bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-objective optimal design of composite box beam using hybrid adaptive harmony search with dynamically reconfigurable harmony memory
Authors: Lakshmi K , Rao A Rama Mohan
Published: March 2018

In the design of helicopter rotor blades, the composite materials are being popularly used, as they are lighter in weight with high specific strength and modulus apart from superior fatigue characteristics. As the performance of the composite materials can be tailored with the optimized layup sequence, the robust optimization algorithms, which cater to this, become necessary. We propose an approach for multi-objective optimization of composite box beam by considering the cross-sectional dimensions and the discrete ply angles as design variables. We present a new improved version of the basic harmony search optimization algorithm by building the features like adaptivity, hybrid search with a customized local search, and multiple sub harmonies with dynamic interaction among them. These features greatly improve both intensification and diversification capabilities of the proposed algorithm. Numerical studies carried out on a box beam clearly reflects the superiority of the proposed approach in providing wider as well as improved design configuration while handling multiple objectives of box-beam design. Finally, we have used a set of performance metrics to demonstrate the effectiveness of the proposed algorithm by comparing with other very recent stochastic algorithms.
Exploring lignocellulosic biomass for bio-methane potential by anaerobic digestion and its economic feasibility
Authors: Ali Shehbaz , Shah Tawaf A , Afzal Asifa , Tabassum Romana
Published: March 2018

Anaerobic digestion is a process to convert organic biomass into bio-methane. Plenty of produced waste in Pakistan is enough to compensate energy thirst of country and have potential to replace costly fossil fuels. The lignocellulosic biomass such as wheat straw, almond shell, sugarcane bagasse, maize straw and corn cob were subjected to bio-methane potential assay after proximate, ultimate and chemical analysis. These chemical fractions provide better understanding about theoretically predicating bio-methane potentials such as neutral detergent fibre, acid detergent fibre, acid detergent lignin, cellulose, hemicellulose, carbohydrates, proteins and elemental analysis. Experimental bio-methane potentials were found, 267.74 (wheat straw), 255.32 (almond shell), 222.23 (corn cob), 247.60 (sugar cane bagasse) and 293.12 ml/g (maize straw) volatile solids and was much less than predicted methane potential. The energy content on dry basis and methane potential has been assessed to find economic feasibility of biomass. The biodegradability and methane potential inversely related to the lignin content of biomass. Bioenergy production from biomass is economically favourable. The volatile fatty acids were produced in the percentage of 53–58% acetic acid, 30–35% butyric acids and 6–13% propionic acid and showed same metabolic pathway and types of bacteria involved in digestion.
Refractory neuromyelitis optica spectrum disorder in systemic lupus erythematosus successfully treated with rituximab
Authors: Shidahara K , Hayashi K , Sada K E , Hiramatsu S , Morishita M , Watanabe H , Matsumoto Y , Kawabata T , Wada J
Published: March 2018

We present a case of a woman with systemic lupus erythematosus (SLE) who had refractory episodes of neuromyelitis optica spectrum disorder (NMOSD) and was successfully treated with rituximab. She was positive for anti-aquaporin-4 (AQP4) antibody and had typical cranial and longitudinally extended spinal lesions but no optic nerve involvement. There is no established treatment for NMOSD/SLE overlap cases. Our experience suggests that rituximab may be effective for patients with combined SLE and anti-AQP4 antibody-positive NMOSD.
Eliciting critical care nurses’ beliefs regarding physical restraint use
Authors: Via-Clavero Gemma , Sanjuán-Naváis Marta , Romero-García Marta , de la Cueva-Ariza Laura , Martínez-Estalella Gemma , Plata-Menchaca Erika , Delgado-Hito Pilar
Published: March 2018

Background:

Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice.

Aim:

To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour.

Research design:

A belief elicitation study was conducted.

Participants and research context:

Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed.

Ethical considerations:

Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary.

Findings:

Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation.

Discussion:

Safety arguments based on the surrounding work environment were discussed.

Conclusion:

Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.
The moral experiences of pediatric nurses in Brazil: Engagement and relationships
Authors: Passos dos Santos Raissa , Tatsch Neves Eliane , Carnevale Franco
Published: March 2018

Background:

Pediatric nursing care involves many significant ethical challenges. Although nurses are broadly recognized as professionals with relevant knowledge about children and families, little is known about how nurses experience ethical concerns in their everyday practice.

Objective:

The objective of this study was to better understand the moral experiences and related moral distress experiences of nurses working in pediatric settings in Brazil.

Design:

Interpretative phenomenological study conducted through narrative interviews.

Participants and research context:

Nine nurses working in three pediatric settings of a teaching hospital in a city of Southern Brazil.

Ethical considerations:

The study was approved by the Research Ethics Committee of the research site, and research ethics principles were respected throughout the study.

Findings:

This investigation illuminated a broader dimension of nurses’ moral distress, which was recognized as moral experience. In advancing our understanding of nurses’ moral experiences, engagement was identified as a central phenomenon that is present in the understandings and actions of nurses within their relationships in their daily practice and lived experiences. Three themes were described with regard to nurses’ relationships and their moral experiences: (a) relationship with the healthcare team; (b) relationship with the family; and (c) relationship with the child.

Discussion:

The findings of this study are congruent with emerging health literature that demonstrated the focus on moral distress as limiting for bioethical inquiry. Moreover, it is important to better understand and recognize nurses’ relational environment and engagements to advance understandings of the ethical dimensions of pediatric nursing practice.

Conclusion:

This study provides a better understanding on how engagement affects moral experiences, demonstrating how nurses can experience distress but also satisfaction, gratification, rewarding feelings, and a sense of responsibility for the care they provide.
Extreme variability in succinylcholine dose for muscle relaxation in electroconvulsive therapy
Authors: Bryson Ethan O , Kellner Charles H , Li Erin H , Aloysi Amy S , Majeske Matthew
Published: March 2018

Objectives:

To determine what dose of succinylcholine falls outside the range of 2 SD above or below the mean optimal dose of 0.9 mg/kg used for electroconvulsive therapy (ECT).

Methods:

In this retrospective chart review, for all patients who received ECT at our institution within the 5-year study period, the initial dose of succinylcholine in milligrams per kilogram was compared with subsequent doses after adjustments were made for individual patient responses. Mean and SD were calculated using the dose of succinylcholine, once the optimal dose for each patient had been determined, based on clinical response.

Results:

Five hundred patients treated during the 5-year period met inclusion criteria, 180 (36%) of whom required an adjustment of the succinylcholine dosing either above (119 patients) or below (61 patients) the 0.9 mg/kg standard after their first treatment.

Conclusions:

In those patients who required an adjustment of 2 SD either above or below the mean dose of succinylcholine (29 patients, 5.8%), adequate neuromuscular blockade was only achieved with either an increased dose of up to 2.10 mg/kg or a decreased dose as low as 0.29 mg/kg.
When Do Family Ties Matter? The Duration of Female Suffrage and Women’s Path to High Political Office
Authors: Baturo Alexander , Gray Julia
Published: March 2018

While the percentage of female heads of state in the world has increased to around 10 percent in the 2010s, a female president or prime minister still remains an exception. Recent scholarship has proposed a number of explanations behind this phenomenon, but there exist important gaps. The contribution of this paper is threefold. First, we use new and comprehensive data to undertake a systematic examination of the differences in the personal, education, and career backgrounds between female and male effective political leaders from 1960 to 2010. We find that female leaders are as qualified as men. Second, because the phenomenon of female leadership is still a rare occurrence, we argue that this fact must be accounted for in empirical modeling. Third, we show that many female leaders tend to acquire the necessary resources, support, and name recognition through political dynasties. To that end, women leaders need to rely on family ties more than men do. However, the importance of such connections attenuates when female suffrage has been in place for longer, and citizens are more open to women in politics.
Breaking “News”: Majority Can’t Define Mass Communication
Authors: Ells Kevin
Published: March 2018

Current communication textbooks proffer conflicting, vague, or incomplete definitions of the core concepts of “mass communication” and “news,” contributing to confusion among students, and subsequently in the public sphere, of what experts in the field mean when discussing news and mass media. The analysis in this article disentangles a clear definition of mass communication from the related concepts of mass media and mediated communication, as well as clearly differentiating the concept of “news” from the adjacent concepts of journalism and entertainment. Discussion concludes with implications for communication education and improved public understanding of the field.
Differentiating Adults With Mixed Age Victims From Those Who Exclusively Sexually Assault Children or Adults
Authors: Rice Jenna , Knight Raymond A.
Published: March 2018

Although adults who have sexually offended against both child and adult victims (i.e., adults with mixed aged sexual offense victims [MASOVs]) have been found at increased risk to reoffend, they have been a neglected and rarely studied group of individuals who have sexually offended. The present study explored their differentiating characteristics by comparing them with adults who had sexually offended exclusively against children (child sex offense victims [CSOVs]) or adults (adult sex offense victims [ASOVs]). Using an extensive database gathered on offenders examined for civil commitment, we found that although MASOVs were not distinguished from the other types of offenders by any specific developmental trauma, they cumulatively tended to be higher across traumas. They evidenced lower self-esteem relative to both other offender types. In addition, MASOVs, like ASOVs, exhibited higher levels of psychopathy relative to CSOVs. The implications of these findings for etiology and treatment are discussed.
Comparisons Between Smoking Patterns Among Sexual Minority Females and Males in Romantic Relationships
Authors: Gamarel Kristi E. , Mitchell Jason W.
Published: March 2018

Purpose. Several studies have noted sexual minority disparities in tobacco smoking; however, few studies have examined the role of intimate partners in these different smoking behaviors among sexual minority men and women. Furthermore, few studies distinguish between intermittent and daily smokers. Thus, this study sought to examine whether perceptions of their partner’s smoking behaviors were associated with their own smoking behaviors in a sample of sexual minority adults in romantic relationships. Method. In total, 898 participants (413 sexual minority females and 485 sexual minority males) completed a one-time online anonymous survey. Results. Approximately one third of the sample reported smoking, with 21.2% daily smokers and 9.8% intermittent smokers. Multinomial regression results revealed that for both sexual minority females and males having a partner who was a daily or intermittent smoker was associated with an increased odds of being a daily smoker, whereas having a partner who was an intermittent smoker was associated with an increased odds of being an intermittent smoker. Conclusions. These findings provide valuable information on the need to attend to romantic partners and consider tailored programming to account for different smoking patterns and partners’ potential role in reinforcing smoking.
Prevalence of microorganisms associated with feline gingivostomatitis
Authors: Nakanishi Hitoshi , Furuya Masaru , Soma Takehisa , Hayashiuchi Yoshiki , Yoshiuchi Ryusaku , Matsubayashi Makoto , Tani Hiroyuki , Sasai Kazumi
Published: March 2018

Objectives

Feline gingivostomatitis (FGS) is a painful chronic inflammatory disease of the oral cavity. The purpose of this study was to examine the frequency of detection of certain common feline bacteria and viruses to determine any potential associations with FGS.

Methods

A multicentre case-control study design was conducted. In total, 72 control cats and 32 cats with FGS were included in the study. Oral swabs were cultured for bacterial identification and a PCR assay was carried out to examine the infection of feline calicivirus (FCV), feline herpesvirus-1 (FHV-1), Chlamydia felis, Mycoplasma felis and Bordetella bronchiseptica.

Results

There was a significant difference in age distribution between the control and the FGS group. Based on a PCR assay, the positive rate of FCV was significantly higher in FGS cats than control animals. For other infectious pathogens, including FHV-1, C felis and M felis, there was no significant difference. Bacterial culture of oral swabs revealed that Pasteurella multocida was most frequently detected, but the detection rate was significantly lower in FGS cats. In FGS cats, the incidence of Enterococcus faecalis and anaerobic bacteria were more frequently isolated than in control cats.

Conclusions and relevance

This study indicates that the positive rate of FCV was significantly higher in cats with FGS, and the microflora of the oral cavity of cats with FGS might be disrupted, although additional studies are required to compare the oral microbiome in cats of a variety of ages.
Prospective, randomized controlled comparison of a flash-tip catheter and a traditional intravenous catheter in an urban emergency department
Authors: Moayedi Siamak , Witting Michael , Hirshon Jon Mark , George Nicholas , Burke Alise , Schenkel Stephen
Published: March 2018

Introduction:

Safe and efficient intravenous access is paramount to the practice of emergency medicine. We compared the first-stick success rates and blood spillage of two peripheral intravenous catheters in a busy urban emergency department.

Methods:

In this randomized controlled trial, we assigned emergency department patients requiring peripheral intravenous access to use of either a flash-tip catheter (SurFlash Plus, Terumo Medical Corporation, Somerset, New Jersey) or a widely used control catheter (Insyte Autoguard; Becton, Dickinson and Company, Franklin Lakes, New Jersey). We compared frequency of first-stick success and blood contamination between catheters using chi-squared analysis.

Results:

We enrolled 600 patients, randomizing 309 to the flash-tip catheter and 291 to the control catheter. The first-stick success rate of each device was 79%. Blood contamination, defined as spillage of blood on the patient’s skin, bedding, or the inserter, occurred in 8 of 309 cases (2.6%) with the flash-tip catheter versus 92 of 291 cases (31.6%) for the control catheter.

Conclusion:

The two catheters tested in this study had comparable rates of first-stick success, but the flash-tip catheter was associated with significantly less blood contamination during insertion attempts.
Decision Tree Algorithm–Generated Single-Nucleotide Polymorphism Barcodes of rbcL Genes for 38 Brassicaceae Species Tagging
Authors: Yang Cheng-Hong , Wu Kuo-Chuan , Chuang Li-Yeh , Chang Hsueh-Wei
Published: March 2018

DNA barcode sequences are accumulating in large data sets. A barcode is generally a sequence larger than 1000 base pairs and generates a computational burden. Although the DNA barcode was originally envisioned as straightforward species tags, the identification usage of barcode sequences is rarely emphasized currently. Single-nucleotide polymorphism (SNP) association studies provide us an idea that the SNPs may be the ideal target of feature selection to discriminate between different species. We hypothesize that SNP-based barcodes may be more effective than the full length of DNA barcode sequences for species discrimination. To address this issue, we tested a ribulose diphosphate carboxylase ( rbcL) SNP barcoding (RSB) strategy using a decision tree algorithm. After alignment and trimming, 31 SNPs were discovered in the rbcL sequences from 38 Brassicaceae plant species. In the decision tree construction, these SNPs were computed to set up the decision rule to assign the sequences into 2 groups level by level. After algorithm processing, 37 nodes and 31 loci were required for discriminating 38 species. Finally, the sequence tags consisting of 31 rbcL SNP barcodes were identified for discriminating 38 Brassicaceae species based on the decision tree–selected SNP pattern using RSB method. Taken together, this study provides the rational that the SNP aspect of DNA barcode for rbcL gene is a useful and effective sequence for tagging 38 Brassicaceae species.
Dyshidrotic Bullous Pemphigoid: Case Report and Review of Literature
Authors: Basseri Sana , Ly Thai Yen , Hull Peter R.
Published: March 2018

Background:

Dyshidrotic pemphigoid (DP) is a rare variant of bullous pemphigoid (BP) that affects the hands and feet and may resemble an acute vesicular eczema. While it can remain confined to hands and feet, spread that involves the entire body is described. BP and DP are associated with autoantibodies directed against hemidesmosomal proteins BP180 (collagen XVII) and BP230 (dystonin), which are transmembrane and intracellular proteins in the basement membrane zone, respectively.

Case Summary:

We present a case of DP in a 78-year-old woman who was diagnosed based on histopathologic and immunofluorescence findings and subsequently successfully treated.

Conclusion:

DP is an unusual form of localized BP. While the pathogenesis is still unclear, it may involve differential expression of BP antigens in the cutaneous basement membrane of the hands and feet. The clinical presentation is a diagnostic challenge, and skin biopsies with immunofluorescence studies are required for diagnosis.
Short-term and long-term adaptation algorithm for low-pressure exhaust gas recirculation estimation in spark-ignition engines
Authors: Siokos Konstantinos , Koli Rohit , Prucka Robert
Published: March 2018

Low-pressure exhaust gas recirculation systems are capable of increasing fuel efficiency of spark-ignition engines; however, they introduce control challenges. The low available pressure differential that drives exhaust gas recirculation flow, along with the significant pressure pulsations in the exhaust environment of a turbocharged engine hamper the accuracy of feed-forward estimation models. For that reason, feedback measurements are required in an effort to increase prediction accuracy. Additionally, the accumulation of deposits in the exhaust gas recirculation system and the aging of the valve, change the flow characteristics over time. Under these considerations, an adaptation algorithm is developed which handles both short-term (operating-point-dependent errors) and long-term (system aging) corrections for exhaust gas recirculation flow estimation. The algorithm is based on an extended Kalman filter for joint state and parameter estimation and uses the output of an intake oxygen sensor to adjust the feed-forward prediction by creating an online adaptation map. Two different exhaust gas recirculation estimation models are developed and coupled with the adaptation algorithm. The performance of the algorithm for both estimation models is evaluated in real-time through transient experiments with a turbocharged spark-ignition engine. It is demonstrated that this methodology is capable of creating an adaptation map which captures system aging, while also reduces the estimation bias by more than four times resulting in a prediction error of less than 1%. Finally, this approach proves to be a valuable tool that can significantly reduce offline calibration efforts for such models.
Photorealistic computer-generated images are difficult to distinguish from digital photographs: a case study with professional photographers and photo-editors
Authors: Lehmuskallio Asko , Hӓkkinen Jukka , Seppӓnen Janne
Published: March 2018

There are strict guidelines on photoediting in newsrooms and serious professional repercussions for any failure to adhere to them, while computer-generated imagery is increasingly used in other areas of visual communication. This article presents empirical research on the ability of professional photographers and editors to distinguish photographs from photorealistic computer-generated images by looking at them on a screen. The results show clearly that those studied ( N = 20) are unable to distinguish one from another, suggesting that it is increasingly difficult to make this distinction, particularly since most viewers are not as experienced in photography as those studied. Interestingly, the participants continue to share a conventional understanding of photography that is not in line with current developments in digital photography and digital image rendering. Based on their findings, the authors suggest there is a need for developing a particular visual literacy that understands the computational in digital photography and grounds the use of digital photography among particular communities of practice. When seeing photographs on screens, journals, exhibitions, or newspapers, viewers might actually be looking at computer-generated simulations, and vice versa.
Scripted-IMPROV: Interactive Improvisational Drama With Persons With Dementia—Effects on Engagement, Affect, Depression, and Quality of Life
Authors: Zeisel John , Skrajner Michael J. , Zeisel Evan B. , Wilson Miranda Noelle , Gage Chris
Published: March 2018

Scripted-IMPROV (SI) is a nonpharmacological (ecopsychosocial) intervention that consists of semi-improvised drama performances specifically designed for persons with dementia (PWD). In this 12-site study, 178 PWD took part in the SI intervention. Levels of engagement/affect were assessed at baseline and again during SI performances; quality of life (via the Dementia Quality of Life scale) and depression (via the Geriatric Depression Scale-Short Form [GDS-SF]) were assessed at baseline and post-treatment. Positive forms of engagement/affect increased, while negative forms of engagement decreased. Regarding depression, for a subsample of 29 participants who scored in the depressed range on the GDS-SF at baseline, depressive symptoms were reduced at post-treatment. Although overall quality of life did not change, the increase in positive affect during SI suggests that quality of life was higher during the intervention itself. In conclusion, SI possesses the characteristics of a high-quality intervention for PWD and seems worthy of further investigation in future research.
Successful Resection of a Large Carotid Body Tumor Masquerading Complete Encasement of the Internal Carotid Artery on Preoperative Imaging
Authors: Kakkos Stavros K. , Zampakis Peter , Lampropoulos George C. , Paridis Leonidas , Kaplanis Charalampos , Bantouna Dimitra , Nikolakopoulos Konstantinos M. , Papageorgopoulou Chrysanthi P. , Kalogeropoulou Christina , Tsolakis Ioannis A.
Published: March 2018

A 41-year-old woman presented with a large painful and tender mass of the left side of her neck located just below the angle of the mandible. She was also complaining of frequent attacks of symptoms ranging from dizziness upon resuming the erect position to frank syncope. Color-coded duplex showed a large well-vascularized vascular mass at the level of the carotid bifurcation, suggesting the diagnosis of a carotid body tumor (CBT). A computerized tomographic angiography confirmed the diagnosis of a CBT, which measured 5.7 cm in its craniocaudal axis. The tumor appeared to encase the internal carotid artery (ICA) at the level of its origin, indicating the presence of a Shamblin group 3 tumor. During surgery, the CBT seemingly encased the ICA; however, it was successfully taken off the ICA, by establishing an adventitial dissection place, obviating the need for arterial resection and replacement. A brief intraoperative episode of cardiac arrest was successfully managed. Postoperative course was uneventful, and all symptoms were cured. Pathology confirmed the clinical diagnosis and did not show malignancy. In conclusion, meticulous surgical techniques can spare the ICA from removal or inadvertent injury during CBT surgery and reduce the morbidity often associated with the resection of large or advanced tumors but also cure atypical patient symptoms.
Supervision, Systems Thinking, and the Impact of American School Reform Efforts on Instructional Leadership
Authors: Mette Ian M. , Riegel Lisa
Published: March 2018

This case was written to encourage educators to reflect on what it means to provide high-quality instructional supervision in an era of accountability when the American public education system is heavily influenced by reform efforts that affect how students learn and how teachers are supported as instructors, and pressures school systems face to produce student achievement. The intent of the case is to help leaders explore the difference between supervision (formative feedback intended to help teachers grow as instructors) and evaluation (summative feedback that determines employment decisions) 15 years past the introduction of No Child Left Behind. Educators using this case should also examine how systems thinking can be applied and/or misused to drive school reform and improvement initiatives.
Buying Time: Long-Term Results of Wrist Denervation and Time to Repeat Surgery
Authors: O’Shaughnessy Maureen A. , Wagner Eric R. , Berger Richard A. , Kakar Sanjeev
Published: March 2018

Background: This study reviews long-term outcomes of partial wrist denervation focusing on need for and time to revision procedure. Methods: A retrospective study was conducted of all patients undergoing partial wrist denervation between 1994 and 2014. At average latest follow-up of 6.75 years (range, 1-21 years), clinical and radiographic data and need for revision surgery were recorded. Results: There were 100 wrists in 89 patients (61 male, 28 female) with average age at surgery of 54 years (range, 26-80). Principal diagnoses were arthritis (58%), inflammatory (19%), and posttraumatic arthritis (7%). Average flexion-extension arc was 83% and grip strength 75% of unaffected extremity. Average Mayo Wrist Scores improved from 48 preoperatively to 77 postoperatively. Sixty-nine percent of patients did not undergo other procedures during the time interval studied. Thirty-one percent underwent revision at an average of 26 months following denervation (range, 2-165). Conclusions: Partial wrist denervation is a motion-preserving procedure for patients with refractory wrist pain with 69% in this series requiring no further procedures. The remaining 31% experienced average symptom relief for 2 years prior to ultimately undergoing revision operation.
Morbidity of First Rib Resection in the Surgical Repair of Thoracic Outlet Syndrome
Authors: Jubbal Kevin T. , Zavlin Dmitry , Harris Joshua D. , Liberman Shari R. , Echo Anthony
Published: March 2018

Background: Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. Methods: A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. Results: A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. Conclusions: FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.
Restricted mean survival time: Does covariate adjustment improve precision in randomized clinical trials?
Authors: Karrison Theodore , Kocherginsky Masha
Published: March 2018

Background:

Restricted mean survival time is a measure of average survival time up to a specified time point. There has been an increased interest in using restricted mean survival time to compare treatment arms in randomized clinical trials because such comparisons do not rely on proportional hazards or other assumptions about the nature of the relationship between survival curves.

Methods:

This article addresses the question of whether covariate adjustment in randomized clinical trials that compare restricted mean survival times improves precision of the estimated treatment effect (difference in restricted mean survival times between treatment arms). Although precision generally increases in linear models when prognostic covariates are added, this is not necessarily the case in non-linear models. For example, in logistic and Cox regression, the standard error of the estimated treatment effect does not decrease when prognostic covariates are added, although the situation is complicated in those settings because the estimand changes as well. Because estimation of restricted mean survival time in the manner described in this article is also based on a model that is non-linear in the covariates, we investigate whether the comparison of restricted mean survival times with adjustment for covariates leads to a reduction in the standard error of the estimated treatment effect relative to the unadjusted estimator or whether covariate adjustment provides no improvement in precision. Chen and Tsiatis suggest that precision will increase if covariates are chosen judiciously. We present results of simulation studies that compare unadjusted versus adjusted comparisons of restricted mean survival time between treatment arms in randomized clinical trials.

Results:

We find that for comparison of restricted means in a randomized clinical trial, adjusting for covariates that are associated with survival increases precision and therefore statistical power, relative to the unadjusted estimator. Omitting important covariates results in less precision but estimates remain unbiased.

Conclusion:

When comparing restricted means in a randomized clinical trial, adjusting for prognostic covariates can improve precision and increase power.
Single centre audit of early impact of inclusion of the three vessel and trachea view in obstetric screening
Authors: Edwards Hazel , Hamilton Richard
Published: March 2018

Detection rates of congenital cardiac malformations have traditionally remained low. The NHS Fetal Anomaly Screening Programme (FASP) aims to increase these detection rates for various reasons, including influencing perinatal management and aiding parental decision making. The inclusion of the three vessel view and trachea (3VT) view in 2015 aimed to improve detection rates of arch abnormalities in particular. This study evaluated the early impact of the new initiative at one NHS Trust. Departmental screen-positive rates were compared for a full year before and after implementation. Referrals to, and opinions of, the foetal medicine unit (FMU) were assessed; as were undetected congenital heart defects for the two time periods. Compared with the pre-implementation (pre-3VT) period, the number of completed anomaly scans performed after implementation (post-3VT) increased by 3% and the number of FMU referrals increased by 625%. Departmental screen-positive rates for cardiac abnormalities increased from 40% (pre-3VT) to 91% (post-3VT). Over half (52%) of the FMU referrals were made due to a suspected abnormal 3VT view. Early evaluation of 3VT implementation at this NHS Trust indicates that it has been a success. Departmental screen-positive rates for congenital cardiac malformations have risen. However, this performance has come at a cost: Some abnormalities now being detected, such as loose vascular ring and PLSVC, are frequently asymptomatic and likely to be clinically insignificant. The implementation of 3VT achieves the aims of FASP but may begin to exceed what is expected from a low risk population screening programme.
So what

is

new about leadership-as-practice?
Authors: Collinson Margaret
Published: March 2018

This paper returns to the original focus of my earlier 'Leading Questions' article (Collinson, 2017) which questioned Joe Raelin’s (excessive) claims that LAP is a distinct ‘movement’, particularly new and supercedes post-heroic perspectives and is more critical than critical leadership studies. Arguing that Raelin's claims overstate the value of LAP, this rejoinder draws on Giddens’ structuration theory to illustrate my points about structure, practice and resistance in relation to the foregoing responses from Leadership As Practice (LAP) contributors (Raelin et al, 2018).
Stopping smoking in pregnancy
Authors: Harrison Kathryn
Published: March 2018

Smoking is a significant and modifiable cause of adverse pregnancy outcomes. Although the prevalence of smoking in pregnancy is declining in England there is significant geographic and socioeconomic variation and prevalence remains high in some areas. When patients present to their GP for preconception counselling or antenatal care it is an ideal opportunity to discuss the benefits of smoking cessation for pregnancy and beyond.
Video capsule endoscopy in pediatric patients with Crohn’s disease: a single-center experience of 180 procedures
Authors: Nemeth Artur , Agardh Daniel , Wurm Johansson Gabriele , Thorlacius Henrik , Toth Ervin
Published: March 2018

Background

Video capsule endoscopy (VCE) is a noninvasive method enabling excellent visualization of the small bowel (SB) mucosa. The aim of this study was to examine the impact and safety of VCE performed in children and adolescents with suspected or established Crohn’s disease (CD).

Methods

A total of 180 VCE examinations in 169 consecutive patients conducted in 2003–14 in a single center were retrospectively analyzed. The median age was 13 years (range 3–17 years) and indications for VCE were suspected (125 cases, 69%) and established (55 cases, 31%) CD. VCE was performed with a PillCam SB (Given Imaging, Yokneam, Israel) VCE system with 8–12 h of registration without bowel preparation.

Results

A total of 154 of 180 (86%) patients swallowed the capsule and 26 (14%) had the capsule endoscopically placed in the duodenum. Patency capsule examination was performed in 71 cases prior to VCE to exclude SB obstruction. VCE detected findings consistent with SB CD in 71 (40%) examinations and 17 (9%) procedures showed minor changes not diagnostic for CD. A total of 92 (51%) examinations displayed normal SB mucosa. The capsule did not reach the colon within the recording time in 30 (17%) procedures and were defined as incomplete examinations. A change in diagnosis or therapy was recommended in 56 (31%) patients based on VCE results. Capsule retention occurred in one patient.

Conclusions

VCE is a safe method in children with suspected or established CD. VCE often leads to a definitive diagnosis and has a significant impact on the clinical management of pediatric patients with CD.
Neuroanatomical distribution of sensory receptors in the human elbow joint capsule
Authors: Kholinne Erica , Lee Hyun-Joo , Deslivia Maria F , Ga Yeong Kim , Lee Suk-Joong , Lim Sungjoon , Jeon In-Ho
Published: March 2018

Background

The topographic arrangement of sensory receptors in the human elbow joint capsule is pertinent to their role in the transmission of neural signals. The signals from stimuli in the joint are concisely delivered via afferent pathways to allow recognition of pain and proprioception. Sensory receptors in the elbow joint include mechanoreceptors and free nerve endings acting as nociceptors, although the distribution of each of the structures has not been determined, despite their importance for the integrity of the joint. We therefore aimed to investigate the neuroanatomical distribution and densities of mechanoreceptors and free nerve endings in the capsule of the elbow, at the same time as considering surgical approaches that would result in the minimum insult to them.

Methods

Four elbow joint capsules were harvested from fresh cadavers. The specimens were carefully separated from adjacent osteoligamentous attachments and the capsular complex was stained with a modified gold chloride method. Evaluations of free nerve endings, and Golgi, Ruffini and Pacinian corpuscles were performed under an inverted light microscope. The number and density of each structure were recorded.

Results

Ruffini corpuscles observed to be the dominant mechanoreceptor type. No Golgi corpuscle was observed. Free nerve endings were found at the highest density at posterodistal sites, whereas mechanoreceptors were most frequent at bony attachment sites.

Conclusions

A consistent distribution pattern of articular sensory receptors was observed, which allows further understanding of elbow pathology. An awareness of the neuroanatomical distribution of sensory receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology.
Bladder Management in Children: Intermittent Catheterization Education
Authors: Fortuna Suzanne Marie , Korcal Layna , Thomas Ginger
Published: March 2018

Clean intermittent catheterization (IC) of the bladder is one example of advanced medical care required by students with special health care needs. The success of a child’s intermittent catheterization program in a community setting such as a school is dependent on an educated team. This article discusses indications and problems that arise with IC bladder management in the pediatric population. The article also provides information about current best practice for IC management to assist school nurses in the optimization of bladder health.
Safety and efficacy of nilotinib in routine clinical practice in patients with chronic myeloid leukemia in chronic or accelerated phase with resistance or intolerance to imatinib: results from the NOVEL study
Authors: Kuo Ching-Yuan , Wang Po-Nan , Hwang Wen-Li , Tzeng Cheng-Hwai , Bai Li-Yaun , Tang Jih-Luh , Chang Ming-Chih , Lin Sheng-Fung , Chen Tsai-Yun , Chen Yeu-Chin , Tan Tran-Der , Hsieh Chih-Yi , Lin Chinjune , Lai Clinton , Miljkovic Darko , Chang Cheng-Shyong
Published: March 2018

Background:

Nilotinib, a second-generation tyrosine kinase inhibitor (TKI), is approved for the treatment of patients with chronic myeloid leukemia (CML) in many countries, including Taiwan. Though a number of controlled clinical trials have demonstrated the safety and efficacy of nilotinib, studies assessing the safety and efficacy of nilotinib in routine clinical practice are limited.

Methods:

The current study was an open-label, single-arm study conducted across 12 centers in Taiwan in adult patients with CML in chronic or accelerated phase with confirmed Ph+ chromosome (or BCR-ABL) and resistant or intolerant to one or more previous TKIs. The primary objective was to collect the long-term safety data in patients treated with nilotinib 400 mg, twice daily for up to 2 years.

Results:

The study enrolled 85 patients with CML, including 76 in the chronic phase (CML-CP) and 9 in the accelerated phase (CML-AP). Overall, 1166 adverse events (AEs) were reported in 80 patients (94.1%), of which 70 AEs (6%) in 28 patients (32.9%) were serious and 336 AEs (28.8%) reported in 60 patients (70.6%) were drug-related. Common drug-related AEs were thrombocytopenia (21.2%), increased alanine aminotransferase (21.2%) and pruritus (17.7%). Of the 85 patients, 19 switched from imatinib due to intolerance – AEs were resolved in 16 of these 19 patients (84.2%). By 24 months, the cumulative rates of complete cytogenetic response (CCyR), major molecular response (MMR), MR4.0 ( BCR-ABL1IS ⩽0.01%) and MR4.5 ( BCR-ABL1IS ⩽0.0032%) were 75.3, 56.8, 16.2 and 7.4%, respectively. Patients with CML-CP at baseline had higher overall survival (OS) and progression-free survival (PFS) than those with CML-AP.

Conclusion:

This is the first study that demonstrated that nilotinib is effective and well-tolerated in patients resistant or intolerant to imatinib in the real-world setting in Taiwan, reflecting effective management of CML by physicians under routine clinical practice in Taiwan.
The role of hyperthermia in the battle against cancer
Authors: Palazzi Mario , Maluta Sergio , Dall'Oglio Stefano , Romano Mario
Published: March 2018

Aims and background

Hyperthermia, the heating of tumors to 41.5–43 °C, could be today considered the fourth pillar of the treatment of cancer. Employed for 20 years in Europe, the USA and Asia, hyperthermia, used in addition to radiotherapy, chemotherapy and surgery, increases both local control and overall survival, restores the chance of the surgery for inoperable tumors and allows a new low-dosage treatment of relapsed cancers previously treated with high radiotherapy dosage without increasing toxicity.

Methods

Hyperthermia can be either superficial, produced by a microwave generator, or regional, produced by a radiofrequency applicator with multiple antennas, which emanate a deep focalized or interstitial heating.

Results

The results are confirmed by phase III randomized trials, with level 1 evidence. A review of the international literature on hyperthermia, the experience of the University Hospital of Verona Radiotherapy Department (Italy) and a summary of the Symposium regarding the Evolution of Clinical Hyperthermia plus Radiotherapy during the Twentieth Congress of the French Society of Radiation Oncology (SFRO) are presented.

Conclusions

Hyperthermia is an important treatment modality in cancer treatment and its results are strongly supported by criteria of evidence-based medicine. Fifteen years of experience of the Radiation Oncology Department in Verona confirms the positive results obtained with international prospective trials, with level 1 evidence. Hyperthermia appears to be the fourth pillar beside surgery, radiotherapy and chemotherapy. Free full text available at www.tumorionline.it
Modelling fertility in rural South Africa with combined nonlinear parametric and semi-parametric methods
Authors: Eyre Robert W. , House Thomas , Gómez-Olivé F. Xavier , Griffiths Frances E.
Published: March 2018

Background

Central to the study of populations, and therefore to the analysis of the development of countries undergoing major transitions, is the calculation of fertility patterns and their dependence on different variables such as age, education, and socio-economic status. Most epidemiological research on these matters rely on the often unjustified assumption of (generalised) linearity, or alternatively makes a parametric assumption (e.g. for age-patterns).

Methods

We consider nonlinearity of fertility in the covariates by combining an established nonlinear parametric model for fertility over age with nonlinear modelling of fertility over other covariates. For the latter, we use the semi-parametric method of Gaussian process regression which is a popular methodology in many fields including machine learning, computer science, and systems biology. We applied the method to data from the Agincourt Health and Socio-Demographic Surveillance System, annual census rounds performed on a poor rural region of South Africa since 1992, to analyse fertility patterns over age and socio-economic status.

Results

We capture a previously established age-pattern of fertility, whilst being able to more robustly model the relationship between fertility and socio-economic status without unjustified a priori assumptions of linearity. Peak fertility over age is shown to be increasing over time, as well as for adolescents but not for those later in life for whom fertility is generally decreasing over time.

Conclusions

Combining Gaussian process regression with nonlinear parametric modelling of fertility over age allowed for the incorporation of further covariates into the analysis without needing to assume a linear relationship. This enabled us to provide further insights into the fertility patterns of the Agincourt study area, in particular the interaction between age and socio-economic status.