bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncertainty prior to pulmonary rehabilitation in primary care
Authors: Lewis Adam , Bruton Anne , Donovan-Hall Maggie
Published: July 2014

Pulmonary rehabilitation (PR) is recommended for patients functionally restricted by chronic obstructive pulmonary disease (COPD). However, attendance and adherence to PR remains suboptimal. No previous research has explored COPD patient experiences during the key period from referral to initiation of PR in the United Kingdom. This research aimed to explore the lived experience of COPD patients referred to PR programmes prior to participation. COPD participants were recruited from referrals to two community PR programmes. Semi-structured interviews with COPD participants occurred following PR referral, but prior to programme initiation. Data were analyzed using applied interpretive phenomenology. Twenty-five COPD participants aged 42–90 were interviewed. ‘Uncertainty’ affected participants throughout their lived experience of COPD that negatively impacted illness perceptions, PR perceptions and increased participant’s panic and anger. Participants who perceived COPD less as a chronic condition and more as a cyclical process experienced fewer feelings of panic or anger. The experience of uncertainty was disabling for these COPD participants. Recognition of the role that uncertainty plays in patients with COPD is the first step towards developing interventions focused on reducing this uncertainty, thereby reducing the burden of the disease for the individual patient and facilitating PR attendance.
How Affective Science Can Inform Clinical Science
Authors: Tracy Jessica L. , Klonsky E. David , Proudfit Greg Hajcak
Published: July 2014

The construct of emotion dysregulation has been used to describe and explain diverse psychopathologies. Although this is intuitively appealing and sensible, the application of emotion reactivity and regulation to the study of psychopathology has, to a large extent, proceeded independently from concepts and measures informed by affective science. Utilizing the innovative research approaches, measures, paradigms, and insights that have emerged in the burgeoning field of affective science holds substantial promise for emotion dysregulation theories of psychopathology. In this introduction to the special series on emotions and psychopathology, we review many of these advances, and highlight several broad methodological and conceptual issues that researchers seeking to continue this crosscutting work should bear in mind. We close with a brief review of the six articles that constitute the special series, noting how each exemplifies the pioneering methodological and substantive advances that are typical of the best work in this new interdisciplinary field.
Study protocol of the Going to Stay at Home program: evaluation of a residential carer training program to reduce dementia carer distress and burden
Authors: Gresham Meredith , Tsang Ruby S M , Heffernan Megan , Brodaty Henry
Published: July 2014

Background

Caring for a person with dementia has profound physical, psychological, social and financial impacts on the carer, while morbidity in carers has detrimental effects on outcomes in people with dementia. A 10-day hospital-based residential carer training program (BMJ 299(6712):1375–1379, 1989) delayed residential care placement, delayed mortality, reduced carer’s psychological morbidity and lowered care costs. This study aims to evaluate the effects of a similar program adapted for use with residential respite.

Methods/Design

This is a single-arm longitudinal study conducted at a residential aged care facility involving 100 people with dementia and their primary carers. In a 7-day residential program, carers will attend intensive training sessions while the people with dementia are engaged in daily activities. Data will be collected at the start of the residential program (baseline), at 6 months (post 1) and at 12 months (post 2) after completion of the program. The primary outcome is carer psychological distress. Secondary outcomes include carer burden, carer quality of life and time to residential care placement.

Discussion

This study will provide evidence on the effectiveness of the program in reducing carer distress and burden as well as delaying institutionalisation of the person with dementia, which may have important implications for policy.
Cyclin-dependent kinases
Authors: Malumbres Marcos
Published: July 2014

Cyclin-dependent kinases (CDKs) are protein kinases characterized by needing a separate subunit - a cyclin - that provides domains essential for enzymatic activity. CDKs play important roles in the control of cell division and modulate transcription in response to several extra- and intracellular cues. The evolutionary expansion of the CDK family in mammals led to the division of CDKs into three cell-cycle-related subfamilies (Cdk1, Cdk4 and Cdk5) and five transcriptional subfamilies (Cdk7, Cdk8, Cdk9, Cdk11 and Cdk20). Unlike the prototypical Cdc28 kinase of budding yeast, most of these CDKs bind one or a few cyclins, consistent with functional specialization during evolution. This review summarizes how, although CDKs are traditionally separated into cell-cycle or transcriptional CDKs, these activities are frequently combined in many family members. Not surprisingly, deregulation of this family of proteins is a hallmark of several diseases, including cancer, and drug-targeted inhibition of specific members has generated very encouraging results in clinical trials.
Psychodynamic psychotherapy: developing the evidence base
Authors: Yakeley Jessica
Published: July 2014

Psychodynamic psychotherapy has been criticised as being based on outdated principles of psychoanalysis and lacking an adequate evidence base to convincingly demonstrate its efficacy. This article summarises the recent evidence from high-quality outcome studies to show that psychodynamic psychotherapy is as effective in the treatment of a range of mental disorders as other psychological treatment modalities such as cognitive-behavioural therapy, as well as reviewing process-outcome research aiming to elucidate mechanisms of therapeutic change. A paradigm for psychodynamic psychotherapy research based on attachment theory is introduced, which may inform the development of psychodynamic therapeutic modalities tailored for specific conditions.

LEARNING OBJECTIVES

Understand the basic principles and techniques of psychodynamic psychotherapy.

Be able to summarise the recent evidence base for the efficacy of psychodynamic psychotherapy.

Appreciate process-outcome research that elucidates therapeutic mechanisms underpinning psychodynamic psychotherapy.
Improved Survival After Transplantation of More Donor Plasmacytoid Dendritic or Naïve T Cells From Unrelated-Donor Marrow Grafts: Results From BMTCTN 0201
Authors: Waller Edmund K. , Logan Brent R. , Harris Wayne A.C. , Devine Steven M. , Porter David L. , Mineishi Shin , McCarty John M. , Gonzalez Corina E. , Spitzer Thomas R. , Krijanovski Oleg I. , Linenberger Michael L. , Woolfrey Ann , Howard Alan , Wu Juan , Confer Dennis L. , Anasetti Claudio
Published: July 2014

Purpose

To characterize relationships between specific immune cell subsets in bone marrow (BM) or granulocyte colony-stimulating factor–mobilized peripheral blood (PB) stem cells collected from unrelated donors and clinical outcomes of patients undergoing transplantation in BMTCTN 0201.

Patients and Methods

Fresh aliquots of 161 BM and 147 PB stem-cell allografts from North American donors randomly assigned to donate BM or PB stem cells and numbers of transplanted cells were correlated with overall survival (OS), relapse, and graft-versus-host disease (GvHD).

Results

Patients with evaluable grafts were similar to all BMTCTN 0201 patients. The numbers of plasmacytoid dendritic cells (pDCs) and naïve T cells (Tns) in BM allografts were independently associated with OS in multivariable analyses including recipient and donor characteristics, such as human leukocyte antigen mismatch, age, and use of antithymocyte globulin. BM recipients of > median number of pDCs, naïve CD8+ T cells (CD8Tns), or naïve CD4+ T cells (CD4Tns) had better 3-year OS (pDCs, 56% v 35%; P = .025; CD8Tns, 56% v 37%; P = .012; CD4Tns, 55% v 37%; P = .009). Transplantation of more BM Tns was associated with less grade 3 to 4 acute GvHD but similar rates of relapse. Transplantation of more BM pDCs was associated with fewer deaths resulting from GvHD or from graft rejection. Analysis of PB grafts did not identify a donor cell subset significantly associated with OS, relapse, or GvHD.

Conclusion

Donor immune cells in BM but not PB stem-cell grafts were associated with survival after unrelated-donor allogeneic hematopoietic stem-cell transplantation. The biologic activity of donor immune cells in allogeneic transplantation varied between graft sources. Donor grafts with more BM-derived Tns and pDCs favorably regulated post-transplantation immunity in allogeneic hematopoietic stem-cell transplantation.
Adaptive Dose-Finding Studies: A Review of Model-Guided Phase I Clinical Trials
Authors: Iasonos Alexia , O'Quigley John
Published: July 2014

Purpose

We provide a comprehensive review of adaptive phase I clinical trials in oncology that used a statistical model to guide dose escalation to identify the maximum-tolerated dose (MTD). We describe the clinical setting, practical implications, and safety of such applications, with the aim of understanding how these designs work in practice.

Methods

We identified 53 phase I trials published between January 2003 and September 2013 that used the continual reassessment method (CRM), CRM using escalation with overdose control, or time-to-event CRM for late-onset toxicities. Study characteristics, design parameters, dose-limiting toxicity (DLT) definition, DLT rate, patient-dose allocation, overdose, underdose, sample size, and trial duration were abstracted from each study. In addition, we examined all studies in terms of safety, and we outlined the reasons why escalations occur and under what circumstances.

Results

On average, trials accrued 25 to 35 patients over a 2-year period and tested five dose levels. The average DLT rate was 18%, which is lower than in previous reports, whereas all levels above the MTD had an average DLT rate of 36%. On average, 39% of patients were treated at the MTD, and 74% were treated at either the MTD or an adjacent level (one level above or below).

Conclusion

This review of completed phase I studies confirms the safety and generalizability of model-guided, adaptive dose-escalation designs, and it provides an approach for using, interpreting, and understanding such designs to guide dose escalation in phase I trials.
Conformational remodeling of the fibronectin matrix selectively regulates VEGF signaling
Authors: Ambesi Anthony , McKeown-Longo Paula J.
Published: July 2014

The fibronectin matrix plays a critical role in the regulation of angiogenesis during development, tissue repair and disease pathogenesis. Earlier work has identified a fibronectin-derived homophilic binding peptide, anastellin, as an effective inhibitor of angiogenesis; however its mechanism of action is not well understood. In the present study, we demonstrate that anastellin selectively inhibits microvessel cell signaling in response to VEGF165 but not VEGF121 by preventing the assembly of the VEGF receptor/Neuropilin-1 complex. Anastellin treatment resulted in the inactivation of α5β1 integrins but was not accompanied by a change in either adhesion complexes or adhesion based signaling. Integrin inactivation was associated with a masking of the fibronectin synergy site within the extracellular matrix, indicating that α5β1 inactivation resulted from a decrease in available ligand. These data demonstrate that anastellin influences the microvessel cell response to growth factors by controlling the repertoire of ligated integrins and point to anastellin as an effective regulator of fibronectin matrix organization. These studies further suggest that homophilic fibronectin binding peptides may have novel applications to the field of tissue regeneration as tools to regulate neovascularization.
An Alternative Carbon Dioxide Capture by Electrochemical Method
Authors: Taniguchi Ikuo , Ioh Daichi , Fujikawa Shigenori , Watanabe Takayuki , Matsukuma Yosuke , Minemoto Masaki
Published: July 2014

CO2 capture with liquid amine scrubbing has received current acceptance; however, the energy intensive heating process in CO2 recovery requires alternate effective CO2 separation methods. Condensation of CO2-trapping solutions by electrodialysis and successive CO2 recovery under reduced pressure would decrease the required energy in the CO2 capture drastically. Energy calculations and basic experiments reveal that the required energy can be reduced to less than 2.0 GJ (t-CO2)−1, which is about a half of the energy required for aqueous monoethanolamine.
The Effect of Biochar and Cro p Veil on Growth and Yield of Tomato (Lycopersicum esculentus Mill) in Jos, North central Nigeria
Authors: Yilangai Rahila , Manu S , Pineau W , Mailumo S , Okeke-Agulu K
Published: July 2014

This study investigated the effect of charcoal(biochar) and crop veil on the growth of tomato (Lycopersicum esculentus Mill) in Jos, North central Nigeria. Four Super Vegetable Garden growingbeds and four traditional vegetable beds each measuring 15 m2 (12.5 m by 1.2 m) and 1 m gap between beds were laid out.The soil on both SVG and traditional beds were mixed with the same quantity of inorganic and organic fertilizer for plant development. After preparing the subsoil, 30 kg of biochar was spread on the four SVG beds as evenly as possible.Tomato seedlings were raised in the nursery for the period of 4 weeks after which they were transplanted on the SVG and traditional beds at 30 cmspacing. Data werecollected using systematic random sampling technique by creating small plots of 2.5 by 1.2 cm on the beds at 2.5 cm intervals between plots. The stem growth was recorded twice at 4 and 6 weeks after transplanting using a 100 cm rule. Fruits were counted on each plant within plots and recorded. Results obtained from this research showed that stem growth was very significantly higher in tomatoes grown on SVG beds treated with charcoal and covered with veil than traditional beds without charcoal and veil covering. Fruit yield in tomato plant was also significantly higher on beds with charcoal than beds without charcoal. This finding is important in improving food security through increase in soil fertility and crop yield in Nigeria and Sub Saharan Africa at large.
What's happening in postnatal care
Authors: Henderson Christine
Published: July 2014

Women's health after birth is of paramount importance and the part that health professionals play in the delivery of care is critical in helping them towards readjustment following childbirth. Midwives, GPs and health visitors each have a distinct contribution to make and although good practices and schemes have been introduced to improve the quality of care given and communication between professionals, there is much that is not known with little evidence about the effectiveness of our interventions or care.
Developing the use of EPDS in a Punjabi-speaking community
Authors: Clifford Collette , Day Asha , Cox John
Published: July 2014

The purpose of this article is to share the experience of developing a tool used in the assessment of postnatal depression in the English-speaking population for use in the Punjabi-speaking population. This is an important project In developing ways of ensuring equitable access to service provision across diverse multicultural caseloads.
Nottinghams pregnancy diary: A method of evaluating maternity care
Authors: Pittman Avril , Bailey Vicky , Whynes David , James Veronica
Published: July 2014

Diaries have increasingly been used as a data collection method in health and social research yet, despite their particular suitability, have not previously been employed as a major evaluation tool in maternity care. This article describes the methodology used in a study involving 700 Nottingham women.
Making sense of ‘horizontal violence’ in midwifery
Authors: Leap Nicky
Published: July 2014

Within the Australian midwifery world there is increasing use of the term ‘horizontal violence’, a term which has a similar impact to the 1970s use of ‘domestic violence’. The intent of such terms is not merely to compel the attention: they represent a shorthand for a political analysis of specific forms of oppression. ‘Horizontal violence’ is not just a description of intergroup conflict or various forms of ‘bullying’: it embodies an understanding of how oppressed groups direct their frustrations and dissatisfactions towards each other as a response to a system that has excluded them from power.
Economic evaluation of early amniotomy in low risk women
Authors: Henderson Jane , Mugford Miranda , Kavanagh Shane , Fraser William , Mlika-Cabanne Najoua , Maillard Paris Francoise , Breart Gerard
Published: July 2014

The effects of the routine use of early amniotomy to speed up labour have been analysed in a systematic review of randomized controlled trials. In this paper the authors used this data from the systematic review and a survey of costs to analyse the cost consequences of early amniotomy.
Independent midwifery — future inspiration or relic of the past?
Authors: Hunter Billie
Published: July 2014

Independent midwives have been seen as pioneers in providing innovative, woman-centred care. With the implementation of ‘Changing Childbirth’ (Dept. of Health, 1993), do they still have a role to play? This paper investigates the past and current position of independent midwifery and considers It's future potential. It is suggested that independent midwives will still have an important role as innovators and pioneers, However, the issues of insurance and remuneration pose difficulties which need attention.
A comparative assessment of small-head metal-on-metal and ceramic-on-polyethylene total hip replacement
Authors: Lübbeke A. , Gonzalez A. , Garavaglia G. , Roussos C. , Bonvin A. , Stern R. , Peter R. , Hoffmeyer P.
Published: July 2014

Large-head metal-on-metal (MoM) total hip replacements (THR) have given rise to concern. Comparative studies of small-head MoM THRs over a longer follow-up period are lacking. Our objective was to compare the incidence of complications such as infection, dislocation, revision, adverse local tissue reactions, mortality and radiological and clinical outcomes in small-head (28 mm) MoM and ceramic-on-polyethylene (CoP) THRs up to 12 years post-operatively.

A prospective cohort study included 3341 THRs in 2714 patients. The mean age was 69.1 years (range 24 to 98) and 1848 (55.3%) were performed in women, with a mean follow-up of 115 months (18 to 201). There were 883 MoM and 2458 CoP bearings. Crude incidence rates (cases/1000 person-years) were: infection 1.3 vs 0.8; dislocation 3.3 vs 3.1 and all-cause revision 4.3 vs 2.2, respectively. There was a significantly higher revision rate after ten years (adjusted hazard ratio 9.4; 95% CI 2.6 to 33.6) in the MoM group, and ten of 26 patients presented with an adverse local tissue reaction at revision. No differences in mortality, osteolysis or clinical outcome were seen.

In conclusion, we found similar results for small-head MoM and CoP bearings up to ten years post-operatively, but after ten years MoM THRs had a higher risk of all-cause revision. Furthermore, the presence of an adverse response to metal debris seen in the small-head MOM group at revision is a cause for concern.

Cite this article: Bone Joint J 2014; 96-B:868–75.
The stability of the femoral component in the Oxford unicompartmental knee replacement
Authors: Reiner T. , Jaeger S. , Schwarze M. , Klotz M. C. , Beckmann N. A. , Bitsch R. G.
Published: July 2014

Aseptic loosening of the femoral component is an important indication for revision surgery in unicompartmental knee replacement (UKR). A new design of femoral component with an additional peg was introduced for the cemented Oxford UKR to increase its stability. The purpose of this study was to compare the primary stability of the two designs of component.

Medial Oxford UKR was performed in 12 pairs of human cadaver knees. In each pair, one knee received the single peg and one received the twin peg design. Three dimensional micromotion and subsidence of the component in relation to the bone was measured under cyclical loading at flexion of 40° and 70° using an optical measuring system. Wilcoxon matched pairs signed-rank test was performed to detect differences between the two groups.

There was no significant difference in the relative micromotion (p = 0.791 and 0.380, respectively) and subsidence (p = 0.301 and 0.176, respectively) of the component between the two groups at both angles of flexion. Both designs of component offered good strength of fixation in this cadaver study.

Cite this article: Bone Joint J 2014;96-B:896–901.
Coronal alignment in total knee replacement
Authors: Abdel M. P. , Oussedik S. , Parratte S. , Lustig S. , Haddad F. S.
Published: July 2014

Substantial healthcare resources have been devoted to computer navigation and patient-specific instrumentation systems that improve the reproducibility with which neutral mechanical alignment can be achieved following total knee replacement (TKR). This choice of alignment is based on the long-held tenet that the alignment of the limb post-operatively should be within 3° of a neutral mechanical axis. Several recent studies have demonstrated no significant difference in survivorship when comparing well aligned versus malaligned TKRs. Our aim was to review the anatomical alignment of the knee, the historical and contemporary data on a neutral mechanical axis in TKR, and the feasibility of kinematically-aligned TKRs.

Review of the literature suggests that a neutral mechanical axis remains the optimal guide to alignment.

Cite this article: Bone Joint J 2014;96-B:857–62.
The importance of epidemiological fracture data
Authors: Aitken S. A. , Hutchison J. D. , McQueen M. M. , Court-Brown C. M.
Published: July 2014

Epidemiological studies enhance clinical practice in a number of ways. However, there are many methodological difficulties that need to be addressed in designing a study aimed at the collection and analysis of data concerning fractures and other injuries. Most can be managed and errors minimised if careful attention is given to the design and implementation of the research.

Cite this article: Bone Joint J 2014;96-B:863–7.
Iatrogenic gastric perforation during laparoscopy presenting on anaesthesia monitor
Authors: Parvaiz MA , Pervaiz MA
Published: July 2014

Unfortunately, in the era of minimal access surgery, visceral injuries due to laparoscopic port insertion are common. Most such injuries are diagnosed on direct vision through a laparoscope camera. We report a case of iatrogenic gastric perforation during laparoscopy, presenting in an unusual way in the form of a very high carbon dioxide output on the anaesthesia monitor. This atypical presentation should be borne in mind while performing laparoscopy.
Luc’s abscess as an unlucky complication of mastoiditis
Authors: Scrafton DK , Qureishi A , Nogueira C , Mortimore S
Published: July 2014

Luc’s abscess is a rare but important complication of acute otitis media (AOM), whereby infection spreads from the middle ear, resulting in a subperiosteal collection beneath the temporal muscle. Unlike other extracranial abscesses relating to AOM, Luc’s abscess is not believed to involve the mastoid bone. We present the case of a patient with a Luc’s abscess with mastoid involvement and discuss its successful management. We believe that patients presenting with a subperiosteal collection beneath the temporal muscle and mastoiditis may represent a different group of patients to those described originally by Luc. These individuals can be differentiated using computed tomography (CT) of the temporal bones. We advocate CT in patients with Luc’s abscess and AOM; this aids preoperative surgical planning.
Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy
Authors: Shelton JA , Brown JJS , Young JA
Published: July 2014

Introduction

Diagnostic laparoscopy with appendicectomy (LA) has become the accepted method of investigation and treatment of appendicitis. However, concerns remain in cases of complicated appendicitis when many advocate conversion to an open procedure (LCOA) owing to the risk of complications. The aim of this study was to look for factors that could predict complications occurring in patients undergoing appendicectomy.

Methods

Data inclusive of all consecutive appendicectomies over a two-year period were retrieved from the computerised theatre database. Clinical details including admission inflammatory markers, complications, severity (final pathology) and length of stay were collected from the discharge letter. Readmissions were identified as those hospital identifiers had a second set of admission dates and/or a second discharge letter.

Results

During the 2-year study period, 517 appendicectomies were performed. Of these, 429 patients (83%) had LA and the remaining 88 (17%) had LCOA. The LA group had a mean age of 28 years (range: 2–86 years) and a mean C-reactive protein (CRP) level of 71mg/l (range: 0–480mg/l) while the LCOA group had a mean age of 46 years (range: 11–92 years) and a mean CRP level of 162mg/l (range: 3–404mg/l). These differences in age and CRP were significant (p<0.001). LA patients were less likely to have complications overall (22% vs 52%, p=0.015). Complications were independently more than twice as common with established inflammation with a CRP level of >150mg/l (p<0.05).

Conclusions

A high preoperative CRP level predicts an increased rate of postoperative complication due to established inflammation and/or infection. This raises the question of whether we should be offering primary open appendicectomies to patients with a CRP level of >150mg/l.
Dental core trainee emergency workload and patterns in a district hospital oral and maxillofacial unit: a prospective snapshot audit
Authors: Batley Haris , Cousin Gary , Elrasheed Adel
Published: July 2014

As every hospital looks at how it can provide 24/7 care, even for smaller specialties, the Royal Blackburn Hospital tries using a Hospital at Night model to cover the OMFS service. What does this mean for dental core trainees and can they really get enough exposure to emergency cases if they only train in office hours?
Identification of alcohol misuse in dental patients
Authors: Roked Zairah , Watson Rhys , Moore Simon , Shepherd Jonathan
Published: July 2014

It’s on the medical history form and you may feel like you’ve asked it thousands of times: ‘How many units of alcohol do you consume each week?’. But is this question effective at identifying people with alcohol problems? Our authors provide evidence that a new approach to recording alcohol consumption would lead to more and better advice being given to patients.
Envolvimento parental na escola e ajustamento em crianças do 1º ciclo do ensino básico
Authors: Pereira Ana Isabel de Freitas , Canavarro José Manuel P. , Cardoso Margarida Fonseca , Mendonça Denisa
Published: July 2014

O presente trabalho tem por principal objectivo o estudo da relação entre o envolvimento parental na escola, percebido por pais e por professores, e o ajustamento de crianças do primeiro ciclo do ensino básico. A amostra é constituída por 563 crianças dos 3º e 4º anos de escolaridade, pelos seus pais e pelos seus professores. O envolvimento parental na escola foi avaliado através das duas versões, para pais e para professores, do Questionário de Envolvimento Parental na Escola (QEPE-VPa e QEPEVPr). Foram considerados dois indicadores de ajustamento das crianças, o seu desempenho académico, avaliado pelos professores e a sua autoestima global, avaliada pelas crianças. Na primeira parte do trabalho apresentam-se, ainda, alguns estudos psicométricos da versão para pais do Questionário de Envolvimento Parental na Escola (QEPE-VPa), cujos resultados apoiam a fiabilidade e a validade desta versão. Os resultados revelam uma associação positiva entre o envolvimento parental na escola e o ajustamento das crianças, mesmo quando controlado o efeito do nível sócio-económico das famílias das crianças. No entanto, verifica-se alguma variabilidade das associações encontradas em função da fonte que avalia o envolvimento parental e em função dos indicadores de ajustamento. Concretamente, a percepção dos professores do envolvimento parental na escola é a que apresenta associações mais elevadas com o desempenho académico. Por outro lado, é o envolvimento parental percebido pelos pais que apresenta associações mais elevadas com a autoestima global da criança.
Games e educação – a construção de novos significados
Authors: Alves Lynn Rosalina Gama
Published: July 2014

O presente artigo traz uma reflexão sobre a emergência dos games enquanto fenômeno investigativo, principalmente na área de educação na qual começam a surgir experiências que constroem um significado diferenciado para os jogos eletrônicos, apontando a possibilidade de tê-los como parceiros no processo de ensinar e aprender. No texto são indicadas experiências significativas do Brasil e dos Estados Unidos que vem utilizando a mediação dos jogos eletrônicos para processos de ensino aprendizagem na escola e empresas. Assim, nossa intenção é abrir um espaço para novas contribuições em torno dos jogos eletrônicos que vem se constituindo em um fenômeno cultural na sociedade contemporânea.
Os LMS no Apoio ao Ensino Presencial: dos conteúdos às interacções
Authors: Carvalho Ana Amélia A.
Published: July 2014

A utilização de LMS (Learning Management Systems) no apoio ao ensino presencial tem vindo a ganhar adeptos pelas vantagens que traz aos docentes e aos discentes, nomeadamente por ser um espaço privado de partilha e de interacção, sempre acessível.
A facilidade de disponibilização de conteúdos, de interacção através de ferramentas de comunicação síncronas e assíncronas, e de colaboração fazem das plataformas espaços apetecíveis para os agentes educativos. O papel do professor tem vindo a sofrer profundas alterações e o LMS tem funcionalidades que suportam mais facilmente as exigências da actividade docente, permitindo-lhe apoiar os alunos, ajudá-los a reflectir e a debater as temáticas abordadas. Além disso, os alunos ao desenvolverem colaborativamente um trabalho encontram nas ferramentas disponíveis no LMS a possibilidade de continuarem a trabalhar para além dos momentos presenciais, podendo contar com o apoio privado do professor.
A política externa russa no espaço euro-atlântico: dinâmica de cooperação e competição num espaço alargado
Authors: Daehnhardt Patricia , Freire Maria Raquel
Published: July 2014

Com enfoque no espaço Euro-Atlântico, este volume analisa as relações daRússia com atores diversos, em níveis de análise diferenciados, e comênfase nas dimensões de atuação relevantes a nível político, económico ede segurança. Destacam-se o espaço pós-soviético, área vital de atuaçãoe influência russa; as relações com a União Europeia (UE); o Ártico,pelos recursos energéticos abundantes e pelas rotas de distribuição; asrelações com os Estados Unidos da América; as relações com a Turquia, umator emergente com estatuto regional importante para a diplomacia deMoscovo; e as relações no quadro do Médio Oriente, região em grandemudança desde a primavera Árabe com implicações para a diplomacia russa.De um modo inclusivo esta análise visa clarificar os alinhamentos depolítica externa russa mais de duas décadas após o fim da UniãoSoviética, com todas as implicações que lhe estão subjacentes,constituindo um contributo fundamental para a compreensão das relaçõesinternacionais russas num contexto em mudança.
Effects of reindeer grazing and forestry on ground lichens in Finnish Lapland
Authors: Akujärvi Anu , Hallikainen Ville , Hyppönen Mikko , Mattila Eero , Mikkola Kari , Rautio Pasi
Published: July 2014

Reindeer husbandry and forestry are practiced in the same areas in northern Fennoscandia. Reindeer pastures have largely deteriorated. We aimed to quantify the separate and combined effects of reindeer grazing and forestry on the amount of ground lichens. To do this, we mapped and inventoried all larger enclosures (49) in Finnish Lapland where forest management practices were similar in both sides of the fence. The average time since fencing was 43 years. We recorded the cover and estimated dry biomass of ground lichens, as well as parameters describing forest stand characteristics. The effect of reindeer grazing on both the cover and estimated dry biomass of lichens was clear: in the ungrazed (fenced) sites, the lichen cover (35.8%) was on average 5.3-fold and the dry biomass (1929 kg ha) 14.8-fold compared with the corresponding estimates in the grazed sites (6.8% and 130 kg ha). The effect of forestry on lichens was smaller. In the grazed stands the cover and biomass of lichens were higher in the mature stands compared to the younger stand development classes, whereas in the ungrazed stands there were no significant differences between the development classes. Both reindeer grazing and forestry affect the cover and biomass of ground lichens. The influence of reindeer grazing is, however, much heavier than that of forestry. The decrease of not only the biomass, but also the lichen cover, is alarming. The decrease of lichen cover may hinder the recovery of reindeer pastures, which in the long run endangers the sustainability of reindeer husbandry.â1â1
Perfil nutricional y dializabilidad de minerales de alimentos de interés social
Authors: Galán María Gimena , González Rolando José , Drago Silvina Rosa
Published: July 2014

Introducción: evaluar la composición, digestibilidad proteica (DP) y bioaccesibilidad de Fe, Zn y Ca (antes y luego de la cocción) de Alimentos de Interés Social (AIS).Material y Métodos: se analizaron 4 AIS. La composición se determinó según AOAC (2000). La bioaccesibilidad de minerales se estimó a través del porcentaje del mineral dializado, luego de un proceso de digestión que simula los procesos gastrointestinales. El aporte potencial (AP) de minerales se estableció como el producto de su concentración y dializabilidad. La DP se determinó por digestión enzimática y midiendo el incremento del nitrógeno no proteico.Resultados: la composición de AIS fue la siguiente: proteínas: 11,53-24,67g/100g; grasa: 4,31–8,46g/100g; cenizas: 2,95–3,66g/100g; fibra dietaria: 0,6–4g/100g; carbohidratos: 49,38–60,37g/100g; energía: 366,05–389,38Kcal/100g; Fe: 28,91-60,41mg/Kg; Zn: 5,99–33,08mg/Kg; Ca: 1127,69-417,39mg/Kg; Na: 2517,21–13217,50mg/Kg. La DP estuvo en un rango de 58–92%. Los alimentos cocidos presentaron una bioaccesibilidad de Fe y Zn menor que los alimentos crudos, lo cual puede atribuirse, en el caso del Fe, a la pérdida de ácido ascórbico que se produce durante la cocción, y para el Zn a interacciones con otros componentes de la matriz alimentaria que dificultan su liberación durante los procesos digestivos. Según su AP, los AIS cubrirían entre un 10–26% los requerimientos de Fe, 6-8% de los requerimientos de Ca y 2–34% de los requerimientos de Zn.Conclusiones: los AIS, poseen un buen balance nutricional. La disponibilidad de minerales de los AIS fue muy buena y se redujo ligeramente al ser cocidos.
Moderately Elevated Intracranial Pressure Produces Greater Cross-Filling of the Anterior Communicating Artery
Authors: Zhang Yi C. , Young Robert J , Jones Kevin , Koh Elsie , Lien Ruby J. , Kagetsu Nolan J.
Published: July 2014

This study aimed to investigate whether moderately elevated intracranial pressure is associated with greater cross-filling of the anterior communicating artery on diagnostic cerebral angiography. A retrospective study of 12 patients with subarachnoid hemorrhage was performed. Data on sequential cerebral angiograms and clinical data were used to indirectly estimate intracranial pressure (ICP). Cross-filling of the anterior communicating artery (ACom) was recorded according to our scoring system. Our study included 12 patients with mean age 43 ± 11 yrs. Six patients demonstrated greater ICP associated with greater cross-filling of the ACom on initial angiogram. One patient had greater ICP with greater cross-filling on follow-up angiogram secondary to infarction and midline shift. Two patients had lower ICP yet greater cross-filling on follow-up angiogram due to higher injection rate and volume. One patient with no change in ICP demonstrated the same degree of cross-filling. A markedly elevated ICP is traditionally associated with no cross-filling across the ACom. We propose a counter-intuitive model in which moderately elevated ICP produces greater cross-filling of the ACom. This diagnostic angiographic finding should make the angiographer consider that the patient has moderately elevated ICP, and facilitate more timely clinical management.
Polymicrogyria, Large Corpus Callosum and Psychomotor Retardation in Four-Year-Old Girl: Potential Association Based on MR Findings
Authors: Budai Caterina , Moscato Giulia , Patruno Francesco , Leonardi Marco , Maffei Monica
Published: July 2014

We describe a child from consanguineous parents presenting mega corpus callosum (MegaCC), polymicrogyria, psychomotor retardation with swallowing difficulties and language impairment perhaps linked to the syndrome of megalencephaly-polymicrogyria-mega corpus callosum (MEG-PMG-MegaCC). Reviewing the literature, we speculate that MegaCC, psychomotor retardation and anomalies in cortical migration are the three pathognomonic features. The presence of additional possibly associated anomalies such as megalencephaly, indicates that the spectrum of linked malformations with this rare syndrome is broad and yet to be defined.
Inhibition of leptin-induced vascular extracellular matrix remodelling by adiponectin
Authors: Zhang Zhi , Wang Fang , Wang Bing-jian , Chu Guang , Cao Qunan , Sun Bao-Gui , Dai Qiu-Yan
Published: July 2014

Vascular extracellular matrix (ECM) remodelling, which is the result of disruption in the balance of ECM synthesis and degradation, induces vessel fibrosis and thereby leads to hypertension. Leptin is known to promote tissue fibrosis, while adiponectin has recently been demonstrated to be anti-fibrogenic in tissue fibrosis. In this study, we aimed to evaluate the leptin-antagonist function of adiponectin and to further elucidate the mechanisms through which adiponectin dampens leptin signalling in vascular smooth muscle cells, thus preventing excess ECM production, in our already established 3D co-culture vessel models. Our 3D co-culture vessel model, which mimics true blood vessels, is composed of vascular endothelial cells, vascular smooth muscle cells and collagen type I. We validated the profibrogenic effects of leptin and analysed matrix metalloproteinase 2 (MMP2), MMP9, tissue inhibitor of metalloproteinase 1 (TIMP1) and collagen types II/IV secretion in 3D vessel models. The protective/inhibitory effects of adiponectin were re-analysed by inhibiting adiponectin receptor 1 (AdipoR) and AdipoR2 expression in endothelial cells using RNAi technology. In the 3D vessel models, adiponectin blocked the leptin-stimulated secretion of collagen types II/IV and TIMP1 while significantly increasing MMP2/9 activity. In endothelial cells, adiponectin induced phosphorylation of AMPK, thereby suppressing leptin-mediated STAT3 phosphorylation through induction of SOCS3 in smooth muscle cells. Our findings indicate that adiponectin disrupted the leptin-induced vascular ECM remodelling via AdipoR1 and enhanced AMPK signalling in endothelial cells, which, in turn, promoted SOCS3 up-regulation in smooth muscle cells to repress leptin-stimulated phosphorylation of STAT3.
A Quality Improvement Study to Improve Inpatient Problem List Use
Authors: Bakel Leigh Anne , Wilson Karen , Tyler Amy , Tham Eric , Reese Jennifer , Bothner Joan , Kaplan David W.
Published: July 2014

Background:

The problem list is a meaningful use incentivized criterion, and >80% of patients should have 1 problem entered as structured data.

Objective:

The aim of the present study was to use a series of interventions to increase the use of the problem list for inpatients to >80% as measured by at least 1 hospital problem at discharge.

Methods:

This study was a quasi-experimental time series quality improvement trial. The primary outcome was 80% of medical and psychiatric inpatients with a problem added to the problem list before discharge. Control charts of percentage (p charts) of medical and psychiatric patients with an inpatient problem list at discharge were constructed with three-σ control limits. Control limits were revised after evidence of improvement. The charts were annotated with interventions, including increasing awareness, focused education, and timely feedback in the form of performance graphs e-mailed to providers.

Results:

For medical inpatients, use rose from 31% to 97% at its peak in April 2011 and continues to maintain above the goal of 80%. In psychiatry, problem list use rose from 2% initially to an average of 72% after the interventions.

Conclusions:

Significant gains were made with inpatient problem list usage by the medical and psychiatric teams. Our goal ascribed by meaningful use for >80% of inpatients to have a problem at discharge was met after initiation of our series of interventions.
Family-Centered Rounding: Can It Impact the Time of Discharge and Time of Completion of Studies at an Academic Children’s Hospital?
Authors: Oshimura Jennifer M. , Downs Stephen M. , Saysana Michele
Published: July 2014

Background and Objective:

Family-centered rounds (FCR) involve multidisciplinary rounds at the patient bedside with an emphasis on physicians partnering with patients and families in the clinical decision-making for the patient. Although the purpose of FCR is to provide patient-centered care, an unanticipated benefit of FCR may be to improve time to discharge. The objective of this study was to determine the impact of FCR on time to discharge for pediatric patients in an academic medical center.

Methods:

We retrospectively compared the timing of patient discharges from July 2007 to June 2008 (before FCR) versus those from July 2008 to May 2009 (after FCR) on the pediatric hospital medicine service. We further compared time from order entry to study completion on a subset of patients receiving head MRIs and EEGs, studies that typically occurred on the day of discharge.

Results:

In our center, before FCR, 40% of patients were discharged before 3:00 pm (n = 912). After FCR, 47% of children were discharged before 3:00 pm (n = 911) (P = .0036). Time from order entry to study completion for MRIs and EEGs decreased from 2.15 hours before FCR (n = 225) to 1.73 hours after FCR (n = 206) (P = .001).

Conclusions:

FCR provided a modest improvement in the timeliness of the discharge process at our institution.
Topics in Neonatal Informatics: Meaningful Use: Implications for the Neonatologist
Authors: Hunt Patricia G. , Pallotto Eugenia K.
Published: July 2014

Meaningful use is promoting rapid spread and implementation of the electronic health record in hospital systems and practices of eligible providers. Meaningful use criteria are directed at supporting policy priorities for health outcomes. The staged timeline began in 2010 and extends to 2021 with final incentive payments. Specific objectives and clinical quality measures must be met in order for hospitals or providers to be eligible for the incentives. Neonatologists can benefit from understanding meaningful use and advocating for systems and measures that meet the workflow and clinical needs of the neonatal care providers and patients.
Translational Research in Pediatrics III: Bronchoalveolar Lavage
Authors: Radhakrishnan Dhenuka , Yamashita Cory , Gillio-Meina Carolina , Fraser Douglas D.
Published: July 2014

The role of flexible bronchoscopy and bronchoalveolar lavage (BAL) for the care of children with airway and pulmonary diseases is well established, with collected BAL fluid most often used clinically for microbiologic pathogen identification and cellular analyses. More recently, powerful analytic research methods have been used to investigate BAL samples to better understand the pathophysiological basis of pediatric respiratory disease. Investigations have focused on the cellular components contained in BAL fluid, such as macrophages, lymphocytes, neutrophils, eosinophils, and mast cells, as well as the noncellular components such as serum molecules, inflammatory proteins, and surfactant. Molecular techniques are frequently used to investigate BAL fluid for the presence of infectious pathologies and for cellular gene expression. Recent advances in proteomics allow identification of multiple protein expression patterns linked to specific respiratory diseases, whereas newer analytic techniques allow for investigations on surfactant quantification and function. These translational research studies on BAL fluid have aided our understanding of pulmonary inflammation and the injury/repair responses in children. We review the ethics and practices for the execution of BAL in children for translational research purposes, with an emphasis on the optimal handling and processing of BAL samples.
Five-Year Follow-up of Community Pediatrics Training Initiative
Authors: Minkovitz Cynthia S. , Goldshore Matt , Solomon Barry S. , Guyer Bernard , Grason Holly
Published: July 2014

OBJECTIVE:

To compare community involvement of pediatricians exposed to enhanced residency training as part of the Dyson Community Pediatrics Training Initiative (CPTI) with involvement reported by a national sample of pediatricians.

METHODS:

A cross-sectional analyses compared 2008–2010 mailed surveys of CPTI graduates 5 years after residency graduation with comparably aged respondents in a 2010 mailed national American Academy of Pediatrics survey of US pediatricians (CPTI: n = 234, response = 56.0%; national sample: n = 243; response = 59.9%). Respondents reported demographic characteristics, practice characteristics (setting, time spent in general pediatrics), involvement in community child health activities in past 12 months, use of ≥1 strategies to influence community child health (eg, educate legislators), and being moderately/very versus not at all/minimally skilled in 6 such activities (eg, identify community needs). χ2 statistics assessed differences between groups; logistic regression modeled the independent association of CPTI with community involvement adjusting for personal and practice characteristics and perspectives regarding involvement.

Results:

Compared with the national sample, more CPTI graduates reported involvement in community pediatrics (43.6% vs 31.1%, P < .01) and being moderately/very skilled in 4 of 6 community activities (P < .05). Comparable percentages used ≥1 strategies (52.2% vs 47.3%, P > .05). Differences in involvement remained in adjusted analyses with greater involvement by CPTI graduates (adjusted odds ratio 2.4, 95% confidence interval 1.5–3.7).

Conclusions:

Five years after residency, compared with their peers, more CPTI graduates report having skills and greater community pediatrics involvement. Enhanced residency training in community pediatrics may lead to a more engaged pediatrician workforce.