bluuebunny/crossref_metadata_2025_split huggingface dataset:
Return to work after stroke – Feasibility of 6-year follow-up
Authors: Phillips Julie , Gaffney Kathryn , Phillips Margaret , Radford Kate 
Published: August 2018

Introduction Little is known about long-term work sustainability of stroke survivors. A feasibility trial of early stroke specialist vocational rehabilitation had 32/46 (69.5%) participants available for follow-up at 12 months post stroke. Of these, 19/32 (59.4%) were in work. This study aims to determine the feasibility of longer-term follow-up and explore work status 6 years post stroke. Method Forty-eight participants fitting criteria for the feasibility trial were sent postal questionnaires measuring employment, income, mood, functional ability and quality of life, and were invited for interview to explore working 6 years after stroke. Ethical approval was obtained. Results Of the 48 participants, five (10.4%) had died; 19/43 (44.2%) responded. Fourteen were men; mean age 62 (24–78) years. Fourteen (74%) reported working (paid work n = 10, voluntary work n = 3, full-time education n = 1). Five had retired. Most (11/13) remained with preinjury employers. Half (8/15, 53%) reported decreased income since stroke. Compared to one year, median functional ability was marginally higher (extended activities of daily living 63 (IQR 8, range 32–66) to 60 (IQR 9, range 17–66)), but health-related quality of life was lower (EuroQuol Visual Analogue Scale mean 77.4 [SD 11] to 70.7 [SD14]). Six interviewees felt returning to work was the correct decision but struggled with invisible impairments. Conclusion This study suggests that long-term follow-up is feasible and that those who made a good recovery were more likely to respond. Work remains important to stroke survivors 6 years post stroke.
Impediments to the formation of intensive care nurses' professional identify
Authors: Mousazadeh Somayeh , Yektatalab Shahrzad , Momennasab Marzieh , Parvizy Soroor 
Published: August 2018

Background: Nurses face challenges regarding professional identify. Being unaware of these challenges and not owning positive professional identify leads to a lack of self-confidence. Thus, nurses face problems in interpersonal communication and lose their attachment to their profession. Few studies have engaged with impediments to forming positive professional identity in relation to intensive care nurses. Objective: The purpose of this study is to investigate the impediments to forming positive professional identity in nurses working in intensive care unit. Research design: In this study, the conventional content analysis method was used in order to obtain the impediments to forming positive professional identities in nurses. Data were collected through 15 semi-structured interviews and 2 focus group interviews from March 2015 to June 2016. Purposive sampling was used and participants were recruited until data saturation was reached; they were then analyzed using the conventional content analysis method. Participants and research context: In total, 24 intensive care unit nurses from one hospital in Northern Iran were selected through purposive sampling. Ethical consideration: This study was approved by the Ethics Committee of Shiraz University of Medical Sciences. Findings: Four main themes of professional identity challenges were extracted from the analysis of the data: neglect of professional status of nursing; distrust of nursing knowledge; unprofessional performance; and low professional attraction. Discussion and conclusion: Nurses stated that the neglect of the professional status of nursing and distrust of nursing knowledge have always been a hindrance in forming a positive professional identity. They also mentioned that unprofessional performance and low professional attraction are the other influencing factors in this regard. Thus, detecting these factors can guide nurses and their managers towards creating positive professional identity, and as a result, will improve their job satisfaction, professional advancement, and durability.
A Strategic Essay: Dynamics between a Super President, a Military Alliance and an Intrastate Entity
Authors: Mukherjee Bhaswati 
Published: August 2018

The emerging dynamics between President Trump, NATO and EU promises to constitute a fascinating new narrative of the changing contours of the international order in this millennium. President Trump has completely reversed American policy towards NATO. As a businessman, Trump has made it clear that henceforth US funding and support would be linked to the US getting a ‘good deal’ from its NATO partners. NATO had earlier anchored itself to the benchmark goal that 2% of a country’s GDP should go to defence spending. President Trump is yet to establish close and friendly relations either with NATO Secretary General or leaders of NATO Member States. Trump’s public embrace of autocratic rulers has caused resentment within NATO. On CSDP the earlier European approach was to lean heavily on the Americans to fund NATO. The friction between the goals of NATO and CSDP increased under the Trump Presidency because of Trump’s insistence on burden sharing of resources and funds among NATO Member States. The CSDP and NATO have overlapping mandates which could be complicated in crisis situations. An independent CSDP remains the core issue causing friction. The U.S. and other non EU weapons producing countries (chiefly Norway and soon the U.K.) also believe that CSDP is manipulating the rules of defence procurement in favour of companies based on EU soil. Is the US justified in attacking CSDP? Many EU Member States believe that protecting European defence industries is a small price to pay for ensuring that a NATO under American leadership not get involved in small regional wars, as an example, in Francophone Africa. Brexit is casting a long shadow. EU and NATO would need to realign themselves from a strategic perspective. NATO and the EU need to prepare for a strategic scenario post Brexit. Following Brexit, 80 percent of NATO defence spending will come from non-EU members. This would shift the onus of decision making within NATO away from the EU. One of the greatest challenges for NATO and the EU is America’s new narrative on Iran and North Korea. EU and NATO are slowly waking up to the new reality that there will be no “business as usual”. If NATO’s military deterrence loses its credibility, this will undermine the credibility of both EU and NATO and endanger international peace and security. What could the EU and NATO do next? Are there any “low hanging fruits” that could be picked in the near future? The EU and NATO understand that there can be no ‘business as usual’. The new global narrative on security would depend on how NATO and EU respond to America’s changed narrative. A timely response is the need of the hour.
Structures at Risk During Percutaneous Screw Fixation for Talonavicular Fusion
Authors: Lee Sung Ro , Stibolt Davis , Patel Harshadkumar , Abyar Eldar , Moon Andrew , Naranje Sameer , Shah Ashish 
Published: August 2018

Background: Talonavicular (TN) fusion using screws dorsomedially and dorsolaterally can cause neurovascular injury. The purpose of our cadaveric study was to evaluate the safety of percutaneous screw insertion in relation to dorsal neurovascular structures. Methods: Ten fresh-frozen cadaver legs were used for this study. Percutaneous cannulated screws were inserted to perform isolated TN arthrodesis. The screws were inserted at 3 consistent sites: a “medial screw” at the dorsomedial navicular where it intersected at the medial plane of the first cuneiform, a “central screw” at the edge of the dorsal navicular between the medial and intermediate cuneiforms, and a “lateral screw” at the edge of the dorsal navicular between the intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and/or tendons. Results: The medial screw injured the anterior tibialis tendon in 2 cases (20%), the central screw injured the extensor hallucis longus tendon in 3 cases (30%), and the lateral screw injured the anterior branch of the superior peroneal nerve (SPN), the lateral branch of the SPN, and the medial branch of the distal peroneal nerve (DPN) once each in a total of 3 cases (30%). Despite no direct injury, the central screw indicated a potential risk of neurovascular injury: closest distance to the anterior SPN was 2 mm and to the medial DPN 2 mm. Conclusion: Although neurovascular injury risk exists for all of these screw placements, TN fusion with a central screw introduced a potentially decreased risk of neurovascular injury at the expense of increased risk of tendon injury compared to the lateral screw. Clinical Relevance: Based on these results, we recommend a careful dissection be performed prior to percutaneous screw insertion.
Outcome Following a Modified Broström Procedure and Arthroscopic Debridement of Medial Gutter Osteoarthritis Combined With Chronic Ankle Instability
Authors: Cho Byung-Ki , Shin Young-Duck , Park Hyun-Woo 
Published: August 2018

Background: There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic ankle instability. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively ( P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points ( P < .001), 8 patients (36.4%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression of arthritis stage. Conclusions: Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability. Level of Evidence: Level IV, retrospective case series.
Angiotensin-Converting Enzyme Inhibitors Provide Better Long-Term Survival Benefits to Patients With AMI Than Angiotensin II Receptor Blockers After Survival Hospital Discharge
Authors: Choi In Suck , Park Ie Byung , Lee Kiyoung , Ahn Tae Hoon , Kim Ju Han , Ahn Youngkeun , Chae Sung-Chull , Kim Hyo-Soo , Kim Young Jo , Cho Myeong Chan , Kim Chong Jin , Jeong Myung Ho , Lee Dae Ho 
Published: August 2018

Aim: Renin–angiotensin–aldosterone system inhibitors (RASIs) are widely used in high-risk cardiovascular (CV) diseases, including acute myocardial infarction (AMI). However, it is not yet clear which class of RASIs provides specific benefits to patients with AMI. The present study aimed to evaluate whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) had any different effects on long-term CV and all-cause mortality in patients with AMI who received either agent from admission and were discharged alive from the hospital. Methods: We analyzed data of patients with AMI from the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry. Cardiovascular and all-cause mortality at 12 months after AMI were assessed. Results: Among 12 481 patients with AMI who were discharged alive, RASI treatment was as follows: ACEIs (n = 5910), ARBs (n = 4009), and no RASI (n = 2562). After adjustment for multiple factors, compared with no RASI therapy, ACEI therapy was associated with lower hazard ratios (HRs) for 1-year CV and total mortality rates, whereas ARB therapy was not. In a direct comparison, compared with ARB treatment, ACEI treatment was associated with lower HRs (95% confidence interval) for CV and total mortality: 0.562 (0.420-0.753) and 0.567 (0.451-0.713), respectively. The superiority of ACEI to ARB was also observed across several subgroups. The mortality differences between the 2 treatment groups were reproduced in a propensity-score matched analysis (n = 2855 each). Conclusions: Our study of a recent AMI registry data revealed that ACEI therapy in patients with AMI was associated with better long-term survival benefits than ARB therapy.
Seroprevalence and Associated Risk Factors of Hepatitis B Virus Infection Among Children in Enugu Metropolis
Authors: Ezeilo Maryann Chinenye , Engwa Godwill Azeh , Iroha Romanus Ifeanyi , Odimegwu Damian Chukwu 
Published: August 2018

Background: Though measures are being put in place for the management of Hepatitis B virus (HBV) infection in Nigeria, children remain the most vulnerable to develop chronic hepatitis. Routine screening in children is therefore necessary for effective control. However, the performance of the commonly used immunochromatographic test (ICT) strips has been challenging. Also, identifying the risk factors of transmission in this age group is of importance for the implementation of preventive measures. Hence, the goal of this study was to assess the test performance of the routinely used ICT strip and identify the associated clinical manifestations and risk factors of HBV. Methods: A cross sectional study involving 270 children below six years of age was conducted at ESUTH and Favor Child Pediatrics Hospital in Enugu, Nigeria. The subjects were screened for HBV by ICT and ELISA assays and a structured questionnaire was used to obtain participants data including demographic, socioeconomic, signs and symptoms, risk factors and vaccination. Results: BBased on ELISA, 31 out of 270 children were positive for HBV with an infection rate of 11.5%. ICT kit showed a low sensitivity of 51.6% in diagnosing HBV but was highly specific (100%) and accurate (94.4%). HBV infection was not associated with sex (χ2: 0.209; p = 0.401). The prevalence of HBV infection was similar in all the age group and HBV infection was not associated (χ2: 2.099; p = 0.914) with age group. All the clinical manifestations were not associated ( p > 0.05) with HBV infection. Blood transfusion, shared items, tattoo marks and history of surgery associated significantly ( p < 0.05) with HBV infections having odd ratios of 4.247, 4.224, 3.134 and 3.195 respectively. The vaccination rate was 55.2% (159/270) and only 3 (1.1%) out of 159 vaccinated subjected contracted the infection (OR: 0.068, p < 0.0001). Conclusions: HBV was prevalent (11.5%) in children below six years old in Enugu metropolis. Moreover, the routinely used ICT test was less reliable than ELISA in diagnosis HBV infection. More so, shared items, blood transfusion, tattooing and history of surgery were potential risk factors while vaccination served as a protective factor against the infection.
Predictors of Emergent Emergency Department Visits and Costs in Community-Dwelling Older Adults
Authors: Coe Antoinette B , Moczygemba Leticia R , Ogbonna Kelechi C , Parsons Pamela L , Slattum Patricia W , Mazmanian Paul E 
Published: August 2018

Background: The number of yearly emergency department (ED) visits by older adults in the United States has been increasing. Purpose: The objectives were to (1) describe the demographics, health-related variables, and ED visit characteristics for community-dwelling older adults using an urban, safety-net ED; (2) examine the association between demographics, health-related variables, and ED visit characteristics with emergent vs nonemergent ED visits; and (3) examine the association between demographics, health-related variables, ED visit characteristics, and ED visit costs. Methods: A cross-sectional, retrospective analysis of administrative electronic medical record and billing information from 2010 to 2013 ED visits (n = 7805) for community-dwelling older adults (⩾65 years old) from an academic medical center in central Virginia was conducted. Results: Most of the ED visits were by women (62%), African Americans (75%), and approximately 50% of ED visits were nonemergent (n = 3871). Men had 1.2 times the odds of an emergent ED visit (95% confidence interval [CI]: 1.02-1.37). The ED visits by white patients had 1.3 times the odds of an emergent ED visit (95% CI: 1.09-1.57) and 14% higher costs (white race: 95% CI: 1.07-1.21) compared with African American patients. Emergent ED visits were 60% more likely to have higher costs than nonemergent visits (95% CI: 1.52-1.69). White race and arrival by ambulance were associated with both emergent ED visits and higher total ED visit costs in this sample of ED visits by community-dwelling older adults. Conclusions: Strategies to maximize opportunities for care in the primary care setting are warranted to potentially reduce nonemergent ED utilization in community-dwelling older adults.
Triggered or routine site monitoring visits for randomised controlled trials: results of TEMPER, a prospective, matched-pair study
Authors: Stenning Sally P , Cragg William J , Joffe Nicola , Diaz-Montana Carlos , Choudhury Rahela , Sydes Matthew R , Meredith Sarah 
Published: August 2018

Background/aims In multi-site clinical trials, where trial data and conduct are scrutinised centrally with pre-specified triggers for visits to sites, targeted monitoring may be an efficient way to prioritise on-site monitoring. This approach is widely used in academic trials, but has never been formally evaluated. Methods TEMPER assessed the ability of targeted monitoring, as used in three ongoing phase III randomised multi-site oncology trials, to distinguish sites at which higher and lower rates of protocol and/or Good Clinical Practice violations would be found during site visits. Using a prospective, matched-pair design, sites that had been prioritised for visits after having activated ‘triggers’ were matched with a control (‘untriggered’) site, which would not usually have been visited at that time. The paired sites were visited within 4 weeks of each other, and visit findings are recorded and categorised according to the seriousness of the deviation. The primary outcome measure was the proportion of sites with ≥1 ‘Major’ or ‘Critical’ finding not previously identified centrally. The study was powered to detect an absolute difference of ≥30% between triggered and untriggered visits. A sensitivity analysis, recommended by the study’s blinded endpoint review committee, excluded findings related to re-consent. Additional analyses assessed the prognostic value of individual triggers and data from pre-visit questionnaires completed by site and trials unit staff. Results In total, 42 matched pairs of visits took place between 2013 and 2016. In the primary analysis, 88.1% of triggered visits had ≥1 new Major/Critical finding, compared to 81.0% of untriggered visits, an absolute difference of 7.1% (95% confidence interval −8.3%, +22.5%; p = 0.365). When re-consent findings were excluded, these figures reduced to 85.7% versus 59.5%, (difference = 26.2%, 95% confidence interval 8.0%, 44.4%; p = 0.007). Individual triggers had modest prognostic value but knowledge of the trial-related activities carried out by site staff may be useful. Conclusion Triggered monitoring approaches, as used in these trials, were not sufficiently discriminatory. The rate of Major and Critical findings was higher than anticipated, but the majority related to consent and re-consent with no indication of systemic problems that would impact trial-wide safety issues or integrity of the results in any of the three trials. Sensitivity analyses suggest triggered monitoring may be of potential use, but needs improvement and investigation of further central monitoring triggers is warranted. TEMPER highlights the need to question and evaluate methods in trial conduct, and should inform further developments in this area.
Neuritis and vinblastine-induced axonal transport disruption lead to signs of altered dorsal horn excitability
Authors: Satkeviciute Ieva , Dilley Andrew 
Published: August 2018

Background Many patients with neuropathic pain present without signs of nerve injury on routine clinical examination. Some of these patients may have inflamed peripheral nerves (neuritis). In this study, we have examined whether neuritis causes changes within the dorsal horn that may contribute to a central pain mechanism. Comparisons have been made to a model of axonal transport disruption induced using vinblastine, since neuritis disrupts such processes. Results At the peak of cutaneous hypersensitivities, recordings from wide dynamic range neurons revealed increases in wind-up following neuritis but not vinblastine treatment. Ongoing activity from these neurons was unchanged. Vinblastine treatment caused a reduction in the responses of wide dynamic range neurons to noxious mechanical stimulation of the receptive field. The response of neurons to innocuous mechanical stimulation was also reduced in wide dynamic range neurons that were at a depth ≥550 µm following vinblastine treatment. An examination of the superficial dorsal horn revealed an increase in c-Fos–positive neurons in both groups following electrical stimulation of the sciatic nerve. The area of dorsal horn expressing substance P was also decreased following vinblastine treatment. Conclusion These findings indicate that a minor nerve insult, such as neuritis, can lead to changes within the dorsal horn that are consistent with a central neuropathic pain mechanism.
Population balance modeling for air–water bubbly flow in a vertical U-bend
Authors: Huang Yichuan , Zhu Hongye , Yang Xingtuan , Tu Jiyuan , Jiang Shengyao 
Published: August 2018

Bubbly flow in U-bend is widely encountered in two-phase flow systems because of its compactness and high heat transfer coefficient. The modeling of phase distributions, velocity fields, and interfacial area concentration in the U-bend is crucial for the analysis of mass, momentum, and energy transportation processes in the equipment. However, this subject has not received enough attention yet. In this paper, the combination of population balance model and two-fluid model was used in the simulation of air–water bubbly flow in a U-bend with 24 mm inner diameter and 96 mm curvature. The homogeneous multiple size group model was used to solve the population balance equation and reconstruct the bubble size distribution function. The phase distribution at 0°, 90°, and 180° was predicted and the results showed that the superficial velocities of gas and liquid phase were the control parameters. Under higher gas superficial velocity, the buoyant force is dominant and makes the bubbles concentrate on the outer side of the tube wall; while under lower gas superficial velocity, the centrifugal force is dominant and makes the bubbles concentrate on the inner side of the tube wall. These results met well with the experimental results of Usui.