bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of split and single injection strategies on particle number emission and combustion of a GDI engine
Authors: Xie Fangxi , Zheng Wenliang , Chen Hong , Liu Yu , Su Yan , Hong Wei
Published: March 2018

Influence of fuel injection parameters of the single and split injection strategies on combustion, performance and particle number emission had been investigated on a gasoline direct injection engine with stoichiometric mixture combustion under medium and low engine operating conditions. The test results showed that the optimal injection timing for single injection strategy was about 290–280 °CA BTDC, and an earlier or a later injection timing could lead to a deterioration of particle number emission. For split injection strategy, the injected parameters also needed to be optimized subtly in order to improve particle number emission. When the inappropriate injected parameters were adopted, particle number emission increased rather than decrease when compared with single injection strategy. Similar to single injection strategy, when the second injection timing of split injection strategy further retarded from 280 °CA BTDC, the particle number emission and brake-specific fuel consumption also started to deteriorate, and the in-cylinder combustion process was delayed and slowed. The optimal first injection timing was about 300 °CA BTDC. When the first injection timing was delayed to 280 °CA BTDC with the second injection timing being 260 °CA BTDC, the particle number emission increased and the shortened interval time between first and second fuel injection might have had a negative effect. The smaller difference of the fuel quantity between the first and the second injection was not good for the improvement of particle number emission and brake-specific fuel consumption, and the best injection proportion was 2:8. Overall, the engine particle number emission could be decreased to some extent, which could reach about 10–30%, by split injection strategy with optimal control parameters at medium and low engine loads.
‘Time … lost time’: Exploring how partners of long-term prisoners experience the temporal pains of imprisonment
Authors: Kotova Anna
Published: March 2018

This article identifies and examines the temporal pains of imprisonment as experienced by female partners of male long-term prisoners in the UK. Drawing on in-depth interviews with 33 women, it discusses how long sentences interrupted the women’s normative life courses, shaped their daily lives, and resulted in them having to negotiate living within both prison time and outside time. It also highlights the need to go beyond the focus on concentrated family time and consider the extent to which prisoners and their families are deprived of mundane but meaningful family moments. In exploring these temporal pains of imprisonment, it is argued that time is not just a critical aspect of a long-term prisoner’s sentence, but also of his partner’s experiences. Finally, this article seeks to take the scholarship beyond the assumption that a long-term prisoner’s partner exists in a temporal limbo, and discusses the processes of change and adaptation the women interviewed used to cope with their partners’ long sentences.
An Empirical Analysis of Asymmetry and Threshold Effect of Intergovernmental Grants in India: A Panel Data Analysis
Authors: Samal Asharani
Published: March 2018

The present study empirically examines the effect of intergovernmental grants on the expenditure of state government in India. Using a panel data set during 1980–1981 to 2009–2010, the flypaper effect was found in the case of total and revenue expenditure and also an evidence of an asymmetric effect to change (increase or decrease) in grant variable for entire sample period. Again, to understand the flypaper and asymmetry effect in the pre- and post-reform period, this study uses the data from 1980–1981 to 1989–1990 as a pre-reform period and 1991–1992 to 2009–2010 as a post-reform period. The results of the panel regression model and two-stage least squares (2SLS) method show that there is an absence of flypaper effect except capital expenditure in the pre-reform period, whereas there exists an evidence of flypaper effect except capital expenditure in the post-reform period. Similarly, the responses of all the expenditure accounts are found to be asymmetric except capital expenditure. Further, in order to find the non-linear effect, this study employs Hansen (1999) threshold regression model to measure the threshold effect of intergovernmental grants on total expenditure of state government. The threshold regression results indicate that lower-income state grants have a stronger flypaper effect than middle- and higher-income states.
Assessment Tools for Peripheral Neuropathy in Pediatric Oncology: A Systematic Review From the Children’s Oncology Group
Authors: Smolik Suzanne , Arland Lesley , Hensley Mary Ann , Schissel Debra , Shepperd Barbara , Thomas Kristin , Rodgers Cheryl
Published: March 2018

Peripheral neuropathy is a known side effect of several chemotherapy agents, including vinca alkaloids and platinum-based chemotherapy. Early recognition and monitoring of this side effect is an important role of the pediatric oncology nurse. There are a variety of peripheral neuropathy assessment tools currently in use, but the usefulness of these tools in identifying and grading neuropathy in children varies, and there is currently no standardized tool in place to evaluate peripheral neuropathy in pediatric oncology. A systematic review was performed to identify the peripheral neuropathy assessment tools that best evaluate the early onset and progression of peripheral neuropathy in pediatric patients receiving vincristine. Because of the limited information available in pediatric oncology, this review was extended to any pediatric patient with neuropathy. A total of 8 studies were included in the evidence synthesis. Based on available evidence, the pediatric–modified Total Neuropathy Scale (ped-m TNS) and the Total Neuropathy Score–pediatric version (TNS-PV) are recommended for the assessment of vincristine-induced peripheral neuropathy in children 6 years of age and older. In addition, several studies demonstrated that subjective symptoms alone are not adequate to assess for vincristine-induced peripheral neuropathy. Nursing assessment of peripheral neuropathy should be an integral and regular part of patient care throughout the course of chemotherapy treatment.
Alternate Assessment Formats for Progress Monitoring Students With Intellectual Disabilities and Below Average IQ: An Exploratory Study
Authors: Jones Francesca G. , Gifford Diane , Yovanoff Paul , Al Otaiba Stephanie , Levy Dawn , Allor Jill
Published: March 2018

As part of standards-based reforms, there is increasing emphasis on ensuring that students with moderate intellectual disabilities (ID), including students with Autism Spectrum Disorders (ASD), learn to read. There is also converging evidence that explicit teaching of letter sounds, phonics, and sight words is effective for this population, but that students’ responsiveness varies. A critical part of individualizing reading instruction for students with disabilities is the reliable assessment of progress and mastery of reading skills. However, assessment of many students with ID and students with ASD is challenging because of attention, behavioral, and communication issues related to testing situation; therefore, obtaining consistent results often proves to be a difficult task. We hypothesized that alternate assessment presentation formats, as a testing accommodation, would improve the reliability, validity, and consistency of assessment performance. In this study, three different presentation formats—word lists, flash cards, and PowerPoint presentation—were used when administering proximal, curriculum-based reading assessments to determine whether a particular format increased student engagement, reduced the need for prompts, and increased accuracy of identifying known items on the test. While statistical analyses did not support the hypothesis of a format by student effect, visual analysis of the data did suggest that the number of prompts required varied by student as a function of assessment format. Most noteworthy, assessment reliability, estimated with generalizability theory, indicated that reliability increased as a function of format by student.
Effect of duration and severity of migraine on retinal nerve fiber layer, ganglion cell layer, and choroidal thickness
Authors: Abdellatif Mona K , Fouad Mohamed M
Published: March 2018

Purpose:

To investigate the factors in migraine that have the highest significance on retinal and choroidal layers’ thickness.

Methods:

Ninety patients with migraine and 40 age-matched healthy participants were enrolled in this observational, cross-sectional study. After full ophthalmological examination, spectral domain-optical coherence tomography was done for all patients measuring the thickness of ganglion cell layer and retinal nerve fiber layer. Enhanced depth imaging technique was used to measure the choroidal thickness.

Results:

There was significant thinning in the superior and inferior ganglion cell layers, all retinal nerve fiber layer quadrants, and all choroidal quadrants (except for the central subfield) in migraineurs compared to controls. The duration of migraine was significantly correlated with ganglion cell layer, retinal nerve fiber layer, and all choroidal quadrants, while the severity of migraine was significantly correlated with ganglion cell layer and retinal nerve fiber layer only. Multiregression analysis showed that the duration of migraine is the most important determinant factor of the superior retinal nerve fiber layer quadrant (β = −0.375, p = 0.001) and in all the choroidal quadrants (β = −0.531, −0.692, −0.503, −0.461, −0.564, respectively, p  < 0.001), while severity is the most important determinant factor of inferior, nasal, and temporal retinal nerve fiber layer quadrants (β = −0.256, −0.335, −0.308; p  = 0.036, 0.005, 0.009, respectively) and the inferior ganglion cell layer hemisphere (β = −0.377 and p = 0.001).

Conclusion:

Ganglion cell layer, retinal nerve fiber layer, and choroidal thickness are significantly thinner in patients with migraine. The severity of migraine has more significant influence in the thinning of ganglion cell layer and retinal nerve fiber layer, while the duration of the disease affected the choroidal thickness more.
Ultrastructural effects of silicone oil on the clear crystalline lens of the human eye
Authors: Soliman Wael , Sharaf Mohamed , Abdelazeem Khaled , El-Gamal Dalia , Nafady Allam
Published: March 2018

Purpose:

To evaluate light and electron microscopic changes of the anterior capsule and its epithelium after clear lens extraction of vitrectomized myopic eyes with silicone oil tamponade.

Methods:

This prospective, controlled, non-randomized, interventional study included 20 anterior lens capsular specimens that were excised during combined clear lens extraction and silicone oil removal from previously vitrectomized highly myopic patients with silicone oil tamponade for previous retinal detachment surgeries. The specimens were examined via light microscopy and electron microscopy and compared with 20 anterior capsule specimens removed during clear lens extraction of non-vitrectomized highly myopic eyes.

Results:

Light microscopic examination of clear lens anterior capsule specimens of vitrectomized myopic eyes filled with silicone oil showed relatively more flat cells with irregular outline of lens’ epithelial cells with wide intercellular spaces, deeply stained nuclei, and multiple intracytoplasmic vacuoles. Scanning electron microscopy revealed collagenous surfaces filled with multiple pits, depressions, and abnormal deposits. Transmission electron microscopy revealed lens epithelial cells with apoptotic changes, many cytoplasmic vacuoles, and filopodia-like protrusions between lens epithelial cells and the capsule. Epithelial proliferation and multilayering were also observed.

Conclusion:

silicone oil may play a role in the development of apoptotic and histopathological changes in clear lens epithelial cells. Clarity of the lens at the time of silicone oil removal does not indicate an absence of cataractous changes. We found justification of combined clear lens extraction and silicone oil removal or combined phacovitrectomy when silicone oil injection is planned, but further long-term studies with larger patient groups are required.
Optical coherence tomography angiography and choroidal neovascularization in multifocal choroiditis: A descriptive study
Authors: Dutheil Cyril , Korobelnik Jean-François , Delyfer Marie-Noëlle , Rougier Marie-Bénédicte
Published: March 2018

Purpose:

To analyze the ability of optical coherence tomography angiography to identify choroidal neovascularization in multifocal choroiditis and to describe active and inactive choroidal neovascularization findings.

Methods:

Retrospective study of consecutive patients with multifocal choroiditis and choroidal neovascularization examined between January and November 2016. In addition to usual exams, optical coherence tomography angiography (AngioPlex™ CIRRUS™ HD-OCT model 5000; Carl Zeiss Meditec, Inc., Dublin, CA, USA) images were assessed for morphological analysis: choroidal neovascularization size, choroidal neovascularization margin (well or poorly circumscribed), choroidal neovascularization shape (tangled or interlacing), choroidal neovascularization core (feeder vessel) and dark ring around the choroidal neovascularization.

Results:

A total of 10 eyes were included. Optical coherence tomography angiography identified all choroidal neovascularization. Active choroidal neovascularization had well-circumscribed margins (67%), interlacing shape (83%), and a surrounding dark ring (83%). Inactive choroidal neovascularization had rather poorly circumscribed margins (75%), tangled shape, and “dead tree” appearance (50%) with less frequently a surrounding dark ring (50%).

Conclusion:

Optical coherence tomography angiography is adapted to confirm the diagnosis of choroidal neovascularization complicating multifocal choroiditis, but it is still insufficient to differentiate active and inactive lesions.
Feel-bad moments: Unpacking the complexity of class, gender and whiteness when studying ‘up’
Authors: Sohl Lena
Published: March 2018

Intimacy, shared experiences and evening out the power relations between researcher and the participants play an important role in feminist methodology. However, as highlighted in previous research on studying ‘up’, such methods might not be appropriate when studying privileged groups. Therefore, studying privileged women challenges fundamental assumptions in feminist methodology. When researching privileged women, the assumption that the researcher is almost always in a superior position within the research process becomes more complicated. The article seeks to contribute to the feminist methodological literature on how to study privileged groups by exploring how class, gender and whiteness are produced in three fieldwork situations with women who hold privileges in a postcolonial and capitalist landscape. Drawing on interviews and participant observations with white Swedish migrant women, the article argues that researchers need to turn the problems, fears and feelings of being uncomfortable into important data, in order to study privileged groups of women.
Challenges and impossibilities of ‘standing alongside’ in an intolerable context: Learning from refugees and volunteers in the Calais camp
Authors: Burck Charlotte , Hughes Gillian
Published: March 2018

This article describes the experience of setting up a psychosocial and therapeutic support project in the French Calais refugee camp, by a group of family therapists and clinical psychologists from the United Kingdom. This came about in response to reports of a humanitarian crisis unfolding on our doorstep, with the British government’s lack of support for the growing numbers of refugees gathering along the UK border with France. The project involved working alongside other agencies in the camp to provide psychosocial and resilience-based therapeutic support to unaccompanied young people, women, children and their families and also to many volunteers in the camp. The process of setting up the work is described, as well as the challenges and dilemmas of offering an intervention in extremely unsafe and insanitary conditions, where for most the experience of trauma was ongoing. The project was informed by systemic–narrative practice and community/liberation psychology, which incorporate the political and social context. A narrative framework offered a way of drawing on people’s strengths and resources, rooted in their cultural and social histories and helping them connect with preferred identities, which we found to be essential in the context of ongoing crisis.
Decision fatigue: A conceptual analysis
Authors: Pignatiello Grant A , Martin Richard J , Hickman Ronald L
Published: March 2018

Decision fatigue is an applicable concept to healthcare psychology. Due to a lack of conceptual clarity, we present a concept analysis of decision fatigue. A search of the term “decision fatigue” was conducted across seven research databases, which yielded 17 relevant articles. The authors identified three antecedent themes (decisional, self-regulatory, and situational) and three attributional themes (behavioral, cognitive, and physiological) of decision fatigue. However, the extant literature failed to adequately describe consequences of decision fatigue. This concept analysis provides needed conceptual clarity for decision fatigue, a concept possessing relevance to nursing and allied health sciences.
Towards a modular language curriculum for using tasks
Authors: Ellis Rod
Published: March 2018

Task-based language teaching (TBLT) and task-supported language teaching (TSLT) are often seen as incompatible as they draw on different theories of language learning and language teaching. The position adopted in this article, however, is that both approaches are needed especially in instructional contexts where ‘pure’ task-based teaching may be problematic for various reasons. The article makes a case for a modular curriculum consisting of separate (i.e. non-integrated) task-based and structure-based components. Different curriculum models are considered in the light of what is known about how a second language is learned. The model that is proposed assumes the importance of developing fluency first. It consists of a primary task-based module implemented with focus-on-form (Long, 1991) and, once a basic fluency has been achieved, supported by a secondary structural module to provide for explicit accuracy-oriented work to counteract learned selective attention (N. Ellis, 2006): one of the main sources of persistent error. The article also addresses the content and grading of the task-based and structural modules. It considers the factors that need to be considered in the vertical and horizontal grading of tasks but also points out that, for the time being, syllabus designers will have to draw on their experience and intuition as much as on research to make decisions about how to sequence tasks. An argument is presented for treating the structural component as a checklist rather than as a syllabus so as to allow teachers to address selectively those features that are found to be problematic for their students when they perform tasks.
Optimum design of composite conical tanks under hydrostatic pressure
Authors: Elansary Ahmed A , Nassef Ashraf O , Damatty Ashraf A El
Published: March 2018

Elevated tanks are used all over the world to store water for times of shortage. These tanks can be made of steel, reinforced concrete, or composite, that is, concrete and steel. Composite tanks consist of an external steel shell attached to an internal reinforced concrete wall through steel studs. Composite conical tanks combine the advantages of reinforced concrete and steel tanks as they resist efficiently both tensile and compressive stresses. A comparison showed that the material cost of composite conical tanks is significantly less than that of steel or reinforced concrete tanks having the same layout dimensions. A numerical tool is developed to obtain the optimum design of composite conical tanks under hydrostatic pressure incorporating both finite element and genetic algorithm techniques. This tool is used to obtain the optimum design of a case study composite conical tank that was recently constructed. The developed optimization tool provides the thicknesses of the concrete and steel walls as well as the stud configuration corresponding to the minimum material cost. A comparison between the optimized and unoptimized case study composite tank revealed that a reduction of 32% in the material cost can be achieved. A sensitivity analysis is conducted by changing the price of concrete, steel plate, and studs by (±) 50% of the datum prices and obtaining the corresponding optimum design variables. This analysis showed that the optimum thicknesses of the concrete wall and steel shell as well as studs’ configuration are significantly sensitive to the change in the material prices.
Repressive administrative law
Authors: Tollenaar Albertjan
Published: March 2018

With the introduction of strict obligations and sanctions in social security, the traditional boundary between criminal law and administrative law seems to fade away. Administrative fines in particular facilitate strict, efficient and effective law enforcement. In spite of the fact that administrative fines are part of administrative law, criminal law safeguards are still applicable. This could cause problems, since administrative authorities and administrative judges are not necessarily familiar with these criminal law principles. This article addresses the question of how administrative authorities and administrative judges assess culpability when deciding on administrative fines in the Netherlands. The main finding is that administrative authorities, and especially municipalities, overestimate the degree of culpability. The case shows that, in the search for more repressive instruments, it is imperative to allow courts to keep an eye on the proportionality of the sanctions.
Liberalised dualisation. Labour market reforms and the crisis in Portugal
Authors: Cardoso Daniel , Branco Rui
Published: March 2018

Drawing on quantitative and qualitative data, this article examines how the main dimensions of labour market legislation (employment protection, security in unemployment, collective bargaining and activation policies) changed in Portugal during the sovereign debt crisis from 2011 to 2014. We show that the reforms passed during the Troika years were qualitatively different to earlier reforms. Despite building upon previous trends, there were path-shifting changes. First, security in employment and in unemployment for standard workers (insiders) declined substantially. Second, a significant decentralisation of wage bargaining shifted the balance of power towards employers, while a move from joint to statutory regulation stalled social cooperation. Third, neither of these trends was offset by any relevant unemployment compensation strategy or activation effort targeted at outsiders: no recalibration occurred in a historically dualised labour market. The balance of power between employees and employers shifted towards the latter at the expense of the former. A worse situation for insiders and outsiders points to wide market flexibilisation and enduring segmentation at a lower level of security. The austerity-driven reforms brought the Portuguese labour market to a liberalized dualisation, signalling a new departure for Portuguese labour market relations.
Disrupting the “Heroic” Male Within Policing: A Case of Direct Entry
Authors: Silvestri Marisa
Published: March 2018

This article drives forward a more critical insight into the position of women within policing. In focusing on women as police leaders, it problematizes taken for granted representations of gender and proposes an alternative reading of their experiences. Drawing on theoretical work on gendered organizations, the article argues that greater attention needs to be paid to the cultural and structural conditions that enable the “heroic male” to emerge as the “ideal” police leader. It also considers the recent introduction of Direct Entry for senior officers in England and Wales as a disruptive tool to the gendered order within policing.
Measurements in swirling spray flames at blow-off
Authors: Yuan Ruoyang , Kariuki James , Mastorakos Epaminondas
Published: March 2018

Various characteristics of swirling spray flames of ethanol, n-heptane, n-decane, and n-dodecane have been measured at conditions far from and close to blow-off using phase Doppler anemometry and OH* chemiluminescence, OH-planar laser-induced fluorescence, and Mie scattering at 5 kHz. The blow-off transient has also been examined. The OH* showed that the two main heat release regions lie around the spray jet at the inner recirculation zone and along the outer shear layer between the inner recirculation zone and the annular air jet. The heat release region is shortened and more attached as the flame approached blow-off. Mie images and phase Doppler anemometry data showed a wider dispersion of the ethanol spray compared to the other fuels. Similar spatial distributions of the Sauter mean diameter were observed for the four fuels for identical flow conditions, with the Sauter mean diameter value increasing with decreasing fuel volatility, but with the exception of significant presence of droplets in the nominally hollow cone for the ethanol spray. The OH-planar laser-induced fluorescence measurements showed an intermittent lift-off from the corner of the bluff body and the average lift-off height decreased with increasing air velocity, with less extinction along the inner flame branch especially for the heavier fuels. At the blow-off conditions, local extinctions appeared at both flame branches. The blow-off process followed a gradual reduction of the size of the flame, with the less volatile fuels showing a more severe flame area reduction compared to the condition far from blow-off. The average blow-off duration, [Formula: see text], calculated from the evolution of the area-integrated OH* signal, was a few tens of milliseconds and for all conditions investigated the ratio [Formula: see text] /( D/ UB) was around 11, but with large scatter. The measurements provide useful information for validation of combustion models focusing on local and global extinction.
Towards an EU leadership role in shaping globalisation
Authors: Virkkunen Henna
Published: March 2018

Globalisation poses significant challenges, but the EU has the economic power to use the process to its benefit. While technological innovation may be disrupting the traditional understanding of labour and the free market, and of international cooperation more generally, it represents an opportunity for the EU to become a global leader. The EU should continue its efforts to provide citizens with the skills they need for the future and to promote research and development. By remaining competitive and ensuring a stable geographical environment, the EU will be able to shape globalisation to its benefit.
Supporting the Accommodation of Voluntary and Involuntary Migrants
Authors: Verkuyten Maykel , Altabatabaei Hadi Ghazi , Nooitgedagt Wybren
Published: March 2018

Immigration leads to strong public and political debates in Europe and the Western world more generally. In some of these debates, migrants are described as either having little choice but to migrate (involuntary migrants) or migrating out of their own free choice (voluntary migrants). In two experimental studies among national samples of native Dutch respondents, we examined whether support for the accommodation of newcomers differs for voluntary and involuntary migrants and whether this depends on the relative importance of humanitarian considerations and host society considerations. The findings demonstrate that for people who find the topic of immigration personally important, involuntary, compared to voluntary, migration leads to stronger societal considerations which, in turn, is associated with weaker support for the accommodation of migrants. Additionally, humanitarian considerations are associated with stronger support but especially for participants who do not find the topic of immigration very important.
Frequent cross-resistance to rilpivirine among subtype C HIV-1 from first-line antiretroviral therapy failures in South Africa
Authors: Penrose Kerri J , Brumme Chanson J , Scoulos-Hanson Maritsa , Hamanishi Kristen , Gordon Kelley , Viana Raquel V , Wallis Carole L , Harrigan P Richard , Mellors John W , Parikh Urvi M
Published: March 2018

Background

Rilpivirine (TMC278LA) is a promising drug for pre-exposure prophylaxis of HIV-1 because of its sub-nanomolar potency and long-acting formulation; however, increasing transmission of non-nucleoside reverse transcriptase inhibitor-resistant HIV-1 with potential cross-resistance to rilpivirine could reduce its preventive efficacy. This study investigated rilpivirine cross-resistance among recombinant subtype C HIV-1 derived from 100 individuals failing on first-line non-nucleoside reverse transcriptase inhibitor-containing antiretroviral therapy in South Africa whose samples were sent for routine HIV-1 drug resistance testing to Lancet Laboratories (Johannesburg, South Africa).

Methods

Plasma samples were selected from individuals with HIV-1 RNA > 10,000 copies/ml and ≥1 non-nucleoside reverse transcriptase inhibitor-resistance mutation in reverse transcriptase. Recombinant HIV-1LAI-containing bulk-cloned full-length reverse transcriptase sequences from plasma were assayed for susceptibility to nevirapine (NVP), efavirenz (EFV) and rilpivirine in TZM-bl cells. Fold-change (FC) decreases in drug susceptibility were calculated against a mean IC50 from 12 subtype C HIV-1 samples from treatment-naïve individuals in South Africa. Cross-resistance was evaluated based on biological cutoffs established for rilpivirine (2.5-FC) and the effect of mutation combinations on rilpivirine phenotype.

Results

Of the 100 samples from individuals on failing antiretroviral therapy, 69 had 2.5- to 75-fold decreased susceptibility to rilpivirine and 11 had >75-fold resistance. Rilpivirine resistance was strongly associated with K103N especially in combination with other rilpivirine-associated mutations.

Conclusion

The frequently observed cross-resistance of HIV-1 suggests that the preventive efficacy of TMC278LA pre-exposure prophylaxis could be compromised by transmission of HIV-1 from individuals with failure of first-line non-nucleoside reverse transcriptase inhibitor-containing antiretroviral therapy.
Propofol for gastrointestinal endoscopy
Authors: Nishizawa Toshihiro , Suzuki Hidekazu
Published: March 2018

Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continues to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals. According to published values, endoscopist‐directed propofol has a lower mortality rate than endoscopist‐delivered benzodiazepines and opioids, and a comparable rate to general anesthesia by anesthesiologists. Rapid recovery has a major impact on patient satisfaction, post‐procedure education and the general flow of the endoscopy unit. According to estimates, the absolute economic benefit of endoscopist‐directed propofol implementation in a screening setting is probably substantial, with 10‐year savings of $3.2 billion in the USA. Guidelines concerning the use of propofol emphasize the need for adequate training and certification in sedation by non‐anesthetists.
The International Olympic Committee: A United Nations Permanent Observer of post-politics?
Authors: van Luijk Nicolien
Published: March 2018

In October of 2009 the United Nations (UN) General Assembly accepted the International Olympic Committee’s (IOC) application for Permanent Observer status. This is an honour usually reserved for non-Member States and intergovernmental organisations; very rarely do non-governmental organisations (NGOs) obtain this position. The position enables the IOC to directly influence General Assembly policy decisions. This paper examines how the IOC was able to obtain such a unique status when other NGOs have had their applications rejected, and asks: what does this appointment mean for the involvement of broader civil society at the UN? The paper argues that there are various factors at play that have influenced the relationship between a global sports organisation and an international development organisation, including the neoliberalisation of development, the global power of sport, and processes of legitimation for both the IOC and the UN.
Next Education: Technology Transforming Education
Authors: Yadav Neetu , Gupta Kritesh , Khetrapal Vibhor
Published: March 2018

The approach towards teaching and learning has drastically changed with the advent of technology. Classrooms are no longer what they used to be. The traditional spaces fitted with blackboards and controlled by overbearing/strict teachers have given way to the new-age ‘smart’ classrooms. The post-millennial generation, which is highly exposed to gadgets like smartphones, has a short attention span and seeks quick learning at the click of a button. They want the freedom to decide what and how they want to learn; this wish is fulfilled by technology that has democratized Indian education system. The integration of technology and education was seen as a thrust area for business development in the early 2000s. In 2007, two IIT alumni and serial entrepreneurs, Beas Dev Ralhan and Raveendranath Kamath, started Next Education with the aim of changing the face of education in India by melding it with technology. In a short span of 10 years, it reached over more than 10,000 schools across the country transforming lives of more than 1,000,000 students with its flagship products such as TeachNext, LearnNext, MathsLab, Next ERP and aims at becoming the leader in technology-based education solution provider. The journey has been quite challenging with stiff competition from EdTech market leaders and resistance from various stakeholders. The questions Ralhan and Kamath were facing: How to enter into an industry which was at the nascent stage? How to create its market space and how to sustain it? How to beat the challenges in establishing a foothold in technology-driven education industry?
Managing Physically Challenged Workers at Microsign
Authors: Gupta Manish , Ravindranath Sindhu
Published: March 2018

This case is about Nisheeth’s Microsign Products (Microsign), a manufacturer of electronical, electronics, and automobile components. Since its inception in 1979, the company underwent several HR related changes. The biggest decision in this regard was to employ as many differently abled people as many possible. The firm could sustain financially because of the modifications done in the HR practices to adapt to the differently abled workforce. In 2017, the company felt the pinch of increased competition and demand for better quality products. Therefore, the CEO, Nisheeth, decided to embrace advanced German machines. However, he knew that embracement of technology is not easy and this move could potentially change the existing HR practices. He wondered what he and other organizations that employ differently abled people could do to sustain in this turbulent time.
Project Nirman: The Way Ahead
Authors: Sinha Anamika , Varkkey Biju , Dave Priyanka
Published: March 2018

Project Nirman by SAATH, a Gujarat-based NGO, aimed at empowering and training migrated workmen as masons, carpenters and electricians as per industry requirements. The project was funded by Bosch India Foundation. Although all aspects of the pilot project were successfully tested for sustainability, continuous funding remained a challenge. The project’s protagonist wanted to upscale operations but was facing a dilemma. While exploring options for sustainability on a continuum of dependency to complete self-sufficiency, the protagonist became increasingly aware of roles and identities of each partner in such alliances.

Some peripheral dilemmas like challenges in identifying a socially relevant project, upscaling the pilot project, identifying team capabilities for growth and need for value integration by different stakeholders for desired growth were noted. This case closes by questioning on how strategic alliances should be made so that the four partners — government, community, Non-government Organization and corporate — learn to coexist with mutual respect.
The evolution of functional hand replacement: From iron prostheses to hand transplantation
Authors: Zuo Kevin J , Olson Jaret L
Published: March 2018

The hand is an integral component of the human body, with an incredible spectrum of functionality. In addition to possessing gross and fine motor capabilities essential for physical survival, the hand is fundamental to social conventions, enabling greeting, grooming, artistic expression and syntactical communication. The loss of one or both hands is, thus, a devastating experience, requiring significant psychological support and physical rehabilitation. The majority of hand amputations occur in working-age males, most commonly as a result of work-related trauma or as casualties sustained during combat. For millennia, humans have used state-of-the-art technology to design clever devices to facilitate the reintegration of hand amputees into society. The present article provides a historical overview of the progress in replacing a missing hand, from early iron hands intended primarily for use in battle, to today's standard body-powered and myoelectric prostheses, to revolutionary advancements in the restoration of sensorimotor control with targeted reinnervation and hand transplantation.
Are online learning modules an effective way to deliver hand trauma management continuing medical education to emergency physicians?
Authors: Williams Jason G
Published: March 2018

Background

The enormity of modern medical knowledge and the rapidity of change have created increased need for ongoing or continuing medical education (CME) for physicians. Online CME is attractive for its availability at any time and any place, low cost and potentially increased effectiveness compared with traditional face-to-face delivery.

Objective

To determine whether online CME modules are an effective method for delivering plastic surgery CME to primary care physicians.

Methods

A needs assessment survey was conducted among all emergency and family physicians in Nova Scotia. Results indicated that this type of program was appealing, and that hand trauma related topics were most desired for CME. 7 Lesson Builder (SoftChalk LLC, www.softchalk.com ) was used to construct a multimedia e-learning module that was distributed along with a pretest, post-test and feedback questionnaire. Quantitative (pre- and post-test scores) and qualitative (feedback responses) data were analyzed.

Results

The 32 participants who completed the study indicated that it was a positive and enjoyable experience, and that there was a need for more resources like this. Compared with pretest scores, there was a significant gain in knowledge following completion of the module (P=0.001).

Conclusion

The present study demonstrated that an e-learning format is attractive for this population and effective in increasing knowledge. This positive outcome will lead to development of additional modules.
Inpatient silver sulphadiazine versus outpatient nanocrystalline silver models of care for pediatric scald burns: A value analysis
Authors: Malic Claudia , Verchere Cynthia , Arneja Jugpal S
Published: March 2018

Background/Objective

Scalds represent the most frequent pediatric burn injury. Inpatient nonsurgical wound management of small or medium-size burns (<20% total body surface area) represents a significant proportion of the cost of care, with nanocrystalline silver (NCS) and silver sulphadiazine (SSD) among the most commonly used dressings. Although several articles have described healing outcomes using these dressings, there are few concurrent economic analyses. To analyze overall health care value (outcomes/cost) in burns not requiring surgery, the authors compared management of scald burns with NCS versus SSD from both a quality perspective and using bottom-up microcosting to determine which dressing option optimizes health care value.

Methods

A value analysis was performed. Published studies investigating NCS and/or SSD in the treatment of pediatric burns over the past 25 years were analyzed. Healing time, hospital duration and frequency of dressings were chosen as quality metrics. A bottom-up microcosting analysis was performed to estimate costs associated with the two dressing options.

Results

Over the 25-year period, 356 studies investigated the use of SSD in burns, while 55 studies evaluated the use of NCS. Mean age and burn size were equivalent. Mean time to healing was 14.9 days for NCS and 17.2 days for SSD. The mean duration of hospital stay was 14.9 days for SSD and 5.9 days for NCS. Dressings were performed twice per week for NCS, and once or twice per day for SSD. The mean total cost per patient to the health care system was estimated to be $61,140 for SSD and $17,220 for NCS.

Conclusion

Published outcomes of healing time are equivalent or slightly better using NCS over SSD for pediatric scalds. The financial model illustrated a potential significant cost saving with NCS, primarily as a result of an outpatient model of care. Overall health care value is optimized using NCS for pediatric scalds.
Is routine pathological evaluation of tissue from gynecomastia necessary? A 15-year retrospective pathological and literature review
Authors: Senger Jenna-Lynn , Chandran Geethan , Kanthan Rani
Published: March 2018

Objective

To reconsider the routine plastic surgical practice of requesting histopathological evaluation of tissue from gynecomastia.

Method

The present study was a retrospective histopathological review (15-year period [1996 to 2012]) involving gynecomastia tissue samples received at the pathology laboratory in the Saskatoon Health Region (Saskatchewan). The Laboratory Information System (LIS) identified all specimens using the key search words “gynecomastia”, “gynaecomastia”, “gynecomazia” and “gynaecomazia”. A literature review to identify all cases of incidentally discovered malignancies in gynecomastia tissue specimens over a 15-year period (1996 to present) was undertaken.

Results

The 15-year LIS search detected a total of 452 patients that included two cases of pseudogynecomastia (0.4%). Patients' age ranged from five to 92 years and 43% of the cases were bilateral (28% left sided, 29% right sided). The weight of the specimens received ranged from 0.2 g to 1147.2 g. All cases showed no significant histopathological concerns. The number of tissue blocks sampled ranged from one to 42, averaging four blocks/case (approximately $105/case), resulting in a cost of approximately $3,200/year, with a 15-year expenditure of approximately $48,000. The literature review identified a total of 15 incidental findings: ductal carcinoma in situ (12 cases), atypical ductal hyperplasia (two cases) and infiltrating ductal carcinoma (one case).

Conclusions

In the context of evidence-based literature, and because no significant pathological findings were detected in this particular cohort of 452 cases with 2178 slides, the authors believe it is time to re-evaluate whether routine histopathological examination of tissue from gynecomastia remains necessary. The current climate of health care budget fiscal restraints warrants reassessment of the current policies and practices of sending tissue samples of gynecomastia incurring negative productivity costs on routine histopathological examination.
The unfunded costs incurred by patients accessing plastic surgical care in Northern Saskatchewan
Authors: Robb Jessica L , Clapson Brian J
Published: March 2018

The Canadian health care system was designed to ensure that all Canadian citizens would receive equal access to health care. However, in rural areas of Canada, patients are required to travel long distances and pay significant out-of-pocket expenses to access health care.

The present study attempted to quantify the added out-of-pocket costs that rural Saskatchewan residents must pay to receive plastic surgical specialist care compared with urban residents of Saskatoon. A cost analysis was performed to generate a numerical value that would represent a minimum cost for patients travelling from three different locations within the province. The cost analysis performed in the present study approximated that the unfunded costs for common plastic surgical procedures are, at a minimum, 30 times greater for rural patients in La Ronge compared with their urban counterparts in Saskatoon.

The fundamental principle of the Canadian health care system is equal access to necessary health care for all Canadians. Despite this, inequalities persist. The present cost-analysis study demonstrated that the unfunded (out-of-pocket) expenses for rural Saskatchewan patients seeking plastic surgical treatment is significantly higher than for their urban counterparts. These unfunded costs represent a significant barrier to health care access in Canada and serve to propagate inequalities in the nation's heath care system.
Tracking the aesthetic outcomes of prosthetic breast reconstructions that have complications
Authors: Mioton Lauren M , Seth Akhil , Gaido Jessica , Fine Neil A , Kim John Ys
Published: March 2018

Background

Aesthetic results following breast reconstruction have been shown to be a major contributor to patient satisfaction. While many presume that complications after reconstruction impact final aesthetic results, little data exist to substantiate this putative relationship.

Objective

To track and evaluate aesthetic outcomes following implant reconstructions with complications.

Methods

A chart review was conducted on a series of consecutive expander-implant breast reconstructions performed by the senior author between 2004 and 2012. Included patients completed their prosthetic reconstruction or converted to autologous methods and had a minimum follow-up period of 130 days. Four blinded members of the division of plastic surgery independently rated postoperative anterior photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains: breast mound volume, contour, placement, scarring and inframammary fold.

Results

Of the 172 patients who met the inclusion criteria, 36 experienced a complication. The tissue expander in one-half of these patients was salvaged and the remaining patients converted to autologous reconstruction. The average aesthetic scores for each domain did not differ significantly between patients who experienced a complication and retained their expander and those who did not experience a complication. Patients who converted to autologous tissue reconstruction after experiencing a complication had the highest aesthetic scores.

Discussion

The ability to obtain aesthetic results following a complication that were not statistically different from results in those without complications may reflect the surgeon's refined attempt to salvage the initial implant reconstruction; in other circumstances, the improved cosmesis was achieved through conversion to an autologous tissue-based method.

Conclusion

The present study quantitatively assessed the impact of complications on aesthetic outcomes following implant breast reconstruction. Continuance of prosthetic reconstruction and conversion to autologous reconstruction serve as viable options to obtain adequate aesthetic scores following a complication. Information gained from the present analysis will help manage patient expectations.