bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laryngeal mask placement in a teaching institution: analysis of difficult placements
Authors: Katsiampoura Anastasia D , Killoran Peter V , Corso Ruggero M , Cai Chunyan , Hagberg Carin A , Cattano Davide 
Published: April 2015

Background: Laryngeal mask airway (LMA) placement is now considered a common airway management practice. Although there are many studies which focus on various airway techniques, research regarding difficult LMA placement is limited, particularly for anesthesiologist trainees. In our retrospective analysis we tried to identify predictive factors of difficult LMA placement in an academic training program.Methods: This retrospective analysis was derived from a research airway database, where data were collected prospectively at the Memorial Hermann Hospital, Texas Medical Center, Houston, TX, USA, from 2008 to 2010. All non-obstetric adult patients presenting for elective surgery requiring general anesthesia, were enrolled in this study: anesthesiology residents primarily managed the airways. The level of difficulty, number of attempts, and type of the extraglottic device placement were retrieved.Results: Sixty-nine unique Laryngeal Mask Airways (uLMAs) were utilized as a primary airway device. Two independent predictors for difficult LMA placement were identified: gender and neck circumference. The sensitivity for one factor is 87.5% with a specificity of 50%. However with two risk factors, the specificity increases to the level of 93% and the sensitivity is 63%.Conclusion: In a large academic training program, besides uLMA not been used routinely, two risk factors for LMA difficulty were identified, female gender and large neck circumference. Neck circumference is increasingly being recognized as a significant predictor across the spectrum of airway management difficulties while female gender has not been previously reported as a risk factor for difficult LMA placement.
Spontaneously Developed Bisphosphonate Related Osteonecrosis of the Jaws: Three Cases
Authors: Ates Ufuk , Gulsahi Ayse 
Published: April 2015

Aim: The aim of this case report is to present the clinical and radiologic diagnose of the spontaneously developed bisphosphonate-related osteonecrosis of the jaws in the edentulous patients.
Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a common side effect of long term bisphosphonate therapy. It is characterized with the presence of exposed necrotic bone appearing in the jaws of patients treated bisphosphonates never irradiated in the head and neck area. BRONJ lesions may occur spontaneously or at the site of a dentoalveolar procedure. Clinically evident lesions are confirmed through radiographs showing poorly defined radiolucent- radiopaque lesions. At present, no predictable remedy is available for BRONJ.
Case Description: Three edentulous male patients were referred to our clinic for non-healing defect in the posterior region of the mandible. Medical anamnesis revealed prostate carcinoma and the use of zoledronate (Zometa). Clinical examinations showed oval shaped defect or exposed necrotic bone. Digital panoramic radiographs revealed destructive radiolucent area. Biopsy was performed for the exclusion of the metastic disease and revealed inflammation consistent with osteomyelitis. Treatment protocol included systemic antibiotic therapy and conservative surgical treatment.
Clinical Significance: BRONJ should be mentioned that presence of exposed necrotic bone or non-healing oral mucosa in patients with a history of bisphosphonate use without a history of dentoalveolar procedures.
Primary Anorectal Melanoma-Uncommon Entity and Rare Presentation
Authors: Malhotra Parveen , Malhotra Naveen , Malhotra Vani , Chugh Ajay , Dahiya Abhisekh Hemant 
Published: April 2015

Background: Malignant melanomas of the gastrointestinal (GI) tract are usually metastatic. Primary malignant melanoma of the GI tract is rare and occurs mainly in the anorectum and esophagus, but can also involve stomach rarely. Case: We report a case of 65-year-old female who presented with short duration of anemia but on detailed evaluation had primary Anorectal melanoma (ARM) with extensive metastasis. Conclusion: An evaluation of short duration of anemia led to unexpected widely metastasized primary anorectal melanoma. Hence anemia presenting at old age should be evaluated in detail including endoscopy of whole gastro-intestinal tract to rule out malignancy.
Inferior epigastric artery pseudoaneurysms
Authors: Edwards KJ , Avula SK , Babu BDH , England RA 
Published: April 2015

IntroductionInferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication.MethodsWe describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000.FindingsThe main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique.ConclusionsThe incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.
Human factors in decision making in major trauma in Camp Bastion, Afghanistan
Authors: Arul GS , Pugh HEJ , Mercer SJ , Midwinter MJ 
Published: April 2015

Introduction The concentration of major trauma experience at Camp Bastion has allowed continuous improvements to occur in the patient pathway from the point of wounding to surgical treatment. These changes have involved clinical management as well as alterations to the physical layout of the hospital, training and decision making. Consideration of the human factors has been a major part of these improvements. Methods We describe the Camp Bastion patient pathway with the communication template that focused decision making at various key moments during damage control resuscitation and damage control surgery (DCR–DCS). This system identifies four key stages: ‘command huddle’, ‘snap brief’, ‘sit-reps’ (situation reports) and ‘sign-out/debrief’. The attitude of staff to communication and decision making is also evaluated. Results Twenty cases admitted to Camp Bastion with battlefield injuries were studied from 6 September to 6 October 2012. Qualitative responses from 115 members of staff were collected. All patients were haemodynamically shocked with a median pH of 7.25 (range: 6.83–7.40) and a median of 18 units of mixed red cells and plasma were transfused. In 89% of instances, theatre staff were aware of what was required of them at the beginning of the case, 86% felt there were regular updates and 93% understood what was required of them as the case progressed. Conclusions The evolution of the hospital at Camp Bastion has been a unique learning experience in the field of major trauma. The Defence Medical Services have responded with continuous innovation to optimise DCR–DCS for seriously injured patients. Together with the improvements in clinical care, a communication and decision making matrix was developed. Staff evaluation showed a high degree of satisfaction with the quality of communication.
Implementation of a novel emergency surgical unit significantly improves the management of gallstone pancreatitis
Authors: Bokhari S , Kulendran M , Liasis L , Qurashi K , Sen M , Gould S 
Published: April 2015

Introduction Emergency surgery is changing rapidly with a greater workload, early subspecialisation and centralisation of emergency care. We describe the impact of a novel emergency surgical unit (ESU) on the definitive management of patients with gallstone pancreatitis (GSP). Methods A comparative audit was undertaken for all admissions with GSP before and after the introduction of the ESU over a six-month period. The impact on compliance with British Society of Gastroenterology (BSG) guidelines was assessed. Results Thirty-five patients were treated for GSP between December 2013 and May 2014, after the introduction of the ESU. This was twice the nationally reported average for a UK trust over a six-month period. All patients received definitive management for their GSP and 100% of all suitable patients received treatment during the index admission or within two weeks of discharge. This was a significantly greater proportion than that prior to the introduction of the ESU (57%, p=0.0001) as well as the recently reported national average (34%). The mean length of total inpatient stay was reduced significantly after the ESU was introduced from 13.7 ± 4.7 days to 7.8 ± 2.1 days (p=0.03). The mean length of postoperative stay also fell significantly from 6.7 ± 2.6 days to 1.8 ± 0.8 days (p=0.001). Conclusions A dedicated ESU following national recommendations for emergency surgery care by way of using dedicated emergency surgeons and a streamlined protocol for common presentations has been shown by audit of current practice to significantly improve the management of patients presenting to a busy district general hospital with GSP.
Why authors have to use a rigid format for their journal articles
Authors: Heseltine E 
Published: April 2015

‘Proper words in proper places make the true definition of style.’ Jonathan Swift Medical writing is a creative process. It combines rhetoric and science to produce a piece of work that connects the scientific community with the general public. However, despite pressure to publish, many researchers dread the thought of medical writing. It can be an intimidating journey and hard work – and after all, where does one learn how to write a good science paper? Is there a recipe for success? The answer lies in the IMRaD (Introduction, Methods, Results and Discussion) structure. This allows authors to organise and structure their work in an effective manner, which maintains the emphasis on the matter of good science. Some may think applying such a structure is too formulaic and breeds mediocrity. Others may believe IMRaD allows authors to organise thoughts and ideas as well as helping them to remember to convey critical elements. That it makes evaluation of a manuscript easier for editors and reviewers and also allows readers to locate specific information without going through the entire article is less contentious. Although the IMRaD structure may not reflect the order of scientific enquiry and activities, most journals continue to apply it to medical articles. It appears that having such a discipline to writing opens the doors to those who have not yet overcome their writer’s block. In the third article of the publishing series, Elisabeth Heseltine informs readers ‘how to write’. Elisabeth became a scientific editor through science rather than language. She has worked as a researcher on the BBC science programme Horizon, as a proof-reader and then as a copy-writer. She is head of publications at the World Health Organization International Agency for Research on Cancer, in Lyon, France. She has edited many documents for other United Nations agencies and for research institutes around the world. She also runs workshops in scientific communication in over 30 countries. JYOTI SHAH Commissioning Editor
Causality and Unification: How Causality Unifies Statistical Regularities
Authors: Schurz Gerhard 
Published: April 2015

Two key ideas of scientific explanation - explanations as causal information and explanation as unification - have frequently been set into mutual opposition. This paper proposes a "dialectical solution" to this conflict, by arguing that causal explanations are preferable to non-causal explanations because they lead to a higher degree of unification at the level of the explanation of statistical regularities. The core axioms of the theory of causal nets (TC) are justified because they give the best if not the only unifying explanation of two statistical phenomena: screening off and linking up. Alternative explanation attempts are discussed and it is shown why they don't work. It is demonstrated that not the core of TC but extended versions of TC have empirical content, by means of which they can generate independently testable predictions.
Next steps for electronic health records to improve the diagnostic process
Authors: Liebovitz David 
Published: April 2015

Abstract
Electronic health record (EHR) usage is accelerating while preventable diagnostic error persists. EHRs may even contribute to diagnostic error through several pathways including poor usability and an over reliance on electronic chart based communication. The changing context of healthcare delivery offers potential financial incentives for organizations to leverage EHRs to reduce diagnostic error. The lack of standard quality metrics for reporting rates of diagnostic error, a lack of diagnostic feedback systems for physicians and organizations, and a lack of compelling evidence for specific interventions underscore the need for further research in preventing diagnostic error. Many potential strategies exist for EHRs to reduce the likelihood of diagnostic error. Practical next steps for leveraging EHR systems to assist in the diagnostic process are suggested. These include patient engagement strategies, closed loop result tracking, targeted next step reminder systems, and expansion of a list of actionable patient states based on diagnosis triggers.
Harmonization of clinical laboratories in Africa: a multidisciplinary approach to identify innovative and sustainable technical solutions
Authors: Putoto Giovanni , Cortese Antonella , Pecorari Ilaria , Musi Roberto , Nunziata Enrico 
Published: April 2015

Abstract

Background: In an effective and efficient health system, laboratory medicine should play a critical role. This is not the case in Africa, where there is a lack of demand for diagnostic exams due to mistrust of health laboratory performance. Doctors with Africa CUAMM (Collegio Universitario Aspiranti Medici Missionari) is a non-profit organization, working mainly in sub-Saharan Africa (Angola, Ethiopia, Mozambique, Sierra Leone, South Sudan, Tanzania and Uganda) to help and sustain local health systems. Doctors with Africa CUAMM has advocated the need for a harmonized model for health laboratories to assess and evaluate the performance of the facilities in which they operate.

Methods: In order to develop a harmonized model for African health laboratories, previous attempts at strengthening them through standardization were taken into consideration and reviewed. A survey with four Italian clinicians experienced in the field was then performed to try and understand the actual needs of health facilities. Finally a market survey was conducted to find new technologies able to update the resulting model.

Results: Comparison of actual laboratories with the developed standard – which represents the best setting any African health laboratory could aim for – allowed shortcomings in expected services to be identified and interventions subsequently prioritized. The most appropriate equipment was proposed to perform the envisaged techniques. The suitability of appliances was evaluated in consideration of recognized international recommendations, reported experiences in the field, and the availability of innovative solutions that can be performed on site in rural areas, but require minimal sample preparation and little technical expertise.

Conclusions: The present work has developed a new, up-to-date, harmonized model for African health laboratories. The authors suggest lists of procedures to challenge the major African health problems – HIV/AIDS, malaria, tubercolosis (TB) – at each level of pyramidal health system. This model will hopefully support the non-governmental organization (NGO) Doctors with Africa CUAMM in its activities in sub-Saharan hospitals, providing them with a guideline to programme future interventions.
Underage drinking: does the minimum age drinking law offer enough protection?
Authors: Green Rivka , Jason Hannah , Ganz Debora 
Published: April 2015

Abstract
Underage drinking is a significant problem in the US. It is responsible for several thousand mortalities and fatalities each year, both among minors and other members of society. Additionally, underage alcohol consumption produces a severe economic burden in the US. Introduction to alcohol in youth poses serious long-term risks for adolescents, including occupational, educational, and psychosocial impairments, and increases the risk for developing alcohol abuse disorders in adulthood. In order to address and mitigate this problem, the US has set a minimum age drinking law of 21 in all 50 states, and has implemented several supplementary laws limiting the possession and consumption of alcohol. Though these laws have successfully reduced underage drinking, several additional strategies are noteworthy, including preventative and intervention efforts incorporating environmental, individual, communal, and parental factors. The following literature review describes these concepts as they relate to underage drinking laws in the US. Directions for future research, interventions, and ongoing challenges related to the minimum drinking age in the US are also discussed.
Comparison of Splitting Methods on Survival Tree
Authors: Shimokawa Asanao , Kawasaki Yohei , Miyaoka Etsuo 
Published: April 2015

AbstractWe compare splitting methods for constructing survival trees that are used as a model of survival time based on covariates. A number of splitting criteria on the classification and regression tree (CART) have been proposed by various authors, and we compare nine criteria through simulations. Comparative studies have been restricted to criteria that suppose the survival model for each terminal node in the final tree as a non-parametric model. As the main results, the criteria using the exponential log-likelihood loss, log-rank test statistics, the deviance residual under the proportional hazard model, or square error of martingale residual are recommended when it appears that the data have constant hazard with the passage of time. On the other hand, when the data are thought to have decreasing hazard with passage of time, the criterion using the two-sample test statistic, or square error of deviance residual would be optimal. Moreover, when the data are thought to have increasing hazard with the passage of time, the criterion using the exponential log-likelihood loss, or impurity that combines observed times and the proportion of censored observations would be the best. We also present the results of an actual medical research to show the utility of survival trees.
Cross-cultural Adaption and Validity of the “Patient Specific Functional Scale” / Kulturelle Adaption und Validierung der deutschen Version der “Patient Specific Functional Scale”
Authors: Heldmann Patrick , Schöttker-Königer Thomas , Schäfer Axel 
Published: April 2015

Abstract
Objective: Measurement of activity and participation related outcomes play an important role in rehabilitation of low back pain. Therefore the „Patient Specific Functional Scale»(PSFS) was developed to assess individual, patient related activities. The aim of this study is the cultural adaptation and validation of the PSFS for German speaking countries.
Method: A cultural translation and adaptation process was carried out in accordance with standardized guidelines. The internal and external responsiveness and the construct validity adjustment to the German version pertaining to patients with lumbar back pain was examined in comparison to the «Oswestry Disability Index»(ODI).
Results: In both groups the PSFS proved itself to be more sensitive in comparison to the ODI. The internal responsiveness of ODI improved ES= -0.75), (non-improved ES= -0.38). PSFS (improved ES= 1.96), (non-improved ES 0.77). The external responsiveness of ODI (AUC= 0.59), of PSFS (AUC= 0.83) (P= 0.0068). Constructs of both measurement instruments have a weak and a moderate correlation on measuring point 1 (r= -0.28) and 2 (r= -0.58).
Conclusion: The German version of PSFS proves itself to be a feasible model and a method of high sensitivity in evaluating changes in the functional ability of patients with lumbar back pain. The instrument can be recommended to be used in clinical practice.
Concepts of Colours in Children with Congenital Blindness
Authors: Dimitrova-Radojichikj Daniela 
Published: April 2015

AbstractThis descriptive qualitative interview study investigates knowledge of colours in students who are congenitally blind. The purpose of this research was to explore how the lack of direct experience with colour, as a result of congenital blindness, affects judgments about semantic concepts. Qualitative methods were used to conduct interviews with 15 students. The results of the study indicate that students know the colours and have a favourite colour. The implications for practice are to pay more attention when we teach students with congenital blindness to associate colours with specific objects.
Four types of evidentiality in the native languages of Brazil
Authors: Hengeveld Kees , Dall’Aglio Hattnher Marize Mattos 
Published: April 2015

AbstractIn this paper we argue that the notions generally grouped together under the heading of evidentiality actually belong to four different evidential subcategories, which are different from one another in terms of their semantic scope. The hierarchical, scopal architecture of Functional Discourse Grammar is used to define these four categories. After giving our arguments for this new classification, we test a number of predictions that follow from it concerning the coexistence of evidential subcategories within a language and the co-occurrence of evidential markers in a single clause. We investigate our predictions in a sample of 64 native languages of Brazil. The data from these languages show that the presence of one or more of the four evidential subcategories can be systematically described in terms of an implicational hierarchy.
Surface Quality Assessment Following High Performance Cutting of AZ91HP Magnesium Alloy
Authors: Gziut Olga , Kuczmaszewski Józef , Zagórski Ireneusz 
Published: April 2015

Abstract
The article presents test results of surface roughness after AZ91HP magnesium alloy machining with variable technological parameters (vc, fz, ap) as well as tool geometry (γ=5°. and γ = 30°.). Two carbide end mills were applied during the tests. Roughness analysis was conveyed at the end face (Ra, Rq, RzDIN, Rt, Ry, RSm) and lateral face (Ra, Rz, RSm) of the tested sample. A decrease of roughness parameters (for increasing vc) as well as an increase (with growing fz) was observed in the lateral face tests. Similar interrelations were noticed for end face of the sample. Lower roughness parameters values were recorded for tool rake angle equal to γ = 5°.