bluuebunny/crossref_metadata_2025 huggingface dataset:
Biological Degradation and Biostability of Nanocomposites Based on Polysulfone with Different Concentrations of Reduced Graphene Oxide
Authors: Peña‐Bahamonde J. , San‐Miguel V. , Cabanelas J. C. , Rodrigues D. F.
Published: December 2017

Increasing incorporation of rGO in the polysulfone polymer generates materials with improved chemical and mechanical stability and less prone to biodegradation at the end of the nanocomposite life cycle. The results of attenuated total reflection infrared (ATR‐IR) and mechanical strength, after exposure to wastewater influent, show that the increasing concentrations of rGO into the polymer matrix reduce changes in the nanocomposite properties. The increasing incorporation of rGO also increases growth inhibition of the wastewater microbial population on the surface of nanocomposites. Highest biofilm inhibition and material stability are observed with nanocomposites containing 3 wt% rGO. These results suggest that reduction in the material biodegradation is linked to the inhibition of biofilm growth on the nanocomposite surface due to the antimicrobial properties of rGO. This study demonstrates, for the first time, that the amount of rGO incorporated in the nanocomposite impact the biodegradability and end of life of polysulfone nanocomposites.
Short report: Follow‐up of Bahamian women with a BRCA1 or BRCA2 mutation
Authors: Narod Steven A. , Butler Raleigh , Bobrowski David , Akbari Mohammad R. , Curling DuVaughan , Lunn John , Ho Catherine , Panahi Sara , Llacuachaqui Marcia , Donenberg Talia , Hurley Judith
Published: December 2017

Purpose

We sought to determine to what extent the knowledge of carrying a BRCA1 or BRCA2 mutation influences the uptake of preventive surgeries in Bahamian women, including bilateral salpingo‐oophorectomy and bilateral mastectomy.

Patients and methods

The study population consisted of 78 female residents of the Bahamas for whom a BRCA1 or BRCA2 mutation had been detected between 2004 and 2014. The mean age of the 78 participants at the time of genetic testing was 46 years (age range 22–73 years). The mean time of follow‐up was 4.4 years.

Results

Of the 78 study participants, 19 women had a bilateral salpingo‐oophorectomy (24%). Seven out of 37 patients who had unilateral breast cancer chose to remove the unaffected contralateral breast (19%). Three of 13 patients with no history of breast cancer chose to have a prophylactic bilateral mastectomy (23%).

Conclusion

Preventive surgery is an acceptable option for a significant proportion of Bahamian women with a BRCA1 or BRCA2 mutation. It will be important to identify and reduce barriers to preventive surgery in the Bahamas in order that the benefit of getting testing can be fully realized.
Sensitivity of chemical reaction networks: A structural approach. 3. Regular multimolecular systems
Authors: Brehm Bernhard , Fiedler Bernold
Published: December 2017

We present a systematic mathematical analysis of the qualitative steady‐state response to rate perturbations in large classes of reaction networks. This includes multimolecular reactions and allows for catalysis, enzymatic reactions, multiple reaction products, nonmonotone rate functions, and non‐closed autonomous systems. Our structural sensitivity analysis is based on the stoichiometry of the reaction network, only. It does not require numerical data on reaction rates. Instead, we impose mild and generic nondegeneracy conditions of algebraic type. From the structural data, only, we derive which steady‐state concentrations are sensitive to, and hence influenced by, changes of any particular reaction rate—and which are not. We also establish transitivity properties for influences involving rate perturbations. This allows us to derive an influence graph which globally summarizes the influence pattern of any given network. The influence graph allows the computational, but meaningful, automatic identification of functional subunits in general networks, which hierarchically influence each other. We illustrate our results for several variants of the glycolytic citric acid cycle. Biological applications include enzyme knockout experiments and metabolic control.
Negative perceptions of illness and health are associated with frequent use of physiotherapy in primary healthcare
Authors: Opseth Gro , Wahl Astrid Klopstad , Bjørke Gustav , Mengshoel Anne Marit
Published: December 2017

Background

There is growing concern that an ageing population and increasing number of patients with chronic illnesses in the future will foster a need for health services beyond the resources available in society. Patients with chronic illnesses are reported to be frequent users of physicians' services in the primary health sector. Therapies for patients with chronic musculoskeletal illnesses are delivered by physiotherapists in this sector. However, we know little about the use of physiotherapy services and the factors that may explain their use.

Purpose

The aim of the present study was to examine the association between the regular/non‐regular use of physiotherapy services, impacts of illness, and perceptions of illness and health.

Methods

A cross‐sectional survey included patients between 18 and 70 years of age who visited a physiotherapy outpatient clinic in Oslo during one randomly chosen week. Patient characteristics and use of physiotherapy were mapped. The Brief Illness Perception Questionnaire (BIPQ), a single item of the Short Form Health Survey (SF‐12) and the Ørebro Musculoskeletal Pain Questionnaire (ØMPQ) were used to assess perceptions of illness and health, and impacts of illness. Data were analysed using independent sample t‐tests and logistic regression analysis.

Results

A total of 507 patients with a mean age of 46 (standard deviation 12) years participated, of whom 54% were regular users of physiotherapy. BIPQ (p = 0.02; β = 0.03) and the single‐item on general health perception (p = 0.001; β = 0.44,) were the only significant variables in the final equation associated with regular use of physiotherapy.

Conclusion

About half of the participants were regular, high consumers of physiotherapy, and negative perceptions of illness and health were associated with this regular use.
Multivoxel proton magnetic resonance spectroscopy in facioscapulohumeral muscular dystrophy
Authors: Leung Doris G. , Wang Xin , Barker Peter B. , Carrino John A. , Wagner Kathryn R.
Published: December 2017

Introduction: Facioscapulohumeral muscular dystrophy (FSHD) is a hereditary disorder that causes progressive muscle wasting. This study evaluates the use of proton magnetic resonance spectroscopy (1H MRS) as a biomarker of muscle strength and function in FSHD. Methods: Thirty‐six individuals with FSHD and 15 healthy controls underwent multivoxel 1H MRS of a cross‐section of the mid‐thigh. Concentrations of creatine, intramyocellular and extramyocellular lipids, and trimethylamine (TMA)‐containing compounds in skeletal muscle were calculated. Metabolite concentrations for individuals with FSHD were compared with those of controls. The relationship between metabolite concentrations and muscle strength was also examined. Results: The TMA/creatine (Cr) ratio in individuals with FSHD was reduced compared with controls. The TMA/Cr ratio in the hamstrings also showed a moderate linear correlation with muscle strength. Discussion: 1H MRS offers a potential method of detecting early muscle pathology in FSHD prior to the development of fat infiltration. Muscle Nerve 57: 958–963, 2018
Does nebulized hypertonic saline shorten hospitalization in young children with acute viral wheezing?
Authors: Kanjanapradap Thanakorn , Deerojanawong Jitladda , Sritippayawan Suchada , Prapphal Nuanchan
Published: December 2017

Background

Although previous studies have shown benefits of nebulized hypertonic saline (HS) for improving airway clearance and shortening hospitalization in infants with bronchiolitis, prospective blinded studies in preschool children with acute viral wheezing are limited.

Objectives

To determine nebulized 3% HS efficacy in young children admitted with acute viral wheezing.

Methods

This double‐blind, randomized controlled trial was conducted in children aged 6 months to 5 years admitted with acute viral wheezing from July 1st to December 31st 2016. Patients were randomized to receive inhalation of 2.5 mg salbutamol dissolved in either 3% HS or normal saline (NS). Clinical data, asthma clinical severity score, and length of hospital stay (LOS) were recorded.

Results

A total of 47 patients were enrolled (22 in HS and 25 in NS) without significant differences in demographic data and baseline clinical scores. Median LOS and median time of oxygen therapy were significantly shorter in HS than NS group: 48 versus 72 h, P = 0.021 and 36 versus 72 h, P = 0.025, respectively. HS patients had significantly improved asthma clinical severity scores, respiratory rates and oxygen saturation at 12 h compared to NS group (P‐value 0.042, 0.032, and 0.043). There were no adverse events.

Conclusion

In children under 5 years admitted with acute viral wheezing, nebulized hypertonic saline/salbutamol significantly shortened hospital stay length, time of oxygen therapy, and improved asthma clinical severity score faster than normal saline/salbutamol.
Fracture toughness and brittle failure: A pressure vessel case study
Authors: Puryear John , Ramirez Guillermo , Botard Clint , Kenady Kollin
Published: December 2017

That the manufacturing and fabrication process can introduce low fracture toughness and cause brittle failure in steel has been documented in well‐known studies. These include failure of Liberty ships during World War II and, more recently, weld failures in steel moment frames during the 1994 Northridge earthquake. In both of these cases, the manufacturing and fabrication process introduced stress states that reduced fracture toughness and caused brittle failures.

Control of the manufacturing and fabrication process to maintain sufficient fracture toughness remains a challenge for the Oil and Gas Industry. In this article, we will review an incident of a brittle failure of a pressure vessel. The head of the pressure vessel, which was operating as a low‐pressure separator, detached about its circumference at a pressure much less than the vessel's maximum operating pressure. A root cause analysis of the incident identified the performance gaps and root causes from the vessel's service conditions, manufacture, and fabrication that combined to cause the brittle failure.

This article examines the performance gaps that lead to the failure and their root causes. The effect of the root causes on the vessel's mechanical properties is discussed. Further, the performance gaps are related to material and fabrication guidelines in the ASME Boiler & Pressure Vessel Code. Finally, recommendations for correcting the performance gaps are offered. © 2017 American Institute of Chemical Engineers Process Saf Prog 37: 305–310, 2018
Population projection accuracy: The impacts of sociodemographics, accessibility, land use, and neighbour characteristics
Authors: Chi Guangqing , Wang Donghui
Published: December 2017

Population projection is essential to governments, businesses, and research communities for many purposes. Although projection performance is often evaluated, we know very little about what factors affect projection accuracy. It is important to understand these factors in order to utilise the projections knowledgeably. This study fills this gap in the literature by comprehensively investigating the possible factors associated with population projection accuracy in 2010 for the continental U.S. counties. The results indicate that the counties whose populations are more predictable tend to be desirable places—places with abundant employment opportunities, reliable public transportation infrastructure, easy access to work, and/or high land development potential; their neighbouring counties tend to have a well‐educated population and a higher income level. Also, projection accuracy is highly spatially associated. The findings provide important insights for population projection users to understand the characteristics of counties and their neighbouring counties associated with their projection accuracy.
Understanding the social geographies of urban regions through the socio‐economic and cultural dimension of class
Authors: Boterman Willem R. , Manting Dorien , Musterd Sako
Published: December 2017

Economic restructuring and changing demographic and migration patterns have significantly altered the population compositions of urban regions. Whereas there is evidence that employees in various sectors of the economy have different residential preferences, there exists much less insight into the social geography of various class fractions at the level of urban regions. The aims of this paper are (1) to describe the spatial orientations of various employment groups in the largest urban regions in the Netherlands and (2) to understand the extent to which spatial orientations towards various residential urban and suburban milieus can be explained by belonging to a specific class fraction. We draw on individual‐level register data for the whole population of urban regions, applying a multidimensional and detailed perspective on social class that takes into account both economic and cultural capital. We demonstrate a strong urban orientation among the cultural classes, who are often working in the new economies—irrespective of their income status—and an over‐representation in suburban areas of more economically orientated class fractions. Despite the differences in terms of economic structure of the researched urban regions, these variegated residential orientations are remarkably consistent.
Migration aspirations and migration cultures: A case study of Ukrainian migration towards the European Union
Authors: Van Mol Christof , Snel Erik , Hemmerechts Kenneth , Timmerman Christiane
Published: December 2017

An abundant body of research focused on macrolevel, mesolevel, and microlevel factors explaining why individuals move across international borders. In this paper, we aim to complement the existing literature by exploring how, within a single country, mesolevel factors differently impact migration aspirations, focusing on a case study of Ukraine. We particularly focus on how migration aspirations of individuals in two different regions can be explained by their international social networks with family members, on the one hand, and with friends, on the other. Furthermore, we explore whether regional migration characteristics play a role, as well as the interaction of such characteristics with individuals' frequency of contact with transnational networks. Our analyses are based on the EUMAGINE project and suggest that the interplay between regional migration characteristics and transnational social contact are key for explaining the decline of migration systems over time.
S/elective belonging: how rural newcomer families with children become stayers
Authors: Haartsen Tialda , Stockdale Aileen
Published: December 2017

Rural stayers are often defined as people who have never left their rural home region or village. However, rural regions and villages also receive new inhabitants. This paper explores if and how newcomers become inhabitants who stay put. We do so by interviewing couples of newcomers who moved to a rural area of the Netherlands at the family formation life stage. All had moved between 5 and 10 years prior to this study. We view the process of becoming a stayer through the lens of getting attached to and identifying with the new home region. We adopt the concepts of 'elective belonging' and 'selective belonging' to explore the newcomers' actual experiences of rural place and, in turn, the ways rural newcomer families become stayers. We identify two types of stayers: children‐led and convinced stayers. Both envisage a re‐negotiation of staying or leaving at a later life stage (either the empty nest or old age stage). They all elected to belong to residential places in enchanted rural landscapes. But they also are selective in developing belonging to the rural. First, especially convinced stayers consciously adapt their behaviour in order to fit in the local community. Second, children‐led stayers seek only to become involved in child‐related activities. Third, both types of stayers ‘identify against’ certain elements of local culture and of real rural stayers. S/elective strategies of belonging are found to go hand‐in‐hand with processes of becoming a stayer. Moreover, s/elective belonging to the place leaves the option to 'leave in future'.
Camera‐augmented mobile C‐arm (CamC): A feasibility study of augmented reality imaging in the operating room
Authors: von der Heide Anna Maria , Fallavollita Pascal , Wang Lejing , Sandner Philipp , Navab Nassir , Weidert Simon , Euler Ekkehard
Published: December 2017

Background

In orthopaedic trauma surgery, image‐guided procedures are mostly based on fluoroscopy. The reduction of radiation exposure is an important goal. The purpose of this work was to investigate the impact of a camera‐augmented mobile C‐arm (CamC) on radiation exposure and the surgical workflow during a first clinical trial.

Methods

Applying a workflow‐oriented approach, 10 general workflow steps were defined to compare the CamC to traditional C‐arms. The surgeries included were arbitrarily identified and assigned to the study. The evaluation criteria were radiation exposure and operation time for each workflow step and the entire surgery. The evaluation protocol was designed and conducted in a single‐centre study.

Results

The radiation exposure was remarkably reduced by 18 X‐ray shots 46% using the CamC while keeping similar surgery times.

Conclusions

The intuitiveness of the system, its easy integration into the surgical workflow, and its great potential to reduce radiation have been demonstrated.
Real‐time nonlinear moving horizon observer with pre‐estimation for aircraft sensor fault detection and estimation
Authors: Wan Yiming , Keviczky Tamás
Published: December 2017

This paper presents a real‐time nonlinear moving horizon observer (MHO) with pre‐estimation and its application to aircraft sensor fault detection and estimation. An MHO determines the state estimates by minimizing the output estimation errors online, considering a finite sequence of current and past measured data and the available system model. To achieve the real‐time implementability of such an online optimization–based observer, 2 particular strategies are adopted. First, a pre‐estimating observer is embedded to compensate for model uncertainties so that the calculation of disturbance estimates in a standard MHO can be avoided without losing much estimation performance. This strategy significantly reduces the online computational complexity. Second, a real‐time iteration scheme is proposed by performing only 1 iteration of sequential quadratic programming with local Gauss‐Newton approximation to the nonlinear optimization problem. Since existing stability analyses of real‐time moving horizon observers cannot address the incorporation of the pre‐estimating observer, a new stability analysis is performed in the presence of bounded disturbances and noises. Using a nonlinear passenger aircraft benchmark simulator, the simulation results show that the proposed approach achieves a good compromise between estimation performance and computational complexity compared with the extended Kalman filtering and 2 other moving horizon observers.
Changes and predictors of psychological stress among elderly stroke survivors 6 months after hospital discharge
Authors: dos Santos Emanuella Barros , Rodrigues Rosalina Aparecida Partezani , Fhon Jack Roberto Silva , Haas Vanderlei José
Published: December 2017

The aim of this study was to analyse the changes in psychological stress and identify its basal predictors among elderly stroke survivors after 6 months following discharge from hospital to home directly, rather than to a rehabilitation facility. The sample comprised 50 elderly stroke survivors. Data were collected at 2 weeks (T1), at 3 months (T2), and at 6 months (T3) after hospital discharge. The following instruments were applied: Perceived Stress Scale—10 items (PSS‐10), National Institute of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale—15 items. Study records indicated that the age of the study participants ranged from 60 to 87 years old (mean = 70.3; standard deviation = 7.6). The number of male and female participants was similar. The PSS‐10 score decreased almost 6 points between T1 (mean = 15.1) and T3 (mean = 9.7; p < .001). Both Functional Independence Measure (p = .025) and Geriatric Depression Scale‐15 (p = .017) scores at T1 predicted the PSS‐10 score at T3. The study thus demonstrated that elderly stroke survivors experienced significant stress after hospital discharge, which tended to improve over the next 6 months. Depression and lower functional independence 2 weeks after discharge were predictors of a greater level of psychological stress at 6 months following discharge.
Achieving High Capacitance of Paper‐Like Graphene Films by Adsorbing Molecules from Hydrolyzed Polyimide
Authors: Zhao Yi , Liu Jinzhang , Zheng Dezhi , Wang Bin , Hu Mingjun , Sha Jiangbo , Li Yan
Published: December 2017

To date, graphene‐based electric double layer supercapacitors have not shown the remarkable specific capacitance as theoretically predicted. An efficient strategy toward boosting the overall capacitance is to endow graphene with pseudocapacitance. Herein, molecules of hydrolyzed polyimide (HPI) are used to functionalize N‐doped graphene (NG) via π–π interaction and the resulting enhanced electrochemical energy storage is reported. These aromatic molecules in monolayer form on graphene contribute strong pseudocapacitance. Paper‐like NG films with different areal mass loadings ranging from 0.5 to 4.8 mg cm−2 are prepared for supercapacitor electrodes. It is shown that the gravimetric capacitance can be increased by 50–60% after the surface functionalization by HPI molecules. A high specific capacitance of 553 F g−1 at 5 mV s−1 is achieved by the HPI‐NG film with a graphene mass loading of 0.5 mg cm−2 in H2SO4 aqueous electrolyte. For the HPI‐NG film with highest mass loading, the gravimetric specific capacitance drops to 340 F g−1 while the areal specific capacitance reaches a high value of 1.7 F cm−2. HPI‐NG films are also tested in Li2SO4 aqueous electrolyte, over an extended voltage window of 1.6 V. High specific energy densities up to 40 Wh kg−1 are achieved with the Li2SO4 electrolyte.
Micro/Nanostructured Materials for Sodium Ion Batteries and Capacitors
Authors: Li Feng , Zhou Zhen
Published: December 2017

High‐efficiency energy storage technologies and devices have received considerable attention due to their ever‐increasing demand. Na‐related energy storage systems, sodium ion batteries (SIBs) and sodium ion capacitors (SICs), are regarded as promising candidates for large‐scale energy storage because of the abundant sources and low cost of sodium. In the last decade, many efforts, including structural and compositional optimization, effective modification of available materials, and design and exploration of new materials, have been made to promote the development of Na‐related energy storage systems. In this Review, the latest developments of micro/nanostructured electrode materials for advanced SIBs and SICs, especially the rational design of unique composites with high thermodynamic stabilities and fast kinetics during charge/discharge, are summarized. In addition to the recent achievements, the remaining challenges with respect to fundamental investigations and commercialized applications are discussed in detail. Finally, the prospects of sodium‐based energy storage systems are also described.
Human Mesenchymal Stem Cell Failure to Adapt to Glucose Shortage and Rapidly Use Intracellular Energy Reserves Through Glycolysis Explains Poor Cell Survival After Implantation
Authors: Moya Adrien , Paquet Joseph , Deschepper Mickael , Larochette Nathanaël , Oudina Karim , Denoeud Cyprien , Bensidhoum Morad , Logeart-Avramoglou Delphine , Petite Hervé
Published: December 2017

Mesenchymal stem cells (MSCs) hold considerable promise in tissue engineering (TE). However, their poor survival when exogenously administered limits their therapeutic potential. Previous studies from our group demonstrated that lack of glucose (glc) (but not of oxygen) is fatal to human MSCs because it serves as a pro-survival and pro-angiogenic molecule for human MSCs (hMSCs) upon transplantation. However, which energy-providing pathways MSCs use to metabolize glc upon transplantation? Are there alternative energetic nutrients to replace glc? And most importantly, do hMSCs possess significant intracellular glc reserves for ensuring their survival upon transplantation? These remain open questions at the forefront of TE based-therapies. In this study, we established for the first time that the in vivo environment experienced by hMSCs is best reflected by near-anoxia (0.1% O2) rather than hypoxia (1%–5% O2) in vitro. Under these near-anoxia conditions, hMSCs rely almost exclusively on glc through anerobic glycolysis for ATP production and are unable to use either exogenous glutamine, serine, or pyruvate as energy substrates. Most importantly, hMSCs are unable to adapt their metabolism to the lack of exogenous glc, possess a very limited internal stock of glc and virtually no ATP reserves. This lack of downregulation of energy turnover as a function of exogenous glc level results in a rapid depletion of hMSC energy reserves that explains their poor survival rate. These new insights prompt for the development of glc-releasing scaffolds to overcome this roadblock plaguing the field of TE based-therapies.
Introduction
Authors: Mauger Alice
Published: December 2017

The Introduction sets out key themes and arguments relating to private, voluntary and public asylum care in nineteenth-century Ireland. It situates the book within exiting scholarship, providing context on Irish and British frameworks. The nine asylums selected as case studies are introduced, along with an explanation of the other sources consulted and methodology used. It includes a discussion of the difficulties in accessing the patient’s view and defining social class in Ireland. Extract:Overall, this book argues that the failure of the nineteenth-century Irish state to provide accommodation for the non-pauper insane when setting up the district asylum system gained public, state and medical recognition, both at national and local level. Fresh and revised legislation and increased centralisation sought to address the challenges of accommodating this social cohort, while the lunacy inspectors, the medical community and the press raised the question of who should be legally, financially and morally accountable. No single solution was reached; instead, the state, philanthropists and private asylum proprietors came to share responsibility. This enabled many families to select between rival sectors of asylum provision. Meanwhile, the emerging psychiatric profession, sometimes sharing a sense of social equality with their paying patients, constructed class-and gender-based readings of their disorders, fashioning treatments and accommodation accordingly. The patients, acutely conscious of their own status and the threat incarceration posed to their social standing, entertained certain expectations of what their care should entail. Ultimately, however, mental illness apparently overtook class identity and often patients themselves threatened to disrupt the social decorum of the institutions in which they resided.
An Institutional Marketplace
Authors: Mauger Alice
Published: December 2017

This chapter explores the networks through which boards gathered financial information about patients and their families, their motivations for chasing fees and the inherent difficulties surrounding their negotiation and payment. Historians of psychiatry have long recognised the centrality of families in dialogues with medical and legal authorities during the certification and discharge process. As this chapter reveals, relatives were also crucial mediators in the admission and discharge of paying patients. Families in negotiations with voluntary and private asylums enjoyed comparatively greater influence as both asylum models depended heavily on patient fees. While the managing committees of voluntary asylums struggled to balance providing charity for the ‘respectable’ against attracting a wealthier clientele, private asylum proprietors made their livelihood from profits. Although voluntary asylums were not kept for profit, this chapter contends that by the later nineteenth century, many were forced into competition with private asylums. By the 1890s, this professional competition, together with the depressed economy, had come to inform their strategies for advertising and securing fees. The chapter also provides a comparative analysis of the length and outcome of stay for patients admitted to the nine asylums studied. Overall, this chapter argues that the existence of a ‘mixed economy of care’, particularly after 1870, gave rise to an institutional marketplace for the insane.
‘The Evil Effects of Mental Strain and Overwork’: Employment, Gender and Insanity
Authors: Mauger Alice
Published: December 2017

Focusing primarily on the period from 1868 to 1900, this chapter considers the extent to which the social class, gender and occupational profile of fee-paying patients influenced medical and lay identification of the causative factors of their insanity. Analysis of admissions registers is supplemented by a survey of asylum doctors’ casebooks, which cast further light on psychiatric definitions. Lay interpretations are also present in the case notes, where medical personnel recorded information supplied by families, friends and patients. In addition, correspondence written by patients’ friends and relatives provides indications of lay understandings. The chapter argues that asylum doctors in Ireland often constructed gender- as well as class-specific aetiologies for their non-pauper patients: primarily work for men and domesticity for women. Contrary to Britain, ‘alcohol’ was often attributed as a cause of illness, particularly among private asylum patients, reflecting cultural disparities in attitudes towards alcohol consumption on the two islands.
Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia
Authors: van der Naald Niels , Prins Marloes I. , Otten Kars , Kumwenda Dayson , Bleichrodt Robert P.
Published: December 2017

Aim

In sub‐Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini‐laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of “Enhanced Recovery After Surgery (ERAS)”, in a low‐resource setting.

Materials and methods

Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini‐laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively.

Results

From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini‐laparotomy. There were 29 men and 2 women, median age 57 (range 17–92) years. Patients were operated after a median period of 4 (range 1.5–18) hours. The median duration of the operative procedure was 50 (range 30–105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann’s procedure, he died on the 17th post‐operative day as a result of a HIV‐related double‐sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion.

Conclusion

Acute sigmoid resection and primary anastomosis via a mini‐laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.
Blunt Cerebrovascular Artery Injury and Stroke in Severely Injured Patients: An International Multicenter Analysis
Authors: Weber Christian D. , Lefering Rolf , Kobbe Philipp , Horst Klemens , Pishnamaz Miguel , Sellei Richard M. , Hildebrand Frank , Pape Hans‐Christoph ,   TraumaRegister DGU
Published: December 2017

Introduction

Blunt cerebrovascular injury (BCVI) is considered to be a rare entity in patients with high‐energy trauma and is a potentially preventable cause of secondary brain damage. If it occurs, it may be fatal or associated with poor outcomes related to devastating complications. We hypothesized that analyses of epidemiology and concomitant injuries may predict the development of BCVI and associated complications.

Methods

The TraumaRegister DGU® (TR‐DGU), a prospectively maintained database, was used for retrospective data analysis (01/2009–12/2015). Inclusion criteria: adult trauma patients (≥16 years) with severe injuries (ISS ≥ 16 points) with and without BCVI. Subgroups: carotid artery injury (CAI) and vertebral artery injury (VAI). The degree of vascular injury was classified according to the Abbreviated Injury Scale values. Demographic, injury, therapy and outcome characteristic data (length of stay, stroke, multiple organ failure and mortality) were collected and analyzed for each patient with SPSS statistics (Version 23, IBM Inc., Armonk, NY).

Results

Out of 76,480 individuals, a total of 786 patients with BCVI (1%) were identified. The 435 CAI patients included 263 dissections, 78 pseudoaneurysms and 94 bilateral injuries. The 383 VAI patients presented with 198 dissections, 43 pseudoaneurysms, 122 thrombotic occlusions and 20 bilateral injuries. The risk for stroke was excessive in BCVI patients versus controls (11.5 vs. 1.1%, p < 0.001) and increased with vascular injury severity, up to 24.1% in CAI patients and 30.0% in VAI patients. We confirmed that cervical spine injuries were a major BCVI predictor (OR 6.46, p < 0.001, 95% CI 5.34–7.81); furthermore, high‐energy mechanisms (OR 1.79), facial fractures (OR 1.56) and general injury severity (OR 1.05) were identified as independent predictors. Basilar skull fractures (BSF) were found with comparable frequency (p = 0.63) in both groups, and the predictive value was found to be insignificant (OR 1.1, p = 0.36, 95% CI 0.89–1.37). Age ≥ 60 years was associated with a decreased risk for BCVI (OR 0.54, p < 0.001, 95% CI 0.45–0.65); however, in BCVI patients over 60 years of age, mortality was excessive (OR 4.33, p < 0.001, 95% CI 2.40–7.80). Even after adjusting for head injuries, BCVI‐associated stroke remained a significant risk factor for mortality (OR 2.52, p < 0.001, 95% CI 1.13–5.62).

Conclusion

Our data validated cervical spine injuries as a major predictor, but the predictive value of BSF must be scrutinized. Patient age appears to play a contradictory role in BCVI risk and BCVI‐associated mortality. Predicting which patients will develop BCVI remains an ongoing challenge, especially since many patients do not present with concomitant injuries of the head or spine and therefore might not be captured by standard screening criteria.
Associations Between the Prognostic Nutritional Index and Morbidity/Mortality During Intestinal Resection in Patients with Ulcerative Colitis
Authors: Chohno Teruhiro , Uchino Motoi , Sasaki Hirofumi , Bando Toshihiro , Takesue Yoshio , Ikeuchi Hiroki
Published: December 2017

Background

Onodera’s prognostic nutritional index (O‐PNI) is a well‐known predictor of the prognosis of several surgeries. The aim of this study was to evaluate the association between O‐PNI and surgical outcome during surgery for ulcerative colitis (UC).

Methods

This was a single‐institution retrospective cohort study conducted in the Department of Inflammatory Bowel Disease at Hyogo College of Medicine, Japan. The preoperative predictive factors associated with mortality, morbidity, and pouch‐related complications (PRCs) were examined separately from surgical procedure.

Results

A total of 1151 patients with UC who underwent surgery between January 2000 and December 2015 were included. Total colectomy (TC) alone, ileal pouch‐anal anastomosis (IPAA) with ileostomy, and IPAA without ileostomy were performed in 254 patients, 736 patients, and 161 patients, respectively. Mortality and morbidity were found in nine (0.8%) and 320 (27.8%) patients, respectively. The median O‐PNI score was 22.6 in patients with mortality and 35.6 in patients without mortality among TC alone (p < 0.01). The significant predictive factors for mortality among TC alone were older age [p = 0.03, odds ratio (OR) 6.8], higher C‐reactive protein (p = 0.02, OR 14.5), and O‐PNI < 24.9 (p = 0.04, OR 5.6). Among IPAA with ileostomy, an American Society of Anesthesiologists score ≥3 (p = 0.01, OR 2.3), prednisolone (PSL) dosage just before surgery ≥14 mg/day (p = 0.04, OR 1.8), and O‐PNI < 35.5 (p < 0.01, OR 2.1) were predictors of PRCs. O‐PNI did not predict PRCs among IPAA without ileostomy.

Conclusion

Lower O‐PNI may predict the prognosis in patients with UC. O‐PNI may be a useful indicator for decision‐making regarding surgical timing and procedure.
The thin line between protection and conviction: Experiences with child protection services and later criminal convictions among a population of adolescents☆
Authors: Alain Marc , Marcotte Julie , Desrosiers Julie , Turcotte Daniel , Lafortune Denis
Published: December 2017

Relying on official data provided by the Québec City Youth Center, Canada, we explore the nature and intensity of officially known criminality for all youth (N = 5399) found guilty under the provisions of the Youth Criminal Justice Act between 2003 and 2012 and assess the relationship between criminality and previous episodes of child maltreatment. This article proposes to further verify the general hypothesis stating that there are empirical links between these two phenomena. The results suggest that those youth victims of specific types of child maltreatment (physical abuse, sexual abuse) seem to be found guilty of criminal acts that are significantly in line with these earlier episodes of maltreatment. These results might help to prevent potential occurrences of such a phenomenon and also contributes to the ongoing development of psychological and criminological theories assessing why and to what extent a child victim of maltreatment might later commit criminal offenses.
EDEUS, a Real-Life Study on the Users of Phosphodiesterase Type 5 Inhibitors: Prevalence, Perceptions, and Health Care-Seeking Behavior Among European Men With a Focus on 2nd-Generation Avanafil
Authors: Corona Giovanni , Maggi Mario , Jannini Emmanuele A.
Published: December 2017

Introduction

Erectile dysfunction (ED) is a multidimensional disorder with an estimated prevalence of 1% to 10% in men younger than 40 years and up to 100% in men in their 70s and 80s.

Aim

To evaluate the real-life characteristics and unmet needs of men with ED, its impact on well-being, and treatment rates across Europe.

Methods

Adult men in Belgium, France, Germany, Italy, Poland, Portugal, and Spain were invited to participate in the survey. Men who did not use at least a drug for sexual health in the past 3 months, had cancer or spinal cord injuries, and/or underwent non–nerve-sparing radical prostatectomy were excluded.

Main Outcome Measures

The 15-item International Index of Erectile Function (IIEF-15) with study-specific, self-constructed questions was used.

Results

Overall, 940 subjects (age = 46.2 ± 13.4 years) were considered. Subjects (n = 778) using on-demand phosphodiesterase type 5 inhibitors (PDE5is) were designated “performers” (60%) without a formal ED diagnosis or “patients” with a medical diagnosis. Patients were older than performers, with more self-reported comorbidities; patients used a higher PDE5i dosage and purchased it from official pharmacies more often than performers did. Of avanafil users (n = 39), no differences in total IIEF or subdomain scores were observed after adjusting for confounders. However, avanafil users less often declared its use without an ED diagnosis and a physician prescription. Overall, the latter condition was associated with higher PDE5i-related satisfaction.

Conclusion

The survey shows 2 different attitudes toward ED and PDE5i use: for recreational use and without a medical prescription or with a formal diagnosis and medical prescription. Avanafil, a 2nd-generation PDE5i with a good balance between efficacy and tolerability profile, is more frequently prescribed by doctors than self-prescribed compared with other PDE5is. Because the major challenge is to decrease the high dropout of 1st-generation PDE5is, further studies will be needed to clarify this topic.
The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration
Authors: Egydio Paulo H. , Kuehhas Franklin E.
Published: December 2017

Background

Patients with severe erectile dysfunction (ED) and penile size issues, especially seen in Peyronie's disease (PD), are candidates for more invasive penile prosthesis insertion techniques that aim for penile length and girth reconstruction.

Aim

To present the feasibility and safety of penile length and girth restoration based on the so-called multiple-slit technique (MUST) for patients with severe ED and significant penile shortening with or without PD.

Methods

From July 2013 through January 2016, 138 patients underwent the MUST. The International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction were completed.

Outcomes

Outcome analysis was focused on penile length restoration, penile curvature correction, intra- and postoperative complications, and patient satisfaction.

Results

138 patients underwent the procedure (103 malleable and 35 inflatable devices). Etiologies of penile shortening and narrowing were PD, severe ED, post-radical prostatectomy, and androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, and post-penile fracture in 60.1%, 24.6%, 10.1%, 3.6%, and 2.2%, respectively. In PD cases, the mean deviation of the penile axis was 55° (range = 0–90°). Mean subjective penile length loss reported was 3.2 cm (range = 1–5 cm), and shaft constriction was present in 44.9%. Median follow-up was 15.2 months (range = 6–36 months). Mean penile length gain was 3.1 cm (range = 2–5 cm). No penile prosthesis infection caused device explantation. One glans necrosis was encountered. The average IIEF score increased from 22 points at baseline to 66 points at 6-month follow-up.

Clinical Implications

The MUST helps address penile size issues in cases of severe ED with concomitant conditions that impair penile length or girth.

Strengths and Limitations

The strength of the study is its applicability to provide surgeons with a solution for cases in which patients have severe ED and penile size impairment owing to underlying conditions such as PD. The study is limited by the relatively short follow-up.

Conclusions

The MUST is an effective, safe, and viable treatment option for a selected patient cohort. Because of the potential complications, proper counseling should take place and only experienced surgeons should perform this type of surgery.
Plasma Testosterone and Sexual Function in Southeast Asian Men Receiving Methadone and Buprenorphine Maintenance Treatment
Authors: Yee Anne , Loh Huai Seng , Danaee Mahmoud , Riahi Shahrzad , Ng Chong Guan , Sulaiman Ahmad Hatim
Published: December 2017

Background

Methadone has been recognized as an effective maintenance treatment for opioid dependence. However, its use is associated with several complications, including sexual dysfunction in men.

Aim

To assess plasma testosterone and sexual function in Southeast Asian men on methadone maintenance treatment (MMT) or buprenorphine maintenance treatment (BMT).

Methods

76 sexually active men on MMT (mean age = 43.30 ± 10.32 years) and 31 men on BMT (mean age = 41.87 ± 9.76 years) from a Southeast Asian community were evaluated using plasma total testosterone (TT) and prolactin levels, body mass index, social demographics, substance use measures, and depression severity scale.

Outcomes

Prevalence and associated factors of TT level lower than the reference range in men on MMT or BMT.

Results

More than 1 third of men (40.8%, n = 31) on MMT had TT levels lower than the reference range, whereas 1 fourth of men (22.6%, n = 7) on BMT did. At univariate analysis, MMT vs BMT (β = 0.298, adjusted R2 = 0.08, P = .02) and body mass index (β = −0.23, adjusted R2 = 0.12, P = .02) were associated with changes in TT after stepwise regression. There were no significant associations with age; Opiate Treatment Index Q scores for alcohol, heroin, stimulant, tobacco, or cannabis use and social functioning domain; education levels; hepatitis C status; and severity of depression. Prolactin level did not differ between the MMT and BMT groups.

Clinical Implications

The sex hormonal assay should be used regularly to check men on MMT.

Strengths and Limitations

This is the first study conducted in the Southeast Asian community. Our study was limited by the lack of a healthy group as the reference for serum levels of testosterone and prolactin.

Conclusions

The findings showed that plasma testosterone levels are lower in MMT than in BMT users. Hence, men who are receiving MMT should be screened for hypogonadism routinely in the clinical setting.
Cyber Mercenaries
Authors: Maurer Tim
Published: December 2017

Cyber Mercenaries explores the secretive relationships between states and hackers. As cyberspace has emerged as the new frontier for geopolitics, states have become entrepreneurial in their sponsorship, deployment, and exploitation of hackers as proxies to project power. Such modern-day mercenaries and privateers can impose significant harm undermining global security, stability, and human rights. These state-hacker relationships therefore raise important questions about the control, authority, and use of offensive cyber capabilities. While different countries pursue different models for their proxy relationships, they face the common challenge of balancing the benefits of these relationships with their costs and the potential risks of escalation. This book examines case studies in the United States, Iran, Syria, Russia, and China for the purpose of establishing a framework to better understand and manage the impact and risks of cyber proxies on global politics.