bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear vibration and instability of a visco-Pasternak coupled double-DWBNNTs-reinforced microplate system conveying microflow
Authors: Ghorbanpour Arani A , Vossough H , Kolahchi R
Published: February 2015

The present article deals with the nonlinear vibration and instability analysis of a bonded double-smart composite microplate system (DSCMPS) conveying microflow based on nonlocal piezoelasticity theory. Two microplates are connected together by visco-Pasternak medium and both of them made of poly-vinylidene fluoride reinforced by double walled boron nitride nanotubes (DWBNNTs). Modified Navier–Stokes relation is used to evaluate fluid–microplate interaction considering the effects of bulk viscosity and slip boundary condition. Energy method and Hamilton's principle are employed to derive motion equations with regard to von Kármán geometric nonlinearity. Also, charge equation is used to consider electromechanical coupling. Due to existence of nonlinear terms, the governing equations are solved with the help of the differential quadrature method (DQM). A detailed parametric study is conducted to elucidate the effects of the flow velocity, fluid viscosity, Knudsen number, type of elastic medium, temperature change, small scale, aspect ratio, volume fraction, and orientation angle of the DWBNNTs on the vibration and instability behaviors of the coupled DSCMPS. This study might be helpful for the design of nano-electro-mechanical systems/ micro-electro-mechanical systems.
Active attenuation of sound transmission through a soft-core sandwich panel into an acoustic enclosure using volume velocity cancellation
Authors: Sahu Kiran Chandra , Tuhkuri Jukka , Reddy JN
Published: February 2015

In this paper, active control of harmonic sound transmitted through a soft-core sandwich panel into a rectangular enclosure is studied. As it has already been shown for the low frequency region, the noise transmission through a soft-core sandwich panel mainly occurs due to the flexural and the dilatational modes. Therefore, in this study, volume velocity cancellation control strategy is used to control these modes, and achieve sound attenuation in a broad frequency range. Point force and uniformly distributed force actuators are used as the secondary actuator to cancel the volume velocity of the bottom faceplate, which opens to the cavity, of the sandwich panel. Cancelling the net volume velocity of the bottom faceplate is compared not only in terms of the reduction in sound transmission through the sandwich panel into cavity but also in terms of the faceplate velocities. Also, the effectiveness of the volume velocity cancellation strategy has been studied for different values of isotropic loss factor of the core. Sound transmission into the cavity has also been calculated by considering the effect of cavity pressure on the sandwich panel. Numerical studies indicate that the active control method controls both the flexural and the dilatational modes of the sandwich panel and therefore, attenuates significant amount of sound pressure inside the cavity irrespective of the isotropic loss factors of the viscoelastic core in a broad frequency range. Also a finite element study has been done in the commercially available COMSOL Multiphysics software to compare with the analytical results.
Analysis on damage mechanical characteristics of marble exposed to high temperature
Authors: Liu Shi , Xu Jinyu
Published: February 2015

Study on the mechanical response of rock under the combined effects of high temperature and mechanical load using the method of damage mechanics is a relatively new research direction of rock mechanics. The thermal damage and mechanical damage are indicated by the uniaxial compression mechanical test of marble after exposure to high temperature. The overall damage evolution equation of rock is deduced and high-temperature damage constitutive equation is established on the basis of the macroscopic phenomenological damage mechanics and nonequilibrium statistical methods. The evolution law of the damage characteristics of rock after exposure to high temperature, taking the temperature and mechanical load as the control variable, is discussed. The results show that the effect of temperature on the mechanical properties of marble can be accurately described through the definition of thermal damage using elastic modulus. The high-temperature damage constitutive model curves are similar to the experimental curves, reflecting well the brittleness of marble. Additionally, the constitutive relations of rock after exposure to high temperature have close relationships with the elastic modulus, compressive strength, and peak strain. The overall damage of rock changes along two evolutionary pathways of high temperature and strain, reflecting the mutual combined influences of high temperature and strain on the material damage extension, can accurately reveal the damage mechanical behavior and the damage propagation law of rock material after exposure to high temperature.
Patient Expectation and Satisfaction as Measures of Operative Outcome in End-Stage Ankle Arthritis
Authors: Younger Alastair S. E. , Wing Kevin J. , Glazebrook Mark , Daniels Timothy R. , Dryden Peter J. , Lalonde Karl-André , Wong Hubert , Qian Hong , Penner Murray
Published: February 2015

Background:

Current operative outcome scales are based on pain and function, such as the Ankle Osteoarthritis Scale (AOS). Outcomes based on patient expectation and satisfaction may be more useful. The purpose of this prospective cohort study was to evaluate associations between patient expectation, satisfaction, and outcome scores for ankle fusion and total ankle replacement (TAR).

Methods:

In total, 654 ankles in 622 patients were analyzed at a mean of 61 months. Patient expectation and satisfaction with symptoms were quantified pre- and postoperatively using the Musculoskeletal Outcomes Data Evaluation and Management Scale questionnaires from the American Academy of Orthopaedic Surgeons, while function was quantified using the AOS.

Results:

Patients undergoing ankle replacement had a higher preoperative expectation score (79; 95% confidence interval [CI], 77-81) compared with those undergoing ankle fusion (72; 95% CI, 68-75). Preoperative expectation scores correlated weakly with AOS scores ( R2 = 0.02) and with the “expectations met” score for ankle fusion ( R2 = 0.07) but not for ankle replacement ( R2 < 0.01). Satisfaction scores were similar for ankle fusion and ankle replacement at follow-up, but a greater number of ankle replacement patients showed improvement in satisfaction (84% vs 74%, P < .005). Higher satisfaction at final follow-up was associated with better expectations met and greater improvement in AOS outcome scores for both ankle fusion and ankle replacement. Expectations met and AOS scores at follow-up correlated for ankle fusion ( R2 = 0.38, P < .0001) and ankle replacement ( R2 = 0.31, P < .0001).

Conclusions:

Patients undergoing TAR had higher expectation scores prior to surgery than those undergoing ankle fusion. Expectations may be more likely to be met by ankle replacement compared with ankle fusion. Ankle replacement patients were more likely to report improved satisfaction scores after surgery. Preoperative expectation scores showed little correlation with preoperative AOS scores, indicating that expectation is independent of pain and function. However, postoperative expectations met and satisfaction scores were strongly associated with AOS scores at follow-up. Better preoperative patient education may change expectations and requires study.

Level of Evidence:

Level II, prospective cohort study.
Ubuntu-Inspired Training of Adult Literacy Teachers as a Route to Generating “Community” Enterprises
Authors: Quan-Baffour Kofi P. , Romm Norma R. A.
Published: February 2015

This article describes experiences of an adult educator (Kofi Quan-Baffour) at the University of South Africa, 1995 to 2009, teaching tutorial classes to train teachers who, in turn, would offer adult literacy classes/sessions (in relation to adult basic education and training [ABET] policies initiated post-1994). The article aims to make a contribution to the literature on how literacy education can in practice activate a potential for the “humanization” of economic and social life. In the context of South Africa, we consider practices for nurturing a variant of humanism called Ubuntu. As co-authors, we use a narrative inquiry approach, drawing on exemplars that arose in dialogue, to report on our joint deliberations on the import of Kofi’s attempts to keep an Ubuntu spirit alive in the various learning settings with the trainees. Our reflective exercise took place via “debriefing sessions” in 2012, where we focused on the offshoots of literacy education for Ubuntu-informed cooperative work in community business enterprises. We point to some cooperative enterprises (a restaurant, a farming enterprise, and a sewing business), which we suggest incorporate an Ubuntu-style approach to human relationships based on people recognizing (and living) their mutual connectedness. We concentrate on what it may mean to be involved in basic adult education processes geared toward generating an improvement in people’s lives economically and socially. We argue that this co-constructed notion of Ubuntism in the context of adult education practices is relevant for other geographical contexts where practitioners hope to accomplish humanistic goals.
The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder
Authors: Papadopoulos Nicole , Sciberras Emma , Hiscock Harriet , Mulraney Melissa , McGillivray Jane , Rinehart Nicole
Published: February 2015

Objective: Sleep problems are common in children with autism spectrum disorders (ASD) and ADHD and impact adversely on child and parent well-being. The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD–ASD. Method: A subsample of children with ADHD–ASD ( n = 61; 5-13 years; 89% male) participating in the Sleeping Sound With ADHD study were included in the current investigation. The subsample comprised of 28 children randomized to the sleep intervention group, while 33 were randomized to usual clinical care. The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and standardized behavioral strategies. Results: Children with ADHD–ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-randomization. Conclusion: These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD–ASD.
You make the road by walking: A case study of partnership and collaboration
Authors: Kroeger Stephen , Beirne James , Kraus Timothy
Published: February 2015

A Sage expression, you make the road by walking, captures the nature of accompaniment in partnership development. The purpose of this action research project was to examine the partnership of a city school and an urban university as one that engaged mutual generation of knowledge from all participants. Action research, where participants are coequals in decision making, enhances the co-construction of knowledge and applied practice when stakeholders work to achieve more practical goals. Two high school co-instructors and a university faculty member examined what initially brought them together—a classroom instructional need. While designing and implementing an investigation of the use of class instructional time, they simultaneously conducted a self-study action research project about the dynamics of their partnership and how to improve it. Critical interviews revealed challenges to integrating research findings into practice as well as convergent benefits of partnership development that may be relevant to partnerships of all kinds.
Barriers to Physical Activity Among Gay Men
Authors: Cary Miranda A. , Brittain Danielle R. , Dinger Mary K. , Ford Melissa L. , Cain Meagan , Sharp Teresa A.
Published: February 2015

Gay men may not be physically active at recommended levels to achieve health benefits. Thus, a need exists to identify general (i.e., common across populations) and population-specific barriers that hinder or stop gay men from participating in physical activity (PA). Salient barriers may be identified through the extent each barrier limits PA (i.e., barrier limitation) and the level of one’s confidence to overcome barriers and engage in PA (i.e., self-regulatory efficacy). The purposes of this study were to (1) provide a description of general and population-specific barriers to PA among sufficiently and insufficiently active gay men, (2) identify barrier limitation and self-regulatory efficacy for the reported barriers, and (3) examine the associations between meeting the current PA recommendation, barrier limitation, and self-regulatory efficacy. Participants were 108 self-identified gay males aged 21 to 64 years who completed a web-based survey. A total of 35 general barriers and no population-specific barriers were identified by the sufficiently and insufficiently active groups. The sufficiently active group reported higher self-regulatory efficacy and lower barrier limitation for nearly all reported barriers. A binary logistic regression used to examine the associations between PA, barrier limitation, and self-regulatory efficacy was statistically significant, χ2(2, N = 108) = 19.26, p < .0001, R2 = .16. Only barrier limitation significantly contributed to the model. Future research should continue to examine barriers to PA among gay men to determine whether an intervention needs to be designed specifically for gay men or whether a one-size-fits-all intervention would be effective in helping all men overcome common barriers to engaging in PA.
Satire as counter-discourse: Dissent, cultural citizenship, and youth culture in Morocco
Authors: Marzouki Mohamed El
Published: February 2015

This article explores user-generated satirical YouTube videos as forms of citizen-made, participatory cultural production in the context of post-protest Morocco. Using a combined method of textual and critical discourse analysis, I map out the issues most satirized in these alternative cultural forms, then examine their counter-discursive ideological positions, and last explore the consequences of online satire on political culture in Morocco. I argue that the emergence of the web as a participatory medium and a competing cultural form is giving rise to new articulations of dissenting political culture through the enabling of (counter)publics, and the invitation of global, cosmopolitan practices of cultural citizenship.
The Emerging Field of Nutritional Mental Health
Authors: Kaplan Bonnie J. , Rucklidge Julia J. , Romijn Amy , McLeod Kevin
Published: February 2015

We live in a transformational moment for understanding the etiology of mental disorders. The previous leap in understanding occurred 60 years ago, which led us to incorporate psychopharmacology into our curricula to address the chemical basis of neurotransmitter function, especially as explained through the then-popular catecholamine hypothesis. The current revolution is broader, consisting of the rapidly accumulating knowledge of how inflammation, microbiome imbalance (gut dysbiosis), oxidative stress, and impaired mitochondrial output affect brain function. Suitable interventions for fighting inflammation, restoring normal gut function, reducing oxidative stress, and improving mitochondrial metabolism incorporate lifestyle variables, including nutrients and probiotics. This article invites readers to stay abreast of this emerging model of the biological basis of mental illness, given that it has particular relevance for those readers interested in alleviating the suffering of individuals with mental disorders. This overview describes the basis for a new field in mental health: nutritional psychiatry/psychology.
Nutritional Interventions in Clinical Depression
Authors: Rechenberg Kaitlyn
Published: February 2015

Depression is one of the leading causes of mental disability worldwide and a significant public health problem in the United States. Individuals with depression have lower quality of life, diminished role functioning, increased comorbidity, and increased mortality. Although psychotherapy and pharmacotherapy are well-validated treatment options for clinical depression, nutritional supplements may be another means of alleviating depressive symptoms while limiting adverse effects. Nutritional supplements can be utilized in tandem with preexisting therapeutic regimens, or as stand-alone therapies. Omega-3 fatty acids, B-vitamins (folate, vitamin B12, and vitamin B6), S-adenosylmethionine (SAMe), 5-hydroxytryptophan (5-HTP), and magnesium have been of interest in the treatment of depression for several decades. This article reviews the literature investigating these nutritional interventions for the treatment of clinical depression, with a particular focus on pathophysiology, epidemiology, and clinical research.
Rapid and Sensitive Identification of Bacterial Infection and Bacteria Gram Types in Pleural Fluid of Children
Authors: Wu Yi-Dong , Li Wei , Wei Yi , Gao Hui-Hui , Shang Shi-Qiang , Du Li-Zhong
Published: February 2015

Real-time polymerase chain reaction (RT-PCR) techniques have been increasingly used to detect microbial DNA in clinic for the diagnosis of bacterial infection. This study aims to developing an RT-PCR method to detect bacteria in pleural fluid (PF). We performed a method to simultaneously detect and classify the clinically relevant bacterial pathogens in hydrothorax with Gram probe RT-PCR (GRT-PCR), which targets the conserved region of the 16S rRNA gene. Our results showed this method could specifically and correctly identify 14 clinically important bacterial strains in hydrothorax including 7 gram-positive and 7 gram-negative bacteria. And the sensitivity of this GRT-PCR method in serial dilution can reach 10 CFU/mL. In clinical trial, 180 PF samples from children who were clinically suspected to suffer from bacterial pneumonia and empyema were collected. These samples were detected by GRT-PCR, standard culture, and biochemical routine analysis. The positive rate of the GRT-PCR array was 17.78% (32/180), significantly higher than that of PF culture (11.67%; 21/180; P = .003). When PF culture was used as control, the sensitivity of GRT-PCR was 95.24% (95% confidence interval = 74.13-99.75), and the specificity was 92.45% (95% confidence interval = 86.89-95.86). Our study showed that GRT-PCR is a more effective method for rapid, sensitive, and specific diagnosis of bacterial infection in hydrothorax compared with other traditional methods.
Propofol increases morbidity and mortality in a rat model of sepsis
Authors: Schläpfer Martin , Piegeler Tobias , Dull Randal O , Schwartz David E , Mao Mao , Bonini Marcelo G , Z’Graggen Birgit Roth , Beck-Schimmer Beatrice , Minshall Richard D
Published: February 2015

Introduction

Severe sepsis is associated with approximately 50% mortality and accounts for tremendous healthcare costs. Most patients require ventilatory support and propofol is commonly used to sedate mechanically ventilated patients. Volatile anesthetics have been shown to attenuate inflammation in a variety of different settings. We therefore hypothesized that volatile anesthetic agents may offer beneficial immunomodulatory effects during the course of long-term intra-abdominal sepsis in rats under continuous sedation and ventilation for up to 24 hours.

Methods

Sham operation or cecal ligation and puncture (CLP) was performed in adult male Wistar rats followed by mechanical ventilation. Animals were sedated for 24 hours with propofol (7 to 20 mg/kg/h), sevoflurane, desflurane or isoflurane (0.7 minimal alveolar concentration each).

Results

Septic animals sedated with propofol showed a mean survival time of 12 hours, whereas >56% of all animals in the volatile groups survived 24 hours (P<0.001). After 18 hours, base excess in propofol + CLP animals (−20.6 ± 2.0) was lower than in the volatile groups (isoflurane + CLP: -11.7 ± 4.2, sevoflurane + CLP: -11.8 ± 3.5, desflurane + CLP -14.2 ± 3.7; allP<0.03). Plasma endotoxin levels reached 2-fold higher levels in propofol + CLP compared to isoflurane + CLP animals at 12 hours (P<0.001). Also blood levels of inflammatory mediators (tumor necrosis factor-α, interleukin-1β, interleukin-10, CXCL-2, interferon-γ and high mobility group protein-1) were accentuated in propofol + CLP rats compared to the isoflurane + CLP group at the same time point (P<0.04).

Conclusions

This is the first study to assess prolonged effects of sepsis and long-term application of volatile sedatives compared to propofol on survival, cardiovascular, inflammatory and end organ parameters. Results indicate that volatile anesthetics dramatically improved survival and attenuate systemic inflammation as compared to propofol. The main mechanism responsible for adverse propofol effects could be an enhanced plasma endotoxin concentration, leading to profound hypotension, which was unresponsive to fluid resuscitation.
Do corticosteroids reduce the mortality of influenza A (H1N1) infection? A meta-analysis
Authors: Zhang Yi , Sun Wenjie , Svendsen Erik R , Tang Song , MacIntyre Raina C , Yang Peng , Zhang Daitao , Wang Quanyi
Published: February 2015

Introduction

Corticosteroids are used empirically in influenza A (H1N1) treatment despite lack of clear evidence for effective treatment. This study aims to assess the efficacy of corticosteroids treatment for H1N1 infection.

Methods

Systematic review and meta-analysis were used to estimate the efficacy of corticosteroids for the prevention of mortality in H1N1 infection. Databases searched included MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Clinical Trials and so on, and bibliographies of retrieved articles, from April 2009 to October 2014. We included both cohort studies and case-control studies reported in English or Chinese that compared treatment effects between corticosteroids and non-corticosteroids therapy in inpatients with H1N1 virus infection. Cohort studies employed mortality as outcome, and case-control studies employed deaths as cases and survivors as controls; both were assessed in this meta-analysis.

Results

In total twenty-three eligible studies were included. Both cohort studies (nine studies, n = 1,405) and case-control studies (14 studies, n = 4,700) showed a similar trend toward increased mortality (cohort studies relative risk was 1.85 with 95% confidence interval (CI) 1.46 to 2.33; case-control studies odds ratio was 4.22 with 95% CI 3.10 to 5.76). The results from both subgroup analyses and sensitive analyses were consistent with each other, showing that steroid treatment is associated with mortality. However, considering the fact that corticosteroids were tend to be used in sickest case-patients and heterogeneity was observed between studies, we cannot make a solid conclusion.

Conclusions

Available evidence did not support the use of corticosteroids as standard care for patients with severe influenza. We conclude that further research is required.
Ethnic moralities and reciprocity: towards an ethic of South-South relations
Authors: Lorenzana Jozon A
Published: February 2015

Normative critiques of South-South relations assess the extent to which solidarity and cooperation are achieved among partner countries. However, they tend to overlook the role of inter-ethnic tensions in partnerships and the ways global South actors exercise agency in achieving cooperation. Transnational skilled migration between global South countries is an emerging context where South-South cooperation takes place. Using the case of Filipino skilled workers in Indian cities, this paper aims to ascertain the sort of tensions that characterise South-South relations and the manner in which actors work out cooperative partnerships. The concept of boundary work, a process of defining ‘us’ and ‘them’ and relating to others through a set of socio-cultural criteria (ASR 73:37-59, 2008), is deployed to analyse Filipino-Indian interactions in the workplace. Ethnographic data reveal that while ethnic moralities constitute boundaries and tensions between Filipino and Indian workers, they also become bases of affinity. Cooperation is achieved when Filipino and Indian participants engage in personal and mutually beneficial arrangements such as guru-student and patron-client relations. An ethic of reciprocity thus animates South-South cooperation. I conclude with some implications for global South partnerships.
Minimally invasive resection of synchronous thoracic esophageal and gastric carcinomas followed by reconstruction: a case report
Authors: Honda Masayuki , Daiko Hiroyuki , Kinoshita Takahiro , Fujita Takeo , Shibasaki Hidehito , Nishida Toshiro
Published: February 2015

We report on a case of synchronous carcinomas of the esophagus and stomach. A 68-year-old man was referred to our hospital for an abnormality found during his medical examination. Further evaluation revealed squamous cell carcinoma in the thoracic lower esophagus and gastric adenocarcinoma located in the middle third of the stomach. Thoracoscopic esophagectomy in the prone position (TSEP), laparoscopic total gastrectomy (LTG) with three-field lymph node dissection, and laparoscopically assisted colon reconstruction (LACR) were performed. The patient did not have any major postoperative complications. His pathological examination revealed no metastases in 56 harvested lymph nodes and no residual tumor. He was followed up for 30 months without recurrence. To our knowledge, this is the first report of esophageal and gastric synchronous carcinomas that were successfully treated with a combination of TSEP, LTG, and LACR. These operations may be a feasible and appropriate treatment for this disease.
Editorial: Resident good? Persistent infection increases the number of potentially protective T cells localized in peripheral tissue
Authors: Bullock Timothy
Published: February 2015

Discussion of chronic viral infection and impact on effector T cell phenotype and localization.
Active Smoking and Mortality Among Colorectal Cancer Survivors: The Cancer Prevention Study II Nutrition Cohort
Authors: Yang Baiyu , Jacobs Eric J. , Gapstur Susan M. , Stevens Victoria , Campbell Peter T.
Published: February 2015

Purpose

Active smoking is associated with higher colorectal cancer risk, but its association with survival after colorectal cancer diagnosis is unclear. We investigated associations of smoking, before and after diagnosis, with all-cause and colorectal cancer–specific mortality among colorectal cancer survivors.

Patients and Methods

From a cohort of adults who were initially free of colorectal cancer, we identified 2,548 persons diagnosed with invasive, nonmetastatic colorectal cancer between baseline (1992 or 1993) and 2009. Vital status and cause of death were determined through 2010. Smoking was self-reported on the baseline questionnaire and updated in 1997 and every 2 years thereafter. Postdiagnosis smoking information was available for 2,256 persons (88.5%).

Results

Among the 2,548 colorectal cancer survivors, 1,074 died during follow-up, including 453 as a result of colorectal cancer. In multivariable-adjusted Cox proportional hazards regression models, prediagnosis current smoking was associated with higher all-cause mortality (relative risk [RR], 2.12; 95% CI, 1.65 to 2.74) and colorectal cancer–specific mortality (RR, 2.14; 95% CI, 1.50 to 3.07), whereas former smoking was associated with higher all-cause mortality (RR, 1.18; 95% CI, 1.02 to 1.36) but not with colorectal cancer–specific mortality (RR, 0.89; 95% CI, 0.72 to 1.10). Postdiagnosis current smoking was associated with higher all-cause (RR, 2.22; 95% CI, 1.58 to 3.13) and colorectal cancer–specific mortality (RR, 1.92; 95% CI, 1.15 to 3.21), whereas former smoking was associated with all-cause mortality (RR, 1.21; 95% CI, 1.03 to 1.42).

Conclusion

This study adds to the existing evidence that cigarette smoking is associated with higher all-cause and colorectal cancer–specific mortality among persons with nonmetastatic colorectal cancer.
Corporate Coalitions and Policy Making in the European Union: How and Why British American Tobacco Promoted “Better Regulation”
Authors: Smith Katherine Elizabeth , Fooks Gary , Gilmore Anna B. , Collin Jeff , Weishaar Heide
Published: February 2015

Over the past fifteen years, an interconnected set of regulatory reforms, known as Better Regulation, has been adopted across Europe, marking a significant shift in the way that European Union policies are developed. There has been little exploration of the origins of these reforms, which include mandatory ex ante impact assessment. Drawing on documentary and interview data, this article discusses how and why large corporations, notably British American Tobacco (BAT), worked to influence and promote these reforms. Our analysis highlights (1) how policy entrepreneurs with sufficient resources (such as large corporations) can shape the membership and direction of advocacy coalitions; (2) the extent to which “think tanks” may be prepared to lobby on behalf of commercial clients; and (3) why regulated industries (including tobacco) may favor the use of “evidence tools,” such as impact assessments, in policy making. We argue that a key aspect of BAT's ability to shape regulatory reform involved the deliberate construction of a vaguely defined idea that could be strategically adapted to appeal to diverse constituencies. We discuss the theoretical implications of this finding for the Advocacy Coalition Framework, as well as the practical implications of the findings for efforts to promote transparency and public health in the European Union.
Overutilization, Overutilized
Authors: Levine Deborah , Mulligan Jessica
Published: February 2015

Overutilization is commonly blamed for escalating costs, compromising quality, and limiting access to the US health care system. Recent estimates suggest that nearly one-third of health care spending in the United States is a result of unnecessary care. Despite the surge of exposés that purport to uncover this “new” problem, narratives about overutilization have been circulating in health policy debates since the beginnings of the health insurance industry. This article traces how the term overutilization has spread in popularity from a relatively small community of mid-twentieth-century insurance experts to economists, physicians, epidemiologists, and eventually the news media of the early twenty-first century. A quick glimpse at the history of the term reveals that there has been constant disagreement and debate over the meaning and impact of overutilization. Moreover, the term has been put to very different uses, from keeping socialism at bay to preserving the fiscal integrity of Medicare to protecting the health of patients. The overutilization narrative, seductive in its promise of cutting costs without sacrificing access to quality care, too often drowns out other difficult conversations about social welfare, health equity, prices, and universal coverage.
Environmental Health Risks and Housing Values: Evidence from 1,600 Toxic Plant Openings and Closings
Authors: Currie Janet , Davis Lucas , Greenstone Michael , Walker Reed
Published: February 2015

Regulatory oversight of toxic emissions from industrial plants and understanding about these emissions' impacts are in their infancy. Applying a research design based on the openings and closings of 1,600 industrial plants to rich data on housing markets and infant health, we find that: toxic air emissions affect air quality only within 1 mile of the plant; plant openings lead to 11 percent declines in housing values within 0.5 mile or a loss of about $4.25 million for these households; and a plant's operation is associated with a roughly 3 percent increase in the probability of low birthweight within 1 mile. (JEL I12, L60, Q52, Q53, Q58, R23, R31)
Robustness and Linear Contracts
Authors: Carroll Gabriel
Published: February 2015

We consider a moral hazard problem where the principal is uncertain as to what the agent can and cannot do: she knows some actions available to the agent, but other, unknown actions may also exist. The principal demands robustness, evaluating possible contracts by their worst-case performance, over unknown actions the agent might potentially take. The model assumes risk-neutrality and limited liability, and no other functional form assumptions. Very generally, the optimal contract is linear. The model thus offers a new explanation for linear contracts in practice. It also introduces a flexible modeling approach for moral hazard under nonquantifiable uncertainty. (JEL D81, D82, D86)
Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys Are Transplanted
Authors: Anderson Ross , Ashlagi Itai , Gamarnik David , Rees Michael , Roth Alvin E. , Sönmez Tayfun , Ünver M. Utku
Published: February 2015

Many end-stage renal disease sufferers who require a kidney transplant to prolong their lives have a relative or friend who has volunteered to donate a kidney to them, but whose kidney is incompatible with the intended recipient. This incompatibility can sometimes be overcome by exchanging a kidney with another incompatible patient-donor pair. Such kidney exchanges have emerged as a standard mode of kidney transplantation in the United States. The Alliance for Paired Donation (APD) developed and implemented nonsimultaneous extended altruistic donor (NEAD) chains, an innovative technique that allows a previously binding constraint (of simultaneity) to be relaxed; thus, it permits longer chains and better-optimized matching of potential donors to patients, greatly increasing the number of possible transplants. Since 2006, the APD has saved more than 220 lives through its kidney exchange program, with more than 75 percent of these achieved through nonsimultaneous chains. Other kidney exchange programs have adopted the technology and methods pioneered by APD, resulting in more than 1,000 lives already saved, with the promise of increasing impact in coming years. In 2013, the percentage of transplants from nonsimultaneous chains reached more than six percent of the number of transplants from living donors. In this paper, we describe the long-term optimization and market design research that supports this innovation. We also describe how a team of physicians and operations researchers worked to overcome the skepticism and resistance of the medical community to the NEAD innovation.
The Energy Authority Optimizes Water Routing and Hydroelectric Generation on the Columbia River
Authors: Hu Zengjian , Putz John , Sutjandra Yohan , Chan Abel , Mount Edmond , Baker Kristen
Published: February 2015

We describe a software application that enables owners of generation output from a virtualized Federal Columbia River Power System to safely operate the system, while also shaping the generation to meet their energy and economic needs. The application, the Optimizer, employs modern operations research techniques to convert a highly nonlinear problem into a linear one to create a robust solution for the six-dam system on an hourly basis, over a 10-day time horizon, and within a few minutes. The Optimizer helps to simultaneously manage and optimize the generation portfolios for 13 utilities in a stringent time frame around the clock, and enables hydroelectric (i.e., hydro) planners to ensure that the operation of the river meets all the requirements for flood control, fish management, electrical reliability, safe dam operations, and recreation under high degrees of uncertainty. The Optimizer allows utilities to integrate renewable, environmentally friendly wind and solar generation into their resource portfolio with hydro generation, and empowers these utilities to rapidly make decisions and adapt to changing conditions. We estimate that this project will reap benefits of $765–$952 million between 2011 and 2028.
Transforming Hospital Emergency Department Workflow and Patient Care
Authors: Lee Eva K. , Atallah Hany Y. , Wright Michael D. , Post Eleanor T. , Thomas Calvin , Wu Daniel T. , Haley Leon L.
Published: February 2015

When we encounter an unexpected critical health problem, a hospital’s emergency department (ED) becomes our vital medical resource. Improving an ED’s timeliness of care, quality of care, and operational efficiency while reducing avoidable readmissions, is fraught with difficulties, which arise from complexity and uncertainty. In this paper, we describe an ED decision support system that couples machine learning, simulation, and optimization to address these improvement goals. The system allows healthcare administrators to globally optimize workflow, taking into account the uncertainties of incoming patient injuries and diseases and their associated care, thereby significantly reducing patient length of stay. This is achieved without changing physical layout, focusing instead on process consolidation, operations tracking, and staffing. First implemented at Grady Memorial Hospital in Atlanta, Georgia, the system helped reduce length of stay at Grady by roughly 33 percent. By repurposing existing resources, the hospital established a clinical decision unit that resulted in a 28 percent reduction in ED readmissions. Insights gained from the implementation also led to an investment in a walk-in center that eliminated more than 32 percent of the nonurgent-care cases from the ED. As a result of these improvements, the hospital enhanced its financial standing and achieved its target goal of an average ED length of stay of close to seven hours. ED and trauma efficiencies improved throughput by over 16 percent and reduced the number of patients who left without being seen by more than 30 percent. The annual revenue realized plus savings generated are approximately $190 million, a large amount relative to the hospital’s $1.5 billion annual economic impact. The underlying model, which we generalized, has been tested and implemented successfully at 10 other EDs and in other hospital units. The system offers significant advantages in that it permits a comprehensive analysis of the entire patient flow from registration to discharge, enables a decision maker to understand the complexities and interdependencies of individual steps in the process sequence, and ultimately allows the users to perform system optimization.
Delayed cord clamping in the compromised baby
Authors: Gruneberg Felicity , Crozier Kenda
Published: February 2015

Compromised babies are routinely immediately separated from the umbilical cord in order to be resuscitated. The benefits of delayed cord clamping are numerous and apply as much, if not more, to the non-breathing baby, thus it is important to ask ‘does early cord clamping cause harm?’ The evidence suggests that early cord clamping can cause bradycardia in the baby and create the need for resuscitation. Invasive measures such as drugs and volume expanders are not required as frequently when delayed cord clamping is practised. Allowing the placenta to perform its role in the resuscitation means that oxygen supply continues, despite the failure to achieve effective respiration immediately. There appears to be no adverse psychological affects for the mother and birth partner if adequate midwifery support is provided. As midwives we must use the best available evidence to support our practice and improve outcomes.
Alcohol consumption in pregnancy and its implications for breastfeeding
Authors: Dunney Clare , Muldoon Kathryn , Murphy Deirdre J
Published: February 2015

Background:

Current advice to women in Ireland is to abstain from alcohol when pregnant or breastfeeding. This study aims to establish whether women embrace this advice when pregnant and if there is a need for additional midwifery-led education in relation to alcohol consumption and breastfeeding.

Methods:

A cohort study of 907 women who booked for antenatal care and to give birth in a large maternity hospital in Dublin, was undertaken from 2010–2011. Eligible women completed an interview at the first visit, a postal questionnaire during the third trimester of pregnancy, and were followed-up until the birth and discharge.

Results:

During pregnancy women who planned to exclusively breastfeed continued to consume alcohol at a rate similar to those who did not plan to breastfeed (30.2% compared with 27.5%; (OR 1.13; 95% CI; 0.84–1.53). Consuming alcohol was associated with older maternal age, Irish nationality and private health care. Intention to exclusively breastfeed was associated with socioeconomic group, non-Irish nationality and private health care. The findings at follow-up were similar to the first set of results with almost a third of women who consumed alcohol in pregnancy exclusively breastfeeding at the time of hospital discharge; (OR 1.28; 95% CI, 0.95–1.73)

Conclusions:

Many women who plan to breastfeed continue to consume alcohol in pregnancy despite national and international guidelines that recommend abstention. There may be opportunities in the antenatal period to influence behavioural change in relation to breastfeeding and alcohol consumption.
Maternal attitudes towards participation in a mother–baby research study
Authors: Barnett Sara , Jones Christine E
Published: February 2015

Maternal attitudes to participation in an observational research study were assessed using a structured self-administered questionnaire. The study involved collecting blood samples from mothers and infants after birth and at 5 months postpartum to analyse the concentration of specific antibodies against vaccine preventable diseases. The most common reason for study participation was a desire to further scientific knowledge (n=29; 44%); a smaller number were motivated by the benefits of study participation for their baby (n=11; 17%). Most mothers were not upset, or only a little upset, by blood sampling from their newborn; only a minority found it very upsetting. Most women expressed that they had derived some benefit from study participation as they were reminded when their babies' vaccines were due. This study has shown that participation in a study involving blood sampling of newborn babies was acceptable to participating women and this may encourage health professionals to consider postpartum mothers and neonates as candidates for inclusion in research studies.
Participation in strength training activities among US physical therapists: A nationwide survey
Authors: Tapley Howell , Dotson Megan , Hallila Daniel , McCrory Haley , Moss Kendall , Neelon Kris , Santos Bianca , Turner Andrew , Turner Lorena , Hendrick Paul
Published: February 2015

Background/Aims:

The typical physical therapist's workday involves teaching patients exercises to strengthen muscles. It is important for physical therapists to ‘practice what they preach’ by modelling good health behaviours in their own personal lives. The purpose of this study was to determine: i) whether strength training participation among physical therapists meets or exceeds commonly accepted standards for maintaining health; ii) how physical therapists participate in strength training.

Methods:

A Psychdata survey was developed and administered electronically to members (n=800) of the American Physical Therapy Association nationwide as part of a cross-sectional study design. A final sample of 153 surveys was collected and analysed in SPSS 15.0 for a 19% response rate. Frequency analysis was performed for all relevant survey items.

Results:

Approximately 67% of physical therapists regularly participate in traditional strength training that meets the American College of Sports Medicine exercise guidelines, and 55% regularly participate in alternative strength training, such as yoga and pilates, working all major muscle groups at moderate-to high-intensity at least two days per week.

Conclusions:

Most physical therapists appear to be good role models for engaging in strength training; more than half the physical therapists surveyed meet minimum guidelines for strength training whereas less than 20% of the general population meets the same minimum guidelines.
Topical oxygen wound therapies for chronic wounds: a review
Authors: Dissemond J. , Kröger K. , Storck M. , Risse A. , Engels P.
Published: February 2015

Chronic wounds are an increasing problem in our ageing population and can arise in many different ways. Over the past decades it has become evident that sufficient oxygen supply is an essential factor of appropriate wound healing. Sustained oxygen deficit has a detrimental impact on wound healing, especially for patients with chronic wounds. This has been proven for wounds associated with peripheral arterial occlusive disease (PAOD) and diabetic foot ulcers (particularly in combination with PAOD). However, this is still under debate for other primary diseases.

In the past few years several different new therapeutic approaches for topical oxygen therapies have been developed to support wound healing. These tend to fall into one of four categories: (1) delivery of pure oxygen either under pressurised or (2) ambient condition, (3) chemical release of oxygen via an enzymatic reaction or (4) increase of oxygen by facilitated diffusion using oxygen binding and releasing molecules.

In this review article, the available therapeutic topical oxygen-delivering approaches and their impact on wound healing are presented and critically discussed. A summary of clinical data, daily treatment recommendations and practicability is provided.

Declaration of interest:

J. Dissemond received an honorarium for lectures, advisory boards and/or clinical studies from the following companies: 3M, B. Braun, BSN, Coloplast, Convatec, Draco, Hartmann, KCI, Lohmann&Rauscher, Medoderm, Merz, Sastomed, Systagenix, UCB-Pharma, Urgo. K. Kröger received an honorarium for lectures, advisory boards and/or clinical studies from the following companies: Bayer, Sanofi, GSK, Hartmann, Sastomed, UCB-Pharma, Urgo. M. Storck received an honorarium for lectures for the following companies: KCI, Systagenix, and UCB-Pharma. A. Risse received an honorarium for lectures, advisory boards and/or clinical studies from the following companies: Bracco, Coloplast, Draco, Lilly Deutschland, NovoNordisk, Sastomed, Urgo. P. Engels received an honorarium for lectures, and consulting from the following companies: Sastomed, Oculus.
Management of a patient with small-area burns, severe sepsis and superficial vein thrombosis
Authors: Shao H , Luo R. , Wang X. , Pan X. , Chen G.
Published: February 2015

Sepsis is frequently seen in severely burned patients, however it is not common in those with small-area burns. We present a case of a 22-year-old man suffering from a hot crush injury to his left hand dorsum covering 1% of his total body surface area. The patient developed severe sepsis and superficial vein thrombosis, probably due to wound infection. Culture of the wound secretion indicated Corynebacterium striatum. Following intensive topical and systemic treatment the severe sepsis was controlled. The local wound was repaired by the abdominal skin pedicle flap which had taken well by day 27 post admission. A topical superficial vein thrombosis, unintentionally found 42 days after admission, was partially excised. This case demonstrates that when treating severe sepsis in patients with small-area burns, the timely recognition and diagnosis along with active systemic support, play a vital role in successful management.

Declaration of interest:

None of the authors have any financial interest to declare.