bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies
Authors: Pfleiderer AG , Ahmad N , Draper MR , Vrotsou K , Smith WK 
Published: March 2009

INTRODUCTION Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia. PATIENTS AND METHODS A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study. Serial serum calcium measurements were recorded as well as details of the operation, pathology, indications for surgery, number of parathyroids identified at operation and any complications. RESULTS Eighty-four (52%) patients did not develop hypocalcaemia but 69 (43%) were found to have temporary hypocalcaemia and 9 (5%) had permanent hypocalcaemia. Hypocalcaemia was more common after total than completion thyroidectomies and the identification of parathyroids at operation appears to have a significant adverse effect on outcome. The calcium levels measured on day 1 postoperatively and the slope (serum calcium levels of day 1 postoperative minus day of operation) were statistically significant in predicting the development of hypocalcaemia and possibly to differentiate between temporary or permanent hypocalcaemia. DISCUSSION Although almost half the patients having extensive thyroid surgery developed hypocalcaemia (as defined by any postoperative corrected serum calcium level of < 2.12 mmol/l) only 24% had a serum calcium of < 2.12 mmol/l associated with clinical symptoms of hypocalcaemia or a calcium level of < 2.0 mmol/l. Only 5% had persistent hypocalcaemia defined as requiring exogenous supplements at 6 months' postoperatively. Patients having a completion thyroidectomy appear to be less likely to develop hypocalcaemia perhaps as a result of any iatrogenic effects on the parathyroids at the first operation being reversed before the second operation. Identification and, therefore, exposure of parathyroids at operation may have an adverse effect on the blood supply to the glands affecting their function. CONCLUSIONS Serum calcium levels measured 6 hours' post-surgery and on day 1 postoperatively can be useful in predicting if the patient will develop hypocalcaemia and the slope may indicate whether the hypocalcaemia will be temporary or permanent. Patients with toxic goitres and those having a one-stage total thyroidectomy are most at risk of developing hypocalcaemia.
Ear, Nose and Throat Day-Case Surgery at a District General Hospital
Authors: Pézier T , Stimpson P , Kanegaonkar RG , Bowdler DA 
Published: March 2009

INTRODUCTION In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. PATIENTS AND METHODS Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. RESULTS Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. DISCUSSION ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.
Consent for Non-Therapeutic Male Circumcision on Religious Grounds
Authors: Robinson Richard , Makin Erica , Wheeler Robert 
Published: March 2009

INTRODUCTION The aim of this study was to assess whether surgeons are conforming to guidance laid down by professional organisations and the courts in obtaining dual parental consent for non-therapeutic circumcision. PATIENTS AND METHODS A retrospective case-note review over a 12-month period (April 2005 to April 2006) of circumcisions in boys under the age of 16 years in a tertiary paediatric surgical unit was undertaken. RESULTS A total of 62 boys aged 1–14 years (median age, 4 years) underwent non-therapeutic circumcision. Written consent from both parents was obtained in only 4 cases (6.4%). In no case was written consent obtained from the patient or their views documented. In 58 cases, the written consent was provided by only one parent; the mother in 34 (55%), the father in 24 (45%). Of these 58 cases, in 25 (43%) both parents attended with the child on the day of surgery. CONCLUSIONS The data reveal a consistent non-conformity with recommended practice and the common law. It seems unlikely that the doctors involved are deliberate and inveterate law-breakers. The reason for this non-compliance may be ignorance of the rules, or due to the impracticality of their implementation. There is evidence that doctors are ignorant of the legal rules pertaining to their patients, and the results may reflect this ignorance. However, there are also practical difficulties in obtaining dual consent that may be partially responsible for the variance. Inevitably, investment will be required to overcome these difficulties. Cost may tempt service providers to abandon the provision, leaving parents to their own devices.
Challenging Dogma: Radical Conservation Surgery for Early Stage Cervical Cancer in Order to Retain Fertility
Authors: Shepherd John H 
Published: March 2009

INTRODUCTION Cervical cancer is the second commonest cancer to affect women with over half a million cases world-wide yearly. Screening programmes have reduced the incidence and death rate dramatically in Western societies. At the same time, professional and social pressures may delay child bearing such that a significant number of women will present with early stage disease, but be anxious to retain their fertility potential. Standard treatment by radical hysterectomy or radiotherapy has good results, but inevitably renders the women infertile. The rationale for extensive surgery resecting parametrium or destructive radiotherapy treating the whole pelvis in all cases of cervical cancer has been questioned. PATIENTS AND METHODS Lessons learnt from the less radical surgical approach to breast cancer can be applied to cervical cancer whilst still observing Halstead's principles of surgical oncology. Wide, local excision of early stage small tumours by radical vaginal trachelectomy combined with a laparoscopic pelvic lymphadenectomy utilises modern technology with traditional surgery. Radical vaginal trachelectomy comprises the distal half of a radical abdominal (Wertheim's) or vaginal (Schauta's) hysterectomy. An isthmic–vaginal anastomosis restores continuity of the lower genital tract after insertion of a cerclage that is necessary to maintain competence during future pregnancies. RESULTS A total of 142 cases were performed between 1994 and 2006, most (98%) in women with Stage 1B carcinoma of the cervix with a mean follow-up of 57 months. Twelve (9%) had completion treatment, 11 with chemo/radiotherapy and one radical hysterectomy. There were four recurrences (3%) among the women who did not have completion treatment, and two (18%) in those that did. There were 72 pregnancies in 43 women and 33 live births in 24 women. The 5-year accumulative pregnancy rate among women trying to conceive was 53%. Delivery was by classical caesarean section in a high-risk feto-maternal units with 8 babies (25%) born before 32 weeks. CONCLUSIONS Radical vaginal trachelectomy appears safe when performed in centres with appropriate experience of radical vaginal surgery and laparoscopic techniques. The impact of this new approach questions traditional teaching whilst preserving potential fertility in hitherto impossible circumstances.
Stereotype threat contributes to social difficulties in people with schizophrenia
Authors: Henry Julie D. , von Hippel Courtney , Shapiro Lisa 
Published: March 2009

Objective. The experience of stereotype threat (where the prospect of conforming to a stereotype, or of being treated in terms of it, becomes self‐threatening) affects members of social groups about whom devaluing stereotypes exist. Although a widely endorsed stereotype of schizophrenia concerns social skill impairment, it is unclear whether the experience of stereotype threat impacts social functioning in this group. The purpose of the present study was to test whether people with schizophrenia would perform more poorly in a social setting in which they felt stereotyped as mentally ill.Methods. Thirty individuals with schizophrenia engaged in conversations with two confederates, one of whom they were told knew nothing about them (control conversation), and the other of whom they were told had been informed of their diagnosis (stereotype threat conversation). In reality, neither confederate had been informed of participants' mental health status.Results. Although participants with schizophrenia did not perceive any differences in their own social behaviour across the two conditions, their social skill was rated by the confederates as poorer in the stereotype threat conversation on three out of the six measures used.Conclusions. These results suggest that social skill difficulties in people with schizophrenia may be exacerbated by their awareness that others know of their diagnosis. These findings have implications for disclosure of mental health status.
Salivary Leptin as a Candidate Diagnostic Marker in Salivary Gland Tumors
Authors: Schapher Mirco , Wendler Olaf , Gröschl Michael , Schäfer Renate , Iro Heinrich , Zenk Johannes 
Published: March 2009

AbstractBackground: Since the discovery of autonomous leptin production in salivary glands, very few studies have reported on the physiological or pathological meaning of this particular cytokine in saliva. The aim of this study was to investigate the expression of leptin and its receptors Ob-Ra and Ob-Rb in parotid salivary gland tumors, with particular regard to a potential use of leptin as a tumor marker.Methods: Parotid tissue samples from healthy individuals (n = 31) and tumor patients (n = 97, including tissue samples from pleomorphic adenomas, adenolymphomas, basal cell adenomas, and diverse carcinomas) were analyzed by use of ApoTome-technique microscopy, immunohistochemistry, immunofluorescence, immunoblotting, and quantitative real-time PCR. Salivary and plasma leptin concentrations were measured by using ELISA. Ultrasound was used to determine tumor size before surgery.Results: In all salivary gland tumors leptin was expressed in much higher amounts than in healthy parotid tissues. The cytokine was not imported from the blood but actively produced by the tumors. Immunoblotting results indicated that leptin was present as oligomers in salivary glands. Furthermore, the examined tumors overexpressed the receptor isoforms Ob-Ra and Ob-Rb. Measured leptin concentrations in mixed saliva samples were significantly increased in patients with parotid tumors [mean (SD) 673 (484) pg/mL in pleomorphic adenomas, 679 (465) pg/mL in adenolymphomas, and 880 (618) pg/mL in carcinomas] vs controls [125 (36) pg/mL] (P &lt; 0.001).Conclusions: This is the first study to show that the analysis of salivary leptin in mixed saliva samples may allow preoperative differentiation between tumor patients and healthy individuals.
Internet adoption in the newsroom: Journalists' use of the Internet explained by attitudes and perceived functions
Authors: Hermans Liesbeth , Vergeer Maurice , Pleijter Alexander 
Published: March 2009

Abstract
Journalists differ in the degree to which they have adopted the Internet professionally. While earlier studies were predominantly descriptive, this study explains why journalists differ in the amount (time spent on the Internet) and nature (diversity of Internet applications) of their use of the Internet. Based on a random sample of members of the Dutch Association of Journalists, results indicate that the digital divide in terms of demographic characteristics is absent. The perceived functionality of the Internet as a professional tool is the most important explanatory factor for the use of the Internet. Surprisingly, professional attitudes towards journalistic quality are not reflected in journalists' use of the Internet.
A New Automatic Device for Measuring Large Volume Changes
Authors: Fair Peter , Anderson William F. 
Published: March 2009

Abstract
The design and construction of a new automatic volume change unit, which is capable of measuring large volume changes without the need for reversing flow direction, is described. It works on the principle of a floating magnet at an air-water interface activating a magnetorestrictive sensor. Its performance is assessed against the criteria listed by Lade (1988) as desirable for any automatic volume change measuring device, and is shown to satisfy these criteria.
Developing a Project Evaluation and Testing Model to Assess Stable Photovoltaic Slicing Machine
Authors: Chang Che-Wei , Wu Cheng-Ru , Chen Huang-Chu 
Published: March 2009

AbstractThis study discusses and develops a project selection model for the purchase of diamond cutting machines for 12-in. photovoltaic silicon wafer slicing based on an analytical network process and preference by similarity to ideal solution (ANP-TOPSIS) method. Simultaneously, process capability indices are presented to test and verify the feasibility and effectiveness of the proposed method. The proposed method can help decision makers to establish a project evaluation and testing mode to affect and choose the best mode for diamond cutting machines of photovoltaic wafer slicing.
Crack-Velocity Considerations
Authors: Krafft JM , Irwin GR 
Published: March 2009

If resistance to crack growth always increased with crack velocity, then its measure at nil velocity, Gc or GIc, would always represent minimum toughness and thus a safe criterion. The practical difficulty arises if an increased crack speed, or loading rate of a fixed crack, results first in a decrease in R, possibly to some minimum, prior to its increase for the “stable” propagation balance. Arrest of such a crack will require reduction of the crack driving force, G, at least to minimum R. In strain-rate and temperature-sensitive materials this minimum can lie far below initiation levels. Even in relatively high-strength materials, speed-thermal effects can be large.
The onset and arrest of rapid fracture provide relatively abrupt measurement points suitable for crack toughness evaluation. An understanding of these behaviors can be sought through study of the influence of plastic flow properties. Use of strain-rate sensitive materials over a wide range of temperatures and strain rates permits study of the influences of flow properties without alteration of the inherent flaws. A correlation of rising-load KIc values with the strain-hardening exponent, n, suggests that the onset of fast fracture is controlled to a substantial degree by a tensile instability with a simple relationship to the strain-hardening exponent. The limited information available suggests that crack-arrest conditions can be predicted on the basis of adiabatic values of n at high strain rates.
Fracture Toughness Testing in Alloy Development
Authors: Wei RP 
Published: March 2009

In the past five years, fracture mechanics has been used as a basis for the evaluation of the fracture toughness of high-strength steels and other high-strength alloys. Some of the considerations involved in the selection of plane-strain fracture toughness as the most appropriate and significant parameter for ultrahigh-strength alloy steel development are discussed in this paper.
The contribution of fracture mechanics to steel research and development is illustrated by brief reviews of three investigations: (1) a study of the relationships between microstructure and toughness in quenched and tempered low-alloy ultrahigh-strength steels, (2) an investigation of the effect of sulfur level on the fracture toughness of AISI 4345 alloy steel, and (3) a study of the influence of banding on fracture toughness anisotropy in a maraging steel.
Fracture Testing of Weldments
Authors: Kies JA , Smith HL , Romine HE , Bernstein H 
Published: March 2009

A new and improved apparatus has been designed and built for three-point loading of bend bars. A new formula for KIc independent of Young's modulus has been derived which fits experimental calibrations and calculations by B. Gross with satisfactory accuracy. A formula is provided by which the requirements for specimen size and notch depth can be calculated for measuring KIc for a given yield strength of material. A number of comparisors are shown for the effect of rolling direction on KIc for base plate and for several different kinds of welding. The effect of notch position on KIc is shown. The slow bend test has advantages of adaptability and simplicity for the purpose at hand.
It seems noteworthy that the effect of directionality on KIc in the base plate is in the same direction but magnified in tests of the welds in the 250-ksi yield-strength grade. For some welding procedures the KIc for some positions in welds was better than for the base plate with no deficiency of hardness. Significance tests were applied to the differences between average values of KIc. From the KIc numbers listed one may calculate the largest tolerable surface crack corresponding to a given stress applied. The center of the weld presents the lowest toughness of any position.
Representative Sampling in Location, Quality, and Size
Authors: Rowe PW 
Published: March 2009

Large (260-mm) diameter samples are required to provide relevant laboratory consolidation and strength data on clay soils which exhibit a fabric of layers, varves, silt, and organic inclusions or fissures. Large clay specimens with permeable fabric can show coefficients of consolidation 103 to 104 times those measured on conventional small samples. The undrained strength of fissured clays decreases with increase in specimen size and improved representation of fabric.
Examination of initial small (76-mm) diameter continuous samples allows a selection of location, quality, and size of representative samples relevant to the geology and the engineering problems. Photographs of visual fabric are compared with laboratory data and field performance to illustrate when large samples are essential.
Use of a 260-mm thin-walled flush-tube piston sampler with 6 percent area ratio gives good quality samples. Handling and extraction of organic clays under water is necessary to prevent oxidation of rootlet channels. Laboratory test equipment is illustrated.
Effect of Sampling, Size, and Storage on Test Results for Marine Clay
Authors: Bozozuk M 
Published: March 2009

Consolidation tests on a soft marine clay formation indicated that it was normally consolidated when the tests were performed on cores obtained with a 2-in.-diameter (54-mm) tube sampler and overconsolidated by 0.16 tons/ft2 (kg/cm2) when the tests were performed on cores obtained with a 5-in.-diameter (124-mm) tube sampler. From comparative tests on 20, 40, and 60-cm2 test specimens trimmed from a block of stiff overconsolidated marine clay, the maximum preconsolidation pressures were measured on the 40-cm2 size. Storing the block sample in a humid room at 55 F for one and a half years decreased the measured preconsolidation pressure. Coating the consolidometer rings with Teflon and molybdenum-disulphide-based grease was effective in reducing side friction.
Triaxial strength tests with pore pressure measurements were performed on the soft marine clay, sampled with both 2-in.-diameter (54-mm) and 5-in.-diameter (124-mm) tube samplers. Although the measured strengths were comparable, the tests on specimens trimmed from the 2-in.-diameter (54-mm) cores produced greater strains to failure and a smaller pore pressure parameter A than did tests on specimens from the 5-in.-diameter (124-mm) cores.
The Dependence of Fatigue Crack Propagation on Strain Energy Release Rate and Crack Opening Displacement
Authors: Barsom JM 
Published: March 2009

Information on the growth of fatigue cracks in engineering structures is necessary for the prediction of service lives of structures subjected to fatigue loading. Thus, considerable work has been done to develop fatigue crack propagation laws. To determine the primary material parameters affecting fatigue crack growth, a review and analysis of existing fatigue crack propagation data were conducted.
The results show that the primary factor affecting fatigue crack growth rates in high yield strength steels, titanium, and aluminum is the applied energy release rate range, ΔGI, in psi ∙inches. The stress intensity factor, KI, can be related to GI by using the modulus of elasticity; consequently, crack growth rates usually are expressed in terms of ΔKI for a particular material. However, the primary factor affecting fatigue crack growth rate is ΔGI. Crack growth rates also can be expressed in terms of the crack opening displacement range, Δδ, because GI can be related to δ. By using a critical strain, crack extension criterion, analysis of crack propagation behavior for these metals suggests that a change to accelerated crack growth rates occurs when δ reaches a value of 1.6 × 10-3 in.
Measuring the Apparatus Contribution to Bending in Tension Specimens
Authors: Schmieder AK 
Published: March 2009

Methods are given for resolving measured bending strains into contributions from the following three sources: first, inaccuracies in the gages or their application; second, nonsymmetry of the specimen; and third, imperfections in the apparatus. The methods are applied to tests on tension specimens with three commonly used forms of grip ends. A method for correcting for inaccuracies in gage factors and gage misalignment is derived and applied. After correction by this method gage errors are insignificant. For the accurately machined, ½-in.-diameter specimen used, the specimen contribution to bending is small. The calculated apparatus contribution is most reproducible and significant when the load string has a minimum number of loose, threaded joints. The three specimens tested give bending strains well within the limit of ASTM recommended practices when the testing machine is in good condition.
A method also is explained for determining the maximum bending strain at any point in the reduced portion of the specimen. By this method it is shown that the maximum may be more than twice the value measured by using an extensometer or strain gages centered on the reduced portion.