bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review of Dating Violence Risk Factors Among Undergraduate College Students
Authors: Duval Alicia , Lanning Beth A. , Patterson Megan S.
Published: June 2018

College students are a vulnerable population for dating violence (DV) because of the social environment in which they live and interact with other students. Campus climate surveys are considered best practice for gathering information about the severity and cause of college DV; however, there are still unanswered questions as to why DV remains an alarming public health concern among college students. The aim of this systematic literature review was to examine DV risk factors specific to college students with a special focus on methodological factors and gaps in the literature. Databases EBSCO, Scopus, PsycINFO, MEDLINE, ERIC, and PubMed were searched for articles published between 2006 and 2016, resulting in 23 articles that met inclusion criteria for this review. Very few studies were conducted at private universities ( n = 4). Most researchers used descriptive cross-sectional surveys ( n = 22), while only one utilized a mixed-methods approach. Measurement scales used to collect DV rates were similar across studies, yet the definition of DV was inconsistent. Types and severity of DV varied across studies, but overall, females were more likely to perpetrate and/or experience DV than males. Individual risk factors (e.g., substance use, risky sexual behaviors) were identified more often than family risk factors (e.g., intergenerational violence) and peer and social risk factors (e.g., Greek-life or athletic team membership, relationship type). A better understanding of new college relationships is critical to identify modifiable risk factors for DV. Recommendations for future practice and research are also discussed.
Student Experiences With Community-Based Enforcement of a Smoke-Free University
Authors: Seitz Christopher M. , Ragsdale Thomas L.
Published: June 2018

A common approach to enforcing a university smoke-free policy is through “community-based” enforcement, in which the entire campus community is responsible for asking smokers in violation to abide by the policy. The purpose of the study was to explore university students’ experiences with this strategy of enforcing a smoke-free policy. A total of 43 undergraduate students were interviewed regarding their experiences and opinions of community enforcement. The interviews were transcribed and analyzed using phenomenological methods, in which six major themes emerged from the data: Fear (alarm that smokers might respond with verbal insults or physical violence), Situational (enforcing the policy depended on violators’ distance, group settings, strangers vs. peers), Protect Image (not wanting to be viewed as annoying, judgmental, or offensive), Lack of Authority (feeling a lack of authority to enforce the smoking policy), Compassion (empathy that violators smoke due to physical/emotional needs), and Enforcer (willingness to confront a policy violator). These findings reflected previous studies regarding people’s fear to ask a smoker to extinguish a cigarette, feelings of a lack of authority, and so on. The study demonstrated that using only a community-based approach to enforcement may not be a realistic responsibility to impose on an entire campus community.
New approach to evaluation of orthopaedic supports compression properties
Authors: Muraliene L , Mikucioniene D , Laureckiene G , Brazaitis M
Published: June 2018

This research was carried out to investigate behaviour of a knitted orthopaedic knee support in simulated real conditions as well as to propose a new approach to compression evaluation to preclude the possibility of any error in designing of new orthopaedic supports with exact compression level. Fully finished supports with all additional non-textile elements were analysed in this research. The support is defined as a corrective or orthopaedic item intended to grip or support any movable part of the body in the correct position and allows movement of that body part. The ways how textile material deforms under applied stresses as well as relaxation processes over the time play an important role in its processing and end use. A strong linear dependence between elongation of the support and compression generated by the support was found in this research. However, investigation on stress relaxation over the time showed that stress decrease over 36,000 s coincides with ranges of one full compression class, and the highest change (approx. 50%) in tensile force occurs during the first 100–200 s of relaxation. Such a change of compression has significant influence on the predictive pressure value generated by the compression garment and undermines its functionality. The obtained results indicate that a new approach to compression evaluation methodology must be adopted for theoretical compression value computation. Consequently, evaluation of the compression according to the tensile force must be performed not earlier than after at least 120 s relaxation.
Processing techniques and properties of metal/polyester composite plain material: Electromagnetic shielding effectiveness and far-infrared emissivity
Authors: Lin Jia-Horng , Lin Ting An , Lin Ting Ru , Jhang Jia-Ci , Lou Ching-Wen
Published: June 2018

In this study, a composite plain material is composed of woven fabrics containing metal wire with shielding ability and polyester filament that can provide flexibility and far-infrared emissivity. Furthermore, a wrapping process is used to form metal/far-infrared–polyester wrapped yarns, which are then made into metal/far-infrared–polyester woven fabrics. The effects of using stainless steel wire, Cu (copper) wire, or Ni–Cu (nickel-coated copper) wire on the wrapped yarns and woven fabrics are examined in terms of tensile properties, electrical properties, and electromagnetic shielding effectiveness. Moreover, SS+Cu+Ni-Cu woven fabrics have maximum tensile strength, while SS+Ni-Cu woven fabrics have the maximum elongation and SS+Cu+Ni-Cu woven fabrics have the lowest surface resistivity. Stainless steel composite woven fabrics have far-infrared emissivity of 0.89 when they are composed of double layers. electromagnetic shielding effectiveness test results indicate that changing the number of lamination layers and lamination angle has a positive influence on electromagnetic shielding effectiveness of woven fabrics. In particular, SS+Cu+Ni-Cu woven fabrics exhibit electromagnetic shielding effectiveness of −50 dB at a frequency of 2000–3000 MHz when they are laminated with three layers at 90°.
Is It Really Mandatory to Harvest the Contralateral Saphenous Vein for Use in Repair of Traumatic Injuries?
Authors: Reddy Neil P. , Rowe Vincent L.
Published: June 2018

Since the transition time in surgical technique of vascular repair to current civilian practice, the great saphenous vein (GSV) remains unarguably the preferred conduit for surgical reconstruction in the lower extremity. With qualities such as accessibility, expendability, and long-term durability, it is easy to understand the enthusiasm with using the GSV in arterial or venous vascular injuries. However, the question does arise whether these detailed benefits of the GSV warrant harvest from an uninjured limb for vascular reconstruction on an injured limb. For those ardent followers of surgical dogma, harvest of contralateral vein from the uninjured lower extremity traumatic vascular repair is mandated. Unfortunately, this principle is not supported by high-quality data and remains folklore at best.
A low-cost solution for unmanned aerial vehicle navigation in a global positioning system–denied environment
Authors: Ashraf Shahrukh , Aggarwal Priyanka , Damacharla Praveen , Wang Hong , Javaid Ahmad Y , Devabhaktuni Vijay
Published: June 2018

The ability of an autonomous unmanned aerial vehicle to navigate and fly precisely determines its utility and performance. The current navigation systems are highly dependent on the global positioning system and are prone to error because of global positioning system signal outages. However, advancements in onboard processing have enabled inertial navigation algorithms to perform well during short global positioning system outages. In this article, we propose an intelligent optical flow–based algorithm combined with Kalman filters to provide the navigation capability during global positioning system outages and global positioning system–denied environments. Traditional optical flow measurement uses block matching for motion vector calculation that makes the measurement task computationally expensive and slow. We propose the application of an artificial bee colony–based block matching technique for faster optical flow measurements. To effectively fuse optical flow data with inertial sensors output, we employ a modified form of extended Kalman filter. The modifications make the filter less noisy by utilizing the redundancy of sensors. We have achieved an accuracy of ~95% for all non-global positioning system navigation during our simulation studies. Our real-world experiments are in agreement with the simulation studies when effects of wind are taken into consideration.
Models of the relationship among geometric parameters and anti-friction mechanism of micro-texture ball-end milling cutter
Authors: Liu Xianli , Tong Xin , Yang Shucai , He Chunsheng , Liu Xiao
Published: June 2018

Researches on the effect of the micro-texture on the cutting performance and the life of cutters are mostly aimed at turning cutters, but there are few researches on the ball-end milling cutter. On the basis geometry of the micro-texture, the distribution and the relationship among the geometric parameters of micro-pits are studied. A mechanical characteristic model of machining titanium alloy with the micro-texture ball-end milling cutter is established. Optimal parameters of the micro-texture are determined by the simulation. By the test of machining the titanium alloy with the micro-texture ball-end milling cutter, anti-friction properties, the influence laws of the micro-texture diameter on forces, and area occupancy on the tool wear are studied. This article provides a theoretical reference for determining the location of the micro-texture on ball-end milling cutter and selecting texture parameters reasonably. The anti-friction mechanism of the micro-texture is revealed by the theory, which provides a theoretical basis for the efficient processing of titanium alloy.
Dynamic tensile strength enhancement of concrete in split Hopkinson pressure bar test
Authors: Chen Jingyi , Xiang Da , Wang Zhihua , Wu Guiying , Wang Genwei
Published: June 2018

Split Hopkinson pressure bar technique has been widely used to measure the dynamic tensile strength of concrete materials. Most experimental results show that the tensile strength of concrete material increases with strain rates. However, the dynamic tensile strength derived from the split Hopkinson pressure bar test is affected by lateral inertia confinement, which may lead to the overestimation of dynamic mechanical properties of concrete materials. The true dynamic characteristics of concrete materials are not actually shown by experimental data. It is impossible to completely eliminate the influence of lateral inertia confinement in split Hopkinson pressure bar tests. In this study, a rate-insensitive material model is used in commercial finite element software to study how the lateral inertia confinement affects the dynamic tensile strength of concrete material at strain rates between 30/s and 150/s. Comparison of finite element results and split Hopkinson pressure bar test results shows that the dynamic tensile strength enhancement of concrete materials is strongly influenced by the inertial effect. The dynamic increase factor of concrete materials which remove the influence of lateral inertia confinement in split Hopkinson pressure bar tests can reflect the true dynamic characteristics of concrete materials. It is also found that the influence of lateral inertia confinement is related to the size of the specimen.
The reinforcement effects of deep soft soil foundation with high degree of saturation under dynamic compaction
Authors: Wei Jihong , Men Yan , Zhu Feng , Le Huilin , Fan Haotian
Published: June 2018

The dynamic compaction method is effective to reinforce soft soil foundation with a low degree of saturation. However, deep soft soil foundation with high degree of saturation has some different characteristics. It has been widely considered that dynamic compaction method is unsuitable to improve the characters of deep soft soil foundation with high degree of saturation. In this article, we will show that the dynamic compaction method with vacuum well-point dewatering is effective to deep soft soil foundation with high degree of saturation reinforcement. In situ and laboratorial experiments are used to assess the reinforcement effect of the deep soft soil foundation with high degree of saturation. Our results show that the dynamic compaction method causes long dissipation time of pore water pressure, and the dynamic compaction method with vacuum well-point dewatering makes construction time of a project 25% shorter. The effective depth of deep soft soil foundation with high degree of saturation reinforcement using the two experimental methods can reach to 8.0 m. In comparison with the total settlement and layered settlement of the dynamic compaction method with vacuum well-point dewatering, the dynamic compaction method settlement is relatively smaller. For soils with depth of 4 m, the reinforcement effect of dynamic compaction method with vacuum well-point dewatering is obviously superior to dynamic compaction method. Based on these results, we suggest construction procedures for different reinforcement depth of soils and construction time.
EBOVAC-Salone: Lessons learned from implementing an Ebola vaccine trial in an Ebola-affected country
Authors: Mooney Thomas , Smout Elizabeth , Leigh Bailah , Greenwood Brian , Enria Luisa , Ishola David , Manno Daniela , Samai Mohamed , Douoguih Macaya , Watson-Jones Deborah
Published: June 2018

Background/aims

During the 2014–2016 West African Ebola epidemic, clinical trials were fast-tracked in order to identify prophylactic vaccines and experimental treatments that might be useful in preventing or treating Ebola. These trials included the ongoing EBOVAC-Salone study, which was established and implemented in Sierra Leone to assess the safety and immunogenicity of the Ad26.ZEBOV/MVA-BN-Filo prime-boost Ebola vaccine regimen.

Methods

This article describes the experiences of the EBOVAC-Salone research team in setting up and implementing the trial, and provides recommendations for research teams aiming to conduct clinical trials in future outbreak situations.

Results

Establishing a clinical trial during an outbreak brought some unique challenges, including those related to trial design and the regulatory environment, operational issues, and community engagement. The situation was further complicated by the weak infrastructure and limited experience of clinical trials in Sierra Leone. However, operating in an outbreak context also brought some benefits to the research team, including strong stakeholder support. The EBOVAC-Salone study recruited participants both during and after the outbreak, leading to additional challenges to trial implementation during the post-outbreak transition.

Conclusion

Many lessons have been learned about setting up and implementing a clinical trial during a devastating Ebola epidemic, and some of the experiences of the EBOVAC-Salone team were mirrored by those of other researchers operating in the region. Common to several of these research groups is a recommendation that research should be more closely incorporated into outbreak response planning, which could expedite the establishment of timely and appropriate research projects. We recommend that the lessons learned by researchers during the West African Ebola epidemic are built into programmes and strategies to improve the responses to future epidemics, wherever they occur.
Quality of surgical randomized controlled trials in hand surgery: a systematic review
Authors: Long Chao , desJardins-Park Heather E. , Popat Rita , Fox Paige M.
Published: June 2018

We assessed the quantity, quality and trends of randomized controlled trials comparing hand surgical interventions. Study characteristics were collected for 125 randomized controlled trials comparing hand surgical interventions. The Jadad scale (0–5), which assesses methodological quality of trials, was calculated. Logistic regressions were conducted to determine associations with the Jadad score. The studies were published between 1981 and 2015, with an increase over time, most often in Journal of Hand Surgery (European). Mean study size was 68 patients. Mean Jadad score was 2.1, without improvement over time. Thirty percent conducted a power analysis and 8% an intention-to-treat analysis. Studies conducted in the United Kingdom and with smaller sample sizes, power analysis and intention-to-treat analysis were associated with a higher Jadad score. The quantity of trials has increased over time while methodological quality has remained low, indicating a need to improve quality of trials in hand surgery literature.
Risk factors for and timing of adverse events after revision total shoulder arthroplasty
Authors: Keswani Aakash , Chi Debbie , Lovy Andrew J , London Daniel A , Cagle Paul J , Parsons Bradford O , Bosco Joseph A
Published: June 2018

Background

Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications.

Methods

Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated.

Results

Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA.

Discussion

Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.
A Comparison of Two Designs of Postoperative Shoe on Function, Satisfaction, and Back Pain After Hallux Valgus Surgery
Authors: Patel Shelain , Garg Parag , Fazal M. Ali , Shahid Muhammad S. , Park Derek H. , Ray Pinak S.
Published: June 2018

Background. The reverse camber shoe is commonly used after hallux valgus corrective surgery to offload the forefoot but is associated with back pain and poor compliance. Recent designs of postoperative shoes may obviate the need for a reverse camber. The purpose of this study was to compare the effects of a reverse camber shoe and a noncambered shoe with transitional rigidity after hallux valgus correction. Methods. A cohort of 80 feet was prospectively studied undergoing surgery at a single NHS trust. The first 40 feet received the reverse cambered Jura Medical Off-loader Heel shoe and the subsequent 40 feet received the noncambered DonJoy Podalux shoe. No demographic differences existed between the groups and data were collected at 2 weeks, 6 weeks, and 6 months. The Manchester-Oxford Foot Questionnaire (MOXFQ), a 5-question survey and dichotomous question about back pain was used to assess clinical outcome and radiographs were reviewed by 2 orthopaedic surgeons to monitor for loss of correction. Results. Both groups experienced comparable improvements in MOXFQ and shoe satisfaction from 2 weeks compared with 6 weeks. Six patients experienced back pain in the reverse cambered shoe group and none in the noncambered shoe group. Five patients stopped using the reverse cambered shoe during the first 6 weeks after surgery and none stopped using their prescribed noncambered shoe. No loss of corrections were observed in either group. Conclusion. Both shoe designs gave equal foot specific functional and radiological outcomes, but the noncambered shoe with transitional rigidity was associated with less back pain and better compliance.

Levels of Evidence: Level II: Prospective comparative study
Increased posterior cingulate cortex efficiency may predict cognitive impairment in asymptomatic HIV patients
Authors: Ventura Nina , Douw Linda , Correa Diogo G , Netto Tania M , Cabral Rafael F , Lopes Fernanda Cristina Rueda , Gasparetto Emerson L
Published: June 2018

Purpose

Despite antiretroviral therapy, approximately half of individuals with human immunodeficiency virus (HIV) will develop HIV-associated neurocognitive disorder (HAND). Efficiency of brain networks is of great importance for cognitive functioning, since functional networks may reorganize or compensate to preserve normal cognition. This study aims to compare efficiency of the posterior cingulate cortex (PCC) between patients with and without HAND and controls. We hypothesize HAND negative (HAND–) patients will show higher PCC efficiency than HAND positive (HAND+) patients.

Methods

A total of 10 HAND + patients were compared with 9 HAND– patients and 17 gender-, age-, and education-matched controls. Resting-state functional MRI was acquired with a 3 Tesla scanner. Local efficiency, a measure of network functioning, was investigated for PCC. Network differences among HAND + , HAND– patients and controls were tested as well as correlations between network parameters and cognitive test performance in different domains.

Results

HAND– patients showed significantly increased PCC efficiency compared with healthy controls ( p = 0.015). No differences were observed between HAND + patients and either controls ( p = 0.327) or HAND– patients ( p = 0.152). In HAND– patients, PCC efficiency was positively related with cognitive performance in the attention/working memory domain ( p = 0.003). Conversely, in HAND + patients, PCC efficiency was negatively correlated with performance in the abstraction/executive domain ( p = 0.002).

Conclusion

HAND– patients showed a higher level of PCC efficiency compared with healthy subjects, and PCC efficiency was positively related to cognitive performance. These results support the functional reorganization hypothesis, that increased PCC efficiency is a compensation technique to maintain cognitive functioning.
Reference intervals of thyroid hormones in a previously iodine-deficient area in Darfur, Sudan
Authors: Ali Nagi I. , Alamoudi Abdullah O. , Adam Ishag
Published: June 2018

Background:

Thyroid-stimulating hormone (TSH), thyroxin (T4) and T3 levels are varied in the different settings with disorders of thyroid homeostasis. It is recommended that every setting has to establish its own reference intervals (RIs) for these hormones.

Methods:

A multi-stage stratified sampling method was used to select a representative sample of a Sudanese adult (>20 years of age) in Nyala in western Sudan in the Darfur region during the period between January and June 2016 to establish RIs of thyroid-related hormones (TSH, T4 and T3). In this study, 1753 serum samples (male and female) with different age groups were investigated. A radioimmunoassay gamma counter was used to measure the level of these hormones.

Results:

The median (95% intervals) of serum TSH, T4 and T3 levels was 1.2 (0.50–3.0) mIU/l, 111.0 (72.0–161.0) nmol/l and 1.5 (0.8–2.8) nmol/l respectively. While the level of TSH was significantly higher in the age group between 31 and 40 years, both T4 and T3 levels have shown a progressive increase with age. There was no significant difference in the TSH, T4 and T3 level when the RIs were compared between males and females.

Conclusion:

The RIs for TSH, T4 and T3 in this setting were different from the levels provided by the manufacturers. The RIs were different in the different age groups.
Do primary care providers who prescribe more opioids have higher patient panel satisfaction scores?
Authors: North Frederick , Crane Sarah J , Ebbert Jon O , Tulledge-Scheitel Sidna M
Published: June 2018

Objectives:

Opioid prescribing in the United States has tripled since 1999. At the same time, there has been increasing attention to patient satisfaction. It has been suggested that providers concerned about patient satisfaction may be more likely to treat pain with opioids. We examined primary care providers’ opioid prescribing practices to determine if higher provider opioid prescribing was associated with higher patient satisfaction.

Methods:

For 77 primary care providers, we compared each provider’s opioid prescription count and amount prescribed to each provider’s patient panel satisfaction measures. Satisfaction measures were obtained from surveys following office visits and consisted of Likert-type scale answers concerning satisfaction for pain management and other provider satisfaction domains. Satisfaction surveys were generated independent of patient complaint of pain and had the aim of overall assessment of patient satisfaction with the provider and the healthcare system. We assessed the correlation between opioid prescribing and patient panel pain management satisfaction using linear regression models with and without adjustment for patient complexity.

Results:

We observed no statistically significant correlation between patient panel satisfaction with their provider and the quantity of opioids that the provider prescribed (R2 = 0.006; p = 0.52). There was also no correlation between patient panel satisfaction and the number of opioid prescriptions written by their provider (R2 = 0.005; p = 0.54). Additional multivariate analysis after adjusting for patient complexity also demonstrated no correlation of pain management satisfaction with opioids prescribed. Although the quantity of opioid prescriptions was not correlated with pain management satisfaction, several other patient satisfaction measures correlated significantly with pain management satisfaction.

Conclusion:

Primary care providers with a greater rate of opioid prescribing did not have higher patient panel satisfaction scores for pain management. In primary care, providers who want to improve patient satisfaction should focus on other components of patient care besides opioid-based pain management.
“My Greatest Fear Is Becoming a Robot”: The Paradox of Transitioning to Nursing Practice in Lebanon
Authors: Clinton Michael , Madi Murielle , Doumit Myrna , Ezzeddine Sawsan , Rizk Ursula
Published: June 2018

We investigated the challenges final-year nursing students (FYNSs) and first-year registered nurses (FYRNs) face as they transition to nursing practice in Lebanon. Our purpose was to understand the challenges of transition from the perspective of FYNS and FYRNs. We conducted focus group discussions with FYNSs and FYRNs recruited from four leading universities. Thematic analysis identified an unexpected paradox that has implications for quality of nursing care and retention of graduates. While humanoids are marketed to communicate empathically with patients, FYNSs in Lebanon struggle to resist becoming robots.
Frequent Quizzes and Student Improvement of Reading: A Pilot Study in a Community College Setting
Authors: Gokcora Deniz , DePaulo Daniel
Published: June 2018

This pilot study explores the extent to which frequent quizzes given in a developmental Academic Critical Reading (ACR) course in a community college affects student success on a standardized CUNY (The City University of New York) assessment test on reading skills. Participants included 41 students in two class sections of ACR class who received frequent quizzes and 47 students in two sections of ACR without frequent quizzes as the control group. Results showed that students who received frequent quizzes showed greater improvement on the standardized CUNY test compared with controls, with gender moderating this effect. In addition, students who received a Pell Grant improved their performance on the standardized CUNY test more than those who did not receive a Pell Grant. Lower levels of absences were also associated with improvement on the standardized CUNY test. Quiz attitude survey results indicate that students have a positive attitude toward completing frequent quizzes, and they felt much more confident when taking the CUNY test at the end of the semester. Receiving frequent quizzes also encouraged students to attend classes at a higher rate.
Promoting Hearing Health
Authors: Randolph Susan A.
Published: June 2018

Noise-induced hearing loss is a chronic illness that develops gradually over time. Occupational health nurses can intervene in meaningful ways to promote best practices to prevent hearing loss.
Agrarian Movements in Neoliberal India: A Case Study of Andhra Pradesh Vyvasaya Vruthidarula Union
Authors: Smitha K. C.
Published: June 2018

One of the major weaknesses of agrarian workers has been the inability to form unions due to the heterogeneous nature and difficulties in locating them, which has delayed efforts to organize struggles against, and exert pressure on, the government. As such, agrarian workers do not qualify under the ambit of traditional unionization. Under the operating context of neoliberal restructuring, this study examines the efforts of the Andhra Pradesh Vyavasaya Vruthidarula Union (APVVU) in organizing the informal sector workers, mainly agricultural workers. The purpose here is to discern the specific nature and processes involved in agrarian movements by exploring the role of APVVU. The aim is to decipher the phenomenon of class mobilization of agrarian labourers/workers and capture their existential crisis in India. The study further identifies elements of both class and ideological congruity of collective community mobilization.
An Unusual Cause of Failure to Ventilate
Authors: Denny John T. , Mungekar Sagar S. , Landgraf Benjamin R. , Rocke Zoe M. , McRae Valerie A. , McDonough Christian P. , Tse James T. , Mellender Scott J. , Kiss Geza K.
Published: June 2018

We report an unusual case of endotracheal tube failure. It was due to a manufacturing defect in the internal white plastic piece that is normally depressed by the luer-lock syringe within the blue pilot balloon. Prior to use, the endotracheal tube was tested and functioned normally. A 64-year-old patient in the intensive care unit with a history of hypertension was being mechanically ventilated after uneventful abdominal surgery. After several hours in the intensive care unit, he was noted to be suddenly no longer receiving adequate tidal volumes from the ventilator. It was found that the cuff on the endotracheal tube was not retaining air when it was filled with air from a syringe. This lead to a large “leak” around the endotracheal tube such that the intended tidal volumes set on the ventilator were not delivered to the patient. The patient was uneventfully reintubated and did well. Subsequent investigation revealed the cause to be a manufacturing defect in the internal white plastic piece that is normally depressed by the luer-lock syringe within the blue pilot balloon. Other mechanisms of cuff failure are reviewed in this case report. This case is an unusual reason for cuff failure. Illustrations supplied alert the reader how to identify the appearance of this manufacturing defect in a pilot balloon. This case illustrates the potential device malfunctions that can develop during a procedure, even when the equipment has been tested and previously functioned well. Even small defects developing in well-engineered products can lead to critical patient care emergencies.
From Alienation to Partnership: Israel–Japan Relation
Authors: Medzini Meron
Published: June 2018

The relations between Japan and Israel, established in 1952, can be divided into two periods. The first between 1952 and 1989 was known as the “the forty wasted years.” They were marked by chill bordering on alienation. The second began in the late 1980s and saw the flourishing of ties. Today, Japan–Israel relations are marked by much warmth and friendship at many levels. What were the causes for the Japanese policy in the early years and what factors led to the drastic change that occurred since then?
Dalit Women and Water: Availability, Access and Discrimination in Rural India
Authors: Dutta Swarup , Sinha Ishita , Parashar Adya
Published: June 2018

The present study identifies the multiplicity of issues and challenges faced by dalit women in accessing water from common, often distant sources of water, across five Indian states. Their reality of poor availability of drinking water was worsened by limited access to common resources due to their caste identity. On account of their social exclusion, dalit women suffer from physical as well as mental anguish. Discrimination against them is rampant on account of untouchability, and verbal and physical abuse accompanied with violence, which is a very real part of their everyday lives.
Socio-economic Inequality or Demographic Conditions: A Micro-level Analysis of Terrorism in Jharkhand
Authors: Ouassini Nabil , Verma Arvind
Published: June 2018

A popular perception is that left-wing extremism has its roots in the phenomenon of socio-economic inequality. Yet, empirical work analysing this perception and exploring the links between left-wing extremism and socio-economic deprivation is limited. This article examines the relationship between socio-economic-demographic indices and left-wing extremism in the state of Jharkhand in India. The analysis tests the strength of the relationship linking left-wing terrorist incidents that occurred between the years of 2005 and March of 2012 and various socio-economic-demographic factors. The results suggest that the districts that report high incidents of terrorist attacks are not only linked to socio-economic inequality but also associated with socio-demographic conditions concerning state access and the lack of penetration by security and government agencies. In the conclusion, policy implications and future research for the state of Jharkhand are suggested.
Spacer devices for inhaled therapy: why use them, and how?
Authors: Vincken Walter , Levy Mark L. , Scullion Jane , Usmani Omar S. , Dekhuijzen P.N. Richard , Corrigan Chris J.
Published: June 2018

We present an extensive review of the literature to date pertaining to the rationale for using a spacer/valved holding chamber (VHC) to deliver inhaled therapy from a pressurised, metered-dose inhaler, a discussion of how the properties of individual devices may vary according to their physical characteristics and materials of manufacture, the potential risks and benefits of ancillaries such as valves, and the evidence that they contribute tangibly to the delivery of therapy.

We also reiterate practical recommendations for the correct usage and maintenance of spacers/VHCs, which we trust offer practical help and advice to patients and healthcare professionals alike.
Prevention of haematoma progression by tranexamic acid in intracerebral haemorrhage patients with and without spot sign on admission scan: a statistical analysis plan of a pre-specified sub-study of the TICH-2 trial
Authors: Ovesen Christian , Jakobsen Janus Christian , Gluud Christian , Steiner Thorsten , Law Zhe , Flaherty Katie , Dineen Rob A. , Bath Philip M. , Sprigg Nikola , Christensen Hanne
Published: June 2018

Objective

We present the statistical analysis plan of a prespecified Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH)-2 sub-study aiming to investigate, if tranexamic acid has a different effect in intracerebral haemorrhage patients with the spot sign on admission compared to spot sign negative patients. The TICH-2 trial recruited above 2000 participants with intracerebral haemorrhage arriving in hospital within 8 h after symptom onset. They were included irrespective of radiological signs of on-going haematoma expansion. Participants were randomised to tranexamic acid versus matching placebo. In this subgroup analysis, we will include all participants in TICH-2 with a computed tomography angiography on admission allowing adjudication of the participants’ spot sign status.

Results

Primary outcome will be the ability of tranexamic acid to limit absolute haematoma volume on computed tomography at 24 h (± 12 h) after randomisation among spot sign positive and spot sign negative participants, respectively. Within all outcome measures, the effect of tranexamic acid in spot sign positive/negative participants will be compared using tests of interaction. This sub-study will investigate the important clinical hypothesis that spot sign positive patients might benefit more from administration of tranexamic acid compared to spot sign negative patients.

Trial registration ISRCTN93732214 (http://www.isrctn.com)
Ethnic variation in personality disorder: evaluation of 6 years of hospital admissions
Authors: Hossain A. , Malkov M. , Lee T. , Bhui K.
Published: June 2018

Aims and method

There is limited evidence on ethnic differences in personality disorder prevalence rates. We compared rates of people with personality disorder admitted to hospital in East London from 2007 to 2013.

Results

Of all people admitted to hospital, 9.7% had a personality disorder diagnosis. The admission rate for personality disorder has increased each year. Compared with White subjects, personality disorder was significantly less prevalent among Black and other minority ethnic (BME) groups. Personality disorder was diagnosed in 20% of forensic, 11% of general adult, 8% of adolescent and 2% of old-age in-patients.

Clinical implications

The increasing number of personality disorder diagnoses year on year indicates the increasing impact of personality disorder on in-patient services. It is important to identify and appropriately manage patients with a personality disorder diagnosis due to the significant strain they place on resources. The reasons for fewer admissions of BME patients may reflect alternative service use, a truly lower prevalence rate or under-detection.

Declaration of interest

None.
Tracking progress: an update on animal models for Duchenne muscular dystrophy
Authors: Wells Dominic J.
Published: June 2018

Duchenne muscular dystrophy (DMD) is a progressive, fatal, X-linked monogenic muscle disorder caused by mutations in the DMD gene. In order to test treatments for DMD, a range of natural and engineered animal models have been developed, including mice, rats, dogs and pigs. Sui and colleagues have now added a dystrophic rabbit model to this range using CRISPR/Cas9 to disrupt exon 51 of DMD. Rabbits have the advantage of being easier to breed and less costly than dog or pig models, but having clear clinical signs, in contrast to many mouse models. There appears to be an effect of body size in models of DMD, as the severity of the clinical signs increases with increasing body size across species. All DMD models have advantages and disadvantages, and it is crucial that investigators understand the limitations of each model when testing novel therapies for DMD in pre-clinical studies.
Hospital mortality scores are unduly influenced by changes in service configuration
Authors: Jones Rodney
Published: June 2018

Any hospital doctor will inform you that length of stay is a far better indicator of patient acuity than diagnosis. So why do hospital doctors continue to be harassed over supposed changes in hospital mortality generated by models which largely rely on diagnosis?
Latest clinical research
Authors: Greener Mark
Published: June 2018

Mark Greener presents key studies published in healthcare journals
GP online services: The wider picture
Authors: Hancock Dave
Published: June 2018

Awareness of online services is increasing but that is not the whole story. Is digital exclusion a factor? Dave Hancock investigates
Get ready for the new NHS wage deal
Authors: Burwood Andrew
Published: June 2018

The NHS pay deal agreed by union leaders and government ministers earlier this year is likely to lead to increases in staff salaries, particularly at the lower end of the pay scales. Accountant Andrew Burwood looks at the impact on general practice
Data protection and the rules on retention
Authors: Granger Catriona
Published: June 2018

The General Data Protection Regulation came into effect in May and since then, staff will have been getting to grips with a number of changes. Catriona Granger explains the practice's obligations when it comes to medical records
There is no ‘weekend effect’ in elective orthopaedic surgery
Authors: Al-Ashqar Mohammad , Aqil Adeel , Phillips Hannah , Sheikh Hassaan , Harrison Simon , Sidhom Sameh , Chakrabarty Gautam , Dimri Ravinder
Published: June 2018

Introduction

The ‘weekend effect’ is said to occur when patient outcomes are adversely affected by the day of the week on which they present to hospital or have surgery. However, it is uncertain whether such a phenomenon exists for elective orthopaedic surgery. We investigated whether there is a ‘weekend effect’ in elective orthopaedic patients.

Methods

Retrospectively collected data were obtained from our institution’s electronic patient records. We collected demographic and International Statistical Classification of Diseases and Related Health Problems tenth revision coding data for all included patients. Multivariate analyses identified covariate-adjusted risk factors, associated with prolonged stays. Thirty-day mortality data were assessed according to the day on which surgery occurred.

Results

We analysed data for 892 patients over a one-year period. During the year, 457 patients had a total hip and 435 had a total knee replacement; 814 patients (91.3%) underwent surgery during the week, while 78 (8.7%) had surgery on a Saturday. There was no difference in average length of stay between the groups (5.0, 2.6 vs 5.0, 3.4, P = 0.95). Variables associated with prolonged hospitalisation included increasing age (covariate adjusted relative risk 1.02, 95% confidence interval 1.01–1.03, P < 0.001) and an American Society of Anesthesiologists score of 2, (relative risk 1.6, 95% confidence interval 1.15–2.20, P = 0.005). There was one death in a patient who underwent surgery on a Monday.

Conclusions

There is no ‘weekend effect’ for elective orthopaedic surgery.
Predicting in-hospital mortality in older general surgical patients
Authors: Vilches-Moraga A , Fox J , Paracha A , Gomez-Quintanilla A , Epstein J , Pearce L
Published: June 2018

Introduction

A significant number of emergency general surgical admissions occur in older patients. Clinical decision making in this group is challenging and current risk prediction tools extrapolate data from cohorts of younger patients. This is the first UK study to examine risk factors predicting in-hospital mortality in older acute surgical patients undergoing comprehensive geriatric assessment.

Methods

This was a prospective study of consecutive patients aged ≥75 years admitted non-electively to general surgery wards between September 2014 and February 2017 who were reviewed by an elderly medicine in-reach service.

Results

A total of 577 patients were included with a mean age of 82.9 years. There was a female predominance (56%). The majority were living at home alone or with carers (93%) and most were independent in basic activities of daily living (79%). Over two-thirds (69%) were mobile with no walking aids or use of a walking stick and overt here-quarters (79%) had no cognitive impairment. Seventy-seven per cent of patients were managed non-operatively. The in-hospital mortality rate was 6.9%. Female sex (p=0.031), dependence in activities of daily living (p<0.001), cognitive impairment (p<0.001) and incontinence (p<0.001) were predictors of in-hospital mortality. ASA (American Society of Anesthesiologists) grade ≥3 was also associated with increased in-hospital mortality (odds ratio: 5.3, 95% confidence interval: 2.6–10.7).

Conclusions

Older general surgical patients present a high level of complexity. This study highlights the predictive role of mobility, functional and cognitive impairment when assessing this population. Accurate risk stratification requires global assessment by teams experienced in care of the older patient rather than the traditional focus on co-morbidities.
Is it necessary to change instruments between sampling sites when taking multiple tissue specimens in musculoskeletal infections?
Authors: Makki D , Abdalla S , El Gamal TA , Harvey D , Jackson G , Platt S
Published: June 2018

Introduction

Surgical debridement of orthopaedic infections allows biopsy for microbiology and facilitates successful treatment. It is recommended that biopsy instruments are changed when taking multiple samples. This study compared assessed cross-contamination between biopsy sites when using same instruments to take tissue samples from multiple sites.

Materials and methods

During the surgical debridement, we defined five sampling sites and marked them with diathermy. Two sampling techniques were performed on same patient to minimise any potential bias arising from the type of host and the severity of infection. First, fresh instruments were used for each biopsy site. Titleond, the instruments used in the first sampling site were reused to take samples from the remaining sites. By comparing the microbiology results of the samples taken by each technique for each site we determined cross-contamination with microorganisms.

Results

Fifteen patients with foot and ankle infections (mean age 56 years) were included. Ten patients were diabetic and five had neuropathies. Cross-contamination between sampling sites occurred in eight cases when the same instruments were used to take biopsies (P = 0.002, Fisher’s exact test). One or more microorganisms were involved in cross-contamination and the latter always occurred between two consecutive sites rather than sites that were further apart.

Conclusion

It is important to use fresh instruments for each biopsy site when taking multiple samples in musculoskeletal infection as cross-contamination might occur otherwise and affect microbiological studies.
Repercusiones de la Unión Ibérica en el sur de Brasil: el caso de Santa Catarina
Authors: Rico Bodelón Óscar
Published: June 2018

Cuando los españoles conquistaron la isla de Santa Catarina en 1777 ya hacía mucho tiempo que habían perdido las opciones de dominar este importante puerto en la ruta hacia el Río de la Plata. Fue durante el período de la Unión de las Coronas Ibéricas (1580-1640) cuando se abandonaron los planes castellanos para impulsar un enclave atlántico con el que se pretendían acortar las comunicaciones con Asunción, y cuando, por otra parte, también se desarrolla la acción de los bandeirantes en la Guairá y la de los comerciantes portugueses en Buenos Aires. Tres elementos que resultarán determinantes para la posterior y definitiva inclusión de los territorios situados al sur de la capitanía de São Vicente en la esfera colonial luso-brasileña.
De la asociación estratégica a la crisis: las relaciones hispano-brasileñas en un contexto de cambios estructurales
Authors: Ayllón Pino Bruno
Published: June 2018

Después de varias décadas de mutua irrelevancia, las relaciones entre España y Brasil se intensificaron en la última década del siglo XX, dando paso a una nueva fase de asociación estratégica. Sin embargo, a partir de 2010, en el contexto de la crisis que castiga a España y del ascenso internacional de Brasil, las relaciones bilaterales se han ido redefiniendo para traducir a la realidad las respectivas prioridades de los países, enfatizándose aspectos cruciales como la ciencia y la tecnología, las infraestructuras y la identificación de sectores potenciales para el incremento de los intercambios comerciales.