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CHERRY, Kevin M. Plato, Aristotle, and the Purpose of Politics. New York: Cambridge University Press, 2012. xii + 232 pp. Cloth, $95.00--In this rewarding and wide ranging book Kevin Cherry [...]

Aim: New stoma patients often rely heavily on the assistance of the ward nursing staff during the hospital stay and on the availability of home nursing care services (HNCS) after discharge. An easily executable 4‐day in‐hospital educational stoma pathway was developed and implemented. The aim was to increase their level of independence (LOI) in order to reduce the need for HNCS after discharge. Method : All new stoma patients on the gastrointestinal surgery ward, physically and psychologically capable of performing independent stoma care (SC), were enrolled in this pathway. They were compared to a retrospective control group of new stoma patients before the onset of the stoma pathway. The primary outcome is the need and frequency of HNCS for SC at the moment of discharge. Secondary outcome is the LOI in SC at discharge. Results: A total of 145 patients [m:f = 102:43, median age 67 (range 27–90) years] were included in the present study. Patients requiring daily HNCS for SC decreased from 80% to 50%, P < 0.001; patients discharged without HNCS for SC increased from 5% to 27%. Patients' independence in SC at discharge increased from 8% to 68%, P < 0.001. Conclusion: This study shows that a clinical 4‐day in‐hospital educational stoma pathway is feasible and effective in increasing the LOI in SC of new stoma patients and significantly reducing their need for HNCS. Cost–benefit analysis and applicability of this pathway in multicentre settings are currently being investigated. [ABSTRACT FROM AUTHOR]

Aim: Surgical site infection in colorectal surgery is associated with significant healthcare costs, which may be reduced by using a closed‐incision negative‐pressure therapy device. The aim of this study was to assess the impact of closed‐incision negative‐pressure therapy on the incidence of surgical site infection. Method: In this retrospective cohort study we evaluated all patients who had undergone high‐risk open colorectal surgery at a single tertiary care centre from 2012 to 2016. We compared the incidence of surgical site infection between those receiving standard postoperative wound care between 2012 and 2014 and those receiving closed‐incision negative‐pressure therapy via a customizable device (Prevena Incision Management System, KCI, an Acelity company, San Antonio, Texas, USA) between 2014 and 2016. A validated surgical site infection risk score was used to create a 1:1 matched cohort subset. Results: Negative pressure therapy was used in 77 patients and compared with 238 controls. Negative pressure patients were more likely to have a stoma (92% vs 48%, P < 0.01) and to be smokers (33% vs 15%, P < 0.01). Surgical site infection was higher in control patients (15%, n = 35/238) compared with negative pressure patients (7%, n = 5/77) (P = 0.05). On regression analysis, negative pressure therapy was associated with decreased surgical site infection (OR 0.27; 95% CI 0.09–0.78). These differences persisted in the matched analysis. Conclusion: Negative pressure therapy was associated with decreased surgical site infection. Negative pressure therapy offers significant potential for quality improvement. [ABSTRACT FROM AUTHOR]

Ten fresh frozen right cadaver arms were placed in a motorized jig and an in-situ ulnar nerve decompression was performed in 5 mm increments distally to the flexor carpi ulnaris (FCU) aponeurosis then proximally to the intermuscular septum. The elbows were ranged 0–135° after each incremental decompression and the ulnar nerve to medial epicodyle distance was measured to assess for nerve translation/subluxation compared with baseline (prerelease) values. None of the specimens had ulnar nerve subluxation (defined as anterior translation past the medial epicondyle) even after full decompression. Furthermore, there were no statistically significant ulnar nerve translations (defined as any difference in distance from ulnar nerve to medial epicondyle before and after each decompression) for any flexion angle or extent of decompression. This study provides biomechanical evidence that in situ ulnar nerve decompression from the FCU aponeurosis to the intermuscular septum does not result in significant ulnar nerve translation or subluxation. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical outcomes and radiographic features of surgically treated traumatic ulnocarpal translocation in nine patients (ten cases). All ligament and fracture repairs were completed within 2 months of injury. Seven cases were examined at a mean of 6.5 years, and information in three cases was obtained from medical records at a mean of 13 months after injury. At final evaluation, the mean disabilities of the arm, shoulder, and hand score was 6 (range, 0–16), and the mean Mayo modified wrist score was 76 (range, 40–100). Ulnocarpal translocation was evident in nine of the injured wrists, six of which showed arthritis, and in four of the uninjured wrists. Ulnar variance measured negative in nine cases and neutral in one case. Pre-existing medial alignment of the carpus and ulnar minus variance may predispose to traumatic ulnocarpal translocation. Early injury repair does not assure restoration of radiocarpal alignment or prevent joint deterioration; however, these changes do not always portend a suboptimal result. [ABSTRACT FROM PUBLISHER]

Object-based storage is the natural evolution of the block storage interface, aimed at efficiently and effectively meeting the performance, reliability, security, and service requirements demanded by current and future applications. The object-based storage interface provides an organizational container, called an object, into which higher-level software (e.g., file systems, databases, and user applications) can store both data and related attributes. In 2004, the ANSI (American National Standards Institute) T10 Standards body ratified an Object-based Storage Device (OSD) command set for SCSI (Small Computer System Interface) storage devices that implements the OSD interface. This paper describes the rationale for OSDs, highlights the ANSI T10 OSD V1.0 interface, and presents three OSD implementations: an OSD from Seagate, an IBM object-based storage prototype (ObjectStone), and the Panasas object-based distributed storage system. [ABSTRACT FROM AUTHOR]

Thirty-six flexor tendons from fresh frozen cadavers were randomized to three types of repairs: a Kessler-Tajima, a 4-strand modified Tsuge, and a 6-strand modified Tsuge. All repairs were accompanied by a standard epitendinous suture. The repaired tendons were then tested to initial gap and ultimate failure in an Instron machine. The average forces to ultimate failure were 31.8 N (SD, 8.8), 48.4 N (SD, 10.7), and 64.2 N (SD, 11.0) respectively. The 6-strand modified Tsuge suture was significantly stronger than the other repairs and the 4-strand modified Tsuge was significantly stronger than the 2-strand Kessler-Tajima. The 6-strand and 4-strand modified Tsuge repairs appear strong enough to withstand the forces generated during early active range of motion flexor tendon rehabilitation protocols. Clinical trials are required to evaluate the usefulness of these repairs. [ABSTRACT FROM PUBLISHER]

We present our series of 17 patients who underwent wrist arthrodesis with excision of the proximal row carpal bones using the AO wrist fusion plate and local bone graft obtained from the excised proximal carpal row. All patients were evaluated using a questionnaire to assess pain, function, ability to perform an occupation and satisfaction with the procedure. The mean follow-up was 17 months, at which time all the fusions had united. Clinical outcome scores showed that 14 and 15 of the 17 patients achieved good or excellent results with regard to their current condition and clinical improvement, respectively. Four patients required secondary surgery, two for fractures and two for instability of the distal radio-ulnar joint unrelated to the wrist fusion. [ABSTRACT FROM PUBLISHER]

A model was developed to simulate the combination of Davis's electrical model of cochlear excitation and the electrical model of a neuron; both afferent and efferent fibers were included. The resulting model was stimulated by varying the hair cell resistance. This is equivalent to varying the sound pressure level presented to the cochlea in the physiological system. It was found that, in the normal ear, there was a critical level of hair cell resistance below which no firings were obtained (no information transmitted). The scala media potential was varied and the previous tests repeated. This was done to simulate changes in the stria vascularis of the physiological system. It was found that as the scala media potential decreased, the critical value of the hair cell resistance increased. Two clinical procedures are proposed: the first is a procedure to improve hearing for persons with a "linear or flat loss"; the second is a procedure for improving the hearing for persons with a "ski slope loss." [ABSTRACT FROM AUTHOR]

The authors measured the impact of educational efforts on the number of college students who received meningococcal vaccine. First-year Brown University students from the classes of 2004 (n = 1,562) and 2005 (n = 1,518) received educational vaccine materials before they arrived on campus, whereas students from the class of 2003 (n = 1.441) did not. Students in the class of 2003, 13% (n = 184) of whom had received vaccine before their arrival on campus, served as the baseline. These educational efforts by the college health services before students arrived on campus increased the number of students immunized before campus arrival to 46% (n = 724) for the class of 2004, and 60% (n = 913) for the class of 2005. Education about the benefits of meningococcal vaccine before students' arrival on campus increased both the number of immunized students and the overall immunization rate among students. [ABSTRACT FROM AUTHOR]