bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain in Children With Developmental Disabilities
Authors: Genik Lara M. , McMurtry C. Meghan , Breau Lynn M. , Lewis Stephen P. , Freedman-Kalchman Tamlyn
Published: September 2017

Introduction:

Pain in children with intellectual disabilities (ID) is common and complex, yet there is no standard pain training for their secondary caregivers (ie, respite staff).

Objectives:

Determine perceived pain training needs/preferences of children’s respite staff (phase 1) and, use this information combined with extant research and guidelines to develop and pilot a training (phase 2).

Methods:

In phase 1, 22 participants responded to questionnaires and engaged in individual interviews/focus groups about their experiences with pain in children with ID, and perceived training needs/preferences. In phase 2, 50 participants completed knowledge measures and rated the feasibility of, and their own confidence and skill in, pain assessment and management for children with ID immediately before and after completing a pain training. They also completed a training evaluation.

Results:

Participants viewed pain training as beneficial. Their ideal training involved a half-day, multifaceted in-person program with a relatively small group of trainees incorporating a variety of learning activities, and an emphasis on active learning. Phase 2 results suggested that completion of the 3 to 3.5-hour pain training significantly increased respite workers’ pain-related knowledge (effect sizes: r=0.81 to 0.88), as well as their ratings of the feasibility of, and their own confidence and skill in, pain assessment and management in children with ID (effect sizes: r=0.41 to 0.70). The training was rated favorably.

Discussion:

Training can positively impact respite workers’ knowledge and perceptions about pain assessment and management. As such, they may be better equipped to care for children with ID in this area.
Time Demand and Radiation Dose in 3D-Fluoroscopy-based Navigation-assisted 3D-Fluoroscopy-controlled Pedicle Screw Instrumentations
Authors: Balling Horst
Published: September 2017

Study Design.

Prospective single-center cohort study to record additional time requirements and radiation dose in navigation-assisted O-arm-controlled pedicle screw (PS) instrumentations.

Objective.

The aim of this study was to evaluate amount of extra-time and radiation dose for navigation-assisted PS instrumentations of the thoracolumbosacral spine using O-arm 3D-real-time-navigation (O3DN) compared to non-navigated spinal procedures (NNSPs) with a single C-arm and postoperative computed tomography (CT) scan for controlling PS positions.

Summary of Background Data.

3D-navigation is reported to enhance PS insertion accuracy. But time-consuming navigational steps and considerable additional radiation doses seem to limit this modern technique's attraction. A detailed analysis of additional time demand and extra-radiation dose in 3D-navigated spine surgery is not provided in literature, yet.

Methods.

From February 2011 through July 2015, 306 consecutive posterior instrumentations were performed in vertebral levels T10-S1 using O3DN for PS insertion. The duration of procedure-specific navigational steps of the overall collective (I) and the last cohort of 50 consecutive O3DN-surgeries (II) was compared to the average duration of analogous surgical steps in 100 consecutive NNSP using a single C-arm. 3D-radiation dose (dose-length-product, DLP) of navigational and postinstrumentation O-arm scans in group I and II was compared to the average DLP of 100 diagnostic lumbar CT scans.

Results.

The average presurgical time from patient positioning on the operating table to skin incision was 46.2 ± 10.1 minutes (O3DN, I) and 40.6 ± 9.8 minutes (O3DN, II) versus 30.6 ± 8.3 minutes (NNSP) (P < 0.001, each). Intraoperative interruptions for scanning and data processing took 3.0 ± 0.6 minutes. DLPs averaged 865.1 ± 360.8 mGycm (O3DN, I) and 562.1 ± 352.6 mGycm (O3DN, II) compared to 575.5 ± 316.5 mGycm in diagnostic lumbar CT scans (P 
< 0.001 (I), P ≈ 0.81 [II]).

Conclusion.

After procedural experience, navigated surgeries can be performed with an additional time demand of 13.0 minutes compared to NNSP, and with a total DLP below that of a diagnostic lumbar CT scan (P ≈ 0.81).

Level of Evidence: 4
Simulation training for family planning procedures
Authors: Goldthwaite Lisa M. , Tocce Kristina
Published: September 2017

Purpose of review

To review the current evidence for use of simulation in family planning procedural training.

Recent findings

A variety of simulation models exist for abortion, contraception, and sterilization procedures, ranging from low to high fidelity. Most models for abortion and contraception are low fidelity, inexpensive, and provide opportunities for acquisition and practice of procedural skills. Hysteroscopic and laparoscopic simulation models for sterilization procedures are generally higher fidelity, and their use has been shown to increase knowledge, skill performance, and procedural comfort.

Existing evaluation of family planning simulation education shows consistently positive results related to improved procedural knowledge and comfort. Although some studies have shown increased provision of family planning services following simulation-training interventions, further evaluation is needed to determine the impact on clinical outcomes.
Conventional Corneal Collagen Cross-Linking Versus Transepithelial Diluted Alcohol and Iontophoresis-Assisted Corneal Cross-Linking in Progressive Keratoconus
Authors: Bilgihan Kamil , Yesilirmak Nilufer , Altay Yesim , Yuvarlak Armagan , Ozdemir Huseyin Baran
Published: September 2017

Purpose:

To compare clinical outcomes of conventional corneal cross-linking (C-CXL) and diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL) for the treatment of progressive keratoconus (KC).

Methods:

Ninety-three eyes of 80 patients with KC were treated by C-CXL (n = 47) or DAI-CXL (n = 46). Visual acuity, keratometry, KC indexes, pachymetry, and aberrations were recorded before treatment and 1, 3, 6, and 12 months after treatment. The demarcation line was assessed 1 month after treatment.

Results:

A significant improvement in visual acuity was observed at month 3 and month 6 after DAI-CXL and C-CXL, respectively. A significant decrease in maximum keratometry was observed in both groups at month 6. The front symmetry index significantly improved in both groups after 6 months, whereas the Baiocchi Calossi Versaci index significantly improved only after DAI-CXL at month 12 (P = 0.01). Average keratometry and other KC indexes were stable during 12 months of follow-up. Central corneal thickness decreased by 28.6 and 40.2 μm after DAI-CXL and C-CXL at month 1, respectively (P < 0.01), and it reached baseline at the 12th month (P = 0.14) only in the DAI-CXL group. Higher-order aberrations, coma, and spherical aberration significantly worsened at month 1 (P < 0.01) only after C-CXL; however, they improved significantly at month 12 compared with baseline (P < 0.05) in both groups. The demarcation line was visible in all cases at month 1 at a mean depth of 302 ± 56 μm and 311 ± 57 μm after DAI-CXL and C-CXL, respectively (P = 0.7).

Conclusions:

The DAI-CXL protocol seems as effective as the C-CXL protocol in halting KC progression after 1 year of follow-up.
The Impact of Nondifferential Exposure Misclassification on the Performance of Propensity Scores for Continuous and Binary Outcomes
Authors: Wood Mollie E. , Chrysanthopoulou Stavroula , Nordeng Hedvig M.E. , Lapane Kate L.
Published: September 2017

Purpose:

To investigate the ability of the propensity score (PS) to reduce confounding bias in the presence of nondifferential misclassification of treatment, using simulations.

Methods:

Using an example from the pregnancy medication safety literature, we carried out simulations to quantify the effect of nondifferential misclassification of treatment under varying scenarios of sensitivity and specificity, exposure prevalence (10%, 50%), outcome type (continuous and binary), true outcome (null and increased risk), confounding direction, and different PS applications (matching, stratification, weighting, regression), and obtained measures of bias and 95% confidence interval coverage.

Results:

All methods were subject to substantial bias toward the null due to nondifferential exposure misclassification (range: 0%–47% for 50% exposure prevalence and 0%–80% for 10% exposure prevalence), particularly if specificity was low (<97%). PS stratification produced the least biased effect estimates. We observed that the impact of sensitivity and specificity on the bias and coverage for each adjustment method is strongly related to prevalence of exposure: as exposure prevalence decreases and/or outcomes are continuous rather than categorical, the effect of misclassification is magnified, producing larger biases and loss of coverage of 95% confidence intervals. PS matching resulted in unpredictably biased effect estimates.

Conclusions:

The results of this study underline the importance of assessing exposure misclassification in observational studies in the context of PS methods. Although PS methods reduce confounding bias, bias owing to nondifferential misclassification is of potentially greater concern.
Otolaryngologic management of Down syndrome patients: what is new?
Authors: Bassett Ethan C. , Musso Mary F.
Published: September 2017

Purpose of review

The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported.

Recent findings

The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea–Hypopnea Index, up to 80% may have persistent OSA. Surgical techniques involving reduction of the base of tongue are effective for those who fail adenotonsillectomy, and it is expected that drug-induced sleep endoscopy may improve outcomes. New technology is also on the horizon that can assist with diagnosis and treatment including computational modelling and upper airway stimulation. Children with Down syndrome may not respond to medical management of eustachian tube dysfunction as well as normally developing children. In addition, there is a high prevalence of inner ear anomalies, increasing the risk for sensorineural hearing loss.

Questions remain pertinent to the otolaryngologist regarding the ideal management of children with Down syndrome. Additional studies are necessary, to optimize understanding and treatment of this complex population, in particular as opportunities develop with technological advances.
Posttraumatic Stress Disorder Symptoms Among Trauma-Exposed Inpatient Adolescents
Authors: Viana Andres G. , Hanna Abigail E. , Raines Elizabeth M. , Woodward Emma C. , Paulus Daniel J. , Berenz Erin C. , Zvolensky Michael J.
Published: September 2017

The present investigation examined the role of anxiety symptom severity in the relation between emotional nonacceptance and posttraumatic stress disorder (PTSD) symptoms in a diverse sample of trauma-exposed adolescents admitted for acute psychiatric care at an inpatient state hospital (N = 50; 52.0% women; 44% white; mean [SD] age, 15.1 [0.51] years; range, 12–17 years). Anxiety symptom severity partially accounted for the association between emotional nonacceptance and PTSD total symptoms, and fully accounted for the association between emotional nonacceptance and PTSD symptom cluster severity, even after controlling for covariates. Reverse model testing provided confidence in the direction of hypothesized effects. These findings add to a body of literature underscoring the detrimental effect of nonaccepting reactions to negative emotions in the context of PTSD and provide preliminary support for a possible underlying role of anxiety symptom severity in the association between emotional nonacceptance and PTSD symptoms.
Temporal Indices of Ankle Clonus and Relationship to Electrophysiologic and Clinical Measures in Persons With Spinal Cord Injury
Authors: Manella Kathleen J. , Roach Kathryn E. , Field-Fote Edelle C.
Published: September 2017

Background and Purpose:

Clonus arising from plantar flexor hyperreflexia is a phenomenon that is commonly observed in persons with spastic hypertonia. We assessed the temporal components of a biomechanical measure to quantify ankle clonus, and validated these in persons with spasticity due to spinal cord injury.

Methods:

In 40 individuals with chronic (>1 year) spinal cord injury, we elicited ankle clonus using a standardized mechanical perturbation (drop test). We examined reliability and construct validity of 2 components of the drop test: clonus duration (timed with a stopwatch) and number of oscillations in the first 10-second interval (measured via optical motion capture). We compared these measures to the Spinal Cord Assessment Tool for Spastic reflexes (SCATS) clonus score and H-reflex/M-wave (H/M) ratio, a clinical and electrophysiologic measure, respectively.

Results:

Intra- and interrater reliability of clonus duration measurement was good [intraclass correlation coefficient, ICC (2, 1) = 1.00]; test-retest reliability was good both at 1 hour [ICC (2, 2) = 0.99] and at 1 week [ICC (2, 2) = 0.99]. Clonus duration was moderately correlated with SCATS clonus score (r = 0.58). Number of oscillations had good within-session test-retest reliability [ICC (2, 1) > 0.90] and strong correlations with SCATS clonus score (r = 0.86) and soleus H/M ratio (r = 0.77).

Discussion and Conclusions:

Clonus duration and number of oscillations as measured with a standardized test are reliable and valid measures of plantar flexor hyperreflexia that are accessible for clinical use. Tools for objective measurement of ankle clonus are valuable for assessing effectiveness of interventions directed at normalizing reflex activity associated with spasticity.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A179).
“Stuck in the ICU”: Caring for Children With Chronic Critical Illness*
Authors: Henderson Carrie M. , Williams Erin P. , Shapiro Miriam C. , Hahn Emily , Wright-Sexton Laura , Hutton Nancy , Boss Renee D.
Published: September 2017

Objective:

Neonatal ICUs and PICUs increasingly admit patients with chronic critical illness: children whose medical complexity leads to recurrent and prolonged ICU hospitalizations. We interviewed participants who routinely care for children with chronic critical illness to describe their experiences with ICU care for pediatric chronic critical illness.

Design:

Semi-structured interviews. Interviews were transcribed and analyzed for themes.

Setting:

Stakeholders came from five regions (Seattle, WA; Houston, TX; Jackson, MS; Baltimore, MD; and Philadelphia, PA).

Subjects:

Fifty-one stakeholders including: 1) interdisciplinary providers (inpatient, outpatient, home care, foster care) with extensive chronic critical illness experience; or 2) parents of children with chronic critical illness.

Interventions:

Telephone or in-person interviews.

Measurements and Main Results:

Stakeholders identified several key issues and several themes emerged after qualitative analysis. Issues around chronic critical illness patient factors noted that patients are often relocated to the ICU because of their medical needs. During extended ICU stays, these children require longitudinal relationships and developmental stimulation that outstrip ICU capabilities. Family factors can affect care as prolonged ICU experience leads some to disengage from decision-making. Clinician factors noted that parents of children with chronic critical illness are often experts about their child’s disease, shifting the typical ICU clinician-parent relationship. Comprehensive care for children with chronic critical illness can become secondary to needs of acutely ill patients. Lastly, with regard to system factors, stakeholders agreed that achieving consistent ICU care goals is difficult for chronic critical illness patients.

Conclusions:

ICU care is poorly adapted to pediatric chronic critical illness. Patient, family, clinician, and system factors highlight opportunities for targeted interventions toward improvement in care.
Validation of a Portable Coagulometer for Routine In-Hospital Use for Newborns
Authors: Jerez Calero Antonio E. , Fernández Jiménez Dolores , Molina Oya Manuel , Narbona López Eduardo , Uberos Fernández José
Published: September 2017

Objectives:

To verify the reliability and clinical benefits of the coagulation tests made by a point of care device in newborn admitted to a neonatal unit.

Design:

We made a statistical comparison between results obtained by the point of care device versus conventional laboratory analysis.

Setting:

Level 3 neonatal unit.

Patients:

Thirty-one infants admitted to the neonatal unit at the San Cecilio University Hospital (Granada, Spain) were recruited to this study.

Interventions:

All underwent a double analytical determination: a small drop of blood was taken for analysis with a portable coagulometer (qLabs Electrometer Plus) and the rest of the blood sample was analyzed with conventional hospital laboratory equipment.

Measurements and Main Results:

According to the linearity test performed, the measuring methods presented a good linear regression fit. Lin’s concordance coefficient showed a “good” agreement for activated partial prothrombin time and international normalized ratio (>0.61) and a moderate one for prothrombin time (0.41–0.6) for the sample of newborns.

Conclusions:

The portable coagulometer qLabs Electrometer Plus device has the potential to be an alternative to standard hospital coagulation autoanalyzers in a subset of patients where the amount of blood drawn can have significant risks. Our study is the first of its kind to analyze the use of this device with severely ill newborns.
Extubation Failure Is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction Operation
Authors: Scodellaro Thomas , McKenzie Jane M. , d’Udekem Yves , Butt Warwick , Namachivayam Siva P.
Published: September 2017

Objectives:

To identify the prevalence, causes, risk factors, and outcomes associated with extubation failure following first stage single ventricle reconstruction surgery.

Design:

Retrospective cohort analysis of neonates who underwent a first stage single ventricle reconstruction operation. Extubation failure was defined as endotracheal reintubation within 48 hours of first extubation attempt.

Setting:

The Royal Children’s Hospital, Melbourne.

Patients:

Data were collected for all infants who underwent a Norwood or Damus-Kaye-Stansel procedure between 2005 and 2014 at our institution.

Interventions:

None.

Measurements and Main Results:

Extubation failure occurred in 23 of 137 neonates (16.8%; 95% CI, 11.0–24.1%) who underwent a trial of extubation. Overall, 42 patients (30.7%) were extubated to room air, 88 (64.2%) to nasal continuous positive airway pressure, and seven (5.1%) to high-flow nasal cannulae, though there was no major difference in extubation failure rates between these three groups (p = 0.37). The median time to reintubation was 16.7 hours (interquartile range, 3.2–35.2), and male infants failed extubation more frequently (63.2% vs 87.0%; p = 0.02), although age, gestation, weight, cardiac diagnosis (hypoplastic left heart syndrome vs other single ventricle conditions), shunt type (modified Blalock-Taussig vs right ventricle-pulmonary artery shunt), intraoperative perfusion times, preextubation mechanical ventilation duration, preextubation acid-base status, and postoperative fluid balance were not related to extubation outcome. Infants who failed extubation had a higher intensive care mortality (19.4% vs 3.5%; p = 0.03) and in-hospital mortality (30.4% vs 6.1%; p < 0.001).

Conclusions:

There is a high prevalence of extubation failure following first stage single ventricle reconstruction, and this is associated with considerably worse patient outcomes. The high prevalence and also the wide variation in rates of extubation failure in reported literature provide with an opportunity for implementation of quality assurance activities to minimize this complication and improve outcomes.
Time to Asthma-Related Readmission in Children Admitted to the ICU for Asthma*
Authors: Tse Sze Man , Samson Christian
Published: September 2017

Objectives:

To compare the time to asthma-related readmissions between children with a previous ICU hospitalization for asthma and those with a non-ICU hospitalization and to explore predictors of time to readmission in children admitted to the ICU.

Design:

Retrospective cohort study using a pan-Canadian administrative inpatient database from April 1, 2008, to March 31, 2014.

Setting:

All adult and pediatric Canadian hospitals.

Subjects:

Children 2–17 years old with a hospitalization for asthma.

Interventions:

None.

Measurements and Main Results:

A total of 26,168 children were hospitalized 33,304 times during the study period. The time to readmission was shorter in the ICU group compared with the non-ICU group (median time to readmission 27 mo in ICU vs 35 mo in non-ICU group). Preschool-aged children (hazard ratio, 1.48; 95% CI, 1.02–2.14) and increased length of stay (hazard ratio, 1.63; 95% CI, 1.17–2.27) were associated with a shorter time to readmission.

Conclusions:

Children previously admitted to the ICU for asthma had a shorter time to asthma-related readmission, compared with children who did not require intensive care, underlining the importance of targeted long-term postdischarge follow-up of these children. Children of preschool age and who have a lengthier hospital stay are particularly at risk for future morbidity.
The Expanded Use of Autoaugmentation Techniques in Oncoplastic Breast Surgery
Authors: Losken Albert , Hart Alexandra M. , Dutton James Walter , Broecker Justine S. , Styblo Toncred M. , Carlson Grant W.
Published: September 2017

Background:

Autoaugmentation techniques have been applied to oncoplastic reductions to assist with filling larger, more remote defects, and to women with smaller breasts. The purpose of this report is to describe the use of autoaugmentation techniques in oncoplastic reduction and compare the results with those of traditional oncoplastic reduction.

Methods:

The authors queried a prospectively maintained database of all women who underwent partial mastectomy and oncoplastic reduction between 1994 and October of 2015. The autoaugmentation techniques were defined as (1) extended primary nipple autoaugmentation pedicle, and (2) primary nipple pedicle and secondary autoaugmentation pedicle. Comparisons were made to a control oncoplastic group.

Results:

There were a total of 333 patients, 222 patients (67.7 percent) without autoaugmentation and 111 patients (33 percent) with autoaugmentation (51 patients with an extended autoaugmentation pedicle, and 60 patients with a secondary autoaugmentation pedicle). Biopsy weight was smallest in the extended pedicle group (136 g) and largest in the regular oncoplastic group (235 g; p = 0.017). Superomedial was the most common extended pedicle, and lateral was the most common location. Inferolateral was the most common secondary pedicle for lateral and upper outer defects. There were no significant differences in the overall complication rate: 15.5 percent in the regular oncoplastic group, 19.6 percent in the extended pedicle group, and 20 percent in the secondary pedicle group.

Conclusions:

Autoaugmentation techniques have evolved to manage complex defects not amenable to standard oncoplastic reduction methods. They are often required for lateral defects, especially in smaller breasts. Autoaugmentation can be performed safely without an increased risk of complications, broadening the indications for breast conservation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
ACR–ACNM Practice Parameter for the Performance of Dopamine Transporter (DaT) Single Photon Emission Computed Tomography (SPECT) Imaging for Movement Disorders
Authors: Subramaniam Rathan M. , Frey Kirk A. , Hunt Christopher H. , Mercier Gustavo A. , Solnes Lilja B. , Colletti Patrick M. , Lu Yang , Savir-Baruch Bital , Williams Hadyn T.
Published: September 2017

This American College of Radiology and American College of Nuclear Medicine joint clinical practice parameter is for performance of dopamine transporter single photon emission computed tomography (SPECT) imaging, for patients with movement disorders. Parkinsonian syndrome (PS) consists of a group of neurodegenerative diseases including Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies (DLB). Accurate diagnosis of PS is critical for clinical management. An important diagnostic dilemma is the differentiation of PS and non-neurodegenerative disorders, such as essential tremor (ET) or drug-induced tremor, due to the overlap of clinical symptoms. The management approach to these conditions is distinctly different. An abnormal iodine-123 ioflupane SPECT scan suggests a decreased amount of dopamine transporter in the striatum, that is, a diagnosis of nigrostriatal neurodegenerative PS, whereas a normal scan suggests ET or other nondegenerative parkinsonism (drug-induced, vascular, or psychogenic).
An Efficient Method for Hair Containment During Head and Neck Surgery
Authors: Zingaretti Nicola , De Biasio Fabrizio , Riccio Michele , Marchesi Andrea , Parodi Pier Camillo
Published: September 2017

The authors present a simple technique for operations around hair-bearing areas such as during a rhytidectomy. Hair surrounding the surgical field is twisted into bundles and clipped with duckbill clips. The authors repeat the procedure for each strand of hair. Between 5 and 7 duckbill clips may be required per surgery.

The clippers are faster, easily applicable, and well performing. They can be used with different hair lengths, and they do not require any additional trimming or shaving; clips also keep the hair firmly in place, and they do not loosen up in the process.

This technical note explains a very simple, economical, and less time-consuming method to control hair located around the surgical site. It may be applied to all procedures within the field of the hair-bearing scalp, including craniofacial and maxillofacial surgery.
Intrabronchial Catheter Resuscitation for Respiratory and Cardiorespiratory Arrest
Authors: Wolf Jeffrey S. , Hebert Andrea , Sanchez Pablo , Wijesinha Marniker , Shapiro Scott , Morales Robert , Iacono Aldo T.
Published: September 2017

Introduction:

We sought to determine whether intrabronchial oxygenation would provide adequate gas exchange during both anesthesia induced apneic and cardiopulmonary arrest and cardiac massage (CPR).

Methods:

Ten pigs underwent general anesthesia with mechanical ventilation. Blood gases were measured in each animal at 4 min intervals for up to 28 min. An intrabronchial catheter (4 L/min O2) was inserted through an endotracheal tube after respirator cessation. Group A animals (6) were resuscitated with the catheter but without CPR. Group B animals (4) were rendered apneic and cardioplegic and resuscitated by CPR for 28 min using the intrabronchial device.

Results:

All group A animals were resuscitated and survived after 24 min of apnea. Mean pO2 decreased from 378 mmHg (95% confidence interval [CI], 288–468) to 292 mmHg (95% CI, 246–339), P = 0.009; pCO2 increased from 52 mmHg (95% CI, 43–61) to 137 mmHg (95% CI, 116–158), P < 0.0001; and pH decreased from 7.32 (7.29–7.36) to 6.98 (6.92–7.03), P < 0.0001. In a control animal bronchial catheter oxygen flow ceased at baseline and pO2 decreased from 268 to 30 mmHg by 20 min. In group B animals mean pO2 decreased from 426 mmHg (95% CI, 273–579) to 130 mmHg (95% CI, 92–168) after 28 min, P < 0.0001; pCO2 increased from 49 mmHg (95% CI, 41–58) to 73 mmHg (95% CI, 61–86), P = 0.03; and pH decreased from 7.34 (7.33–7.35) to 7.07 (6.98–7.16), P < 0.0001. In the control receiving intratracheal oxygen pO2 decreased from 324 to 88 mmHg after 16 minu of CPR.

Conclusions:

Intrabronchial oxygenation provides sustained hyperoxemia during complete apnea and cardiac arrest with CPR.
Laparoscopic Colorectal Surgery in Patients With Previous Abdominal Surgery: A Single-center Experience and Literature Review
Authors: Kamer Erdinc , Acar Turan , Cengiz Fevzi , Durak Evren , Haciyanli Mehmet
Published: September 2017

To present the outcomes of laparoscopic colorectal surgery in colorectal cancer patients with a previous history of abdominal surgery. Data of a total of 121 patients with primary colorectal cancer who underwent laparoscopic surgery were retrospectively analyzed. The patients were divided into 2 groups as those with previous abdominal surgery (PAS, n=34) and those without (non-PAS, n=87). Gastric and colonic surgeries were the most common procedures in the major PAS group, whereas gynecologic and obstetric surgeries and appendectomy were the most common procedures in the minor PAS group. However, there were statistically significant differences in the overall complication rates, wound complications, and anastomotic leaks, although there were no significant differences in the rates of postoperative ileus, pneumonia, port site herniation, and postoperative bleeding between the groups. Our study results suggest that laparoscopic colorectal surgery can be safely performed in patients with colorectal cancer who underwent abdominal surgery previously.
Resident Knowledge, Surgical Skill, and Confidence in Transobturator Vaginal Tape Placement: The Value of a Cadaver Laboratory
Authors: Chong Woojin , Downing Keith , Leegant Ava , Banks Erika , Fridman Dmitry , Downie Sherry
Published: September 2017

Objectives

The objective of this study is to examine the effect of additional cadaver laboratory use in training obstetrics and gynecology (OBGYN) residents on transobturator vaginal tape (TOT) insertion.

Methods

Thirty-four OBGYN residents were randomized into 2 groups (group 1, control; group 2, intervention; 17 in each group). Before and after the interventions, written knowledge and confidence levels were assessed. Both groups received didactic lectures using a bony pelvis and an instructional video on TOT insertion; group 2 participated in a half day cadaver laboratory. Surgical skills were assessed by placing 1 arm of the TOT trocar on a custom-designed pelvic model simulator while being graded by an Female Pelvic Medicine and Reconstructive Surgery (FPMRS) board-certified proctor.

Results

Demographics were comparable. Baseline knowledge and confidence level before interventions were similar. After interventions, knowledge scores improved for both groups (8.8% for group 1; 14.1% for group 2); TOT insertion scores were significantly higher in group 2 (6.76/15 ± 2.54 group 1; 10.24/15 ± 2.73 group 2, P < 0.01); confidence scores improved in both groups. The pelvic model simulator was rated as the most useful method to learn TOT placement by group 1. Group 2 rated TOT simulation (47%) and cadaver laboratory (41%). All trainees reported that the pelvic model was highly realistic.

Conclusions

Cadaver laboratory exposure, along with other educational interventions (lectures and video), improves OBGYN residents' confidence, knowledge, and surgical skills regarding TOT placement. The custom-designed pelvic model allows for a realistic simulation of TOT placement: it can be used to assess resident surgical skills and also aid the training of OBGYN residents.
Safe summers: Adapting evidence-based injury prevention into a summer curriculum
Authors: Schaeffer Melody , Cioni Claire , Kozma Nicole , Rains Catherine , Todd Greta
Published: September 2017

BACKGROUND

Unintentional injury is the leading cause of death for those aged 0 years to 19 years. St. Louis Children’s Hospital created Safety Land, a comprehensive injury prevention intervention which is provided during summer months. This program uses a life-size board game to teach safety education to children in ages 5 years to 11 years. The purpose of this study was to evaluate the effect of Safety Land on safety knowledge in children that participated in the intervention.

METHODS

St. Louis Children’s Hospital identified ZIP codes with the highest use of the emergency room for injury. Daycares and summer camps within these ZIP codes were targeted for the Safety Land intervention. A multiple choice pretest and posttest survey was designed to measure knowledge change within program participants. Students were selected for testing based on site availably. Within these sites, a convenience sample of children was selected for pretesting and posttesting. Safety Land staff conducted the pretest a week before the intervention, and the posttest was administered the week after the intervention. A total knowledge score was calculated to determine overall knowledge change. Descriptive statistics and independent-samples t tests were conducted to determine statistical significance of change in knowledge (p < 0.05) for each question.

RESULTS

Between May 2014 and August 2016, 3,866 children participated in Safety Land. A total of 310 children completed the pretest and 274 completed the posttest. Mean test scores increased from 66.7% to 85.1% and independent-samples t test of the total knowledge score was significant (p < 0.05) between pretest and posttest values.

CONCLUSION

Findings suggest that this intervention is effective in increasing the knowledge of safety behaviors for children receiving the curriculum during the summer months. Further research should focus on long-term behavior changes in these youth.
Hybrid multilevel solution of sparse least-squares linear systems
Authors: Filelis-Papadopoulos Christos K. , Gravvanis George A.
Published: September 2017

Purpose

Large sparse least-squares problems arise in different scientific disciplines such as optimization, data analysis, machine learning and simulation. This paper aims to propose a two-level hybrid direct-iterative scheme, based on novel block independent column reordering, for efficiently solving large sparse least-squares linear systems.

Design/methodology/approach

Herewith, a novel block column independent set reordering scheme is used to separate the columns in two groups: columns that are block independent and columns that are coupled. The permutation scheme leads to a two-level hierarchy. Using this two-level hierarchy, the solution of the least-squares linear system results in the solution of a reduced size Schur complement-type square linear system, using the preconditioned conjugate gradient (PCG) method as well as backward substitution using the upper triangular factor, computed through sparse Q-less QR factorization of the columns that are block independent. To improve the convergence behavior of the PCG method, the upper triangular factor, computed through sparse Q-less QR factorization of the coupled columns, is used as a preconditioner. Moreover, to further reduce the fill-in, then the column approximate minimum degree (COLAMD) algorithm is used to permute the block consisting of the coupled columns.

Findings

The memory requirements for solving large sparse least-squares linear systems are significantly reduced compared to Q-less QR decomposition of the original as well as the permuted problem with COLAMD. The memory requirements are reduced further by choosing to form larger blocks of independent columns. The convergence behavior of the iterative scheme is improved due to the chosen preconditioning scheme. The proposed scheme is inherently parallel due to the introduction of block independent column reordering.

Originality/value

The proposed scheme is a hybrid direct-iterative approach for solving sparse least squares linear systems based on the implicit computation of a two-level approximate pseudo-inverse matrix. Numerical results indicating the applicability and effectiveness of the proposed scheme are given.
Schedule and cost overrun analysis for R&D projects using ANP and system dynamics
Authors: Kumar Sandeep , Thakkar J.J.
Published: September 2017

Purpose

Schedule and cost overrun analysis for a typical research & development (R&D) project is necessary to identify and mitigate the non-feasible alternatives at the design stage. Typically, this should include an analysis of technological and economic factors of R&D project. This paper aims to discuss these issues.

Design/methodology/approach

This research proposes an integrated analytic network process (ANP) and reusable system dynamics (SD) model for a quick and strategically consistent decision making. The technological and economic factors of R&D project were first identified and compiled through a systematic literature review. An ANP model was first developed for calculating Risk Priority Index (RPI) for set of technological and economic factors. The computed RPI are considered as an input to SD models. Two SD models (technological and economic) are developed to undertake a detailed investigation on effect of individual factor on schedule and cost overrun. The approach is exemplified for a case of government R&D project in India.

Findings

ANP identifies “Testing & qualification facility” and “Raw material availability” as the highest RPI factors. A detailed sensitivity analysis of SD models suggests that technological factors such as “Design Changes,” “Hidden Activities,” and “Lack of Expertise” and economic factors such as “Project delays,” “Unexpected incidents” and “Conflicts” have the highest influence on schedule and cost overrun.

Practical implications

The outcomes of this research can help managers to estimate the severity of various technological and economic factors on cost and schedule overrun and develop an adequate risk mitigation contingency plan.

Originality/value

In case of R&D projects where systems are being developed for the first time, changes are inevitable, and hence schedule and cost management plays a very important role in its success. This paper proposes an integrated reusable approach of ANP and SD for analyzing the influence of technological and economic factors on schedule and cost overrun of R&D project.
Can clicking promote learning?
Authors: Rana Nripendra P. , Dwivedi Yogesh K.
Published: September 2017

Purpose

The purpose of this paper is to explore the impact of factors such as attention, preparation, participation, feedback and engagement on the student learning performance.

Design/methodology/approach

Students of an undergraduate business course of a British university took part in the survey. The survey questionnaire was distributed to students during the revision week of the course and a total of 61 valid responses were gathered from them. The linear regression analysis using statistical package for the social sciences was performed to analyse the data.

Findings

The results indicated the significant relationships for all six hypotheses. The model explains a variance of 43.2 per cent in learning performance, which indicates that independent constructs contribute significantly on the research model’s performance.

Research limitations/implications

First, the sample only provides the students’ views about the use of clickers in the classroom setting. Second, the sample size for the gathered data is small. Third, the variance explained by the research model is reasonably moderate and hence can be improved further.

Originality/value

This is the first study to explore the impact of factors such as attention, preparation, participation, feedback and engagement on the student learning performance in the UK educational setting.
Social media technology management in College of Technology in Oman
Authors: Sharma Himanshu , Pillai Sunil Prakash
Published: September 2017

Purpose

The purpose of this paper is to examine the impact of the constructs – utilitarian, hedonic and social value on the perceptions of the full-time instructors related to their social media technology (SMT) management for learning and teaching practices at workplace.

Design/methodology/approach

A survey is used to gather the data from 180 instructors (full time) working at one of the colleges owned by the ministry of manpower, Oman. This paper uses reliability analysis to determine Cronbach’sαand analysis of variance for the empirical investigation of instructors’ perceptions on SMT management.

Findings

The analysis shows that 98 per cent of the instructors use SMTs at their workplace. Social influence is found more dominating than utilitarian and hedonic constructs in impacting on instructors’ intention for SMT use. Findings also claim that higher the use of SMT at workplace stronger the influence on learning and teaching practices of higher education instructors.

Practical implications

The findings of this study can be used as the recommendations for all the faculty members to use SMTs for their educational, learning and teaching practices. The administration can develop policies to motivate instructors to manage such technologies for professional and personal development to enhance learning and teaching environment at workplace.

Originality/value

This study is perhaps the leading attempt to use utilitarian, hedonic and social value perceptions of the instructors to investigate the management of SMTs in an academic culture and settings of the developing country in the Middle East (Oman).
The impact of employees’ values on role engagement
Authors: Rice Bridget , Fieger Peter , Rice John , Martin Nigel , Knox Kathy
Published: September 2017

Purpose

The purpose of this paper is to investigate the manner in which employees’ experience of distributive justice (DJ) moderates the impact of intrinsic and extrinsic values on role engagement (RE). RE is especially important in the healthcare setting (examined here) due to the sector’s complexity, changeability and emotionally challenging nature.

Design/methodology/approach

Using data collected from a survey of employees from a large government health district in Southeast Queensland (Australia), this study examined the determinants of RE among a group of employees working across three hospital locations.

Findings

The focus of the study was on the impact, both directly and in combination, of espoused extrinsic and intrinsic values and perceived DJ on RE. The authors identify strong direct effects from DJ on RE, and complex third-order effects for the combinations of intrinsic (IM) and extrinsic motivation and DJ in predicting RE.

Research limitations/implications

As a cross-sectional and attitudinal survey, care must be taken in relation to common-method variance.Post hoccontrols were performed in relation to this.

Practical implications

DJ is important for all, and is a powerful motivator for engagement of employees reporting highly on IM. There is evidence that the most engaged employees are not those most motivated by extrinsic rewards alone, although employees who are motivated primarily by extrinsic rewards alone can be highly engaged when they experience high levels of DJ.

Social implications

For managers seeking to engage their employees, an understanding of the different motivators for intrinsically vs extrinsically inclined employees is important. Taken together, these results suggest that employee RE is driven by a complex set of factors that differ between employees. Managing this complexity is an important consideration for managers.

Originality/value

This is the first empirical study to show these interaction effects using these measures. The healthcare context, generally under researched, also features in this study.
Environmental influences on pre-schooler’s understanding of brand symbolism
Authors: Watkins Leah , Aitken Robert , Thyne Maree , Robertson Kirsten , Borzekowski Dina
Published: September 2017

Purpose

The purpose of this paper is to understand the factors influencing young children’s (aged three to five years) understanding of brand symbolism.

Design/methodology/approach

Multiple hierarchical regression was used to analyse the relationships between age, gender and environmental factors, including family and the media, on the development of brand symbolism in pre-school children based on 56 children and parent dyad interviews.

Findings

Results confirmed the primary influence of age, television exposure and parental communication style on three to five-year-old children’s understanding of brand symbolism. The study demonstrates that the tendency to infer symbolic user attributes and non-product-related associations with brands starts as early as two years, and increases with age throughout the pre-school years. Children exposed to more television and less critical parental consumer socialisation strategies are more likely to prefer branded products, believe that brands are better quality and that they make people happy and popular.

Social implications

Identifying the factors that influence the development of symbolic brand associations in pre-school children provides an important contribution to public policy discussions on the impact of marketing to young children.

Originality/value

The paper extends existing research by considering, for the first time, the role of environmental factors in pre-schooler’s understanding of brand symbolism. The results provide a more informed basis for discussion about the impact of marketing messages on very young children and the environmental factors that may lead to a more critical engagement with brands.
Managing change at Urban Affordable Housing
Authors: Mazzei Matthew J. , Carson Charles M.
Published: September 2017

Synopsis

Urban Affordable Housing (UAH) Inc. was a real estate asset management syndication firm that sponsored affordable housing to low-income families and seniors across the USA. The case examines the firm’s management of an internal information technology (IT) change initiative. The case follows the firm’s recently hired IT manager, Anthony Bryant, as he works to change a culture while acquiring resources and acceptance for the project he was hired to oversee. Bryant deals with numerous changing priorities, inadequate sponsorship, resistance from various levels, and a dearth of resources as he struggles to get the organization to complete an overdue database conversion.

Research methodology

This case is based upon the firsthand experiences of the lead author over a seven-year period while working at UAH. Measures have been taken to disguise the firm’s identity, including using a pseudonym, fictitious names for firm employees, a fictitious location, and the alteration of key dates. Key elements of the case have been constructed around semi-structured interviews and the review of archival documentation. Most quotes are verbatim in an attempt to preserve their authenticity, and were drawn from the semi-structured interviews and from historical accounts of actual occurrences and conversations.

Relevant courses and levels

The UAH case is multi-faceted, as it can be used in a number of environments amid a business school curriculum. A primary use is likely in a course revolving around organizational change and development. It might also be featured as part of the organizational change component in a course on organizational behavior, used to illustrate and analyze organizational culture and change leadership. Furthermore, the case could be used for change-related topics in management information systems or project management courses. The authors suggest the case be assigned at the graduate level, though it could also be suitable for an advanced undergraduate class.

Theoretical bases

Critical knowledge for successfully analyzing this case includes the following concepts: the change process (Lewin, 1951); leading change (Kotter, 1996); resistance to change (Kegan and Lahey, 2001); and communicating change (Armenakis and Harris, 2002).