bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework
Authors: Marshall Martin , Cruickshank Lesley , Shand Jenny , Perry Sarah , Anderson James , Wei Li , Parker Dianne , de Silva Debra 
Published: April 2017

BackgroundUnderstanding the cultural characteristics of healthcare organisations is widely recognised to be an important component of patient safety. A growing number of vulnerable older people are living in care homes but little attention has been paid to safety culture in this sector. In this study, we aimed to adapt the Manchester Patient Safety Framework (MaPSaF), a commonly used tool in the health sector, for use in care homes and then to test its face validity and preliminary feasibility as a tool for developing a better understanding of safety culture in the sector.MethodsAs part of a wider improvement programme to reduce the prevalence of common safety incidents among residents in 90 care homes in England, we adapted MaPSaF and carried out a multimethod participatory evaluation of its face validity and feasibility for care home staff. Data were collected using participant observation, interviews, documentary analysis and a survey, and were analysed thematically.ResultsMaPSaF required considerable adaptation in terms of its length, language and content in order for it to be perceived to be acceptable and useful to care home staff. The changes made reflected differences between the health and care home sectors in terms of the local context and wider policy environment, and the expectations, capacity and capabilities of the staff. Based on this preliminary study, the adapted tool, renamed ‘Culture is Key’, appears to have reasonable face validity and, with adequate facilitation, it is usable by front-line staff and useful in raising their awareness about safety issues.Conclusions‘Culture is Key’ is a new tool which appears to have acceptable face validity and feasibility to be used by care home staff to deepen their understanding of the safety culture of their organisations and therefore has potential to contribute to improving care for vulnerable older people.
Noise level and its influences on dental professionals in a dental hospital in Hong Kong
Authors: Ai ZT , Mak CM , Wong HM 
Published: April 2017

Noise is recognized as one of the major indoor environmental issues in dental settings. This study presents the noise measurements and questionnaire surveys conducted in the clinics for pediatric dentistry and laboratories in the Prince Philip Dental Hospital in Hong Kong. Noise level and octave noise spectrum were measured at 60 locations distributed around the working areas. Totally, 60 valid questionnaires were collected, of which 30 were completed by dental surgery assistants and 30 by laboratory technicians. Data were coded and analyzed statistically using SPSS 19.0. The average noise levels in the dental clinics and laboratories were 62.6 dB(A) and 67.7 dB(A), respectively, which are well below the limit of 85 dB(A) for causing hearing loss. Statistical analysis shows that there is a significant difference in hearing status (condition of hearing ability) between different gender, age and occupation groups. Among others, noise generated by the equipment operated by others presents a principal influence on dental professionals. Importantly, suddenness and frequency of noise occurrence, rather than noise level, produce a significant influence on dental works. Most dental professionals work routinely and do not take any precautions or actions against noise at work. Practical application: The findings of this study should first increase the understanding of acoustical environment in dental settings for clinicians and its influence on dental professionals and second help designers and engineers improve the acoustical environment in dental settings.
The Role of the Legal Profession in the South African Truth and Reconciliation Commission
Authors: Rombouts Heidy , Parmentier Stephan 
Published: April 2017

In situations of a transition to democracy, the legal profession tends to have a strong impact. While this is quite clear in the case when criminal prosecutions are initiated against perpetrators of gross human rights violations, and when amnesty provisions are enacted for some violations, it is far less obvious in cases when a truth commission is set up. The current article looks into the role that the legal profession, i.e. the judiciary, the bar and the non-governmental organisations, has played in the notorious case of the South African Truth and Reconciliation Commission (TRC). It draws on the systems analysis of political life by David Easton, which identifies how demands (input) that rise in society, are processed (conversion) and produce results (output), which provide new inputs to the political system. This ‘flow model’ is applied to two separate processes during the life of the TRC: the Special Legal Hearing of October 1997, and the legal challenges put to the Commission in Court in 1996. Our analysis reveals a number of interesting conclusions. One is that the organised profession approached the Special Legal Hearing from a very legalistic point of view, despite the non-judicial character of the Truth and Reconciliation Commission at large. This stands in contrast with the position of the Constitutional Court, which recognised the limits of the traditional judicial system and came out in support of the TRC. Another conclusion is that, although the participation of the judges and the magistrates in the Special Legal Hearing was limited to written submissions, their influence proved very large, as they threatened the TRC with a constitutional crisis. Finally, throughout the two processes under review, breaches became visible within the legal profession, between the ‘progressive’ non-governmental organisations and the ‘conservative’ organised profession on the one hand, and between the organised profession on the one hand and the judges on the other hand. In sum, it can convincingly be concluded that the impact of the legal profession remains quite important when a truth commission is opted for in a context of transition to democracy.
Completing the UN Complaint Mechanisms for Human Rights Violations Step by Step: Towards a Complaints Procedure Complementing the International Covenant on Economic, Social and Cultural Rights
Authors: Vandenhole Wouter 
Published: April 2017

With the entry into force of the Optional Protocol to CEDAW in 2000, four of the six main UN human rights treaties are now complemented with an individual complaints procedure. The proposal to establish an individual complaints mechanism for economic, social and cultural rights (ESCR) meets with considerable political opposition. Progress has been jeopardised by an ongoing discussion on the nature of ESCR, which are still very often considered as second-class human rights. It is submitted here that the two main issues of debate – justiciability and the nature of the obligations of States – have been sufficiently clarified in recent years in order to allow for individual complaints. Ongoing reluctance to establish an individual complaints procedure for ESCR can therefore no longer convincingly be based on legal motives. A new impetus to the debate on the establishment of an individual complaints procedure for ESCR was given in 2001, with the appointment of an independent expert, and in 2003, with the establishment of an open-ended working group. The suggested amendments to the draft for an Optional Protocol as prepared by the ESCR-Committee in 1996, may assist the working group in bringing the draft Optional Protocol in line with changed circumstances since 1996, with particular reference to the OP-CEDAW.
The African Charter and Commission on Human and Peoples' Rights; How to Make it More Effective
Authors: Benedek Wolfgang 
Published: April 2017

This contribution discusses how to improve the African system of human and peoples' rights on the basis both of the practice of the African Commission and of a revision of the African Charter in the light of the practice and experience of other regional human rights conventions and bodies. Particular emphasis is put on improvements in the procedure of communications. Furthermore, the role of the African Commission with regard to the move towards democracy and human rights in Africa and the relationship between the Commission and the OAU will be analyzed, and a number of proposals on strengthening the African Charter and the African Commission will be made. In presenting the actual situation of the African Commission particular attention is given to the results of the 11th and 12th sessions (March and October 1992 respectively) of the African Commission which in respect to some concerns were breaking new ground.
Agreement between MRI and pathologic analyses for determination of tumor size and correlation with immunohistochemical factors of invasive breast carcinoma
Authors: Yoo Eun Young , Nam Sang Yu , Choi Hye-Young , Hong Min Ji 
Published: April 2017

Background There may be discordance between tumor size determined by magnetic resonance imaging (MRI) and that observed during pathologic analyses. Purpose To evaluate MRI-pathology concordance of tumor size in patients with invasive breast carcinoma. Material and Methods Data from 307 invasive breast carcinomas were analyzed retrospectively. Preoperative breast MRI was reviewed for size, lesion type, morphology, and dynamic contrast-enhanced tumor kinetics. MRI tumor size was compared with tumor size measurements from the pathologic analysis. Concordance was defined as a difference in diameter of ≤ 0.5 cm. MRI-pathology concordance was compared according to clinical and histopathologic features. Results The mean tumor size on MRI was 2.48 ± 1.41 cm. Tumor measurements determined by MRI were not significantly different from those recorded in the pathologic reports (2.56 ± 1.61 cm, P = 0.199). MRI-pathology concordance was found in 229/307 (74.6%) cases; the size was overestimated in 36 (11.7%) tumors and underestimated in 42 (13.7%). On univariate analysis, MRI-pathology discordance was associated with larger tumor size ( P < 0.001), estrogen receptor (ER) negativity ( P = 0.006), and lymphovascular invasion ( P = 0.003). Human epidermal growth factor receptor 2 positive molecular subtype showed worse correlation between the tumor size measured by MRI and pathology compared with luminal A and luminal B subtypes ( P = 0.008 and 0.007). On multivariate analysis, tumor size and ER status significantly influenced MRI-pathology concordance ( P < 0.05). Conclusion ER negativity and larger tumor size were strongly associated with MRI-pathology discordance in invasive breast carcinomas. Awareness of these factors might improve surgical planning.
Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes
Authors: Nakagawa Shigeto , Mae Tatsuo , Yoneda Kenji , Kinugasa Kazutaka , Nakamura Hiroyuki 
Published: April 2017

Background: The usefulness of arthroscopic Bankart repair for collision/contact athletes has varied in previous reports. Purpose: To investigate the influence of glenoid rim morphologic characteristics on the clinical outcome after arthroscopic Bankart repair without additional reinforcement procedures in male collision/contact athletes, including athletes with a large glenoid defect. Study Design: Case-control study; Level of evidence, 3. Methods: Eighty-six athletes (93 shoulders) followed for a minimum of 2 years were retrospectively investigated. The sports were rugby (36 shoulders), American football (29 shoulders), and other collision/contact sports (28 shoulders). Preoperative glenoid defect size, bone fragment size, and bone union after bony Bankart repair were investigated regarding factors influencing postoperative recurrence. Postoperative changes in glenoid defect size and bone fragment size were investigated as well as their influence on the clinical outcome. Results: Postoperative recurrence of instability was noted in 22 shoulders (23.7%). The recurrence rate was 33.3% in rugby, 17.2% in American football, and 17.9% in other collision/contact sports. The recurrence rate was only 7.1% in 28 shoulders without a preoperative glenoid defect, but it increased to 43.8% in 16 shoulders that did not have a bone fragment even though there was a preoperative glenoid defect. Additionally, the recurrence rate was 7.7% in 26 shoulders with bone union after arthroscopic bony Bankart repair but rose to 45% in 20 shoulders without bone union. In the shoulders with bone union, the mean bone fragment size increased from 8.2% preoperatively to 15.2% postoperatively, while the mean glenoid defect size decreased from 18.0% to 2.8%, respectively. The recurrence rate was 8.3% in shoulders with a final glenoid defect 5% or less versus 38.1% in shoulders with a defect greater than 5%. While the recurrence rate was low among athletes other than rugby players with a final defect of 10% or less, it was low in only the rugby players with a defect of 0%. Conclusion: In male collision/contact athletes, while the overall clinical outcome was unsatisfactory, a favorable outcome was achieved in athletes without a preoperative glenoid defect and athletes with bone union. The glenoid defect decreased in size postoperatively due to remodeling of the united bone fragment, and the recurrence rate was low when the final glenoid defect size was 5% or less.
Remifentanil for Sedation of Children With Traumatic Brain Injury
Authors: Hungerford James L. , O’Brien Nicole , Moore-Clingenpeel Melissa , Sribnick Eric A. , Sargel Cheryl , Hall Mark , Leonard Jeffrey R. , Tobias Joseph D. 
Published: April 2017

Objective: To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. Design: Retrospective review. Setting: Tertiary care PICU. Patients: Thirty-eight patients over a 30-month period. Measurements and Main Results: Median age was 9 years (interquartile range [IQR] 2.25-12 years). The median Glasgow Coma Scale (GCS) was 9 (IQR: 8-10). All patients were tracheally intubated and receiving mechanical ventilation. A continuous infusion of remifentanil was started at 0.1 μg/kg/min, and bolus doses of 0.25 to 1 μg/kg were administered every 3 to 5 minutes as needed to reach the desired sedation level. Infusions were stopped at least hourly to perform neurologic examinations. The median remifentanil dose was 0.25 μg/kg/min with an IQR of 0.1 and 0.6 μg/kg/min. The maximum dose for any patient in the cohort was 2 μg/kg/min. Median duration of therapy with remifentanil was 20 hours (IQR: 8-44 hours). Adequate sedation was achieved with sedation scores (State Behavioral Scale) meeting target levels with a median value of 100% of the time (IQR: 79%-100%). Neurologic examinations were able to be performed within a median of 9 minutes (IQR: 5-14 minutes) of pausing the infusion. No serious safety events occurred. In 68% of the patients, neurologic examinations remained reassuring during remifentanil infusion, and patients were extubated. The remaining patients were transitioned to traditional sedative agents for long-term management of their traumatic injuries once the neurologic status was deemed stable. Conclusion: This data suggest that remifentanil is a suitable sedative agent for use in children with TBI. It provides a rapid onset of sedation with recovery that permits reliable and reproducible clinical examination.
Guarding the “Southern Border” in Communist Bulgaria: Policies, Practices, Experiences
Authors: Vukov Nikolai 
Published: April 2017

This article is part of the special section titled From the Iron Curtain to the Schengen Area, guest edited by Wolfgang Mueller and Libora Oates-Indruchová. Soon after the establishment of communist rule in Bulgaria, the state’s “Southern border” (with Turkey and Greece) became its most staunchly guarded borderline, stimulated by the ideological interpretation of the two countries as imperialist states that posed a direct threat to the entire socialist bloc. Since the early 1960s—copying the strategies applied to the Berlin Wall—various new measures were introduced by the communist state to make this borderline even more impermeable, involving the actions of military institutions, propaganda units, and the local population. The current article analyzes the guarding of the “Southern border” in communist Bulgaria and interprets it as an element of the overall strategy of these years to put borderline areas under strict supervision and control. The article presents the main steps in the organization of Border Troops in Bulgaria after 1944 and the various political, educational, and cultural policies developed by the communist state to create loyalty among the soldiers, the military staff, and the population in general. On the basis of archival materials, published memoirs, and literary texts, the article reconstructs the maintenance of constant alert about illegal trespassing, the organization of “voluntary troops” for border-guarding, the training of the young generations, and the romanticizing of the border guard service in those years. In the last part, emphasis is paid to the discrepancies between the propaganda messages and the reactions of the local population, which outline the multi-faceted encounters with ideological policies at the edges of this staunchly guarded world.
Cross-sectional quantitative RT-PCR study of feline coronavirus viremia and replication in peripheral blood of healthy shelter cats in Southern California
Authors: Fish Eric J , Diniz Pedro Paulo VP , Juan Yen-Chen , Bossong Frank , Collisson Ellen W , Drechsler Yvonne , Kaltenboeck Bernhard 
Published: April 2017

Objectives The objectives of this study were to determine the prevalence of feline coronavirus (FCoV) viremia, and its replication in peripheral blood using quantitative RT-PCR (qRT-PCR) methodology in a population of 205 healthy shelter cats in Southern California, as well as to assess any possible connection to longitudinal development of feline infectious peritonitis (FIP). Methods The study was performed on buffy-coat samples from EDTA-anticoagulated whole blood samples of 205 healthy shelter cats. From 50 of these cats, fecal samples were also examined. FCoV genomic and subgenomic RNA in the buffy coats was amplified by a total FCoV RNA qRT-PCR. Evidence for FCoV replication in peripheral blood and feces was obtained by M gene mRNA qRT-PCR. Results Nine of 205 cats (4.4%) were viremic by the total FCoV RNA qRT-PCR, and one of these cats had evidence of peripheral FCoV blood replication by an FCoV mRNA qRT-PCR. The single cat with peripheral blood replication had a unique partial M gene sequence distinct from positive controls and previously published FCoV sequences. Neither seven of the nine viremic cats with follow-up nor the single cat with replicating FCoV with positive qRT-PCR results developed signs compatible with FIP within 6 months of sample collection. Conclusions and relevance FCoV viremia and peripheral blood replication in healthy shelter cats have a low prevalence and do not correlate with later development of FIP in this study population, but larger case-control studies evaluating the prognostic accuracy of the qRT-PCR assays are needed.
Clinical characteristics of unknown symptom onset stroke patients with and without diffusion-weighted imaging and fluid-attenuated inversion recovery mismatch
Authors: Thomalla Götz , Boutitie Florent , Fiebach Jochen B , Simonsen Claus Z , Pedraza Salvador , Lemmens Robin , Nighoghossian Norbert , Roy Pascal , Muir Keith W , Ebinger Martin , Ford Ian , Cheng Bastian , Galinovic Ivana , Cho Tae-Hee , Puig Josep , Thijs Vincent , Endres Matthias , Fiehler Jens , Gerloff Christian 
Published: April 2017

Background Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch was suggested to identify stroke patients with unknown time of symptom onset likely to be within the time window for thrombolysis. Aims We aimed to study clinical characteristics associated with DWI-FLAIR mismatch in patients with unknown onset stroke. Methods We analyzed baseline MRI and clinical data from patients with acute ischemic stroke proven by DWI from WAKE-UP, an investigator-initiated, randomized, placebo-controlled trial of MRI-based thrombolysis in stroke patients with unknown time of symptom onset. Clinical characteristics were compared between patients with and without DWI-FLAIR mismatch. Results Of 699 patients included, 418 (59.8%) presented with DWI-FLAIR mismatch. A shorter delay between last seen well and symptom recognition (p = 0.0063), a shorter delay between symptom recognition and arrival at hospital (p = 0.0025), and history of atrial fibrillation (p = 0.19) were predictors of DWI-FLAIR mismatch in multivariate analysis. All other characteristics were comparable between groups. Conclusions There are only minor differences in measured clinical characteristics between unknown symptom onset stroke patients with and without DWI-FLAIR mismatch. DWI-FLAIR mismatch as an indicator of stroke onset within 4.5 h shows no relevant association with commonly collected clinical characteristics of stroke patients. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01525290; URL: https://www.clinicaltrialsregister.eu . Unique identifier: 2011-005906-32.
Beyond Pelvic Incidence–Lumbar Lordosis Mismatch: The Importance of Assessing the Entire Spine to Achieve Global Sagittal Alignment
Authors: Merrill Robert K. , Kim Jun S. , Leven Dante M. , Kim Joung Heon , Cho Samuel K. 
Published: April 2017

Study Design: Retrospective case series. Objective: To investigate which sagittal parameters contribute to a normal sagittal vertical axis (SVA) when there is a pelvic incidence-lumbar lordosis (PI-LL) mismatch >10° following adult spinal deformity (ASD) correction. Methods: We performed a retrospective review of ASD patients with >5 levels fused. Sagittal measurements between cohorts of postoperative PI-LL >10° and PI-LL<10° were compared. We correlated SVA to pelvic tilt (PT), thoracic kyphosis (TK), PI-LL, cervical lordosis (CL), and correlated the pre- to postoperative change in SVA to change in PT, change in TK, change in PI-LL, and change in CL. We also correlated SVA and the change in SVA to combined parameters of ((PI-LL) − PT + TK). Results: We analyzed 52 patients with a mean age of 59 ± 16 years. In patients with a postoperative SVA <5cm, a smaller TK was seen when PI-LL >10° than when PI-LL<10° (15.45° vs 33.04°, P = .0004). Additionally, PT was larger when PI-LL >10° than when PI-LL <10° (25.73° vs 19.07°, P = .006). SVA correlated better with ((PI-LL) − PT + TK) ( R2 = 0.51) than with PI-LL alone ( R2 = 0.33). Lastly, there was no significant correlation between change in pre- to postoperative SVA with change in TK for all cases ( P = .73), but in cases where change in PI-LL was <10°, there was a significant correlation between change in TK and change in SVA ( P = .009). Conclusion: Our results demonstrate that PT and TK, and not just PI-LL, play an important role in maintaining sagittal balance when there is a PI-LL mismatch >10°.