bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient Education Tools: Using Pets to Empower Patients’ Self-care—A Pilot Study
Authors: Hodgson Kate , Darling Marcia , Monavvari Alan , Freeman Douglas
Published: November 2018

Six patient education tools were designed to guide patients’ self-care by activating pets to positively impact social determinants of health. Distributed to both pet owners and primary health-care providers, each tool addressed a specific area of health and outlined a pet-related activity. Surveys questioned how participants used the tools and their impact on health and health care. Pet owners shared the tools with family and friends. Primary health-care providers used the tools to target specific health concerns. Primary health-care providers reported that working with the tools improved rapport with their patients.
Reservation Lands as a Protective Social Factor: An Analysis of Psychological Distress among Two American Indian Tribes
Authors: Huyser Kimberly R. , Angel Ronald J. , Beals Janette , Cox James H. , Hummer Robert A. , Sakamoto Arthur , Manson Spero M. ,   the AI-SUPERPFP Team
Published: November 2018

The unique physical, cultural, and ecological location of U.S. American Indian reservations simultaneously presents risks for mental health and offers sources of resilience to Native peoples. Using survey data from two American Indian tribes, we explore whether the length of one’s life spent on a reservation is associated with lower odds of psychological distress. In both tribes, we find that individuals who live a vast majority of their lives on the reservation have lower odds of psychological distress than individuals who spent portions of their life off or near the reservation. These findings suggest a need to reframe the perception of life experience on tribal reservations but also call for a more nuanced investigation of the life experience of American Indians. This study illustrates the importance of deeply exploring the relationship that American Indians have with their tribal reservation lands.
Leader Messaging and Attitudes toward Sexual Violence
Authors: Hart Chloe Grace , Crossley Alison Dahl , Correll Shelley J.
Published: November 2018

Research exploring sexual assault within universities and sexual harassment within companies has largely overlooked how leadership in organizations can shape constituents’ perceptions of sexual violence. This question has become particularly relevant as organizations are increasingly tasked with measuring and communicating about sexual violence. We use two national survey experiments to test how altering an organization’s communication of information about sexual assault or harassment affects participants’ agreement that it is a high-priority issue. In Study 1, we show that participants are strongly influenced by the way in which the leader interprets the problem of sexual violence at the organization and not by the placement of prevalence statistics in the statement. In Study 2, we identify the leader messages that are the most influential in shaping opinions about sexual assault and harassment. This research demonstrates the influence that leaders of organizations have in shaping narratives about sexual violence within them.
Creating Value through Social Media: Fresh Evidence from Cultural Organizations
Authors: Amitrano Cristina Caterina , Gargiulo Roberta , Bifulco Francesco
Published: November 2018

The impacts of digital technologies are gaining increasing attention in the service literature, and a growing number of cultural organizations are using online websites and social media to interact with their actual and potential customers. However, the contributions developed by service marketing scholars show little interest in examining the role of underlying technologies in a particular service experience context, namely, the cultural heritage context and the corresponding visiting experience. Therefore, the purpose of this research is to analyse how digital technologies, especially social media, can help cultural organizations stimulate customer engagement. To reach this aim, we conducted a single exploratory case study of a communication project developed by the National Archaeological Museum of Naples (MANN) to attract their actual and potential Italian and foreign visitors. The achieved results allow for us to show how digital communication tools can stimulate customer engagement in a cultural heritage context.
Reflection moveout approximation for a P-SV wave in a moderately anisotropic homogeneous vertical transverse isotropic layer
Authors: Farra Véronique , Pšenčík Ivan
Published: November 2018

A description of the subsurface is incomplete without the use of S-waves. Use of converted waves is one way to involve S-waves. We have developed and tested an approximate formula for the reflection moveout of a wave converted at a horizontal reflector underlying a homogeneous transversely isotropic layer with the vertical axis of symmetry. For its derivation, we use the weak-anisotropy approximation; i.e., we expand the square of the reflection traveltime in terms of weak-anisotropy (WA) parameters. Traveltimes are calculated along reference rays of converted reflected waves in a reference isotropic medium. This requires the determination of the point of reflection (the conversion point) of the reference ray, at which the conversion occurs. This can be done either by a numerical solution of a quartic equation or by using a simple approximate solution. Presented tests indicate that the accuracy of the proposed moveout formula is comparable with the accuracy of formulas derived in a weak-anisotropy approximation for pure-mode reflected waves. Specifically, the tests indicate that the maximum relative traveltime errors are well below 1% for models with P- and SV-wave anisotropy of approximately 10% and less than 2% for models with P- and SV-wave anisotropy of 25% and 12%, respectively. For isotropic media, the use of the conversion point obtained by numerical solution of the quartic equation yields exact results. The approximate moveout formula is used for the derivation of approximate expressions for the two-way zero-offset traveltime, the normal moveout velocity and the quartic term of the Taylor series expansion of the squared traveltime.
Relationship Between Preoperative Antidepressant and Antianxiety Medications and Postoperative Hospital Length of Stay
Authors: Vashishta Rishi , Kendale Samir M.
Published: November 2018

BACKGROUND:

Patients on antidepressant or antianxiety medications often have complex perioperative courses due to difficult pain management, altered coping mechanisms, or medication-related issues. This study examined the relationship between preoperative antidepressants and antianxiety medications on postoperative hospital length of stay while controlling for confounding variables.

METHODS:

From an administrative database of 48,435 adult patients who underwent noncardiac surgery from 2011 to 2014 at a single, large urban academic institution, multivariable zero-truncated negative binomial regression analyses controlling for age, sex, medical comorbidities, and surgical type were performed to assess whether preoperative exposure to antidepressant or antianxiety medication use was associated with postoperative hospital length of stay.

RESULTS:

There were 5111 (10.5%) patients on antidepressants and 4912 (10.1%) patients on antianxiety medications. The median length of stay was 3 days (interquartile range = 2–6). After controlling for confounding variables, preoperative antidepressant medication was associated with increased length of stay with an incidence rate ratio of 1.04 (99% confidence interval, 1.0–1.08, P < .001) and antianxiety medication with an incidence rate ratio of 1.1 (99% confidence interval, 1.06–1.14; P < .001).

CONCLUSIONS:

The association between antidepressants or antianxiety medications and increased postoperative length of stay suggests that these patients may require greater attention in the perioperative period to hasten recovery, which may involve integrating preoperative counseling, postoperative psychiatric consults, or holistic recovery approaches into enhanced recovery protocols.
Acute Kidney Injury and Risk of Death After Elective Surgery: Prospective Analysis of Data From an International Cohort Study
Authors: Chaudery Hannan , MacDonald Neil , Ahmad Tahania , Chandra Susilo , Tantri Aida , Sivasakthi Velayuthapillai , Mansor Marzida , Matos Ricardo , Pearse Rupert M. , Prowle John R.
Published: November 2018

BACKGROUND:

Postoperative acute kidney injury (AKI) is associated with a high mortality rate. However, the relationship among AKI, its associations, and mortality is not well understood.

METHODS:

Planned analysis of data was collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logistic regression to examine the relationships among preoperative creatinine-based estimated glomerular filtration rate (eGFR), postoperative AKI, and hospital mortality, accounting for the effects of age, major comorbid diseases, and nature and severity of surgical intervention on outcomes. We similarly modeled preoperative associations of AKI. Data are presented as n (%) or odds ratios (ORs) with 95% confidence intervals.

RESULTS:

A total of 36,357 patients were included, 743 (2.0%) of whom developed AKI with 73 (9.8%) deaths in hospital. AKI affected 73 of 196 (37.2%) of all patients who died. Mortality was strongly associated with the severity of AKI (stage 1: OR, 2.57 [1.3–5.0]; stage 2: OR, 8.6 [5.0–15.1]; stage 3: OR, 30.1 [18.5–49.0]). Low preoperative eGFR was strongly associated with AKI. However, in our model, lower eGFR was not associated with increasing mortality in patients who did not develop AKI. Conversely, in older patients, high preoperative eGFR (>90 mL·minute−1·1.73 m−2) was associated with an increasing risk of death, potentially reflecting poor muscle mass.

CONCLUSIONS:

The occurrence and severity of AKI are strongly associated with risk of death after surgery. However, the relationship between preoperative renal function as assessed by serum creatinine-based eGFR and risk of death dependent on patient age and whether AKI develops postoperatively.
Ο "Καλλικράτης" και η διαχείρηση των στερεών αποβλήτων
Authors: Κουταλάκης Χαράλαμπος
Published: November 2018

Η μελέτη αποσκοπεί στη συγκριτική αξιολόγηση της ποιότητας εφαρμογής της εθνικής πολιτικής για τη διαχείριση των στερεών αποβλήτων, υπό το πρίσμα των πρόσφατων διοικητικών αλλαγών που επέφερε το πρόγραμμα "Καλλικράτης". Βάσει εμπειρικών πρωτογενών δεδομένων αναλύονται οι βασικοί θεσμικοί και διαχειριστικοί παράμετροι υλοποίησης του εθνικού σχεδίου άμεσης συμμόρφωσης με την Ευρωπαϊκή νομοθεσία από τους φορείς της τοπικής αυτοδιοίκησης. Συγκεκριμένα, εξετάζεται η ποιότητα του ρυθμιστικού σχεδιασμού και τα μέσα εφαρμογής του προγράμματος αποκατάστασης των χώρων ανεξέλεγκτης διάθεσης αποβλήτων (ΧΑΔΑ) και ολοκληρωμένης διαχείρισης απορριμμάτων, με στόχο την ανάδειξη των παραγόντων που διευκολύνουν ή δυσχεραίνουν την προσαρμογή της ελληνικής διοίκησης στις διαδικαστικές και ουσιαστικές προϋποθέσεις αποτελεσματικής εφαρμογής της ενωσιακής νομοθεσίας.
Χωρικές διαστάσεις της οικονομικής κρίσης - το «γεωγραφικό αποτύπωμα» της οικονομικής κρίσης στην Ελλάδα
Authors: Ψυχάρης Γιάννης
Published: November 2018

Σκοπός αυτού του άρθρου είναι, με βάση εμπειρικά ευρήματα πρόσφατων μελετών, να κάνει μια επισκόπηση των χωρικών επιδράσεων της οικονομικής κρίσης στην Ελλάδα καθώς και των πολιτικών για την αντιμετώπισή της. Σύμφωνα με τα πρώτα ευρήματα των μελετών οι περιφερειακές ανισότητες στην Ελλάδα έχουν προ-κυκλικό χαρακτήρα. Το συμπέρασμα αυτό είναι σε συμφωνία με μεγάλο μέρος της επιστημονικής βιβλιογραφίας που εξετάζει τις περιφερειακές ανισότητες σε σχέση με τον οικονομικό κύκλο. Παράλληλα, η δημοσιονομική κρίση έχει οδηγήσει σε υποχώρηση της πολιτικής περιφερειακής ανάπτυξης καθώς μειώνονται οι δαπάνες δημοσίων επενδύσεων σε όλους σχεδόν τους νομούς και τις περιφέρειες της χώρας. Τo άρθρο καταλήγει με προτάσεις πολιτικής στο επίκεντρο των οποίων βρίσκεται η ανάπτυξη ‘περιφερειακού κεϋνσιανισμού’ με τη συνδρομή της Ευρωπαϊκής Ένωσης.
Γεωγραφίες Αποκλίσεων: Προκλήσεις για τις θεωρίες και τις πολιτικές συνοχής και ανάπτυξης
Authors: Πετράκος Γιώργος
Published: November 2018

Δε διατίθεται περίληψη
Οι πολιτικές της Ε.Ε. για την περίοδο 2014-2020: Εξελίξεις Το νέο τοπίο της Ευρωπαϊκής Πολιτικής Συνοχής
Authors: Μουσουρούλης Κώστας
Published: November 2018

No abstract available
Proyecto Venus: An Interview with Roberto Jacoby
Authors: Kalyva Eve , Jacoby Roberto
Published: November 2018

No abstract available
Translational Space and Creolising Aesthetics in Three Women’s Novels: the Radical Diasporic (Re)turn
Authors: Anim-Addo Joan
Published: November 2018

Proposing the notion of translational space, I consider the classroom and the literary text as crucial though differentiated spaces of translation. The idea of translational space borrows from Doreen Massey’s elaboration of space as a “complex web of relations of domination and subordination, of solidarity and cooperation.” I interlink the complexity of Massey’s “web” with an intention by the radical Other to translate, and interrogate how selected Caribbean diasporic texts might be shown to engage a process of translation, and for whom, particularly in light of George Lamming’s pronouncement concerning the West Indian writer, that “[h]e writes always for the foreign reader”. What is the translational impetus of a later generation of writers who Lamming was unable to imagine, namely, women authors of the region? I consider the translational space created by those authors’ challenging of canonical traditions that not only break through publication barriers, but place black women protagonists as central to their writing. The crux of my enquiry is the diasporic imaginary–represented in Beryl Gilroy’s In Praise of Love and Children, Andrea Levy’s Small Island, and Velma Pollard’s Karl–an imaginary which, centring black women characters is also concerned with a dialogic representation of the Other. I highlight issues of Creole or Caribbean identity that such an imaginary figures in its aesthetics and I foreground the diaspora as contested space whether public or intimate. Additionally in these texts, the (re)turn, as I consider it, affords a contemporary contextual presencing in dialogue with a violently muted historical past. Arising from this, my larger questions concern the meanings that might be inferred from such a Creole diasporic imaginary and its representation in terms of aesthetics and translational space. I explore the fictional representation of Caribbean lives “on the move” in Cresswell’s terms and their transnational representation. In their gendering of creolisation, diaspora and race, how do the writers translate the spatial interface that their characters negotiate? Whether in memories of Toronto in Pollard’s writing or in the London of Levy’s and Gilroy’s fiction, how do these texts represent space not only as cultural crossings but also as translational space within the new triangle that contests and dislodges notions of identity?
Radical Others in the New “Contact Zone”: Tensions, Breaks, Relations
Authors: Marchi Lisa
Published: November 2018

Drawing from recent conceptualizations of translation as an open, fragmentary, and unpredictable process (Simon, 2006; Bassnett, 1998), in this article, I employ creolization as a theoretical paradigm of transnational significance to explore the ways in which Other cultures translate cultures, by paying particular attention to the breaks, tensions, and relations that these translations both reveal and produce. The essay examines and compares three creolized ‘texts’: the cycle of paintings “Changing Perceptions” (2005) by Arab-American visual artist Helen Zughaib; the collection breaking poems (2008) by Arab-American poet Suheir Hammad; and the libretto Imoinda or She Who Will Lose her Name (2008) by African-Caribbean-British writer Joan Anim-Addo. The main goal of the paper is to test the potential of creolization as a transnational poetics and practice and a theoretical tool to read and critically interrogate the creolized texts produced by today’s “signifying minorities” (Anim-Addo, 2009) within the British and US nations, and by extension within an increasingly interconnected, heterogeneous, and “uneven” (Radhakrishnan, 2003) world.
Kings, Celebrities and Working Mums: Kjartan Poskitt’s Plays for Young Actors as History and Entertainment
Authors: Flothow Dorothea
Published: November 2018

After postmodern approaches called into question the foundations of academic history in the 1970s and 1980s, recent studies have identified a new boom in popular history formats such as historical novels, costume drama and TV documentaries. This trend has also spurred new theoretical approaches towards (popular) history, which are both a continuation and a reaction to postmodern theories. On the basis of these, this paper analyses two plays by the British writer and comedian Kjartan Poskitt – Henry the Tudor Dude: A Musical Play (1995) and Nell’s Belles: The Swinging Sixteen-Sixties Show: A Musical (2002)—both aimed at young amateur actors. These two plays present panoramic views of the lives of the English kings Henry VIII and Charles II, respectively, and show their objects in a highly entertaining and irreverent light, concentrating on their flamboyant private lives and personal failures. The paper demonstrates how these plays approach the dual aims of teaching and entertaining that are so typical of both children’s literature and popular history in general. Moreover, it argues that though the plays represent a new development in the previously neglected field of historical drama for the young, they can also serve to demonstrate recent theoretical approaches towards (popular) history.
Introduction: In the Wake of the Polity to Come
Authors: Karavanta Mina
Published: November 2018

No abstract (available).
Modalities of Death and the Thought of Life: The Politics of Metaphoricity in Julia Kristeva and Jacques Derrida
Authors: Margaroni Maria
Published: November 2018

This article throws into relief the difference that renders both Kristeva and Derrida's articulations of metaphor difficult. The difficulty lies in appreciating what I shall call the reversive force at work in every motion, a force suggested by the prefix dis-/dif- shared by both difference and difficulty. If misreading is the index of carelessness in the face of precisely such a reversive force, then the felicity of our conveyance through footsteps destined to remain ahead of us necessitates a commitment to a care-full reading that (following Maurice Blanchot) will take the risk of imagining the hand writing and the death (i.e. the promise, chance, fear of impossibility) that bears this hand along. Paradoxically, for Blanchot this difficult reading is marked by an ease that we associate with happiness and innocence, for it opens itself joyfully as well as trustingly to the death borne by writing and "holds [it] in its turn" though (as Blanchot emphasizes) only in order to reverse it (precisely "through its ease"). It is this happy innocence, this joyful beginning as if for the first time (without guilt or knowledge, without fear of harm, without praejudicium) that determines an understanding of politics in the second part of the essay which investigates the stakes of each theorist's pas au-delà: that is, their step beyond in the direction of a more archaic motility.
Reading Contrapuntally, Living in the Present: An Interview with R. Radhakrishnan
Authors: Karavanta Mina , Radhakrishnan R.
Published: November 2018

No abstract (available).
Δούκα-Καμπίτογλου Αικατερίνη, Μυθιστόρημα Γυναίκας: Ποιήτριες του 20ου αιώνα
Authors: Sakelliou-Schultz Liana
Published: November 2018

No abstract (available).
Capitalist Realism and the Refrain: The Libidinal Economies of Degas
Authors: Philips Dougal
Published: November 2018

This article looks to the work of Degas as an exemplar of a kind of Capitalist Realism, a kind of second generation realism following on from the earlier work of Courbet and Manet. It is posited here that Degas took up the mantle of a ‘corporeal’ realism distinguished from the Impressionists by its nuanced approach to the realism of the body, in particular to its place in the Parisian network of capital and desire. Degas’s paintings and his experiments with photography mapped two spaces: the space of the libidinal and capitalist exchange (theatre, café, stock-exchange) and the space of the production of painting. Further, Degas attempts to represent his own disappearance into both these spaces. Degas continued the politicised social project of realism but with a personalised, modernised vision that prefigures the realisms of the twentieth century.
Head Dominic, The State of the Novel: Britain and Beyond.
Authors: Camatsos Efrosini
Published: November 2018

No abstract (available).
Recent advances in understanding dominant spinocerebellar ataxias from clinical and genetic points of view
Authors: Coarelli Giulia , Brice Alexis , Durr Alexandra
Published: November 2018

Abstract

Spinocerebellar ataxias (SCAs) are rare types of cerebellar ataxia with a dominant mode of inheritance. To date, 47 SCA subtypes have been identified, and the number of genes implicated in SCAs is continually increasing. Polyglutamine (polyQ) expansion diseases

(ATXN1/SCA1, ATXN2/SCA2, ATXN3/SCA3, CACNA1A/SCA6, ATXN7/SCA7, TBP/SCA17, and ATN1/DRPLA) are the most common group of SCAs. No preventive or curative treatments are currently available, but various therapeutic approaches, including RNA-targeting treatments, such as antisense oligonucleotides (ASOs), are being developed. Clinical trials of ASOs in SCA patients are already planned. There is, therefore, a need to identify valid outcome measures for such studies. In this review, we describe recent advances towards identifying appropriate biomarkers, which are essential for monitoring disease progression and treatment efficacy. Neuroimaging biomarkers are the most powerful markers identified to date, making it possible to reduce sample sizes for clinical trials. Changes on brain MRI are already evident at the premanifest stage in SCA1 and SCA2 carriers and are correlated with CAG repeat size. Other potential biomarkers have also been developed, based on neurological examination, oculomotor study, cognitive assessment, and blood and cerebrospinal fluid analysis. Longitudinal studies based on multimodal approaches are required to establish the relationships between parameters and to validate the biomarkers identified.
Key Concepts for assessing claims about treatment effects and making well-informed treatment choices
Authors: Oxman Andrew David , Chalmers Iain , Austvoll-Dahlgren Astrid ,   Informed Health Choices group
Published: November 2018

Background:The Informed Health Choices (IHC) Key Concepts are standards for judgement, or principles for evaluating the trustworthiness of treatment claims and treatment comparisons (evidence) used to support claims, and for making treatment choices. The list of concepts provides a framework, or starting point, for teachers, journalists and other intermediaries for identifying and developing resources (such as longer explanations, examples, games and interactive applications) to help people to understand and apply the concepts. The first version of the list was published in 2015 and has been updated yearly since then. We report here the changes that have been made from when the list was first published up to the current (2018) version.

Methods:We developed the IHC Key Concepts by searching the literature and checklists written for the public, journalists, and health professionals; and by considering concepts related to assessing the certainty of evidence about the effects of treatments. We have revised the Key Concepts yearly, based on feedback and suggestions; and learning from using the IHC Key Concepts, other relevant frameworks, and adaptation of the IHC Key Concepts to other types of interventions besides treatments.

Results:We have made many changes since the Key Concepts were first published in 2015. There are now 44 Key Concepts compared to the original 32; the concepts have been reorganised from six to three groups; we have added higher-level concepts in each of those groups; we have added short titles; and we have made changes to many of the concepts.

Conclusions:We will continue to revise the IHC Key Concepts in response to feedback. Although we and others have found them helpful since they were first published, we anticipate that there are still ways in which they can be further improved. We welcome suggestions for how to do this.
Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit
Authors: Kripke Daniel F.
Published: November 2018

This is a review of hypnotic drug risks and benefits. Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality (especially overdose deaths, quiet deaths at night, and suicides), infections, cancer, depression, automobile crashes, falls, other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with even greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse (not better) and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
Variation in the effectiveness of insecticide treated nets against malaria and outdoor biting by vectors in Kilifi, Kenya
Authors: Kamau Alice , Mwangangi Joseph M. , Rono Martin K. , Mogeni Polycarp , Omedo Irene , Midega Janet , Scott J. Anthony G. , Bejon Philip
Published: November 2018

Background: Insecticide treated nets (ITNs) protect humans against bites from the Anopheles mosquito vectors that transmit malaria, thereby reducing malaria morbidity and mortality. It has been noted that ITN use leads to a switch from indoor to outdoor feeding among these vectors. It might be expected that outdoor feeding would undermine the effectiveness of ITNs that target indoors vectors, but data are limited.

Methods: We linked homestead level geospatial data to clinical surveillance data at a primary healthcare facility in Kilifi County in order to map geographical heterogeneity in ITN effectiveness and observed vector feeding behaviour using landing catches and CDC light traps in six selected areas of varying ITN effectiveness. We quantified the interaction between mosquitoes and humans to evaluate whether outdoor vector biting is a potential explanation for the variation in ITN effectiveness.

Results: We observed 37% and 46% visits associated with positive malaria slides among ITN users and non-ITN-users, respectively; ITN use was associated with 32% protection from malaria (crude OR = 0.68, 95% CI: 0.64, 0.73). We obtained significant modification of ITN effectiveness by geographical area (p=0.016), and identified significant hotspots using the spatial scan statistic. Majority of mosquitoes were caught outdoor (60%) and were of the An. funestus group (75%). The overall propensity to feed at times when most people are indoor was high; the vast majority of the Anopheles mosquitoes were caught at times when most people are indoor. Estimates for the proportion of human-mosquito contact between the first and last hour when most humans were indoor was consistently high, ranging from 0.83 to 1.00.

Conclusion: Our data do not provide evidence of an epidemiological association between microgeographical variations in ITN effectiveness and variations in the microgeographical distribution of outdoor biting.
Health care in a technological world
Authors: Meetoo Danny , Rylance Rebecca , Abuhaimid Hanan Abdulrahman
Published: November 2018

Ongoing innovation in the field of mobile health (mHealth) has the potential to change the landscape of healthcare practice both inside and outside formal clinical settings. mHealth could enhance patient education, prevent disease, improve diagnosis and research-based treatment, reduce healthcare costs and enable patients to manage long-term conditions. In addition, unimpeded by geographical distance, smartphone-linked wearable sensors, built around real-time connectivity, will improve communication between health professionals and improve the understanding of physiological variability, thereby improving clinical decisions and quality of care. However, despite the potential of mHealth, there are still significant information gaps regarding its long-term effects, acceptability, costs and risks. There is therefore a significant need for continued research to evaluate the functions and appropriateness of these medical devices that are slowly entering the healthcare arena, while not neglecting the rights of the individual.
Use of dermal gel pads in preventing and managing pressure ulcers in ICU: an audit
Authors: Swan Joanna
Published: November 2018

Most of the pressure ulcers (PUs) that developed in the intensive care unit (ICU) of an acute trust were medical-device related. While use of a dermal pad was recommended as part of its pressure ulcer prevention strategy, staff were concerned that it tended to tear or split while in use. An alternative gel pad (Dermisplus® Prevent, Frontier Medical), that was cost-effective and appeared to be more robust, was identified. A 4-week non-comparative audit involving 37 patients was therefore undertaken to investigate the effect of this alternative gel pad on PU incidence in the ICU. With the exception of the change in the gel pad used, there was no difference to the overall PU prevention strategy. No new PUs developed during the audit period with the new gel pad, although there was also no reduction in incidence compared with the previous 3 months. None of the four patients (11%) with blanching erythema developed category 1 PUs. There were also no reports of tearing or splitting with the new gel pad. The ICU staff commented that they found the new gel pad simpler to use, easier to clean and more robust than the previous product used. Following the audit, the ICU incorporated the new gel pad into its PU prevention strategy.
Stress-induced hyperglycaemia
Authors: Mifsud Simon , Schembri Emma L , Gruppetta Mark
Published: November 2018

Stress-induced hyperglycaemia is an important clinical entity. It is an adaptive immune-neurohormonal response to physiological stress in an attempt to increase metabolic substrates to struggling organs during a time of crisis. However, this acute hyperglycaemia is also responsible for a number of detrimental effects implying that treatment is necessary. Hence, admission hyperglycaemia is not necessarily equivalent to a diagnosis of diabetes mellitus but the blood glucose level needs to be interpreted in context of the patient's presenting complaint and previous glycaemic status. Stress-induced hyperglycaemia is associated with increased morbidity and short-term mortality. Thus prompt recognition of stress-induced hyperglycaemia and high risk hyperglycaemic patients with the stress hyperglycaemia ratio can help improve inpatient management. Patients with stress-induced hyperglycaemia who have recovered from their acute illness should be followed up as they remain at risk for incident diabetes. This review focuses on the definition, pathophysiology, targets, management and significance of stress-induced hyperglycaemia.
The junior doctor contract 2 years on: one trust's experience of exception reporting
Authors: Kirwan Christopher J , Ali Aktar , McCarten Neil
Published: November 2018

The new junior doctor contract allows trainees to exception report when they breach safe working hours. After a full year of foundation year 1 rotations, analysis from a large NHS trust in London showed that exception reporting works to highlight rota and working issues. It is unsurprising that trainees are busy but simple things such as competent infrastructure and senior support could go a long way to improving working conditions. In addition, results from a local survey suggest that trainees think the new contract is less safe for both doctors and patients, with inflexibility of rota patterns having a significant impact on the ability to take annual and study leave. A drive to modernise the way health care is delivered in hospitals is needed as a shortage of doctors will only worsen the situation.
Assessing antibiotic stewardship using the surgical site infection prevention bundle
Authors: Mohamed Ryian , Wall Josh , Arumainathan Renuka , Fink Douglas , Sandhu Taranveer , Garg Suchika , Spiers Shabnamnaomi , Hughes Jonathan , Burdett Edward
Published: November 2018

Background:

Antibiotic prophylaxis is crucial in head and neck surgery to prevent infection from clean contaminated wounds. Scottish Intercollegiate Guidelines Network (SIGN) guidance, the gold standard of practice, recommends that administration of broad spectrum antibiotics is discontinued after 24 hours post-operation. A three-audit cycle quality improvement project was conducted to assess clinical practice against SIGN guidance at a large London teaching hospital.

Methods:

Three change initiatives were implemented to improve antibiotic stewardship. First, an update of Trust guidelines with an associated poster campaign to educate staff and improve awareness. Second, introduction of a specific ‘prophylactic antibiotics in head and neck surgery’ bundle on the electronic hospital-wide prescribing system. Third, an update to an antibiotic prescribing guide (Microguide).

Results:

Over a 3-year study period the number of patients receiving antibiotics beyond 24 hours declined significantly (88% in 2015, 76% in 2016, 25% in 2018), demonstrating improved compliance with SIGN guidelines overall. Despite this, staff documentation of indications for extended antibiotic use remains suboptimal (58% in 2016 and 44% in 2018) as does the number of specimens sent for microbiological analysis (52% in 2016 and 0% in 2018).

Conclusions:

Appropriate prophylactic antibiotic prescribing can improve morbidity and mortality rates in head and neck cancer patients. Three change initiatives have been demonstrated which can help to improve prescribing compliance in line with SIGN guidance. Ongoing auditing is required to maintain the longevity of improvements made and encourage staff documentation of indications for extended antibiotic use and microbiology specimen analysis.
Choosing to read – what the evidence tells us…
Authors: Twist Liz
Published: November 2018

Literacy and numeracy are critical skills for pupils to develop if they are to reach their potential and achieve rewarding outcomes during and after education. Liz Twist highlights the evidence showing why reading – including reading out loud – must be at the heart of the curriculum in the primary years
The mean ten-year results of metal-on-metal hybrid hip resurfacing arthroplasty
Authors: Amstutz H. C. , Le Duff M. J.
Published: November 2018

Aims

This study presents the long-term survivorship, risk factors for prosthesis survival, and an assessment of the long-term effects of changes in surgical technique in a large series of patients treated by metal-on-metal (MoM) hip resurfacing arthroplasty (HRA).

Patients and Methods

Between November 1996 and January 2012, 1074 patients (1321 hips) underwent HRA using the Conserve Plus Hip Resurfacing System. There were 787 men (73%) and 287 women (27%) with a mean age of 51 years (14 to 83). The underlying pathology was osteoarthritis (OA) in 1003 (75.9%), developmental dysplasia of the hip (DDH) in 136 (10.3%), avascular necrosis in 98 (7.4%), and other conditions, including inflammatory arthritis, in 84 (6.4%).

Results

The mean follow-up time was 10.5 years (1 to 20). Using revision for any reason as the endpoint, the overall survivorship at 15 years was 89.4% (95% confidence interval (CI) 86.8 to 91.4). There was a substantial increase between the first and second generation of surgical technique (86.6% vs 90.1%; p = 0.05). Men with idiopathic OA had a 15-year survivorship of 94.5% and women, 82.2% (p = 0.001); gender was not a risk factor after stratification by component size and aetiology. Using revision for excessive wear (ion levels > 7 µg/l associated with symptoms or adverse local tissue reactions) as the endpoint, the 15-year survivorship was 98.5%. Risk factors for revision for all modes of failure were an underlying pathology of hip dysplasia, a contact patch to rim (CPR) distance of 7 mm or less, an age at surgery of 55 years or less, and a femoral component size of 46 mm or less. Specific risk factors for aseptic failure of the femoral component were early surgical technique, a cementless metaphyseal stem, and a body mass index of 24 kg/m2 or less.

Conclusion

HRA is a viable concept; metal-on-metal bearings are well suited for this procedure when a well-designed device is properly implanted. The best results were obtained in men with OA, but survivorship was better for other underlying pathologies and for women after changes were made to the technique of implantation. Lifetime durability is a possible outcome for many patients despite a high level of activity. Cite this article: Bone Joint J 2018;100-B:1424–33.
Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study
Authors: Mazhar F. Najd , Ebrahimi H. , Jafari D. , Mirzaei A.
Published: November 2018

Aims

The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury.

Patients and Methods

The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded.

Results

The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex–Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively.

Conclusion

The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient’s radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499–505.
Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity
Authors: Hipfl C. , Janz V. , Löchel J. , Perka C. , Wassilew G. I.
Published: November 2018

Aims

Severe acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems.

Patients and Methods

We undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).

Results

The cumulative five-year survivorship of the implant with revision for any cause was 89% (95% confidence interval (CI) 72 to 96) with eight hips at risk. No revision was required for aseptic loosening; however, one patient with one hip (3%) required removal of the ischial flange of the cage due to sciatic nerve irritation. Two patients (6%; two hips) suffered from hip dislocation, whereas one patient (one hip) required revision surgery with cement fixation of a dual-mobility acetababular component into a well-fixed cup-cage construct. Two patients (6%; two hips) developed periprosthetic infection. One patient was successfully controlled with a two-stage revision surgery, while the other patient underwent excision arthroplasty due to severe medical comorbidities. For the whole series, the Harris Hip Score significantly improved from a mean of 30 (15 to 51) preoperatively to 71 (40 to 89) at the latest follow-up (p < 0.001).

Conclusion

Our findings suggest that cup-cage reconstruction is a viable option for major segmental bone defects involving the posterior column and PD. It allows adequate restoration of the acetabulum centre with generally good stability and satisfactory postoperative function. Instability and infection remain drawbacks in these challenging revision cases. Cite this article: Bone Joint J 2018;100-B:1442–48.
Excellent results of large-diameter ceramic-on-ceramic bearings in total hip arthroplasty
Authors: Blakeney W. G. , Beaulieu Y. , Puliero B. , Lavigne M. , Roy A. , Massé V. , Vendittoli P-A.
Published: November 2018

Aims

This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing.

Patients and Methods

Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up.

Results

There were four re-operations (1%) including one early revision for insufficient primary fixation (0.4%). No hip dislocation was reported. The mean University of California, Los Angeles (UCLA) activity score, 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS) score, SF-12 Physical Component Summary (PCS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Forgotten Joint Score (FJS) were 6.6 (2 to 10), 52.8 (25.5 to 65.7), 53.0 (27.2 to 66.5), 7.7 (0 to 63), and 88.5 (23 to 100), respectively. No signs of loosening or osteolysis were observed on radiological review. The incidence of squeaking was 23% (n = 51/225). Squeaking was significantly associated with larger head diameter (p < 0.001), younger age (p < 0.001), higher SF-12 PCS (p < 0.001), and UCLA scores (p < 0.001). Squeaking did not affect patient satisfaction, with 100% of the squeaking hips satisfied with the surgery.

Conclusion

LDH CoC THAs have demonstrated excellent functional outcomes at medium-term follow-up, with very low revision rate and no dislocations. The high incidence of squeaking did not affect patient satisfaction or function. LDH CoC with a monoblock acetabular component has the potential to provide long term implant survivorship with unrestricted activity, while avoiding implant impingement, liner fracture at insertion, and hip instability. Cite this article: Bone Joint J 2018;100-B:1434–41.
Acetabular retroversion
Authors: Direito-Santos Bruno , França Guilherme , Nunes Jóni , Costa André , Rodrigues Eurico Bandeira , Silva A. Pedro , Varanda Pedro
Published: November 2018

Acetabular retroversion (AR) consists of a malorientation of the acetabulum in the sagittal plane. AR is associated with changes in load transmission across the hip, being a risk factor for early osteoarthrosis. The pathophysiological basis of AR is an anterior acetabular hyper-coverage and an overall pelvic rotation. The delay or the non-diagnosis of AR could have an impact in the overall management of femoroacetabular impingement (FAI). AR is a subtype of (focal) pincer deformity. The objective of this review was to clarify the pathophysiological, diagnosis and treatment fundaments inherent to AR, using a current literature review. Radiographic evaluation is paramount in AR: the cross-over, the posterior wall and ischial spine signs are classic radiographic signs of AR. However, computed tomography (CT) evaluation permits a three-dimensional characterization of the deformity, being more reliable in its recognition. Acetabular rim trimming (ART) and periacetabular osteotomy (PAO) are the best described surgical options for the treatment of AR. The clinical outcomes of both techniques are dependent on the correct characterization of existing lesions and adequate selection of patients.

Cite this article: EFORT Open Rev 2018;3:595-603. DOI: 10.1302/2058-5241.3.180015
SOCIAL NETWORKS AS TOOLS TO ENRICH LEARNING ENVIRONMENTS IN HIGHER EDUCATION
Authors: González Pérez Alicia
Published: November 2018

INTRODUCTION. Digital technologies offer new educational opportunities in a connected society, where learning to work with others and self-regulated learning processes have become important elements that are enriched through interactions, improve learner engagement, and increase the sense of community. METHOD. The purpose of this case study was to analyse the perception of students, who use social networks as learning environments. To this end, reflective notes were gathered from students and analysed by Nvivo Pro Version 11. The final sample consisted of 15 students (cases), who successfully accomplished all the assignments. The students came from Nesna University College (Norway), the University of Szczecin (Poland) and the University of Extremadura (Spain). RESULTS. The results provide some clues about the students’ engagement in the process of creating knowledge through social networks considering the pedagogical, technological and social factors analysed. Norwegian and Polish students are more autonomous learners; they reflected more on the process through which they learnt with technology, and they self-regulated their learning process. In all three countries, most of them spent a lot of time learning how to use the social networks selected in the study and posting information. The students consider very important the role that connectivity and interaction play when they use any social network. DISCUSSION. Technology is a powerful tool for extending and creating opportunities to innovate in higher education, and social networks offer new ways for learning in an increasingly connected society, in which learning to work with others and collaborate has become extremely important skills to take into consideration. Promoting student-centred learning approaches to encourage and engage learners in decision-making and in the learning process is an effective strategy to exploit learning opportunities in online courses. Students value the importance of self-regulating their own learning to achieve goals, gain knowledge and acquire skills. Collaborative learning is key to empower students as the main protagonists of their own learning processes.