Relationship factors in the development and maintenance of ED : implications for treatment effectiveness

Introduction. With the advent of effective medical treatments for erectile dysfunction (ED), there has been a reduced focus in recent years on the role of relationship in the development of this disorder.
Aim. This article examines the contribution of relationship factors to the success or otherwise of different treatment
approaches for ED.
Main Outcome Measures. The results of findings in the literature on the association between relationship factors and the development and maintenance of ED.
Methods. This article reviews and evaluates the literature that relates to the role of relationship factors in the development and maintenance of ED.
Results. The current review demonstrates that relationship dynamics are frequently dysfunctional among men with ED. Research demonstrates that addressing these problems is likely to improve the effectiveness of therapy. However, there have been limited studies conducted in this area; many of these studies are methodologically flawed, and so it is difficult to determine the effectiveness of these interventions.
Conclusions. There needs to be further research on the association between relationship factors and ED. Suggestions for future research that include combined medical and psychological interventions for ED are proposed.

Effect of coagulants on the fouling and performance of ultrafiltration (UF) membranes

The combined coagulation and ultrafiltration (UF) system (C-UF system) is an advanced technology to treat natural organic matter (NOM) present in water. Traditional coagulants — prehydrolyzed inorganic coagulants, organic coagulants and composite coagulants were chosen to treat synthetic water containing humic acid (HA) in order to find an efficient coagulant that could remove NOM from the water effectively. The fouling, removal efficiency of UF and the chlorine decay in the permeate were used to evaluate the effectiveness of the coagulants. The initial UV254 absorption of the tested water samples were from 0.208 to 0.234, and the UV254 after coagulation was from 0.05 to 0.184. The UV254 did not increase after coagulation. Since the humic acid used was soluble, the initial turbidity of the tested water samples were very close to zero. The turbidity increased after coagulation, as the coagulants react with humic acid to form micro-flocs, which cannot be removed fully by sedimentation. The results showed that polyferric chloride could not remove humic acid efficiently during coagulation process, but removed the humic acid well when used in the C-UF system. Moreover, for polyferric chloride and UF system, the concentration of organic compounds in permeates were minimal indicating very low levels of disinfection by-product formation, if chlorinated.

Modelling of bending-dominated forming processes of metal sheets

Theoretical solutions, finite element models, and experimental techniques are developed for three major sheet metal forming operations: bending (pure bending and cyclic bending), die bending, and deep drawing. These have been applied to two different commercial quality cold-rolled steels, one stainless steel, and one magnesium alloy.

Analytic study on pure bending of metal sheets

In this work, analytical models of pure bending are developed to simulate a particular type of bend test and to determine possible errors arising from approximations used in analyzing experimental data. Analytical models proposed for steels include a theoretical solution of pure bending and a series of finite element models, based on the von Mises yield function, are subjected to different stress and strain conditions. The results show that for steel sheets the difference between measured and calculated results of the moment-curvature behaviour is small and the numerical results from the finite element models indicate that experimental results obtained from the test are acceptable in the range of the pure bending operation. Further for magnesium alloys, which exhibit unsymmetrical yielding, the algorithm of the yield function with a linear isotropic hardening model is implemented by programming a user subroutine in Abaqus for bending simulations of magnesium. The simulations using the proposed user subroutine extract better results than those using the von Mises yield function.

Thermal and mechanical properties of ultrasonically treated wool

Wool fabrics, ultrasonically treated in various chemical conditions and for different time durations, were analysed for thermal properties by thermo-gravimetric analysis and differential scanning calorimeter, in comparison with the untreated fabric. Fabric mechanical properties, such as bending and tensile performance, and changes in fibre morphology were also evaluated before and after ultrasonic treatment.It is found that wool treated with ultrasonics at the appropriate time, has less mass loss and a higher thermal degradation temperature than that without ultrasonic treatment or with prolonged ultrasonic treatment. Resistance to thermal degradation is reduced when wool is ultrasonically treated in the presence of alkali. Differential scanning calorimeter analysis shows that while ultrasonic treatment has little effect on fibre crystallinity, an appropriate treatment can provide wool with increased water absorption. Ultrasonic treatment stiffens wool fabric to some extent when the treatment time is prolonged. The addition of detergent alone to the ultrasonic bath has little effect on fabric tensile behaviour, whereas a treatment with both detergent and alkali produces severe fibre damage and significant loss of fabric tensile strength.

A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds : the transform-us! study

Background: Physical activity (PA) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior (SB) may be detrimental to children’s health independent of PA. The primary aim of the Transform-Us! study is to determine whether an 18-month, behavioral and environmental intervention in the school and family settings results in higher levels of PA and lower rates of SB among 8-9 year old children compared with usual practice (post-intervention and 12-months follow-up). The secondary aims are to determine the independent and combined effects of PA and SB on children’s cardio-metabolic health risk factors; identify the factors that mediate the success of the intervention; and determine whether the intervention is cost-effective.
Methods/design: A four-arm cluster-randomized controlled trial (RCT) with a 2 × 2 factorial design, with schools as the unit of randomization. Twenty schools will be allocated to one of four intervention groups, sedentary behavior (SB-I), physical activity (PA-I), combined SB and PA (SB+PA-I) or current practice control (C), which will be evaluated among approximately 600 children aged 8-9 years in school year 3 living in Melbourne, Australia. All children in year 3 at intervention schools in 2010 (8-9 years) will receive the intervention over an 18-month period with a maintenance ‘booster’ delivered in 2012 and children at all schools will be invited to participate in the evaluation assessments. To maximize the sample and to capture new students arriving at intervention and control schools, recruitment will be on-going up to the post-intervention time point. Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey.
Discussion: To our knowledge, Transform-Us! is the first RCT to examine the effectiveness of intervention strategies for reducing children’s overall sedentary time, promoting PA and optimizing health outcomes. The integration of consistent strategies and messages to children from teachers and parents in both school and family settings is a critical component of this study, and if shown to be effective, may have a significant impact on educational policies as well as on pedagogical and parenting practices.

Clinical and economic burden of emergency department presentations for neutropenia following outpatient chemotherapy for cancer in Victoria, Australia

Objective. To examine the clinical characteristics and financial charges associated with treating adult cancer patients receiving chemotherapy in outpatient clinics who presented to the emergency department (ED) with neutropenia.
Design and Setting. A retrospective audit was conducted across two health services involving ED episodes and subsequent hospital admissions of patients who received chemotherapy through day oncology from January 1 to December 31, 2007 and presented to the ED with neutropenia. ED data were collected from the Victorian Emergency Minimum Dataset and charges were collected from Health Information Services. Descriptive and bivariate statistics were used to describe the patient and clinical characteristics and financial outcomes, and to explore associations between these factors.
Results. In total, 200 neutropenic episodes in 159 outpatients were seen in the ED over the survey period. The mean patient age was 56.6 years (standard deviation, 13.2 years) and 47.2% were male. Overall, 70.0% of ED episodes were triaged as Australasian Triage Scale 2 (emergency). The median ED wait time was 10 minutes and the median ED length of stay was 6.8 hours. The median charge for each ED episode was $764.08 Australian dollars. The total combined ED and inpatient charge per episode was in the range of $144.27-$174,732.68, with a median charge of $5,640.87.
Conclusions. This study provides important insights into the clinical and economic burden of neutropenia from both the ED and inpatient perspectives. Alternative treatment models, such as outpatient treatment, early discharge programs or prophylactic interventions to reduce the clinical and economic burden of neutropenia on our health system, must be explored.

Structure and phase stability of NiMnGa ferromagnetic shape memory alloys by experimental and ab-initio techniques

This paper summarizes some of our recent results on crystal structure, microstructure, orientation relationship between martensitic variants and crystallographic features of martensitic transformation in Ni-Mn-Ga FSMAs. It was shown that Ni53Mn25Ga22 has a tetragonal I4/mmm martensitic structure at room temperature. The neighboring martensitic variants in Ni53Mn25Ga22 have a compound twinning relationship with the twinning elements K1={112}, K2={11-2}, η1=<11-1>, η2=<111>, P={1-10} and s=0.379. The ratio of the relative amounts of twins within the same initial austenite grain is ~1.70. The main orientation relationship between austenite and martensite is Kurdjumov-Sachs (K-S) relationship. Based on the crystallographic phenomenological theory, the calculated habit plane is {0.690 -0.102 0.716}A (5.95° from {101}A), and the magnitude, direction and shear angle of the macroscopic transformation shear are 0.121, <-0.709 0.105 0.698>A (6.04° from <-101>A) and 6.88°, respectively.

Successful outcomes with oral fluoroquinolones combined with rifampicin in the treatment of Mycobacterium ulcerans : an observational cohort study

Background: The World Health Organization currently recommends combined streptomycin and rifampicin antibiotic treatment as first-line therapy for Mycobacterium ulcerans infections. Alternatives are needed when these are not tolerated or accepted by patients, contraindicated, or neither accessible nor affordable. Despite in vitro effectiveness, clinical evidence for fluoroquinolone antibiotic use against Mycobacterium ulcerans is lacking. We describe outcomes and tolerability of
fluoroquinolone-containing antibiotic regimens for Mycobacterium ulcerans in south-eastern Australia.

Methodology/Principal Findings: Analysis was performed of prospectively collected data including all primary Mycobacterium ulcerans infections treated at Barwon Health between 1998 and 2010. Medical treatment involved antibiotic use for more than 7 days; surgical treatment involved surgical excision of a lesion. Treatment success was defined as complete lesion healing without recurrence at 12 months follow-up. A complication was defined as an adverse event attributed to an antibiotic that required its cessation. A total of 133 patients with 137 lesions were studied. Median age was
62 years (range 3–94 years). 47 (34%) had surgical treatment alone, and 90 (66%) had combined surgical and medical treatment. Rifampicin and ciprofloxacin comprised 61% and rifampicin and clarithromycin 23% of first-line antibiotic
regimens. 13/47 (30%) treated with surgery alone failed treatment compared to 0/90 (0%) of those treated with combination medical and surgical treatment (p,0.0001). There was no difference in treatment success rate for antibiotic combinations containing a fluoroquinolone (61/61 cases; 100%) compared with those not containing a fluoroquinolone (29/29 cases; 100%). Complication rates were similar between ciprofloxacin and rifampicin (31%) and rifampicin and clarithromycin (33%) regimens (OR 0.89, 95% CI 0.27–2.99). Paradoxical reactions during treatment were observed in 8 (9%) of antibiotic treated cases.

Conclusions: Antibiotics combined with surgery may significantly increase treatment success for Mycobacterium ulcerans infections, and fluoroquinolone combined with rifampicin-containing antibiotic regimens can provide an effective and safe oral treatment option.

Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures

Background
Neck of femur fractures (NOFFs) are a common cause of morbidity and mortality in our community. Minimally displaced intracapsular fractures are treated with internal fixation by a two-hole dynamic hip screw (DHS) or three partially threaded cancellous screws. Data to support the superiority of one are limited. This prospective randomized controlled trial compares outcomes with these two fixation methods.

Methods
We prospectively recruited patients over 50 years, with an acute fracture subcapital NOFF, who walked and lived independently, and were cognitively intact. They were randomized into DHS or cancellous screw groups and followed up for 2 years (overall 75.9%). Outcomes of mortality, revision, loss of fixation, avascular necrosis, surgical complications, WOMAC, Harris hip score and SF-12 were measured.

Results
We recruited 62 patients (31 DHS, 29 cancellous screws, 2 failed consent). Six deaths (19.3%) were seen in each group. A total of 3.2% of DHS (1 out of 31) and 10.3% (3 out of 29) of cancellous screw patients required re-operation (P = 0.272). There was no statistical significant difference in patient satisfaction, quality of life (QoL), radiological union or osteonecrosis. There are trends towards better functional scores and QoL in cancellous screws, particularly at 1 year (P = 0.0061), but with a higher re-operation rate. There was a combined mortality and transition to institutional care of 40.0% (24 out of 60) at 2 years.

Conclusions
This study found no difference in outcomes between DHS and cancellous screws in the treatment of subcapital NOFFs in a fit, independent population, but we found a high level of physical decline in previously fit, independently ambulating patients. A large, multicentre trial will be required to differentiate between these two fixation methods.

Journalism ethics and law: stories of media practice

Journalism Ethics and Law ignites the conversation about journalism ethics and the function of the law in today’s media. Emphasising a practical work-based approach to develop best practice multimedia journalism; this book presents a combined ethics and law experience for journalism students and uses stories and case studies to highlight the most significant questions for the practice of law and ethics today.

Journalism Ethics and Law offers readers a new way about thinking about journalism ethics and empowers future journalists to make good and ethical decisions in the field.

Evidence from genetic and Lagrangian drifter data for transatlantic transport of small juvenile green turtles

Aim  A key life-history component for many animals is the need for movement between different geographical locations at particular times. Green turtle (Chelonia mydas) hatchlings disperse from their natal location to spend an early pelagic stage in the ocean, followed by a neritic stage where small juveniles settle in coastal areas. In this study, we combined genetic and Lagrangian drifter data to investigate the connectivity between natal and foraging locations. In particular we focus on the evidence for transatlantic transport. Location  Atlantic Ocean.

Methods  We used mitochondrial DNA (mtDNA) sequences (n = 1567) from foraging groups (n = 8) and nesting populations (n = 12) on both sides of the Atlantic. Genetic data were obtained for Cape Verde juvenile turtles, a foraging group not previously sampled for genetic study. Various statistical methods were used to explore spatial genetics and population genetic structure (e.g. exact tests of differentiation, Geneland and analysis of molecular variance). Many-to-many mixed stock analysis estimated the connectivity between nesting and foraging groups.

Results  Our key new finding is robust evidence for connectivity between a nesting population on the South American coast (25% of the Surinam nesting population are estimated to go to Cape Verde) and a foraging group off the coast of West Africa (38% of Cape Verde juveniles are estimated to originate from Surinam), thus extending the results of previous investigations by confirming that there is substantial transatlantic dispersal in both directions. Lagrangian drifter data demonstrated that transport by drift across the Atlantic within a few years is possible.

Main conclusions  Small juvenile green turtles seem capable of dispersing extensively, and can drop out of the pelagic phase on a transatlantic scale (the average distance between natal and foraging locations was 3048 km). Nevertheless, we also find support for the ‘closest-to-home’ hypothesis in that the degree of contribution from a nesting population to a foraging group is correlated with proximity. Larger-sized turtles appear to feed closer to their natal breeding grounds (the average distance was 1133 km), indicating that those that have been initially transported to far-flung foraging grounds may still be able to move nearer to home as they grow larger.

An experimental investigation of edge strain and bow in roll forming a V-section

V-sections were roll formed from two grades of steel, and the strain on the top and bottom of the strip near the edge was measured using electrical resistance strain gauges. The channels were bent to a radius of 2 and 15 mm along the centerline. The steel strips were of mild and dual phase steel of yield strength 367 MPa and 597 MPa respectively. The longitudinal bow was measured using a 3-dimensional scanning system. The strain measurements were analysed to determine bending and mid-surface strains at the edge during forming. The peak longitudinal edge strain increased with material yield strength for both profile radii. For the 15 mm radius, the bow was larger in the dual phase steel than in the mild steel. For the 2 mm profile radius, the bow was smaller compared with the 15 mm profile radius and it was similar for both steels. It was observed that the difference between the peak longitudinal edge strain and yield strength to Youngs modulus ratio of the material is an important factor in determining longitudinal bow.

Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios

Aims and objectives: To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Background: Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Design: Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Methods: Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Results: Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. Conclusions: There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. Relevance to clinical practice: There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Modeling of shear ductile fracture considering a changeable cut-off value for stress triaxiality

 A macroscopic ductile fracture criterion is proposed based on micro-mechanism analysis of nucleation, growth and shear coalescence of voids from experimental observation of fracture surfaces. The proposed ductile fracture model endows a changeable cut-off value for the stress triaxiality to represent effect of micro-structures, the Lode parameter, temperature, and strain rate on ductility of metals. The proposed model is used to construct fracture loci of AA 2024- T351. The constructed fracture loci are compared with experimental data covering wide stress triaxiality ranging between –0.5 and 1.0. The comparison suggests that the proposed model can provide a satisfactory prediction of ductile fracture for metals from compressive upsetting tests to plane strain tension with slanted fracture surfaces. Moreover, it is expected that the proposed model reasonably describes ductile fracture behavior in high velocity perforation simulation since a reasonable cut-off value for the stress triaxiality is coupled with the proposed ductile fracture criterion.