bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of Postnatal Care
Authors: Cranfield Frances M
Published: March 2018

A postal survey of the postnatal care received by 250 mothers during the three months after delivery in the North Herts Maternity Unit achieved a response rate of 74.6%. More than 80% of mothers responding felt that they had received adequate help from the hospital staff, community midwife and health visitor but only 50% felt that they had received adequate help from their general practitioner. There seemed to be a need for some relaxation of the policy of length of hospital stay, an increase in the level of postnatal instruction and improvement in the interaction between general practitioner and mothers.
What is Indigestion?1
Authors: Kingham J G C , Fairclough P D , Dawson A M
Published: March 2018

Ninety patients and 30 senior hospital doctors were questioned about indigestion and dyspepsia. There were marked discrepancies between the views of patients and doctors. Most doctors considered indigestion to be synonymous with dyspepsia and associated it with peptic ulcer. Patients, however, were not generally conversant with the term dyspepsia and linked indigestion with psychological factors, feeding patterns and bowel function rather than physical illness. The patients’ concept of indigestion corresponded closely with medically-accepted features of irritable bowel syndrome. Uncritical use of these terms may lead to misinterpretation of the patient's complaint and inappropriate management.
Peripheral Neuropathy in Hypothyroidism - an Association with Spurious Polycythemia (Gaisbock's Syndrome)1
Authors: Martin Jane , Tomkin G H , Hutchinson Michael
Published: March 2018

The neurological complications of hypothyroidism, including dementia, cerebellar ataxia, myopathy and entrapment neuropathy, are well recorded, but peripheral neuropathy has rarely been documented (Swanson et al. 1981). In this paper two patients are described who developed myxoedema and peripheral neuropathy. The first patient had a very rapid onset of myxoedema, and during observation he developed spurious polycythemia (Gaisbock's syndrome) over a period of nine days.
Renal trauma and the intravenous urogram
Authors: Oakland C D H , Britton J M , Charlton C A C
Published: March 2018

A retrospective analysis of all patients with blunt abdominal trauma associated with haematuria admitted to one hospital (Royal United, Bath) in a 10-year period was conducted to establish the contribution of the intravenous urogram (IVU) in their management. Eighty-one case records were analysed. Of 35 IVUs performed in patients with microscopic (reagentstrip positive) haematuria, only one was abnormal. In contrast, 27 IVUs performed in patients with macroscopic (naked eye) haematuria revealed 17 major injuries and 5 previously unrecognized congenital abnormalities. It is concluded that an IVU is an unnecessary and non-contributory investigation in patients with microscopic haematuria and guidelines are suggested for the role of IVU in patients with blunt abdominal trauma associated with haematuria.
Effects of Cytotoxic Chemotherapy on Dental Development
Authors: Macleod R I , Welbury R R , Soames J V
Published: March 2018

A histological study of 21 teeth from 9 patients who had received cytotoxic chemotherapy for malignant disease showed increased prominence of incremental lines in the dentine. The number and distribution of these lines corresponded to periods of intravenous therapy and vincristine appeared to be the most likely cause. This effect was probably due to temporary disturbance of microtubular function in the odontoblasts resulting in decreased secretion of collagenous dentine matrix. Calcification appeared to be unaffected.
Measurement and Prediction of Progress in Delayed Wound Healing
Authors: Bulstrode C J K , Goode A W , Scott P J
Published: March 2018

Thirty chronic leg ulcers have been studied under controlled conditions until complete healing occurred. Measurement was performed weekly using a computer-linked stereocamera which is capable of measuring skin defects noninvasively with errors of less than 2%. There was a significant difference in healing rate for the first two weeks between clean ulcers entering the trial directly and ulcers admitted first for cleansing before joining the trial. The difference suggests that the weekly healing rate of an ulcer may take up to 2 weeks to respond to a new form of treatment. Absolute ulcer size, change in ulcer size and rate of epithelial migration did not correlate well with time to complete healing, but percentage change in area in the third week was found to be the parameter which gave the earliest close correlation with time to complete healing. Using this parameter, on the data available it was found that time to complete healing could be predicted to within one week for 50% of the ulcers, making this a simple and useful early predictor of treatment efficiency.
The Irritable Bowel Syndrome: A Disease or a Response? Discussion Paper
Authors: Eastwood M A , Eastwood J , Ford M J
Published: March 2018

The irritable bowel syndrome is a problem commonly found in the population as a whole, in general practice and in general hospital and specialist gastroenterological clinical practice. A population survey found that 14% of those interviewed exhibited symptoms of the irritable bowel syndrome but did not present to their general practitioner. In the gastroenterology clinic it is said to represent approximately one-third to one-half of referrals1.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (4)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the fourth of a series of articles on the planning and building of anew radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning. (The first article in the series appeared in the January issue, p 40.)
Autologous Blood Transfusion in Elective Orthopaedic Surgery
Authors: James S E , Smith M A
Published: March 2018

Autologous blood transfusion is one of the most effective ways of avoiding the need for homologous transfusion and all its associated complications. Since the beginning of 1985, autotransfusions have been used in 48 patients undergoing total joint replacement, without significant complications. Their average haemoglobin level two weeks postoperatively was 11.3 mg/dl. We believe that this is a safe, effective and economical procedure which benefits both patients and medical staff, and its use should be more widespread.
‘D’ Excision for Sacrococcygeal Pilonidal Sinus Disease
Authors: Mann C V , Springall R
Published: March 2018

A new procedure is described for treating pilonidal sinus by an excision and primary suture technique, and the results reported in 30 consecutive patients so treated - 28 with chronic sinuses and 2 with an acute abscess. Seventeen patients (Group 1) had had no previous surgery, while 13 (Group 2) had had multiple previous operations. A total of 24 patients (80%) healed after the operation, their mean hospital stay being 16 days. In Group 1 the success rate was 88% with a mean hospital stay of 15 days; in Group 2 the comparable figures were 69% and 17 days. After additional procedures (usually curettage) all patients healed.
National Study of Health and Growth: Effect of change in design with reference to efficiency of mixed longitudinal studies for measuring trends
Authors: Chinn S , Rona R J
Published: March 2018

The National Study of Health and Growth (NSHG) is a surveillance system which monitors the growth of primary school children in England and Scotland, set up in 1972 following changes in the school milk and welfare system. However, the study contained few children from inner city areas or ethnic minorities. In 1982 its design was changed from one in which the same areas were surveyed every year, to two separate systems with areas surveyed every two years, one set of areas corresponding to those in the original study, and the other set consisting of inner city and ethnic minority areas. The precision of the estimates of trends in height and weight for each system was smaller than that of the original system, but by less than 50%, so that an overall gain in information was achieved. Studies of mixed longitudinal design are shown also to be generally, but not always, less efficient for estimating trends than independent cross-sectional surveys obtaining the same number of measurements.
Intractable Trigeminal Neuralgia
Authors: Watts P G
Published: March 2018

In 49 cases of trigeminal neuralgia seen at the Abingdon Pain Relief Unit, Oxfordshire, the average time between initial onset of pain and first referral to the unit was 9.8 years. The pattern of presentation and distribution was no different from previously published studies, indicating that the more intractable cases cannot be predicted at first presentation.
Intracranial Pressure and its Monitoring in Childhood: A Review
Authors: Newton R W
Published: March 2018

Failure to measure intracranial pressure (ICP) in the childhood encephalopathies has been likened to treating heart failure without measuring the blood pressure. Raised ICP adds considerably to the morbidity and mortality of cerebral disease, yet its routine measurement remains controversial. This paper reviews the causes, measurement and management of ICP and outlines the indications for monitoring.
Alcohol and Seizures: A Review
Authors: Brennan F N , Lyttle J A
Published: March 2018

A relationship between alcohol and seizures has been recognized for many centuries, and in the last century Echevarria1 described 45% of an alcoholic population as having seizures at some stage. The exact relationship, however, between alcohol and seizures has remained uncertain. Advice with regard to the management of these patients, particularly as regards drug therapy and advice on fitness to drive, remains equally imprecise.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (9)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the ninth of a series often articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning.

An expanded version of this series is to be published as a book in 1988 by the Royal Society of Medicine, and will include a comprehensive index.
Undergraduate clinical neurosciences programme development: A consumer-based evaluation
Authors: Gledhill R F
Published: March 2018

Intern responses to a questionnaire were used to evaluate an undergraduate clinical neurosciences programme. The data obtained were judged an authentic measure of instructional efficacy. Most interns rated themselves competent in performing the neurological examination but ill-equipped to interpret their findings and to manage effectively common problems, especially emergencies. Neurological diseases and the non-biomedical aspects of patient care were identified relatively infrequently as matters needing greater emphasis. Explanations for these findings may include a curriculum of traditional format, differences in teaching and assessing theoretical and practical competence, and the typical responsibilities of interns in an academic hospital.

Intern evaluation of undergraduate clinical programmes can provide data useful to their development.
Undergraduate urology teaching: Results of a pre-examination revision quiz
Authors: Kelly M J
Published: March 2018

A ‘revision quiz’ using some 20 projected photographic slides and a structured open-ended answer sheet was administered to, and marked for, 75 Final MB candidates and 7 Final FRCS candidates at Bristol. Despite only a modest exposure to specialist urological teaching, the undergraduates were judged to have achieved an acceptable level of performance in most areas except for the treatment of urinary infections. The performance of the senior house officers was not better than that of the undergraduates. Nearly all candidates in both groups undermarked their own scripts compared to the marks given by their teachers, thus fuelling, perhaps needlessly, their anxieties about examinations.
Anticoagulation Control with Warfarin by Junior Hospital Doctors
Authors: Doble N , Baron J H
Published: March 2018

Anticoagulation control in hospital inpatients was monitored in a prospective study. Only 47% of the blood results were within the therapeutic range which is presently recommended.
Cardiac Munchausen's syndrome
Authors: Dickinson E J , Evans T R
Published: March 2018

Ten years' experience of cardiac Munchausen's syndrome in the Cardiac Care Unit of an Inner London teaching hospital is reported. Thirty-six admissions in this category were identified and analysed, and 4 typical cases are described. The common presenting complaints, recurring features and the relationship with other forms of Munchausen's syndrome are discussed, as are posible strategies available to deal with this clinical entity.
Building or Extending a Hospital Department: Radiology a Path through the Planning Minefield (10)
Authors: Roebuck E J , Manton D J , Fordham G L
Published: March 2018

This is the last of a series of ten articles on the planning and building of a new radiology department or the extension of an old one. While the series focuses on a radiology department, it will be of interest to anyone who is planning any part of a hospital, particularly in the detailed information about the planning process and the part to be played by hospital staff during the subsequent building and commissioning.

An expanded version of this series is to be published as a book in 1988 by the Royal Society of Medicine, and will include a comprehensive index.
Mushroom Compost Worker's Lung
Authors: Phillips M S , Robinson A A , Higenbottam T W , Calder I M
Published: March 2018

This study draws attention to difficulties in the diagnosis and the understanding of the mechanism of action of mushroom compost worker's lung. Descriptions are given of 4 workers in one factory who developed acute respiratory failure within a 6-month period; 13 others who were unaffected were also studied. Serological investigation appears to be largely unhelpful, and the evidence against the condition being included amongst the extrinsic allergic alveolitides is discussed. A detailed clinical and occupational history is essential for diagnosis.
Multimodality Detection of Metastatic Melanoma
Authors: Kuan A K , Jackson F I , Hanson J
Published: March 2018

A retrospective evaluation of radionuclide liver and spleen scintigraphy (LS), ultrasonography (US), and computed tomography (CT) was performed in 88 patients who had pathologically proven cutaneous melanoma. In patients who had all three examinations ( n=24), the matrix analysis showed that CT was significantly more sensitive (0.94) in detecting intra-abdominal metastasis when compared to US (0.62, P<0.05) and LS (0.38, P<0.01). Sixty-four patients had only US and LS studies. In this group of patients US was found to be more sensitive than LS, 0.88 and 0.54 respectively ( P<0.01). Furthermore, when CT was compared with US, CT was shown to detect metastases significantly earlier than US ( P=0.03). Overall, CT provided the most accurate means for detecting the intra-abdominal metastases of cutaneous melanoma.
Neurological Presentations of AIDS-when to Test for HIV
Authors: Fuller G N , Guiloff R J , Gazzard B , Harcourt-Webster J N , Scaravilli F
Published: March 2018

Nine of 122 patients dead from AIDS in central London presented with neurological disease, confirmed pathologically in seven. Seven had no other major systemic manifestations. AIDS needs to be considered in the differential diagnosis of meningitis, dementia, diffuse and focal encephalopathies, brainstem syndromes, myelopathy, visual failure and peripheral nerve syndromes. As AIDS becomes more widespread there will be an increasing need for diagnostic HIV testing in many neurological syndromes.
Subarachnoid Haemorrhage-Can We Do Better?
Authors: Johnston S R D , Hammond A , Griffiths L , Greenwood R , Clarke C R A
Published: March 2018

Patients with subarachnoid haemorrhage often have warning symptoms which are unrecognized. Specific neurological signs such as cranial nerve palsies due to aneurysm expansion may occur. Sudden and severe ‘out-of-the-blue’ headache following minor haemorrhage may be misinterpreted as migraine. Focal neurological signs from secondary ischaemia may be misinterpreted as thromboembolic events. Computed tomography (CT) head scans can be misleading especially if performed too late.
Intolerance to Oral and Intravenous Calcium Supplements in Atopic Eczema
Authors: Devlin J , David T J
Published: March 2018

Children treated with dietary restriction for food intolerance may require calcium supplementation, particularly if cows' milk and milk substitutes are not tolerated12. We report two children with atopic eczema who reacted adversely to a number of calcium supplement formulations.
The Pentothal Test in the Management of Orthopaedic Patients with Hysterical Illness
Authors: Cornell M S , Ahktar T , Slater R N S , Walker C J
Published: March 2018

Hysterical illness may be defined as symptoms normally associated with disease without pathological basis. Orthopaedics attracts more of these patients than most specialties. They are intensively and expensively investigated, yet clinicians remain anxious they are missing genuine pathology. We use examination under pentothal, without analgesia, to help distinguish real from imagined symptoms. The results of a review of patients evaluated under pentothal over the past two years are presented.
Cavernous Haemangioma with Kasabach-Merritt Syndrome: Treatment with Alpha-Interferon
Authors: Ettlinger J J , Fleming P J , Joffe H S , Kennedy C T C
Published: March 2018

A small number of patients with haemangioma need treatment for serious complications such as Kasabach-Merritt syndrome, cardiac failure and obstruction of the airway. We report on the management of an infant with Kasabach-Merritt syndrome.
Near-Death Experiences
Authors: Blackmore Susan J
Published: March 2018

Reactions to claims of near-death experiences (NDE) range from the popular view that this must be evidence for life after death, to outright rejection of the experiences as, at best, drug induced hallucinations or, at worse, pure invention.

Twenty years, and much research, later, it is clear that neither extreme is correct.
A Winter Survey of Domestic Heating among Elderly Patients
Authors: Morgan R , Blair A , King D
Published: March 2018

Elderly people have a greater need for domestic heating given the time they spend at home and the decline in the body thermoregulation that occurs with ageing. The use of domestic heating by 200 mentally competent newly admitted elderly in patients was evaluated by means of a questionnaire survey. Most patients (69%) were aware of the addition of value added tax (VAT) to their fuel bill and 31 % said they had reduced the amount of heating they use because of this. A third of patients (29.5%) said they had difficulty keeping warm prior to this admission. The majority of patients said they could not manage to keep warm in the winter without financial hardship. In addition, 29% said they had reduced the amount spent on food in order to pay for fuel bills. This study suggests that cold may contribute to hospital admissions in elderly patients. This should have implications for government spending and taxation policy on domestic heating.
Recurrent Panniculitis as the First Clinical Manifestation of Recurrent Acute Pancreatitis Secondary to Cholelithiasis
Authors: Cheng K S , Stansby G , Law N , Gardham R
Published: March 2018

A case of recurrent panniculitis in the legs as the first clinical manifestation of recurrent acute pancreatitis secondary to cholelithiasis is described in a 59-year-old Caucasian woman.
Secondary Amenorrhoea after Total Body Irradiation in Pre-Puberty
Authors: Albanese A , Leiper A D , Pritchard J , Stanhope R
Published: March 2018

Bone marrow transplant (BMT) has been used as part of the overall treatment of refractory malignant diseases. High dose cyclophosphamide and total body irradiation (TBI) are frequently used as conditioning for BMT. Initial regimens included a single fraction of TBI, with doses varying from 7.5-1O Gy, but this was associated with a high incidence of late sequelae including multiple endocrinopathies1. A fractionated irradiation course over 3-4 days of a higher total dose, 12-15 Gy, of TBI is now used1,2. Successfully treated patients with childhood cancer have an increased risk, of developing second tumours. We describe a patient successfully treated for AML who developed multiple endocrine dysfunction and a second benign ovarian tumour.
Preventing the Admission of Difficult Psychiatric Patients—A Questionnaire Survey
Authors: Neeleman Jan , Watts Vik
Published: March 2018

By means of a postal survey of all consultant psychiatrists (n=143) in the South East Thames Region, the authors examined factors associated with psychiatrists’ decisions to impose restrictions on certain patients’ access to admission. Twenty-two per cent of respondents reported the use of admission restrictions. Usage of this measure was associated with a local absence of psychotherapy services (OR 0.34; 95% CI 0.17–0.63) which might suggest that there is a need for more equal access to specialist psychiatric services across health districts.
The Canadian Familial Adenomatous Polyposis Registry: Past, Present and Future
Authors: Stern Hartley S
Published: March 2018

The advent of the molecular world opening up for familial adenomatous polyposis and other genetically predisposed cancers has now provided us with wonderful tools to study these diseases. The challenges, however, clearly remain to transfer discoveries in the laboratory to improvements in the care of these patients.
Severe Small Airways Disease Resistant to Medical Treatment in a Child with Cystic Fibrosis
Authors: Davies J , Rosenthal M , Bush A
Published: March 2018

At the age of 12, a child with cystic fibrosis developed severe small airways obstruction of unknown aetiology, in the absence of significant bronchiectasis. He remained resistant to medical treatment until, following an exacerbation of allergic bronchopulmonary aspergillosis 18 months later, he responded to high dose oral steroids. He now remains steroid-dependent, and suffering from multiple side-effects. Possible aetiology and further therapeutic strategies are discussed.
Intra-Operative Parathyroid Hormone Assay for Simplified Localization of Parathyroid Adenomas
Authors: Saharay M , Farooqui A , Farrow S , Fahie-Wilson M , Brown A
Published: March 2018

Lack of success in parathyroid surgery is usually due to failure to identify the abnormal parathyroid gland correctly at operation. The surgeon may be helped by rapid parathyroid hormone (PTH) assay in peripheral blood after removal of a suspected adenoma, and by frozen section histology, but these are not true localization techniques. We have adapted a non-isotopic immunoassay for rapid measurement of PTH in samples from the upper, middle and lower thyroid veins taken at operation, before exploration begins.

Fifteen patients with primary hyperparathyroidism were operated on. In 10 the parathyroid adenoma was located easily, and was associated with high local venous PTH levels. In four patients the abnormal parathyroid was not immediately apparent but the assay indicated its location, which was confirmed after further exploration. In one patient there was no difference in PTH levels in the six venous samples. An ectopic adenomatous gland was successfully identified behind the thymus. The operation was successful in all patients as shown by a fall in the plasma calcium to the normal range.

We conclude that intra-operative selective venous sampling and rapid PTH assay facilitates operative localization of parathyroid adenomas.
Can Acupuncture have Specific Effects on Health? A Systematic Review of Acupuncture Antiemesis Trials
Authors: Vickers Andrew J
Published: March 2018

The effects of acupuncture on health are generally hard to assess. Stimulation of the P6 acupuncture point is used to obtain an antiemetic effect and this provides an excellent model to study the efficacy of acupuncture. Thirty-three controlled trials have been published worldwide in which the P6 acupuncture point was stimulated for treatment of nausea and/or vomiting associated with chemotherapy, pregnancy, or surgery.

P6 acupuncture was equal or inferior to control in all four trials in which it was administered under anaesthesia; in 27 of the remaining 29 trials acupuncture was statistically superior. A second analysis was restricted to 12 high-quality randomized placebo-controlled trials in which P6 acupuncture point stimulation was not administered under anaesthesia. Eleven of these trials, involving nearly 2000 patients, showed an effect of P6. The reviewed papers showed consistent results across different investigators, different groups of patients, and different forms of acupuncture point stimulation.

Except when administered under anaesthesia, P6 acupuncture point stimulation seems to be an effective antiemetic technique. Researchers are faced with a choice between deciding that acupuncture does have specific effects, and changing from ‘Does acupuncture work?’ to a set of more practical questions; or deciding that the evidence on P6 antiemesis does not provide sufficient proof, and specifying what would constitute acceptable evidence.
An Analysis of Telephone Calls to an Inner-City Accident and Emergency Department
Authors: Crouch Robert , Patel Anita , Williams Susan , Dale Jeremy
Published: March 2018

The general public in the UK often telephone accident and emergency (A&E) departments for medical advice. Such calls are usually dealt with by nursing staff in an informal manner (often with no written record of the call being made). The specific questions addressed in this study are who was calling for advice, when did they call, what were their presenting complaints, and what was the outcome of the call? In addition, the study provided an opportunity to test the implementation of a new system of record-keeping for telephone consultation. A telephone consultation record (TCR) was developed and used to record details of each call made to the A&E department for medical/health advice.

An analysis of 597 consecutive documented calls is presented in this paper. The majority of calls were dealt with by ‘E’ grade nursing staff (42.7%); only four calls (0.7%) were recorded by medical staff. Two hundred and six (43.5%) calls related to patients aged up to 15 years. In 57% of the cases the call was made by a third party. In all, 149 different presenting complaints were recorded on the TCRs. The three most common presenting complaints were dental problems (7.4%), fever (4.3%), and concerns about drug reactions (23%). Seventy-three per cent of callers were advised that a visit to the A&E department was not immediately necessary.

The study identifies several important issues for development of a more formal and effective system of telephone advice. The majority of calls made to the A&E department appeared to be of a primary care nature but the extent to which nurses are trained to assess and advise on these problems needs to be questioned. A reluctance to document the calls to A&E was identified, one reason being a concern about accountability. Training and support are clearly required.
Seroprevalence of Hepatitis B and C Virus in Two Institutions Caring for Mentally Handicapped Adults
Authors: Cramp M E , Grundy H C , Perinpanayagam R M , Barnado D E
Published: March 2018

Hepatitis B virus infection is common in institutions caring for the mentally handicapped. Hepatitis B virus and hepatitis C virus share routes of transmission but the prevalence of hepatitis C virus infection in this population is unknown.

We have tested 101 patients from two institutions in South-East England caring for adults with mental handicap for the presence of hepatitis C antibody, hepatitis B core antibody, and if necessary hepatitis B surface antigen. None tested positive for hepatitis C antibody, but 43 had hepatitis B core antibody of whom 14 were chronic carriers positive for hepatitis B surface antigen.

Unlike hepatitis B virus, hepatitis C virus infection appears to be uncommon in UK institutions.
Advance Directives: From the Perspective of the Patient and the Physician
Authors: Johnson Sarah Coate
Published: March 2018

American physicians and patients share some common ground in their perspectives on advance directives. The majority in both groups strongly endorse the use of these documents. Both groups believe it is the physician's responsibility to initiate the discussion about advance directives. However, a gap between the two perspectives can be defined. In end-of-life decision making, physicians balance the ethical principle of patient autonomy with other principles such as appropriate withholding of care in the setting of futility. Patients’ preferences for end-of-life care are most influenced by expected outcomes. Physicians tend to be selective in their indications for initiating a discussion about advance directives, according to clinical factors. In contrast, most patients want to discuss advance directives with their physician under all circumstances.
Do Community Hospitals Reduce the Use of District General Hospital Inpatient beds?
Authors: Hine Christine , Wood Victorine A , Taylor Stephen , Charny Mark
Published: March 2018

Community hospitals have been supported by the general public and by professionals as one means of increasing choice between local, low technology, care and high technology care at the district general hospital. However, there is no information on the impact of community hospitals on district general hospital use subsequent to NHS and community care reforms.

Examination of routinely gathered activity data in the Bath Health District revealed that availability of community hospital beds was associated with reduced use of central inpatient services in the city of Bath. The reduction was most apparent for medical and geriatric beds. Decrease in the use of surgical beds was small. However, total inpatient bed use (including central and community hospital beds) was higher in the population with access to community hospital beds.

We conclude that community hospitals offer one option for accessible health care and, as such, merit systematic evaluation of costs and benefits. This study presents some evidence that savings could be achieved through improved efficiency.
The Countess Margaret of Henneberg and Her 365 Children
Authors: Bondeson J , Molenkamp Arie
Published: March 2018

According to an oBScure medieval legend, the Countess Margaret of Henneberg, a notable Dutch noblewoman, gave birth to 365 children in the year 1276. The haughty Countess had insulted a poor beggar woman carrying twins, since she believed that a pair of twins must have different fathers, and that their mother must be an adultress. She was punished by God, and gave birth to 365 minute children on Good Friday, 1276. The Countess died shortly after, together with her offspring, in the village of Loosduinen near The Hague. The Countess and her numerous brood were frequently described in historical and obstetrical works. To this day, a memorial tablet and two basins, representing those in which the 365 children were baptized, are to be seen in the church of Loosduinen.
Towards a framework to evaluate the ‘total’ performance of buildings
Authors: Taylor Jonathon , Liu Yanchen , Lin Borong , Burman Esfand , Hong Sung-Min , Yu Juan , Wang Zhe , Mumovic Dejan , Shrubsole Clive , Vermeer Daan , Davies Mike
Published: March 2018

Internationally, buildings are a major contributor to carbon emissions. Despite significant advances in the technology and construction of energy-efficient buildings, in many cases a performance gap between designed and actual performance exists. While much research has investigated the drivers of the building energy performance gap – both static and transient– there has been considerably less research into the total performance gap, defined here as performance gaps in building energy use, occupant satisfaction and Indoor Environmental Quality parameters such as thermal comfort and air quality which may impact on occupant health and wellbeing. This paper presents a meta-analysis of building performance data from buildings in the UK and China – selected due to their contrasting development environments – which illustrate the presence of and complexities of evaluating total performance gaps in both countries. The data demonstrate the need for (1) high end-use, spatial granularity and temporal resolution data for both energy and Indoor Environmental Quality, and (2) developing methodologies that allow meaningful comparisons between buildings internationally to facilitate learning from successful building design, construction methodologies and policy environments internationally. Using performance data from a UK building, a potential forward path is illustrated with the objective of developing a framework to evaluate total building performance.

Practical application: While much research has examined building energy performance gaps, Indoor Environmental Quality and occupant satisfaction gaps are rarely included despite their relationship to energy. We use a meta-analysis of energy, indoor environmental quality, and occupant satisfaction data from buildings in the UK and China to illustrating the presence of and complexities of evaluating total performance gaps for buildings in the two countries, and the need for high resolution dynamic buildings data and novel methodologies for comparison between buildings across different contexts. Illustrative case studies are used to demonstrate potential future directions for evaluating ‘total’ building performance.
What Constitutes ‘Discrimination’ in Everyday Talk? Argumentative Lines and the Social Representations of Discrimination
Authors: Greenland Katy , Andreouli Eleni , Augoustinos Martha , Taulke-Johnson Richard
Published: March 2018

Most people agree that discrimination is wrong, but the boundary between ‘discrimination’ and ‘not discrimination’ is often highly contested in everyday practice. We explore the social representations of ‘discrimination’ as an object of study in qualitative interviews and focus groups with both minority (self-identified as BAME [Black, Asian, and minority ethnic] and/or gay men) and majority (self-identified as White and/or heterosexual) participants ( n = 54). Our analysis suggests three repeated and pervasive argumentative lines in social representations of discrimination: (1) that there are two distinct kinds of discrimination (hard vs. soft), (2) that you need to understand the intention of the actor(s), and (3) that a claim of discrimination requires strong evidence. We outline the macro Functions of these resources to argue that each was non-performative: They appeared to be tools to make claims of discrimination, but in practice they were much more effective at making claims of what was not discrimination.
A hybrid dynamical extension of averaging and its application to the analysis of legged gait stability
Authors: De Avik , Burden Samuel A , Koditschek Daniel E
Published: March 2018

We extend a smooth dynamical systems averaging technique to a class of hybrid systems with a limit cycle that is particularly relevant to the synthesis of stable legged gaits. After introducing a definition of hybrid averageability sufficient to recover the classical result, we illustrate its applicability by analysis of first a one-legged and then a two-legged hopping model. These abstract systems prepare the ground for the analysis of a significantly more complicated two legged model: a new template for quadrupedal running to be analyzed and implemented on a physical robot in a companion paper. We conclude with some rather more speculative remarks concerning the prospects for further extension and generalization of these ideas.
Metal composition of ambient PM2.5 influences the pulmonary function of schoolchildren: A case study of school located nearby of an electric arc furnace factory
Authors: Huang Bing-Fang , Chang Ya-Chi , Han Ai-Ling , Hsu Hui-Tsung
Published: March 2018

The present study combined air sampling with pulmonary function tests (PFTs) to determine both the extent of air pollution proximal to an electric arc furnace (EAF) and its impact on human health. The mass concentrations of particulate matter with aerodynamic diameters less than 2.5 µm (PM2.5) in exposure areas were not significantly higher than the samples taken at a control area. However, the concentrations of five metal elements, Cd, Cr, Cu, Ni, and Zn in PM2.5 were significantly higher in the exposure area than that of the control area. PFTs showed that the average forced vital capacity (FVC) of boys was decreased with decreasing distance from the EAF factory. With normalization of pulmonary function by age, height, and weight, we found that the FVC became more negative with a decrease in distance from the EAF. Lastly, regression analysis was performed to analyze the impact of the concentrations of the five metals in PM2.5 on the performance of pulmonary function. The results showed that the metals can be ranked from the highest to the lowest in terms of impact on the FVC of boys as follows: Cr, Cd, Ni, Cu, and Zn. This finding is consistent with the ranking of metal toxicity reported in the literature for a rat lung epithelial cell line. The results of this study showed that only measuring PM2.5 mass concentrations may not provide a full explanation of its toxicity and health effects. The chemical composition of the PM2.5 can be an important factor that determined the health impact of PM2.5.
Caregiver Burden, Care Recipient Depressive Symptomology, and Social Exchange
Authors: Ejem Deborah , Bauldry Shawn , Bakitas Marie , Drentea Patricia
Published: March 2018

Informal caregivers play a vital role in supporting seriously ill patients. However, informal caregiving is burdensome and can lead to negative health outcomes for the caregiver and the care recipient. The study’s aim was to evaluate relationships among caregiver burden, care recipient depressive symptomology, and race. Guided by the social exchange perspective, we examined cross-sectional dyadic data from the National Long-Term Care Survey (N = 1279). Using ordinal logistic regression, we found that higher caregiver-reported objective burden was associated with higher care recipient depressive symptoms ( P < .05), an association that was stronger for blacks. Interestingly, despite significant levels of objective burden, there was an association between lower depressive symptoms in black care recipients when there was an exchange of the social good “helpful company” with a caregiver. These findings illustrate the importance of supporting reciprocal exchange as a promising component of maintaining balanced caregiver–care recipient relationships among black older adults and their informal caregivers.
Theory, practice and policy
Authors: Zhang Qiantao
Published: March 2018

This article examines the progress of university knowledge exchange in the United Kingdom over a decade, linking theory, practice and policy. As indicated by the literature, the performance of university knowledge exchange is influenced by institutional and locational characteristics. Data on 133 UK universities between 2003–2004 and 2012–2013 are used in the empirical analysis, which confirms the important roles of institutional (established vs. new) and locational (competitive vs. uncompetitive) characteristics of universities. Nevertheless, it is found that the current policy approach in the United Kingdom fails to consider the heterogeneity of the higher education sector. This is problematic given that a substantial amount of funding has been committed to boosting university knowledge exchange over the past 20 years. In addition, the results suggest that the knowledge exchange policy should not be implemented alone; rather, it should be developed in conjunction with industrial and innovation policies.
The effects of shape memory alloys’ tension–compression asymmetryon NiTi endodontic files’ fatigue life
Authors: Karamooz-Ravari MR , Dehghani R
Published: March 2018

Nowadays, NiTi rotary endodontic files are of great importance due to their flexibility which enables the device to cover all the portions of curved canal of tooth. Although this class of files are flexible, intracanal separation might happen during canal preparation due to bending or torsional loadings of the file. Since fabrication and characterization of such devices is challenging, time-consuming, and expensive, it is preferable to predict this failure before fabrication using numerical models. It is demonstrated that NiTi shape memory alloy shows asymmetric material response in tension and compression which can significantly affect the lifetime of the files fabricated from. In this article, the effects of this material asymmetry on the bending response of rotary files are assessed using finite element analysis. To do so, a constitutive model which takes material asymmetry into account is used in combination with the finite element model of a RaCe file. The results show that the material asymmetry can significantly affect the maximum von Mises equivalent stress as well as the force–displacement response of the tip of this file.
The Effect of Supply Chain Relationships on Resilience: Empirical Evidence from India
Authors: Mandal Santanu , Sarathy Rathin
Published: March 2018

The purpose of this study is to explore the influence of supply chain relationships on supply chain (SC) resilience through empirically exploring the effects of trust, communication, commitment and cooperation on SC resilience and its further impact on supply chain performance. We employed a cross-sectional survey through online mode for collecting perceptual responses from supply chain professionals. Using 155 completed responses, the study further analysed using SmartPLS to validate the proposed relationships. Findings suggest communication and cooperation as dominant enablers of SC resilience in the integrated model that explored the inter-relationships also among the proposed relational attributes. Also, SC resilience has positive performance implications. Alternate models were suggested to further explore the inter-play between communication, trust, commitment and cooperation and how the same influences the SC resilience. The study is the first to consider the inter-relationships among the relational attributes and how the same as a whole influences SC resilience.
A Prescription for Prescribing: Ensuring Continued Pharmacist Preparedness
Authors: Zimmerman Kristin M. , Salgado Teresa M. , Goode Jean-Venable R. , Sisson Evan M. , Dixon Dave L.
Published: March 2018

The scope of practice for pharmacists in the United States increasingly includes elements of prescribing under collaborative practice agreements and statewide protocols. However, as a result of continued health care access concerns, we believe that pharmacists will be called on to serve as independent prescribers in the future. For this anticipated practice expansion to become a successful reality, the assurance of pharmacist preparedness and continuous professional development through profession-wide standards will be imperative.
Perioperative Surgical Home Reduces Rapid Response Calls to a Postoperative Surgical Ward: How Anesthesiologists Are Improving the Inpatient Safety Net
Authors: Walters Tessa L. , Kim T. Edward , Mariano Edward R. , Lighthall Geoffrey Kenton
Published: March 2018

Background. The Perioperative Surgical Home (PSH) is an anesthesiologist-led, coordinated care model that may improve patient experience and safety. We hypothesized that PSH will decrease activation of the rapid response system for surgical inpatients. Methods. This retrospective study was performed at an academic Veterans Affairs hospital with a PSH. Data from both medical and surgical cohorts admitted to a single ward were analyzed for the Pre-PSH (July 2006 to October 2010) and Post-PSH (November 2011 to May 2015) epochs. The primary outcome was incidence of rapid response team (RRT) activations per 1000 bed-days. Results. Surgical patients had 5.8 RRT activations per 1000 bed-days Pre-PSH versus 3.7/1000 bed-days Post-PSH ( P = .006). There was no difference in RRT activations per 1000 bed-days for medical patients before and after PSH implementation. Pre-PSH was an independent predictor of mortality in the multivariable model (odds ratio = 1.7; P = .010). Conclusion. PSH is associated with decreased RRT activations among surgical inpatients only.
Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management
Authors: Poletti Fabrizio , Coccino Claudio , Monolo Davide , Crespi Paolo , Ciccioli Giorgio , Cordio Giuseppe , Seveso Giovanni , De Servi Stefano
Published: March 2018

Purpose:

Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care.

Methods:

All patients admitted to cardiac intensive care unit with indication for elective central venous access were checked by venous arm ultrasound for peripherally inserted central catheter’s implantation. Peripherally inserted central catheters were inserted by ultrasound-guided puncture. After 7 days from the catheter’s placement and at the removal, vascular ultrasound examination was performed searching signs of upper extremity deep venous thrombosis. In case of sepsis, blood cultures peripherally from the catheter and direct culture of the tip of the catheter were done to establish a catheter-related blood stream infection.

Results:

In our cardiac intensive care unit, 137 peripherally inserted central catheters were placed: 80.3% of patients eligible for a peripherally inserted central catheter were implanted. The rate of symptomatic catheter-related peripheral venous thrombosis was 1.4%. Catheter-related blood stream infection was diagnosed in one patient (0.7%; 5.7 × 1000 peripherally inserted central catheter days). All peripherally inserted central catheters were inserted successfully without other major complications.

Conclusions:

In patients admitted to cardiac intensive care unit, peripherally inserted central catheters’ insertion was feasible in a high percentage of patients and was associated with low infective complications and clinical thrombosis rate.