bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative cerebral blood flow using xenon-enhanced CT after decompressive craniectomy in traumatic brain injury
Authors: Vedantam Aditya , Robertson Claudia S. , Gopinath Shankar P. 
Published: October 2017

OBJECTIVEFew studies have reported on changes in quantitative cerebral blood flow (CBF) after decompressive craniectomy and the impact of these measures on clinical outcome. The aim of the present study was to evaluate global and regional CBF patterns in relation to cerebral hemodynamic parameters in patients after decompressive craniectomy for traumatic brain injury (TBI).METHODSThe authors studied clinical and imaging data of patients who underwent xenon-enhanced CT (XeCT) CBF studies after decompressive craniectomy for evacuation of a mass lesion and/or to relieve intractable intracranial hypertension. Cerebral hemodynamic parameters prior to decompressive craniectomy and at the time of the XeCT CBF study were recorded. Global and regional CBF after decompressive craniectomy was measured using XeCT. Regional cortical CBF was measured under the craniectomy defect as well as for each cerebral hemisphere. Associations between CBF, cerebral hemodynamics, and early clinical outcome were assessed.RESULTSTwenty-seven patients were included in this study. The majority of patients (88.9%) had an initial Glasgow Coma Scale score ≤ 8. The median time between injury and decompressive surgery was 9 hours. Primary decompressive surgery (within 24 hours) was performed in the majority of patients (n = 18, 66.7%). Six patients had died by the time of discharge. XeCT CBF studies were performed a median of 51 hours after decompressive surgery. The mean global CBF after decompressive craniectomy was 49.9 ± 21.3 ml/100 g/min. The mean cortical CBF under the craniectomy defect was 46.0 ± 21.7 ml/100 g/min. Patients who were dead at discharge had significantly lower postcraniectomy CBF under the craniectomy defect (30.1 ± 22.9 vs 50.6 ± 19.6 ml/100 g/min; p = 0.039). These patients also had lower global CBF (36.7 ± 23.4 vs 53.7 ± 19.7 ml/100 g/min; p = 0.09), as well as lower CBF for the ipsilateral (33.3 ± 27.2 vs 51.8 ± 19.7 ml/100 g/min; p = 0.07) and contralateral (36.7 ± 19.2 vs 55.2 ± 21.9 ml/100 g/min; p = 0.08) hemispheres, but these differences were not statistically significant. The patients who died also had significantly lower cerebral perfusion pressure (52 ± 17.4 vs 75.3 ± 10.9 mm Hg; p = 0.001).CONCLUSIONSIn the presence of global hypoperfusion, regional cerebral hypoperfusion under the craniectomy defect is associated with early mortality in patients with TBI. Further study is needed to determine the value of incorporating CBF studies into clinical decision making for severe traumatic brain injury.
Hospital-acquired conditions: predictors and implications for outcomes following spine tumor resection
Authors: Lakomkin Nikita , Hadjipanayis Constantinos G. 
Published: October 2017

OBJECTIVEHospital-acquired conditions (HACs) significantly compromise patient safety, and have been identified by the Centers for Medicare and Medicaid Services as events that will be associated with penalties for surgeons. The mitigation of HACs must be an important consideration during the postoperative management of patients undergoing spine tumor resection. The purpose of this study was to identify the risk factors for HACs and to characterize the relationship between HACs and other postoperative adverse events following spine tumor resection.METHODSThe 2008–2014 American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify adult patients undergoing the resection of intramedullary, intradural extramedullary, and extradural spine lesions via current procedural terminology and ICD-9 codes. Demographic, comorbidity, and operative variables were evaluated via bivariate statistics before being incorporated into a multivariable logistic regression model to identify the independent risk factors for HACs. Associations between HACs and other postoperative events, including death, readmission, prolonged length of stay, and various complications were determined through multivariable analysis while controlling for other significant variables. The c-statistic was computed to evaluate the predictive capacity of the regression models.RESULTSOf the 2170 patients included in the study, 195 (9.0%) developed an HAC. Only 2 perioperative variables, functional dependency and high body mass index, were risk factors for developing HACs (area under the curve = 0.654). Hospital-acquired conditions were independent predictors of all examined outcomes and complications, including death (OR 2.26, 95% CI 1.24–4.11, p = 0.007), prolonged length of stay (OR 2.74, 95% CI 1.98–3.80, p < 0.001), and readmission (OR 9.16, 95% CI 6.27–13.37, p < 0.001). The areas under the curve for these models ranged from 0.750 to 0.917.CONCLUSIONSThe comorbidities assessed in this study were not strongly predictive of HACs. Other variables, including hospital-associated factors, may play a role in the development of these conditions. The presence of an HAC was found to be an independent risk factor for a variety of adverse events. These findings highlight the need for continued development of evidence-based protocols designed to reduce the incidence and severity of HACs.
Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual
Authors: Gershenwald Jeffrey E. , Scolyer Richard A. , Hess Kenneth R. , Sondak Vernon K. , Long Georgina V. , Ross Merrick I. , Lazar Alexander J. , Faries Mark B. , Kirkwood John M. , McArthur Grant A. , Haydu Lauren E. , Eggermont Alexander M. M. , Flaherty Keith T. , Balch Charles M. , Thompson John F. ,   for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform
Published: October 2017

AbstractAnswer questions and earn CME/CNETo update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8‐1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors “microscopic” and “macroscopic” for regional node metastasis are redefined as “clinically occult” and “clinically apparent”; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA‐IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in‐transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor‐involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence‐based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472‐492. © 2017 American Cancer Society.
Ruptures dans la filiation et transmissions lacunaires
Authors: Collins-Bur Sophie 
Published: October 2017

La famille est un lieu de transmission, et le groupe familial se crée à partir de l’héritage qui lui a été transmis. Lorsqu’il se produit une rupture dans la filiation, qu’elle soit généalogique ou génétique, cela donne lieu à une transmission lacunaire. Une famille suivie en thérapie familiale analytique viendra illustrer la manière dont ces transmissions lacunaires peuvent influer sur le groupe familial, notamment en ce qui concerne le contrat narcissique et la prise en charge de l’héritage en négatif. Elle montrera aussi comment l’affiliation peut combler ce qui fait lacune. Cet exemple clinique s’intéressera également au rôle joué par le mythe familial et la matrice de l’identité culturelle familiale dans le maintien du « nous » groupal familial.
Sur l’origine d’Ebola : discours biomédical versus interprétations populaires à Macenta en Guinée
Authors: Thys Séverine , Boelaert Marleen 
Published: October 2017

En décembre 2013, un enfant de deux ans meurt d’une fièvre hémorragique virale dans le village de Méliandou, dans le sud-est de la Guinée. C’est le cas index probable d’une épidémie de grande ampleur. Lorsque le virus Ebola fut formellement identifié, des épidémiologistes ont commencé à enquêter sur les chaînes de transmission, tandis que les populations locales ont essayé de donner un sens à ces décès. Les mesures de lutte mises en place par les organismes de santé nationaux et internationaux ont très vite rencontré de fortes réticences et une attitude parfois agressive des communautés touchées. Des enquêtes ethnographiques ont été réalisées à Macenta (région forestière) au cours d’une mission conduite d’octobre à novembre 2014 pour le Réseau mondial d’alerte et d’action en cas d’épidémie (GOARN) de l’Organisation Mondiale de la Santé (OMS). Observation participante, conversations informelles et entrevues approfondies ont été effectuées pour identifier les rumeurs et leurs sources, pour comprendre la perception de la population ainsi que ses connaissances sur l’histoire et l’origine de l’épidémie d’Ebola en Guinée. Les épidémiologistes impliqués dans la riposte ont attribué, les premiers morts d’Ebola dans la Région Forestière, à la transmission d’un virus par contact avec les fluides des patients. Mais certains citoyens guinéens ont cru que ces décès avaient été causés suite à la transgression d’un tabou. Évoluant principalement en parallèle, parfois se chevauchant, les explications épidémiologiques et populaires sont animées par différents modèles explicatifs, biomédicaux et traditionnels-religieux. La riposte doit être flexible et doit systématiquement documenter les discours populaires, rumeurs, codes, pratiques, connaissances et opinions relatifs à l’épidémie. La riposte doit alors utiliser cette information pour dessiner et adapter ses interventions de lutte.
L’hépatite C et la prison : une opportunité de soins ?
Authors: Hagège Meoïn 
Published: October 2017

La population carcérale est une population vulnérable, où les individus désaffiliés, précaires, en marge du système de santé sont surreprésentés et les prévalences de maladies infectieuses supérieures aux prévalences nationales. La mauvaise santé des personnes détenues et sortant de prison est un problème de santé publique peu étudié. Les parcours de santé de détenus vivant avec une hépatite C offre une étude de cas intéressante pour discuter les interventions de santé publique auprès de la population carcérale. Elle s’appuie sur une enquête socio-anthropologique auprès de détenus et de professionnels de santé carcérale. Ces parcours éclairent les expériences de la prise en charge et leurs contraintes économiques et sociales, matérielles, institutionnelles. Ils sont inscrits dans le contexte du débat public sur la santé carcérale. Deux types de positions y sont saillantes : celle de la « prison pathogène » et celle de la « prison soignante ». Ces positions permettent de mieux comprendre les enjeux des initiatives de santé publique qui visent à améliorer le soin d’une population vulnérable particulière, des personnes détenues et sortant de prison.
Moteurs et freins à la reconnaissance en maladie professionnelle des patients atteints de cancers bronchiques : une étude psychosociale
Authors: Britel Manon , Pérol Olivia , Blois Da Conceiçao Stéphanie , Ficty Manon , Brunet Houria , Avrillon Virginie , Charbotel Barbara , Fervers Béatrice 
Published: October 2017

Objectifs : Bien que 10 à 20 % des cancers bronchopulmonaires seraient liés au travail, 60 % d’entre eux ne seraient pas indemnisés en maladie professionnelle. La démarche de reconnaissance est souvent méconnue des patients, néanmoins d’autres facteurs peuvent expliquer cette sous-déclaration. L’objectif de cette étude était d’identifier les facteurs psychosociaux pouvant influencer le souhait des patients d’entreprendre une démarche de demande de reconnaissance. Méthodes : Une étude de cas réalisée à partir d’entretiens semi-directifs, analysés thématiquement, a été menée auprès de huit patients atteints d’un cancer bronchique, inclus dans une cohorte visant à repérer systématiquement les expositions professionnelles et à proposer le cas échéant une démarche de reconnaissance. Résultats : Sept patients interrogés connaissaient les cancers professionnels, néanmoins la plupart d’entre eux ne font pas de lien entre des expositions passées et leur maladie actuelle. Les patients ont évoqué une démarche longue, complexe, pour un enjeu souvent abstrait. Un attachement fort à l’entreprise a été mentionné par plusieurs d’entre eux. Conclusion : La démarche de reconnaissance est souvent perçue comme une procédure contre l’employeur pour les patients qui ne les jugent pas responsables de leur état. Le contexte du cancer bronchique est également un frein à la démarche, tant sur le plan des traitements lourds et des effets secondaires, du pronostic sombre à moyen terme, que le poids du tabagisme dans l’origine de cette pathologie. Face aux freins identifiés, la motivation financière et le rôle d’accompagnement des professionnels de santé sont des éléments pouvant favoriser la déclaration en maladie professionnelle.
Occuper les institutions
Authors: Lamant Ludovic 
Published: October 2017

Résumé En Espagne, six ans après le mouvement du 15-M, les « mairies du changement » ne renoncent pas l’ancrage local, qu’elles cultivent par culture politique ou fidélité à leurs idéaux « indignés ». Elles mêlent les échelles et donnent de la voix là où on ne les attend pas.
Corruption and the Challenges of Good Governance in the Nigerian Public Sector
Authors: Fatile Jacob Olufemi 
Published: October 2017

The role of the public service in achieving good governance cannot be underestimated. This can be gleaned from the central role it plays in the formulation and implementation of policies designed for the development of the society. In Nigeria, the role of public service has come under severe criticisms within the context of the gap that exists between its anticipated role and its actual output in guiding the society along the course leading to the desired goal as a result of corruption. This article observes that the fact that Nigeria is still grappling with the problems of bad governance goes to show the level of non-accountability and ever present manifestation of crude corruption that is open, naked, undisguised and yet legally untameable because of the system. The article also reveals that many of the anti-corruption efforts are part of the liberal reforms that are based on the assumption that corruption is an individual act or personal misuse of public office for private gain. It points out that as laudable as the intentions of government in putting in place institutions and laws meant to curb corruption, the enforcement of these laws has left much to be desired. In fact, the various reform efforts of the Nigerian government are of limited value because they fail to take into account much of the dynamics that support corruption in the country. Thus, people now regard the law as paper tigers, meant only to the enforced when breached by low-level public officers. While successive administrations have taken partially successful steps to control corruption, these efforts have not fundamentally undermined the supporting environmentfor corruption in the country. The article therefore recommends the need for greater transparency in the management of public funds by the public office holders as well as the need for political will and commitment from governments at Federal, State and Local, including bureaucracies at various levels of governance in the country. The article concludes that there is a need to transform social values as well as state institutions that work as enabling environments for corruption. The also has enormous responsibility in controlling corruption and restoring the hope to the citizenry goodgovernance. Unless good governance is in place with accountability carefully observed, sustainable development cannot be realized.
The State of Local Government and Service Delivery in Nigeria: Challenges and Prospects
Authors: Majekodunmi Aderonke 
Published: October 2017

Local government creates an appropriate and conduciveenvironment for the people at the local level through efficient and effective service delivery. The value of localgovernment in a country is inestimable because it is an indispensable arm of government. As a result, the link between the qualities of service that citizens enjoy is very significant. The article examines local government and effective service delivery with special reference to Nigerianlocal governments. It notes that Local government is the closest government<br />to the people at the grassroots level,so it is expected to play significant roles in providing the social services for the people in order to improve their standard of living. But in Nigeria, the impact of local government is so far limited, especially with regard to improving service delivery. The article observes that despite the strategic importance of local government to the development process through effective service delivery, there has not been much development in most local governments in Nigeria. The article recommends that local governments in Nigeria need adequate autonomy that can facilitate their operations and development of the localities through effective service delivery.
Assessing the Implementation Process of Consulting Citizen Participation in Policy and Housing Delivery in South Africa
Authors: Ssekibuule Henry J. 
Published: October 2017

This article aims to assess the implementation process of consulting citizen participation and conflicts involved in housing delivery against the environment of the South Africanhousing need and housing policy. In this way the study wants to clarify the relationship between housing policy and housing practice. The article is based on the legislations and policies designed to foster and promote public participation in South Africa. These include legislation at both the national and local government levels and a survey of planning departments measuring the types of public participation strategies used by local governments. The article’s findings indicate that South African Municipalities need adopt a broader range of public participation techniques related to: voluntarism and public engagement, neighbourhood and strategic planning, and e-government. In contrast, the article’s findings indicate that South African Municipalities are more likely to crumple if they do not promote public participation through mechanisms such as annual community meetings and referendums on public issues. The conclusion of the article offers recommendations for expanding the scope of public participation and developing strategies that maximize citizen input in community development activities in both the Provincial and local spheres of government. The survey was conducted to identify the scope of public participation techniques used by local governments and the Department of Housing in Tyutyu housing project located in the Buffalo city metropolitan municipality. It is an initiative which was started in the year 2000 with the aim of alleviating housing shortage in the area. Formerly, the area was made up of mud houses that were constructed by the former Ciskei government. Later on, shacks were added in the area. Originally, <br />these structures were meant to form agricultural rural village settlements. One limitation of this methodology is that it does not gauge the effectiveness of the participation techniques used by local governments and the department of housing or the intensity of public engagement. However, the results from this study provide future researchers with a mechanism for focusing future analysis. The findings can assist in identifying new directions for enhancing public participation in South Africa and globally.
Exploring Challenges of Municipal Service Delivery in South Africa (1994 - 2013)
Authors: Kanyane Modimowabarwa 
Published: October 2017

This article aims to explore municipal service delivery challenges in South Africa between 1994 and 2013 in order to stimulate debate in addressing problems and challenges confronting municipalities. A fundamental question to be asked stems from the challenges of municipal service delivery. Why, in spite of the existence of regulatory and institutional frameworks, are municipalities still struggling to satisfy basic community needs such as water and electricity amongst others? All of government’s official documents and contemporary literature reviewed, including the summative record of historical facts and narrative data, are evidence of the qualitative research design employed in this study. It is clearly articulated in this article that the existence of a local municipality with poor service delivery is, amongst others, a direct consequence or manifestation of municipal capacity constraints, financial viability problems, service delivery protests, convoluted political process, corruption and poor planning as well as monitoring and evaluation challenges. In the main, the article accounts for why service delivery has failed to meet the expectations of the communities and thereby provide some possible propositions for consideration to attempt to bring a resolve to critical issues raised.
Curbing Kidnapping in Nigeria: An Exploration of Strategic Peace Building Tools
Authors: Ani Kelechi Johnmary , Nweke Eugene Ndubuisi 
Published: October 2017

The increasing growth of kidnapping inNigeria has become a strong threat tonational peace and security. It has affected the national image of the state and has eaten deep into every region and segmentof the nation. This work unveils howidentity fanaticism and political violence led to emergence of economy of violence referred as "kidnapping” in Nigeria. Upon this circumstance, the paper argues that peace building is a potent strategic tool that can eliminates kidnapping and other terror related crime from Nigeria by ensuring that violent actors and their sponsors embrace peace while exploring other non-violent mechanisms for resolving such differences that trigger kidnapping in the Nigerian state. It adds that adequate public information process, a behavioural change messages and actions that return the mindsets of of kidnapping into the life of rule of law and peaceful coexistence, eliminates the network of organized crime used by kidnappers to carry out its nefarious activities. Essentially eradication of kidnapping restores security climate for establishment of democratic culture, promotion of national development, and foreign direct investment.