bluuebunny/crossref_metadata_2025 huggingface dataset:
Translating Behavioral Health Services Research into Benefits Policy
Authors: Grazier Kyle L. , Pollack Harold
Published: January 2017

This article uses a 4-pronged statistical approach to examine the impact of a mental health carve-out at a major employer. To examine net financial impact of the carve-out, the authors perform a pre-post, multivariate regression analysis of changes in costs. Using a random-effects model, the authors explore the ultimate financial impact of the carve-out for patients and for the firm. Using a multinomial logistic regression, they examine differing program effects by intensity of use. A fixed-effects negative binomial regression models the episodic nature of outpatient care, controlling for patient-specific unobserved characteristics that influence health care utilization. The carve-out slightly reduced overall mental health costs and utilization while expanding entry-level access to routine services. At the same time, the specific carve-out shifted financial burdens from the firm onto high-utilization patients. Therefore, this carve-out appears poorly suited to the care of individuals experiencing severe and debilitating psychiatric disorders.
Are Women Being Counseled about Estrogen Replacement Therapy?
Authors: Gallagher Teresa C. , Geling Olga , FitzGibbons Jennifer , Aforismo John , Comite Florence
Published: January 2017

The U.S. Preventive Services Task Force and several medical professional associations have published guidelines recommending that all women be counseled around the time of menopause about the benefits and risks of estrogen replacement therapy (ERT) so that they may make an informed decision about its use. Despite the proliferation of ERT counseling guidelines, little is known about whether these guidelines are being followed. There were 1,500 female members (aged 40 to 69) of a Northeastern U.S. Independent Practice Association-model Health Maintenance Organization who were surveyed, and 51 percent reported that a health care provider had talked with them about the benefits and risks of ERT. In multivariate analyses, a woman’s demographic characteristics (age, race, income), stage of menopause, severity of menopausal symptoms, and body weight were the major correlates of receipt of ERT counseling. Women at greater risk for osteoporosis or heart disease were no more likely to be counseled, although those with diagnosed osteo-porosis were. What appear to be selective ERT counseling practices will need to be modified if the goal of providing universal ERT counseling to midlife women is to be attained.
Motives for Health Plan-Academic Health Center Relationships: Journal Review of the First Quarter Century
Authors: Parkerton Patricia H.
Published: January 2017

Motives for health plan (HP)-academic health center (AHC) relationships, including both deterrents and inducements, are explored through a review of 153 articles, published from 1970 through 1997, in academic and health care industry journals about HP-AHC relationships. Every article that met inclusion criteria was coded for year, journal, author, audience, type of article, organization of focus, purposes, priorities, affiliation motives, and issues. Peak years were 1973 (the passage of HMO legislation) and the most recent years from 1994 through 1997. The motives to affiliate were found to be different for AHCs and HPs (e.g., physician attitudes, a deterrent for AHCs and inducement for HPs; resources, a deterrent for HPs and inducement for AHCs). Increases in size of HPs and decreases in political power of AHCs have resulted in changes to motives to form relationships. Motives must be acknowledged to move from competitive to collaborative relationships.
Extended infusion compared to standard infusion cefepime as empiric treatment of febrile neutropenia
Authors: Wrenn Rebekah H , Cluck David , Kennedy LeAnne , Ohl Christopher , Williamson John C
Published: January 2017

Background

Extended infusion (EI) dosing provides a longer time above the minimum inhibitory concentration, which is important for the clinical success of β-lactam antibiotics, especially for patients with impaired immunity. The aim of this study was to determine the feasibility and clinical impact of administering cefepime by EI as treatment of febrile neutropenia.

Methods

This was a prospective, randomized, comparative pilot study. All patients received cefepime 2 g IV every 8 h, with the first dose administered using a 30-min infusion. After the first dose, patients were randomized to receive cefepime over 30 min as a standard infusion (SI) or 3 h (EI). Patients were >18 years old with febrile neutropenia (neutrophil count <500 cells/mm3 and temperature >38.0ºC) and received chemotherapy or stem cell transplant as treatment for malignancy. Patients were excluded for the following: allergy to a cephalosporin, creatinine clearance (CrCl) < 50 mL/min, receipt of concurrent Gram-negative antimicrobial, sepsis, or solid tumor malignancy. The primary outcome was defervescence by 72 h. Secondary outcomes included time to defervescence, clinical success, in-hospital mortality, hospital length of stay, and need for additional antimicrobials.

Main results

Sixty-three patients were enrolled: 33 in the SI arm and 30 in the EI arm. The groups were similar with regard to age, gender, weight, estimated creatinine clearance, and duration of neutropenia. None of the patients in the EI arm withdrew due to practical complications of receiving EI cefepime. Twenty-three patients in the SI arm and 20 patients in the EI arm defervesced by 72 h ( p = 0.99). There were no differences in secondary outcome measures; however, patients in the EI arm appeared to have defervesced more rapidly (median 19 vs. 41 h, p = 0.305).

Conclusion

Administration of cefepime by EI for the treatment of febrile neutropenia is feasible. Larger clinical trials are necessary to determine if EI cefepime imparts a clinical benefit in the treatment of febrile neutropenia.
Baxter elastomeric pumps: Weighing as an alternative to visual inspection
Authors: Cusano Ellen L , Ali Raafi , Sawyer Michael B , Chambers Carole R , Tang Patricia A
Published: January 2017

Purpose

Elastomeric pumps are used to administer 46-hour infusions of 5-fluorouracil (5FU). Baxter suggests patients visually monitor their pumps to ensure that infusions are proceeding correctly. This can be confusing and lead to concerns about under- or over-dosing. Baxter has not considered weighing pumps as a validated method for monitoring. This study aims to validate weighing as a more accurate method for patients and healthcare professionals, and describe real life Baxter Infusor™ variability.

Methods

Patients who had been started on a 46-hour 5FU infusion returned to the clinic approximately 24 h after starting treatment. The pump was weighed on a StarFrit kitchen scale, and date, time, and weights recorded. Patients were asked if they had a preference for weighing or visually inspecting their pump.

Results

Pumps ( n = 103) were weighed between 17.25 and 27.5 h after connection. The average weight of a pump was 189 g. Of 103 pumps weighed, 99 weighed less than expected, corresponding to average flow rates of 5.69 mL/h over the elapsed time. The expected flow rate is 5 mL/h with 10% variability. Average flow rates within the 17.25- to 27.5-hour window were 4.561 mL/h, which is 8.78% slower than expected, but within the 10% known variability. Forty-seven percent of patients didn’t have a preference for either method, but for those who did have a preference, more than twice as many preferred weighing.

Conclusion

With proper education, weighing Baxter Infusors at home with kitchen scales can be an accepted and objective alternative to the current recommendation of visual inspection.
Numerical study of energy absorption in aluminum foam sandwich panel structures using drop hammer test
Authors: Nouri Damghani Mohammad , Mohammadzadeh Gonabadi Arash
Published: January 2017

The sandwich structures with aluminum foam core and metal surfaces have widespread use in the absorption of energy, because they are light weighted with high performance in dissipating energy. The cell structure of the foam core is subjected to plastic deformation in the constant compression level that absorbs a lot of kinetic energy before destruction of the structure. In this research, experimental tests of low-velocity impact on the sandwich structure by a drop machine are simulated by LS-DYNA software. Numerical results are obtained for different velocities and weights of projectile on samples of aluminum foam core sandwich panels with relative density (the ratio of the density of aluminum foam to the density of solid aluminum) of 18, 23, and 27. The results are compared with experimental results which reveal a good conformity. As well, from the numerical simulations, the effect of weight, velocity and energy of the projectile and the density of the foam core on the global deformation and energy loss rate of projectile have been studied.
Exponential matrix method for the solution of exact 3D equilibrium equations for free vibrations of functionally graded plates and shells
Authors: Brischetto Salvatore
Published: January 2017

The present paper analyzes the convergence of the exponential matrix method in the solution of three-dimensional equilibrium equations for the free vibration analysis of functionally graded material structures. The three-dimensional equilibrium equations are written in general orthogonal curvilinear coordinates for one-layered and sandwich plates and shells embedding functionally graded material layers. The resulting system of second-order differential equations is reduced to a system of first-order differential equations redoubling the variables. This system is exactly solved using the exponential matrix method and harmonic displacement components. In the case of functionally graded material plates, the differential equations have variable coefficients because of the material properties which depend on the thickness coordinate z. For functionally graded material shells, the differential equations have variable coefficients because of both changing material properties and curvature terms. Several mathematical layers M can be introduced to approximate the curvature terms and the variable functionally graded material properties to obtain differential equations with constant coefficients. The exponential matrix is applied to solve the resulting system of partial differential equations with constant coefficients, where the used expansion has a very fast convergence ratio. The present work investigates the convergence of the proposed method related to the order N used for the expansion of the exponential matrix and to the number of mathematical layers M used for the approximation of curvature shell terms and variable functionally graded material properties. Both N and M values are analyzed for different geometries, thickness ratios, materials, functionally graded material laws, lamination sequences, imposed half-wave numbers, frequency orders, and vibration modes.
Processing speed test: Validation of a self-administered, iPad®-based tool for screening cognitive dysfunction in a clinic setting
Authors: Rao Stephen M , Losinski Genna , Mourany Lyla , Schindler David , Mamone Bernadett , Reece Christine , Kemeny Danielle , Narayanan Sridar , Miller Deborah M , Bethoux Francois , Bermel Robert A , Rudick Richard , Alberts Jay
Published: January 2017

Background:

Cognitive dysfunction is common in multiple sclerosis (MS) patients and has important consequences for daily activities, yet, unlike motor function, is not routinely assessed in the clinic setting. We developed the Processing Speed Test (PST), a self-administered iPad®-based tool to measure MS-related deficits in processing speed.

Objective:

To determine whether the PST is valid for screening cognitive dysfunction by comparing it to the paper-and-pencil Symbol Digit Modalities Test (SDMT).

Methods:

We assessed PST test–retest reliability, sensitivity of PST and SDMT in discriminating MS patients from healthy controls (HC), convergent validity between PST and SDMT, correlations between T2 lesion load and PST and SDMT, and PST performance with and without technician present during administration.

Results:

PST had excellent test–retest reliability, was highly correlated with SDMT, was slightly more sensitive than SDMT in discriminating MS from HC groups, and correlated better with cerebral T2 lesion load than did SDMT. Finally, PST performance was no different with or without a technician in the testing environment.

Conclusion:

PST has advantages over SDMT because of its efficient administration, scoring, and potential for medical record or research database integration. PST is a practical tool for routine screening of processing speed deficits in the MS clinic.
The Vascular Biology of S-Nitrosothiols, Nitrosated Derivatives of Thiols
Authors: Upchurch Gilbert R , Welch George N , Loscalzo Joseph
Published: January 2017

Nitric oxide (NO) is a simple heterodiatomic molecule with a broad range of biologic actions. In the cardiovascular system NO serves as an endothelium-dependent vasodilator, an antithrombotic agent, an antiproliferative molecule, and a regulator of cardiac contractility. Owing to its reactivity under physiologic conditions, accumulating data suggest that NO forms derivatives with several classes of biologic compounds. One group of biochemical functionalities that serves this role is that of thiols, which can form thionitrites or S-nitrosothiols with NO. In this paper we will examine the effects of the biologically known and the chemically produced S-nitrosothiols on the cardiovascular system in order to understand better what role these compounds may play in physiologic and pathologic states.
Experimental Models of Chronic Lower Extremity Arterial Occlusive Disease: Lessons for Drug Development
Authors: Nicholson CD
Published: January 2017

Peripheral vascular disease is the result of chronic vascular insufficiency. As the vascular insufficiency of the lower limbs progressively deteriorates, the condition progresses from intermittent claudication (pain upon exercise) to pain at rest and gangrene. In very severe cases amputation of the leg may be necessary. Whilst dieting, cessation of smoking and physical exercise all beneficially affect the progression of the disorder, the available drug therapy is of limited benefit. Very effective pharmacological agents capable of alleviating the symptoms of chronic peripheral vascular disease have not been developed. In order to mimic the vascular insufficiency of intermittent claudication, an animal model was developed in rats. This involves short-term and long-term 6–10 weeks ligation of the femoral artery of the rat. As demonstrated using measurements of hindlimb skeletal muscle, blood flow, pO2, metabolism and function, a model of intermittent claudication was produced. Using this model, the beneficial effects of physical training was demonstrated. Physical training induced an increase in blood flow and a greater capacity for aerobic metabolism in the partially ischaemic skeletal muscle. The effect of vasodilators has also been examined in this model; in contrast to agents such as Ca2+ antagonists, K+ channel openers appear to improve nutritional blood flow and metabolism in the afflicted skeletal muscle. This model can also be utilized to demonstrate the effects of haemorrheological interventions and of agents modulating muscle metabolism. However, additional effort is required to develop models for the evaluation of efficacy of antiatherothrombotic drugs.
Microvascular Changes in Arterial Occlusive Disease: Target for Pharmacotherapy
Authors: Bollinger Alfred , Hoffmann Ulrich , Franzeck Ulrich K
Published: January 2017

The main techniques which have been used to study skin microcirculation in patients with peripheral arterial occlusive disease include intravital microscopy with and without the use of fluorescent dyes, laser Doppler fluxmetry and transcutaneous oximetry.

In patients with severe ischaemia (rest pain or incipient gangrene) the number of perfused skin capillaries is reduced. Parallel to the decreased number of microvessels containing blood, transcutaneous oxygen tension is low or even approaches the zero level. The tendency to oedema formation is documented by increased leakage of intravenously injected sodium fluorescein at the capillary apex of foot skin (‘candlelight phenomenon’).

Laser Doppler flux at rest may still be within the normal range even in advanced disease, since the sample volume of these instruments also contains non-nutritive shunt vessels. However, reactive hyperaemia after arterial occlusion is decreased and delayed in peripheral ischaemia. Whereas rhythmic low-frequency vasomotion is significantly enhanced in patients with intermittent claudication, vasoparalysis with no flux fluctuations prevails in patients with critical ischaemia.
The Correlation between Symptoms and Non-Invasive Test Results in Patients Referred for Peripheral Arterial Disease Testing
Authors: Criqui Michael H , Denenberg Julie O , Bird Cameron E , Fronek Arnost , Klauber Melville R , Langer Robert D
Published: January 2017

The WHO/Rose questionnaire has served as the epidemiologic and clinical standard in the assessment of leg pain in patients with peripheral arterial disease (PAD) for over three decades. However, the structure of this questionnaire does not allow assessment of leg-specific (i.e. right versus left) symptoms. We studied 508 patients aged 39–95 years (mean 68 years), initially referred for PAD non-invasive testing. A revised questionnaire, the San Diego Claudication Questionnaire, was administered which allowed determination of leg-specific symptoms and evaluated thigh and buttock as well as calf pain. Leg-specific symptoms were categorized into no pain, pain at rest, non-calf claudication, non-Rose calf claudication, and Rose claudication. At the same visit, the ankle brachial index, the toe brachial index, and peak posterior tibial flow velocity were measured by Doppler ultrasound and five categories of non-invasive results by type and severity of PAD were defined. Legs with previous intervention (Rx), surgery or angioplasty, were evaluated separately. Claudication was reported in 42% of no Rx legs and 50% of Rx legs; 40% of claudication was atypical (not Rose); 64% of no Rx and 81% of Rx legs had PAD by non-invasive testing, and 27% of affected legs had severe PAD. The correlation between the severity of symptoms and the severity of ipsilateral PAD in no Rx legs was r=−0.40, p< 0.001. In Rx legs, this correlation was somewhat less ( r=0.27, p< 0.001) due to more symptomatology at lesser degrees of PAD, suggesting reporting bias and/or more residual disease than evident from non-invasive testing. To our knowledge, these results provide the first comparison between a standardized assessment of leg pain and the severity of ipsilateral PAD by non-invasive testing.
Gendered health inequalities in mental well-being? The Nordic countries in a comparative perspective
Authors: Olafsdottir Sigrun
Published: January 2017

Aims: The aims of this study were to: (a) compare gender differences in mental well-being in the Nordic countries with gender differences in 28 other countries around the world; and (b) evaluate whether gender differences in the Nordic countries remain when other social and lifestyle factors are taken into account. Methods: Data were obtained from 32 countries around the world that participated in the 2011 health module of the International Social Survey Programme. Ordered logit regression models were used to evaluate whether gender differences remained significant when other social and lifestyle factors were considered. Results: Gender differences in mental well-being in the Nordic countries are not particularly small and the four countries do not cluster together. The gender differences remain when other social and lifestyle factors are taken into account. Conclusions: There appears to be a similar Nordic health paradox for mental well-being outcomes as for physical health outcomes. Although there may be multiple reasons for this, continued gender equality, including sex segregation in the labour market and gendered expectations, are considered to play a part.
Pyloroplasty for Benign Gastric Outlet Obstruction — Indications and Techniques
Authors: Søreide K. , Sarr M. G. , Søreide J. A.
Published: January 2017

The understanding of peptic ulcer disease (PUD) etiology, and improvements in treatment during the last two decades, has dramatically decreased the once so frequently performed procedures for PUD and its complications. Benign gastric outlet obstruction may, however, still require operative intervention when non-operative treatment fails. Today, surgeons in training, and even practicing surgeons, may have limited operative experience with procedures required to alleviate an obstructed pylorus. Our aim of this paper is to review the techniques (the Heineke-Mikulicz and Finney pyloroplasties, and modifications) and indications for pyloroplasty in the modern surgical era.
Recovery of Muscle Strength after Late Repair of Distal Biceps Brachii Tendon
Authors: Ryhänen J. , Kaarela O. , Siira P. , Kujala S. , Raatikainen T.
Published: January 2017

Background and Aims:

Ruptures of the distal part of the biceps brachii tendon are rare. The diagnosis is often delayed and only late repair can be considered. In this study, the recovery of muscle strength after late repair of the distal biceps brachii tendon was evaluated.

Materials and Methods:

Sixteen patients with a ruptured distal biceps brachii tendon were analysed. The mean delay from the primary trauma to the operation was 35 weeks. The tendon was anatomically re-attached with bone anchors. In three cases a tendon graft was needed. The operated arms were immobilised postoperatively for four weeks, after which mobilisation was allowed. Maximal static flexion and supination strength was measured after an average follow-up time of 124 weeks by using a computer-based isokinetic dynamometer.

Results:

Patient satisfaction and overall muscle strength recovery were very good. Compared to the non-operated side, average flexion strength recovery was 90% and corresponding recovery of supination strength 78%. Weakness on supination remained in the cases where a tendon graft was used. One patient needed a re-operation for a re-rupture. There were three cases of transient paresthesia of the cutaneous nerve. All patients resumed their previous work.

Conclusion:

Late anatomical repair of the biceps brachii tendon restores very good flexion and moderate supination strength. This operation should always be considered when the primary diagnosis is delayed.
Trends in Surgical Wound Healing
Authors: Gottrup F.
Published: January 2017

The understanding of acute and chronic wound pathophysiology has progressed considerably over the past decades. Unfortunately, improvement in clinical practice has not followed suit, although new trends and developments have improved the outcome of wound treatment in many ways. This review focuses on promising clinical development in major wound problems in general and on postoperative infections in particular.
The Increasing Incidence and Difference in Sex Distribution of Achilles Tendon Rupture in Finland in 1987–1999
Authors: Nyyssönen T. , Lüthje P. , Kröger H.
Published: January 2017

Background and Aims:

There have been reports about the increasing number of Achilles tendon ruptures. The most of the reports are based on records in a few hospitals only. We wanted to verify the increasing trend by investigating the epidemiology of Achilles tendon rupture in a very large population.

Material and Methods:

The retrospective data was collected from 1987 to 1999 in finnish National Hospital Discharge Register. The study includes 7 375 tendon rupture patients. We recorded their age, gender, home district and the date of admission in a hospital.

Results:

The incidence of operatively treated Achilles tendon rupture was 11.2/105. The number of the patients was increasing particularly in the old age-groups. The change during the study period was statistically significant (p=0.015). The females with a tendon rupture were on average 2–3 years older than men (p<0.01). The urban areas around the capital city had a higher occurrence of tendon ruptures than the rural areas (p<0.05).

Conclusion:

The number of Achilles tendon ruptures is increasing, but the reasons for this remain unknown. The geographical variations in rupture rate might indicate the role of the urban life-style as a risk factor. One reason for the differences between the men and the women might be the different level of the sport activities, especially ball-games.
Intraoperative Pressure Measurement in Radial Artery Harvest. A Tool with Additional Value?
Authors: Kohonen M. , Teerenhovi O. , Taskinen P. , Nissinen J. , Loponen P. , Luther M. , Tarkka M.
Published: January 2017

Objectives:

The radial artery is widely used as a graft in coronary artery bypass surgery (CABG). Due to its location and function it should be screened prior to harvesting to avoid ischaemic complications of the hand. In acute situations the Allen test is often the only preoperative screening method available. As has been noted earlier, a negative Allen test does not mean a non-harvestable radial artery. We endeavoured to find out whether intraoperative pressure measurement could be used as a complement while screening the radial artery.

Design:

Ninety patients planned for elective CABG with radial artery as a conduit were examined preoperatively with the Allen test, handheld Doppler and pletysmography of the second and fourth digits. Radial artery pressure was measured intraoperatively. Symptom scale was recorded pre- and postoperatively.

Results:

There were ten patients with a positive Allen test. The intraoperative index of radial artery pressures was 0.868 in the Allen positive group and 0.885 in the Allen negative group with no statistically significant difference (P value .68). Tolerance of exercise and cold was significantly impaired postoperatively, P values .002 and .001 respectively. No ischaemic complications occurred.

Conclusions:

Intraoperative pressure measurement can be used when screening radial arteries are to be harvested and no metric preoperative screening methods are available.
Celiac Trunk Coverage in Endovascular Aneurysm Repair
Authors: Delle M. , Lönn L. , Henrikson O. , Formgren J. , Vogt K. , Falkenberg M.
Published: January 2017

Background and Aims:

This retrospective study was undertaken to examine the risks associated with obstruction of the coeliac trunk in the process of treating aneurysms with endografting.

Material and Methods:

120 patients were treated by endografting for aneurysmal disease. Of these, a subgroup of 9 patients had their celiac trunk covered. If possible, a preoperative angiography was performed to evaluate collateral flow from the superior mesenteric artery. This was considered to predict the risk for ischemia.

Results:

None of the patients had any severe clinical event of the celiac trunk occlusion or clinical signs of intestinal ischemia. Three patients had transient increase of liver enzymes.

Conclusions:

In cases where the distal landing zone of the descending thoracic aorta is to short for endografting, covering of the celiac trunk may be an option if no other surgical alternative is apparent. Preoperative angiography to visualise the presence of collateral vessels from the superior mesenteric artery is recommended.
High Leg Salvage Rate after Infrainguinal Bypass Surgery for Ischemic Tissue Loss (Fontaine IV) is Compromised by the Short Life Expectancy
Authors: Söderström M. , Arvela E. , Aho P.-S. , Lepäntalo M. , Albäck A.
Published: January 2017

Background and Aims:

Most studies analysing the prognosis of infrainguinal bypass surgery (IBS) in patients with critical leg ischemia (CLI) have combined the outcome of patients with rest pain and tissue loss. The aim of the present study was to evaluate amputation-free survival (AFS) after IBS in patients with the most advanced form of peripheral arterial disease, CLI with tissue loss (Fontaine IV), and to analyse the risk factors for an adverse outcome.

Patients and Methods:

636 patients with CLI and tissue loss who underwent unilateral IBS between January 2000 and December 2006 at our institution were included in this retrospective study.

Results:

At one year, the leg salvage, survival and amputation-free survival rates were 83%, 71% and 55%, respectively, and at five years 76%, 38% and 30%, respectively. In univariate analysis, diabetes was associated with decreased AFS. In multivariate analysis, age, coronary artery disease, chronic pulmonary disease, gangrene and renal insufficiency were independent risk factors for decreased AFS.

Conclusion:

Infrainguinal bypass grafting results in a high rate of leg salvage. Amputation-free survival was low during the follow-up due to the high mortality of patients with CLI and tissue loss. Several co-morbidities of the CLI patients were associated with decreased amputation-free survival.
Network ties and survival
Authors: Acheampong George , Narteh Bedman , Rand John
Published: January 2017

Poultry farming has been touted as one of the major ways by which poverty can be reduced in low-income economies like Ghana. Yet, anecdotally there is a high failure rate among these poultry farms. This current study seeks to understand the relationship between network ties and survival chances of small commercial poultry farms (SCPFs). We utilize data from a 2-year network survey of SCPFs in rural Ghana. The survival of these poultry farms are modelled using a lagged probit model of farms that persisted from 2014 into 2015. We find that network ties are important to the survival chances of the SCPFs in Ghana. Distribution ties are associated with negative survival chances and this is not even reversed if the human capital of the owner increases although managers with higher human capital and higher distribution ties experience positive effects. Industry ties are associated with positive ties but this probability reduces as the number of industry ties increases but moderation with dynamic capability of the firm reverses this trend. Our findings show that not all network ties aid survival and therefore small commercial poultry farmers need to be circumspect in the network ties they cultivate and develop.
Social franchising as rural entrepreneurial ecosystem development
Authors: McKague Kevin , Wong Jennifer , Siddiquee Nurul
Published: January 2017

This study explores the potential of social franchising to contribute to the development of the rural entrepreneurial ecosystem in contexts of market and governance failure in least developed countries. Social franchising is a social enterprise business model that provides market coordination and support systems to rural enterprises so they can achieve social objectives in a financially sustainable way. The case of Krishi Utsho—a network of 112 agricultural input shops in Bangladesh—illustrates how social franchising can address market and government coordination failures in the entrepreneurial ecosystem to benefit both rural entrepreneurs and their client smallholder farming families who earn under US$1 per day.
How young children make sense of two different writing systems: Korean written in the Hangul alphabet, and English written in the Roman alphabet
Authors: Nam Kyung Min
Published: January 2017

Although many young children become literate within an environment in which different writing systems exist, there is little research on what children know about different writing systems and how they understand and develop them when they are learning more than one simultaneously. This qualitative study discusses how Korean EFL (English as a Foreign Language) children understand two different writing systems, the Korean alphabet, Hangul, and the Roman alphabet, used for English, within a peer teaching setting. The findings show that they were able not only to discover key orthographic principles which characterise each writing system but also to find similarities and differences between Hangul and English from different points of view: shapes of letters (block shaped vs linear), language units (syllables vs letters) and sound–letter relationship (shallow orthography vs deep orthography). The paper suggests that young children are able to look for key concepts in different writing systems by constructing their own ideas about the principles of reading and writing from an early age as active language learners.
Exploring the roots of participatory action research: An interview with Dr Marja-Liisa Swantz
Authors: Nyemba Florence , Mayer Minna
Published: January 2017

This article is based on a dialog with Professor Marja-Liisa Swantz, a distinguished participatory action research expert whose work has contributed immensely in the fields of development studies, women's studies, health, and technology internationally. Drawing from her experiences, the conversation provides an insight into how one can grow from a novice researcher to a very distinguished intellectual by staying focused and with a clear grasp of one's aspirations. We also learn from this dialog how participatory action research emerged as the most significant research style that argues in favor of involving participants as research partners in the knowledge production process.
Using pedometers to monitor walking activity in outcome assessment for pulmonary rehabilitation
Authors: Dallas MI , McCusker C. , Haggerty MC , Rochester CL , ZuWallack R. , Northeast Pulmonary Rehabilitation Consortium
Published: January 2017

Background: The purpose of this study was to determine whether a commercially available pedometer could detect changes in home-based walking activity among chronic obstructive pulmonary disease (COPD) patients completing pulmonary rehabilitation (PR). Methods: Patients with COPD referred to outpatient PR wore a pedometer to count steps for 1 week at the beginning and 1 week at the end of PR. Patients also completed the 6-min walk test (6MWT), the Medical Research Council (MRC) dyspnea scale and the self-administered chronic respiratory disease questionnaire (CRQ) at the beginning and the end of PR. Paired t tests were used to compare pre- and post-PR changes in outcome variables. Results: 45 patients with severe COPD (forced expiratory volume in 1 second [FEV1] 45% ± 18% of predicted) participated in a total of 17.4 ± 4.6 PR sessions. Significant improvements in 6MWT (49 ± 59 m; p < .0001), MRC dyspnea score (—0.64 ± 0.96 units; p = .003) and CRQ score (10 ± 18 units; p = .0007) were noted following PR. Patients whose pedometer-measured steps were within 20% of observed counted steps were included in the analysis. Pedometer counts increased by 33 ± 149 steps per hour worn after, as compared with before PR ( p = .14). There was a significant inverse relationship between baseline pedometer counts and change in pedometer counts per hour post-PR ( r = —.46; p = .001). Patients with low baseline activity levels had significant increases in pedometer activity (88 ± 30 counts per hour worn) and a greater reduction in MRC dyspnea score (—0.94 vs —0.29; p = .04) following PR, whereas those with higher baseline activity levels had a decrease in pedometer activity (—19 ± 29 counts/hour; p = .015). Conclusions: A standard pedometer worn at the waist did not detect changes in lower extremity activity following PR. This negative finding occurred despite demonstrated improvements in dyspnea, exercise tolerance and quality of life measures. Although pedometers are inexpensive and easy to use, they may not be sensitive enough to be used routinely as an outcome measure for PR.
Bacterial Infection during Adult Donor Care
Authors: Powner David J. , Allison Teresa A.
Published: January 2017

Assessment, prevention, and treatment of bacterial infection in donors are critically important to the welfare of grafts and recipients after transplantation. Transmission of bacterial, viral, fungal, and protozoan infections from a donor to recipient(s) has been documented to have serious or fatal consequences. This article reviews issues of bacterial infection only. The organ procurement coordinator, supported by guidelines developed and prospectively modified by the organ procurement organization, must assess the donor for the presence and severity of bacterial tissue invasion and administer appropriate antimicrobial agents during donor care. Continuation of infection control measures, obtaining serial or surveillance samples for culture, review of antibiotic sensitivity data, initiation of empiric treatment, and modification of medications or their dosing are components of this important responsibility during donor care.
A Model for Structuring the Donor Discussion in Emergent Transplant Procedures
Authors: Clarke Alex , Malloy Jonathan , White Paul , Simmons Jon , Gwanmesia Ivo , Withey Simon , Butler Peter E. M.
Published: January 2017

Objective

To investigate the potential for maximizing organ and tissue donation by identifying an empirical basis for structuring donor discussions.

Design

Intentions to donate organs and tissues were recorded in 2 separate samples of participants and analyzed separately by using Guttman scaling, the second sample providing a replication of the findings from the first.

Participants

304 participants were recruited from the Royal Society Summer Science Exhibition 2004, and 200 health professionals were recruited from the Royal Free Hospital.

Results

High coefficients of scalability and reproducibility in both samples indicate a one-dimensional scale for intentions to donate organs and tissues, with solid organs more likely to be donated than corneal, hand, and facial tissue. Thus donor discussions can be structured in a robust order, with the potential for reliable use of cutoff points once donation of a particular organ or tissue has been refused.

Conclusions

This reliable pattern can be used to maximize organ and tissue donation rates and to underpin emergent transplant techniques.
Hand Surgeons and Orthopedic Trauma Surgeons Call Coverage of Acute Upper Extremity Injuries: Where Should the Line Be Drawn?
Authors: Cantlon Matthew B. , Miller Andrew J. , Ilyas Asif M.
Published: January 2017

Background: There is a lack of consensus as to which subspecialty service should cover acute upper extremity injuries in the emergency department (ED). The purpose of the present study is to understand how upper extremity injuries are currently triaged to specialists and to assess the current opinion among hand and orthopedic trauma specialists as to how these injuries should be best triaged based on injury location and severity. Methods: The American Association for Hand Surgery (AAHS) membership and Orthopaedic Trauma Association (OTA) membership were surveyed using a 28-item online questionnaire. Results: A total of 103 responses from the AAHS and 114 responses from the OTA were received. Nearly 50% of the respondents report no formal anatomic line as to how upper extremity injuries are triaged to specialists from the ED. Approximately 57% of the AAHS respondents feel that hand call should begin at the distal radius or proximal, while 71% of the OTA respondents feel that hand call should begin at the radiocarpal joint or distal. There was increasing agreement that more complex injuries be assigned to the hand surgeon. Conclusions: There is agreement that proximal to the elbow, the trauma consultant should be called, and distal to the distal radius, the hand consultant should be called. However, there is a lack of agreement as to who should be responsible for call between the elbow and the hand. To optimize patient care, better allocate consultant resources, and minimize conflict between consultants, establishing anatomic guidelines for consultation should be considered.
Endovascular Treatment of Ruptured Intracranial Aneurysms Using Platinum Coils in Patients over 70 Years of Age
Authors: Sawada M. , Kaku Y. , Hayashi K. , Ueda T. , Yoshimura S. , Sakai N.
Published: January 2017

Endovascular treatment of intracranial aneurysms using platinum coils was performed in 26 patien with age over 70 years. The patients ranged from 70 to 86 years old (mean 77.5). Preoperative World Federation of Neurological Surgeons (WFNS) scale revealed that 6 patients were in grade I, 5 in grade II, 2 in grade III, 12 in grade IV, and 1 in grade V. The location of aneurysms are as follows; 10 were in the internal carotid artery, 7 in the anterior cerebral artery, 1 in the middle cerebral artery, and 8 in the vertebro-basilar system. Intra-aneurysmal occlusion was accomplished in 25 patients, resulting in 6 complete occlusion (24%), 3 neck remnant (12%), 11 body filling (44%), and both of neck remnant and body filling in 5 (20%). In one patient with vertebral artery union aneurysm, the parent artery was occluded just proximal to the aneurysm.

Eleven of 13 patients with good clinical grade (grade I, II, and III) resulted in good clinical outcome, whereas 11 of 13 patients with poor clinical grade (grade IV and V) showed poor outcome. Periprocedural complications such as thromboembolism and intra-procedural rupture occurred in 5 patients (19.2%). Each of the complications was attributed to severe atherosclerotic changes of parent arteries. Symptomatic cerebral vasospasm occurred in only one patient (3.8%).

In conclusion, endovascular coil emboilization is a useful therapeutic alternative for treating ruptured intracranial aneurysms in patients over 70 years of age, especially in patients with good clinical grade (better than grade III).
Neck Protective Basket
Authors: Fukasaku K. , Negoro M. , Kamikita Y. , Oguchi K. , Sone S.
Published: January 2017

For neck protection technique to prevent migration or protrusion of GDCs, non detachable balloons or microcatheters/wires are used. Non detachable balloon has good protective effect with great effect to the flow in the parent artery which is risky for safe procedure. Microcatheter has little effect to the parent flow and poor protective effect. We have developed retrievable microbasket for neck protective technique which can be delivered and retrieved through standard 18 catheters. These baskets have good protective effect in aneurysm model.
Detection of Unstable Plaques in Patients with Carotid Stenosis Using B-Mode Ultrasonography
Authors: Kobayashi E. , Ono J. , Hirai S. , Yamakami I. , Saeki N. , Yamaura A.
Published: January 2017

Distal embolism is a detrimental complication of stent placement for the carotid artery stenosis. To evaluate usefulness of B-mode ultrasonography (US) for the detection of unstable plaques in patients with carotid artery stenosis, we examined US in 46 arteries of 35 patients with carotid stenosis of >30%.

The echogenicity of 46 carotid plaques was hyperechoic in 20 plaques, hypoechoic in 15, and mixed-echoic in 11. The echogenicity of carotid plaques was correlated with severity of carotid stenosis, ipsilateral stroke or T1A, heart attack, and risk factors of systemic atherosclerosis. Hypoechoic plaques were associated with severe carotid stenosis and ipsilateral ischemic event. Mixed-echoic plaques had a high incidence of past history of heart attack. Hyperechoic plaques were less likely to associate with risk factors of systemic atherosclerosis.

We developed a new method of echodensity analysis. Using a computer software, echodensity values of seven plaque components were determined by comparing US findings and pathology of surgical specimens. The echodensity value was defined as a relative value to the arterial lumen.

The calcified part of plaques had the highest echodensity of 6.24 ± 0.86 (mean ± 2 S.D.); fibrosis or hyarynoid degeneration of 2.05 ± 0.40, foamy histiocytes of 1.47 ± 0.05, necrosis of 1.32 ± 0.16, cholestelin clefts of 1.28 ± 0.13, intraplaque hemorrhage of 1.02 ± 0.09, and intraluminal thrombus of 1.27 ± 0.07. Constructed from the echodensity value, an echo-densitometry color mapping of the carotid plaque illustrated the exact location and extent of plaque component. B-mode US of carotid plaques represents clinical characteristics relating distal embolism and systemic atherosclerosis. A new method of echodensity analysis and echo-densitometry color mapping of the carotid plaque is useful to detect unstable plaques in patients with carotid stenosis.
Provocative Testing for Embolization of Spinal Cord AVMs
Authors: Niimi Y. , Sala F. , Deletis V. , Berenstein A.
Published: January 2017

The purpose of this study is to evaluate efficacy and reliability of chemical provocative testing using neurophysiological monitoring prior to embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of provocative testing using sodium amytal and lidocaine injected superselectively in 41 angiography and / or embolization procedures in 26 patients with a SCAVM, including 23 amytal and 26 lidocaine injections. All procedures were performed under general anesthesia using neuroleptic drugs, and with monitoring of cortical somatosensory evoked potentials (SEPs) and trans-cranial motor evoked potentials (MEPs). After recording baseline SEPs and MEPs, 50mg of sodium amytal was injected through the microcatheter at the position of the intended embolization, followed by assessment of SEPs and MEPs. If no changes occurred, 40mg of lidocaine was then injected followed by recording of SEPs and MEPs. If again no changes were noted, embolization was performed using NBCA. If there was any change in either SEPs or MEPs, NBCA embolization was not performed from that catheter position. No false negative results of the provocative testing were experienced. One amytal test from the posterior spinal artery (PSA) was positive, causing loss of MEPs. Lidocaine testing was positive in 10 cases including 4 injections in the PSA (with loss of MEPs in two and SEPs in two), 5 injections in the anterior spinal artery (with loss of MEPs in four and SEPs in one), and 1 case involving the posterior inferior cerebellar artery (with loss of MEPs). Neither amytal nor lidocaine injection caused loss of both SEPs and MEPs. In conclusion, sodium amytal and lidocaine are complimentary as pharmacological agents for provocative testing, and SEPs and MEPs are complimentary to each other as physiologic monitoring methods. Provocative testing should be performed using both amytal and lidocaine with monitoring of both SEPs and MEPs.
Utilization of Extracorporeal Pump during Local Intra-Arterial Fibrinolysis in the Treatment of Acute Cerebral Arterial Occlusion
Authors: Matsumaru Y. , Sonobe M. , Mashiko R. , Sugimori M. , Takahashi S. , Nose T.
Published: January 2017

Local intra-arterial fibrinolysis may improve the outcome of patients with ischemic cerebrovascular disease. A favorable prognosis is thought to be related to early re-establishment of blood flow into the affected brain. To minimize the time to revascularization during local intraarterial fibrinolysis, we employed an extracorporeal pump to deliver oxygenated blood into the affected brain through a microcatheter. The patient, a 57-year-old man, showed disturbance of consciousness with left hemiparesis and was admitted to our hospital one hour after onset of symptoms. Cerebral angiography demonstrated an acute occlusion of the right middle cerebral artery, and the patient underwent local intra-arterial fibrinolysis with an extracorporeal pump. Oxygenated blood was successfully delivered through a microcatheter into the affected brain before recanalization. Subsequently, recanalization was obtained by intra-arterial fibrinolysis with a tissue plasminogen activator. The outcome of this patient was excellent. Thus, local intra-arterial thrombolysis with extracorporeal pump may be an effective method by which to increase the residual blood flow and widen the therapeutic window for fibrinolysis.