bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Subjective versus Data Base Approaches for Improving Efficiency of Operating Room Scheduling
Authors: Shukla Ramesh K. , Ketcham Jonathan S. , Ozcan Yasar A.
Published: January 2017

This paper compares subjective and four data-based models to estimate length of surgery for operating room scheduling systems. The four data-based models for predicting case block length are based on 1) procedure, 2) procedure and surgeon, 3) procedure and case complexity, and 4) procedure, case complexity, and surgeon. Data-based approaches performed better than subjective estimates. In establishind data-based standards it is more important to account for complexity of cases than for differences among surgeons.
The Results of a Study on Certified Sickness Amongst Nurses in a Welsh Health District
Authors: Reidy Elizabeth A.
Published: January 2017

There is a general impression given in the Occupational Health literature that certain socioeconomic variables are associated with increasing days lost from sickness absence. This writer does not wish here to take issue with these findings. Instead it is hoped to show that when certified sickness data for staff in a Health District is analysed in the search for associations between days lost and the variables age, sex, length of time in post, marital status and hours worked there is no overall convincing evidence that these variables are associated with more or less days lost by workers in the population from which these samples are taken. Calculations of the power of the study were made to compute the likelihood of the study of detecting a hypothesised degree of association as a “statistically significant” one assuming a critical p.value of 0.05.
Volume and Outcome in Hospital Care: Evidence, Explanations and Implications
Authors: Black Nick , Johnston Alastair
Published: January 2017

The relationship between the volume of work undertaken in a hospital and the outcome of care has assumed increasing importance in recent years. A review of the literature reveals that most studies have been carried out in the USA and have largely been confined to six specific areas of health care. There is evidence that better outcomes are obtained at higher volumes for several surgical operations, cardiac catheterisation and care of the severely injured. As yet there is no clear association for coronary, neo-natal and burn care. There are two competing hypotheses to explain any association — ‘practice-makes-perfect’ and ‘selective referral’. These are discussed and implications for the future provision of hospital services considered.
Towards a Common Vocabulary for Identifying Management Issues in Health Projects
Authors: De Geyndt Willy
Published: January 2017

Management issues are one of the most important constraints in achieving social sector development objectives. The practice of labeling a variety of operational weaknesses as management problems hinders diagnostic power and, hence induces a low probability of removing or reducing management constraints. Moreover terms related to management are used differently. The set of terms presented here disaggregates the concept of management into nine discrete measurable management tasks: planning systems, beneficiary analysis, provision of goods and services, procurement and logistics of materials, financing and budgeting, organizational design, personnel, leadership, and control systems. The nine functional management areas are applied to three stages of a project cycle, viz. sector analysis/project identification, project design/project appraisal, and project implementation/project supervision. The set of terms proposed is seen as a first step towards developing a common vocabulary for identifying management issues in health projects.
The Elderly Healthcare Consumer: A Critical Review of Information Source Use and Advertising Recommendations
Authors: Pemberton Judy Hathaway
Published: January 2017

A critical review of the literature is undertaken to examine the state of the art and degree of articulation of theories, methods, and findings between health care marketing and the traditional “generic” marketing literature as related to knowledge of information use by and advertising to the elderly consumer. Evaluative criteria suggestive of scientific rigor are applied to this domain as consistencies, discrepancies, and gaps are identified.

Recommendations for future research are advanced.
Chlamydia Test Monitoring during Therapy
Authors: Cerin Å , Grillner L , Persson E
Published: January 2017

Forty-eight women with chlamydial cervicitis were followed with chlamydial culture and antigen tests (immunofluorescence and enzyme immunoassays) during the course of therapy to study the rate of disappearance of viable organisms and chlamydial antigen. On treatment day 2, two-thirds of the patients were positive by one or more of the tests while 81% were negative by all tests on day 4. All screening methods used had turned negative on the 6th day of therapy. The antigens were found to persist somewhat longer than viable organisms. This persistance should, however, be of no clinical significance.
Detection of Mycoplasma Genitalium in the Genitourinary Tract of Women by the Polymerase Chain Reaction
Authors: Palmer H M , Gilroy C B , Claydon E J , Taylor-Robinson D
Published: January 2017

A polymerase chain reaction (PCR) was used to demonstrate the presence or absence of Mycoplasma genitalium in the lower genital tract of 57 women who attended a sexually transmitted diseases clinic. The mycoplasma was detected in the cervix of 10 (17.5%) women and also in the vagina of 4 (16%) and the urethra of 6 (24%) of 25 women from whom multiple samples were obtained. Chlamydia trachomatis was detected also by a PCR in 9 (16%) of the women, but only 3 were chlamydia-positive and mycoplasma-positive. M. genitalium was detected occasionally in women with vaginal disease (for example, bacterial vaginosis), whereas C. trachomatis was not, but whether there is any causal relationship between the mycoplasma and vaginal or cervical disease requires further study.
Primary and Secondary Syphilis: A Histopathological Study
Authors: Engelkens H J H , ten Kate F J W , Vuzevski V D , van der Sluis J J , Stolz E
Published: January 2017

We present a study of biopsies taken from skin lesions of 44 patients presenting with primary or secondary syphilis. In most primary lesions erosion or, more often, ulceration was present, with a dense inflammatory infiltrate. In secondary syphilis a wide variety of histological changes was present. Blood vessels were frequently involved, with marked endothelial swelling and often proliferation. Treponemes were demonstrated with the Steiner staining method in all investigated cases of primary syphilis and in 71% of secondary syphilis cases. Treponemes were present throughout the dermis, particularly perivascularly, and in the dermal–epidermal junction zone. In two specimens of secondary syphilis treponemes were located predominantly in the epidermis, but there were always some microorganisms demonstrable in the dermis. The inflammatory infiltrate was often located in a perivascular coat-sleeve-like arrangement. In this study plasma cells and lymphocytes were present in all specimens of primary and secondary syphilis. Syphilitic lesions differed from yaws lesions mostly in the location of treponemes and the affection of blood vessels. In this histopathological study of early syphilis, treponemes did not show the epidermiotropic character of yaws, and blood vessel changes were more pronounced than in yaws. Unfortunately, due to the protean histopathological manifestations described in venereal syphilis and in yaws, these two treponemal diseases cannot always be differentiated on histological grounds alone.
A Reappraisal of Chlamydial and Non-Chlamydial Acute Non-Gonococcal Urethritis
Authors: Hay P E , Thomas B J , Gilchrist C , Palmer H M , Gilroy C B , Taylor-Robinson D
Published: January 2017

A cohort of 112 men presenting with acute non-gonococcal urethritis (NGU) was investigated for the presence of Chlamydia trachomatis. Men with 3 or more episodes of NGU in the preceding 12 months, or who had received treatment for NGU in the preceding 3 months were excluded. C. trachomatis was sought by examination of urethral smears by direct immunofluorescence, and by examination of the centrifuged deposit from a first pass urine (FPU) sample by direct immunofluorescence, IDEIA, and the polymerase chain reaction. Urethral samples from 48 men were positive for CT, and the FPU samples from an additional 7 men were positive by at least 2 assays. With such intensive investigation it is likely that those men identified as chlamydia-negative were genuinely free from the infection. The clinical history and response to treatment of those men who were chlamydia-positive were compared with those of the chlamydia-negative men. They differed in that a larger proportion of the chlamydia-positive men reported having had intercourse with more than one partner in the previous 3 months, and having had fewer previous episodes of NGU. Moreover, in contrast to some previous studies, after one week of treatment with doxycycline, a larger proportion (65%) of the chlamydia-negative men than the chlamydia-positive men (40%) was cured, although the difference was not sustained following later treatment.
Human Papillomavirus DNA in the Urogenital Tracts of Men with Genital Dermatoses: Evidence for Multifocal Infection
Authors: Hillman R J , Ryait B K , Botcherby M , Walker M M , Taylor-Robinson D
Published: January 2017

In an attempt to assess the multifocal nature of anogenital HPV infection in men, skin biopsies, urethral swabs and urine specimens were obtained from 100 men with genital dermatoses. The specimens were examined for the presence of human papillomavirus (HPV) types 6, 11, 16, 18, 31 and 33 using the polymerase chain reaction and Southern blotting techniques. HPV DNA was detected in one or more specimens from 39 patients, that is 29 of 100 biopsy specimens, 21 (25%) of 85 urethral swab specimens and 6 (10%) of 59 urine specimens. HPV DNA was more common in men with at least 20 lifetime sexual partners and in those who gave a history of anogenital warts. Twelve (18%) of 66 biopsy specimens with no histological evidence of warty change or neoplasia had detectable HPV DNA. HPV DNA was detected no more frequently in the urethral and urine specimens from men with histological evidence of warts or neoplasia than from men without such changes.

HPV types 6 and 11 were most common in biopsy specimens with histological changes of typical HPV infection. HPV type 16 was commonest in biopsy specimens with neoplasia and type 18 with other changes. Furthermore, ‘high-risk’ HPV types were found proportionately more often in urethral swab and urine specimens than in biopsy specimens. There was generally a poor correlation between the detection of HPV DNA at the different sites.

A greater understanding of the role of HPV in the production of genital abnormalities is required in order to develop a rational approach to the management of these patients.
Comparison of the Influence of Spermicidal and Non-Spermicidal Contraception on Bacterial Vaginosis, Candidal Infection and Inflammation of the Vagina—A Preliminary Study
Authors: Jones B M , Eley A , Hicks D A , Patel R , Wordsworth J M
Published: January 2017

This preliminary study compared the signs, symptoms and prevalence of bacterial vaginosis (BV) and candidal infections in women using spermicides, with those using other forms of contraception, to establish whether nonoxynol-9 had any therapeutic value against BV or gave rise to vaginal candidiasis and inflammation. Overall results showed that the prevalence of BV in non-spermicide users was 35/113 (31%) but was significantly less in spermicide users, 10/66 (15%), P<0.05. Nonoxynol-9 was not associated with increased isolation of Candida albicans, which was found in 16/113 (14%) of non-spermicide users, and in 8/66 (12%) of those using spermicides, P>0.1. Vaginal inflammation and discharge were significantly less in spermicide users, 19/66 (29%) than in the non-spermicide group, 50/113 (44%), P<0.05. Nonoxynol-9 contraception was associated with a significantly reduced prevalence of BV, but not with increased candidiasis or vaginal inflammation.
Female Genital Schistosomiasis as a Risk-Factor for the Transmission of HIV
Authors: Feldmeier H , Krantz I , Poggensee G
Published: January 2017

Sexually transmitted diseases increase the probability for HIV transmission, presumably through lesions in the genital mucosa. Female genital schistosomiasis, a special form of urinary schistosomiasis due to infection with Schistosoma haematobium, may be another risk-factor for transmission of HIV. From published data there seem to be pathophysiological, immunological and epidemiological evidence for an association between genital ulcer disease due to S. haematobium and HIV-infection in women. Female genital schistosomiasis could be seen as an example of how an interaction between a parasitic disease and HIV facilitates the propagation of the latter. As long as the prevalence of HIV is low in the general population, interventions targeted to high risk groups will significantly delay, or even prevent, widespread dissemination of the HIV infection in the rest of the population. If female genital schistosomiasis is a risk factor for the spread of HIV like other genital ulcer diseases, there should be interesting ways to intervene from the public health point of view.
The Role of Chlamydia Trachomatis in Urethritis and Urethral Symptoms in Women
Authors: Horner P J , May P E , Thomas B J , Benton A M , Taylor-Robinson D
Published: January 2017

One hundred and fifty women who attended a genitourinary medicine clinic and who required a speculum examination were investigated to determine the association between Chlamydia trachomatis and urethral symptoms and signs. Those who had taken antibiotics with anti-chlamydial activity within 3 months or those who were menstruating, pregnant or using an intrauterine contraceptive device were excluded. C. trachomatis infection of the urethra, or infection of the urethra and cervix together, combined with each separately, were strongly associated with > = 5 polymorphonuclear (PMN) leucocytes per high-power field (× 1000) in a Gram-stained urethral smear ( P < 0.00005 and P < 0.0005, respectively). This appeared not to arise from leucocyte contamination from the lower genital tract. However, C. trachomatis infection of the urethra was not associated with symptoms of dysuria or frequency. In conclusion, it seems likely that C. trachomatis infection of the urethra in women probably causes urethritis which is usually asymptomatic. Women who have objective evidence of urethritis might best be managed by appropriate antibiotic therapy and counselling, and advice that partners should attend for review.
Testing for HIV Antibody: A Comparison of Two Services Offered in a Genitourinary Medicine Clinic
Authors: Rowen D , Carne C A , Sonnex C , Jones M , Maloney M E , Lefort W , Wreghitt T G
Published: January 2017

Rates of screening for sexually transmissible infections in patients using different services provided by a genitourinary medicine clinic for testing for HIV antibodies are presented. Those patients whose primary reason for attending the clinic was HIV antibody testing and used the same day result (SDR) service were significantly less likely to be screened for other infections than those using the normal waiting time (NWT) service, ( P < 0.00001). This was true for both males and females. Of those patients screened for other infections in the SDR and NWT groups 29% and 35% respectively were found to have a sexually transmitted infection. It would appear that an SDR service offers little benefit for the majority of patients as only a few patients would not have had an HIV antibody test had the SDR not been available.
Clinical Features and Serum β2-Microglobulin Levels in HIV-1 Positive and Negative Tanzanian Patients with Tuberculosis
Authors: Kennedy Nick , Whitelaw Fiona M , Gutmann Jacques , Berger Leslie , Uiso Leonard , Ngowi Frank I , Gillespie Stephen H
Published: January 2017

Serum β2-microglobulin (β2M) rises in the later stages of HIV disease and has therefore been used to monitor progression to AIDS. However, little work has been done on patients co-infected with HIV and tuberculosis. We studied clinical features and serum β2-M in 35 Tanzanian patients treated for pulmonary tuberculosis (9 HIV-positive, 26 HIV-negative). The provisional WHO clinical definition of AIDS for use in Africa was fulfilled by 89% of the HIV-positive and 65% of the HIV-negative patients. Median serum β2-M on admission was slightly higher in HIV-positive (3.17 mg/l) than in HIV-negative (2.85 mg/1) patients. Serum β2-M fell during treatment in 17/24 (71%) of HIV-negative and 3/7 (43%) HIV-positive patients followed up for 6 months. We conclude that serum β2-M is frequently raised in active tuberculosis, and is therefore an unreliable indicator of the stage of HIV disease in co-infected patients. The WHO clinical definition of AIDS also proved unreliable in patients with tuberculosis.
Women, Contraception and STDs Including HIV
Authors: Carlin E M , Boag F C
Published: January 2017

It is estimated that eight million women are infected with the human immunodeficiency virus (HIV) worldwide. Heterosexual transmission is the predominant mode of HIV transmission on a global basis and is becoming increasingly important in the Western world. Women have long used contraceptives as a means of protection against an unwanted pregnancy, some of which may also protect against sexually transmitted disease (STD) including HIV. We review the relationship between contraceptive methods and STD acquisition and transmission; HIV acquisition and transmission; and the implications of contraceptive use, particularly regarding disease progression, in those women who are already infected with the virus. It is important for all women that protection against both unwanted pregnancy and HIV acquisition and transmission are considered together and not in isolation as nowhere is the argument for a broad based multi-disciplinary approach more cogent.
HIV in UK Prisons: A Review of Seroprevalence, Transmission and Patterns of Risk
Authors: Curtis Simon P , Edwards Anne
Published: January 2017

Prisons contain individuals at high risk of HIV infection, notably through intravenous drug use. For complex political, social and legal reasons penal institutions in the UK are unable to provide condoms and clean needles. The outbreak of HIV and hepatitis B that occurred in a Scottish prison in 1993 focused attention on the potential problems. Debate about the issue is hampered by a lack of useful information. Current data about risk behaviour and seroprevalence is reviewed, and compared with experience in other countries. Injecting drug use in prison appears to be common, and the majority who inject in prison share equipment, which can be used many times. Sexual activity may be a smaller risk factor, but does occur between men in prison. In addition, prisoners appear to have high rates of partner change between sentences. The true prevalence of HIV in UK prisons is difficult to assess, but the available data suggest it is between 0.1 and 4.5%, lower than in Southern Europe and the USA. A window of opportunity still exists to prevent further outbreaks of HIV in UK penal institutions and to maintain these low prevalence rates. Strenuous, and possibly unpalatable measures are needed now.
Spectrum of Opportunistic Infections among AIDS Patients in Tamil Nadu, India
Authors: Kumarasamy N , Solomon Suniti , Paul S A Jayaker , Venilla Rosy , Amalraj R Edwin
Published: January 2017

A retrospective case note review of 100 AIDS patients attending a large Indian centre was performed. Of these 100 patients, 94% gave a history of heterosexual HIV transmission, 68% were male. The majority of females were aged 21 to 30 years. The most common mode of presentation was tuberculosis (61%), both pulmonary (46%) and extrapulmonary (15%). Oral candidiasis extending on to the oesophagus was the second most predominant opportunistic infection. This study also highlights the difficulty in detecting AIDS cases in India owing to difficulties in taking a sexual history and lack of laboratory facilities.
Thank God it's Monday…
Authors: Hagerty Bill
Published: January 2017

Deadline Sunday; A Life in the Week of the Sunday Times by Brian MacArthur Hodder and Stoughton #15.99
We Know Who Likes Us, but Not Who Competes Against Us
Authors: Eisenkraft Noah , Elfenbein Hillary Anger , Kopelman Shirli
Published: January 2017

Research on dyadic meta-accuracy suggests that people can accurately judge how their acquaintances feel toward them. However, existing studies have focused exclusively on positive feelings, such as liking. We present the first research on dyadic meta-accuracy for competition, a common dynamic among work colleagues. Data from the sales staff at a car dealership and students working on project teams suggest that the prevailing model of dyadic meta-accuracy breaks down for judgments of competition. For liking, projecting one’s own feelings promotes dyadic meta-accuracy because colleagues tend to reciprocate each other’s liking. For competition, the tendency to compete against superior performers reduces reciprocity and renders self-projection ineffective. You can accurately estimate how much your colleagues like you, but are unlikely to know how much those same colleagues compete against you.
Parents’ Perceptions of Their Children as Overweight and Children’s Weight Concerns and Weight Gain
Authors: Robinson Eric , Sutin Angelina R.
Published: January 2017

The global prevalence of childhood obesity is alarmingly high. Parents’ identification of their children as overweight is thought to be an important prerequisite to tackling childhood obesity, but recent findings suggest that such parental identification is counterintuitively associated with increased weight gain during childhood. One possibility is that parental identification of their child as being overweight results in that child viewing his or her body size negatively and attempting to lose weight, which eventually results in weight gain. We used data from two longitudinal cohort studies to examine the relation between children’s weight gain and their parents’ identification of them as being overweight. Across both studies, children whose parents perceive them to be overweight are more likely to view their body size negatively and are more likely than their peers to be actively trying to lose weight. These child-reported outcomes explained part of the counterintuitive association between parents’ perceptions of their children as being overweight and the children’s subsequent weight. We propose that the stigma attached to being recognized and labeled as “overweight” may partly explain these findings.
Experimental investigation of an actively controlled automotive cooling fan using steady air injection in the leakage gap
Authors: Azzam Tarik , Paridaens Richard , Ravelet Florent , Khelladi Sofiane , Oualli Hamid , Bakir Farid
Published: January 2017

In an axial fan, a leakage flow driven by a pressure gradient between the pressure side and the suction side occurs in the gap between the shroud and the casing. This leakage flow is in the opposite direction to the main flow and is responsible for significant energy dissipation. Therefore, many authors have worked to understand this phenomenon in order to reduce these inherent energy losses. Up to now, most of the studies reported in the literature have been passive solutions. In this paper, an experimental controlling strategy is suggested to reduce the leakage flow rate. To this end, a fan with hollow blades and a specific drive system were designed and built for air injection. Air is injected in the leakage gap at the fan periphery. The experiment was performed for three rotation speeds, five injection rates and two configurations: 16 and 32 injection holes on the fan’s circumference. The experimental results of this investigation are presented in this article.
Feasibility of Hydrogen Utilization in Gas Turbine Engines
Authors: Najjar Yousef S.H. , Zahed A.H. , Bashir M.D. , Alp Talip
Published: January 2017

The gas turbine engine has a promising future in different applications. Hydrogen, on the other hand, is being considered as a good candidate fuel in combustion processes.

In this work, a model two-shaft gas turbine engine was run on LPG under different operating conditions of compressor and free power turbine speeds. Performance parameters such as torque, power, specific fuel consumption, and thermal efficiency were calculated. Comparison of performance with hydrogen was carried out based on simulation studies, especially fuel-air ratio, and specific fuel consumption, which showed clearly improved performance with hydrogen.
Implementing Social Costing in the Electric Utility Industry1
Authors: Palmer Karen , Dowlatabadi Hadi
Published: January 2017

Social costing refers to the regulatory practice of requiring electric utilities to incorporate external costs into utility decision making. This practice is being adopted by a growing number of state public utility commissions (PUCs). The effectiveness of this new regulatory approach in reducing the social costs of supplying electricity will depend on the range of utility decisions covered. We use a utility planning model and illustrative estimtes of environmental costs to analyze the implications of different social costing regimes for generation technology choice, social and private costs of electricity supply and electricity price. Due to large differences in private costs across technologies and fuel types, social costing regulation has little or no effect on the utility's investment decisions, dispatch of generators or output price for many of the external cost estimates considered. Applying social costing exclusively to new generating units could result in increased use of existing units and higher social cost electricity production.
Metabolic changes in rat serum after administration of suberoylanilide hydroxamic acid and discriminated by SVM
Authors: Yu J , Wu H , Lin Z , Su K , Zhang J , Sun F , Wang X , Wen C , Cao H , Hu L
Published: January 2017

Suberoylanilide hydroxamic acid (SAHA) exerts marked anticancer effects via promotion of apoptosis, cell cycle arrest, and prevention of oncogene expression. In this study, serum metabolomics and artificial intelligence recognition were used to investigate SAHA toxicity. Forty rats (220 ± 20 g) were randomly divided into control and three SAHA groups (low, medium, and high); the experimental groups were treated with 12.3, 24.5, or 49.0 mg kg−1 SAHA once a day via intragastric administration. After 7 days, blood samples from the four groups were collected and analyzed by gas chromatography–mass spectrometry, and pathological changes in the liver were examined using microscopy. The results showed that increased levels of urea, oleic acid, and glutaconic acid were the most significant indicators of toxicity. Octadecanoic acid, pentadecanoic acid, glycerol, propanoic acid, and uric acid levels were lower in the high SAHA group. Microscopic observation revealed no obvious damage to the liver. Based on these data, a support vector machine (SVM) discrimination model was established that recognized the metabolic changes in the three SAHA groups and the control group with 100% accuracy. In conclusion, the main toxicity caused by SAHA was due to excessive metabolism of saturated fatty acids, which could be recognized by an SVM model.
Protection by extracellular glutathione against sulfur mustard induced toxicity in vitro
Authors: Amir A , Chapman S , Gozes Y , Sahar R , Allon N
Published: January 2017

1 The present study characterizes the role of extracellularly added glutathione in protection against sulfur mustard (HD) toxicity in a macrophage monocyte cell line J774.

2 Toxic effects of HD depend on dose and duration of exposure with an ED50 of 50 and 75 mM for dividing and confluent cells respectively.

3 Exposure to HD, 100-200 mM caused *15% decrease in the cellular glutathione (GSH) content 2 h after exposure, pretreatment with GSH, 0.2-10 mM, elevated cellular GSH *61.5.

4 GSH pretreatment increased cell viability after HD 2-3-fold. Similar protective effects of GSH treatment were found in a human epidermoid carcinoma cell line (KB).

5 Protection by post treatment with GSH was apparent even 60 min post HD exposure.

6 No protection was afforded when the intracellular GSH concentration was elevated prior to exposure and the extracellular GSH had been washed out. However, GSH depleted cells were more sensitive to HD than normal cells, and were also protected by addition of GSH to the growth medium, although the intracellular GSH content remained low.

7 We conclude that it is essential for the GSH to be present extracellularly in order to protect cells from HD toxicity.

8 Our findings have therapeutic implications in particular for the protection of lungs after inhalation exposure to HD vapor.
The pre-clinical assessment of QT interval prolongation: a comparison of in vitro and in vivo methods
Authors: Davis A Stewart
Published: January 2017

The literature was searched for in vivo dog studies reporting QT prolongation and in vitro studies reporting increased myocardial action potential duration, which indicates the potential to prolong QT interval, for nine non-cardiac drugs that have been reported to produce QT prolongation in man. The drugs were: astemizole; terfenadine; erythromycin; sparfloxacin; cisapride; probucol; terodiline; risperidone and sertindole.

1 There were reports of the appropriate finding with in vitro methods for six of the drugs and with in vivo methods for seven of the drugs. No reports were found concerning the remaining drugs with each method. This indicates that both methods are effective and each method would have correctly identified the drugs in question as having the potential to prolong the QT interval in man in all cases for which studies were reported.

2 This suggests that, if properly conducted, either method alone is sufficient for the pre-clinical assessment of QT interval prolongation. This does not support the routine use of both methods before the administration of new drugs to man.
Statistical methods for the meta-analysis of cluster randomization trials
Authors: Donner Allan , Piaggio Gilda , Villar José
Published: January 2017

Cluster randomization trials have become a very attractive research strategy, particularly for the evaluation of health service interventions. The need to conduct meta-analyses of such trials is also becoming more common. However, as with cluster randomization trials in general, such analyses raise special methodologic challenges. In this paper, we discuss and illustrate several statistical approaches that might be applied to a meta-analysis of cluster randomization trials, each of which has a binary endpoint. Statistical methods for constructing inferences for a summary intervention odds ratio include those based on Mantel-Haenszel procedures, the ratio estimator approach, Woolf procedures and generalized estimating equations using robust variance estimation. The advantages and disadvantages of each method are discussed in the context of an example.
The impact and implication of regression to the mean on the design and analysis of medical investigations
Authors: Chuang-Stein Christy , Tong Donald M
Published: January 2017

We have examined the regression effect and its magnitude under the Gaussian distributional assumption. The impact and implication of regression to the mean on the analysis of medical investigations was discussed. For simplicity, we called the approach adjusting for the regression effect a two-stage procedure and noted its relationship to the analysis of covariance model for comparing treatment groups. We also proposed to examine the correlation structure among repeated measurements in the absence of any external interventions through a model more realistic than the one assuming equal correlations. The proposed structure led us to investigate ways to reduce or eliminate regression effect via study designs when patient selection is inevitable. Two examples were given to help illustrate the discussion in this paper.
Adjusting for regression toward the mean when variables are normally distributed
Authors: Lin H M , Hughes M D
Published: January 2017

Many studies use the same variable, for example blood pressure in studies of antihypertensive treatments, to identify subjects to be included in the study and to evaluate the effects of a treatment. As a consequence, if not properly accounted for, the effect of regression toward the mean can confound the evaluation of treatment effects if the study has no randomized control group. In this paper we review the methods that have been proposed for adjusting for the effect of regression toward the mean when the variable of interest is assumed to be normally distributed. Maximum likelihood estimation and moment-based estimation are considered, including more recent methods which can be applied when repeated measurements on each subject are available.
Cigarette smoking prevalence, cessation and relapse
Authors: Stapleton John
Published: January 2017

This paper briefly reviews three aspects of cigarette smoking behaviour: recent British trends in prevalence and cessation, tobacco dependence and the nicotine withdrawal syndrome, and treatment for smokers using nicotine replacement therapy. It concludes with a meta-analysis of the effect of relapse in nicotine replacement trials. For many years, until 1994, smoking prevalence in the UK declined at a steady rate but since the early 1980s uptake in the young has remained high. This failure to curb recruitment in the young may be in part responsible for the recent rise in all-age smoking prevalence. Cessation rates are very low when compared with the proportion of smokers who wish to stop and repeatedly try to do so. This disparity can be attributed to the addictiveness of nicotine and the withdrawal symptoms which confront the would-be quitter. To date, the most effective adjunctive aid for smokers trying to quit is nicotine replacement therapy but even when abstinence for several months has been achieved the risk of relapse remains high.
Criminalizing Vulnerability
Authors: Singh Sarah
Published: January 2017

This article aims to uncover how, in attempting to ameliorate the vulnerability of children, the offence of ‘causing or allowing the death of the child’ criminalizes abused mothers. It explores how, in the courtroom, tropes of female criminality and constructs of the ‘bad’ mother are mobilized in ways that are both gendered and ‘classed’. The effect is to silence female defendants, deprive their actions of context, and deny them agency. This argument has implications for assessing the moral and legal culpability of abused women who fail to protect their children, because it shifts the focus onto how the abuser has exploited and exacerbated the vulnerability of both mother and child. This approach also challenges law’s preoccupation with scrutinizing (and punishing) women who do not adhere to a glorified, middle-class ideal of motherhood. More broadly, by focusing on the context of a woman’s alleged ‘failure’, there opens a space within legal discourse to refute the characterization of female criminality as being either ‘mad’ or bad, and of women who engage in criminal behaviour as being either ‘virgins’ or ‘whores’. Finally, in focusing on vulnerability as a universal and unavoidable part of the human experience, gendered assumptions of autonomy and the self/other dichotomy are challenged.
Georg Händel (1622–97): The Barber-Surgeon Father of George Frideric Handel (1685–1759)
Authors: Adams Aileen K , Hofestädt B
Published: January 2017

George Frideric Handel was born in Halle (Saale) in Germany. After initial musical education in Germany and Italy, he came to London as a young man and spent the rest of his life in England. Until recently, little has been written of his early life in either the English or the German literature, and it is not widely known that he was the son of Georg Händel, a barber-surgeon of repute. When his father's name is mentioned, it is usually to claim that he actively discouraged his son's musical education. Georg Händel lived in a turbulent time; he became an eminent surgeon who served as valet and barber to the Courts of Saxony and Brandenburg, as well as a distinguished citizen of Halle. In describing his surgical duties, we show how these differed from those of barbers in England and France at that time. Barbers in Germany were less controlled, freer to practise as they pleased, and Händel himself had important duties in public health and forensic medicine. George Frideric was the first son of the second marriage, born when his father was 63 years of age. We aim also to dispel the notion that Händel's influence on his son's career was as obstructive as has been claimed, but rather that he was a responsible father with his children's interests at heart. This is shown in the success achieved by all his children, most of whom followed their father into medicine, while George Frideric became the most famous of them all, being regarded by posterity as one of the greatest composers.
Predicting the effectiveness of the Finnish population-based colorectal cancer screening programme
Authors: Chiu Sherry Yueh-Hsia , Malila Nea , Yen Amy Ming-Fang , Chen Sam Li-Sheng , Fann Jean Ching-Yuan , Hakama Matti
Published: January 2017

Objective

Because colorectal cancer (CRC) has a long natural history, estimating the effectiveness of CRC screening programmes requires long-term follow-up. As an alternative, we here demonstrate the use of a temporal multi-state natural history model to predict the effectiveness of CRC screening.

Methods

In the Finnish population-based biennial CRC screening programme using faecal occult blood tests (FOBT), which was conducted in a randomised health services study, we estimated the pre-clinical incidence, the mean sojourn time (MST), and the sensitivity of FOBT using a Markov model to analyse data from 2004 to 2007. These estimates were applied to predict, through simulation, the effects of five rounds of screening on the relative rate of reducing advanced CRC with 6 years of follow-up, and on the reduction in mortality with 10 years of follow-up, in a cohort of 500,000 subjects aged 60 to 69.

Results

For localised and non-localised CRC, respectively, the MST was 2.06 and 1.36 years and the sensitivity estimates were 65.12% and 73.70%. The predicted relative risk of non-localised CRC and death from CRC in the screened compared with the control population was 0.86 (95% CI: 0.79–0.98) and 0.91 (95% CI: 0.85–1.02), respectively.

Conclusion

Based on the preliminary results of the Finnish CRC screening programme, our model predicted a 9% reduction in CRC mortality and a 14% reduction in advanced CRC.
A Principal-Agent Approach to Foreign Economic Policy: State-Business Relations during U.S. Debt Crisis Management
Authors: Dombrowski Peter
Published: January 2017

U.S. officials often rely on American corporations to achieve public policy objectives within the international economy. For example, commercial banks played an integral role in U.S. debt crisis management efforts. The reliance on American businesses to achieve policy ends challenges theoretical assumptions about relations between private firms and the American state. It also forces analysts to develop new methodological tools for analyzing policy implementation. When foreign policy outcomes depend on the behavior of private firms, traditional models must be modified to account for the complexity of state-business relations in a globalized political economy.

To analyze the contribution of American firms to U.S. economic policy objectives, this paper draws upon institutionalist approaches to social science. Institutional analysis, and in particular economic views of organizations, focus on the role of incentives and information asymmetries in inter-organizational relations. This paper develops an analytic framework based on principal-agent theory and uses it to assess U.S. efforts to manage the global debt crisis.
Linear dynamometer testing of hydraulic artificial muscles with variable recruitment
Authors: Chipka Jordan , Meller Michael A , Volkov Alexander , Bryant Matthew , Garcia Ephrahim
Published: January 2017

A novel, meso-scale hydraulic actuator characterization test platform, termed a linear hydraulic actuator characterization device, is demonstrated and characterized in this study. The linear hydraulic actuator characterization device is applied to testing McKibben artificial muscles and is used to show the energy savings due to the implementation of a variable recruitment muscle control scheme. The linear hydraulic actuator characterization device is a hydraulic linear dynamometer that can be controlled to enable a desired force and stroke profile to be prescribed to the artificial muscles. The linear hydraulic actuator characterization device consists of a drive actuator that is connected in series with the test muscles. Thus, the drive cylinder can act as a controlled disturbance to the artificial muscles to simulate various loading conditions. With the ability to control the loading conditions of the artificial muscles, the linear hydraulic actuator characterization device offers the ability to experimentally validate the muscles’ performance and energetic characteristics. For instance, the McKibben muscles’ quasi-static force–stroke capabilities, as well as the power savings of a variable recruitment control scheme, are measured and presented in this work. Moreover, the development and fabrication of this highly versatile characterization test platform for hydraulic actuators is described in this article, and the characterization test results and efficiency study results are presented.
A novel optimal configuration of sensor and actuator using a non-linear integer programming genetic algorithm for active vibration control
Authors: Zhang Chunyou , Wang Lihua , Wu Xiaoqiang , Gao Weijin
Published: January 2017

Due to widespread applications of a large number of flexible structures, to obtain the best dynamic control performance of a system, optimal locations of the actuators and sensors are necessary to be determined. This article proposes a novel optimal criterion for the actuators or sensors ensuring good controllability or observability of a structure, and also considering the remaining modes to control the spillover effect. Based on the proposed optimization criteria, a non-linear integer programming genetic algorithm is employed to achieve the optimal configurations. Active vibration control is investigated for a cantilever plate with the actuators in optimal positions to suppress the specified modes utilizing linear quadratic regulator controller. Several simulation results validate the efficiency and feasibility of the proposed optimal criteria.
Negotiating “Unmeasurable Harm and Benefit”: Perspectives of General Practitioners and Consultant Pharmacists on Deprescribing in the Primary Care Setting
Authors: Anderson Kristen , Foster Michele , Freeman Christopher , Luetsch Karen , Scott Ian
Published: January 2017

The use of multiple medicines, known as polypharmacy, poses a risk of harm that is greatest in older adults with multimorbidity. Deprescribing aims to improve health outcomes through ceasing medicines that are no longer necessary or appropriate due to changing clinical circumstances and patient priorities. General practitioners (GPs) and consultant pharmacists (CPs) are well positioned to facilitate deprescribing in primary care in partnership with older adults who present with inappropriate polypharmacy. In this article, we explore GPs’ and CPs’ views about inappropriate polypharmacy, the reasoning they apply to deprescribing in primary care, and identify factors that support or inhibit this process. Using focus group methodology and the Framework Method for thematic analysis, two major themes were discerned from the data—working through uncertainty and risk perception as a frame of reference. The findings provide important insights when devising methods for advancing and supporting deprescribing in primary care.
Loss of Efficacy during Long-Term Cifenline Therapy: Development of Antiarrhythmic Resistance?
Authors: Mohiuddin Syed M. , Hee Tom T. , Hunter Claire B. , Hilleman Daniel E. , Sketch Michael H.
Published: January 2017

OBJECTIVE:

To describe the possible development of antiarrhythmic resistance to cifenline, an investigational Class I agent.

METHODS:

Forty patients with chronic ventricular premature depolarizations (VPDs) underwent dose-ranging studies with cifenline, an investigational Class I antiarrhythmic agent. Patients had a minimum of 30 VPDs/h detected by ambulatory electrocardiographic (ECG) monitoring over a 48-hour baseline placebo lead-in period. Twenty-two patients (55 percent) who initially responded received long-term cifenline therapy. Ambulatory ECG monitoring over 24 hours was repeated during active cifenline therapy at three-month intervals and during placebo reintroduction at six-month intervals.

RESULTS:

After an average follow-up of 28 months, VPD frequency during cifenline therapy was similar to that during initial baseline placebo therapy in 8 of the 22 patients (36 percent) who initially responded. Placebo reintroduction following cifenline failure showed a VPD frequency similar to that with active therapy. All patients had further cifenline dosage increases without success. Plasma cifenline concentrations increased in all patients and were in the high therapeutic range. All 8 patients were switched to other Class I antiarrhythmic agents with successful VPD suppression during treatment with the first alternative drug.

CONCLUSIONS:

We conclude that antiarrhythmic resistance occurred with cifenline in these patients as (1) initial efficacy was established for a minimum of two years, (2) VPD frequency was similar during cifenline therapy and placebo reintroduction, (3) cifenline therapy failure continued despite further dosage titration, and (4) alternative Class I antiarrhythmic therapy was successful in all patients. Repeat intermittent ambulatory ECG monitoring is necessary not only to assess the continued need for antiarrhythmic drug therapy, but also to establish continued long-term efficacy.
High Transdermal Fentanyl Requirements in a Patient with Chronic Cancer Pain
Authors: Lehr Victoria Tutag , Renaud Elizabeth A.
Published: January 2017

OBJECTIVE:

To report a case of high transdermal fentanyl dosage requirements in a patient with chronic cancer pain.

DATA SOURCES:

Clinical studies, review articles, and relevant laboratory information.

CASE SUMMARY:

A 42-year-old woman with cervical cancer was admitted for control of her pain. Her outpatient analgesic regimen was a continuous intravenous infusion of morphine sulfate (MS) via an ambulatory infusion device. Upon admission, supplemental doses of intravenous MS were administered in an effort to eliminate the pain. Transdermal fentanyl therapy was initiated on hospital day 1 at 100 μg/h and the MS continuous intravenous infusion dosage was increased. Over the next four days, the patient experienced episodes of inadequate pain control and the transdermal fentanyl dosage was increased in increments of 100 μg/h. On hospital day 4 the MS continuous infusion was converted to patient-controlled analgesia (PCA). The patient reported acceptable pain control with a regimen of transdermal fentanyl 500 μg/h and MS via PCA and she was discharged home on hospital day 7.

CONCLUSIONS:

This patient's high transdermal fentanyl dosage requirement was related to disease progression. She experienced an acute pain episode that may have been effectively managed by increasing the dosage of her continuous intravenous MS infusion.