bluuebunny/crossref_metadata_2025 huggingface dataset:
Liposomal Bupivacaine for Pain Control After Anterior Cruciate Ligament Reconstruction
Authors: Premkumar Ajay , Samady Heather , Slone Harris , Hash Regina , Karas Spero , Xerogeanes John
Published: April 2016

Background:

Local anesthetics are commonly administered into surgical sites as a part of multimodal pain control regimens. Liposomal bupivacaine is a novel formulation of bupivacaine designed for slow diffusion of a single dose of local anesthetic over a 72-hour period. While early results are promising in various settings, no studies have compared pain management regimens containing liposomal bupivacaine to traditional regimens in patients undergoing anterior cruciate ligament (ACL) reconstruction.

Purpose:

To evaluate liposomal bupivacaine in comparison with 0.25% bupivacaine hydrochloride (HCl) for pain control after ACL reconstruction.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

A total of 32 adult patients undergoing primary ACL reconstruction with a soft tissue quadriceps tendon autograft between July 2014 and March 2015 were enrolled. All patients received a femoral nerve block immediately before surgery. Patients then received either a 40-mL suspension of 20 mL Exparel (1 vial of bupivacaine liposome injectable suspension) and 20 mL 0.9% injectable saline or 20 mL 0.5% bupivacaine HCl and 20 mL 0.9% injectable saline, which was administered into the graft harvest site and portal sites during surgery. Patients were given either a postoperative smartphone application or paper-based journal to record data for 1 week after ACL reconstruction.

Results:

Of the 32 patients recruited, 29 patients were analyzed (90.6%). Two patients were lost to follow-up, and 1 was excluded because of a postoperative hematoma. There were no statistically significant differences in postoperative pain, medication use, pain location, recovery room time, or mobility between the 2 study groups.

Conclusion:

There were comparable outcomes with 0.25% bupivacaine HCl at a 200-fold lower cost than liposomal bupivacaine. This study does not support the widespread use of liposomal bupivacaine for pain control after ACL reconstruction in the setting of a femoral nerve block.

Registration:

ClinicalTrials.gov NCT02189317
Intimate Partner Violence Among Older Portuguese Immigrant Women in Canada
Authors: Souto Rafaella Queiroga , Guruge Sepali , Merighi Miriam Aparecida Barbosa , de Jesus Maria Cristina Pinto
Published: April 2016

One third of the immigrant population around the world is made up of women. Of these women, many belong to the Portuguese community. Immigrants account for more than one in five Canadians. The Portuguese older immigrant women living in Canada are vulnerable to be victims of intimate partner violence (IPV), which is a prevalent and important global health issue that affects differently diverse groups. There are few available researches regarding IPV on this population. The objective of this study is to understand how Portuguese older immigrant women living in Canada experience IPV. This is a qualitative study with a social phenomenological focus. Alfred Schutz’s motivation theory was used to analyze the impulses that led older women to face IPV. The data were collected from July to October 2013 in the Greater Toronto Area. Ten women 60 years or older were included in the study. The participants perceived themselves as being victimized by their current or ex partners. They are unhappy and suffer from a variety of health problems, which they related to their experience of IPV. These factors, along with participants’ personal beliefs, and their legal situations as immigrants in Canada, made them act, either in a way that would try to maintain their relationships, or tried to escape the violent situation. IPV is a complex phenomenon, with different perceptions surrounding it. The experiences of the older immigrant women showed that ending the marriage is not always a possibility to them because of cultural issues and their immigrant status in Canada. Some women wish help and support to improve their relationships.
Agency constraints and possibilities: Athletes manoeuvring between the logics of community, market, profession and corporation in their quest for individual sponsorships
Authors: Wagner Ulrik
Published: April 2016

The purpose of this qualitative study is to add a sociological dimension to sponsorship research, which is otherwise dominated by marketing research. This paper analyses how world-class but often not well-paid athletes from time-consuming endurance sports like rowing and triathlon seek individual sponsorships as a strategy to improve their financial situation. With regard to theory, an institutional logics perspective is adopted in which logics both provide tools for individual actors as well as representing agency constraints. To understand how athletes cope with the encounter between sport and business, insights from micro-sociology are employed. The findings indicate that various roles are performed, that sponsorship commitment is an issue of finding a balance between ‘gameworthiness’ and integrity and that the quest for an individual sponsorship is deselected as an option by some athletes. These insights are used to sketch out the paradox of sponsorship commitment, where time-consuming sponsorship engagement as a solution to athletes’ financial problems may potentially undermine their professional identity, which is characterised by the quality of their craft – the quality that simultaneously makes the athlete a market asset.
Cardiovascular Interventions for Immigrant Women
Authors: Fredericks Suzanne , Guruge Sepali
Published: April 2016

The purpose of this scoping review is to identify cardiovascular interventions that are designed to address the needs of immigrant women across North America and Europe. The articles retrieved were reviewed independently by both the first author and a trained research assistant. Although the search revealed many articles and resources related to supporting cardiovascular self-management behaviors among individuals, few focused on interventions designed for immigrant women who were diagnosed and living with cardiovascular disease. Also, it was difficult to determine the quality of the literature retrieved, as the main goal of this scoping review was to assess the body of literature and categorize materials by common themes and topics. A more in-depth structured systematic review is needed to determine the quality of evidence being presented and to serve as a rationale for the design and implementation of future culturally sensitive interventions delivered to immigrant women diagnosed with cardiovascular disease.
Prospective Computed Tomographic Analysis of Osteochondral Lesions of the Ankle Joint Associated With Ankle Fractures
Authors: Nosewicz Tomasz L. , Beerekamp M. Suzan H. , De Muinck Keizer Robert-Jan O. , Schepers Tim , Maas Mario , Niek van Dijk C. , Goslings J. Carel
Published: April 2016

Background:

Osteochondral lesions (OCLs) associated with ankle fracture correlate with unfavorable outcome. The goals of this study were to detect OCLs following ankle fracture, to associate fracture type to OCLs and to investigate whether OCLs affect clinical outcome.

Methods:

100 ankle fractures requiring operative treatment were prospectively included (46 men, 54 women; mean age 44 ± 14 years, range 20-77). All ankle fractures (conventional radiography; 71 Weber B, 22 Weber C, 1 Weber A, 4 isolated medial malleolus and 2 isolated posterior malleolus fractures) were treated by open reduction and internal fixation. Multidetector computed tomography (CT) was performed postoperatively. For each OCL, the location, size, and Loomer OCL classification (CT modified Berndt and Harty classification) were determined. The subjective Foot and Ankle Outcome Scoring (FAOS) was used for clinical outcome at 1 year.

Results:

OCLs were found in 10/100 ankle fractures (10.0%). All OCLs were solitary talar lesions. Four OCLs were located posteromedial, 4 posterolateral, 1 anterolateral, and 1 anteromedial. There were 2 type I OCLs (subchondral compression), 6 type II OCLs (partial, nondisplaced fracture) and 2 type IV OCLs (displaced fracture). Mean OCL size (largest diameter) was 4.4 ± 1.7 mm (range, 1.7 mm to 6.2 mm). Chi-square analysis showed no significant association between ankle fracture type and occurrence of OCLs. OCLs did occur only in Lauge-Hansen stage III/IV ankle fractures. There were no significant differences in FAOS outcome between patients with or without OCLs.

Conclusions:

Ten percent of investigated ankle fractures had associated OCLs on CT. Although no significant association between fracture type and OCL was found, OCLs only occurred in Lauge-Hansen stage III/IV ankle fractures. With the numbers available, OCLs did not significantly affect clinical outcome at 1 year according to FAOS.

Level of Evidence:

Level IV, observational study.
Validated Method for Measuring Functional Range of Motion in Patients With Ankle Arthritis
Authors: Thornton James , Sabah Shiraz , Segaren Neil , Cullen Nicholas , Singh Dishan , Goldberg Andrew
Published: April 2016

Background:

Total range of motion between the tibia and the floor is an important outcome measure following ankle surgery. However, there is wide variation in its measurement: from clinical evaluation, to radiographic metrics, and gait analysis. The purpose of this study was to present and validate a simple, standardized technique for measurement of functional total range of motion between the tibia and the floor using a digital goniometer.

Methods:

Institutional review board approval was obtained. Forty-six ankles from 33 participants were recruited into 2 groups: Group 1 (healthy controls) comprised 20 ankles from 10 participants. None had any musculoskeletal or neurologic pathology. Group 2 (ankle osteoarthritis) comprised 25 ankles from 23 patients. Ankle pathology had been treated with ankle arthrodesis (n = 5), total ankle replacement (n = 6), and nonoperative treatment (n = 14). Measurement was performed by 2 testers according to a standardized protocol developed for the Total Ankle Replacement Versus Arthrodesis (TARVA) randomized controlled trial. Intra- and interrater reliability was calculated using intraclass correlation coefficients (ICCs).

Results:

Group 1 (healthy controls): the median difference for all measurements within an observer was 1.5 (interquartile range [IQR] 0.7-2.5) degrees, and the intraclass coefficients (ICCs) for inter- and intrarater total ankle range of motion were excellent: 0.95 (95% confidence interval [CI] 0.91-0.97, P < .001) and 0.942 (95% CI 0.859-0.977, P < .001), respectively. Group 2 (ankle osteoarthritis): the median difference for all measurements within an observer was 0.6 (IQR 0.2-1.3) degrees, and the ICCs for inter- and intrarater total ankle range of motion were excellent: 0.99 (95% CI 0.97-1.0), P < .001) and 0.99 (95% CI 0.96-1.0), P < .001), respectively.

Conclusion:

This technique provided a reliable, standardized method for measurement of total functional range of motion between the tibia and the floor. The technique required no special equipment or training. It provided a valid functional assessment for patients with or without ankle osteoarthritis, including those who had undergone operative treatment.

Level of Evidence:

Level II, prospective comparative study.
Variable Volumes of Resected Bone Resulting From Different Total Ankle Arthroplasty Systems
Authors: Goetz Jessica E. , Rungprai Chamnanni , Tennant Joshua N. , Huber Emmalei , Uribe Bastian , Femino John , Phisitkul Phinit , Amendola Annunziato
Published: April 2016

Background:

The increased popularity and success of total ankle arthroplasty (TAA) has resulted in the development of varying TAA hardware designs, many of which include specific bone-sparing or bone-sacrificing features. The goal of this work was to determine differences in the volume of bone removed for implantation of different total ankle arthroplasty hardware systems.

Methods:

Sixteen cadaveric specimens were computed tomography–scanned preoperatively and after total ankle arthroplasty using either an INBONE II, Salto Talaris, STAR, or Zimmer TMTA implant. Geometries of the talus and the distal tibia were manually segmented and converted to 3D bony surface models. The volume of bone removed for each implant was calculated as the difference in volume between the preoperative and postoperative bone models. To account for differences in specimen size, volume was expressed as a percentage of the intact bone.

Results:

There was a significant difference ( P = .049) in the average percent of talar bone removed, with the STAR and INBONE II systems requiring removal of greater volumes of bone. The INBONE II system required significantly ( P < .004) more tibial bone resection than the other 3 implants when evaluating a long span of the distal tibia. However, most of this increased bone resection was medullary bone. Close to the articular surface, bone volumes removed for the various tibial components were not significantly different ( P = .056).

Conclusion:

Volume and location of bone removed for different implant systems varied with implant design.

Clinical Relevance:

Primary bone resection associated with different implant hardware systems varied more on the talar side of the articulation, and the stemmed prosthesis did not result in dramatic increases in periarticular bone resection. Clinicians should weigh the effects of greater or lesser bone resection associated with various implant designs against other factors used for hardware selection.
Gender nonconformity and mental health among lesbian, gay, and bisexual adults: Homophobic stigmatization and internalized homophobia as mediators
Authors: Van Beusekom Gabriël , Bos Henny MW , Kuyper Lisette , Overbeek Geertjan , Sandfort Theo GM
Published: April 2016

We assessed among a sample of 724 Dutch lesbian, gay, and bisexual–identified adults ( Mage = 31.42) whether experiences with homophobic stigmatization and internalized homophobia simultaneously mediated the relation of gender nonconformity with mental health. Results indicated that homophobic stigmatization and internalized homophobia partially mediated the relation between gender nonconformity and mental health. Gender nonconformity was related to more mental health problems via increased experiences with homophobic stigmatization and to less mental health problems because of reduced levels of internalized homophobia. However, the mediated relation of gender nonconformity with mental health via homophobic stigmatization was only significant for men.
Theoretical analysis and experimental study on sensitivity of element-length error in cable-strut tensile structures
Authors: Chen Lian-Meng , Deng Hua , Cui Yu-Hong , Dong Shi-Lin , Zhou Yi-Yi
Published: April 2016

In a real cable-strut tensile structure, the element-length errors are inevitable. To understand their effects on the bearing capacity of a cable-strut tensile structure, the element-length error sensitivity analysis was investigated in this study. First, mathematical model of the element-length error was proposed based on stochastic theory. By combining the balance equation, geometric equation, and physical equation, the fundamental equation between the pre-stress deviation and element-length error was derived. After that, pre-stress deviation statistics characteristic was achieved with the help of statistical theory and the element-length error sensitivity analysis method was formulated. Then, a cable-strut tensile structure model with a diameter of 5.0 m was designed and fabricated to validate the proposed method. The element-length was set adjustable in order to simulate the element-length errors. Making use of the measured internal forces induced by element-length errors, the error sensitivity of each kind of element was achieved. In addition, a finite element model was also established with the commercial software ANSYS. The element-length errors were simulated by the changes of element-length due to temperature variations. The results of the three models coincided with each other satisfactorily, verifying the effectiveness of the proposed mathematical model. It was found that different elements had different error sensitivities. The error sensitivity of the hoop cables was most prominent, the ridge cables and diagonal cables the second, and the struts the third.
Multi-objective differential evolution for truss design optimization with epistemic uncertainty
Authors: Su Yu , Tang Hesheng , Xue Songtao , Li Dawei
Published: April 2016

A robust multi-objective optimization method for truss optimum design is presented. In the robust design, materials and loads are assumed to be affected by epistemic uncertainties (imprecise or lack of knowledge). Uncertainty quantification using evidence theory in optimum design subject to epistemic uncertainty is undertaken. In addition to a functional objective, an evidence-based plausibility measure of failure of constraint satisfaction is minimized to formulate the robust design into a multi-objective optimization problem. In order to alleviate the computational difficulties in the evidence theory-based uncertainty quantification analysis, a combined strategy of differential evolution-based interval optimization method and parallel computing technique is proposed. A population-based multi-objective differential evolution optimization algorithm is designed for searching robust Pareto front. Two truss structures with shape and sizing optimum design problems are presented to demonstrate the effectiveness and applicability of the proposed method.
Static and fatigue performance of the bolt-connected structural jointed of deep corrugated steel plate member
Authors: Ju Minkwan , Oh Hongseob
Published: April 2016

Corrugated steel plate culvert bridge has been more commonly used as soil steel bridges because it is the cost-effective alternative for railway-highway crossings. The corrugated steel plate culvert bridge is considered the most suitable for quick rebuilding of bridges compared with the conventional bridges. This study intends to experimentally investigate the static and fatigue performance of the bolted connection of deep corrugated steel plate. Test variables are the thickness of deep corrugated steel plate and the types of bolted connection such as bolted-only, gasket, slot hole, and washer. For static test, the failure is mainly caused by a local buckling of deep corrugated steel plate member and bearing failure of bolts. Type of gasket and slot hole showed the largest stiffness so that they may be recommended for structural safety and redundancy under a static flexural behavior. For fatigue test, the bolted-only specimen exhibited no increase in the strain until failure and the highest fatigue life among the test variables. For structural safety under cyclic loading, bolted-only connection is recommended. According to AASHTO LRFD Bridge Design Specification, fatigue life category can be determined as category D level and the fatigue limit was estimated to be 48.3 MPa. The deep corrugated steel plate members tested in this study can provide a sufficient fatigue performance in compliance with the design specification.
‘You can’t use this, and you mustn’t do that’: A qualitative study of non-consumption practices among Danish pregnant women and new mothers
Authors: Gram Malene , Hohnen Pernille , Pedersen Helle Dalsgaard
Published: April 2016

Anti-consumption literature focuses on consumers’ reasons for avoiding certain products or brands emphasizing consumers’ symbolic and/or political reasons for avoidance. Consumers’ choices have assumedly been voluntary. In contrast, this article discusses anti-consumption as a less explicitly political but also less voluntary form of anti-consumption, termed non-consumption. The empirical data consist of nine in-depth interviews with Danish pregnant women and new mothers regarding potentially ‘risky’ products. The article shows how their avoidance of certain forms of consumption reflects their struggle to perceive themselves – and be perceived by others – as competent mothers(-to-be). Risk is avoided, minimized, modified or balanced against prevailing habits and discourses of womanhood such as the risk of parabens against ideals of beauty when using cosmetic products. The article contributes to the anti-consumption literature by offering insights into the highly normative but less explicitly political field of constrained consumption reflected in the everyday micro-consumption practices of Danish pregnant women and new mothers.
A sociocultural approach to understanding identity as an embedder-of-numeracy: A case of numeracy and history
Authors: Bennison Anne
Published: April 2016

Improving numeracy learning outcomes for students is a goal of the European Commission. While many European countries have placed increased emphasis on links between mathematics and other subjects, in some countries numeracy is seen as an integral part of subjects across the curriculum. However, for this latter approach to be successful teachers need to have the capacity to embed numeracy into the subjects they teach. This article builds on previous research where it was suggested that teacher identity could be used to identify ways to support teachers to embed numeracy in subjects across the curriculum and that an adaptation of Valsiner’s zone theory could be used to understand this identity. The purpose of this article is to use the detailed case study of a secondary school history teacher to explore how the theoretically developed framework for identity as an embedder-of-numeracy plays out in an empirical study. The analysis permits suggestions to be made about ways this teacher could be supported to embed numeracy in history and points to areas for further research.
The Purpose of Tutorial Groups: Social Influence and The Group As Means and Objective
Authors: Rosander Michael , Chiriac Eva Hammar
Published: April 2016

The aim of this study was to investigate how first-year students view the purpose of tutorial groups in problem-based learning. In all, 147 students from 24 groups participated, providing 399 statements. Data were analysed using thematic analysis. The results showed a focus on both learning and social influence. Learning involved the tutorial as both an objective and as a means. Social influence is important for a tutorial to become a well-functioning group, together with opportunities to use the group as an objective in and of itself to learn to work in a group, cooperate, solve problems and communicate. Social support and feelings of togetherness create conditions for intrinsic motivation, as well as stronger identification with the group. A tutorial group as a well-functioning learning environment requires both the group as an objective and as a means.
Maximizing Lumen Gain With Directional Atherectomy
Authors: Stanley Gregory A. , Winscott John G.
Published: April 2016

Purpose: To describe the use of a low-pressure balloon inflation (LPBI) technique to delineate intraluminal plaque and guide directional atherectomy in order to maximize lumen gain and achieve procedure success. Technique: The technique is illustrated in a 77-year-old man with claudication who underwent superficial femoral artery revascularization using a HawkOne directional atherectomy catheter. A standard angioplasty balloon was inflated to 1 to 2 atm during live fluoroscopy to create a 3-dimensional “lumenogram” of the target lesion. Directional atherectomy was performed only where plaque impinged on the balloon at a specific fluoroscopic orientation. The results of the LPBI technique were corroborated with multimodality diagnostic imaging, including digital subtraction angiography, intravascular ultrasound, and intra-arterial pressure measurements. Conclusion: With the LPBI technique, directional atherectomy can routinely achieve <10% residual stenosis, as illustrated in this case, thereby broadly supporting a no-stent approach to lower extremity endovascular revascularization.
Exogenous spermine inhibits hypoxia/ischemia-induced myocardial apoptosis via regulation of mitochondrial permeability transition pore and associated pathways
Authors: Wei Can , Li Hongzhu , Wang Yuehong , Peng Xue , Shao Hongjiang , Li Hongxia , Bai Shuzhi , Xu Changqing
Published: April 2016

Myocardial infarction (MI) is associated with a high mortality rate, which is attributed to the effects of myocyte loss that occurs as a result of ischemia-induced cell death. Very few therapies can effectively prevent or delay the effects of ischemia. Polyamines (PAs) are polycations required for cell growth and division, and their use may prevent cell loss. The aim of this study was to investigate the relationship between hypoxia/ischemia (H/I)-induced cell apoptosis and PA metabolism and to investigate the ability of spermine to limit H/I injury in cardiomyocytes by blocking the mitochondrial apoptotic pathway. Neonatal rat cardiomyocytes were placed under hypoxic conditions for 24 h after being subjected to 5 μM of spermine as a pretreatment therapy. H/I induced PA catabolism, which was indicated by a 1.3-fold up-regulation of spermidine/spermine N1-acetyltransferase expression. Exogenous spermine significantly reduced H/I-induced cell death rate (60 ± 2 to 36 ± 2%) and apoptosis rate (42 ± 2 to 21 ± 2%); it also attenuated lactate dehyodrogenase and creatine kinase leakage (440 ± 13 and 336 ± 16 U/L to 275 ± 15 and 235 ± 13 U/L). Furthermore, it decreases calcium overload (3.8 ± 0.2 to 2.2 ± 0.1 a.u.). Moreover, spermine pretreatment remarkably decreased cytochrome c release from the mitochondria to the cytosol, lowering the expression of cleaved caspase-3 and -9. With spermine pretreatment, there was an increase in Bcl-2 levels and phosphorylation of ERK1/2, phosphoinositide 3-kinase, Akt, and GSK-3β, preserving mitochondrial membrane potential and inducing an mitochondrial permeability transition pore opening. In conclusion, H/I decreased endogenous spermine concentrations in cardiomyocytes, which ultimately induced apoptosis. The addition of exogenous spermine effectively prevented myocyte cell death.
Prophylactic Placement of an Inferior Vena Cava Filter During Aspiration Thrombectomy for Acute Deep Venous Thrombosis of the Lower Extremity
Authors: Kwon Se Hwan , Park So Hyun , Oh Joo Hyeong , Song Myung Gyu , Seo Tae-Seok
Published: April 2016

Purpose:

To evaluate the effect of an inferior vena cava (IVC) filter during aspiration thrombectomy for acute deep vein thrombosis (DVT) in the lower extremity.

Materials and Methods:

From July 2004 to December 2013, a retrospective analysis of 106 patients with acute DVT was performed. All patients received an IVC filter and were treated initially with aspiration thrombectomy. Among the 106 patients, DVT extension into the IVC was noted in 27 but was not evident in 79. We evaluated the presence of trapped thrombi in the filters after the procedure. The sizes of the trapped thrombi were classified into 2 grades based on the ratio of the maximum transverse length of the trapped thrombus to the diameter of the IVC (Grades I [≤ 50%] and II [> 50%]).

Results:

A trapped thrombus in the filter was detected in 46 (43%) of 106 patients on final venograms. The sizes of the trapped thrombi were grade I in 12 (26.1%) patients and grade II in 34 (73.9%). Among the 27 patients with DVT extension into the IVC, 20 (74.1%) showed a trapped thrombus in the filter, 75% (15 of 20) of which were grade II. Among the 79 patients without DVT extension into the IVC, 26 (32.9%) showed a trapped thrombus in the IVC filter, 73% (19 of 26) of which were grade II.

Conclusions:

Thrombus migration occurred frequently during aspiration thrombectomy of patients with acute DVT in the lower extremity. However, further studies are needed to establish a standard protocol for the prophylactic placement of an IVC filter during aspiration thrombectomy.
Numerical study on flow rate limitation of open capillary channel flow through a wedge
Authors: Zhang Ting-Ting , Yang Wen-Jing , Lin Yu-Fei , Cao Yu , Wang Miao , Wang Qian , Wei Yue-Xing
Published: April 2016

The flow characteristics of slender-column flow in wedge-shaped channel under microgravity condition are investigated in this work. The one-dimensional theoretical model is applied to predict the critical flow rate and surface contour of stable flow. However, the one-dimensional model overestimates the critical flow rate for not considering the extra pressure loss. Then, we develop a three-dimensional simulation method with OpenFOAM, a computational fluid dynamics tool, to simulate various phenomena in wedge channels with different lengths. The numerical results are verified with the capillary channel flow experimental data on the International Space Station. We find that the three-dimensional simulation perfectly predicts the critical flow rates and surface contours under various flow conditions. Meanwhile, the general behaviors in subcritical, critical, and supercritical flow are studied in three-dimensional simulation considering variations of flow rate and open channel length. The numerical techniques for three-dimensional simulation is validated for a wide range of configurations and is hopeful to provide valuable guidance for capillary channel flow experiment and efficient liquid management in space.
Burnout in general practice
Authors: Jones Daniel , Davies Peter
Published: April 2016

Workload pressures on GPs are increasing, due to an increasing number of patients requiring attention and the extended periods that they are now living with multiple, complex chronic conditions. In addition, the recruitment and retention of GPs in the UK is falling; at the time of writing this article, these factors have led the profession to be described as being in a state of crisis. In 2015, the RCGP estimated that there was a shortfall of over 3000 GPs. With this in mind, there is increasing concern about the mental and physical health of the workforce, and the sustainability of the speciality and its workload. This article will look at burnout, what it is, its prevalence in the medical profession and what help is available.
Near-field blast test on reactive powder concrete-filled steel tubular columns after exposure to fire
Authors: Chen Wanxiang , Guo Zhikun , Zhang Tao , Zou Huihui , Gu Juan
Published: April 2016

The existing blast tests of concrete-filled steel tubular are mainly on the dynamic behaviors of concrete-filled steel tubular at ambient temperature. ANSYS codes are used to simulate the temperature distribution of reactive powder concrete-filled steel tubular, and subsequently an approximate approach is used to estimate the residual strength of reactive powder concrete. Then blast-resistant capacities of four large-scale reactive powder concrete-filled steel tubular columns after exposure to ISO-834 standard fire are experimentally examined. The overpressures of shock wave, displacements, and strains of reactive powder concrete-filled steel tubular columns are recorded by advanced gauges. Influences of fire durations and scaled stand-off distances of explosive charge on dynamic behaviors and failure modes of reactive powder concrete-filled steel tubular columns are discussed. It is shown that reactive powder concrete-filled steel tubular columns retain excellent blast-resistant capacity after exposure to fire. Reactive powder concrete core column can be effectively confined by steel tube, but its blast-resistant capacity decreases as explosive charge or fire duration increases. Failure modes change from bending types to bending-shear types as explosive charge increases, and obvious plastic deformation at the mid-span section can be observed in the reactive powder concrete-filled steel tubular columns with fire duration of 105 min. It is also indicated that the maximum displacement of reactive powder concrete-filled steel tubular columns is more sensitive to fire duration than to explosive charge weight.
Acromegaly in a non-diabetic cat
Authors: Fracassi Federico , Salsi Margherita , Sammartano Federica , Bo Stefano , Kooistra Hans S
Published: April 2016

Case summary

A 14-year-old, neutered male European shorthair cat was evaluated for a routine health check. The owner did not report any clinical signs except for respiratory stridor. On physical examination the main findings were broad facial features and increased interdental spaces. On haematology, a mild, non-regenerative anaemia was detected, whereas the serum biochemistry profile and urinalysis were unremarkable. The serum glucose concentration was within the reference interval. Serum insulin-like growth factor-1 concentration was markedly elevated (>1600 ng/ml). The basal serum growth hormone concentration was elevated and decreased only mildly after somatostatin administration. Basal serum insulin concentration was high, and the insulin concentration increased considerably after glucose loading, consistent with insulin resistance. CT scanning of the skull showed an enlarged pituitary gland and increased skull bone thickness. The final diagnosis was acromegaly.

Relevance and novel information

These findings demonstrate that acromegaly should be pursued and suspected in cats other than those with diabetes mellitus.
Life Priorities and Work Preferences of Generation Y: An Exploratory Analysis in Indian Context
Authors: Khera Shikha N. , Malik Sahil
Published: April 2016

The aim of the article is to study the influence of life priorities on work preferences in the context of Generation Y, the largest cohort of generation in India. It also attempts to uncover their preferences on both the parameters. The gender variations on the constructs have also been analyzed. Schwartz’s Value Inventory (1994) and Twenge, Campbell, Hoffman, and Lance’s motivational model (2010) are the instruments utilized for life priorities and work preferences. Respondents rank the life priorities and work preferences elicited through a survey questionnaire administered online from a convenience sample of Gen Y. Multiple regression analysis (stepwise) is used to find out the degree of influence of life priorities on work preferences. Independent t-test was conducted to measure the gender variations in life priorities and work preferences. Life priorities showed a link with one or more work preferences. More specifically, self-transcendence has been found to positively influence Gen Y preference for freedom at work. Openness to change explained significant amount of variance in extrinsic work motivation. Conservation and openness to change came out to be the most important life priority among Gen Y and were mostly motivated by altruistic and extrinsic rewards. Gen Y is increasing its presence at workplaces across the world and limited research has been done to study their motivations, needs, and expectations at work in Indian context. This study could help managers gain insightful information related to Gen Y life priorities and work preferences which could be harnessed to make effective strategies for their recruitment and retention.
CompNet: a GUI based tool for comparison of multiple biological interaction networks
Authors: Kuntal Bhusan K. , Dutta Anirban , Mande Sharmila S.
Published: April 2016

Background

Network visualization and analysis tools aid in better understanding of complex biological systems. Furthermore, to understand the differences in behaviour of system(s) under various environmental conditions (e.g. stress, infection), comparing multiple networks becomes necessary. Such comparisons between multiple networks may help in asserting causation and in identifying key components of the studied biological system(s). Although many available network comparison methods exist, which employ techniques like network alignment and querying to compute pair-wise similarity between selected networks, most of them have limited features with respect to interactive visual comparison of multiple networks.

Results

In this paper, we present CompNet - a graphical user interface based network comparison tool, which allows visual comparison of multiple networks based on various network metrics. CompNet allows interactive visualization of the union, intersection and/or complement regions of a selected set of networks. Different visualization features (e.g. pie-nodes, edge-pie matrix, etc.) aid in easy identification of the key nodes/interactions and their significance across the compared networks. The tool also allows one to perform network comparisons on the basis of neighbourhood architecture of constituent nodes and community compositions, a feature particularly useful while analyzing biological networks. To demonstrate the utility of CompNet, we have compared a (time-series) human gene-expression dataset, post-infection by two strains of Mycobacterium tuberculosis, overlaid on the human protein-protein interaction network. Using various functionalities of CompNet not only allowed us to comprehend changes in interaction patterns over the course of infection, but also helped in inferring the probable fates of the host cells upon infection by the two strains.

Conclusions

CompNet is expected to be a valuable visual data mining tool and is freely available for academic use from http://metagenomics.atc.tcs.com/compnet/ or http://121.241.184.233/compnet/
Dexamethasone and High-Dose Methotrexate Improve Outcome for Children and Young Adults With High-Risk B-Acute Lymphoblastic Leukemia: A Report From Children’s Oncology Group Study AALL0232
Authors: Larsen Eric C. , Devidas Meenakshi , Chen Si , Salzer Wanda L. , Raetz Elizabeth A. , Loh Mignon L. , Mattano Leonard A. , Cole Catherine , Eicher Alisa , Haugan Maureen , Sorenson Mark , Heerema Nyla A. , Carroll Andrew A. , Gastier-Foster Julie M. , Borowitz Michael J. , Wood Brent L. , Willman Cheryl L. , Winick Naomi J. , Hunger Stephen P. , Carroll William L.
Published: April 2016

Purpose

Survival for children and young adults with high-risk B-acute lymphoblastic leukemia has improved significantly, but 20% to 25% of patients are not cured. Children’s Oncology Group study AALL0232 tested two interventions to improve survival.

Patients and Methods

Between January 2004 and January 2011, AALL0232 enrolled 3,154 participants 1 to 30 years old with newly diagnosed high-risk B-acute lymphoblastic leukemia. By using a 2 × 2 factorial design, 2,914 participants were randomly assigned to receive dexamethasone (14 days) versus prednisone (28 days) during induction and high-dose methotrexate versus Capizzi escalating-dose methotrexate plus pegaspargase during interim maintenance 1.

Results

Planned interim monitoring showed the superiority of the high-dose methotrexate regimens, which exceeded the predefined boundary and led to cessation of enrollment in January 2011. At that time, participants randomly assigned to high-dose methotrexate during interim maintenance 1 versus those randomly assigned to Capizzi methotrexate had a 5-year event-free survival (EFS) of 82% versus 75.4% (P = .006). Mature final data showed 5-year EFS rates of 79.6% for high-dose methotrexate and 75.2% for Capizzi methotrexate (P = .008). High-dose methotrexate decreased both marrow and CNS recurrences. Patients 1 to 9 years old who received dexamethasone and high-dose methotrexate had a superior outcome compared with those who received the other three regimens (5-year EFS, 91.2% v 83.2%, 80.8%, and 82.1%; P = .015). Older participants derived no benefit from dexamethasone during induction and experienced excess rates of osteonecrosis.

Conclusion

High-dose methotrexate is superior to Capizzi methotrexate for the treatment of high-risk B-acute lymphoblastic leukemia, with no increase in acute toxicity. Dexamethasone given during induction benefited younger children but provided no benefit and was associated with a higher risk of osteonecrosis among participants 10 years and older.
Clinical and Genetic Risk Factors for Acute Pancreatitis in Patients With Acute Lymphoblastic Leukemia
Authors: Liu Chengcheng , Yang Wenjian , Devidas Meenakshi , Cheng Cheng , Pei Deqing , Smith Colton , Carroll William L. , Raetz Elizabeth A. , Bowman W. Paul , Larsen Eric C. , Maloney Kelly W. , Martin Paul L. , Mattano Leonard A. , Winick Naomi J. , Mardis Elaine R. , Fulton Robert S. , Bhojwani Deepa , Howard Scott C. , Jeha Sima , Pui Ching-Hon , Hunger Stephen P. , Evans William E. , Loh Mignon L. , Relling Mary V.
Published: April 2016

Purpose

Acute pancreatitis is one of the common causes of asparaginase intolerance. The mechanism is unknown, and genetic predisposition to asparaginase-induced pancreatitis has not been previously identified.

Methods

To determine clinical risk factors for asparaginase-induced pancreatitis, we studied a cohort of 5,185 children and young adults with acute lymphoblastic leukemia, including 117 (2.3%) who were diagnosed with at least one episode of acute pancreatitis during therapy. A genome-wide association study was performed in the cohort and in an independent case-control group of 213 patients to identify genetic risk factors.

Results

Risk factors associated with pancreatitis included genetically defined Native American ancestry (P < .001), older age (P < .001), and higher cumulative dose of asparaginase (P < .001). No common variants reached genome-wide significance in the genome-wide association study, but a rare nonsense variant rs199695765 in CPA2, encoding carboxypeptidase A2, was highly associated with pancreatitis (hazard ratio, 587; 95% CI, 66.8 to 5166; P = 9.0 × 10−9). A gene-level analysis showed an excess of additional CPA2 variants in patients who did versus those who did not develop pancreatitis (P = .001). Sixteen CPA2 single-nucleotide polymorphisms were associated (P < .05) with pancreatitis, and 13 of 24 patients who carried at least one of these variants developed pancreatitis. Biologic functions that were overrepresented by common variants modestly associated with pancreatitis included purine metabolism and cytoskeleton regulation.

Conclusion

Older age, higher exposure to asparaginase, and higher Native American ancestry were independent risk factors for pancreatitis in patients with acute lymphoblastic leukemia. Those who inherit a nonsense rare variant in the CPA2 gene had a markedly increased risk of asparaginase-induced pancreatitis.
Secular Changes in Postfracture Outcomes Over 2 Decades in Australia: A Time-Trend Comparison of Excess Postfracture Mortality in Two Birth Controls Over Two Decades
Authors: Bliuc Dana , Tran Thach , Alarkawi Dunia , Nguyen Tuan V. , Eisman John A. , Center Jacqueline R.
Published: April 2016

Context:

Hip fracture incidence has been declining and life expectancy improving. However, trends of postfracture outcomes are unknown.

Objectives:

The objective of the study was to compare the refracture risk and excess mortality after osteoporotic fracture between two birth cohorts, over 2 decades.

Design:

Prospective birth cohorts were followed up over 2 decades (1989–2004 and 2000–2014).

Setting:

The study was conducted in community-dwelling participants in Dubbo, Australia.

Participants:

Women and men aged 60–80 years, participating in Dubbo Osteoporosis Epidemiology Study 1 (DOES 1; born before 1930) and Dubbo Osteoporosis Epidemiology Study 2 (DOES 2; born after 1930) participated in the study.

Main Outcome Measure:

Age-standardized fracture and mortality over two time intervals: (1989–2004 [DOES 1] and 2000–2014 [DOES 2]) were measured.

Results:

The DOES 2 cohort had higher body mass index and bone mineral density and lower initial fracture rate than DOES 1, but similar refracture rates [age-standardized refracture rates per 1000 person-years: women: 53 (95% confidence interval [CI] 42–63) and 51 (95% CI 41–60) and men: 53 (95% CI 38–69) and 55 (95% CI 40–71) for DOES 2 and DOES 1, respectively). Absolute postfracture mortality rates declined in DOES 2 compared with DOES 1, mirroring the improvement in general-population life expectancy. However, when compared with period-specific general-population mortality, there was a similar 2.1- to 2.6-fold increased mortality risk after a fracture in both cohorts (age-adjusted standardized mortality ratio, women: 2.05 [95% CI 1.43–2.83] and 2.43 [95% CI 1.95–2.99] and men: 2.56 [95% CI 1.78–3.58] and 2.48 [95% CI 1.87–3.22] for DOES 2 and DOES 1, respectively).

Conclusion:

Over the 2 decades, despite the decline in the prevalence of fracture risk factors, general-population mortality, and initial fracture incidence, there was no improvement in postfracture outcomes. Refracture rates were similar and fracture-associated mortality was 2-fold higher than expected. These data indicate that the low postfracture treatment rates are still a major problem.
The Revolution on Trial: Assassination, Christianity, and the Rule of Law in 1920s Mexico
Authors: Weis Robert
Published: April 2016

The 1928 trial of José de León Toral, assassin of Mexican caudillo Álvaro Obregón, afforded President Plutarco Elías Calles the opportunity to show domestic and international audiences that the revolution had yielded a nation of laws predicated on spiritual principles. Summary executions of Catholics had allowed detractors and even sympathetic observers to question the depth of civic values in Mexico. The article shows how authorities deliberately presented the hearing as the concrete realization of Calles's claim that his administration had established institutions that embodied the principles of the revolution. Although the Christian idioms presented by the prosecution support recent scholarly arguments regarding deist tendencies within revolutionary ideologies, this article points out that the government's emphasis on its spiritual conviction sought to bolster the claim that anticlericalism was not antireligious but rather necessary for the rule of law.
A Division of Listening: Insurgent Sympathy and the Sonic Broadcasts of the Thai Military
Authors: Tausig Benjamin
Published: April 2016

During ten weeks of antigovernment protest in spring 2010, the Thai military used physical and psychological tactics, including coercive broadcasting of music and sound, to combat demonstrations in Bangkok. Before a violent crackdown in May, protesters and soldiers spent ten weeks in a standoff in which such broadcasting figured crucially. An analysis of sound and its reception during those weeks reveals the precarious status of nationalism in a country where other political loyalties, including regionalism and class, have come increasingly (and in this case study, audibly) to the fore.

The army's sonic broadcasting unit was successfully attuned to the regional ear of the largely rural protesters; however, the army may have been winning the battle even as the state was losing the war. The broadcasting unit had its greatest success playing rural-inflected genres like mor lam and luk thung, even as protesters failed to respond to broadly patriotic songs and gestures. The primary locus of sympathetic listening had become local or regional rather than national. I refer to this mode of listening as one of “insurgent sympathy,” an indirect entry point for class-based alliances otherwise impossible in Thai political life.
Team versus Individual Play in Finitely Repeated Prisoner Dilemma Games
Authors: Kagel John H. , McGee Peter
Published: April 2016

In finitely repeated prisoner dilemma games, two-person teams start with significantly less cooperation than individuals, consistent with results from the psychology literature. This quickly gives way to teams cooperating more than individuals. Team dialogues show increased payoffs from cooperation, along with anticipating opponents' recognition of the same, provides the basis for cooperation, even while fully anticipating defection near the end game. A strong status quo bias in defecting across super-games limits unraveling. Defecting typically occurs one round earlier across super-games, consistent with low marginal, or even negative, benefits of more than one-step-ahead defection. (JEL C72, C73, C90, D12)