bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Biomechanical Comparison of Allograft Tendons for Ligament Reconstruction
Authors: Palmer Jeremiah E. , Russell Joseph P. , Grieshober Jason , Iacangelo Abigail , Ellison Benjamin A. , Lease T. Dylan , Kim Hyunchul , Henn R. Frank , Hsieh Adam H. 
Published: November 2016

Background: Allograft tendons are frequently used for ligament reconstruction about the knee, but they entail availability and cost challenges. The identification of other tissues that demonstrate equivalent performance to preferred tendons would improve limitations. Hypothesis/Purpose: We compared the biomechanical properties of 4 soft tissue allograft tendons: tibialis anterior (TA), tibialis posterior (TP), peroneus longus (PL), and semitendinosus (ST). We hypothesized that allograft properties would be similar when standardized by the looped diameter. Study Design: Controlled laboratory study. Methods: This study consisted of 2 arms evaluating large and small looped-diameter grafts: experiment A consisted of TA, TP, and PL tendons (n = 47 each) with larger looped diameters of 9.0 to 9.5 mm, and experiment B consisted of TA, TP, PL, and ST tendons (n = 53 each) with smaller looped diameters of 7.0 to 7.5 mm. Each specimen underwent mechanical testing to measure the modulus of elasticity (E), ultimate tensile force (UTF), maximal elongation at failure, ultimate tensile stress (UTS), and ultimate tensile strain (UTε). Results: Experiment A: No significant differences were noted among tendons for UTF, maximal elongation at failure, and UTϵ. UTS was significantly higher for the PL (54 MPa) compared with the TA (44 MPa) and TP (43 MPa) tendons. E was significantly higher for the PL (501 MPa) compared with the TP (416 MPa) tendons. Equivalence testing showed that the TP and PL tendon properties were equivalent or superior to those of the TA tendons for all outcomes. Experiment B: All groups exhibited a similar E. UTF was again highest in the PL tendons (2294 N) but was significantly different from only the ST tendons (1915 N). UTϵ was significantly higher for the ST (0.22) compared with the TA (0.19) and TP (0.19) tendons. Equivalence testing showed that the TA, TP, and PL tendon properties were equivalent or superior to those of the ST tendons. Conclusion: Compared with TA tendons, TP and PL tendons of a given looped diameter exhibited noninferior initial biomechanical strength and stiffness characteristics. ST tendons were mostly similar to TA tendons but exhibited a significantly higher elongation/UTϵ and smaller cross-sectional area. For smaller looped-diameter grafts, all tissues were noninferior to ST tendons. In contrast to previous findings, PL tendons proved to be equally strong. Clinical Relevance: The results of this study should encourage surgeons to use these soft tissue allografts interchangeably, which is important as the number of ligament reconstructions performed with allografts continues to rise.
Early Ambulation in Patients With External Ventricular Drains
Authors: Shah Syed Omar , Kraft Jacqueline , Ankam Nethra , Bu Paula , Stout Kristen , Melnyk Sara , Rincon Fred , Athar M. Kamran 
Published: November 2016

Introduction: Prolonged immobility in patients in the intensive care unit (ICU) can lead to muscle wasting and weakness, longer hospital stays, increased number of days in restraints, and hospital-acquired infections. Increasing evidence demonstrates the safety and feasibility of early mobilization in the ICU. However, there is a lack of evidence in the safety and feasibility of mobilizing patients with external ventricular drains (EVDs). The purpose of this study was to determine the safety and feasibility of early mobility in this patient population. Methods: We conducted a prospective, observational study. All patients in the study were managed with standard protocols and procedures practiced in our ICU including early mobility. Patients with an EVD who received early mobilization were awake and following commands, had a Lindegaard ratio <3.0 or middle cerebral artery (MCA) mean flow velocity <120 cm/s, a Mean Arterial Pressure (MAP) > 80 mm Hg, and an intracranial pressure consistently <20 mm Hg. Data were collected by physical therapists at the time of encounter. Results: Ninety patients with a total of 185 patient encounters were recorded over a 12-month period. The average time between EVD placement and physical therapy (PT) session was 8.3 ± 5.5 days. In 149 (81%) encounters, patients were at least standing or better. Patients were walking with assistance or better in 99 (54%) encounters. There were 4 (2.2%) adverse events recorded during the entire study. Conclusion: This observational study suggests that PT is feasible in patients with EVDs and can be safely tolerated. Further research is warranted in a larger patient population conducted prospectively to assess the potential benefit of early mobility in this patient population.
A new direct simulation Monte Carlo implementation for more efficient simulation of hypersonic flow over arbitrarily shaped bodies using dynamic cells
Authors: Reji RV , Lal S Anil 
Published: November 2016

Methods are reported for less computationally expensive and more accurate implementations of the direct simulation Monte Carlo (DSMC) method for the simulation of high speed gas flows over arbitrarily shaped bodies. A new particle-tracking algorithm with a saving of computational time of up to 10% is reported in which tracking of particles is done with the help of big triangles having vertices lying on the boundary curves. An algorithm has been developed to generate DSMC cells for collision and sampling that contain a prescribed number of molecules. This algorithm is able to generate over 90% cells having the optimum number of seven or eight molecules for simulating collisions. Sampling for macroscopic properties is done on dynamic cells that contain a number of particles varying spatially as a function of the local number density. A criterion for finding the number of particles in sampling cells is presented. This criterion has been found to result in accurate and fast simulation of two-dimensional hypersonic flows of argon over a wedge, and argon and nitrogen over a circular cylinder.
‘Out of the forest I come’: Lyric and dramatic tension in The World’s Wife
Authors: Roche-Jacques Shelley 
Published: November 2016

This article looks at lyric and dramatic modes of poetic expression in Carol Ann Duffy’s collection The World’s Wife. The book is of particular interest because it is Duffy’s only volume devoted entirely to the dramatic monologue. In the opening sections of this article, lyric and dramatic modes are defined and discussed, and the work of Keith Green on deixis and the poetic persona is considered in relation to the dramatic monologue. Of particular use is Green’s elaboration on the traditional deictic categories of ‘time’ and ‘place’. Green incorporates the concepts of ‘coding time and place’ and ‘content time and place’ into his analysis of lyric poetry. These concepts are used here as tools to consider and describe the communicative contexts established in lyric and dramatic poetry respectively. Ina Beth Sessions’ early, taxonomic approach to defining the dramatic monologue, in particular her idea of ‘action in the present’, is also found to be useful in the identification of the ‘dramatic’. The next section of the article is a close analysis of two poems from The World’s Wife, ‘Little Red Cap’ and ‘Mrs Sisyphus’. Other poems, and the communicative context evoked by the collection as a whole, are also considered in the light of Green, Sessions and the lyric and dramatic traditions in poetry. The work of Duffy examined here is found to be more clearly rooted in lyrical and narrative than dramatic traditions. It is suggested that the indexicalisation of the symbolic elements of deictic terms is essential to the building of the dramatically realised coding environment necessary for a Browningesque dramatic monologue. A call is made for further work to be carried out in identifying the ‘dramatic’ in poetry, and for a more meaningful employment of the term dramatic monologue.
Addressing ethical concerns arising in nursing and midwifery students’ reflective assignments
Authors: McCarthy Bridie , McCarthy Joan , Trace Anna , Grace Pamela 
Published: November 2016

Background: Written reflections on practice are frequently requirements of nursing curricula. They are widely accepted as necessary for improving critical thinking and problem-solving skills. Faculty, are expected to review reflections and provide feedback that helps professional development and facilitates good practice. It is less clear what the actions of nurse educators should be when ethical infractions are revealed in the narratives. Objectives: We had two aims: 1) To combine insights from a literature review of empirical and theoretical research related to responding to ethical issues revealed in student reflections with our experiences reviewing the reflections of undergraduate nursing and midwifery students, and 2) to construct and analyze a hybrid case from these insights in order to develop guidelines for nurse educators. Research Design: A literature review was conducted using CINAHL, MEDLINE, PsycINFO, SocINDEX and ERIC databases and pertinent key words. A hybrid case was constructed of commonly encountered ethical issues using insights from the literature review and the authors’ experiences. The case was analyzed by combining Beauchamp and Childress’ principlist approach with Campbell and McCarthy’s ethical decision-making tool (Table 1). Participants and Research Context: No human participants Findings: A gap in the literature exists related to addressing ethical issues revealed in student practice reflections. However, a combination of insights from the literature and the authors’ experiences facilitated the development of a hybrid case. Subsequent case analysis facilitated the development of a series of guidelines that can be utilized to address a range of issues commonly emerging in the reflections of nursing students during practice experiences. Discussion: A number of recommendations and guidelines are provided to enable the safeguarding of students and staff and support them in practicing ethically. Conclusion: Structured ethical analysis of a constructed hybrid reflection of commonly revealed ethical issues was useful in developing guidelines for educators.
Factors that impact on emergency nurses’ ethical decision-making ability
Authors: Alba Barbara 
Published: November 2016

Background: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Research purpose: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of worked nursing experience and perceived ethical decision-making ability. Research design and context: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions. Participants: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Ethical considerations: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. Findings: A relationship between intuition and perceived ethical decision-making ability ( r = .252, p = .001) was a significant finding in this study. Discussion: This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability. Conclusion: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions.
Comparison of Intra-articular Injection of Hyaluronic Acid and N-Acetyl Cysteine in the Treatment of Knee Osteoarthritis: A Pilot Study
Authors: Ozcamdalli Mustafa , Misir Abdulhamit , Kizkapan Turan Bilge , Uzun Erdal , Duygulu Fuat , Yazici Cevat , Kafadar Ibrahim Halil 
Published: November 2016

Objective To compare the relative effectiveness of intra-articular N-acetyl cysteine (NAC) and hyaluronic acid (HA) on pain, function and cartilage degradation markers in patients with mild to moderate knee osteoarthritis (OA). Design We prospectively conducted a clinical trial with 20 patients having a diagnosis of Kellgren-Lawrence grade 2-3 knee OA, and randomly allocated to the HA or NAC groups. Groups were matched on age, sex, and body mass index. Injections of 3-mL HA (Hylan G-F 20) or 3-mL NAC (Asist ampoule) were administered as a single shot. Functional status and pain were evaluated before and after injection, using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the visual analogue scale (VAS) scores. Pre- and posttreatment concentrations of serum C-reactive protein (CRP), synovial fluid chondroitin-6-sulfate (C-6S), matrix metalloproteinase-3 (MMP-3), cross-linked C-terminal telopeptide of type 2 collagen (CTX-II), total oxidant status (TOS), and total antioxidant concentration (TAC) were obtained. Results WOMAC, VAS scores, and CRP levels were comparable between groups prior to treatment. Both HA and NAC produced comparable reductions in TOS and MMP-3. NAC was more effective in reducing C-6S and CTX-II ( P < 0.05). No effects on TAC were noted. Conclusions NAC is effective in lowering some cartilage degradation markers, with comparable outcomes to HA for pain and function. NAC could provide a cheaper alternative to HA for intra-articular injection treatment of mild to moderate knee OA. Future placebo controlled trials are warranted to evaluate effectiveness in a larger patient population with a wider range of age and OA severity.
Redesigning care delivery with patient support personnel: Learning from accountable care organizations
Authors: Gorbenko Ksenia O , Fraze Taressa , Lewis Valerie A 
Published: November 2016

Introduction Accountable care organizations are a value-based payment model in the United States rooted in holding groups of health care providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, accountable care organizations implement a variety of care delivery changes, including workforce redesign. Patient support personnel—nonphysician staff such as care coordinators, community health workers, and others—are critical to restructuring care delivery. Little is known about how accountable care organizations are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. Methods We conducted semi-structured 1-h interviews with 25 executives at 16 distinct accountable care organizations. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. Results Accountable care organizations deployed patient support personnel to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. Accountable care organizations deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care, and community) depending on their population needs. Most accountable care organizations used personnel with the same level of training across settings. Few accountable care organizations planned to conduct a comprehensive evaluation of their patient support personnel to optimize their value. Discussion Accountable care organization strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of patient support personnel and their performance is needed to demonstrate cost-saving benefits of workforce redesign.
Acquired von Willebrand Syndrome
Authors: Jones Melissa B. , Ramakrishnan Karthik , Alfares Fahad A. , Endicott Kendal M. , Oldenburg Gary , Berger John T. , Shankar Venkat , Nath Dilip S. , Diab Yaser A. 
Published: November 2016

Background: Acquired von Willebrand syndrome (AvWS) in the setting of congenital heart disease is an under-recognized cause of bleeding in the pediatric cardiac critical care unit. Methods: Fourteen patients diagnosed with AvWS admitted to the cardiac intensive care unit at the Children’s National Health System between December 2009 and September 2015 were identified with subsequent chart review and case analysis. Results: Of the 14 patients included in this study, 4 patients were on ventricular-assist devices, 6 patients were on extracorporeal membrane oxygenation, and 4 were patients with congenital heart disease not receiving any mechanical circulatory support. All patients identified manifested persistent severe bleeding, despite appropriate management of anticoagulation and blood product administration based on the established protocols. Detailed hemostatic testing including quantitative von Willebrand factor (vWF) multimer analysis revealed decreased high-molecular-weight multimers (HMWMs) and absent ultra-HMWM, consistent with AvWS in all patients. Eight patients received treatment with vWF concentrate, one patient with desmopressin, and five recovered without specific treatment. Bleeding ceased in all but one patient. Conclusions: Acquired von Willebrand syndrome is an uncommon but important cause of bleeding in pediatric patients with cardiac disease. A high index of clinical suspicion with knowledge of the characteristic clinical scenario in addition to low levels of vWF multimers is required to manage and diagnose AvWS. Although the optimal management of AvWS in this patient population is unclear, vWF concentrates are available and appear to be efficacious for controlling life-threatening bleeding.
Humanitarian Cardiology and Cardiac Surgery in Sub-Saharan Africa
Authors: Tefera Endale , Nega Berhanu , Yadeta Dejuma , Chanie Yilkal 
Published: November 2016

Background: In recent decades, humanitarian cardiology and cardiac surgery have shifted toward sending short-term surgical and catheter missions to treat patients. Although this model has been shown to be effective in bringing cardiovascular care to the patients’ environment, its effectiveness in creating sustainable service is questioned. This study reports the barriers to contribution of missions to effective skill transfer and possible improvements needed in the future, from the perspective of both the local and overseas teams. Methods: We reviewed the mission-based activities in the Children’s Heart Fund Cardiac Center in the past six years. We distributed questionnaires to the local surgeons and the lead surgeons of the overseas teams. Results: Twenty-six missions visited the center 57 times. There were 371 operating days and 605 surgical procedures. Of the procedures performed, 498 were open-heart surgeries. Of the operations, 360 were congenital cases and 204 were rheumatic. Six local surgeons and 18 overseas surgeons responded. Both groups agree the current model of collaboration is not optimal for effective skill transfer. The local surgeons suggested deeper involvement of the universities, governmental institutions, defined training goals and time frame, and communication among the overseas teams themselves as remedies in the future. Majority of the overseas surgeons agree that networking and regular communication among the missions themselves are needed. Some reflected that it would be convenient if the local surgeons are trained by one or two frequently visiting surgeons in their early years and later exposed to multiple teams if needed. Conclusion: The current model of collaboration has brought cardiac care to patients having cardiac diseases. However, the model appears to be suboptimal for skill transfer. The model needs to be reshaped to achieve this complex goal.
Design and Implementation of a Prospective Adult Congenital Heart Disease Biobank
Authors: Opotowsky Alexander R. , Loukas Brittani , Ellervik Christina , Moko Lilamarie E. , Singh Michael N. , Landzberg Elizabeth I. , Rimm Eric B. , Landzberg Michael J. 
Published: November 2016

Background: Adults with congenital heart disease (ACHD) comprise a growing, increasingly complex population. The Boston Adult Congenital Heart Disease Biobank is a program for the collection and storage of biospecimens to provide a sustainable resource for scientific biomarker investigation in ACHD. Methods: We describe a protocol to collect, process, and store biospecimens for ACHD or associated diagnoses developed based on existing literature and consultation with cardiovascular biomarker epidemiologists. The protocol involves collecting urine and ∼48.5 mL of blood. A subset of the blood and urine undergoes immediate clinically relevant testing. The remaining biospecimens are processed soon after collection and stored at −80°C as aliquots of ethylenediaminetetraacetic acid (EDTA) and lithium heparin plasma, serum, red cell and buffy coat pellet, and urine supernatant. Including tubes with diverse anticoagulant and clot accelerator contents will enable flexible downstream use. Demographic and clinical data are entered into a database; data on biospecimen collection, processing, and storage are managed by an enterprise laboratory information management system. Results: Since implementation in 2012, we have enrolled more than 650 unique participants (aged 18-80 years, 53.3% women); the Biobank contains over 11,000 biospecimen aliquots. The most common primary CHD diagnoses are single ventricle status-post Fontan procedure (18.8%), repaired tetralogy of Fallot with pulmonary stenosis or atresia (17.6%), and left-sided obstructive lesions (17.5%). Conclusions: We describe the design and implementation of biospecimen collection, handling, and storage protocols with multiple levels of quality assurance. These protocols are feasible and reflect the size and goals of the Boston ACHD Biobank.
Surgical Treatment for Double Outlet Right Ventricle With Pulmonary Outflow Tract Obstruction
Authors: Wu Qingyu , Jin Yongqiang , Li Hongyin , Zhang Mingkui 
Published: November 2016

Background: Double outlet right ventricle (DORV) is a conotruncal anomaly that is a defining element of many types of complex congenital heart disease. Because of a big variety of pathology, there are still some controversies with respect to the definition, classification, and surgical treatment. We report our experience with surgical treatment for DORV (as defined by the “90% rule”) with pulmonary outflow tract obstruction (POTO). Methods: From July 2005 to July 2015, 90 patients underwent surgical treatment of DORV with POTO at the First Hospital of Tsinghua University. There were 55 males and 35 females whose age varies from 3 months to 36 years (mean age 7.1 ± 9.0 years old), and body weights ranged from 5 to 63 kg (mean weight 20.4 ± 16.6 kg). Besides DORV, ventricular septal defect, and POTO, this group of patients includes some with additional associated cardiac abnormalities. Results: Fourteen patients (15.6%) died. The main cause of death was low cardiac output syndrome. Conclusions: The DORV is usually associated with a variety of cardiac abnormalities and POTO is a common defining feature. Acceptable surgical results can be achieved by individualized surgical treatment of most patients. Some patients may require reoperation, and a close follow-up is needed.