bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost Minimisation Using Clinic-Based Treatment for Common Hand Conditions – A Prospective Economic Analysis
Authors: Webb JA , Stothard J 
Published: March 2009

INTRODUCTION The purpose of this study was to compare the cost of treatment of Dupuytren's disease, ganglia and trigger digits in the out-patient department with the operating theatre. PATIENTS AND METHODS All patients seen in a new patient hand clinic with a diagnosis of Dupuytren's disease, trigger digit or ganglion of the wrist or hand requiring treatment were prospectively identified over a 6-month period. The numbers undergoing a procedure in the out-patient clinic or theatre were recorded. Costings of theatre time and out-patient time, as well as national tariff income, were obtained from the hospital management. RESULTS Over the 6-month period, 80, 26, and 52 patients were treated with regard to Dupuytren's disease, ganglia and trigger digits, respectively. Of these, 37, 23, and 44 were treated by an out-patient procedure, and 43, 3 and 8 underwent a formal operation. The total cost of the out-patient procedures was calculated at £1560 over 6 months. To perform these as formal operations would have cost £64,896. The cost savings were, therefore, £63,336, or £126,672 per annum. CONCLUSIONS Out-patient interventions for Dupuytren's disease, ganglia and trigger digits result in significant cost savings over formal surgical treatment.
A Study of Microbial Colonisation of Orthopaedic Tourniquets
Authors: Ahmed SMY , Ahmad R , Case R , Spencer RF 
Published: March 2009

INTRODUCTION Tourniquets are employed widely in orthopaedic surgery. The use of the same tourniquet on a repetitive basis without a standard protocol for cleaning may be a source of cross-infection. This study examines the contamination of the tourniquets in our institution. MATERIALS AND METHODS Agar plates were used to take samples from 20 tourniquets employed in orthopaedic procedures. Four sites on each tourniquet were cultured and incubated at 37°C for 48 h. RESULTS All sampled tourniquets were contaminated with colony counts varying from 9 to > 385. Coagulase-negative Staphylococcus spp. were the most commonly grown organisms from the tourniquets (96%).Some tourniquets had growths of important pathogens including methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas spp., and S. aureus. On cleaning five tourniquets with Clinell (detergent and disinfectant) wipes (GAMA Healthcare Ltd, London, UK), there was a 99.2% reduction in contamination of the tourniquets 5 min after cleaning. CONCLUSIONS In addition to the manufacturers' guidelines, we recommend the cleaning of tourniquets with a disinfectant wipe before every case.
Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality
Authors: Larkin JO , Thekiso TB , Waldron R , Barry K , Eustace PW 
Published: March 2009

INTRODUCTION Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.
Audit of Two-Week Rule Referrals for Suspected Testicular Cancer in Cornwall, 2003–2005
Authors: Kumaraswamy Prakash , Cox Robert , O'Rourke John S , Willis Robert G. 
Published: March 2009

INTRODUCTION The objective was to evaluate the two-week wait referral system for suspected testicular cancer and to compare waiting times from referral to treatment before and after the introduction of the two-week wait process. PATIENTS AND METHODS We reviewed 241 case notes for patients referred under the two-week wait system with suspected testicular tumour during a complete 3-year period (2003–2005) and recorded information from the referral letter, findings in the urology clinic, results of ultrasound and final outcomes. We also identified 42 cases of testicular tumour treated during a complete 3-year period (1997–1999) just before the two-week wait system was introduced. The journey from referral to treatment for tumour cases was compared during these two periods. RESULTS Testicular cancer was only found in 8% of patients referred by the two-week wait system. We judged the referral to be inappropriate in 48% of cases. Of referred cases, 78% required no surgical treatment. There was a significant improvement of 9 days in the average time from general practitioner (GP) referral to urology clinic attendance but all other journey intervals remained the same. CONCLUSIONS The performance of GPs in examining scrotal swellings and applying the two-week wait guidelines was very poor, resulting in many unnecessary urgent clinic visits. The referral system speeds up the visit to a urology clinic but the overall effect is probably not of clinical significance. We suggest that it would be much more cost-effective for all these patients to have an ultrasound scan within 2 weeks instead of a urology clinic appointment.
Fast-Track Management of Patients Undergoing Proximal Pancreatic Resection
Authors: French JJ , Mansfield SD , Jaques K , Jaques BC , Manas DM , Charnley RM 
Published: March 2009

INTRODUCTION To avoid the risk of complications of biliary drainage, a feasibility study was carried out to determine whether it might be possible to fast-track surgical treatment, with resection before biliary drainage, in jaundiced patients with proximal pancreatic/peri-ampullary malignancy. PATIENTS AND METHODS Over an 18-month period, based on their presenting bilirubin levels and other logistical factors, all jaundiced patients who might be suitable for fast-track management were identified. Data on complications and hospital stay were compared with those patients in whom a conventional pathway (with biliary drainage) was used during the same time period. Data were also compared with a group of patients from the preceding 6 months. RESULTS Nine patients were fast-tracked and 49 patients treated in the conventional pathway. Fast-track patients mean (SD) serum bilirubin level was 265 μmol/l (81.6) at the time of the operation compared to 43 μmol/l (51.3; P ≥ 0.0001) in conventional patients. Mean (SD) of time from referral to operation, 14 days (9) versus 59 days (36.9), was significantly shorter in fast-track patients than conventional patients (P ≤ 0.0001). Length of hospital stay mean (SD) at 17 (6) days versus 22 days (19.6; P = 0.2114), surgical complications and mortality in fast-track patients were similar to conventional patients. Prior to surgery, the 49 conventional patients underwent a total of 73 biliary drainage procedures resulting in seven major complications. Comparison with the group of patients from the previous 6 months indicated that the conventional group were not disadvantaged. CONCLUSIONS Fast-track management by resection without biliary drainage of selected patients with distal biliary strictures is safe and has the potential to reduce the waiting time to surgery, overall numbers of biliary drainage procedures and the complications thereof.
Effect of Mycophenolate Acyl-Glucuronide on Human Recombinant Type 2 Inosine Monophosphate Dehydrogenase
Authors: Gensburger Olivier , Picard Nicolas , Marquet Pierre 
Published: March 2009

AbstractBackground: The immunosuppressive effect of mycophenolic acid (MPA) is essentially attributed to IMPDH II inhibition, which leads to a reduction of lymphocyte proliferation. We investigated the action of the MPA metabolites MPA-phenyl-glucuronide (MPAG) and MPA-acyl-glucuronide (AcMPAG) on recombinant human IMPDH II (rhIMPDH II), as well as their passage into lymphocytes in vitro.Methods: We measured rhIMPDH II activity spectrophotometrically through the initial velocity of NADH formation, leading to the computation of the kinetic parameters Km, IC50, and Ki (Michaelis constant, half-maximal inhibition concentration, and inhibition constant). We measured intracellular and extracellular concentrations of MPA, MPAG, and AcMPAG after incubation of Jurkat lymphoma cells with each compound separately, using liquid chromatography–tandem mass spectrometry.Results: MPA and AcMPAG showed an inhibition of rhIMPDH II (IC50 25.6 μg/L and 301.7 μg/L, respectively; the Ki of MPA for NAD and IMP was 50.8 and 57.7 nmol/L, respectively; and that of AcMPAG for NAD and IMP was 382.0 and 511.0 nmol/L. MPAG had no significant effect on the enzyme. AcMPAG apparently acts by the same uncompetitive inhibition mechanism as MPA, with a 12-fold higher IC50 and an 8–10 times higher Ki. When coincubated with MPA, AcMPAG activity was negligible at pharmacological concentrations. Furthermore, after 6-h incubation at their respective maximum concentration (Cmax), MPA was 10 times more concentrated in Jurkat cells than AcMPAG.Conclusions: AcMPAG is a weaker inhibitor of rhIMPDH II than MPA and is less concentrated in lymphocytes in vitro, suggesting that it would not be pharmacologically active in vivo and might not need to be monitored in MPA-treated patients.
Intense media coverage
Authors: Puijk Roel 
Published: March 2009

Abstract
In an increasingly fragmented media environment, some issues stand out and generate huge publicity for a limited period of time. Using Scannell's categories, event and happening, the article analyses two cases – the 1994 Olympic Winter Games and the death of Princess Diana. It is argued that they, in order to account for audience involvement and the complexity of meanings, should be analyzed in relation to the discourses and narrative developments across different media that embed the main, televised, moments. It is also argued that today's proliferation of media channels and the presence of new media can contribute to increasing attention and involvement of the audience. Ceremonial media events that previously dominated have moved in two directions: integrative, entertainment oriented events organized by the media and disaster events.
Gender and interface agents in the on-line news
Authors: Isotalus Pekka 
Published: March 2009

Abstract
Interface agents are increasingly being used to enhance the user-friendliness of computers. In the new mobile technology of handheld computers, interface agents are also being used to present on-line news. The purpose of the study was to explore how the gender of the interface agent and the user affect evaluations of the agent and the news service. The results revealed that attitudes toward the interface agent significantly correlated with evaluations of the entire news service. Moreover, the gender of the participant and of the agent was significant for an evaluation of the credibility and entertainment value of the news service.
Sampler Trials in Overconsolidated Sensitive Clay
Authors: Eden WJ 
Published: March 2009

During the excavation of pump wells for a sewage treatment plant, it was possible to obtain large, undisturbed, block samples of extremely sensitive yet overconsolidated clay from depths ranging from the surface to 70 ft. With these block samples as a reference, sampling was conducted with four types of piston samples, and the test results were compared with those obtained from the block samples. The in situ strength of the clay also was measured with the field vane test. Samplers used in the trials were the Swedish Foil, the Norwegian 54 mm, the Swedish 50 mm, and the 5-in.-diameter Osterberg hydraulic sampler.
The results showed that none of the samplers nor the field vane test were successful in obtaining results that could be compared consistently with results obtained from the block samples. The main conclusion of this study is that present methods of sampling of such soils by boring from the surface do not produce satisfactory undisturbed samples in this material.
Effect of Thickness on the Fracture Toughness of 7075 Aluminum in the T6 and T73 Conditions
Authors: Allen FC 
Published: March 2009

The objectives of the investigation described were to find the variation of fracture toughness with thickness for 7075-T6 and 7075-T73 materials and to provide data upon which a theory could be established for the variation of fracture toughness with thickness. A test program was conducted on 60 centrally cracked specimens varying in thickness from 0.05 to 0.75 in.
Analysis of the results showed that the two materials displayed substantially different characteristics. This is attributed to the fact that, owing to the low proportional limit of the T73 material, the net section stress was in the plastic range for most specimens, whereas for the T6 material the net section stress was always in the elastic range.
It was noted that during slow crack growth, the crack grew faster in the center than at the surface of the material. A generally parabolic shaped crack front, therefore, existed at failure. It was hypothesized that the crack shape corresponded to the development of plane stress at its boundaries and that fracture toughness based on final crack length would be constant. This appeared to be true for the T6 material, within the range tested, but could not be proved for the T73 material.
A lumped parameter, redundant force analysis of three plates of varying thickness was made. The results show the development of plane strain conditions with increased thickness. Although correlation with the test results was not established, extension of the work may provide explanation of the phenomena observed in tests.
An appendix provides theoretical load-deflection relationships for centrally cracked plates which include the effects of plasticity.
Mechanisms of Fatigue in the Creep Range
Authors: Wells CH , Sullivan CP , Gell M 
Published: March 2009

The mechanisms of deformation and fracture in creep and fatigue are surveyed. Interactions between time- and cycle-dependent mechanisms are discussed from the standpoint of cumulative damage laws for lifetime prediction. The major roles of temperature and time in the fatigue process are shown to be an increase in the homogeneity and irreversibility of slip, cavitation of particle-matrix interfaces, and the growth of surface oxide layers to a thickness that can affect crack initiation; the principal effect of cyclic loading on creep fracture is the acceleration of crack propagation resulting from resharpening of microcracks.
One of the major areas of uncertainty in cumulative damage is concluded to be the influence—either beneficial or deleterious—of compressive loading. Cavities initially produced in tension may be sintered by diffusion or rewelding in compression; on the other hand, sharp microcracks generated in compressive creep can severely accelerate fracture. It is suggested that these effects may be understood by considering whether the deformation is planar or wavy.
Influence of Vehicle Emission Control Systems on the Relationship Between Gasoline and Vehicle Exhaust Hydrocarbon Composition
Authors: Morris WE , Dishart KT 
Published: March 2009

Relationships have been developed that describe how vehicle exhaust hydrocarbon composition is influenced by hydrocarbon composition of the gasoline and by the use of various emission control systems which give a range of exhaust emission levels. The relationships were obtained by computer regression analysis of the detailed individual hydrocarbon compositions of 15 gasolines of varying aromatic and olefin content and the exhaust emissions from these fuels.
The gasolines, which consisted of five refinery-component blended fuels and ten matching commercial gasolines, were all leaded premium grade with similar octane quality and volatility characteristics. The aromatic and olefin contents of the blended gasolines were varied according to a statistical design that covered the usual variation found in commercial premium gasolines.
The vehicles in which these fuels were tested were equipped with several different types of emission control systems. These included no control device, conventional air injection and engine modification systems, and a duPont exhaust manifold reactor system capable of low exhaust emission levels.
With all four emission control systems, most of the hydrocarbons emitted were formed by degradation of fuel hydrocarbons. Regression analyses results indicate that ethylene was formed from saturates and olefins, propylene and isobutylene/1-butene were formed primarily from saturates, and diolefins were formed primarily from olefins. Toluene was the most important fuel hydrocarbon from the standpoint of contribution to calculated photochemical reactivity, and survived through the vehicle in larger proportion than the other principal fuel hydrocarbons. Along with the toluene that survived, additional amounts were formed from higher aromatics. Similarly, additional benzene and xylenes were formed from higher aromatics. Additional 2-methyl-2-butene was formed from fuel saturates.
Fuel effects on photochemical reactivity of the hydrocarbon emissions were quite small in relation to the effects of emission control systems. Calculated total photochemical reactivity of the exhaust from the thermal reactor car was only 2 to 3 percent of that of the cars with other control systems.
The IIEC Program—A Progress Report
Authors: Osterhout DP , Jagel KI , Koehl WJ 
Published: March 2009

After nearly three years of work in the Inter-Industry Emission Control (IIEC) program, research studies in 18 projects directed at the many mechanical and chemical engineering aspects of automotive emissions have been crystallized in three concept vehicle emission control packages. This paper will: (1) outline the makeup and emission control effectiveness of these three packages, (2) review the chemical engineering aspects of their development, and (3) document some of the major problems with these concepts that must be overcome before they can be termed feasible for production.
The major components of the three concept packages are: Package A, thermal reactor and exhaust gas recirculation (EGR) for use with leaded or unleaded gasoline; Package B, catalytic reactor for hydrocarbon and carbon monoxide control and EGR for use with low lead or unleaded gasoline; Package C, dual catalytic reactors to control hydrocarbons, carbon monoxide, oxides of nitrogen and EGR, for use with unleaded gasolines. The important chemical engineering studies embodied in the concept packages include: (1) mathematical modeling of both thermal and catalytic reactors to guide their design, (2) development of effective catalysts for use with both leaded and unleaded fuel, (3) screening of high-temperature oxidation resistant materials for thermal reactor construction, and (4) studies of interactions between EGR and fuel and lubricant compositions as they relate to engine cleanliness.
Correlation of Microfractography and Macrofractography of AISI 4340 Steel—A Report of ASTM E-24/II Task Group
Authors: Carr FL , Biehler D , Connolly A , Dragen R , Faller J , Johari O , Morais R , Parker MT , Sailors RH 
Published: March 2009

A co-operative investigation was made by a task group of ASTM Committee E-24 Subcommittee II to correlate the microfractography and macrofractography of notch tension specimens of 4340 steel heat treated to 8 strength levels. Selected testing temperatures provided fractures with macroscopic topography representing the complete fracture transition of each material. The observed microscopic fracture modes were correlated with the two macroscopic zones of fracture surface configurations (fibrous and radial) and the final area of separation. Regardless of tempering temperature the fibrous zone of all materials consisted of microvoid coalescence and holes. Radial zones consisted of quasi cleavage for specimens tempered at high temperatures, and intergranular fracture with grain boundary microvoid coalescence for specimens tempered at low temperatures. Mixtures of these modes were observed in radial zones on specimens tempered at intermediate temperatures. The amount of each of these modes present in the radial zone depended on both testing and tempering temperatures.
This correlation and the strong temperature dependencies become evident by the examination of fractures representing the complete macroscopic transitional appearances of sufficient materials obtained by different tempering temperatures.
Design, Analysis, and Testing of an Advanced Composite F-111 Fuselage
Authors: Ashton JE , Burdorf ML , Olson F 
Published: March 2009

The paper describes the design, analysis, and testing of a full-scale section of an F-111 aft fuselage center body made from advanced composite materials. A 160-in.-long test component was fabricated and tested to destruction. The composite material systems were graphite/epoxy, boron/ epoxy, boron/aluminum, and glass/epoxy. Maximum use of composites was maintained throughout the structure, with both skins and substructures being treated. Design concepts for the various structural elements were developed through a program of testing of subelement specimens. Test results were obtained on the strength of boron and graphite composites applied to sandwich panels, stiffened sheet panels, frames, bulkheads, and fittings.
A static test component was detail designed and fabricated. Fourteen subassemblies of frames and panels were fabricated and assembled into a 920-lb component using 460 lb of composite material. A weight saving of 18 percent of the counterpart aluminum and steel structure was obtained. Static testing of the part included loading in bending with simultaneous application of internal pressure. The component sustained 130 percent of the design ultimate load. Deflection gage and strain gage data showed excellent agreement with analytical results.