IV, retrospective case series.
Probing the Neural Correlates of Number Processing
Authors: Knops André
Published: May 2016

The cognitive and neural mechanisms that enable humans to encode and manipulate numerical information have been subject to an increasing number of experimental studies over the past 25 years or so. Here, I highlight recent findings about how numerical information is neurally coded, focusing on the theoretical implications derived from the most influential theoretical framework in numerical cognition—the Triple Code Model. At the core of this model is the assumption that bilateral parietal cortex hosts an approximate number system that codes for the cardinal value of perceived numerals. I will review studies that ask whether or not the numerical coding within this system is invariant to varying input notation, format, or modality, and whether or not the observed parietal activity is number-specific over and above the parietal involvement in response-related processes. Extant computational models of numerosity (the number of objects in a set) perception are summarized and related to empirical data from human neuroimaging and monkey neurophysiology.
“Time Out”
Authors: Wistow Richard , Kelly Liz , Westmarland Nicole
Published: May 2016

This article critically explores accounts of how men attending domestic violence perpetrator programs (DVPP) used the “time out” strategy. Findings are drawn from 71 semi-structured interviews with 44 men attending DVPPs and 27 female partners or ex-partners of men in DVPPs. We describe three ways in which the technique was used: first, as intended, to interrupt potential physical violence; second, through the effective adaption of the time-out rules by victim-survivors; and finally, misappropriation by some men to continue and extend their controlling behaviors. Policy and practice lessons are drawn from the findings through connecting broader and deeper measurements of what success means when working with domestic violence perpetrators to the ways in which the time-out technique was used.
Predictive Accuracy of Violence Risk Scale–Sexual Offender Version Risk and Change Scores in Treated Canadian Aboriginal and Non-Aboriginal Sexual Offenders
Authors: Olver Mark E. , Sowden Justina N. , Kingston Drew A. , Nicholaichuk Terry P. , Gordon Audrey , Beggs Christofferson Sarah M. , Wong Stephen C. P.
Published: May 2016

The present study examined the predictive properties of Violence Risk Scale–Sexual Offender version (VRS-SO) risk and change scores among Aboriginal and non-Aboriginal sexual offenders in a combined sample of 1,063 Canadian federally incarcerated men. All men participated in sexual offender treatment programming through the Correctional Service of Canada (CSC) at sites across its five regions. The Static-99R was also examined for comparison purposes. In total, 393 of the men were identified as Aboriginal (i.e., First Nations, Métis, Circumpolar) while 670 were non-Aboriginal and primarily White. Aboriginal men scored significantly higher on the Static-99R and VRS-SO and had higher rates of sexual and violent recidivism; however, there were no significant differences between Aboriginal and non-Aboriginal groups on treatment change with both groups demonstrating close to a half-standard deviation of change pre and post treatment. VRS-SO risk and change scores significantly predicted sexual and violent recidivism over fixed 5- and 10-year follow-ups for both racial/ancestral groups. Cox regression survival analyses also demonstrated positive treatment changes to be significantly associated with reductions in sexual and violent recidivism among Aboriginal and non-Aboriginal men after controlling baseline risk. A series of follow-up Cox regression analyses demonstrated that risk and change score information accounted for much of the observed differences between Aboriginal and non-Aboriginal men in rates of sexual recidivism; however, marked group differences persisted in rates of general violent recidivism even after controlling for these covariates. The results support the predictive properties of VRS-SO risk and change scores with treated Canadian Aboriginal sexual offenders.
Harmonic holes with surface tension in an elastic plane under uniform remote loading
Authors: Dai Ming , Schiavone Peter , Gao Cun-Fa
Published: May 2016

Harmonic holes are designed to leave undisturbed the mean stress in an uncut body subjected to a system of prescribed remote loadings. The role of residual surface tension in the design of harmonic holes is an important consideration, which is usually neglected at the macroscale but remains a significant factor in the design of such holes at the nanoscale. We consider the identification of the geometry of a single harmonic hole in an elastic plane subjected to uniform remote loading when residual surface tension is incorporated into the model of deformation. The geometry of the hole is defined by a conformal mapping with certain unknown coefficients determined from a system of non-linear equations. We illustrate our results with several examples. In particular, we show that for a given remote loading and surface tension, the shapes obtained exhibit strong size-dependency. Moreover, we find that the incorporation of the effect of surface tension greatly extends the range of admissible uniform remote loadings that guarantee the existence of harmonic holes.
Canadian Clinical Practice Guidelines for Rosacea
Authors: Asai Yuka , Tan Jerry , Baibergenova Akerke , Barankin Benjamin , Cochrane Chris L. , Humphrey Shannon , Lynde Charles W. , Marcoux Danielle , Poulin Yves , Rivers Jason K. , Sapijaszko Mariusz , Sibbald R. Gary , Toole John , Ulmer Marcie , Zip Catherine
Published: May 2016

Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review “Interventions in Rosacea” was used as a source of clinical trial evidence on which to base the recommendations.
‘The moral power of the citizen questioner’: scrutinizing the value of audience questions on the ABC’s Q&A
Authors: Eslick Belinda
Published: May 2016

The Australian Broadcasting Corporation’s (ABC) weekly political discussion program Q&A aims to make Australian politics more engaging to ordinary citizens by allowing direct access between ‘punters’ and ‘pollies’. The program is a unique forum in the Australian political public sphere where citizens (represented by the studio audience) are awarded greater power than in conventional political news and current affairs formats. However, some critics have argued that the program is, among other things, overly editorialized and contrived and more autocratic than democratic, where the power of the citizen is superficial only. Using data gathered from focus groups, this article explores attitudes toward the role of the audience questioners on Q&A – one of the defining ‘democratizing’ features of the program. Considering responses of viewers with both high and low levels of political engagement has led to interesting findings about how motivations for watching Q&A, as well as expectations about how it should function, differ according to viewers’ pre-existing level of political interest.
Tables and graphs for monitoring temporal crime trends
Authors: Wheeler Andrew P
Published: May 2016

This article is a practical review on how to construct tables and graphs to monitor temporal crime trends. Such advice is mostly applicable to crime analysts to improve the readability of their products, but is also useful to general consumers of crime statistics in trying to identify crime trends in reported data. First, the use of percent change to identify significant changes in crime trends is critiqued, and an alternative metric based on the Poisson distribution is provided. Second, visualization principles for constructing tables are provided, and a practical example of remaking a poor table using these guidelines is shown. Finally, the utility of using time series charts to easily identify short- and long-term increases, as well as outliers in seasonal data using examples with actual crime data is illustrated.
News blogs versus mainstream media: Measuring the gap through a frame analysis of Greek blogs
Authors: Touri Maria , Kostarella Ioanna
Published: May 2016

This article offers an empirical examination of the power of independent news blogs to expand the boundaries of public debates, through their capacity not only to host volumes of information but also to frame it in unique packages. Despite the scholarly attention given to blogs as a counterforce to traditional news media, there are unanswered questions regarding the discrepancy in the qualitative characteristics of the debates promoted by these two realms. We aim to offer an empirical test of this potential gap with an innovative content analysis that draws on framing research and corpus linguistic techniques. This is performed in the context of Greece, where a rapid increase in the volume of blogging has created a new platform for political debate. Through a computer-assisted qualitative frame analysis of partisan newspapers and independent news blogs, we find differences in the breadth of certain frames that could prove significant for audiences’ understanding of current affairs.
A qualitative study of resilience among asylum seekers from Darfur in Israel
Authors: Lavie-Ajayi Maya , Slonim-Nevo Vered
Published: May 2016

We know more about the experiences of trauma, despair, and abuse of asylum seekers and refugees than we do of their resilience, strength, and active struggle to survive and succeed. This article explores stories narrated by asylum seekers from Darfur, Sudan, currently residing in Israel, to learn about their forms and sources of strength, resilience, and coping mechanisms. In-depth, semi-structured group interviews were conducted in Hebrew and in English with eight single men, aged between the ages 27 and 38, who had lived in Israel for between four and seven years. The interviews were recorded and transcribed, and the data analyzed by analytic induction and constant comparison strategies. Six factors were identified, from the interviewees’ perspective, as contributing to their resilience: cognitive coping strategies, behavioral coping strategies, the ability to work, the ability to study and educate oneself, the support of family and friends, and social and political activism. This study corroborates existing literature by identifying personal strategies and social support as important to resilience of refugees; however, and unlike other studies, we did not find religion as an important factor from our interviewees’ perspective. We have thus expanded the existing literature by identifying the ability to work and the ability to study as important factors contributing to the resilience of refugees.
Measuring Health Literacy Levels of a Patient Portal Using the CDC’s Clear Communication Index
Authors: Alpert Jordan M. , Desens Linda , Krist Alex H. , Aycock Rebecca A. , Kreps Gary L.
Published: May 2016

Once promised to revolutionize health care, patient portals have yet to fully achieve their potential of improving communication between patients and clinicians. In fact, their use can be detrimental to many consumers due to their limited literacy and numeracy skills. This study demonstrates how applying the Centers for Disease Control and Prevention’s Clear Communication Index to a patient portal can be used to identify opportunities for better patient communication and engagement. The Clear Communication Index contains 20 scored items grounded in communication science to enhance patients’ understanding of health information. The Index was applied to one portal used by over 80,000 patients in 12 primary care practices: MyPreventiveCare. This portal was selected because of its ability to personalize preventive and chronic care information by internally using content featuring health literacy principles and linking patients’ externally to trusted materials. Thirty-seven frequently visited portal pages (17 internal and 20 external) were evaluated based on the Index’s four main variables. The overall score for the portal was 72%, which falls below the 90% threshold to be considered clear communication. Internal content scored higher than external (75% vs. 69%). Specific changes to improve the score include simpler language, more specific examples, and clearer numerical explanations.
Detection of expressional changes induced by intrauterine growth restriction in the developing rat pancreas
Authors: Zhang Lin , Chen Wei , Dai Yuee , Zhu Ziyang , Liu Qianqi
Published: May 2016

Intrauterine growth retardation (IUGR) is a disorder that can result in permanent changes in the physiology and metabolism of the newborn, which increased the risk of disease in adulthood. Evidence supports IUGR as a risk factor for the development of diabetes mellitus, which could reflect changes in pancreas developmental pathways. We sought to characterize the IUGR-induced alterations of the complex pathways of pancreas development in a rat model of IUGR. We analyzed the pancreases of Sprague Dawley rats after inducing IUGR by feeding a maternal low calorie diet from gestational day 1 until term. IUGR altered the pancreatic structure, islet areas, and islet quantities and resulted in abnormal morphological changes during pancreatic development, as determined by HE staining and light microscopy. We identified multiple differentially expressed genes in the pancreas by RT-PCR. The genes of the insulin/FoxO1/Pdx1/MafA signaling pathway were first expressed at embryonic day 14 (E14). The expressions of insulin and MafA increased as the fetus grew while the expressions of FoxO1 and Pdx1 decreased. Compared with the control rats, the expressions of FoxO1, Pdx1, and MafA were lower in the IUGR rats, whereas insulin levels showed no change. Microarray profiling, in combination with quantitative real-time PCR, uncovered a subset of microRNAs that changed in their degree of expression throughout pancreatic development. In conclusion, our data support the hypothesis that IUGR influences the development of the rat pancreas. We also identified new pathways that appear to be programmed by IUGR.
An adaptive proportional navigation guidance law for guided mortar projectiles
Authors: Zhang Yongwei , Gao Min , Yang Suochang , Fang Dan
Published: May 2016

Mortar projectiles have large launch angles and curved trajectories, which bring new problems to the application of proportional navigation guidance (PNG). In this article, the ballistic characteristics of mortar projectiles and their impact on the application of PNG are analyzed, and an adaptive proportional navigation guidance (APNG) scheme with a variable coefficient is proposed. The guidance performance of two guidance laws is compared through simulation. Results of the simulation show that the path command angle with PNG is different from the mortar path angle, which leads to poor guidance. On the other hand, the path command angle with APNG is similar to the mortar path angle and easy to track for the guided mortar projectiles, so the application of APNG can significantly improve the firing precision of guided mortar projectiles. The result of an example trajectory and Monte Carlo simulations testifies to the effectiveness of the APNG scheme.
Brachial Plexus Blockade Causes Subclinical Neuropathy
Authors: Perretta Donato J. , Gotlin Matthew , Brock Kenneth , Paksima Nader , Gottschalk Michael B. , Cuff Germaine , Rettig Michael , Atchabahian Arthur
Published: May 2016

Background: The objective of this study is to determine subclinical changes in hand sensation after brachial plexus blocks used for hand surgery procedures. We used Semmes-Weinstein monofilament testing to detect these changes. We hypothesized that patients undergoing brachial plexus nerve blocks would have postoperative subclinical neuropathy detected by monofilament testing when compared with controls. Methods: In total, 115 hand surgery adult patients were prospectively enrolled in this study. All patients undergoing nerve-related procedures were excluded as well as any patients with preoperative clinically apparent nerve deficits. Eighty-four patients underwent brachial plexus blockade preoperatively, and 31 patients underwent general anesthesia (GA). Semmes-Weinstein monofilament testing of the hand was performed preoperatively on both the operative and nonoperative extremities and postoperatively at a mean of 11 days on both hands. Preoperative and postoperative monofilament testing scores were compared between the block hand and the nonoperated hand of the same patient, as well as between the block hands and the GA-operated hands. Results: There were no recorded clinically relevant neurologic complications in the block group or GA group. A statistically significant decrease in sensation in postoperative testing in the operated block hand compared with the nonoperated hand was noted. When comparing the operated block hand with the operated GA hand, there was a decrease in postoperative sensation in the operated block hand that did not reach statistical significance. Conclusions: Brachial plexus blockade causes subtle subclinical decreases in sensibility at short-term follow-up, without any clinically relevant manifestations.
Numerical simulation of bionic foils in tandem arrangement
Authors: Zhou Kai , Liu Junkao , Chen Weishan
Published: May 2016

Based on the backgrounds of underwater propulsors with high hydrodynamic performance, the article focuses on the flapping foils in tandem arrangement and tries to formulate the physical mode and mathematical model of flapping propulsion. Using the commercial software Fluent, the governing equations are discretized by the finite volume method, and dynamic mesh method is adopted to solve the moving boundaries. In order to verify validity and feasibility of the method, hydrodynamic performance of single flapping foil is analyzed. The present results of single flapping foil compare well with those in experimental researches. After that, numerical simulations of flapping foils in tandem arrangement are conducted to reveal the energy absorption mechanisms. By extracting performance parameters and characteristics of the flow field, the interaction between upstream foil and downstream foil is analyzed. The results indicate that the vortices shedding from upstream foil have a significant effect on the hydrodynamic performance of downstream foil, and the downstream foil can use energy from the flow field to improve the hydrodynamic performance. Therefore, the hydrodynamic performance of the system can be improved by adjusting the locations of foils and motion parameters.
Does the diameter of abdominal aortic aneurysm influence late survival following abdominal aortic aneurysm repair? A systematic review and meta-analysis
Authors: Khashram Manar , Hider Phil N , Williman Jonathan A , Jones Gregory T , Roake Justin A
Published: May 2016

Background

Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. Aim: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair.

Methods

Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio.

Results

A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09–1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03–1.12) and 1.20 (1.15–1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02.

Conclusions

This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.
Beyond ghosts, gangs and good sorts: Commercial cannabis cultivation and illicit enterprise in England’s disadvantaged inner cities
Authors: Ancrum Craig , Treadwell James
Published: May 2016

This article focuses on the commercial cultivation of cannabis in England. Based on extensive ethnographic fieldwork with organised crime groups in disadvantaged locales, we argue that the rapid growth of cannabis cultivation is not the preserve of ‘ghosts, gangs and good sorts’. Rather, these new markets reflect significant socio-cultural and technological transformations and the involvement of independent entrepreneurial criminals who, for the most part, come from impoverished neighbourhoods that have experienced, in recent years, a significant decline in legitimate job opportunities. This article offers new empirical data that shed light upon the organisation of commercial cannabis cultivation. It also challenges dominant academic accounts of these markets.
Assuming vulnerability: Ethical considerations in a multiple-case study with older suicide attempters
Authors: Deuter Kate , Jaworski Katrina
Published: May 2016

In conceptualizing vulnerability, it is common for researchers to assume that some participants are more vulnerable on the basis of their membership of a particular group or because they exhibit particular characteristics. Older people are often viewed as inherently more vulnerable by ethics committees and the ethical guidelines committees construct. Because age alone does not confer or cause vulnerability, risk of harm to older research participants is not purely associated with their intrinsic connection to a vulnerable group, and classifying older research participants as vulnerable may not necessarily protect them from harm. Drawing on the preliminary findings of a qualitative study of older people who had survived a suicide attempt, we reflect on how the specific context of our study had the potential of framing older people as vulnerable, and describe ways in which these were managed and resolved. Specifically, we discuss potential for harm through the ethical principles of coercion and distress.
Multi-objective optimization and gray association for multi-focus image fusion
Authors: Wang Suli , Luo Xiaoqing
Published: May 2016

Multi-objective optimization and gray association are classical technologies in intelligent system. In this paper, a novel multi-focus image fusion method based on the technology is proposed. First, the input images are decomposed into low-frequency subband and high-frequency subbands using shift invariant Shearlet transform. Second, low-frequency subbands are fused by the weighted average fusion rule. The weight can be adaptively obtained by vector-evaluated quantum-behaved particle swarm optimization and gray relation analysis. The similarity of a corresponding region-based fusion rule is proposed and used to integrate high-frequency subbands. Last but not least, fusion image is obtained by inverse SIST. Visual and statistical analyses demonstrate that the fusion quality can be significantly improved by the proposed method.