bluuebunny/crossref_metadata_2025 huggingface dataset:
Distributed parameter modeling and thermal analysis of a spiral water wall in a supercritical boiler
Authors: Zheng Shu , Luo Zixue , Zhou Huaichun
Published: February 2014

In this paper, a distributed parameter model for the evaporation system of a
supercritical spiral water wall boiler is developed based on a 3-D
temperature field. The mathematical method is formulated for predicting the
heat flux and the metal-surface temperature. The results show that the
influence of the heat flux distribution is more obvious than that of the heat
transfer coefficient distribution in the spiral water wall tube, and the peak
of the heat transfer coefficient decreases with an increment of supercritical
pressure. This distributed parameter model can be used for a 600 MW
supercritical-pressure power plant.
Homotopy perturbation method for viscous heating in plane Couette flow
Authors: Yun Yin-Shan , Temuer Chaolu
Published: February 2014

In this paper, the problem of viscous heating in plane Couette flow is
considered by the homotopy perturbation method. The non-linear terms are
expanded to Taylor series of the homotopy parameter. The obtained solutions
are shown graphically and are compared with the exact solutions. The obtained
results illustrate the efficiency and convenience of the method.
A numerical model for chemical reaction on slag layer surface and slag layer behavior in entrained-flow gasifier
Authors: Liu Sheng , Tao Mingchun , Hao Yingli
Published: February 2014

The paper concerns with slag layer accumulation, chemical reaction on slag
layer surface, and slag layer flow, heat and mass transfer on the wall of
entrained-flow coal gasifier. A slag layer model is developed to simulate
slag layer behaviors in the coal gasifier. This 3-D model can predict
temperature, slag particle disposition rate, disposition particle
composition, and syngas distribution in the gasifier hearth. The model is
used to evaluate the effects of O2/coal ratio on slag layer behaviors.
Characteristics of a micro-fin evaporator: Theoretical analysis and experimental verification
Authors: Zheng Hui-Fan , Fan Xiao-Wei , Wang Fang , Liang Yao-Hua
Published: February 2014

A theoretical analysis and experimental verification on the characteristics
of a micro-fin evaporator using R290 and R717 as refrigerants were carried
out. The heat capacity and heat transfer coefficient of the micro-fin
evaporator were investigated under different water mass flow rate, different
refrigerant mass flow rate, and different inner tube diameter of micro-fin
evaporator. The simulation results of the heat transfer coefficient are
fairly in good agreement with the experimental data. The results show that
heat capacity and the heat transfer coefficient of the micro-fin evaporator
increase with increasing logarithmic mean temperature difference, the water
mass flow rate and the refrigerant mass flow rate. Heat capacity of the
micro-fin evaporator for diameter 9.52 mm is higher than that of diameter
7.00 mm with using R290 as refrigerant. Heat capacity of the micro-fin
evaporator with using R717 as refrigerant is higher than that of R290 as
refrigerant. The results of this study can provide useful guidelines for
optimal design and operation of micro-fin evaporator in its present or future
applications.
Surface tension and viscosity measurement with surface laser light scattering method
Authors: Wang Feng-Kun , Yue Hong-Ya , Fan Xiao-Wei , Liu Zhi-Gang
Published: February 2014

Measurement of thermal properties is an important topic in the thermophysics.
With the developing of laser technology, laser detection technologies can be
used for thermal properties measurement. Based on the laser light scattering
theory and light heterodyne detection principle, an experimental system by
the surface laser light scattering is developed to measure the liquid surface
tension and viscosity simultaneously. The maximal experimental errors of the
measured surface tension and viscosity are less than 0.5% and 4.73%,
respectively.
Mechanism of nanofiber crimp
Authors: Chen Rou-Xi , Zhang Li , Kong Hai-Yan , He Ji-Huan , Chen Yun
Published: February 2014

Fabrication of crimped fibers has been caught much attention recently due to
remarkable improvement surface-to-volume ratio. The precise mechanism of the
fiber crimp is, however, rare and preliminary. This paper finds that
pulsation of fibers is the key factor for fiber crimp, and its configuration
(wave formation) corresponds to its nature frequency after solidification.
Crimping performance can be improved by temperature control of the uncrimped
fibers. In the paper, polylactide/ dimethylfomamide solution is fabricated
into crimped nanofibers by the bubble electrospinning, an approximate period-
amplitude relationship of the wave formation is obtained.
Lie symmetry and exact solution of (2+1)-dimensional generalized Kadomtsev-Petviashvili equation with variable coefficients
Authors: Ma Hong-Cai , Qin Zhen-Yun , Deng Ai-Ping
Published: February 2014

The simple direct method is adopted to find Non-Auto-Backlund transformation
for variable coefficient non-linear systems. The (2+1)-dimensional
generalized Kadomtsev-Petviashvili equation with variable coefficients is
used as an example to elucidate the solution procedure, and its symmetry
transformation and exact solutions are obtained.
Optimal spinneret size for improvement of fiber's mechanical property
Authors: Yang Zhanping , Zhang Li , Chen Rou-Xi , He Ji-Huan , Cao Jian-Hua , Liu Fu-Juan
Published: February 2014

The effect of spinneret size and place on diameter and tensile property of
cellulose acetate fibers is studied, and a criterion for the maximal breaking
energy is obtained, and the spinneret distribution can be optimized for each
spinning condition.
Study on key technologies of energy-saving and environment-protective pumps
Authors: Zhang Qi-Hua , Xu Yan , Xu Yuan-Hui , Shi Wei-Dong , Lu Wei-Gang , Liu Wei
Published: February 2014

To meet energy-saving and environment-protective purpose, a series of plastic
pumps are developed by composite molding. There are four key techniques
involved, firstly, plastic hydraulic components with light-weight; secondly,
steel barrel as a pump casing and a connection component as well; thirdly,
floating impeller strategy where impeller is drifting freely along shaft; and
lastly, a self balancing impeller technique which can totally keep axial
force balancing. The manufacturing process is energy-saving, and the
components can be recycled, which have great potentials for conservation of
environment.
Overfeeding Polyunsaturated and Saturated Fat Causes Distinct Effects on Liver and Visceral Fat Accumulation in Humans
Authors: Rosqvist Fredrik , Iggman David , Kullberg Joel , Cedernaes Jonathan , Johansson Hans-Erik , Larsson Anders , Johansson Lars , Ahlström Håkan , Arner Peter , Dahlman Ingrid , Risérus Ulf
Published: February 2014

Excess ectopic fat storage is linked to type 2 diabetes. The importance of dietary fat composition for ectopic fat storage in humans is unknown. We investigated liver fat accumulation and body composition during overfeeding saturated fatty acids (SFAs) or polyunsaturated fatty acids (PUFAs). LIPOGAIN was a double-blind, parallel-group, randomized trial. Thirty-nine young and normal-weight individuals were overfed muffins high in SFAs (palm oil) or n-6 PUFAs (sunflower oil) for 7 weeks. Liver fat, visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (SAT), total adipose tissue, pancreatic fat, and lean tissue were assessed by magnetic resonance imaging. Transcriptomics were performed in SAT. Both groups gained similar weight. SFAs, however, markedly increased liver fat compared with PUFAs and caused a twofold larger increase in VAT than PUFAs. Conversely, PUFAs caused a nearly threefold larger increase in lean tissue than SFAs. Increase in liver fat directly correlated with changes in plasma SFAs and inversely with PUFAs. Genes involved in regulating energy dissipation, insulin resistance, body composition, and fat-cell differentiation in SAT were differentially regulated between diets, and associated with increased PUFAs in SAT. In conclusion, overeating SFAs promotes hepatic and visceral fat storage, whereas excess energy from PUFAs may instead promote lean tissue in healthy humans.
Association of Functional Decline With Subsequent Diabetes Incidence in U.S. Adults Aged 51 Years and Older: The Health and Retirement Study 1998–2010
Authors: Bardenheier Barbara H. , Gregg Edward W. , Zhuo Xiaohui , Cheng Yiling J. , Geiss Linda S.
Published: February 2014

OBJECTIVE

We assessed whether functional decline and physical disability increase the subsequent risk of diabetes.

RESEARCH DESIGN AND METHODS

We used a subsample of adults aged 51 years and older with no diabetes at baseline who were followed up to 12 years (1998–2010) in the Health and Retirement Study, an observational study of a nationally representative survey. We assessed baseline disability status and incident disability with subsequent risk of diabetes, accounting for death as a competing risk and controlling for BMI, age, sex, race/ethnicity, net wealth, mother’s level of education, respondents’ level of education, and time of follow-up. Disability was defined as none, mild, moderate, and severe, based on a validated scale of mobility measures. Diabetes was identified by self-report of a diagnosis from a doctor. Population attributable fraction (PAF) was calculated to assess the percentage of diabetes cases that were attributable to mobility disability.

RESULTS

The sample included 22,878 adults with an average of 8.7 years of follow-up; 9,649 (41.2%) reported some level of disability at baseline, and 8,175 (35.7%) additional participants developed disability during follow-up; 3,546 (15.5%) participants developed diabetes; and 5,869 (25.6%) died. Regression analyses found a statistically significant dose–response relationship of increased risk of diabetes (28–95%) among those with any level of functional decline, prevalent or incident. Among the subanalytic sample, including incident disability only, the PAF was 6.9% (CI 4.2–9.5).

CONCLUSIONS

Our findings suggest those who become disabled, even mildly, are at increased risk of developing diabetes. This finding raises the possibility that approaches to prevent disability in older adults could also reduce diabetes incidence.
Evaluation of risk factors, including fluconazole administration, for prolonged anesthetic recovery times in horses undergoing general anesthesia for ocular surgery: 81 cases (2006–2013)
Authors: Krein Stephanie R. , Lindsey Jane C. , Blaze Cheryl A. , Wetmore Lois A.
Published: February 2014

Objective—To determine risk factors for prolonged anesthetic recovery time in horses that underwent general anesthesia for ocular surgery.

Design—Retrospective cohort study.

Animals—81 horses that underwent general anesthesia for ocular surgery between 2006 and 2013.

Procedures—Descriptive information recorded included the ocular procedure performed, concurrent fluconazole treatments, analgesic and anesthetic agents administered, procedure duration, use of sedation for recovery, and recovery time. Data were analyzed for associations between recovery time and other variables.

Results—81 horses met inclusion criteria. In 72 horses, anesthesia was induced with ketamine and midazolam; 16 horses treated concurrently with fluconazole had significantly longer mean recovery time (109 minutes [95% confidence interval {CI}, 94 to 124 minutes]) than did 56 horses that were not treated with fluconazole (50 minutes [95% CI, 44 to 55 minutes]). In 9 horses anesthetized with a protocol that included ketamine but did not include midazolam, there was no difference between mean recovery time in horses that either received (59 minutes [95% CI, 36 to 81 minutes]; n = 5) or did not receive (42 minutes [95% CI, 16 to 68 minutes]; 4) fluconazole. Other variables identified as risk factors for prolonged recovery included duration of anesthesia and use of acepromazine for premedication.

Conclusions and Clinical Relevance—Fluconazole administration was associated with prolonged anesthetic recovery time in horses when ketamine and midazolam were used to induce anesthesia for ocular surgery. Duration of anesthesia and premedication with acepromazine were also identified as risk factors for prolonged recovery time.
Mapping vegetation communities of the Karkonosze National Park using APEX hyperspectral data and Support Vector Machines
Authors: Marcinkowska Adriana , Zagajewski Bogdan , Ochtyra Adrian , Jarocińska Anna , Raczko Edwin , Kupková Lucie , Stych Premysl , Meuleman Koen
Published: February 2014

This research aims to discover the potential of hyperspectral remote sensing data for mapping mountain vegetation ecosystems. First, the importance of mountain ecosystems to the global system should be stressed due to mountainous ecosystems forming a very sensitive indicator of global climate change. Furthermore, a variety of biotic and abiotic factors influence the spatial distribution of vegetation in the mountains, producing a diverse mosaic leading to high biodiversity.

The research area covers the Szrenica Mount region on the border between Poland and the Czech Republic - the most important part of the Western Karkonosze and one of the main areas in the Karkonosze National Park (M&B Reserve of the UNESCO).

The APEX hyperspectral data that was classified in this study was acquired on 10th September 2012 by the German Aerospace Center (DLR) in the framework of the EUFAR HyMountEcos project. This airborne scanner is a 288-channel imaging spectrometer operating in the wavelength range 0.4-2.5 μm.

For reference patterns of forest and non-forest vegetation, maps (provided by the Polish Karkonosze National Park) were chosen. Terrain recognition was based on field walks with a Trimble GeoXT GPS receiver. It allowed test and validation dominant polygons of 15 classes of vegetation communities to be selected, which were used in the Support Vector Machines (SVM) classification. The SVM classifier is a type of machine used for pattern recognition. The result is a post classification map with statistics (total, user, producer accuracies, kappa coefficient and error matrix). Assessment of the statistics shows that almost all the classes were properly recognised, excluding the fern community. The overall classification accuracy is 79.13% and the kappa coefficient is 0.77. This shows that hyperspectral images and remote sensing methods can be support tools for the identification of the dominant plant communities of mountain areas.
Study on antimicrobial effect of disinfecting solutions on alginate impression materials
Authors: Ahsan Mohamad Rafiul , Islam Kazi Ziaul , Begum Jebunnesa
Published: February 2014

Oral cavity contains 600 species of microbes named oral flora.Dental impressions get contaminated with micro-organisms from patients blood or saliva. So, impressions are recommended to disinfect before their further working steps. A study was carried out to find out a more effective disinfectant solution between 1% sodium hypochlorite and 2% glutaraldehyde solution on irreversible hydrocolloid impression and thereby identify their efficacy against microbial transmission to the resultant dental cast. In this study, hydrcolloid impression material was selected as the experimental elements because these are the materials which are mostly used in our country. These are disinfecting solution which are worldwide used. The findings suggested that the transmission rate from impression to the casts was 7% in control group (P<0.001). It was reduced to (0.6%) when disinfected by 1% sodium hypochlorite solution whereas transmission rate was minimum (0.08%) when disinfected by 2% glutaraldehde solution. The most important things is that it will be very easy for the clinician to produce this solution and disinfect the impression by these solutions and there will have no effect on the dimension of the impression or the cast DOI: http://dx.doi.org/10.3329/updcj.v3i1.17980 Update Dent. Coll. j: 2013; 3 (1): 18-23
The Radix Entomolaris : Non-surgical Approach in Endodontics
Authors: Chowdhury Shirin Sultana , Quader SM Abdul
Published: February 2014

Mandibular molars often have an additional root located lingually (the radix entomolaris) or buccally (the radix paramolaris). If present, an awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment. This report discusses endodontic treatment of a mandibular molar with a radix entomolaris, which is a rare macrostructure. The prevalence, the external morphological variations and internal anatomy of the radix entomolaris are described. Avoiding procedural errors during endodontic therapy demand an adapted clinical approach to diagnosis and successful non-surgical endodontic treatment. DOI: http://dx.doi.org/10.3329/updcj.v3i1.17986 Update Dent. Coll. j: 2013; 3 (1): 49-53
A Comparative Study on Accuracy and Reproducibility of Alginate and Addition Reaction Silicone as an Impression Materials.
Authors: Fatema Shakila , Quader Sheikh Md Shahriar , Shamsuzzaman Mohammad , Rahman Mirza Md Arifur , Khan Nasima
Published: February 2014

Background: To achieve accuracy and exact reproduction of prosthesis, choosing a perfect impression material is essential. Especially to make the prosthesis as accurately as possible, impression material should possess some essential properties, like; minimum dimensional changes, good flow ability and easy removal. Purpose: The aim of this study was to evaluate the accuracy and surface detail reproduction of Alginate and Addition Reaction Silicone as an impression materials. Method: This is an experimental in vitro study. In this study Impression by Alginate and Addition Reaction Silicone were made using a round stainless steel test block with three horizontal lines and two vertical lines. The horizontal lines were used for evaluating the surface detail reproduction, and vertical lines were provided for the dimensional accuracy. For dimensional accuracy the length of the middle horizontal line in between vertical lines and the distance between the top and bottom horizontal line was measured using travelling microscope. And for surface detail reproduction three horizontal line of one segment were observed under stereomicroscope. Result: According to study results Addition Reaction Silicone is better than Alginate regarding quality of impression. Conclusion: In comparison to Alginate, Addition Reaction Silicone might have better performance about accuracy and surface detail reproduction. DOI: http://dx.doi.org/10.3329/updcj.v3i2.17996 Update Dent. Coll. j: 2013; 3 (2): 28-33
Learning from Complex Systems: On the Roles of Entropy and Fisher Information in Pairwise Isotropic Gaussian Markov Random Fields
Authors: Levada Alexandre
Published: February 2014

Markov random field models are powerful tools for the study of complex systems. However, little is known about how the interactions between the elements of such systems are encoded, especially from an information-theoretic perspective. In this paper, our goal is to enlighten the connection between Fisher information, Shannon entropy, information geometry and the behavior of complex systems modeled by isotropic pairwise Gaussian Markov random fields. We propose analytical expressions to compute local and global versions of these measures using Besag’s pseudo-likelihood function, characterizing the system’s behavior through its Fisher curve , a parametric trajectory across the information space that provides a geometric representation for the study of complex systems in which temperature deviates from infinity. Computational experiments show how the proposed tools can be useful in extracting relevant information from complex patterns. The obtained results quantify and support our main conclusion, which is: in terms of information, moving towards higher entropy states (A –> B) is different from moving towards lower entropy states (B –> A), since the Fisher curves are not the same, given a natural orientation (the direction of time).
Towards a Tissue-Engineered Ligament: Design and Preliminary Evaluation of a Dedicated Multi-Chamber Tension-Torsion Bioreactor
Authors: Laurent Cédric , Vaquette Cédryck , Martin Céline , Guedon Emmanuel , Wu Xiude , Delconte Alain , Dumas Dominique , Hupont Sébastien , Isla Natalia , Rahouadj Rachid , Wang Xiong
Published: February 2014

Tissue engineering may constitute a promising alternative to current strategies in ligament repair, providing that suitable scaffolds and culture conditions are proposed. The objective of the present contribution is to present the design and instrumentation of a novel multi-chamber tension-torsion bioreactor dedicated to ligament tissue engineering. A preliminary biological evaluation of a new braided scaffold within this bioreactor under dynamic loading is reported, starting with the development of a dedicated seeding protocol validated from static cultures. The results of these preliminary biological characterizations confirm that the present combination of scaffold, seeding protocol and bioreactor may enable us to head towards a suitable ligament tissue-engineered construct.
CD81-Receptor Associations — Impact for Hepatitis C Virus Entry and Antiviral Therapies
Authors: Zona Laetitia , Tawar Rajiv , Zeisel Mirjam , Xiao Fei , Schuster Catherine , Lupberger Joachim , Baumert Thomas
Published: February 2014

Tetraspanins are integral transmembrane proteins organized in microdomains displaying specific and direct interactions with other tetraspanins and molecular partners. Among them, CD81 has been implicated in a variety of physiological and pathological processes. CD81 also plays a crucial role in pathogen entry into host cells, including hepatitis C virus (HCV) entry into hepatocytes. HCV is a major cause of liver cirrhosis and hepatocellular carcinoma. HCV entry into hepatocytes is a complex process that requires the coordinated interaction of viral and host factors for the initiation of infection, including CD81, scavenger receptor BI, claudin-1, occludin, membrane-bound host cell kinases, Niemann-Pick C1 Like 1, Harvey rat sarcoma viral oncogene homolog (HRas), CD63 and transferrin receptor 1. Furthermore, recent data in HCV model systems have demonstrated that targeting critical components of tetraspanins and associated cell membrane proteins open new avenues to prevent and treat viral infection.
Acceptability of Condoms, Circumcision and PrEP among Young Black Men Who Have Sex with Men: A Descriptive Study Based on Effectiveness and Cost
Authors: Crosby Richard , Geter Angelica , DiClemente Ralph , Salazar Laura
Published: February 2014

The current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.
Le suffrage censitaire d'après les débats parlementaires du début de la monarchie de Juillet
Authors: Bacot Guillaume
Published: February 2014

Les débats parlementaires du début de la monarchie de Juillet montrent que le suffrage censitaire était alors très généralement accepté, bien que certains, qui le justifiaient par la théorie de l’électorat-fonction, ne souhaitaient guère l’étendre, tandis que d’autres, qui s’en tenaient à celle de l’électorat-droit, auraient voulu l’ouvrir beaucoup plus largement. C’est cette différence qui sera à l’origine de la distinction cardinale entre souveraineté nationale et souveraineté du peuple. Mais les partisans de l’une comme de l’autre avaient de la peine, quoique pour des raisons différentes, à donner une justification parfaitement cohérente de ce système électoral.
L'étendue du suffrage universel sous la II e République
Authors: Blachèr Philippe
Published: February 2014

En proclamant le suffrage universel en 1848, les constituants de la Seconde République retiennent une conception de l’égalité politique qui prend ses distances avec la théorie démocratique. Pour les républicains, il ne peut y avoir d’égalité en droit que dans la mesure où la norme juridique délimite une catégorie à l’intérieur de laquelle les citoyens sont égaux. Ainsi, paradoxalement, l’égalité politique s’accompagne de l’exclusion dès son émergence dans le droit politique. Si le suffrage universel n’implique pas nécessairement la reconnaissance du droit de vote à tous les citoyens, l’analyse des discours justifiant ce dispositif confirme que le suffrage universel est, au xix e siècle, conçu comme un instrument, et non en tant que principe abstrait.
L'appel au peuple
Authors: Denquin Jean-Marie
Published: February 2014

La notion d’appel au peuple est souvent utilisée exclusivement par référence à la doctrine et la pratique bonapartiste. Prise au sens habituel des termes, elle peut aussi désigner des procédures variées : vote par oui ou par non, ou des élections consécutives à une dissolution. Trois fonctions, qui s’interpénètrent, lui sont prêtées : fonder une légitimité, manifester la responsabilité des gouvernants, ou demander un avis. Le fait que l’appel soit une procédure inhabituelle, fruit d’une décision discrétionnaire des détenteurs du pouvoir, crée des ambiguïtés que seule pourrait lever une procédure symétrique d’initiative populaire.
Examining Taiwanese Psychiatric Nurses’ Knowledge and Confidence in Case Management
Authors: Liu Wen I.
Published: February 2014

Background:

Psychiatric nurses in Taiwan are increasingly required to employ case management strategies for patients with severe mental illness. However, few studies have examined these nurses’ knowledge of case management and identified their unmet educational needs.

Methods:

A national cross-sectional survey was conducted to examine psychiatric nurses’ knowledge of case management and confidence in their case management skills. Structured questionnaires were distributed at an arranged time and using an electronic survey tool. Overall, 424 psychiatric nurses were recruited.

Results:

Participants’ knowledge scores reflected substantial gaps (60% accuracy rate), particularly in basic concepts and case management processes. In addition, the nurses lacked confidence in applying their case management skills. The unmet educational needs of the nurses were related to the skills of assessing resource requirements, conducting referrals, collaborating with service providers, and linking patients to necessary resources. Additionally, 87% of the nurses had no previous education in case management.

Conclusion:

Strategies for enhancing continuing education in case management are required to improve nurses’ knowledge of case management, address their unmet educational needs, and prepare them to serve as case managers.
J Contin Educ Nurs.
2014;45(1):43–48.
Preceptorship Today: Moving Toward Excellence
Authors: Shinners Jean , Mallory Cheryl , Franqueiro Tammy
Published: February 2014

In today’s fast-paced, highly technical clinical environment, preceptor excellence drives nurses in transition to maintain the levels of energy and motivation they had when they first entered the profession. Whether preceptor or preceptee, education that infuses the professional role with new knowledge and practices can inspire nurses to fully engage in their role. Achieving excellence as a preceptor requires dedicated nurturing through continuing nursing education, where educators understand the importance of their involvement in and commitment to enriching the role of the registered nurse preceptor.

J Contin Educ Nurs
2013;44(11):482–483.
Fostering RN-to-BSN Students’ Confidence in Searching Online for Scholarly Information on Evidence-Based Practice
Authors: McCulley Carol , Jones Melissa
Published: February 2014

Graduates of bachelor of science in nursing (BSN) programs are increasingly expected to take an active role in assessing and improving nursing practice, and nurse educators are expected to prepare BSN students for this expanding role. Information literacy, the ability to search for, find, get, and use scholarly information to inform nursing practice, should be a critical component of nursing education. This article focuses on five strategies for teaching information literacy to registered nurse (RN)-to-BSN students in an online continuing education environment. These strategies include the addition of an embedded librarian to the online courses, collaboration between the librarian and nursing faculty, a subject guide with access to resources and tutorials at the point of need, student-centered learning with authentic assignments, and reflection on the learning process. Student reflections suggest that these strategies result in increased confidence in searching for and finding the evidence-based scholarship that they need.

J Contin Educ Nurs.
2014;45(1):22–27.
Resilience-Building Strategies for Nurses in Transition
Authors: Richez Madeline
Published: February 2014

Nursing is stressful, especially for the new graduate entering the work-force and for those transitioning into new roles. This article explores one large health system’s approach to supporting those nurses through a 1-day program devoted to enhancing their resilience. A few resilience-building strategies are highlighted.

J Contin Educ Nurs.
2014;45(2)54–55.
Managing Resident-to-Resident Elder Mistreatment in Nursing Homes: The SEARCH Approach
Authors: Ellis Julie M. , Teresi Jeanne A. , Ramirez Mildred , Silver Stephanie , Boratgis Gabriel , Kong Jian , Eimicke Joseph P. , Sukha Gail , Lachs Mark S. , Pillemer Karl A.
Published: February 2014

This article describes an educational program to inform nursing and care staff of the management of resident-to-resident elder mistreatment (R-REM) in nursing homes, using the SEARCH (
S
upport,
E
valuate,
A
ct,
R
eport,
C
are plan, and
H
elp to avoid) approach. Although relatively little research has been conducted on this form of abuse, there is mounting interest in R-REM because such aggression has been found to be extensive and can have both physical and psychological consequences for residents and staff. The goal of the SEARCH approach is to support staff in the identification and recognition of R-REM as well as to suggest recommendations for management. The educational program and the SEARCH approach are described. Three case studies from the research project are presented, illustrating how nurses and care staff can use the SEARCH approach to manage R-REM in nursing homes. Resident and staff safety and well-being can be enhanced by the use of the evidence-based SEARCH approach.

J Contin Educ Nurs.
2014;45(3):112–121.
Supporting the Mental Health of Children by Treating Mental Illness in Parents
Authors: Kim Sarah Richards , Szigethy Eva , Meltzer-Brody Samantha , Pilowsky Daniel J. , Verhulst Frank
Published: February 2014

CME Educational Objectives

1.

List parental risk factors for the development of psychopathology in children.

2.

Describe the relationship between treatment of maternal psychopathology and level of child symptomatology.

3.

Understand family risk factors for psychopathology in children with chronic medical illness.

Psychiatrists who treat adult patients with children can practice preventatively by considering the potential impact of treatment interventions on the mental health and resiliency of their patients’ offspring. Parental psychopathology is associated with increased risk of a wide range of social, cognitive, and behavioral problems in children.
1
Genetic and environmental factors likely contribute, although which parental factors influence resilience in children remains largely unknown. Resilience is an interactive phenomenon, and significant heterogeneity exists in the individual child’s response to environmental influences. Despite exposure to serious adversities known to result in negative child outcomes, some children seem to do relatively well. Unraveling protective versus risk factors can help identify determinants of resilience as it relates to both mental and physical health outcomes in offspring.
An 8-Month-Old Boy with Purpuric Skin Lesions
Authors: Sorensen Eric P. , Matiz Catalina , Friedlander Sheila F.
Published: February 2014

A previously healthy 8-month-old Hispanic boy presented with a 5-day history of an erythematous, non-pruritic papular eruption on both legs. The eruption was initially diagnosed as impetigo by his primary care practitioner but progressed despite trimethoprim / sulfamethoxazole therapy, with extension to the face, trunk, and all extremities. When the patient subsequently developed a fever of 100.8° F, emesis, diarrhea, and upper respiratory symptoms, he was referred to the pediatric dermatology clinic for evaluation. Further questioning revealed a 3-day febrile illness 6 weeks prior to presentation that was treated with ceftriaxone. Review of systems failed to identify any hematuria, blood in stool, or abdominal pain, but the parents did report swelling of the extremities and face, as well as decreased oral intake.

On examination, the infant was in no apparent distress, afebrile, and had mild rhinorrhea. His mucous membranes were unaffected, and no lymphadenopathy or hepatosplenomegaly was noted. Cutaneous exam revealed numerous edematous erythematous to violaceous plaques on the cheeks, arms, buttocks, and legs with minimal involvement of the trunk. Several lesions on the arms had a distinct cockade (rosette or iris-like) pattern. There were no vesicles, bullae, or necrosis. Edema of the bilateral lower extremities was noted. Laboratory work up revealed a normal complete blood count (CBC), comprehensive metabolic panel, creatinine, and urinalysis. Platelets were borderline elevated at 439 TH/μL (140–440 TH/μL), and erythrocyte sedimentation rate and C-reactive protein (CRP) were minimally elevated at 22 mm (0–15 mm) and 3.1 mg/dL (0.0–0.99 mg/dL), respectively.

To read more and to earn CME credit for reading this article, access the full text by going to
Healio.com/Pediatrics
and searching: doi: 10.3928/00904481-20131223-09.
mHealth Tools for the Pediatric Patient-Centered Medical Home
Authors: Slaper Michael R. , Conkol Kimberly
Published: February 2014

The concept of the pediatric patient-centered medical home (PCMH) as a theory has been evolving since it was initially conceived more than 40 years ago. When the American Academy of Pediatrics’ (AAP) Council on Pediatric Practice first wrote about this model, “medical home” was defined solely as the central location of a pediatric patient’s medical records.
1
Approximately two decades later, the AAP published its inaugural policy statement on this topic. Through this policy statement, the medical home was defined as a place where care for pediatric patients would be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.

Although the lack of access to providers, especially in rural communities, may inhibit the adoption of the PCMH or chronic care models, technology has evolved to the point where many of the gaps in care can be bridged. mHealth, defined by the National Institutes of Health (NIH) as the use of mobile and wireless devices to improve health outcomes, health care services, and health research, can be one specific example of how technology can address these issues. One early study has shown that patients who use mHealth tools are more likely to adhere to self-monitoring requirements and, in turn, have significantly improved outcomes. A rapidly evolving and scalable mHealth technology that has the ability to address these issues are self-management mobile applications, or apps. It has been estimated that there are currently more than 40,000 health care-related apps available. Furthermore, use of these apps is growing, as more than 50% of smartphone users surveyed responded that they have used their device to gather health information, and almost 20% of this population has at least one health care app on their device.
Telemedicine for the Care of Children in the Hospital Setting
Authors: McSwain S. David , Marcin James P.
Published: February 2014

Telemedicine is by no means a new technology, given that audio-video telecommunication links have been utilized for the provision of medical services since the 1950s. Nonetheless, telemedicine is currently in a phase of rapid growth and evolution. The combination of increasingly affordable and powerful networking, computing, and communication technology, along with the continued nationwide crisis in health care access and costs, has created a “tipping point,” whereby telemedicine has progressed from a novel means of practicing medicine to practical tool to help address our nation’s health care needs. Telemedicine has also evolved beyond a means of providing care to remote communities to becoming a versatile tool in the delivery of health care in a variety of non-rural settings. Although no one can be everywhere at once, telemedicine allows us to be in more places at once than we’ve ever been before.

The problems of disparities and access to care are even more evident in pediatrics, where subspecialists are fewer in number and more regionalized than adult providers. Numerous successful telemedicine programs across the country have demonstrated the impact that these technologies can have in pediatrics, with many more programs in development. As a versatile means of delivering care, telemedicine can be used at any point during the course of a health care encounter as not only a means of expanding our reach, but also as a means of increasing efficiency. Using telemedicine to provide consultations to community hospitals has been shown to improve quality of care, strengthen the referral base for the consulting facilities, facilitate cost savings, and improve the financial bottom line for both referring and consulting facilities.

This review highlights some of the ways in which telemedicine is being used to facilitate timely and effective pediatric care in a variety of hospital settings.
Novel Technique for Removal of a Broken Intracortical Screw During THA
Authors: Dietz Matthew J. , Chase Samantha , Burke Dennis W. , Kwon Young-Min
Published: February 2014

Most reports regarding hardware removal involve the violation of the cortex to allow a specialized to tool to extract a retained fragment. This leaves large, unfilled screw holes that act as stress risers for months postoperatively. This article describes a novel technique to remove a retained intracortical screw fragment during total hip arthroplasty. Conversion of an intertrochanteric osteotomy to a total hip arthroplasty can be made more difficult by anatomical changes to the femur and retained hardware. Direct access to the intramedullary canal during total hip arthroplasty allowed for the safe removal of a retained intracortical screw using this technique.
Antimicrobial Properties and Elution Kinetics of Linezolid From Polymethylmethacrylate
Authors: Snir Nimrod , Meron-Sudai Shiri , Deshmukh Ajit J. , Dekel Shmuel , Ofek Itzhak
Published: February 2014

Polymethylmethacrylate (PMMA) impregnated with antibiotics is widely used in the treatment of osteomyelitis and infected arthroplasties. With the emergence of resistant bacterial strains, linezolid, which is active against gram-positive bacteria and toward which resistance has been scarce, has been suggested as an alternative. In the current in vitro study, the authors sought to determine and compare the efficacy and elution kinetics of linezolid from PMMA. Polymethylmethacrylate beads impregnated with linezolid, vancomycin, or gentamicin alone and in combinations were placed in suspensions of vancomycin-resistant enterococci, methicillin-resistantStaphylococcus aureus,Klebsiella pneumoniae,Escherichia coli, andStaphylococcus epidermidis. The leaching out concentrations of antibiotics and growth inhibitory time in days were recorded. The mechanical strength of cement beads was evaluated in accordance with International Standard 5833. The growth inhibitory time of linezolid was significantly longer than that of vancomycin and gentamicin for methicillin-resistantS aureus, vancomycin-resistant enterococci, andS epidermidis. The combination of linezolid with gentamicin and vancomycin significantly increased the growth inhibitory time compared with either antibiotic used alone. Linezolid alone or in combination with vancomycin and gentamicin showed satisfactory elution kinetics and antimicrobial activity in vitro without compromising the mechanical strength of PMMA. Future research evaluating the in vivo profile of linezolid-loaded PMMA in experimental animals is needed before it can be considered for human use.
Early Postoperative Failure of a New Intramedullary Fixation Device for Midshaft Clavicle Fractures
Authors: Wilson David J. , Weaver Dewayne L. , Balog Todd P. , Arrington Edward D.
Published: February 2014

The Sonoma CRx device (Sonoma Orthopedic Products, Santa Rosa, California) is a recently introduced intramedullary device with a flexible shaft that becomes rigid once actuated to allow deployment within the sigmoidal contour of the clavicular shaft. Medial intramedullary cortical purchase is obtained by grippers and lateral purchase through a locking bicortical buttressing screw. This article describes 2 cases of early hardware failure using this device. In both cases, early postoperative radiographs demonstrate adequate initial fracture reduction and implant position. Both patients sustained repeat injuries, one under low physiologic load and the other after returning to mixed martial arts 4 months postoperatively. Implant failure was noted after reinjury in both cases. Complete healing and full return to function was documented for both patients at 2 years. Proper patient selection and counseling regarding the limitations of this intramedullary fixation device are important. Biomechanical comparison of this implant to plate fixation under physiologic loads of combined axial compression and torsion may shed light on differences in fixation stability.
Economic Viability of Geriatric Hip Fracture Centers
Authors: Clement R. Carter , Ahn Jaimo , Mehta Samir , Bernstein Joseph
Published: February 2014

Management of geriatric hip fractures in a protocol-driven center can improve outcomes and reduce costs. Nonetheless, this approach has not spread as broadly as the effectiveness data would imply. One possible explanation is that operating such a center is not perceived as financially worthwhile. To assess the economic viability of dedicated hip fracture centers, the authors built a financial model to estimate profit as a function of costs, reimbursement, and patient volume in 3 settings: an average US hip fracture program, a highly efficient center, and an academic hospital without a specific hip fracture program. Results were tested with sensitivity analysis. A local market analysis was conducted to assess the feasibility of supporting profitable hip fracture centers. The results demonstrate that hip fracture treatment only becomes profitable when the annual caseload exceeds approximately 72, assuming costs characteristic of a typical US hip fracture program. The threshold of profitability is 49 cases per year for high-efficiency hip fracture centers and 151 for the urban academic hospital under review. The largest determinant of profit is reimbursement, followed by costs and volume. In the authors’ home market, 168 hospitals offer hip fracture care, yet 85% fall below the 72-case threshold. Hip fracture centers can be highly profitable through low costs and, especially, high revenues. However, most hospitals likely lose money by offering hip fracture care due to inadequate volume. Thus, both large and small facilities would benefit financially from the consolidation of hip fracture care at dedicated hip fracture centers. Typical US cities have adequate volume to support several such centers.
Four- to Six-year Follow-up of Primary THA Using Contemporary Titanium Tapered Stems
Authors: Goetz Devon D. , Reddy Arun , Callaghan John J. , Hennessy David W. , Bedard Nicholas A. , Liu Steve S.
Published: February 2014

Tapered cementless femoral components have been used in total hip arthroplasty constructs for more than 20 years. In the past 5 to 10 years, these stems have gained popularity in the United States. The purpose of this study was to evaluate the results of the authors’ initial experience using a contemporary tapered, proximally porous-coated, titanium femoral component at 4 to 6 years of follow-up. Eighty-eight patients underwent 100 total hip arthroplasties using the Summit stem (DePuy, Warsaw, Indiana) and a cementless acetabular component. Average age at the time of surgery was 61.6 years. Patients were prospectively followed for 4 to 6 years or until death. Patients were evaluated clinically using Harris Hip Scores and the need for revision. Radiographs were evaluated for femoral loosening and osteolysis. At final follow-up, no hips had been revised for femoral or acetabular loosening. Two hips required revision for dislocation and 1 for early femoral fracture. Bony ingrowth was seen in all but 2 femoral components. There was 1 instance of proximal femoral osteolysis and none distally on radiographs (cross-linked polyethylene was used in 73% of cases). There were 2 cases of severe stress shielding. One percent of cases had an early fracture (too tight) and 1% subsided without ingrowth (too loose). One patient reported significant thigh pain that did not limit activity. At final follow-up, the Summit femoral component demonstrated durable results at 4 to 6 years. Stability of the implant without femoral fracture is paramount.
Bloodless Surgery by a Regional Intra-arterial Tourniquet During Primary and Revision THA
Authors: Bernasek Thomas , Mangar Devanand , Omar Hesham R. , Lyons Steven , Karlnoski Rachel A. , Chen Ren , Baumgarten Adam , Sprenker Collin J. , Camporesi Enrico M.
Published: February 2014

Primary total hip arthroplasty (THA) and revision THA are associated with blood loss that can be significant. The purpose of this retrospective study was to compare the efficacy of intra-arterial occlusive balloons in reducing blood loss during primary and revision THA. Twelve patients (Jehovah’s Witnesses) scheduled for a primary (n=6) or revision (n=6) THA who refused blood transfusions were compared with 48 control-matched patients (primary THA, n=24; revision THA, n=24). All Jehovah’s Witnesses received an intra-arterial balloon preoperatively, and all control patients underwent conventional surgery. Intraoperatively, balloons were periodically inflated to reduce blood loss and deflated to prevent limb ischemia. Endpoints for the study were estimated blood loss, perioperative hemoglobin, mean hospital stay, mean operative time, amount of intraoperative fluid or blood administered, and complications. None of the patients with an occlusive balloon received blood, whereas the primary THA group received an average of 0.6 units (
P
=.08) and the revision THA group received an average of 1.9 units (
P
=.02). Estimated blood loss was significantly decreased in the balloon group compared with the primary THA group (145 vs 402 mL, respectively;
P
<.01) and the revision THA group (333 vs 767 mL, respectively;
P
<.01). No complications were associated with the intra-arterial balloons. All patients showed a significant reduction in hemoglobin immediately postoperatively compared with preoperative values. No statistically significant differences existed in the amount of fluids given intraoperatively or the mean hospital stay among all groups. Temporary internal tourniquets used as an adjuvant to surgery significantly reduce intra-operative blood loss during primary and revision THA.