bluuebunny/crossref_metadata_2025 huggingface dataset:
8. Adverse possession
Authors: Sayles Victoria
Published: September 2018

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses the concept of adverse possession. An owner of an estate in land (paper owner) is under no obligation to make use of that land; mere neglect will not end ownership. However, where that land is adversely possessed by another for the required period, the paper owner will lose his title to the land. Through his acts of adverse possession, the adverse possessor acquires a better title to the land than the paper owner. This is so even if such acts stem from an initial wrong, such as a trespass.
11. Licences and proprietary estoppel
Authors: Sayles Victoria
Published: September 2018

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses licences. A licence is permission given by the licensor to the licensee to allow the latter to enter the land of the former, which, without such permission would otherwise amount to a trespass. Different types of licences have different rules in relation to the original parties and successors in title. A bare licence is revocable by the licensor and does not bind a third party. A licence coupled with an interest, ie a profit à prendre, may be irrevocable and may bind a third party whilst the interest remains. Contractual licences arise under the terms of a contract. An estoppel licence arises as a result of a representation by the licensor and a detrimental reliance by the licensee. It is binding between these two parties but is also capable of binding a third party.
14. Mortgages
Authors: Sayles Victoria
Published: September 2018

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses mortgages. A mortgage is a proprietary interest that can be legal or equitable in status. The equity of redemption encapsulates the rights of a mortgagor and includes the equitable right to redeem and the ability to have certain clauses struck out from a mortgage agreement. The mortgagor of a dwelling house has special legislative protection. Where a mortgage is obtained under undue influence, be it actual or presumed, it may be set aside. The mortgagee has various remedies available to it should the mortgagor fail to meet the mortgage payments, dependent upon the status of the mortgage. A property may be subject to more than one mortgage and where this is the case and the property is sold, proceeds from the sale will be applied in order of priority.
Medical Law Concentrate
Authors: Samanta Jo , Samanta Ash
Published: September 2018

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. Med-ical Law Concentrate provides a study and revision guide aiming to cover the es-sential aspects of this rapidly changing field of law. Topics covered include: the contemporary healthcare environment; medical negligence; consent; confidential-ity; and access to medical records. The volume also looks at abortion and prenatal harm, assisted reproduction, clinical research, and organ transplantation. Finally, it covers mental health law and the end-of-life decisions. The work is underpinned by reference to statutory provisions and the common law. Where appropriate, pertinent bioethical and moral principles that often underpin the law in this area are discussed, as well as the influence of quasi-law. Reference is made to key points of comparison with other jurisdictions, as well as some socio-legal considerations.
2. The Formation and Recognition of Adult Relationships: Marriage, Civil Partnerships, and Cohabitation
Authors: Gaffney-Rhys Ruth
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam and assignment questions. Each book includes key debates, typical questions, diagram answer plans, suggested answers, author commentary, and tips to gain extra marks. This chapter considers the formation and recognition of adult relationships i.e. marriage, same-sex marriage, civil partnerships, and cohabitation. The questions included in this chapter cover: the right to marry contained in article 12 of the European Convention on Human Rights; forced marriage; the difference between opposite-sex marriage, same-sex marriage, and civil partnerships, and the difference between marriage and cohabitation.
3. Void, Voidable, and Non-existent Marriages
Authors: Gaffney-Rhys Ruth
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam and assignment questions. Each book includes key debates, typical questions, diagram answer plans, suggested answers, author commentary, and tips to gain extra marks. This chapter focuses on nullity and void, voidable, and non-existent marriages. The first question requires students to analyse the difference between void and voidable marriages, the grounds for which are contained in ss. 11 and 12 of the Matrimonial Causes Act 1973. The second is an essay question that considers the concept of non-marriage or non-existent marriage, which is regulated by case law. The third question is a problem question that examines void and voidable marriages and covers issues such as bigamy, prohibited degrees of relationship, gender reassignment, and lack of consummation. The final question asks candidates whether the concept of voidable marriage should be abolished.
9. The Law Relating to Children: Children’s Rights and Private Law
Authors: Gaffney-Rhys Ruth
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam and assignment questions. Each book includes key debates, typical questions, diagram answer plans, suggested answers, author commentary, and tips to gain extra marks. This chapter considers children’s rights and private law relating to children. The first essay question focuses on the rights of the child to make his or her own decisions and to participate in private law proceedings, whilst the second examines how the law ensures that children have a relationship with both parents after separation. The third question is a problem scenario that requires discussion of orders under s. 8 of the Children Act 1989, the welfare principle, and the welfare checklist. The final problem question concerns inherent jurisdiction and the right of a child to refuse medical treatment.
11. The Law Relating to Children: Public Law and Adoption
Authors: Gaffney-Rhys Ruth
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam and assignment questions. Each book includes key debates, typical questions, diagram answer plans, suggested answers, author commentary, and tips to gain extra marks. This chapter deals with the public law relating to children, contained in Parts III, IV, and V of the Children Act 1989, and the law relating to adoption, under the Adoption and Children Act 2002. The questions contained in this chapter are a mixture of essay and problem questions that focus on: emergency protection for children, i.e. police protection, emergency protection orders, and local authority enquires; care, supervision, and education supervision orders; the difference between adoption and special guardianship orders and finally, the requirements and procedures for adoption.
13. Skills for Success in Coursework Assessments
Authors: Gaffney-Rhys Ruth
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam and assignment questions. Each book includes key debates, typical questions, diagram answer plans, suggested answers, author commentary, and tips to gain extra marks. This chapter builds upon the guidance provided in chapter one regarding the completion of coursework or assignment questions. It sets out the expectations lecturers will have in relation to coursework submissions and provides advice on: planning and how to research assignment tasks; how to evaluate and critically analyse the law; how to adhere to the word count; how to reference; how to proofread; and the practicalities of submission. It then contains a sample coursework answer.
Concentrate Q&A Criminal Law 2e
Authors: Allen Mischa
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions. Each book includes typical questions, diagram answer plans, suggested answers,author commentary and advice on study skills. Concentrate Questions & Answers Criminal Law offers advice on what to expect in exams and how best to prepare. The book begins by looking at exam and study techniques and then moves on to consider the elements of a crime (including actus reus and mens rea), murder and manslaughter, non-fatal offences, sexual offences. It then looks at a range of property offences, before exploring the defences in depth. The book concludes with a consideration of secondary participation and inchoate offences, a chapter on mixed questions and a chapter on how to tackle coursework assessments.
2. Fundamental Principles of Criminal Liability— Actus Reus and Mens Rea
Authors: Allen Mischa
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions. Each book includes typical questions, diagram answer plans, suggested answers, author commentary and advice on study skills. This chapter presents sample exam questions on the elements of crime and suggested answers. The traditional starting point for the study of criminal law is the constituents of a criminal offence. These are the fundamental principles of criminal liability: actus reus (often referred to as the prohibited conduct, but more accurately described as the external elements of the offence) and mens rea (often referred to as the mental element, but more accurately described as the fault element). They include the distinction between acts and omissions, causation, and the different levels of fault (intention, recklessness and negligence).
8. Secondary Liability and Inchoate Offences
Authors: Allen Mischa
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions. Each book includes typical questions, diagram answer plans, suggested answers, author commentary and advice on study skills. This chapter presents sample exam questions on the inchoate offences and accessories, along with suggested answers. The doctrine of joint enterprise is also considered, especially the decision in R v Jogee which reverses the previous common law position. Inchoate offences and issues of accessorial liability can feature on exam papers in the form of questions dealing with discrete topics, but typically they will feature as part of a problem question dealing with a range of substantive offences. For this reason, candidates sometimes fail to prepare properly to deal with these areas. There is also the fact that accessorial liability is amongst the most confusing and conceptually difficult areas of criminal liability. Some clarity has been achieved in this area in the Supreme Court’s decision in R v Jogee.
2. Definition of Land and Finders’ Titles
Authors: Malcolm Rosalind
Published: September 2018

The Q&A series offer the best preparation for tackling exam questions. Each book includes typical questions, bullet-pointed answer plans and suggested answers, author commentary and illustrative diagrams and flowcharts. This chapter presents sample exam questions about the definition of land and finder’s titles.
6. Successive Interests and Trusts of Land
Authors: Malcolm Rosalind
Published: September 2018

The Q&A series offer the best preparation for tackling exam questions. Each book includes typical questions, bullet-pointed answer plans and suggested answers, author commentary and illustrative diagrams and flowcharts. This chapter examines trusts of land and other issues.
2. Nature of Equity and the Law of Trusts
Authors: Malcolm Rosalind
Published: September 2018

The Concentrate Questions and Answers series offer the best preparation for tackling exam questions. Each book includes typical questions, bullet-pointed answer plans, suggested answers and author commentary. This book offers advice on what to expect in exams and how best to prepare. This chapter covers questions on the nature of equity and the law of trusts.
15. Mixed Topic Questions
Authors: Malcolm Rosalind
Published: September 2018

The Concentrate Questions and Answers series offer the best preparation for tackling exam questions. Each book includes typical questions, bullet-pointed answer plans, suggested answers and author commentary. This book offers advice on what to expect in exams and how best to prepare. This chapter covers questions on a mixture of topic areas including the three certainties, constitution and formalities for the creation of a trust, charitable trusts and trusts of imperfect obligation.
11. Corporate Insolvency
Authors: Moore Imogen
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions and coursework. Each book includes typical questions, suggested answers with commentary, illustrative diagrams, guidance on how to develop your answer, suggestions for further reading, and advice on exams and coursework. This chapter examines the law on corporate insolvency. It considers the important and topical subject of corporate rescue, reviewing, in particular, administration and company voluntary arrangements. The chapter addresses several issues relating to liquidation, including: winding up petitions and the meaning of ‘inability to pay debts’; assets available to creditors; distribution of assets to creditors; priority of claims; the pari passu principle; and transaction avoidance (dispositions of property after the commencement of winding up; transactions at an undervalue; preferences; voidable floating charges; and transactions defrauding creditors). The potential liability of directors on a company’s insolvent liquidation is considered, concentrating on wrongful and fraudulent trading and disqualification.
13. Skills for Success in Coursework Assessments
Authors: Moore Imogen
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions and coursework. Each book includes typical questions, suggested answers with commentary, illustrative diagrams, guidance on how to develop your answer, suggestions for further reading, and advice on exams and coursework. This chapter provides advice on preparing coursework in company law and the skills required to complete it successfully, to ensure you are best prepared for your assessment. A coursework example question, with accompanying answer guidance, is also available. Finally, it provides lots of important tips for coursework success and includes a final checklist of issues to consider before submitting your work.
9. The Right to Private Life
Authors: Foster Steve
Published: September 2018

The Concentrate Questions and Answers series offer the best preparation for tackling exam questions. Each book includes typical questions, diagram answer plans, caution advice, suggested answers, illustrative diagrams and flowcharts, and advice on gaining extra marks. Concentrate Q&A Human Rights & Civil Liberties offers expert advice on what to expect from your human rights and civil liberties exam, how best to prepare, and guidance on what examiners are really looking for. Written by experienced examiners, it provides: clear commentary with each question and answer; bullet point and diagram answer plans; tips to make your answer really stand out from the crowd; and further reading suggestions at the end of every chapter. The book should help you to: identify typical law exam questions; structure a first-class answer; avoid common mistakes; show the examiner what you know; make your answer stand out from the crowd.

This chapter covers the right to private and family life, including the scope of privacy and private and family life, protection in domestic law and under the ECHR, privacy and press freedom, and surveillance powers and privacy.
Concentrate Questions and Answers Evidence
Authors: Spencer Maureen , Spencer John
Published: September 2018

The Concentrate Questions and Answers series offers the best preparation for tackling exam questions and coursework. Each book includes typical questions, bullet-pointed answer plans and suggested answers, author commentary and illustrative diagrams and flow charts. Concentrate Q&A Evidence offers expert advice on what to expect from your Evidence exam, how best to prepare and guidance on what examiners are really looking for. Written by experienced examiners, it provides clear commentary with each question and answer and bullet points and diagram answer plans plus tips to make your answer really stand out from the crowd and further reading suggestions at the end of every chapter. The book should help the reader identify typical law exam questions, structure a first-class answer, avoid common mistakes, show the examiner what the reader knows and find relevant further reading. After an introduction, the book covers burden and standard of proof, presumptions, competence and compellability, Special Measures Directions, character evidence, hearsay, confessions, the defendant’s silence, improperly obtained evidence, supporting evidence, identification expert opinion, issues in the course of trial, privilege, public policy and mixed questions. The final chapter gives guidance on assessed coursework. The book is suitable for undergraduate law students taking optional modules in Evidence.
1. Introduction
Authors: Clements Richard
Published: September 2018

This chapter advises on how to approach the subject of public law and deal with typical exam questions. Public law differs from the other compulsory law subjects in that much is not really law at all, and therefore calls for different skills in the student. To understand public law properly it helps to have some knowledge of current affairs and politics. Public Law is sometimes called constitutional and administrative law, because it looks at both the constitution of the country and the law that regulates the administration. The chapter contains advice on how to answer a problem question using Issue, Relevant Law, Application to the Facts and Conclusion (IRAC) and how to answer an essay question using Point, Evidence and Argument (PEA). Preparation for examinations is also covered. When writing an essay, it is best for students to do a rough plan first, listing the main points that they intend to cover. For a problem question, they might also include a list of the main cases. In this subject, it is important to remember that there is no right answer to an exam question, but there is a right way to approach it.
5. Parliament
Authors: Clements Richard
Published: September 2018

The Q&A series offers the best preparation for tackling exam questions. Each chapter includes typical questions; diagram problem and essay answer plans, suggested answers, notes of caution, tips on obtaining extra marks, the key debates on each topic and suggestions on further reading. This chapter presents information relating to Parliament. It looks at all aspects of how both the House of Commons and House of Lords work and how they might be reformed. The questions the chapter looks at deal with issues such as the reform of procedures and operation of the House of Commons; how newly elected MPs can influence government policy; the role of departmental select committees; parliamentary privilege; and House of Lords reform.
Learning relevance models for patient cohort retrieval
Authors: Goodwin Travis R , Harabagiu Sanda M
Published: September 2018

Objective

We explored how judgements provided by physicians can be used to learn relevance models that enhance the quality of patient cohorts retrieved from Electronic Health Records (EHRs) collections.

Methods

A very large number of features were extracted from patient cohort descriptions as well as EHR collections. The features were used to investigate retrieving (1) neurology-specific patient cohorts from the de-identified Temple University Hospital electroencephalography (EEG) Corpus as well as (2) the more general cohorts evaluated in the TREC Medical Records Track (TRECMed) from the de-identified hospital records provided by the University of Pittsburgh Medical Center. The features informed a learning relevance model (LRM) that took advantage of relevance judgements provided by physicians. The LRM implements a pairwise learning-to-rank framework, which enables our learning patient cohort retrieval (L-PCR) system to learn from physicians’ feedback.

Results and Discussion

We evaluated the L-PCR system against state-of-the-art traditional patient cohort retrieval systems, and observed a 27% improvement when operating on EEGs and a 53% improvement when operating on TRECMed EHRs, showing the promise of the L-PCR system. We also performed extensive feature analyses to reveal the most effective strategies for representing cohort descriptions as queries, encoding EHRs, and measuring cohort relevance.

Conclusion

The L-PCR system has significant promise for reliably retrieving patient cohorts from EHRs in multiple settings when trained with relevance judgments. When provided with additional cohort descriptions, the L-PCR system will continue to learn, thus offering a potential solution to the performance barriers of current cohort retrieval systems.
Banking and Industrialization
Authors: Heblich Stephan , Trew Alex
Published: September 2018

We establish a causal role for banking access in the spread of the Industrial Revolution over the period 1817–1881 by exploiting unique employment data from 10,528 parishes across England and Wales and a novel instrument. We estimate that a one standard deviation increase in 1817 finance employment increases annualized industrial employment growth by 0.93 percentage points. We establish the role of structural transformation as an underlying growth mechanism and show that banking access: (i) increases the industrial employment share; (ii) stimulates urbanization; and (iii) fosters inter-industry transition to high TFP, intermediate and capital-intensive sub-sectors.
Genetic Variation in the Psychiatric Risk Gene CACNA1C Modulates Reversal Learning Across Species
Authors: Sykes Lucy , Haddon Josephine , Lancaster Thomas M , Sykes Arabella , Azzouni Karima , Ihssen Niklas , Moon Anna L , Lin Tzu-Ching E , Linden David E , Owen Michael J , O’Donovan Michael C , Humby Trevor , Wilkinson Lawrence S , Thomas Kerrie L , Hall Jeremy
Published: September 2018

Genetic variation in CACNA1C, which encodes the alpha-1 subunit of Cav1.2 L-type voltage-gated calcium channels (VGCCs), has been strongly linked to risk for psychiatric disorders including schizophrenia and bipolar disorder. How genetic variation in CACNA1C contributes to risk for these disorders is however not fully known. Both schizophrenia and bipolar disorder are associated with impairments in reversal learning (RL), which may contribute to symptoms seen in these conditions. We used a translational RL paradigm to investigate whether genetic variation in CACNA1C affects RL in both humans and transgenic rats. Associated changes in gene expression were explored using in situ hybridization and quantitative PCR in rats and the BRAINEAC online human database. Risk-associated genetic variation in CACNA1C in healthy human participants was associated with impairments in RL. Consistent with this finding, rats bearing a heterozygous deletion of Cacna1c were impaired in an analogous touchscreen RL task. We investigated the possible molecular mechanism underlying this impairment and found that Cacna1c +/− rats show decreased expression of Bdnf in prefrontal cortex. Examination of BRAINEAC data showed that human risk-associated genetic variation in CACNA1C is also associated with altered expression of brain-derived neurotrophic factor (BDNF) in the prefrontal cortex in humans. These results indicate that genetic variation in CACNA1C may contribute to risk for schizophrenia and bipolar disorder by impacting behavioral flexibility, potentially through altered regulation of BDNF expression in the prefrontal cortex. Tests of RL may be useful for translational studies and in the development of therapies targeting VGCCs.
Pressure Injury in the Pediatric Population: Cohort Study Using the Braden Q Scale
Authors: Vocci Marcelli Cristine , Fontes Cassiana Mendes Bertoncello , Abbade Luciana Patricia Fernandes
Published: September 2018

OBJECTIVE:

To identify the risk and incidence of pressure injuries in bedridden pediatric patients to determine the most prevalent risk factors and preventive measures and to define the sociodemographic, clinical, and therapeutic profiles in this group.

METHODS:

Prospective cohort study performed between March 2015 and March 2016 in the intensive care unit and the pediatric ward of a public teaching hospital. The study included 85 pediatric patients (45 intensive care unit and 40 pediatric ward patients).

MAIN OUTCOME MEASURE:

Patients’ Braden Q Scale score was assessed at 48-hour intervals until discharge from the aforementioned units, discharge from the hospital, and/or death.

MAIN RESULTS:

Researchers observed that 93.3% of intensive care unit patients and 87.5% of pediatric ward patients were categorized as high-risk patients, and 12 patients presented with 24 pressure injuries with an incidence of 14.1% and a mean of 4 days before pressure injury occurrence. Patients with pressure injuries in the cohort averaged a hospital length of stay of 7.7 days. Of these, the mean age was 4.1 years and most were female, receiving enteral nutrition, and had diagnoses related to neurological and respiratory diseases." Vasopressor use had a statistically significant association (P < .05) with the development of pressure injuries. The primary risk factor identified on the Braden Q Scale for the development pressure injury was a “mobility and activity” deficit.

CONCLUSIONS:

Most patients (hospitalized in either unit) were at high risk of developing pressure injuries. No specific preventive guidelines were in place in this hospital prior to this study; therefore, the authors aimed to develop a protocol for the prevention and reduction of pressure injuries in pediatric patients.
Radiofrequency ablation-induced esophageal perforation
Authors: Mitchell-Brown Fay , McPherrin Mandy
Published: September 2018

Esophageal perforation (EP) can be a complication of radiofrequency ablation, a standard treatment for certain patients with drug-refractory atrial fibrillation. This article discusses the etiology, clinical manifestations, and diagnosis of EP, as well as nursing care for patients with EP.
Evaluating competence and confidence using simulation technology
Authors: Kiernan Llynne C.
Published: September 2018

This article discusses the role of simulation training in educating nurses and reducing clinical errors and describes a research project designed to determine the effectiveness of deliberate practice and simulation technology.
Biomechanical Comparison of C1 Lateral Mass—C2 Short Pedicle Screw—C3 Lateral Mass Screw-Rod Construct Versus Goel-Harms Fixation for Atlantoaxial Instability
Authors: Lu Young , Lee Yu-Po , Bhatia Nitin N. , Lee Thay Q.
Published: September 2018

Study Design.

A biomechanical in vitro study using human cadaveric spines.

Objective.

The aim of this study was to compare atlantoaxial stability and stiffness of a C1 lateral mass – C2 short pedicle – C3 lateral mass screw-rod construct versus C1 lateral mass – C2 pedicle screw-rod construct.

Summary of Background Data.

The C1 lateral mass – C2 pedicle screw-rod construct provides excellent atlantoaxial fixation, but C2 pedicle screw placement is associated with risk of vertebral artery injury. The use of shorter C2 pedicle screws may mitigate the risk of vascular injury but may result in reduced C1-C2 stabilization. Extending C1 lateral mass – C2 short pedicle screw-rod construct with C3 lateral mass screws may mitigate the risk of vascular injury without compromising C1-C2 fixation.

Methods.

Seven cervical spines were tested with internal control experimental design in the following sequence: intact state, and following creation of type II odontoid fracture, the specimen was instrumented with C1 lateral mass - C2 pedicle screw fixation (C2PED), C1 lateral mass - C2 short pedicle screw fixation (C2SPED), and C1 lateral mass - C2 short pedicle - C3 lateral mass screw fixation (C2SPED-C3LM). For each condition, the angular stiffness and range of motion (ROM) with 1.5-Nm load in flexion/extension (FE), lateral bending (LB), and right/left axial rotation (RAR/LAR) were quantified.

Results.

Instrumented conditions demonstrated significantly lower C1-C2 angular ROM and greater stiffness than the intact state. Compared with C2PED, C2SPED-C3LM demonstrated significantly lower C1-C2 ROM during FE and LB, significantly greater C1-C2 stiffness in flexion and right/left LB, similar C1-C2 ROM and stiffness in RAR/LAR, and similar stiffness in extension. C2SPED-C3LM demonstrated significantly greater atlantoaxial stabilization in the sagittal and coronal planes than C2PED construct.

Conclusion.

Compared with C2PED, C2SPED-C3LM may be a suitable alternative surgical strategy for atlantoaxial instability that provides superior atlantoaxial fixation.

Level of Evidence: N/A
Evaluating the Quality, Content, and Readability of Online Resources for Failed Back Spinal Surgery
Authors: Guo Wei-jun , Wang Wei-kang , Xu Ding , Qiao Zhi , Shi Yu-long , Luo Peng
Published: September 2018

Study Design.

An Internet-based assessment of websites using recognized score systems.

Objective.

To assess the quality, content, and readability of online information for failed back spinal surgery (FBSS).

Summary of Background Data.

A significant amount of patients still suffer from chronic or recurrent back pain with or without radicular symptoms after spinal surgery. More and more patients use the Internet to find health-related information. Low-quality or inaccurate information may not only misleading patients but also have a negative impact on the trust between patients and physicians.

Methods.

The terms “chronic pain after spinal surgery,” “chronic pain after back surgery,” “failed back surgery syndrome,” “post spinal surgery syndrome,” and “post laminectomy syndrome” were entered into three search engines (Google, Yahoo!, and Bing). The first 25 websites from each search were reviewed. The quality, content, and readability of each website were evaluated using DISCERN score, FBSS-specific content score, and the Journal of the American Medical Association (JAMA) benchmark criteria, the first two score systems were assessed by three reviewers independently. The Flesch-Kincaid grade level (FKGL) was used to assess the readability. Each website with or without the Health on the Net Code (HONcode) was also recorded.

Results.

Seventy-two websites were analyzed in our study. The average DISCERN score for all websites was 35.26 ± 11.45, indicating the quality of the websites was poor. The DISCERN score of physician websites was 31.25 ± 9.08, lower than that of media (36.50 ± 0.71, P = 0.017) and commercial websites (42.55 ± 10.93, P = 0.045). The mean FBSS-specific content score was 9.58 ± 3.90 out of maximum 25. We failed to find any difference of FBSS-specific content score among different type of website. Websites with HONcode certification were associated with higher DISCERN score, FBSS-specific content score, and JAMA benchmark criteria score than non-certified websites. The mean FKGL was 12.19 ± 2.20, and none of the websites’ FKGL was lower than the six grade level.

Conclusion.

The quality and content of available online information for FBSS were poor. The readability of online information in our results showed a significantly higher reading level than the sixth-grade level recommended by the AMA and NIH.

Level of Evidence: 4
Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging
Authors: Elmi-Terander Adrian , Burström Gustav , Nachabe Rami , Skulason Halldor , Pedersen Kyrre , Fagerlund Michael , Ståhl Fredrik , Charalampidis Anastasios , Söderman Michael , Holmin Staffan , Babic Drazenko , Jenniskens Inge , Edström Erik , Gerdhem Paul
Published: September 2018

Study Design.

Prospective observational study.

Objective.

The aim of this study was to evaluate the accuracy of pedicle screw placement using augmented reality surgical navigation (ARSN) in a clinical trial.

Summary of Background Data.

Recent cadaveric studies have shown improved accuracy for pedicle screw placement in the thoracic spine using ARSN with intraoperative 3D imaging, without the need for periprocedural x-ray. In this clinical study, we used the same system to place pedicle screws in the thoracic and lumbosacral spine of 20 patients.

Methods.

The study was performed in a hybrid operating room with an integrated ARSN system encompassing a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Three independent reviewers assessed screw placement accuracy using the Gertzbein grading on 3D scans obtained before wound closure. In addition, the navigation time per screw placement was measured.

Results.

One orthopedic spinal surgeon placed 253 lumbosacral and thoracic pedicle screws on 20 consenting patients scheduled for spinal fixation surgery. An overall accuracy of 94.1% of primarily thoracic pedicle screws was achieved. No screws were deemed severely misplaced (Gertzbein grade 3). Fifteen (5.9%) screws had 2 to 4 mm breach (Gertzbein grade 2), occurring in scoliosis patients only. Thirteen of those 15 screws were larger than the pedicle in which they were placed. Two medial breaches were observed and 13 were lateral. Thirteen of the grade 2 breaches were in the thoracic spine. The average screw placement time was 5.2 ± 4.1 minutes. During the study, no device-related adverse event occurred.

Conclusion.

ARSN can be clinically used to place thoracic and lumbosacral pedicle screws with high accuracy and with acceptable navigation time. Consequently, the risk for revision surgery and complications could be minimized.

Level of Evidence: 3
Surgical Outcomes for Drop Body Syndrome in Adult Spinal Deformity
Authors: Yagi Mitsuru , Fujita Nobuyuki , Okada Eijiro , Tsuji Osahiko , Nagoshi Narihito , Yato Yoshiyuki , Asazuma Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota
Published: September 2018

Study Design.

A multicenter retrospective case series of patients treated surgically for adult spinal deformity (ASD).

Objective.

The aim of this study was to compare clinical outcomes between propensity score matched ASD patients with or without drop body syndrome (DBS).

Summary of Background Data.

DBS is an extreme primary sagittal-plane deformity often seen in Asian countries. Although the importance of sagittal alignment is widely recognized, surgical outcomes for deformities purely in the sagittal plane are poorly understood.

Methods.

This study included 243 consecutive patients (age 66 ± 17 years; range 22–78) who were treated surgically for ASD and were followed at least 2 years (mean follow-up 3.7 ± 2.3 years). DBS was defined as a primary lumbar kyphosis with PI–LL >40°, Cobb angle <30°, and multifidus cross-sectional area <300 mm2. DBS patients were matched with non-DBS patients by propensity scores for age, gender, lowest instrumented vertebra (LIV) level, and number of levels fused. Demographics, radiographic findings, and clinical outcomes were compared between DBS and non-DBS patients.

Results.

Of 243 patients with ASD, 34 had DBS (14%); 28 of these were propensity-matched with ASD patients without DBS. Baseline bone mineral density (BMD), body mass index (BMI), and frailty were similar in DBS and non-DBS patients. Baseline sagittal alignment was worse in DBS than in non-DBS patients [C7SVA 14 ± 5 vs. 8 ± 5 cm; pelvic incidence (PI) – lumbar lordosis (LL) 60 ± 14 vs. 36 ± 20°], and scoliosis research society (SRS)22 scores were also worse for DBS patients (2.5 ± 0.6 vs. 2.9 ± 0.8). Although DBS patients had more complications (20 DBS vs. 16 non-DBS), the clinical outcomes were similarly improved in both groups after surgery. At the 2-year follow-up, the spinopelvic malalignment was worse in DBS than non-DBS patients (PI–LL 17 ± 16° vs. 8 ± 13°, P < 0.05).

Conclusion.

DBS affected 14% of 234 ASD patients. Although DBS patients had inferior baseline SRS22 scores than non-DBS patients, ASD surgery resulted in similar clinical improvement in both groups. Future studies should examine the influence of lifestyle and genetics on clinical outcomes after surgery for DBS.

Level of Evidence: 3
Patients Cannot Reliably Distinguish the Iliac Crest Bone Graft Donor Site From the Contralateral Side After Lumbar Spine Fusion
Authors: Lehr A. Mechteld , Oner F. Cumhur , Hoebink Eric A. , Kempen Diederik H.R. , van Susante Job L.C. , Castelein René M. , Kruyt Moyo C.
Published: September 2018

Study Design.

A multicenter, randomized, intrapatient controlled trial.

Objective.

This study investigated whether lumbar fusion patients blinded to the harvest site (A) can identify the iliac crest used for bone harvesting and (B) whether this iliac crest is more painful than the contralateral side.

Summary of Background Data.

Spinal fusion with iliac crest autograft is a frequently performed surgical procedure. A widely reported disadvantage of the harvesting procedure is potential donor site morbidity. This has driven the development of many bone graft substitutes. However, more recently the incidence and severity of donor site pain is debated, especially in lumbar fusion surgery.

Methods.

Ninety-two nontraumatic adult patients underwent a posterolateral (thoraco)lumbar fusion. Iliac crest bone graft was harvested unilaterally through the primary midline incision. At 6 weeks, 3 months, 6 months, and 1 year follow-up, patients were asked to identify the donor site and to rate pain in their back, left iliac crest and right iliac crest on a Visual Analogue Scale (VAS).

Results.

Ninety patients, 44 males and 46 females with a mean age of 54 years, were analyzed. The left/right distribution of the iliac crest donor site was 50/50 and 89% of the patients underwent a lumbar fusion below L3. Only 24% patients identified the harvest site correctly. Moreover, the VAS pain scores for the donor site and contralateral iliac crest did not differ and were at each timepoint lower than the scores for back pain.

Conclusion.

This study showed that, during the first year after lumbar fusion surgery via a single midline incision approach, patients could not reliably identify the iliac crest used for bone graft harvesting and this iliac crest was not more painful than the untouched contralateral iliac crest. Therefore, donor site pain should not be the main reason to use bone graft alternatives for lumbar spinal fusion.

Level of Evidence: 2
Predictors of a Non-home Discharge Destination Following Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS)
Authors: Malik Azeem Tariq , Kim Jeffery , Yu Elizabeth , Khan Safdar N.
Published: September 2018

Study Design.

Retrospective cohort study.

Objective.

Analyze risk factors associated with a non-home discharge following spinal fusions in adolescent idiopathic scoliosis (AIS).

Summary of Background Data.

Current evidence is limited with regard to which patient-level and provider/hospital-level factors predict a non-home discharge disposition following spinal fusions in AIS. Identifying these factors can allow providers to identify which patients would ultimately require facility care and can be discharged early to these facilities to reduce hospital costs.

Methods.

The 2012 to 2016 American College of Surgeons—National Surgical Quality Improvement Program Pediatric database was queried using Current Procedural Terminology codes for posterior spinal fusions (22800, 22802, and 22804) and anterior spinal fusions (22808, 22810, and 22812). Patients were categorized into those receiving a posterior-only fusion, anterior-only fusion, and combined anterior-posterior fusion. Only patients aged 10 to 18 undergoing corrective surgery for idiopathic scoliosis were included in the study.

Results.

Out of a total of 8452 patients—90 (1.1%) were discharged to a destination other than home (skilled-care facility, separate acute care unit, and/or rehabilitation unit). Following multivariate analysis, children with a body mass index of 20 to 30 (P = 0.002) or >30 (P = 0.003), structural pulmonary abnormality (P = 0.030), past history of childhood cancer (P = 0.018), an ASA grade >II (P<0.001), undergoing a revision surgery versus a primary surgery (P = 0.039), a length of stay >4 days (P<0.001), and the occurrence of a predischarge complication (P = 0.003) were independent predictors associated with a non-home discharge disposition.

Conclusion.

In the current era of evolving health-care in which there is an increased focus toward decreasing costs, providers should consider utilizing these data to preoperatively identify patients who can be discharged to facility, and tailor an appropriate postoperative course of care aimed at expediting discharge processes to curb the financial burden of a prolonged length of stay.

Level of Evidence: 3
Nurse and Nurse Student Attitudes and Perceived Self-efficacy in Use of Information and Communication Technologies
Authors: Warshawski Sigalit , Itzhaki Michal , Barnoy Sivia
Published: September 2018

Information and communication technologies have become essential and design-effective tools in the global healthcare system. Evidence suggests that information and communication technologies can promote nursing practice and patient satisfaction and quality of care. Competency with information and communication technologies is essential for both nurses and nursing students, and attitudes toward its use and perceived self-efficacy are important for implementation in the workplace. This study aimed to explore nurse and nursing student attitudes and perceived self-efficacy regarding information and communication technologies use in clinical practice and to examine professional and cultural differences between these groups in their attitudes and perceived self-efficacy in information and communication technologies use. A cross-sectional study was conducted among Israeli nursing students (n = 144) and registered nurses (n = 104). The findings revealed that respondents held overall positive attitudes toward information and communication technologies' use in clinical practice and perceived themselves as competent in this context. Significant differences were found between nurses and students in their attitudes toward information and communication technologies and information and communication technologies self-efficacy. Cultural group (Jewish/Arab) was found related to positive attitudes toward use of information and communication technologies in clinical practice. Nurse educators and managers should be aware of the potential impact of cultural and professional differences on the adoption and implementation of information and communication technologies and should institute initiatives within the organization and academia to manage cultural and professional discrepancies.
Treatment and Survival of Patients With Primary Effusion Lymphoma in the Netherlands
Authors: Dinmohamed Avinash G. , Visser Otto , Doorduijn Jeanette K. , Lugtenburg Pieternella J.
Published: September 2018

Supplemental Digital Content is available in the text
INNER MACULAR CHANGES AFTER VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING FOR RHEGMATOGENOUS RETINAL DETACHMENT
Authors: Fukukita Hiroshi , Ito Yasuki , Iwase Takeshi , Kaneko Hiroki , Yasuda Shunsuke , Kataoka Keiko , Terasaki Hiroko
Published: September 2018

Purpose:

The internal limiting membrane (ILM), the innermost basement membrane of the retina, is peeled occasionally during vitreous surgery. This study aimed to investigate the effect of ILM loss on the retina.

Methods:

We used optical coherence tomography to retrospectively evaluate retinal changes in 26 eyes (11 ILM-peeled and 15 ILM-unpeeled eyes) of 26 patients after vitrectomy for retinal detachment. In addition, we studied six eyes of three patients with Alport syndrome, in which ILM is genetically impaired.

Results:

We observed significant inner retinal displacement of the foveal pit toward the optic disk with inner retinal thickening in the nasal area (fellow, 191.9 ± 24.3 μm vs. affected, 210.3 ± 31.4 μm; P = 0.048), inner retinal thinning in the temporal area (fellow, 174.3 ± 18.3 μm vs. affected, 142.2 ± 23.6 μm; P < 0.001), foveal thickening (ILM-unpeeled, 217.0 ± 39.4 μm vs. ILM-peeled, 302.0 ± 86.2 μm; P = 0.006), inner retinal dimples predominantly in the temporal area, and deviation between the foveal pit and foveal bulge. Eyes with Alport syndrome exhibited similar findings.

Conclusion:

Internal limiting membrane loss seems to cause characteristic inner retinal changes of the macula in both congenital and acquired conditions.
First Report on Detection of Dengue Virus in the Donor Cornea
Authors: Janani Madhuravasal Krishnan , Durgadevi Parthasarathy , Padmapriya Jayavel , Malathi Jambulingam , Kulandai Lily Therese , Rao Madhavan Hajib Narahari
Published: September 2018

Background:

Dengue fever is the most prevalent form of flavivirus infection in humans. We have investigated whether corneoscleral tissue of the donor affected by dengue virus (DENV) harbors the virus.

Purpose:

To identify the risk for viral transmission through corneal transplants in areas where DENV circulates.

Methods:

Excised corneoscleral tissue from a cadaver with a history of viral hemorrhagic fever was analyzed using reverse transcriptase-polymerase chain reaction for the presence of DENV and chikungunya virus (CHIV).

Results:

DENV was detected in RNA extracted from the donor corneoscleral rim. Further genotyping of the viral isolate from the virus-infected cell harvest revealed DENV type 3 as the causative agent. CHIV was not detected.

Conclusions:

The data presented in this study recommend the implementation of polymerase chain reaction for detection of DENV and CHIV to analyze excised corneoscleral tissue of a donor with viral hemorrhagic fever.