bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thermokinetics of Cellulose Fiber Penetration by Physically and Chemically Reactive Liquids and the Structure of Accessible Regions
Authors: Balcerzyk Edward , Kozlowski Wojciech , Wlodarski Gabriel 
Published: January 2017

The thermokinetics of the action of water, methanol, ethanol, n-propanol, n-butanol, acetic acid, and concentrated aqueous solutions of NaOH and ethylenediamine on native, mercerized, and regenerated cellulose has been studied by a microcalorimetric method. The penetration rate depends, first of all, on the structure of accessible regions, the dimensions of the penetrant molecule, and the penetrant reaction with hydroxyl groups. If the penetrant molecule has suitable dimensions, the penetration becomes a slow process, making it possible to follow the structural differences in the accessible region even in fibers of the same type. Such liquids are ethanol and acetic acid for native cellulose, methanol and concentrated solutions of ethylenediamine for regenerated cellulose, and concentrated solutions of NaOH (37.5% and 41.5%) for all kinds of cellulose. The accessible phase in cellulose has a discontinuous structure within the spacing of structural elements in the intermicrofibrillar and intermolecular regions. This discontinuity may sometimes be the cause of composite thermograms. Similar thermograms with two characteristic peaks are obtained for some viscose fibers which have at least a two-zone structure of the skin-core type. The intermolecular distances in the accessible regions of microfibrils seem to be of the same order of magnitude as that of the ethanol molecule with reference to native cellulose and the methanol molecule, to regenerated cellulose. The structure of these regions readily undergoes specific changes under the influence of various treatments. This is reflected in the shape of thermograms and magnitude of integral heat effects. The results indicate that the microcalorimetric measurements of the penetration thermokinetics may be a useful tool for investigating the accessible regions
Bone Age Determination in a Paediatric Population as an Indicator of Nutritional Status
Authors: Fleshman Keith 
Published: January 2017

The United Mission to Nepal Tansen Project is in the hill country, 300 km West of Kathmandu. This 40-year-old service centre's major emphasis has been on clinical and community medicine and education. Agronomy, forestry, water resources development, adult literacy, etc., have also been part of the project's outreach. We had long noted that the children of all of the various tribal groups in the area are small for their age as compared with children in developed countries. Fracture care X-rays were examined to reveal delay in ossification and in physeal closure. Using the standards found in the Radiographic Atlas of Skeletal Development of the Hand and Wrist, we quantified this apparent delay by determining the bone age of all patients presenting at the hospital with upper limb injuries requiring X-ray. The collection of data was limited to 100 days and to those under the age of 21. Two hundred and nineteen patients' data were analysed. We found that bone maturation delay was very common and often severe. The average bone age among the 219 was 28% below chronological age. That is, 60% of all fell two standard deviations below the norm: i.e. two-thirds of all 9 year olds had the expected skeletal development of 6 year olds in Boston, USA. Dental age was also analysed using deciduous tooth shedding and tooth eruption patterns. Dental age retardation averaged 21%, but a larger per cent had normal eruption dates. Other physical and sociological data were included in a questionnaire completed for each patient. Among the variables examined, poverty alone appeared to be the major mover. We believe that national small stature is a result of lifelong community dietary inadequacy.
Need for Paediatric Surgery Care in an Urban Area of the Gambia
Authors: Bickler Stephen W , Telfer Michelle L , Sanno-Duanda Boto 
Published: January 2017

The report evaluates the need for paediatric surgical care in an urban area of sub-Saharan Africa. Seven hundred and forty-one children were treated for surgical problems from January through December 1997. The most common surgical problems were injuries (67.1%), congenital anomalies (15.0%) and surgical infections (6.7%). Forty-six per cent of children presenting with a surgical problem required a surgical procedure, 68.2% of which were classified as minor. The annual presentation rate for all surgical conditions was 543 per 10 000 children aged 0–14 years. The estimated cumulative risk for all surgical conditions is 85.4% by age 15 years. Our data suggest surgical diseases commonly affect children living in Banjul. Surgical care should be an essential component of child health programmes in developing countries.
Prevalence of Wheeze and Self-Reported Asthma and Asthma Care in an Urban and Rural Area of Tanzania and Cameroon
Authors: Mugusi Ferdinand , Edwards Richard , Hayes Louise , Unwin Nigel , Mbanya Jean-Claude , Whiting David , Sobngwi Eugene , Rashid Seif 
Published: January 2017

We investigated the prevalence of wheeze, self-reported asthma, and asthma care via four cross-sectional surveys among adults and children (5-15 years) in urban and rural populations from Tanzania and Cameroon. Age-standardized prevalence of current wheeze (in the previous year) was 2.2% to 5.0% in adults and 1.9% to 5.2% in children in Tanzania, and 1.3% to 2.5% (adults) and 0.8% to 5.4% (children) in Cameroon. There were no consistent patterns of urban:rural prevalence. Peak flow rates varied with age, peaking at 25-34 years, and were higher in urban areas (age adjusted difference 22-70 L/min) and in the Tanzania populations. Awareness (83%–86% versus 52%–58%) and treatment (43%–71% versus 30%–44%) of asthma was higher among those with current wheeze in rural areas. Use of inhaled drugs, particularly steroids, was rare. Diagnosis by traditional healers (15%) and use of traditional remedies (62% of those recalling any treatment) were common only among self-reported asthmatic patients in rural Cameroon. Asthma is an important clinical condition in sub-Saharan Africa. There were major gaps in clinical care, particularly in urban areas. Sustainable methods for delivering accessible and effective asthma care in sub-Saharan Africa are required.
The Patient as a Starting Point for Health Education in Leprosy Control
Authors: Awofeso Niyi 
Published: January 2017

The current strategy for leprosy control remains the early diagnosis and effective treatment of leprosy patients with multi-drug therapy (MDT), together with the prevention and/or limitation of disabilities. This paper proposes patients-centred health education strategies that may help in the goal of eliminating leprosy as a public health problem by the year 2000, in leprosy endemic countries like Nigeria.
The Second Twin: Retained and Unretained
Authors: Adinma J I Brian , Agbai Andy O 
Published: January 2017

In this comparative review of retained and unretained second twins, the commonest causes of retention of the second twins were found to be uterine inertia (48.4%) and obstruction from malpresentation and malposition (32.3%). The pair-presentation most likely to be retained was vertex/transverse. Apgar scores were lower for retained than unretained second twins. The perinatal mortality rate was significantly higher for the retained second twins (258/1000) compared to the unretained second twins (60.2/1000) ( P < 0.002). Early recognition of twin pregnancies in which the 2nd twin is more likely to be retained, and prompt application of appropriate remedial measures would reduce the incidence of retention of the second twin.
Health Problems of Automobile Mechanics in Nigeria
Authors: Omokhodion Folashade O , Osungbade O O 
Published: January 2017

A questionnaire-based survey was conducted among automobile mechanics and allied technicians in a semi-urban city. Three hundred people were interviewed. The questionnaire sought information on health problems associated with work, the presence of chronic illness and where workers seek help when they fall ill. The interview was followed by an examination of the hands for dermatitis. Musculoskeletal disorders were the commonest work-related health problems reported by respondents. Of the 50 respondents who recorded musculoskeletal disorders, 27 (54%) had low back pain. Seventy-five (25%) of the respondents had signs of hand dermatitis: commonest among panel beaters and welders. Hand dermatitis and musculoskeletal disorders are the predominant health problems among automobile mechanics. Recommendations for improved health and safety include health education programmes aimed at eliminating hazardous work practices such as sucking of petrol and poor lifting techniques. This study has shown that workers in small-scale industries are willing to accept assistance and advice on improving the health and safety of their workforce.
The Regulation of MR Neuroimaging Research: Disentangling the Gordian Knot
Authors: Kulynych Jennifer J. 
Published: January 2017

In a typical magnetic resonance imaging (“MRI”) study of the brain, subjects are screened for contraindications before being placed in the bore of a large machine, the MRI scanner, which contains a powerful magnet. The scanner produces cross-sectional images of brain tissue as the subjects undergo a series of brief electromagnetic pulses, perceptible only as noise and vibration. If the protocol involves functional MRI (“fMRI”), a popular research technique for obtaining indirect measurements of brain activity, equipment might be used to present stimuli (sounds or pictures) during the scan, but generally the study involves no invasive procedures, no physical discomfort, and no ionizing radiation. Upon completion of the scan, MRI data is transferred to an investigator's computer for further analysis, often in combination with behavioral test results and clinical information obtained from subjects or their medical records.This procedure sounds benign, and usually is. But an MRI scanner is a powerful medical device, capable of causing serious injury or death if operated carelessly.
Pain Detection and the Privacy of Subjective Experience
Authors: Kolber Adam J. 
Published: January 2017

A neurologist with abdominal pain goes to see a gastroenterologist for treatment. The gastroenterologist asks the neurologist where it hurts. The neurologist replies, “In myhead, of course.” Indeed, while we can feel pain throughout much of our bodies, pain signals undergo most of their processing in the brain. Using neuroimaging techniques like functional magnetic resonance imaging (“fMRI”) and positron emission tomography (“PET”), researchers have more precisely identified brain regions that enable us to experience physical pain. Certain regions of the brain's cortex, for example, increase in activation when subjects are exposed to painful stimuli. Furthermore, the amount of activation increases with the intensity of the painful stimulus. These findings suggest that we may be able to gain insight into the amount of pain a particular person is experiencing by non-invasively imaging his brain.Such insight could be particularly valuable in the courtroom where we often have no definitive medical evidence to prove or disprove claims about the existence and extent of pain symptoms.
Translating Rights into Access: Language Access and the Affordable Care Act
Authors: Teitelbaum Joel , Cartwright-Smith Lara , Rosenbaum Sara 
Published: January 2017

More than twenty-four million people in the United States are considered limited English proficient (LEP), and numerous studies have documented the consequences of communication barriers in healthcare. These consequences include: patients’ inability to become engaged and involved in their care; the absence of crucial information—including cultural information—essential to healthcare quality; risks to patient safety arising from the misunderstanding of physician instructions; and ethical and legal lapses stemming from the absence of informed consent. Addressing healthcare rights necessarily entails coming to grips with how to facilitate communication and the exchange of information between the healthcare system and an increasingly diverse patient population.The history of language access services in healthcare is grounded in two distinct bodies of law: the law of informed consent and civil rights law. Modern notions of informed consent law—which have their roots in the Nuremberg trials of the late 1940s—would recognize a cause of action in tort where a lack of adequate communication creates a barrier to an LEP patient's ability to consent to care. In modern healthcare law, the ability of patients to affirmatively give informed consent to treatment is considered a fundamental element of healthcare quality.
If We Can Force People to Purchase Health Insurance, Then Let's Force Them to Be Treated Too
Authors: Kapp Marshall B. 
Published: January 2017

Proponents of the 2010 Patient Protection and Affordable Care Act (PPACA) justify the Act's mandate that uninsured individuals either purchase a minimally defined health insurance policy (“Maintain Minimum Essential Coverage”) or pay a fine, as a necessary and proper exercise of Congress's express constitutional power to regulate interstate and foreign commerce. The United States Supreme Court will decide the correctness of that highly debatable position during its spring 2012 session.Assuming, without by any means predicting, that the validity of all parts of the PPACA—including the individual insurance mandate—is upheld, the Court's (likely multiple) opinions will constitute a major development in the evolution of American constitutional jurisprudence, even if Congress subsequently repeals specific sections of the legislation. Several commentators have expressed concern about the ramifications of a judicially validated PPACA for attempts by the government, especially through the mechanism of Comparative Effectiveness Research (CER), to limit or ration particular forms of potentially beneficial medical care for some or all patients.
DSM-III: Problems in Diagnosing Partial Forms of Multiple Personality Disorder: Discussion Paper
Authors: Ross Colin A 
Published: January 2017

Of all the defence mechanisms, only one — Dissociation — is treated as a separate diagnostic category in the third edition of the ‘Diagnostic and Statistical Manual of Mental Disorders’ (DSM-III) (American Psychiatric Association 1980). Delusional marital jealousy, for instance, could be classified as one of the projective disorders, but this is not done. A group of disorders based on dissociation should be easily defined and organized, in comparison with the relatively bewildering array of psychotic disturbances. Yet DSM-III does not provide a conceptually coherent set of dissociative diagnoses. This problem in DSM-III is best illustrated by partial forms of multiple personality disorder (MPD) which at present receive the unsatisfactory diagnosis of atypical dissociative disorder. First, the organization of other sections of DSM-III will be discussed.
Bias and Fraud in Medical Research: A Review
Authors: Pollock A V , Evans Mary 
Published: January 2017

‘If a man will begin with certainties, he shall end in doubts; but if he will be content to begin with doubts, he shall end in certainties' (Bacon 1605). Four centuries later, one of the greatest of contemporary philosophers — Sir Karl Popper — has consistently maintained that knowledge advances by refutation of false doctrines and not by verification of true ones (which, indeed, can never be completely verified). ‘Error is unavoidable; it can be rational, and when responsibly made and honestly reported, is not even culpable’ (Laor 1985). The desire to verify an hypothesis rather than to seek to refute it can be responsible for the suppression of deviant data. There is a fine distinction between bias, which may afflict honest investigators, and fraud, which is always dishonest. Even a true statement can be tainted by bias, and Ronald Fisher concluded that Mendel's published figures on the genetics of peas were so close to the expected ratio of 3:1 that it would have taken ‘an absolute miracle of chance’ to produce them (Hamblin 1981).
Employment after Myocardial Infarction Amongst Previously Healthy Men
Authors: Watson P A , Mayberry J F , Calcraft B , Colbourne G 
Published: January 2017

A postal questionnaire was sent to 55 men 18 months after their first myocardial infarction; information obtained was supplemented by interview with two of the authors (PW and GC). Fifty-three men had been in full-time employment prior to their illness, 38 of them in manual work. Their return to work and changes in employment were examined and, in addition, enquiries were made about subsequent health, assistance from trade unions and the local Disabled Resettlement Officer (DRO). Details of attitude to subsequent physical exercise and sexual activity were also recorded. Eighteen months after myocardial infarction, only 35% of these men were employed and 27% asymptomatic. Patients in heavy manual work were largely unable to return to their previous job and little assistance was obtained from trade unions. Even when patients were made aware of the existence of the DRO, few approached him for advice. A counselling service is needed for patients recovering from an infarct to encourage them to return to an active and profitable life.
Postoperative Gastric Aspirations Reduced by Glycopyrrolate during Upper Abdominal Surgery
Authors: Fry E N S 
Published: January 2017

Summary Glycopyrrolate is shown to reduce the incidence of large volumes (more than 40 ml) of postoperative gastric contents, but not the pH, after major abdominal operations and reduce the consequent risk of regurgitation. It should be preferred to atropine during these procedures.
Conservative Outpatient Management of Ingrowing Toenails
Authors: Senapati Asha 
Published: January 2017

Twenty-five patients with ingrowing toenails were treated conservatively by inserting cotton wool under the ingrowing nail edge. Seventy-nine percent were relieved of their symptoms after follow up for a mean of 23.7 weeks. Thirty-six percent had a history of previous surgery to the nail, 75% of whom had a good or excellent result. Although conservative management was first described in the eighteenth century and has been reported sporadically since, only a few doctors treat their patients in this way. There is, however, a distinct place for this highly effective, low cost method as the initial treatment of these patients without the need for hospital referral.
Effect of a National Community Intervention Programme on Healing Rates of Chronic Leg Ulcer: Randomised Controlled Trial
Authors:   Scottish Leg Ulcer Trial Participants
Published: January 2017

Background and Objective: Chronic leg ulcer is a common cause of serious disability in the elderly. Healing rates of chronic leg ulcers of 50–75% at 3–6 months have been reported from clinical trials in which specialist nurses delivered the care. But most patients in the population are managed by community nurses in the home, where the results are largely unknown. The aims of this trial were to audit healing rates and to evaluate the effect of a national community-based intervention programme of nurse training. Design: Fifteen Community Healthcare Trusts and one Healthcare Division in 10 Health Board Areas in Scotland comprising a population of 2.65 million took part in a cluster randomised controlled trial in which geographically and administratively distinct localities averaging 53 000 population were randomised, at the time of dissemination of Scottish Intercollegiate (SIGN) guidelines, to a programme of nurse training (intervention) or no training (control). Data were provided by 649 district nurse Case Load Managers (CLMs) via 10 3-monthly censuses (6 months baseline, 21 months post-randomisation). SIGN guidelines were disseminated nationally and in the intervention areas an intensive training course in leg ulcer care and teaching methods was provided for 51 link nurses who cascaded training to community nurses, supported by regional workshops run by the project team. Training was evaluated at each stage. Findings: A total of 4984 ulcerated legs in 3949 patients were registered: 991 (25%) males and 2958 (75%) females, mean age 77 years. Response rates from CLMs were 99.4% at the first census and 100% for all subsequent censuses. Outcome data were obtained for 98.9% of all ulcerated legs entered into the study. Care was provided by 1700 community nurses, each of whom saw an average of 1.5 leg ulcer patients annually. There were 489 deaths and 65 amputations with identical rates between the two groups. The 3-month healing rate was 28% in the intervention and control groups at baseline and did not change in either during the following 2 years. The more chronic the ulcer the lower the healing rate. Interpretation: The 3-month healing rate of less than 30% throughout more than 2 years of study, together with the lack of any evidence of improvement following an intensive guideline-based community intervention programme, indicate that a radical reappraisal is required of how care for patients with chronic leg ulcer should be delivered.
A case-control study of risk factors of chronic venous ulceration in patients with varicose veins
Authors: Abelyan Gohar , Abrahamyan Lusine , Yenokyan Gayane 
Published: January 2017

Background/objectives Venous ulcers carry psychological and high financial burden for patients, causing depression, pain, and limitation of mobility. The study aimed to identify factors associated with an increased risk of venous ulceration in patients with varicose veins in Armenia. Methods A case-control study design was utilized enrolling 80 patients in each group, who underwent varicose treatment surgery in two specialized surgical centers in Armenia during 2013–2014 years. Cases were patients with varicose veins and venous leg ulcers. Controls included patients with varicose veins but without venous leg ulcers. Data were collected using interviewer-administered telephone interviews and medical record abstraction. Multiple logistic regression analysis was used to identify the risk factors of venous ulceration. Results There were more females than males in both groups (72.5% of cases and 85.0 % of controls). Cases were on average older than controls (53.9 vs. 39.2 years old, p ≤ 0.001). After adjusting for potential confounders, the estimated odds of developing venous ulcer was higher in patients with history of post thrombotic syndrome (odds ratio = 14.90; 95% confidence interval: 3.95–56.19; p = 0.001), with higher average sitting time (odds ratio = 1.32 per hour of sitting time; 95% confidence interval: 1.08–1.61; p = 0.006), those with reflux in deep veins (odds ratio = 3.58; 95% confidence interval: 1.23–10.31; p = 0.019) and history of leg injury (odds ratio = 3.12; 95% confidence interval: 1.18–8.23; p = 0.022). Regular exercise in form of walking (≥5 days per week) was found to be a protective factor from venous ulceration (odds ratio = 0.26; 95% confidence interval: 0.08–0.90; p = 0.034). Conclusion We found that reflux in deep veins, history of leg injury, history of post thrombotic syndrome, and physical inactivity were significant risk factors for venous ulceration in patients with varicose veins, while regular physical exercise mitigated that risk. Future studies should investigate the relationships between the duration and type of regular exercise and the risk of venous ulceration to make more specific recommendations on preventing ulcer development.