bluuebunny/crossref_metadata_2025 huggingface dataset:
An Observational 1-Month Trial on the Efficacy and Safety of Promerim for Improving Knee Joint
Authors: Kilinc Bekir Eray , Oc Yunus , Alibakan Gungor , Bilgin Emre , Kanar Muharrem , Eren Osman Tugrul
Published: February 2018

Objective:

This study was conducted to evaluate the efficacy and tolerability of the oral intake of promerim in the elimination of acute pain and discomfort associated with knee osteoarthritis (OA).

Methods:

Single-center, 1-month, prospective, observational clinical trial. A total of 92 patients not older than 70 years were included. Patients were offered to use 720-mg promerim for the first 15 days after admission after breakfast and then 360 mg for the second 15 days. All patients were analyzed with the visual analog scale (VAS) for pain, which ranges from 0 to 10, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score before the start of treatment and 1 month after the start. Statistical analysis was performed by SPSS 15.0 software. An α level of P < .05 was assumed to be statistically significant.

Results:

This study comprised 92 patients (69 women and 23 men) with a mean age of 51.5 (range: 40-69) years. Before treatment, the mean VAS score was 5.6 ± 1.1, and after treatment, the mean VAS score was 2.6 ± 1.7. Treatment with promerim consistently showed a significant decrease in the VAS score ( P < .001). The mean WOMAC score of the patients was 46.4 ± 8.2 before treatment. After treatment, the mean WOMAC score was 72.1 ± 14.4. Treatment with promerim consistently showed a significant increase in the WOMAC score ( P < .001).

Conclusions:

The results of this single-center, open-label clinical study demonstrate that promerim is a viable natural treatment option for treating knee OA. We recommend that 720-mg promerim taken once daily for the first 15 days after admission and 360 mg taken once daily for the next 15 days significantly and rapidly reduced composite pain and stiffness in the knee OA within 1 month.
Pulmonary Arterial Enlargement is Associated With Acute Chest Pain in Patients Without Obstructive Coronary Artery Disease
Authors: Madam Narasa , Mosleh Wassim , Punnanithinont Natdanai , Carmona-Rubio Andres , Said Zaid H , Sharma Umesh C
Published: February 2018

Background:

Pulmonary hypertension (PH) is an underdiagnosed cause for chest pain in patients without significant coronary artery disease (CAD). Studies showed that enlarged pulmonary arterial (PA) and right ventricular chamber sizes correlate with the severity of PH. Therefore, we studied the association between chest pain, right ventricular dimensions (RVDs), and PA size on coronary coronary tomographic angiography (CCTA).

Methods:

The CCTA of 87 patients presenting with chest pain without evidence of obstructive CAD was examined. The PA diameter (PAD), right atrial dimension (RAD), and RVD were measured. A comparative control cohort included 31 patients who presented without cardiopulmonary complaints and underwent thoracic CT. The risk for obstructive sleep apnea (OSA) was assessed using STOP-BANG questionnaires.

Results:

Patients with chest pain without obstructive CAD showed markedly dilated right atrial and ventricular chambers compared with standard parameters (right atrium: 48 ± 6.4 mm; right ventricle long axis: 61 ± 9.5 mm). When comparing chest pain vs non-chest pain group, respectively, the mean PAD measured 25.92 ± 0.43 mm vs 22.89 ± 0.38 mm ( P < .001), RAD2 measured 40.1423 ± 0.7108 mm vs 34.8800 ± 1.0245 mm ( P = .0048), and RVD2 measured 31.7729 ± 0.7299 mm vs 27.6379 ± 1.6178 mm ( P = .034). Chest pain was associated with higher PAD (odds ratio [OR]: 11.11, P < .05) after adjusting for age, sex, body mass index, history of hypertension, hyperlipidemia, congestive heart failure, chronic obstructive pulmonary disease, OSA, and smoking. The chest pain group had a mean STOP-BANG score of 3.9 ± 1.8 in all patients, and 3.62 ± 0.20 in patients without known history of OSA, representing an elevated risk index for the disease.

Conclusions:

In patients presenting with chest pain without obstructive CAD on CCTA, there is a strong association between the presence of chest pain and enlarged PAD. They also represent a high-risk group for OSA.
Travelogue of secularism: Longing to find a place to call home
Authors: Barras Amélie
Published: February 2018

Recent works have invited us to look into how modes of secularism influence the shape of ‘modern’ religion. This literature has remained quite state-centred, paying less attention to how concepts of secularism migrate from one national context to another. This article seeks to investigate these transnational dynamics. More specifically, it aims to explore this process of travelling through the contemporary writings of the Quebec-based essayist Djemila Benhabib. The article approaches her writings as ‘travelogues’: a genre which acts as an invitation to focus on the ‘travelling’ dimension and politics of location of her accounts. A special emphasis is put on analysing how her writings are vehicles for the travel of gendered visions of secularism from France to Quebec. Ultimately, the article argues that taking these processes of transnational migrations into consideration is necessary to better locate and understand the politics of national debates.
Finding critical action learning through paradox: The role of action learning in the suppression and stimulation of critical reflection
Authors: Vince Russ , Abbey Graham , Langenhan Melissa , Bell Diane
Published: February 2018

In this article, we highlight paradoxical tensions generated by in-company action learning. We consider the implications of these tensions for critical action learning, which has critical reflection as a core element of its theory and practice. Using paradox theory as a lens, we analyze data from two in-company action learning programs and build a model relating to critical action learning that has four interlinked features. The model can help evaluate in-company action learning with a view to identifying emotional and political dynamics that are open (or closed) to critical reflection. Such identification assists in making judgements about the appropriateness of critical action learning within a specific organizational context. Our broader contribution is to frame action learning and critical action learning not only as separate approaches but also as potentially interlinked stages in an ongoing process of individual and organizational learning.
Contemporary trends in party organization: Revisiting intra-party democracy
Authors: Borz Gabriela , Janda Kenneth
Published: February 2018

Party organization has regained a new momentum in the party literature over the past decade. In this context, we review the most important advances in the literature and critically examine issues such as: the link between party organization literature and organizational theory literature, party organization and intra-party democracy, and between party organization on paper and in reality. We ascertain the need for more conceptual clarifications in the field and raise questions for debate. We further outline the contribution of this special issue to the theme of intra-party democracy in representative democracies.
Touchless computer interfaces in hospitals: A review
Authors: Cronin Seán , Doherty Gavin
Published: February 2018

The widespread use of technology in hospitals and the difficulty of sterilising computer controls has increased opportunities for the spread of pathogens. This leads to an interest in touchless user interfaces for computer systems. We present a review of touchless interaction with computer equipment in the hospital environment, based on a systematic search of the literature. Sterility provides an implied theme and motivation for the field as a whole, but other advantages, such as hands-busy settings, are also proposed. Overcoming hardware restrictions has been a major theme, but in recent research, technical difficulties have receded. Image navigation is the most frequently considered task and the operating room the most frequently considered environment. Gestures have been implemented for input, system and content control. Most of the studies found have small sample sizes and focus on feasibility, acceptability or gesture-recognition accuracy. We conclude this article with an agenda for future work.
Robustness of the quadratic partial eigenvalue assignment using spectrum sensitivities for state and derivative feedback designs
Authors: Araújo José M , Dórea Carlos ET , Gonçalves Luiz MG , Carvalho João BP , Datta Biswa N
Published: February 2018

Based on the notions of spectrum sensitivities, proposed by us earlier, we develop a novel optimization approach to deal with robustness in the closed-loop eigenvalues for partial quadratic eigenvalue assignment problem arising in active vibration control. A distinguished feature of this new approach is that the objective function is composed of only the system and the closed-loop feedback matrices. It does not need an explicit knowledge of the eigenvalues and eigenvectors. Furthermore, the approach is applicable to both the state-feedback and derivative feedback designs. These features make the approach viable to design an active vibration controller for practical applications to large real-life structures. A comparative study with existing algorithms and a study on the transient response of a real-life system demonstrate the effectiveness, superiority, and competitiveness of the proposed approach.
Comparison of Angiographic Dissection Patterns Caused by Long vs Short Balloons During Balloon Angioplasty of Chronic Femoropopliteal Occlusions
Authors: Tan Michinao , Urasawa Kazushi , Koshida Ryoji , Haraguchi Takuya , Kitani Shunsuke , Igarashi Yasumi , Sato Katsuhiko
Published: February 2018

Purpose: To describe the feasibility of balloon angioplasty using a long balloon for chronic femoropopliteal occlusions by evaluating angiographic dissection patterns for optimization of outcomes in balloon angioplasty. Methods: A retrospective, single-center analysis examined 101 symptomatic patients (mean age 75.6±9.9 years; 65 men) with single de novo femoropopliteal occlusive lesions treated with balloon angioplasty between August 2012 and October 2016. The patients were classified into 2 groups for comparison of angiographic dissection patterns: 51 patients were treated with balloon angioplasty using long balloons (L-BA; defined as ≥220 mm in length) and 50 patients were treated with short balloon angioplasty (S-BA; defined as <150-mm-long balloons). Results: Severe vessel dissection patterns, defined as type C or higher, were fewer in the L-BA group (47.1% vs 70.0% in the S-BA group, p=0.019) and the total dissection length was shorter (92.7±72.6 vs 160.4±84.6 mm in the S-BA group, p<0.001). Although the results showed no significant differences between the two groups regarding the length of chronic total occlusions (L-BA: 228.6±73.2 vs S-BA: 226.0±53.8 mm, p=0.83), inflation pressure (L-BA; 8.2±2.6 vs S-BA: 8.1±2.9 atm, p=0.86), and the other lesion characteristics, inflation time was significantly longer in the L-BA group (161.2±68.7 seconds vs 51.1±54.0 seconds in the S-BA group, p<0.001). Multivariate analysis identified a balloon length ≥220 mm as an independent negative predictor of severe vessel dissection (odds ratio 0.29, 95% confidence interval 0.11 to 0.83, p=0.02). Conclusion: Using long balloons for balloon angioplasty may help prevent severe vessel dissection in chronic femoropopliteal occlusions.
The Diabetic Foot Attack: “’Tis Too Late to Retreat!”
Authors: Vas Prashanth R. J. , Edmonds Michael , Kavarthapu Venu , Rashid Hisham , Ahluwalia Raju , Pankhurst Christian , Papanas Nikolaos
Published: February 2018

The “diabetic foot attack” is one of the most devastating presentations of diabetic foot disease, typically presenting as an acutely inflamed foot with rapidly progressive skin and tissue necrosis, at times associated with significant systemic symptoms. Without intervention, it may escalate over hours to limb-threatening proportions and poses a high amputation risk. There are only best practice approaches but no international protocols to guide management. Immediate recognition of a typical infected diabetic foot attack, predominated by severe infection, with prompt surgical intervention to debride all infected tissue alongside broad-spectrum antibiotic therapy is vital to ensure both limb and patient survival. Postoperative access to multidisciplinary and advanced wound care therapies is also necessary. More subtle forms exist: these include the ischemic diabetic foot attack and, possibly, in a contemporary categorization, acute Charcot neuroarthropathy. To emphasize the importance of timely action especially in the infected and ischemic diabetic foot attack, we revisit the concept of “time is tissue” and draw parallels with advances in acute myocardial infarction and stroke care. At the moment, international protocols to guide management of severe diabetic foot presentations do not specifically use the term. However, we believe that it may help increase awareness of the urgent actions required in some situations.
Introduction to Special Issue Ludic Economies: Ludic Economics 101
Authors: Giddings Seth , Harvey Alison
Published: February 2018

In this special issue on ludic economies, we argue that the study of digital games—their milieux of production, cultures and contexts of play, user-generated production, and spectatorship should be applied as a primary heuristic in understanding the cultural economy of neoliberal late capitalism—as well as vice versa. The articles here focus on a range of issues related to both mainstream profit models including digital distribution platforms and mobile games as well as peripheral game economies such as jams and indie production. Each of the studies share an attunement to the tensions and contradictions embedded within what are commonly approached as matter-of-fact within traditional economic analysis of games. Rather than framing industrial changes as necessarily either overdetermined exploitation (of workers in the mainstream games industry, players and their ‘free’ labour) or emancipatory and progressive (new forms of creative production, play, resistance), they address the specificity and peculiarity of game economies at both the micro- and macro-levels of industry, technology, and everyday play culture. And rather than simply countering a pessimistic picture with other, more progressive examples of contemporary game culture such as ‘games for change’, art practices and political interventions—as important as these are—the contributions to this special issue instead track the contradictions and tensions within game cultures and economies as reflections of those within the late capitalist and patriarchal cultural economy at large.
Mechanical behavior enhancement of AZ31/WS2 and AZ61/WS2 magnesium metal matrix nanocomposites
Authors: Huang Song-Jeng , Lin Chien-Cheng , Huang Jheng-Yang , Tenne Reshef
Published: February 2018

This study conducted tensile and hardness tests to compare the mechanical properties of Mg alloys and metal matrix composites with and without WS2 or multi-walled carbon nanotubes. We also examined the microscopic structures to investigate their failure characteristics. Our results indicate that AZ61 presented the best mechanical properties following the addition of WS2 and solution heat treatment, and increasing the content of WS2 improved the mechanical properties. This performance of this combination even outperformed that of metal matrix composites containing multi-walled carbon nanotubes. This study developed an image processing method, in which X-ray images of the metal matrix composite specimens undergo filtering, binarization, edge enhancement, and morphological calculations to determine the area of internal defects in Mg metal matrix composites. The results indicated reduced percentage of internal defect area values in AZ31-T4 and AZ61-T4 following the addition of 0.2% WS2 inorganic nanotube (INT). X-ray diffraction results revealed that the solution heat treatment process causes the WS2 to dissolve into the Mg base, thereby shifting the peak to the right. This improves solid solution strengthening and enhances the mechanical properties. Further observation of the microscopic structures indicated that the AZ61-T4 possesses finer grains than does the AZ31-T4, which is consistent with the existing literature.
Visual tracking via improving motion model and model updater
Authors: Xue Wanli , Feng Zhiyong , Xu Chao , Liu Tong , Meng Zhaopeng , Zhang Chengwei
Published: February 2018

Motion model and model updater are two necessary components for online visual tracking. On the one hand, an effective motion model needs to strike the right balance between target processing, to account for the target appearance and scene analysis, and to describe stable background information. Most conventional trackers focus on one aspect out of the two and hence are not able to achieve the correct balance. On the other hand, the admirable model update needs to consider both the tracking speed and the model drift. Most tracking models are updated on every frame or fixed frames, so it cannot achieve the best performance. In this article, we solve the motion model problem by collaboratively using salient region detection and image segmentation. Particularly, the two methods are for different purposes. In the absence of prior knowledge, the former considers image attributes like color, gradient, edges, and boundaries then forms a robust object; the latter aggregates individual pixels into meaningful atomic regions by using the prior knowledge of target and background in the video sequence. Taking advantage of their complementary roles, we construct a more reasonable confidence map. For model update problems, we dynamically update the model by analyzing scene with image similarity, which not only reduces the update frequency of the model but also suppresses the model drift. Finally, we use these improved building blocks not only to do comparative tests but also to give a basic tracker, and extensive experimental results on OTB50 show that the proposed methods perform favorably against the state-of-the-art methods.
Member States’ Sovereignty in the Socio-Economic Field: Fact or Fiction?
Authors: Laagland Femke
Published: February 2018

The author assesses the case law of the Court of Justice of the European Union (the Court) in which the European business freedoms collide with national labour law. The approach of the Court will be scrutinised with the aim of discovering the extent to which the Court encroaches upon the Member States’ autonomy in the field of labour law. This topic became popular directly after the landmark decisions in Viking and Laval of December 2007. Both cases addressed conflicts that were related to socio-economic diversity in the European Union following the enlargements. In the end, the Court decided where the balance between the conflicting economic and social values had to be struck and, by doing so, did not grant any room of discretion to the Member States. Since then, the freedom of establishment and the freedom to provide services have obtruded themselves into the sphere of national labour law. The Court has broadened its jurisdiction in the socio-economic field not only in cross-border situations but also in internal situations via its interpretation of social policy Directives by virtue of Article 16 CFREU. The research shows that the Court is assessing the legitimacy of restrictions imposed by national labour law in seemingly different distinguishable ways since 2007. Although the Court does not seem to aspire to a uniform labour law system throughout the European Union, its approach applied in Viking and Laval cannot be considered a thing of the past. Due to poor reasoning, it is not clear when and where the Court draws the line. Since its rulings cannot readily (or even at all) be subject to political review, the ensuing legal uncertainty leads to anxiety about the Court being the ultimate decider in the socio-economic field.
Dealing with uncertainty in the treatment of Helicobacter pylori
Authors: Calvet Xavier
Published: February 2018

Helicobacter pylori treatment may be viewed as an uncertain situation, where current knowledge is insufficient to provide evidence-based recommendations for all possible scenarios. Evidence suggests that, under uncertainty conditions, a few simple rules of thumb tend to work better than complex algorithms. Overall, five evidence-based rules of thumb are suggested: (1) Use four drugs; (2) Use maximal acid inhibition; (3) Treat for 2 weeks; (4) Do not repeat antibiotics after treatment failure; and (5) If your treatment works locally, keep using it. These simple rules of thumb may help the reader to select the best alternative for a given patient, choosing between the heterogeneous recommendations provided by the many different consensus conferences on H. pylori treatment recently published.
Evaluation of lipid profiles and hematological parameters in hypertensive patients: Laboratory-based cross-sectional study
Authors: Gebrie Alemu , Gnanasekaran Natesan , Menon Menakath , Sisay Mekonnen , Zegeye Abriham
Published: February 2018

Introduction:

Hypertension and dyslipidemia are the two coexisting and synergizing major risk factors for cardiovascular diseases. The cellular constituents of blood affect the volume and viscosity of blood, thus playing a key role in regulating blood pressure. Overweight and obesity are key determinants of adverse metabolic changes including an increase in blood pressure. The aim of this study was to evaluate lipid profiles and hematological parameters in hypertensive patients at Debre Markos Referral Hospital, Northwest Ethiopia.

Methods:

Laboratory-based cross-sectional study was conducted in 100 eligible hypertensive patients at the hospital. The required amount of blood was withdrawn from the patients by healthcare professionals for immediate automated laboratory analyses. Data were collected on socio-demographic factors, anthropometric measurements, blood pressure, lipid profiles, and hematological parameters.

Result:

The mean serum levels of triglyceride, total cholesterol, and low-density lipoprotein were significantly higher than their respective cut-off values in the hypertensive patients. Besides, 54%, 52%, 35%, and 11% of the hypertensive patients had abnormal low-density lipoprotein, total cholesterol, triglyceride, and high-density lipoprotein levels, respectively. Higher levels of low-density lipoprotein, hemoglobin, and red blood cell count were observed in the hypertensive patients whose blood pressure had been poorly controlled than the controlled ones ( p < 0.05). Waist circumference had a significant positive association with the serum levels of total cholesterol and white blood cell count ( p < 0.05).

Conclusion:

Hypertensive patients had a high prevalence of lipid profile abnormalities and poorly controlled blood pressure which synergize in accelerating other cardiovascular diseases. Some hematological parameters such as red blood cell count are also increased as do the severity of hypertension.
A comparison of two structured professional judgment tools for violent extremism and their relevance in the French context
Authors: Herzog-Evans Martine
Published: February 2018

France has repeatedly been hit by terrorist attacks making the use of a structured professional judgement tool essential. Two such tools currently are used in Europe: VERA (Canada) and ERG 22+ (England and Wales). We compare these tools to assess which one would better suit the French context. We find that they have a lot in common in terms of their general content and intrinsic value. However, VERA’s main understanding of terrorism is ideology, whereas ERG’s perceives it as being essentially about identity. ERG was the first tool to introduce a measure for psychopathology; only VERA contains a list of protective factors. The two instruments were developed in similar ways with, for ERG, more emphasis on extremist offenders’ casework. Crucially, ERG 22+ has been developed on the basis of UK cases that are closer to the French extremist populations, with a legal threshold for what constitutes a terrorist or an assimilated terrorist offence, which is similarly low. Lastly, ERG’s structure is simpler and contains less items requiring access to classified data, a crucial factor in a jurisdiction with little interagency information sharing. Although the two tools are intrinsically comparable, ERG seems overall better suited to the French context. This exploratory conclusion ought to be confirmed with field comparisons.
Worldwide Steroid Prescription for Acute Spinal Cord Injury
Authors: Falavigna Asdrubal , Quadros Francine W. , Teles Alisson R. , Wong Chung Chek , Barbagallo Giuseppe , Brodke Darrel , Al-Mutair Abdulaziz , Riew K. Daniel
Published: February 2018

Study Design:

Cross-sectional study.

Objectives:

To continue the line of a previous publication using steroid for acute spinal cord injury (SCI) by spine surgeons from Latin America (LA) and assess the current status of methylprednisolone (MP) prescription in Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) to determine targets for educational activities suitable for each region.

Methods:

The English version of a previously published questionnaire was used to evaluate opinions about MP administration in acute SCI in LA, EU, AP, NA, and ME. This Internet-based survey was conducted by members of AOSpine. The questionnaire asked about demographic features, background with management of spine trauma patients, routine administration of MP in acute SCI, and reasons for MP administration.

Results:

A total of 2659 responses were obtained for the electronic questionnaire from LA, EU, AP, NA, and ME. The number of spine surgeons that treat SCI was 2206 (83%). The steroid was used by 1198 (52.9%) surgeons. The uses of MP were based predominantly on the National Acute Spinal Cord Injury Study III study (n = 595, 50%). The answers were most frequently given by spine surgeons from AP, ME, and LA. These regions presented a statistically significant difference from North America ( P < .001). The number of SCI patients treated per year inversely influenced the use of MP. The higher the number of patients treated, the lower the administration rates of MP observed.

Conclusions:

The study identified potential targets for educational campaigns, aiming to reduce inappropriate practices of MP administration.
Learning the Emotion Rules of Communicating Within a Law Office: An Intern Constructs a Professional Identity Through Emotion Management
Authors: Pickering Kristin
Published: February 2018

This article explores different types of emotion a student experiences as she interns at a public defender’s office and proposes several emotion rules based on her experience. After a literature review that locates emotions within the identity-construction process, the author analyzes data from reflective questionnaires to identify various emotions this student experienced that serve as a basis for inductively formulating the rules. Following a discussion of the rules, the article concludes with implications of this research for educators and newcomers to workplace communication environments.
Shrinking Budgets, Growing Demands: Neoliberalism and Academic Identity Tension at Regional Public Universities
Authors: Dugas Daryl , Summers Kelly H. , Harris Lindsay N. , Stich Amy E.
Published: February 2018

Faculty ( N = 156) at regional public universities (RPUs) in the United States were surveyed for self-reports of their primary academic identity (teacher, researcher) along with alignment of that identity with perceived departmental expectations and how their time is spent. Well-being and job satisfaction were examined as outcome measures of identity and alignment. The results are examined in the context of international concerns about neoliberalism in higher education, particularly with respect to academic identity. Participants were employed by RPUs in Illinois, a state with severe budget challenges, to assess the combined impact of neoliberalism and financial pressures on academic identity at traditionally teaching-focused institutions. Results of MANCOVA and MANOVA analyses suggested that participants who identify as teachers had greater overall well-being and job satisfaction than those who identified as researchers. Greater satisfaction was associated with alignment between identity and how time is spent. Implications and challenges to faculty work and strains on academic identity at RPUs are discussed.
Toward a More Humanistic American Medical Profession: An Analysis of Premedical Web Sites From Ohio’s Undergraduate Institutions
Authors: Skinner Daniel , Rosenberger Kyle
Published: February 2018

In response to changes in health care, American medical schools are transforming their curricula to cultivate empathy, promote professionalism, and increase cultural competency. Many scholars argue that an infusion of the humanities in premedical and medical training may help achieve these ends. This study analyzes Web-based messaging of Ohio’s undergraduate institutions to assess premedical advising attitudes toward humanities-based coursework and majors. Results suggest that although many institutions acknowledge the humanities, most steer students toward science majors; strong advocates of the humanities tend to have religious or other special commitments, and instead of acknowledging the intrinsic value that the humanities might have for future physicians, most institutions promote the humanities because entrance exams now contain related material.
Mixed methods evaluation of the impact of a short term training program on sterile processing knowledge, practice, and attitude in three hospitals in Benin
Authors: Fast Olive , Fast Christina , Fast Dan , Veltjens Suzanne , Salami Zouliha , White Michelle
Published: February 2018

Background

Proper sterile processing is fundamental to safe surgical practice and optimal patient outcomes. Sterile processing practices in low and middle-income countries often fall short of recommended standards. The impact of education and training on sterile processing practices in low and middle-income countries is unknown. We designed a sterile processing education course, including mentoring, and aimed to evaluate the impact on participants’ personal knowledge, skills, and practices. We also aimed to identify institutional changes in sterile processing practices at participants’ work places.

Methods

A mixed methods design study was conducted using a Hospital Sterile Processing Assessment Tool, knowledge tests, and open-ended interviews.

Results

Education and mentoring improved how workers understood and approached their work and to what they paid attention. Sterile processing workers were also better able to identify resources available to do their work and showed improved understanding of the impact of their work on patient safety.

Conclusions

Health care organizations seeking to improve surgical outcomes can find easy wins requiring minimal cost expenditures by paying attention to sterile processing practices. Investing in education and low-cost resources, such as cleaning detergents and brushes, must be part of any quality improvement initiative aimed at providing safe surgery in low and middle-income countries.
Pseudoacoustic tilted transversely isotropic modeling with optimal k-space operator-based implicit finite-difference schemes
Authors: Xu Shigang , Liu Yang
Published: February 2018

Current temporal high-order finite-difference (FD) stencils are mainly designed for isotropic wave equations, which cannot be directly extended to pseudoacoustic wave equations (PWEs) in tilted transversely isotropic (TTI) media. Moreover, it is difficult to obtain the time-space domain FD coefficients for anisotropic PWEs based on nonlinear dispersion relations in which anisotropy parameters are coupled with FD coefficients. Therefore, a second-order FD for temporal derivatives and a high-order FD for spatial derivatives are commonly used to discretize PWEs in TTI media. To improve the temporal and spatial modeling accuracy further, we have developed several effective FD schemes for modeling PWEs in TTI media. Through combining the [Formula: see text] (wavenumber)-space operators with the conventional implicit FD stencils (i.e., regular-grid [RG], staggered-grid [SG], and rotated SG [RSG]), we establish novel dispersion relations and determine FD coefficients using least-squares (LS). Based on [Formula: see text]-space operator compensation, we adopt the modified LS-based implicit RG-FD, implicit SG-FD, and implicit RSG-FD methods to respectively solve the second- and first-order PWEs in TTI media. Dispersion analyses indicate that the modified implicit FD schemes based on [Formula: see text]-space operator compensation can greatly increase the numerical accuracy at large wavenumbers. Modeling examples in TTI media demonstrate that the proposed FD schemes can adopt a short FD operator to simultaneously achieve high temporal and spatial modeling accuracy, thus significantly improve the computational efficiency compared with the conventional methods.
Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial
Authors: Hassiotis Angela , Poppe Michaela , Strydom Andre , Vickerstaff Victoria , Hall Ian S. , Crabtree Jason , Omar Rumana Z. , King Michael , Hunter Rachael , Biswas Asit , Cooper Viv , Howie William , Crawford Michael J.
Published: February 2018

Background

Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.

Aims

To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).

Method

We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.

Results

No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes.

Conclusions

Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.

Declaration of interest

None.
What Every Oncologist Should Know About Geriatric Assessment for Older Patients With Cancer: Young International Society of Geriatric Oncology Position Paper
Authors: Loh Kah Poh , Soto-Perez-de-Celis Enrique , Hsu Tina , de Glas Nienke A. , Battisti Nicolò Matteo Luca , Baldini Capucine , Rodrigues Manuel , Lichtman Stuart M. , Wildiers Hans
Published: February 2018

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient’s underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology.
Cancers of the Major Salivary Gland
Authors: Son Eugene , Panwar Aru , Mosher Charles H. , Lydiatt Daniel
Published: February 2018

Salivary gland malignancies are rare tumors that comprise multiple histologic entities with diverse clinical behavior. Mucoepidermoid carcinoma is the most frequent primary salivary malignancy, followed by adenoid cystic and acinic cell carcinoma. Although most salivary malignancies are asymptomatic, presentation with a rapidly enlarging mass may be accompanied by pain, functional neurologic deficits, soft-tissue invasion, or nodal enlargement. Assessment of clinical behavior and physical exam greatly contributes to diagnostic workup. Preoperative imaging, to include ultrasound, computed tomography, or magnetic resonance imaging, may assist with surgical planning. Limitations of preoperative fine-needle aspiration cytology mean that, in some cases, definitive histologic diagnosis may not be established until therapeutic surgery is undertaken. Treatment strategies rely on oncologic resection of the primary site with negative margins as well as adjuvant radiotherapy in patients with high-risk features, such as high-grade histology, advanced T class, or perineural invasion. Regional lymphadenectomy is recommended for involved nodal basins. Patients with clinically node-negative disease at high risk for occult nodal metastases may be considered for elective lymphadenectomy or radiotherapy. Use of chemotherapy in the adjuvant setting, in combination with radiotherapy, remains controversial. The rate of objective response to palliative chemotherapy in recurrent or metastatic salivary gland malignancy remains low. In studies that include a significant proportion of adenoid cystic carcinomas, whether disease stability represents an indolent disease process or the true effect of a therapeutic drug may be difficult to discern. Recognition of genetic alterations and protein expression unique to salivary malignancies presents exciting new opportunities for molecularly targeted therapy, although the response to molecularly targeted therapy in studies has been modest thus far.
From the unfolded protein response to metabolic diseases – lipids under the spotlight
Authors: Ho Nurulain , Xu Chengchao , Thibault Guillaume
Published: February 2018

The unfolded protein response (UPR) is classically viewed as a stress response pathway to maintain protein homeostasis at the endoplasmic reticulum (ER). However, it has recently emerged that the UPR can be directly activated by lipid perturbation, independently of misfolded proteins. Comprising primarily phospholipids, sphingolipids and sterols, individual membranes can contain hundreds of distinct lipids. Even with such complexity, lipid distribution in a cell is tightly regulated by mechanisms that remain incompletely understood. It is therefore unsurprising that lipid dysregulation can be a key factor in disease development. Recent advances in analysis of lipids and their regulators have revealed remarkable mechanisms and connections to other cellular pathways including the UPR. In this Review, we summarize the current understanding in UPR transducers functioning as lipid sensors and the interplay between lipid metabolism and ER homeostasis in the context of metabolic diseases. We attempt to provide a framework consisting of a few key principles to integrate the different lines of evidence and explain this rather complicated mechanism.
Nucleoplasmic lamins define growth-regulating functions of lamina-associated polypeptide 2α in progeria cells
Authors: Vidak Sandra , Georgiou Konstantina , Fichtinger Petra , Naetar Nana , Dechat Thomas , Foisner Roland
Published: February 2018

A-type lamins are components of the peripheral nuclear lamina but localize also in the nuclear interior in a complex with lamina-associated polypeptide (LAP) 2α. Loss of LAP2α and nucleoplasmic lamins in wild-type cells increases cell proliferation, but in cells expressing progerin, a mutant lamin A that causes Hutchinson-Gilford Progeria syndrome, low LAP2α levels result in proliferation defects. Here we aimed at understanding the molecular mechanism how the relative levels of LAP2α, progerin, and nucleoplasmic lamins affect cell proliferation. Patient cells and inducible progerin-expressing cells expressing low levels of progerin, proliferate faster than wild-type or lamin A-expressing control cells, and ectopic expression of LAP2α impairs proliferation. In contrast, high progerin-expressing cells that lack lamins in the nuclear interior slow down proliferation, and ectopic LAP2α expression enhances proliferation. However, simultaneous expression of LAP2α and wild-type lamin A or an assembly-deficient lamin A mutant in these cells, restoring the nucleoplasmic lamin A pool, abolished the growth-promoting effect of LAP2α. Our data show that LAP2α promotes or inhibits proliferation of progeria cells depending on the level of lamin A/C in the nuclear interior.
Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study
Authors: Esfandiari Hamed , Hassanpour Kiana , Yaseri Mehdi , Loewen Nils A.
Published: February 2018

Background: Pilocarpine is commonly used after angle surgery for glaucoma despite a host of side effects and risks. We hypothesized that a pharmacological miosis during the first two months does not improve short- and long-term results of trabectome-mediated ab interno trabeculectomy.

Methods: In this retrospective comparative 1-year case series, we compared 187 trabectome surgery eyes with (P+) or without (P-) 1% pilocarpine for two months. Primary outcome measures were the surgical success defined as intraocular pressure (IOP) ≤ 21 mmHg and decreased ≥ 20%, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, and IOP.

Results: We categorized 86 (46%) eyes as P- and 101 (54%) eyes as P+. The mean age was 69.8±10.1 in P- and 70.5±9.4 in P+ (P=0.617) with equal gender distribution (P=0.38). The cumulative probability of qualified success at 12 months was 78.1% in the P- and 81% in the P+ (P=0.35). The IOP was decreased significantly from 20.2±6.8 mmHg at baseline to 15.0±4.8 mmHg at 12 months follow-up in P- (P=0.001) and 18.8±5.3 and 14.7±4.0, respectively (P=0.001). The medications decreased significantly from 1.4±1.2 in P- and 1.4±1.2 in P+ at baseline to 1.0±1.2 and 0.7±1.0, respectively (P=0.183). P- and P+ did not differ in IOP or medications (all P>0.05). In Multivariate Cox Regression models, the baseline IOP and central corneal thickness were associated with failure.

Conclusions: Use of postoperative pilocarpine does not improve the efficacy of trabectome surgery.
The New York City Off-Hour Delivery Program: A Business and Community-Friendly Sustainability Program
Authors: Holguín-Veras José , Hodge Stacey , Wojtowicz Jeffrey , Singh Caesar , Wang Cara , Jaller Miguel , Aros-Vera Felipe , Ozbay Kaan , Weeks Andrew , Replogle Michael , Ukegbu Charles , Ban Jeff , Brom Matthew , Campbell Shama , Sanchez-Díaz Ivan , González-Calderón Carlos , Kornhauser Alain , Simon Mark , McSherry Susan , Rahman Asheque , Encarnación Trilce , Yang Xia , Ramírez-Ríos Diana , Kalahasthi Lokesh , Amaya Johanna , Silas Michael , Allen Brandon , Cruz Brenda
Published: February 2018

The New York City Off-Hour Delivery (NYC OHD) program is the work of a private-public-academic partnership—a collaborative effort of leading private-sector groups and companies, public-sector agencies led by the New York City Department of Transportation, and research partners led by Rensselaer Polytechnic Institute. The efforts of this partnership have induced more than 400 commercial establishments in NYC to accept OHD without supervision. The economic benefits are considerable: the carriers have reduced operational costs and parking fines by 45 percent; the receivers enjoy more reliable deliveries, enabling them to reduce inventory levels; the truck drivers have less stress, shorter work hours, and easier deliveries and parking; the delivery trucks produce 55–67 percent less emissions than they would during regular-hour deliveries, for a net reduction of 2.5 million tons of CO2 per year; and citizens’ quality of life increases as a result of reduced conflicts between delivery trucks, cars, bicycles, and pedestrians, and through the use of low-noise delivery practices and technologies that minimize the impacts of noise. The total economic benefits exceed $20 million per year. The success of the OHD program is due largely to the policy design at its core, made possible with the behavioral microsimulation. This unique optimization-simulation system incorporates the research conducted into an operations research/management science tool that assesses the effectiveness of alternative policy designs. This enabled the successful implementation of the project within the most complex urban environment in the United States.
Healthcare technologies: An ethical discussion
Authors: Pinto Sara , Caldeira Sílvia , Marques Goreti , da Conceição Ana Paula
Published: February 2018

The use of new information and communication technologies has become widespread in daily life. In recent years, these technologies have also extended into healthcare settings, and ehealth has been indicated as an important resource for dealing with the unsustainability and the overcrowding of healthcare systems. However, as these technologies become more regular and complex, new ethical questions and concerns may arise. This article aims to describe some ethical aspects of ehealth and provide a discussion about the use of eHealth technologies within healthcare settings.
Accountable care is the new paradigm of healthcare
Authors: Deffenbaugh John
Published: February 2018

This is the first in a series of three articles that explains accountable care and explores its impact on NHS England. This article unearths the rhetoric of accountable care to understand what it is, its impact if it is understood and implemented effectively. This discussion comes at a pivotal time. Previous management structures of the NHS have imposed complexity and transaction costs, but the context now is one of severely limited resources and changing demographics that are stretching these resources to breaking point. Into this mix has been thrust the concept of accountable care, which has been embraced by the NHS without fully acknowledging the implications and impact. The concept of accountable care is introduced and framed by emerging public policy. Discussion is framed by the context surrounding NHS England. Accountable care is explained, and its variants of accountable care system and accountable care organisation are also defined. The challenges faced by leaders as they enter the accountable care environment are explored, leading to the positioning of accountable care as a means to move competition to a new paradigm of public service delivery that is leveraged by accountable care.
To wash or not to wash
Authors: Watson Rebeca
Published: February 2018

Rebeca Watson MSc RVN discusses whether sheath cleaning is really necessary
Use of the Finite Element Method in Predicting Vibrations of Sandwich Beams and Plates Resting on Deformable Foundations Subjected to Moving Loads
Authors: Zbiciak A. , Ataman M. , Szcześniak W.
Published: February 2018

This paper presents the capabilities of ABAQUS finite-element program [1] in modelling sandwich beams and plates resting on deformable foundations. Specific systems of sandwich beams and plates separated by an elastic core layer were subjected to the action of point and distributed moving loads. A few theoretical examples are provided to present different techniques of modelling the foundations and the moving loads. The effects of the boundary conditions and of the foundation parameters on the deflections of the analysed structures are also presented.
The Double Entry System of Accounting
Authors: Fellingham John
Published: February 2018

The author recounts Professor Ijiri’s works throughout his academic
career.
A note on the behavior of the Dunkl maximal operator
Authors: Deleaval Luc
Published: February 2018

This note is a contribution to the Proceedings of the Conference of the Tunisian Mathematical Society CSMT 2017.
After briefly revisiting the case of the standard Hardy–Littlewood maximal operator, we will discuss the behavior of the Dunkl maximal operator in both the scalar and vector-valued cases.