bluuebunny/crossref_metadata_2025_split huggingface dataset:
The challenges of detecting progress in generic competencies in the clinical setting
Authors: Dory Valérie , Gomez‐Garibello Carlos , Cruess Richard , Cruess Sylvia , Cummings Beth‐Ann , Young Meredith 
Published: November 2018

ContextCompetency‐based medical education has spurred the implementation of longitudinal workplace‐based assessment (WBA) programmes to track learners’ development of competencies. These hinge on the appropriate use of assessment instruments by assessors. This study aimed to validate our assessment programme and specifically to explore whether assessors’ beliefs and behaviours rendered the detection of progress possible.MethodsWe implemented a longitudinal WBA programme in the third year of a primarily rotation‐based clerkship. The programme used the professionalism mini‐evaluation exercise (P‐MEX) to detect progress in generic competencies. We used mixed methods: a retrospective psychometric examination of student assessment data in one academic year, and a prospective focus group and interview study of assessors’ beliefs and reported behaviours related to the assessment.ResultsWe analysed 1662 assessment forms for 186 students. We conducted interviews and focus groups with 21 assessors from different professions and disciplines. Scores were excellent from the outset (3.5–3.7/4), with no meaningful increase across blocks (average overall scores: 3.6 in block 1 versus 3.7 in blocks 2 and 3; F = 8.310, d.f. 2, p < 0.001). The main source of variance was the forms (47%) and only 1% of variance was attributable to students, which led to low generalisability across forms (Eρ2 = 0.18). Assessors reported using multiple observations to produce their assessments and were reluctant to harm students by consigning anything negative to writing. They justified the use of a consistent benchmark across time by citing the basic nature of the form or a belief that the ‘competencies’ assessed were in fact fixed attributes that were unlikely to change.ConclusionsAssessors may purposefully deviate from instructions in order to meet their ethical standards of good assessment. Furthermore, generic competencies may be viewed as intrinsic and fixed rather than as learnable. Implementing a longitudinal WBA programme is complex and requires careful consideration of assessors’ beliefs and values.
The redundancy of positivism as a paradigm for nursing research
Authors: Corry Margarita , Porter Sam , McKenna Hugh 
Published: November 2018

AbstractNew nursing researchers are faced with a smorgasbord of competing methodologies. Sometimes, they are encouraged to adopt the research paradigms beloved of their senior colleagues. This is a problem if those paradigms are no longer of contemporary methodological relevance. The aim of this paper was to provide clarity about current research paradigms. It seeks to interrogate the continuing viability of positivism as a guiding paradigm for nursing research. It does this by critically analysing the methodological literature. Five major paradigms are addressed: the positivist; the interpretivist/constructivist; the transformative; the realist; and the postpositivist. Acceptance of interpretivist, transformative or realist approaches necessarily entails wholesale rejection of positivism, while acceptance of postpositivism involves its partial rejection. Postpositivism has superseded positivism as the guiding paradigm of the scientific method. The incorporation in randomized controlled trials of postpositivist assumptions indicates that even on the methodological territory that it once claimed as its own, positivism has been rendered redundant as an appropriate paradigm for contemporary nursing research.
Escape mapping to achieve bidirectional block: A case series
Authors: Gabriels James , Beldner Stuart , Donnelly Joseph , Willner Jonathan , Epstein Laurence M. , Patel Apoor 
Published: November 2018

AbstractEscape mapping is a novel technique that can be used to locate sites of persistent conduction and achieve exit block during an atrial fibrillation ablation. This method allows for mapping solely with the ablation catheter in the left atrium by annotating to a catheter in the coronary sinus. We illustrate the utility escape mapping during an atrial fibrillation ablation where entrance block is achieved without exit block. We further expand upon this technique by describing the first reported case of escape mapping being used to achieve bidirectional block during an atrial flutter ablation.
Prevalence of dental trauma in individuals with special needs participating in local Special Olympics games
Authors: Dagon Nurit , Blumer Sigalit , Peretz Benjamin , Ratson Tal 
Published: November 2018

AbstractObjectivesThe Special Olympics Special Smiles (SOSS) Program provides oral health screening and data collection for athletes with intellectual disabilities who participate in Special Olympics events.AimThis study evaluated the prevalence and severity of dental trauma among Special Olympics athletes with intellectual disabilities who participated in the 2016 Israeli Special Olympics games.MethodsA free voluntary dental examination was offered to all participating athletes. The examination was performed by volunteer dentists who completed a standard SOSS examination form, which included questions on oral health status and evidence of dental trauma in the anterior teeth. The dental traumas were categorized by a modified clinical version of the Ellis classification for dental traumas, and they were combined into three main categories according to their severity. Chi‐square analysis was used to find differences between gender and age in regard to the prevalence of dental trauma.ResultsThe sample consisted of 249 athletes with intellectual disabilities aged 10‐65 years (mean 29.2 ± 11.24). The prevalence of dental trauma was 27.3%, of which 9.64% were categorized as mild and 17.67% as severe. Most of the traumas (94%) involved the maxillary incisors.ConclusionsThe relatively high prevalence of dental trauma in special needs athletes revealed by this study's findings supports the need for using preventive measures, such as mouth guards, during sport activities.
Characteristics, Performance of Blend CA/SPEEK Ultrafiltration Membranes Prepared by Phase Inversion Method using PEG 600 as an Additive
Authors: Arthanareeswaran G. , Anatharaman N. , Raajenthiren M. 
Published: November 2018

Flat sheet asymmetric polymeric membranes is prepared by phase inversion method from homogeneous solution of 17.5 wt% cellulose acetate (CA) and sulfonated poly ether ether ketone (SPEEK) with polar solvent of N, N’– dimethylformamide (DMF). The different concentration of polyethylene glycol is used as the polymeric additives in the CA/SPEEK casting solution. The effects of polyethylene glycol 600 (PEG 600) concentration on the structure and performance of CA/SPEEK ultrafiltration membranes were investigated in more detail. The optimal preparation conditions were: 17.5 wt% total polymer composition, 65/35 wt% CA/SPEEK blend composition and 10 wt% PEG 600. The permeation performances of the membranes were evaluated in terms of pure water flux, equilibrium water content, hydraulic permeability, and solute rejection. The morphology and structure of the resulting membranes were observed by scanning electron microscope (SEM). CA/SPEEK membranes with higher concentration of 10 wt% PEG have higher PWF and equilibrium water content due to high porosity. With increase in PEG concentration from 0 to 10 wt%, the PWF increases from 129 to 259 lm–2h–1 in 65/35 wt% of CA/SPEEK as blend. When increasing concentration of PEG is substituted for SPEEK in proportion to form a homogeneous blend, the membrane hydraulic resistance reduces from 9.2 to 2.9 kPa/l.m–2.h–1for blend membranes with 0 to 10 wt % PEG 600 at 95/5 wt % CA/SPEEK composition. Solution of proteins of different molecular weight was used to study the permeation performance of prepared membranes using a batch membrane cell of 400 ml capacity.
Posttraumatic hip bulging mimicking an abscess in a patient with hip prosthesis: the role of ultrasonography
Authors: Damian Laura Otilia , Simon Siao-pin , Felea Ioana , Coman Mihaela , Fodor Daniela , Voica Cezara Mariana 
Published: November 2018

A 48-yr old female patient, with stage 4 rheumatoid arthritis, who had undergone multiple joint prostheses including four arthroplasties of the left hip, presented for a sudden-onset large bulge on the left thigh, after a minor local injury. Orthopedic examination and radiography excluded fractures. Ultrasonography revealed a large mixed hypo- and hyperechoic collection,with no Doppler signal, but with comet tail artifacts. Repeated cultures from the collection were negative. Fluid analysis revealed increased quantities of titanium and cobalt. The sudden-onset deformity and fluid collection were in favor of a shear lesion (Morel-Lavallée). The new collection communicated with a previously asymptomatic periprosthetic aseptic abscess, mimicking an infection. To our knowledge, Morel-Lavallée shear lesions have not been described in patients with hip prostheses. Their presence may add to the difficulties of ruling out silent infections in such patients. Ultrasonography is a very effective method for the diagnosis and follow-up of collections in this setting.
Tachycardia after acute deceleration injury
Authors: Singh Vickram , Rahman Mesbah , Fraser Alan G 
Published: November 2018

A 29-year-old man crashed at high speed into another vehicle at traffic lights. He was able to get out of his van but then collapsed after running a few metres. On arrival in the emergency department he was conscious, with a pulse of 140 beats/min and blood pressure of 110/32 mm Hg. He had collapsing arterial pulses and an early diastolic murmur. He had a chest radiograph (figure 1A) and a skeletal survey which demonstrated multiple fractures, involving his left hand, right femur, right calcaneus, and left first and second ribs. A CT scan of the thorax was performed with a radiological contrast agent but without gated images because of the tachycardia (Figure 1B). The blood pressure and pulse were attributed to blood loss into the right thigh. Urgent cardiology review and bedside echocardiography were requested before he had emergency orthopaedic surgery (figure 1C, D) (online supplementary video 1).
Supplementary file 1Figure 1(A–D) Chest radiograph, CT thorax with contrast, parasternal long-axis transthoracic view (grey scale) and with colour flow. The arrow in section C highlights the area of significance (mobile linear structure).QuestionWhat is the most likely diagnosis?Traumatic dissection of the aortic root.Subaortic membrane or diaphragm.Traumatic transection of the aorta.Traumatic rupture of the aortic valve.Myocardial rupture.
Efficacy, safety and immunogenicity of GP2015, an etanercept biosimilar, compared with the reference etanercept in patients with moderate-to-severe rheumatoid arthritis: 24-week results from the comparative phase III, randomised, double-blind EQUIRA study
Authors: Matucci-Cerinic Marco , Allanore Yannick , Kavanaugh Arthur , Buch Maya H , Schulze-Koops Hendrik , Kucharz Eugeniusz J , Woehling Heike , Babic Goran , Poetzl Johann , Davis Adanna , Schwebig Arnd 
Published: November 2018

ObjectivesTo demonstrate the equivalent efficacy and compare the safety and immunogenicity of an etanercept biosimilar, GP2015, with reference etanercept (ETN) in patients with moderate-to-severe, active rheumatoid arthritis (RA), characterised by an inadequate response to synthetic or biologic disease-modifying antirheumatic drugs (DMARDs).MethodsIn the EQUIRA study, eligible patients (n=376) were randomised 1: 1 to 50  mg GP2015 or ETN subcutaneously, once weekly, for 24 weeks (treatment period 1). Patients from both groups, with at least moderate European League Against Rheumatism response at week 24, received GP2015 up to week 48 (treatment period 2). All patients continued to receive concomitant methotrexate at a stable dose (10–25  mg/week) until end of the study. The 24-week results are presented here.ResultsEquivalent efficacy between GP2015 and ETN was demonstrated if the 95% CI for the difference in disease activity score 28-joint count C reactive protein (DAS28-CRP) change from baseline to week 24 between treatment arms was contained within the prespecified equivalence margin range of −0.6 to 0.6. The least squares mean difference (GP2015–ETN) in change from baseline in DAS28-CRP up to week 24 was −0.07 (95% CI −0.26 to 0.12 [primary endpoint)]. The incidence of treatment-emergent adverse events was comparable between GP2015 (43.5%) and ETN (49.5%). None of the GP2015-treated patients developed neutralising anti-drug antibodies (NAbs) whereas 1.6% and 0.6% of patients in ETN group were NAb positive at weeks 4 and 12, respectively.ConclusionIn patients with RA who had an inadequate response to DMARDs, GP2015 demonstrated a similar efficacy and a comparable safety and immunogenicity profile with ETN.Trial registrationNCT02638259.
Growth Factor and Intense Pulse Light in Flexor Tendon Repair: A Biomechanical Study at Strength and Gap Resistance
Authors: Singh Rohit , Alzyoud Jihad , Trickett Ryan , Thomas Peter , Theobald Peter , Khan Ilyas 
Published: November 2018

Background: Flexor tendon injuries are extremely common and they are usually the result of incised traumatic glass or knife injury. The process of tendon healing is a complicated and exceptionally-regimented mechanism that is originated and monitored by a vast number of diverse molecules. One of the most pivotal groups of mediators that are crucial to the healing process are growth factors (GF). Intense pulse light (IPL) can lead to evidence of new collagen formation with associated clinical improvement in tissue healing. The biological benefit of Intense pulse light (IPL) relies on judicious photothermolysis, where heat driven radiation is dissipated and focused at the cellular level. The aims of this study is to set out the effect of growth factor and IPL on healing following a tendon repair. Methods: Bovine common digital extensor tendons (CDET) were used as an ex vivo model. 44 tendon repairs were performed by the lead author using 2.5 × magnification loupes and standard instruments. Clamped tendons were assigned into the following groups; control, IPL, GF, IPL and GF. After culturing, biomechanical testing was carried out using monotonic tensile testing with displacement-controlled uniaxial tension to failure. Results: The mean values for ultimate tensile stress (UTS) for the control group was 53.51 N, for IPL it was 51.15 N, for growth factor was 70.10 N and for combined growth factor and IPL it was 75.16 N. Conclusions: This study showed significant improvement in UTS when repaired tendons were cultured with growth factor compared to control and IPL. This would suggest a biomechanical advantage for tendon healing.
Anatomic Pyrocarbon Hemiarthroplasty for Thumb Carpometacarpal Osteoarthritis in Patients under 65 Years: Mid Term Results
Authors: Caudwell Michelle , Bayne Grant , Page Richard S. 
Published: November 2018

Background: To assess the midterm outcome of patients under 65 who underwent anatomic pyrocarbon hemiarthroplasty for thumb carpometacarpal (CMC) osteoarthritis.Methods: A prospective analysis was performed of a consecutive series of active patients, less than 65 years of age, with symptomatic osteoarthritis who had undergone a CMC hemiarthroplasty using a stemmed metacarpal based, anatomic pyrolytic carbon resurfacing with an additional one third flexor carpi radialis (FCR) tendon transfer to maintain stability.The Wrightington Hand Score, Disability Arm Shoulder and Hand (DASH) Score, and the Patient Rated Wrist Evaluation Score (PRWE) were utilised. Clinical data was obtained for grip strength, pinch strength, and range of motion.Results: The MEAN age was 57.6 years. MEAN follow up was 6.5 years. All patients had improvement in pain, grip strength and function. There was no significant difference in grip and pinch strengths between the individual’s left and right hand. All patients stated that they would undergo the procedure again. There was one revision following a traumatic trapezium fracture. One patient underwent a neurolysis of a superficial radial nerve neuroma associated with an impinging trapezial osteophyte.Conclusions: Active patients, under 65 years of age with Eaton-Littler stage III osteoarthritis of the thumb CMC joint who are treated with anatomic pyrolytic carbon resurfacing hemiarthroplasty and stabilisation may achieve sustained improvement in pain and hand function for up to 6.5 years.
Midcarpal Arthrodesis Biomechanics: Memory Staples versus Cannulated Screws
Authors: Ledgard James P. , Siddiqui Javariah , Pelletier Matthew H. , Walsh William R. , Scougall Peter J. 
Published: November 2018

Background: Midcarpal arthrodesis is a treatment of choice in patients with midcarpal arthritis. Traditionally a four corner fusion has been favoured, however recent research has shown improved results when the triquetrum and scaphoid are excised. There is no clear evidence as to which remaining bones should be fused or which implants should be used. The purpose of this study is to compare the biomechanics of midcarpal arthrodesis after scaphoid and triquetrum excision, using memory staples or cannulated screws, in recognised construct patterns. Methods: 36 identical sets of carpal bones were 3D printed from acetyl butyl styrene. Midcarpal arthrodeses were performed in three configurations with shape memory alloy staples or headless compression screws. This gave 6 treatment groups; lunocapitate single staple or screw, lunocapitate with 2 staples or screws, three corner fusion with 2 staples or screws. Peak torque to distraction was measured and analysed. Results: The peak torque to distraction was significantly greater in almost all constructs utilizing screws compared to staples, with two lunocapitate screws having the highest peak torque at both 1 and 3 mm distraction with 244 Nmm and 749 Nmm respectively (p < 0.05). Conclusions: Constructs utilizing screws have a peak torque to distraction significantly higher when compared to staples. Our recommendation when performing a midcarpal arthrodesis after scaphoid and trapezium excision is to fuse the midcarpal joint with 2 headless compression screws.
Particularidades do imperfetto no livro didático de italiano L2 Nuovo Espresso 2
Authors: Carneiro Leandro Vidal , Muller Fernanda Suelly 
Published: November 2018

Tendo em vista a premissa dos propósitos comunicativos desde as correntes funcionalistas (PEZZATI, 2011), bem como sua apresentação e possível aplicação nos mais recentes materiais didáticos inseridos no contexto comunicativo do pós-método (KUMARAVADIVELU, 2006), pretendemos, neste artigo, discutir a apresentação e a abordagem dos valores tempo-aspectuais do imperfetto no material didático Nuovo Espresso 2 (BALÌ; RIZZO, 2014). De modo ainda mais específico, sublinhamos o imperfetto apresentado no manual em questão pela perspectiva do modo realis e as estratégias didáticas utilizadas pelas autoras durante as fases de globalidade, análise, reflexão e síntese. Os resultados apontam que as autoras primam as funções iterativa e descritiva do passado imperfectivo do italiano, apresentando textos motivadores e prototípicos da ocorrência dessas funções, a fim de que o aprendiz alcance as seguintes competências comunicativas: narrar fatos da infância, contar sobre viagens e hábitos do passado ou descrever situações passadas; e encerra com exercícios de verificação da aprendizagem que contemplam a capacidade do aprendiz de relacionar, completar tabelas e textos com formas verbais ou com outros elementos do texto, completar e/ou ligar frases, escolher a expressão adequada e identificar funções. Embora haja um equilíbrio na apresentação dessas duas funções, os dados colhidos atestam que as autoras não apresentam no material didático a função narrativa do imperfetto, desconsiderando-a totalmente.
100 Years of Progress in Gas-Phase Atmospheric Chemistry Research
Authors: Wallington T. J. , Seinfeld J. H. , Barker J. R. 
Published: November 2018

AbstractRemarkable progress has occurred over the last 100 years in our understanding of atmospheric chemical composition, stratospheric and tropospheric chemistry, urban air pollution, acid rain, and the formation of airborne particles from gas-phase chemistry. Much of this progress was associated with the developing understanding of the formation and role of ozone and of the oxides of nitrogen, NO and NO2, in the stratosphere and troposphere. The chemistry of the stratosphere, emerging from the pioneering work of Chapman in 1931, was followed by the discovery of catalytic ozone cycles, ozone destruction by chlorofluorocarbons, and the polar ozone holes, work honored by the 1995 Nobel Prize in Chemistry awarded to Crutzen, Rowland, and Molina. Foundations for the modern understanding of tropospheric chemistry were laid in the 1950s and 1960s, stimulated by the eye-stinging smog in Los Angeles. The importance of the hydroxyl (OH) radical and its relationship to the oxides of nitrogen (NO and NO2) emerged. The chemical processes leading to acid rain were elucidated. The atmosphere contains an immense number of gas-phase organic compounds, a result of emissions from plants and animals, natural and anthropogenic combustion processes, emissions from oceans, and from the atmospheric oxidation of organics emitted into the atmosphere. Organic atmospheric particulate matter arises largely as gas-phase organic compounds undergo oxidation to yield low-volatility products that condense into the particle phase. A hundred years ago, quantitative theories of chemical reaction rates were nonexistent. Today, comprehensive computer codes are available for performing detailed calculations of chemical reaction rates and mechanisms for atmospheric reactions. Understanding the future role of atmospheric chemistry in climate change and, in turn, the impact of climate change on atmospheric chemistry, will be critical to developing effective policies to protect the planet.
The Role of Hadley Circulation and Lapse-Rate Changes for the Future European Summer Climate
Authors: Brogli Roman , Kröner Nico , Sørland Silje Lund , Lüthi Daniel , Schär Christoph 
Published: November 2018

AbstractBy the end of the century, climate projections for southern Europe exhibit an enhanced near-surface summer warming in response to greenhouse gas emissions, which is known as the Mediterranean amplification. Possible causes for this amplified warming signal include a poleward Hadley cell expansion as well as tropospheric lapse-rate changes. In this work, regional climate model (RCM) simulations driven by three different global climate models (GCMs) are performed, representing the RCP8.5 emission scenario. For every downscaled GCM, the climate change signal over Europe is separated into five contributions by modifying the lateral boundary conditions of the RCM. This simulation strategy is related to the pseudo–global warming method. The results show that a poleward expansion of the Hadley cell is of minor importance for the Mediterranean amplification. During summer, the simulated Hadley circulation is weak, and projections show no distinct expansion in the European sector. The north–south contrast in lapse-rate changes is suggested as the most important factor causing the Mediterranean amplification. Lapse-rate changes are projected throughout Europe, but are weaker over the Mediterranean than over northern Europe (around 0.15 vs 0.3 K km−1 by the end of the century). The weaker lapse-rate changes result in a strong near-surface summer warming over the Mediterranean, since the upper-tropospheric warming is of similar magnitude throughout Europe. The differing lapse-rate changes can be understood as a thermodynamic response to lower-tropospheric humidity contrasts.