bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustainability as an ecology of learning, thinking and acting: Using the World Health Organization’s six P’s as an action-research intervention to create public value with multiple bottom lines
Authors: Amhøj Christa Breum
Published: May 2019

This paper elaborate on how sustainabilising entails rethinking about areas that include rationality, organisations, knowledge, leadership and value and about transforming these areas into an ecological way of thinking, learning and acting. We argue that sustainability needs to become a verb, something we do. However, one thing is rethinking areas; another thing is to work it into a craft of research. Therefore, the second section in the paper unfolds a conceptualisation of a specific action-learning project in Danish municipalities, called ‘Sustainable and Healthy Cities through Urban Nature Relations’. This project transforms the theoretically rethinking of sustainability into a craft of research. Informed by the proposed theoretical lens, the action-learning process involves research based on the World Health Organization’s six P’s (people, place, participation, peace, prosperity and planet). The action research can be understood as a process of taking risks, becoming disorientated and moving beyond the comfort zone. However, the six P’s and thereby the cross-professional groups, the place, the participation and the value of the process is all about collective techniques and about care. It aims to create an emerging ecology of practices and of belonging and co-existing lives. It creates a field of actions a ‘milieu’ but without a fixed horizon.
The lived experiences of adults with a visual impairment who experience fatigue when performing daily activities
Authors: Bakker Kim , Steultjens Esther , Price Lee
Published: May 2019

Introduction

Little is known about fatigue experienced by adults with a visual impairment and the impact this can have on their daily activities. This study explored the lived experiences of adults with a visual impairment who experience fatigue when performing daily activities. The aim was to enhance occupational therapists’ knowledge and understanding of the phenomenon and to suggest future interventions for clients who have a visual impairment and fatigue.

Method

An interpretative phenomenological analysis was performed. Five adults with a visual impairment who experienced fatigue were recruited via purposive sampling. Semi-structured interviews were conducted, which were audiotaped and transcribed for analysis. Findings: Three superordinate themes emerged: causes, expressions and perceptions of fatigue; fatigue in daily life; and managing activities of daily living. The findings suggest that although fatigue challenges the performance of activities and roles, and thus occupational balance, the participants applied strategies to manage and adapt to fatigue, limiting its consequences.

Conclusion

The findings have implications for occupational therapists’ adoption of person-centred interventions. We can learn from the participants’ experiences to explore the individual needs of future clients to facilitate person-centred strategies that match the individual and their experience of fatigue, and to promote balance in performance of their daily activities.
The home environments and occupational engagement of people with intellectual disabilities in supported living
Authors: Ashley Danielle , Fossey Ellie , Bigby Christine
Published: May 2019

Introduction

Social inclusion for people with intellectual disabilities includes engagement in the occupations of daily life. Given the focus on people with intellectual disabilities living independently with support, identifying the qualities of their home environments is integral to understanding the possibilities for engagement in occupations of daily life and better quality of life outcomes. In turn, this can inform the types of person-centred supports, such as active support, necessary to enable increased engagement for people with intellectual disabilities.

Method

A case study methodology and mixed methods were utilised to develop an in-depth understanding of the home environments of six people with intellectual disabilities in supported living, and their experience of how these environments impacted their occupational engagement both at home and in their community. Semi-structured interviews and observation of participants’ home environments, using the Residential Environment Impact Survey – Short Form, were completed.

Findings

Participants valued the opportunity to be self-reliant and live in their own homes. They had adequate means to engage in basic daily activities; however, their homes lacked expression of their occupational identity, and they had minimal occupational opportunities and demands, resulting in limited occupational engagement.

Conclusion

For people with intellectual disabilities, it is important to increase opportunities for participation in valued occupations that foster social identities, and to provide adequate environmental supports and demands, to enable sustained occupational engagement and social inclusion.
A Chinese family with familial hemiplegic migraine type 2 due to a novel missense mutation in ATP1A2
Authors: Tang Wenjing , Zhang Meichen , Qiu Enchao , Kong Shanshan , Li Yingji , Liu Huanxian , Dong Zhao , Yu Shengyuan
Published: May 2019

Background

ATP1A2 has been identified as the genetic cause of familial hemiplegic migraine type 2. Over 80 ATP1A2 mutations have been reported, but no data from Chinese family studies has been included. Here, we report the first familial hemiplegic migraine type 2 Chinese family with a novel missense mutation.

Methods

Clinical manifestations in the family were recorded. Blood samples from patients and the unaffected members were collected for whole-exome sequencing to identify the pathogenic mutation. Seven online softwares (SIFT, PolyPhen-2, PROVEAN, PANTHER, MutationTaster2, MutationAssessor and PMut) were used for predicting the pathogenic potential of the mutation. PredictProtein, Jpred 4 and PyMOL were used to analyze structural changes of the protein. The mutation function was further tested by Methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay.

Results

All patients in the family had typical hemiplegic migraine attacks. Co-segregation of the mutation with the migraine phenotype in four generations, with 10 patients, was completed. The identified novel mutation, G762S in ATP1A2, exhibited the disease-causing feature by all the predictive softwares. The mutation impaired the local structure of the protein and decreased cell viability.

Conclusion

G762S in ATP1A2 is a novel pathogenic mutation identified in a Chinese family with familial hemiplegic migraine, which causes loss of function by changing the protein structure of the Na+/K+-ATPase α2 subunit.
Investigation of Bimodal Macroscopic Fundamental Diagrams in Large-Scale Urban Networks: Empirical Study with GPS Data for Shenzhen City
Authors: Huang Chongxuan , Zheng Nan , Zhang Jun
Published: May 2019

This paper investigates traffic dynamics in bimodal urban networks utilizing the macroscopic fundamental diagram (MFD) and the three-dimensional macroscopic fundamental diagram (3D-MFD), which are network-level traffic flow modeling tools. Although the existence and the properties of the MFD have been extensively analyzed with field data in literature, few empirical studies examine these features of the 3D-MFDs for large-scale networks. For this work, GPS data for cars and buses running in the network of Shenzhen city in China are available for analysis and this offers a great opportunity for the investigation. Interestingly, both MFD and 3D-MFD dynamics are reflected in the data. Network partition is performed to reduce the hysteresis on the MFD and the network is split into two regions for further analysis. Then the investigation focuses on the MFD relationship for buses only. The average passenger occupancy is estimated and incorporated to generate a passenger MFD (pMFD) for buses. Moreover, bus operation on dedicated bus lanes is analyzed. Having understood traffic dynamics of cars, buses, and passengers respectively, the 3D-MFDs which illustrate the joint influence of car and bus accumulations on the global network-level traffic performance are presented. Given the scatter plot of the 3D-MFDs for the two partitioned regions, analytical approximations are provided, fitting by exponential functions. These results are promising, as they confirm the traffic features that were found from simulation-based studies in previous work.
Accessibility Impacts of Park-and-Ride Systems
Authors: Carlson Kristin , Owen Andrew
Published: May 2019

This work presents a methodology for calculating park-and-ride (PNR) accessibility and provides case study results for the Minneapolis–Saint Paul, Minnesota (Twin Cities) facility system. PNR is a form of mixed-mode transit travel which is studied for its impacts on access to opportunities. Regional PNR systems offer a long-standing and widespread example of the collective benefits of mixed-mode travel. The Twin Cities metropolitan region has over 100 PNR facilities that are primarily connected to business districts through express and limited-stop transit service. PNR trip types require automobile and transit travel time matrices to link across space and time to capture mixed-mode travel characteristics. The resulting matrix is used in a cumulative accessibility analysis in which total jobs accessible within a travel time threshold is the variable of interest. Experimental results indicate that PNR facilities affect the suburban transit accessibility profile more than exurban or urban areas during the morning commute. The average worker-weighted job accessibility for a 30-min PNR trip increases by 230% from the comparable walk-to-transit measure. The transit accessibility made available through PNR facilities highlights the need to include PNR trip types in transit accessibility analyses and suggests that current methods underestimate transit accessibility in suburban regions.
Adaptive fuzzy radial basis function neural network integral sliding mode tracking control for heavy vehicle electro-hydraulic power steering systems
Authors: Du Heng , Wang Lin , Chen Jinda , Huang Hui , Wang Yunchao
Published: May 2019

Due to parametric uncertainties, unknown nonlinearities, and dynamic external disturbances, it is a challenging and valuable task for heavy vehicle electro-hydraulic power steering systems to realize high-precision tracking control. To cope with this complex nonlinear tracking control problem, the integral sliding mode control is an extremely potential control method, which has strong robustness to model uncertainties and unknown disturbances, and can effectively reduce the steady-state error in tracking control process. However, the inherent chattering phenomenon of integral sliding mode control seriously affects its control performance. In order to suppress the chattering while ensuring robustness, adaptive fuzzy technique is adopted as an effective auxiliary means, which can not only deal with the inherent chattering problem of integral sliding mode control and a priori knowledge of the disturbance upper bound in controller design but also dynamically adjust the parameters in the fuzzy rules. Moreover, the designed adaptive fuzzy–integral sliding mode control scheme still needs the precise mathematical models of the control systems. But it is difficult to obtain the model for heavy vehicle electro-hydraulic power steering systems with highly complex and coupling properties. Therefore, to further improve the method, this paper presents a novel adaptive fuzzy–radial basis function neural network–integral sliding mode control method for the complex systems to achieve timely and accurate steering angle tracking control. In addition to the advantages of adaptive fuzzy–integral sliding mode control, the modified controller no longer requires the precise mathematical models of heavy vehicle electro-hydraulic power steering systems and realizes the continuous adaptive updating of weights. Finally, the effectiveness and superiority of the proposed control scheme is illustrated by comparisons and extensive simulations.
Organizational empowerment: A vital step toward intrapreneurship
Authors: Moghaddas Seyedeh Zeinab , Tajafari Masoumeh , Nowkarizi Mohsen
Published: May 2019

Intrapreneurship as a transformational strategy in non-profit organizations, including libraries, requires special arrangements through improvement of employees’ cooperation and tendency to entrepreneurial activities. Organizational empowerment is a mechanism which not only influences the staff’s attitude toward the organization through creating/enhancing loyalty, value congruence, and affective commitment but also leads to self-empowerment. Consequently, it seems that organizational empowerment in librarians can be one of the contextual factors which can directly lead to more intrapreneurship in libraries. Thus, this study aimed to investigate the status of organizational empowerment, intrapreneurship and the effect of organizational empowerment on intrapreneurship in the university libraries of Iran. The research population of this questionnaire-based survey consisted of 105 individuals who come from two different classes of librarians in two top universities in Iran. Participants were selected from each class through stratified random sampling. The findings demonstrated that organizational empowerment and intrapreneurship did not enjoy adequate status within these two university libraries. In addition, the effect of organizational empowerment on intrapreneurship was confirmed.
Introduction: Teaching in Post-Truth—Challenges, Lessons, and Innovations in Journalism Education
Authors: Gutsche Robert E.
Published: May 2019

Educators across disciplines—including journalism, public relations, and advertising—have struggled with the potential influence of a “post-truth” era on their lesson plans, learning outcomes, and on epistemological examinations of content and context of their fields. This special issue addresses the challenges and solutions for working and teaching some 4 years into the most-recent age of “post-truth.”
Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs
Authors: Wenger Frank Axel , Szucsik Eduard , Hoinoiu Bogdan Florin , Cimpean Anca M. , Matonick John P. , Ionac Mihai , Raica Marius
Published: May 2019

Purpose. Clinically apparent anastomotic leakage (AL) after low anterior rectal resection (LAR; <7 cm from anal verge) using circular double-stapled anastomosis without defunctioning stoma is up to 37.5%. However, it is unclear whether there is reduction of LAR after 21 postoperative days without defunctioning stoma but with extraluminal anastomotic application of fibrin sealant. Methods. Forty-eight-week-old pigs underwent LAR and circular double-stapled anastomosis in end-to-end technique (descendo-rectostomy). Animals were randomized into therapy and control group (cg). Therapy group (n = 20) received additional extraluminal circular anastomotic application of fibrin sealant. Objective was to assess incidence of clinically apparent and nonclinically apparent leakage through the 21st postoperative day. Remaining animals were sacrificed on the 21st day, and anastomotic region was analyzed. In case of earlier diagnosed AL, animals were sacrificed. Results. In cg, we observed clinically and nonclinically AL in 20% (n = 4). No animal was identified with a nonclinical-apparent leakage in this group, and all 4 animals with leakages presented clinical signs. In the therapy group, no animal (0/20) developed clinically apparent leakage signs. There were no leakages in this group, but 3 animals had ulcerative lesions without leak and without clinical signs. These lesions were observed intraluminally at crossing of staple lines after 21 days. In one of these animals, incomplete leakage was observed, blocked by fibrin sealant. Conclusion. In circular stapled colorectal anastomosis, circular fibrin glue sealant successfully protected anastomotic intraluminal wall defects at crossing of staple lines, reducing leakage rate from 20% to 0% (cg vs therapy group) after 21 postoperative days.
Multilevel Mixed Methods Research Designs: Advancing a Refined Definition
Authors: Headley Marcia Gail , Plano Clark Vicki L.
Published: May 2019

Many research problems in social science involve multilevel phenomena. However, discussions about multilevel research designs are limited in the mixed methods (MM) literature. Building on early writings in the field, this methodological discussion advances a refined definition of a multilevel MM research design. The refinement emerges from a review of qualitative and quantitative conceptions of multilevel research designs and an analysis of a literature-based definition of a multilevel MM research design. To illustrate the application of the refined definition, we present an exemplar of a multilevel MM study aimed at explaining cultural, behavioral, and neurobiological aspects of literacy for mathematics. This comprehensive and versatile definition advances the field by offering guidance for designing and conducting innovative multilevel MM studies.
Opportunistic Development and Environmental Disaster Threat Franciscana Dolphins in the Southeast of Brazil
Authors: Pinheiro Flavia Carnelli Frizzera , Pinheiro Hudson Tercio , Teixeira João Batista , Martins Agnaldo Silva , Cremer Marta Jussara
Published: May 2019

The Franciscana dolphin ( Pontoporia blainvillei), a small cetacean endemic to southwestern Atlantic coastal waters, is the most endangered marine mammal species in the south Atlantic. In the Espírito Santo State, in southeastern Brazil, the Franciscana dolphin distribution overlaps regions suppressed and threatened by an intensive industrial and port development in the coastal zone. Moreover, most of Franciscana’s home range was recently impacted by the collapse of a dam that released millions of iron mining waste into the Atlantic Ocean. Considering the restricted coastal habitat of the species, these impacts can be considered an immediate threat, increasing the probability of local extinction of the species. This research calls attention to the necessity for improvement in the regional Environmental Impact Assessments, Conservation Action Plans, and to the development of an effective zoning for ports and conservation areas in the region. These actions could increase conservation efforts and mitigate the current and expected impacts on the Franciscana population in the Espírito Santo State.
Superficial femoral artery stenting via radial access using R2P® Misago® stents: First-in-human report of the new R2P® system
Authors: Shinozaki Norihiko , Ikari Yuji
Published: May 2019

A 73-year-old male with left critical limb ischemia was scheduled to undergo below-the-knee amputation. Prior to the amputation, he was referred to our institute for endovascular treatment. We inserted the new 7-Fr 150-cm-long guiding catheter, SlenGuide®, into the external iliac artery from the right radial artery with the 7-Fr Glidesheath Slender®. We implanted two R2P® Misago® stents with rapid-exchange, 200-cm-long shaft system in the stenosis of the left superficial femoral artery. This new stent system involves rapid-exchange and a long shaft system; furthermore, it is useful in transradial stenting in the superficial femoral artery.
Myocardial dysfunction associated with diabetic ketoacidosis in a 5-year-old girl
Authors: Halloum Amjad , Al Neyadi Shaikha
Published: May 2019

In this study, we report a case of a 5-year-old girl with new onset of insulin-dependent diabetes mellitus, who presented with severe diabetic ketoacidosis associated with brain edema and severe myocardial dysfunction, needing intubation and inotropic support. To our knowledge, this is the youngest reported case with severe diabetic ketoacidosis complicated with myocardial dysfunction.
Innovating the Craft of Phenomenological Research Methods Through Mindfulness
Authors: Nicholls Claire D
Published: May 2019

To conduct qualitative social research requires not only a declarative knowledge of the research methods and methodology, but also a set of honed practical, applied skills. For beginning researchers, particularly those undertaking phenomenological research, the skills of bracketing, the phenomenological reductions and having an awareness of one’s positionality or relationship to their chosen research methods, participants and contexts is of significant importance. More generally, these skills are also required in other qualitative research disciplines under the guise of reflexivity or critical reflective practice. Regardless, these are notoriously slippery and require more than prior reading to translate from theory and philosophy into practice. There is literature which also identifies and highlights the disparity between theory, skill development and practice; however, these practicalities of how one can bracket or bridle and undertake reductions require further elaboration and guidance for how researchers can develop these applied skills of research. In this article, I propose and demonstrate that the therapeutic tradition of mindfulness as specifically practised in dialectical behaviour therapy can be used to de-mystify the practices of reflexivity and work specifically within the tradition of phenomenological reduction and bracketing. I also assert that this innovation can provide a practical tool to craft qualitative and phenomenological research and make achievable the original philosophical ideas which underpin phenomenological research. I begin by focusing on the theory of bracketing and reduction from the philosophic tradition of phenomenology as a framework for research methodology and methods, and then introduce the practical skill of mindfulness as prescribed in dialectical behaviour therapy as an innovation which can assist the researcher in developing these skills. I finish by illustrating the usefulness of mindfulness in undertaking phenomenological research drawing on examples from a current research project.
Successful Implementation of Extracorporeal Membrane Oxygenation Support as a Bridge to Heart-Lung Transplantation in an Eisenmenger’s Syndrome Patient With Paradoxical Coronary Embolism
Authors: Zhang James , Patel Sumit , Clavijo Leonardo , Laughrun David
Published: May 2019

We report a case of a 23-year-old female with a history of unrepaired ventricular septal defect and pulmonary arterial hypertension with Eisenmenger’s syndrome (ES) presenting with chest pain. Electrocardiography demonstrated new anterior Q waves and anterolateral ST elevations, and coronary angiography revealed a large organized thrombus in the mid-left anterior descending artery consistent with paradoxical coronary embolism. Patient was treated with percutaneous coronary intervention and aggressive anticoagulation management. Intensive care unit course was complicated by respiratory failure requiring intubation due to hospital-acquired pneumonia in the setting of severe pulmonary hypertension. Patient was emergently initiated on veno-venous extracorporeal membrane oxygenation support (ECMO) as a bridge to heart-lung transplantation. After initiation of ECMO, patient displayed significant clinical improvement and underwent successful heart-lung transplantation. This case highlights veno-venous ECMO as a bridge to heart-lung transplantation in acutely decompensated patients with ES, and is the first reported case of paradoxical coronary embolism in a patient with ES.
Enhancing Nursing Students' Competency Skills With a Workplace Violence Nursing Simulation: Translating Knowledge Into Practice
Authors: Martinez Angel J. Solorzano
Published: May 2019

The phenomenon of workplace violence (WPV) is prevalent in clinical settings affecting nurses and nursing students. Mental health nursing simulations may be used to impart knowledge and skills to nursing students to manage and prevent incidents of WPV. This article presents attained competency skills by nursing students after attending a simulation, and how they implemented their knowledge learned in their clinical rotations. Students attended a Mental Health Nursing Simulation on WPV and completed surveys. The simulation enhanced the students' communication skills, empathy, ability to manage verbally aggressive patients, ability to set personal boundaries, and ability to seek support from others. Participants reported physical and verbal forms of WPV and application of learned evidence-based skills in their clinical rotations. Evidence-based skills to manage and prevent WPV taught to nursing students via mental health nursing simulations can enhance their clinical competency, and they should be embedded in a nursing curriculum.
Attachment, dependency, and attachment-related behaviors in foster children: A closer look at the nature of the foster child–caregiver relationship
Authors: Kungl Melanie Tamara , Gabler Sandra , Bovenschen Ina , Lang Katrin , Zimmermann Janin , Spangler Gottfried
Published: May 2019

There is evidence that within the first year in the foster home, children are capable of forming secure attachment comparable to normative samples. However, less is known about the nature of these newly formed relationships and it has been claimed that they may serve different developmental functions as those to primary caregivers formed in the first year of life. The current study aimed to address this void by applying a behavioral system approach. The sample consisted of 46 children (aged 3–6), 16 of which were currently placed in foster care. Attachment security and dependency were assessed during a home visit using the Attachment Q-Sort. Furthermore, activation of several attachment-related behavioral systems was assessed during a stranger approach in a standardized laboratory setting. Compared to the control group, foster children showed equal levels of attachment security but highly increased dependency scores. Also, during the stranger approach, they showed increased attachment behaviors toward their foster mothers and, at the same time, increased looking behavior toward the stranger. The study points out the relevance of taking into account various attachment-related constructs when investigating formations to new attachment figures in out of home care. It further claims that increased dependency and proximity-seeking scores in foster children are characteristic of the newly formed relationship and a possible indicator of foster children’s adaption. Moreover, this behavior may even be highly beneficial to foster children’s socio-emotional development as it possibly serves important developmental functions.
Distribution and characteristics of in-patient child and adolescent mental health services in England and Wales
Authors: O'Herlihy Anne , Worrall Adrian , Lelliott Paul , Jaffa Tony , Hill Peter , Banerjee Sube
Published: May 2019

Background

Little is known about the current state of provision of child and adolescent mental health service in-patient units in the UK.

Aims

To describe the full number, distribution and key characteristics of child and adolescent psychiatric in-patient units in England and Wales.

Method

Following identification of units, data were collected by a postal general survey with telephone follow-up.

Results

Eighty units were identified; these provided 900 beds, of which 244 (27%) were managed by the independent sector. Units are unevenly distributed, with a concentration of beds in London and the south-east of England. The independent sector, which manages a high proportion of specialist services and eating disorder units in particular, accentuates this uneven distribution. Nearly two-thirds of units reported that they would not accept emergency admissions.

Conclusions

A national approach is needed to the planning and commissioning of this specialist service.
Treating psychological symptoms in sexually abused children
Authors: Ramchandani Paul , Jones David P. H.
Published: May 2019

Background

The experience of having been sexually abused is associated with a wide range of psychiatric symptoms and difficulties, and these problems can persist over years. The psychological treatment of children who have experienced sexual abuse has only recently begun to be systematically investigated. An increasing number of robust studies have been conducted.

Aims

To review systematically the available evidence from randomised controlled trials of psychological treatments for children who have been sexually abused, and to consider the place of these treatments in a multi-disciplinary service.

Method

A systematic search of the available research was undertaken. Included trials were critically appraised and the results considered.

Results

Twelve studies were included in the review. The best evidence of efficacy for improving psychological symptoms in these children was found for cognitive–behavioural therapy, particularly for young children.

Conclusions

Efficacious treatments exist to improve psychological symptoms in children who have experienced sexual abuse. Consideration is given to the place of these treatments within the response of a multi-disciplinary service.
How should we manage bipolar II disorder in the perinatal period?
Authors: Powell Jennifer , Manoharan Manonmani , Reed Joanna
Published: May 2019

This reflection summarises the evidence regarding the management of bipolar II disorder in the perinatal period, compares this to the authors’ clinical experience using case studies and considers the treatment of patients in current clinical practice.
Ten books
Authors: Szmukler George
Published: May 2019

It is to see the ‘big picture’ that I read psychiatric books – to see the wood despite the trees. Forests of the latter are felled to keep us abreast of new knowledge in the form of mostly ephemeral journal articles. By the ‘big picture’ I mean principles and assumptions: the methods we use to understand the subject matter, the key organising ideas, analyses of the contexts in which we practise (social, political and ethical), and so on.
Service innovations
Authors: Graham Hermine L. , Copello Alex , Birchwood Max , Orford Jim , McGovern Dermot , Georgiou George , Godfrey Emma
Published: May 2019

One of the challenges for services in the UK has been how best to meet the needs of those people who experience severe mental health problems and use drugs and alcohol problematically. It is now well-documented in the international literature that the coexistence of severe mental health and substance misuse problems are common (e.g. Regier et al, 1990; Krausz et al, 1996; Menezes et al, 1996; Fowler et al, 1998; Mueser et al, 2000; Graham et al, 2001) and often correlated with a number of adverse outcomes (Smith & Hucker, 1994; Johnson, 1997; Mueser et al, 2000). Integrated treatment approaches developed in the USA for this client group (e.g. Drake & Wallach, 2000; Drake et al, 2001), and although they offer much food for thought and some direction, they could not be wholly imported and implemented in the UK because of significant differences in the contextual factors that guide service provision in the two countries. The challenge in the UK has been to develop effective services that fit with the unique community-based treatment approaches for substance misuse problems and mental health that have developed and historically offered separately and in parallel.
Body Position Alters Mechanical Power and Respiratory Mechanics During Thoracic Surgery
Authors: Chiumello Davide , Formenti Paolo , Bolgiaghi Luca , Mistraletti Giovanni , Gotti Miriam , Vetrone Francesco , Baisi Alessandro , Gattinoni Luciano , Umbrello Michele
Published: May 2019

BACKGROUND:

During thoracic surgery, patients are usually positioned in lateral decubitus and only the dependent lung ventilated. The ventilated lung is thus exposed to the weight of the contralateral hemithorax and restriction of the dependent chest wall. We hypothesized that mechanical power would increase during one-lung ventilation in the lateral position.

METHODS:

We performed a prospective, observational, single-center study from December 2016 to May 2017. Thirty consecutive patients undergoing general anesthesia with mechanical ventilation (mean age, 68 ± 11 years; body mass index, 25 ± 5 kg·m−2) for thoracic surgery were enrolled. Total and partitioned mechanical power, lung and chest wall elastance, and esophageal pressure were compared in supine and lateral position with double- and one-lung ventilation and with closed and open chest both before and after surgery. Mixed factorial ANOVA for repeated measurements was performed, with both step and the period before or after surgery as 2 within-subject factors, and left or right body position during surgery as a fixed, between-subject factor. Appropriate interaction terms were included.

RESULTS:

The mechanical power was higher in lateral one-lung ventilation compared to both supine and lateral position double-lung ventilation (11.1 ± 3.0 vs 8.2 ± 2.7 vs 8.7 ± 2.6; mean difference, 2.9 J·minute−1 [95% CI, 1.4–4.4 J·minute−1] and 2.4 J·minute−1 [95% CI, 0.9–3.9 J·minute−1]; P < .001 and P = .002, respectively). Lung elastance was higher during lateral position one-lung ventilation compared to both lateral and supine double-lung ventilation (24.3 ± 8.7 vs 9.5 ± 3.8 vs 10.0 ± 3.8; mean difference, 14.7 cm H2O·L−1 [95% CI, 11.2–18.2 cm H2O·L−1] and 14.2 cm H2O·L−1 [95% CI, 10.8–17.7 cm H2O·L−1], respectively) and was higher compared to predicted values (20.1 ± 7.5 cm H2O·L−1). Chest wall elastance increased in lateral position double-lung ventilation compared to supine (11.1 ± 3.8 vs 6.6 ± 3.4; mean difference, 4.5 cm H2O·L−1 [95% CI, 2.6–6.3 cm H2O·L−1]) and was lower in lateral position one-lung ventilation with open chest than with a closed chest (3.5 ± 1.9 vs 7.1 ± 2.8; mean difference, 3.6 cm H2O·L−1 [95% CI, 2.4–4.8 cm H2O·L−1]). The end-expiratory esophageal pressure decreased moving from supine position to lateral position one-lung ventilation while increased with the opening of the chest wall.

CONCLUSIONS:

Mechanical power and lung elastance are increased in the lateral position with one-lung ventilation. Esophageal pressure monitoring may be used to follow these changes.
Characterizing the Structural Integrity of Endotracheal Tube Taping Techniques: A Simulation Study
Authors: Matchett Gerald , Yang Judy H. , Sripathi Nishith R. , Simpkins Landon , Ruikar Kinnari , Minhajuddin Abu , Whitten Charles W.
Published: May 2019

BACKGROUND:

Endotracheal tubes (ETTs) are commonly secured with tape to prevent undesirable tube migration. Many methods of taping have been described, although little has been published comparing various methods of taping to one another. In this study, we evaluated several methods for securing ETTs with tape. We hypothesized a difference in mean peak forces between the methods studied during forced extubation.

METHODS:

Five methods of securing an ETT with tape were studied in a variety of contexts including cadaver and simulation lab settings. Testing included measurement of peak force (Newton [N]) during forced extubation, durability of taping following mechanical stress, effects of tape length–width variation, and characterization of failure mechanisms.

RESULTS:

We found several significant differences in mean peak extubation forces between the 5 methods of taping, with mean peak forces during forced extubation ranging from 20 N to 156 N. In separate tests, we found an association between mean peak forces and total surface area as well as geometric configuration of tape on the face. Long thin strips of tape appeared to provide surprising durability against forced extubation, a phenomenon that was associated with minimization of the “peel angle” as tape was removed.

CONCLUSIONS:

We found evidence of differential structural integrity between the 5 taping methods studied. More generally, we found that increased peak extubation forces were associated with increased total surface area of tape and that minimization of the “peel angle” by lateral application of tape is associated with surprisingly high relative peak extubation forces.
Salivary Interleukin 1-beta levels and clinical periodontal parameters in habitual naswar users and non-users
Authors: Abbasi Zaeem Arif , Hadi Naila Irum , Zubairi Adnan Mustafa , Hosein Mervyn
Published: May 2019

Objectives: Aim of our study was to assess the expression of salivary Interleukin 1-beta (IL-1β) and clinical periodontal parameters in naswar users and non-users (controls).

Methods: Eighty four individuals (forty-two naswar users and forty-two controls) were included in the study which was conducted between August 2017 and May 2018. Salivary IL-1β levels, plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL) was assessed in all the participants.

Results: PD of 4mm (p<0.05), PD of 5-6mm (p<0.05), CAL (p<0.001) and levels of salivary IL1β (p<0.05) were significantly higher among naswar users as compared to controls while PI, BOP and number of missing teeth showed no significant difference among the two groups (p>0.05).

Conclusion: Periodontal inflammatory conditions were worse and salivary IL-1β levels were elevated in naswar users as compared to controls.

doi: https://doi.org/10.12669/pjms.35.3.10

How to cite this:Abbasi ZA, Hadi NI, Zubairi AM, Hosein M. Salivary Interleukin 1-beta levels and clinical periodontal parameters in habitual naswar users and non-users. Pak J Med Sci. 2019;35(3):674-679. doi: https://doi.org/10.12669/pjms.35.3.10

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Knowledge of clinicians/pediatricians about neonatal resuscitation in a tertiary care hospital
Authors: Muneer Ayesha , Bari Attia , Haider Arslan , Ali Agha Shabbir
Published: May 2019

Objective: To analyze the knowledge of the doctors dealing with pediatric patients about neonatal resuscitation.

Methods: This was a cross sectional study conducted at The Lahore General Hospital over one year. Total 137 doctors related to pediatrics with different job descriptions were enrolled and requested to fill a questionnaire proforma regarding their knowledge about basic equipment required and about neonatal resuscitation steps. Data was entered and analyzed using SPSS 20.

Results: Out of 137 participants, majority (71%) had >2 years of experience in pediatrics and 52.5% had higher postgraduate qualification. Neonatal resuscitation workshop was attended by 57% doctors. In resuscitation of newborns at the time of delivery, resuscitating doctors were assisted by nurse in 50%, by junior doctor in 35%, paramedic staff 11% and it was done by single doctor in 4% cases. Oxygen (central or O2 cylinder) and warmer facilities were available in 90% and 82% of health facilities respectively. Majority (86%) of participants were of view that every neonate must be attended at birth. Not a single doctor followed all the standard steps of neonatal resuscitation although 90% had knowledge about resuscitation equipment and common resuscitation drugs.

Conclusion: Pediatric health care professionals had knowledge about neonatal resuscitation but there are gaps in the practical application. There is a strong need of frequent neonatal resuscitation workshops for improving neonatal outcomes.

doi: https://doi.org/10.12669/pjms.35.3.987

How to cite this:Muneer A, Bari A, Haider A, Ali AS. Knowledge of clinicians/pediatricians about neonatal resuscitation in a tertiary care hospital. Pak J Med Sci. 2019;35(3):775-779. doi: https://doi.org/10.12669/pjms.35.3.987

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
COMPARATIVE EVALUATION OF SPRING BARLEY VARIETIES BY QUANTITY AND QUALITY OF PROTEIN
Authors: Ганиева Ирина , Ganieva Irina , Блохин Василий , Blokhin Vasiliy , Сержанов Игорь , Serzhanov Igor
Published: May 2019

To provide a protein-balanced diet for farm animals, a large amount of concentrated feed is included in the feed ration. In our region, spring barley is the main crop. This is due to the fact that barley grain compared with other types of grain provides a relatively large yield of livestock products. In recent years, with the inclusion of breeding varieties in the State Register simultaneously with indicators of grain yield of spring barley, attention is paid to the yield of protein per unit area of crops of this crop. Under the conditions of the Republic of Tatarstan, providing a stably increased protein yield per 1 hectare of crops, regardless of the weather conditions of the year, the varieties are Kamashevsky, Vakula, Rakhat, Gelios. Along with the amount of protein in the grain of barley for animal husbandry, its quality indicators of protein are important, which is expressed by the ratio of low and high molecular weight proteins. To improve the efficiency of livestock production, agricultural enterprises specializing in the production of pork, it is desirable to cultivate varieties of spring barley with more low molecular weight proteins in the grain. Such varieties are Kamashevsky and Gelios. For agricultural producers engaged in milk production, it is better to cultivate the Rakhat and Timerkhan spring barley varieties, in the grain of which a high proportion is occupied by high-molecular-weight proteins.
RESPONSE OF OILSEED FLAX OF VNIIMK 620 AND SEVERNUY VARIETIES TO FALL-PLOUGHING IN THE MIDDLE URAL
Authors: Корепанова Елена , Korepanova Elena , Галиев Рамис , Galiev Ramis , Гореева Вера , Goreeva Vera
Published: May 2019

In 2016-2017 on the experimental areas of JSC “Uchkhoz Iyulskoe of Izhevsk State Agricultural Academy” the studies were conducted to identify the reaction of oilseed flax of VNIIMK 620 and Severny varieties to spraying with Zero herbicide after harvesting its predecessor and the methods of fall-tillage by forming the yield of seeds. The soil of the experimental plot is sod-podzolic medium loamy. The predecessor is winter triticale. On average, over two years of research of the oilseed flax of VNIIMK 620 and Severnuy varieties, they increased seed productivity by 2.2–7.2 centners per hectare or 1.6–2.8 times in variants with fall-tillage KN-4, PLN-4 -35, BDT-3, relative to the same indicator in the variants without fall-ploughing. In the variant with soilless autumn-tillage of KN-4, the productivity of oilseed flax VNIIMK 620 (11.0–11.3 centners per hectare) and Northern (10.6–11.4 centners per hectare) was on the same level as the seed yield in option with dump soil treatment PLN-4-35 (10.9-11.2 centners per hectare and 11.3-11.5 centners per hectare, respectively). However, in the version without the use of the herbicide Zero with the small tillage of the BDT-3, since autumn the seed yield decreased by 1.8-2.0 centners per hectare (16-18%) in the variety VNIIMK 620 and by 1.9 centners per hectare ( 17%) for the Northern variety, in comparison with the yield in the variants with the treatment of KN-4 and PLN-4-35. In the variant with spraying with Zero herbicide and ground treatment of BDT-3 soil, the yield of oilseed flax VNIIMK 620 and Severny did not have significant differences with seed yield in variants with KN-4 and PLN-4-35.
PECULIARITIES OF PHOTOSYNTHETIC ACTIVITY OF WHEAT DICOCCUM (EMMER) AT DIFFERENT SEED TIMES, PREDECESSORS AND BACKGROUND
Authors: Шайхутдинов Фарит , Shaykhutdinov Farit , Сержанов Игорь , Serzhanov Igor , Миникаев Рагат , Minikaev Ragat , Зиннатуллин Дамир , Zinnatullin Damir
Published: May 2019

The article presents the results of three years of research on the study of the photosynthetic activity of Dicoccum plants (emmer) depending on the methods of agricultural technology (sowing time, predecessors, different levels of nutrition) in the conditions of gray forest soils of the middle Volga region. During the years of research, relatively favorable meteorological conditions were created for the growth and development of wheat of the willower (emmer). Observations, surveys, analyzes for the growth and development of wheat emmer made it possible to establish that in all the years of research, the dynamics of accumulation of dry matter to the phase of plant entry into the tube are not dependent on their predecessors, the time of sowing and food background is weak. As is known, during this period, the formation and enhanced growth of the root system and the formation of the generative organs take place. After the plants entered the tube before the beginning of the milky ripeness, an intensive increase in dry matter was observed, especially for the predecessor of one-year-old clover in the first term of sowing when applying the calculated rates of fertilizers. The collection of dry organic matter, the assimilation power of wheatgrass plants was higher in the first term of sowing according to its predecessor, one-year-old clover and vetch + oats to the green mass, regardless of the food background. The planting dates, as well as the precursors, have a significant impact on the dynamics of leaf surface growth and the increase in dry biomass. More favorable conditions for the photosynthetic activity on wheat crops, double-weeds (emmer) are created during early sowing of the precursors of one-year-old clover and vico-oatmeal mixture for green fodder, regardless of the food background.
IMPROVING THE ACCURACY OF REGULATING THE CAPACITY OF PUMPING SECTIONS OF THE DISTRIBUTIVE TYPE FUEL PUMP
Authors: Доброхотов Юрий , Dobrohotov Yuriy , Иванщиков Юрий , Ivanschikov Yuriy , Валиев Айрат , Valiev Ayrat , Васильев Александр , Vasil'ev Aleksandr
Published: May 2019

Due to the design features of ND-22 type of distribution pumps, equalization of cycle feed values between high-pressure sections is a rather complicated and time-consuming task, the solution of which is accompanied by repeated changes in the dimensions of the drive links with subsequent multiple metering of feed rates. In order to reduce the labor-intensiveness of adjustment operations and increase the accuracy of their performance, a technique and a device have been proposed, that significantly reduce the laboriousness of adjustment operations to equalize performance values between high-pressure sections, while simultaneously increasing the accuracy of their performance. The regularity of the change in the feed rate of the first section of the pump, the change in the length of the adjusting thrust of the metering drive is revealed. The linearity of the correlation relationship between the length of the adjusting thrust and the performance of the first high pressure section has been established. An equation, describing this relationship, is given. The graphic representation of the relationship between the change in the length of the adjustment thrust and the supply of the pump section allows it to be used as a nomogram for selecting the length of the thrust when a given feed cycle value is set during the adjustment work after repair.