bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcome Measurement, Cost-Effectiveness and Clinical Audit: The Importance of Standardised Assessment to Occupational Therapists in Meeting These New Demands
Authors: de Clive-Lowe Sarah
Published: April 2015

This article was commissioned by the Practice Development Board, College of Occupational Therapists, and gives a brief outline of the rationale and structure of standardised assessments. It then examines the role of these in helping occupational therapists working in public service provision to meet the demands of quality assurance initiatives.
Evaluating the Sensory Integrative Functions of Mainstream Schoolchildren with Specific Developmental Disorders
Authors: Chu Sidney
Published: April 2015

Clinicians and educators are becoming increasingly aware of sensory integrative dysfunctions (SIDs) in mainstream schoolchildren with specific developmental disorders (SDDs). This study was designed (1) to determine whether or not SID occurred significantly in mainstream schoolchildren aged 5–8 years, referred to the Ealing Paediatric Occupational Therapy Service (EPOTS); (2) to explore the patterns and nature of SID found In such a group; and (3) to ascertain any relationships between certain types of SID and specific behavioural traits.

The study adopted a differential research method. The subjects were two groups of children aged 5–8 years. The experimental group (EG) consisted of 25 children referred to EPOTS. The control group (CG) consisted of 18 mainstream schoolchildren with no known dysfunction. All subjects were administered the Sensory Integration and Praxis Tests (SIPT) and Clinical Observations of neurobehavioural and neuromuscular functions. The Conners' Parent Rating Scales – 93 (CPRS-93) was used to evaluate specific behavioural traits in the EG children.

The results of statistical analysis supported that mainstream schoolchildren with SDD (EG, n=25) referred to EPOTS had significantly lower scores (p<.001) in the SIPT than a normal control group of children (CG, n=18) with matched demographic data. The EG children showed significant neurobehavioural and neuromuscular dysfunctions (p<.05) in comparison with the CG in the Clinical Observations. The percentage of EG children with scores similar to the six SIPT clusters was 44%, which is higher than the figure of 29.6% produced by the test publisher. There was no consistent correlation between the SIPT variables and the variables identified in the CPRS-93. Although the findings were not conclusive, some partial pattern could be identified.
Ranking the Problems of Fieldwork Supervision Reveals a New Problem: Failing Students
Authors: Ilott Irene
Published: April 2015

In 1988 and 1993, fieldwork supervisors attending a study day at the Derby School of Occupational Therapy (now part of the University of Derby) were surveyed to identify, and then verify, whether ‘failing the student’ was difficult. An opportunity sample of 113 trained and experienced supervisors completed a structured questionnaire. The statement about assigning a fall grade was ranked as most problematical by two-thirds of respondents on both surveys. Time demands was ranked second. A fall scenario involves making judgements about threshold standards. Preparation for this gatekeeper role is important to enable supervisors to counter institutional pressure to achieve output targets.
The Delivery of Equipment and Home Adaptations to People with Disabilities in New Zealand: A Review of an Innovative Model of Service Provision
Authors: Leonard Conor , Biggs Herbert C
Published: April 2015

A new model of service delivery for people with disabilities in the community has emerged in New Zealand. Health purchasing authorities were given responsibility for the delivery of all services to this group. Responsibility for the delivery of assistive devices and adaptations was put out to tender. The New Zealand Disability Resource Centre Ltd formed the Equipment Management Service (EMS) which won the majority of contracts. In conjunction with the health authority, it has produced a comprehensive service manual. Professionals apply to be providers of categories of equipment and/or adaptations. Once accepted, they have autonomy to purchase equipment or adaptations to set monetary limits. Retailers of equipment must be registered, which involves making service quality commitments. This model may result in more efficient use of available professionals, but the practical difficulties of administration may be overwhelming. It should be monitored closely to Judge whether the possible benefits are realised.
Review of Wheelchair Services in England
Authors: Jelier Pamela , Turner-Smith Alan
Published: April 2015

This article reviews the results of investigations into wheelchair service provision in the United Kingdom since its devolution to National Health Service trusts in 1991. The following key issues persist:

– Funding: The existing dilemma is to find how far a comprehensive service can be provided in a climate with decreasing, real-term funding. – Staffing: The availability of specialist staff on a multidisciplinary team is variable across the country. Some people are not being used in a manner that is suitable to their education and training. – Education and training. Educational backgrounds are variable; however, guidelines for standards have been published for occupational therapists, physiotherapists and rehabilitation engineers. – Accessibility: Users are often not provided with enough information to feel that they have been able to contribute to the prescription of their wheelchairs. – Assessment and prescription: This procedure varies from being based on a referral form to individual meetings between the therapist and the user. – Audit. User satisfaction and the provision of data for purchasers are the advantages of doing regular audits. Where the standards of provision are decided at local level without national guidelines, it is important that information about successful outcomes on limited resources is shared among service managers, therapists and rehabilitation engineers.
Using the Core Values and Skills of Occupational Therapy in Management
Authors: Marriott Anne
Published: April 2015

The contribution of occupational therapy to the management of the health service is largely an unexplored domain. This article examines the meaning of effective management practice and the integration of occupational therapy values and skills within the management role. It proposes a link between the occupational therapy philosophy and a participative approach to management. The benefits and challenges that develop from this particular management style are highlighted, with particular reference to the power dimension of the health service. The use of power in organisational life is explored and the nature of participative management is reviewed in the light of this. The article concludes by advocating the positive use of power within the political arena and by encouraging all occupational therapists to participate fully in the management of their services.
Rationales for the Use of Occupation in 19th Century Asylums
Authors: Paterson Catherine F
Published: April 2015

The use of occupation was a key aspect of moral treatment, the reformed management of the ‘mad’1 in the late 18th and 19th centuries. Physicians observed that the lack of occupation exacerbated symptoms, and held the philosophical and religious beliefs that occupation was intrinsically good and that patients should be encouraged to become useful members of society. They propounded that occupation could divert or provide respite from the patients' delusional or painful thoughts; could counteract symptoms by stimulating the withdrawn, calming the excited and channelling the activity of the obsessive; could be used to strengthen underdeveloped mental faculties or improve existing ones; and, finally, could provide bodily exercise which induced tranquil and refreshing sleep.

Some American authors have already explored the links between moral treatment and occupational therapy. This article attempts to identify the rationales for occupation in a British context.
Managing Health and Safety: A Role for Occupational Therapists
Authors: Cullum Frederick W H
Published: April 2015

The management of health and safety requires employers to undertake risk assessments, identifying hazards in the workplace and the associated risks. They are then required to eliminate or reduce the level of risk to employees through the introduction of adequate control measures. Some health and safety legislation develops this aspect of assessment further, such as the Manual Handling Operations Regulations 1992 and the Health and Safety (Display Screen Equipment) Regulations 1992. The Disability Discrimination Act 1995 also places a number of duties on employers, some of which have an impact on health and safety.

The Management of Health and Safety at Work Regulations 1992 requires employers to have access to competent advice to assist them to comply with the legislation. There are many people who can provide such advice: safety practitioners, occupational health nurses and physicians, occupational hygienists, physiotherapists and occupational therapists. The role of each practitioner needs to be appreciated by the employer and there should be systems in place that will allow referral within a reasonable timescale and contact between practitioners to work as a team.

The benefits from having access to an occupational therapist can be demonstrated through the use of examples that highlight reduced costs to the employer from both reactive and proactive involvement. There are also a number of benefits to be gained by the employee.
Society's Perceptions of Visibly Burned Adults and the Implications for Occupational Therapy
Authors: Franks Teresa , Goodrick-Meech Anne
Published: April 2015

This study aimed to investigate public perceptions of the visibly burned adult (face, neck and hands) using an experimental design. The methodology involved two groups of subjects (n=20) rating five pictures of women for the personality traits of attractiveness, sense of humour, intelligence and sociability. Both groups rated the same pictures, except that one group saw a picture of a woman before a facial burn while the other group had this picture substituted for one of the same woman after the facial burn.

The results supported the hypothesis that ‘adults with visible burns are perceived significantly less favourably than those without visible burns’ for each of the personality traits except intelligence. The discussion analyses these results further, comparing them with past studies on disfigurement and suggesting some implications that such stigmatisation may have for occupational therapy. Clients need to be assisted not only in coming to terms with trauma and personal loss, but also in learning to adapt psychologically to the negative perception society has towards people with visible disfigurement.
Evidence-Based Practice and Occupational Therapy
Authors: Lloyd-Smith Walter
Published: April 2015

Occupational therapists, like other health care professionals, are constantly being asked to confront major changes in the way health and social care services are structured and, in turn, how their working practices are organised. In order for the market-driven National Health Service to function, it requires detailed information on whether services are clinically effective. The use of evidence-based practice has been widely advocated as one way to meet these demands.

This article focuses on evidence-based practice as an approach, and considers its implications and relevance for occupational therapists. First, a short history of the background of evidence-based practice is given, followed by a discussion of recent social and political developments which have increased demands for its wider use. A number of key issues associated with evidence-based practice are then considered, including implementing research findings into practice; the nature of evidence itself; time; the accessibility of research findings; and skills required for evidence-based practice. Practical suggestions are also offered to enable therapists to make the most appropriate use of evidence-based practice. The aim of this article is to stimulate debate about evidence-based decision making for practitioners.
Assessment Tools Used by Occupational Therapists with Head Injured Patients in a Rehabilitation Setting
Authors: Haig Jane
Published: April 2015

This article describes the assessment tools that are used by occupational therapists working with head injured patients in a rehabilitation setting. The study method used was a postal questionnaire sent to all head injury rehabilitation units in the United Kingdom, inviting occupational therapists working there to respond.

The results indicated that both standardised and non-standardised methods of assessment were used with this patient group, and a comprehensive list of all those used is now available. Standardised methods tended to assess component skills (such as memory), whereas non-standardised methods were generally used to assess functional skills (such as getting dressed). The occupational therapists felt that the objectivity of standardised tests gave them more credibility in the eyes of other professionals. However, non-standardised methods were more frequently used because the occupational therapists stressed the importance of the assessment of functional tasks, both in hospital and at home, within their professional role. They were clear that assessment of component skills did not necessarily indicate how patients performed in daily living activities.

The relationship between choice of assessment method and length of experience of the therapist was also examined. A statistically significant correlation (p<0.05) was found between the longer a therapist had worked in the field of head injury and his or her likelihood to assess work skills using non-standardised methods. However, from the findings, it became evident that clinical reasoning most affected assessment choice, and this subject may be worthy of further research.
Study into the Equipment Needs of People with Restricted Growth
Authors: Jepson Jill
Published: April 2015

This article describes a recent study into the unmet equipment needs of people with restricted growth, carried out by the Bath Institute of Medical Engineering. The study involved selecting a group of people to work with, followed by an exploration of their problems in all areas of daily life. A combination of questionnaires and semi-structured interviews was used to achieve the objective. Information gathered from both the questionnaires and the interviews was collated to form a list of equipment needs and general problem areas experienced by the volunteers. This list was circulated as widely as possible to people with restricted growth with a request to assign a priority rating to each item. The results identified six items of high priority which will be designed at the institute over the next 3 years.
Standardised Assessment: A Comparison of the Community Dependency Index and the Barthel Index with an Elderly Hip Fracture Population
Authors: Ward Gillian , Macaulay Fiona , Jagger Carol , Harper William
Published: April 2015

The Community Dependency Index (CDI) is a standardised outcome measure of independence in self-care activities, based upon the Barthel Index, for the assessment of disabled and elderly people living in the community. The operational definitions take account of the influence that the environment has on a person's ability to carry out activities of daily living.

This paper reports the results of a longitudinal study of two groups of community-dwelling elderly people who had sustained a hip fracture. The inter-rater reliability of the CDI was assessed, the agreement between the CDI and the Barthel Index was assessed and the sensitivity to change over time of the two measures was compared. The CDI was found to be equally as sensitive to a change in overall scores as the Barthel Index but tended to give lower scores. This trend has important implications for its use as an outcome measure of independence in activities of daily living following trauma.
Occupation and Lifestyle: Implications for Mental Health Practice
Authors: Lambert Rod
Published: April 2015

Occupation is central to the concept of occupational therapy. However, the definition and use of the term occupation have been through many stages. This paper considers some of these stages. It then discusses the role of lifestyle and the emergence of what has become known as lifestyle medicine. Lifestyle is an important area for occupational therapy to explore because it influences both the individual's perception and his or her experience of health. The suggestion is made that lifestyle provides both occupational form and occupational performance. Occupational synthesis can be achieved through the use of a therapeutic intervention promoting lifestyle change.

Research evidence is presented relating to two specific lifestyle factors, caffeine and general fluid intake, examining their potential effect on mental health. Case studies demonstrate how a lifestyle approach can provide a beneficial early intervention strategy. The discussion resulting from the case studies illustrates how the approach can be used in a number of different ways to influence the outcome of therapeutic interventions positively.
Determining the Effectiveness of a Short-Term Anxiety Management Course
Authors: Prior Sarah
Published: April 2015

The effectiveness of a 6-week anxiety management course at a mental health day hospital was researched. The author was motivated to research these sessions due to her own observations of the clients' progress in the groups. There was also an increasing demand for anxiety management groups with many clients being referred by general practitioners. The subjects were 37 clients. The diagnosis of the clients varied but anxiety must have been identified as a problem. Four of the 6-week courses were run over a period of 10 months.

The course was evaluated using three questionnaires: the Hospital Anxiety and Depression (HAD) Scale, the Spielberger Questionnaire (state and trait) and the Fear Questionnaire. The clients completed the questionnaires four times: pre-treatment, at the beginning and at the end of the course, and at 2 months post-treatment. A control group was used.

The data collected from the questionnaires were analysed using paired t-tests. The results showed that the anxiety management course was effective, with a statistically significant reduction in symptoms by the end of the course. The control group did not show significant change.

It was the HAD Scale that showed the statistically significant positive change. The state section of the Spielberger Questionnaire followed the same pattern as the HAD Scale and showed a reduction in symptoms, although it was not statistically significant. The results of the Fear Questionnaire suggested that the clients' phobias were not treated by the anxiety management course. A client satisfaction questionnaire was used and participants made positive comments about the value of the course.
Assessment of Psychosocial Factors in Functional Capacity Evaluation of Clients with Chronic Back Pain
Authors: Gibson Libby , Strong Jeny
Published: April 2015

Psychosocial factors have been shown to be major determinants in the return to work of individuals with chronic back pain. It is important, therefore, for occupational therapists to have an understanding of these factors and to include an evaluation of them when assessing function for work.

This article presents an overview of the influence of some of these factors on function and, in particular, return to work in individuals with chronic back pain. It also provides an introduction to tools occupational therapists may use to assess these factors within a comprehensive functional capacity evaluation. Variables discussed include perceived disability, expectation of return to work, self-efficacy, perceived effort, pain intensity, pain location and pain behaviour. Consideration is given to the reliability and validity of the tools reviewed.
Just Playing … is it Time Wasted?
Authors: Reade Susanna , Hunter Heather , McMillan Ian R
Published: April 2015

Occupational therapists may embark on play therapy as part of an intervention package in child psychiatry. This article examines the effectiveness of play therapy with children who have experienced emotional deprivation. Even though emotional deprivation is seldom the primary reason for referral, it may underpin the behavioural difficulties with which the children present. One important aspect of emotional deprivation appears to be the disruption of early dose relationships and, traditionally, the damage caused by this has been considered irreversible. Consequently, the possibility of children deriving benefit from play therapy and the lack of clarity about emotional deprivation are examined.

Research that sheds light on this discussion is considered and, finally, the ways in which occupational therapists might contribute to this body of research are suggested.
Total Hip Replacement: An Audit of the Provision and Use of Equipment
Authors: Davidson Tracy
Published: April 2015

Historically, Perth and Kinross Social Services supplied every total hip replacement patient with a ‘hip pack’ containing a raised toilet seat, a helping hand, a long-handled shoe horn and a sock/tights aid. This pack was issued by the hospital occupational therapist prior to discharge. In January 1996 the funding for this equipment was withdrawn. This move obstructed the hospital-based occupational therapists from achieving the standard practice that ‘all patients will be provided with a hip pack prior to discharge’. The hip pack should be used for 6–12 weeks postoperatively to reduce the risk of dislocation. These standards are in agreement with guidelines in James (1992). The occupational therapy department was concerned that patients would be at greater risk of dislocation if this equipment was not provided. A variety of options were considered to overcome this, including patients purchasing their own equipment or the hospital trust funding a loan service.

In order to support these proposals an audit was carried out with three main aims: (i) to assess whether the hospital occupational therapists were meeting the standards by providing every total hip replacement patient with equipment from a hip pack; (ii) to assess whether the standard statement that the hip pack equipment should be used for 6–12 weeks was an appropriate time scale for patients; and (iii) to obtain the patient's perspective on the proposals being explored to continue to meet the standards.

There was an 85% (63/74) response rate and the results of the audit highlighted how important the equipment was to the patient. The time each item was used for varied, but many were still in use 6 months postoperatively. Due to budget constraints, patients were also asked if they would purchase some of the equipment; 51 (93%) of the 55 respondents stated that they would have purchased at least one item in the hip pack. The standards were nearly but not fully met. This was due to the lack of flexibility in the standards not acknowledging that some patients would not need equipment.
A Pilot Study exploring Families' Experience of Caring for Children with Chronic Arthritis: Views from the Inside
Authors: Britton Carrie
Published: April 2015

Control of juvenile chronic arthritis (JCA) is sought by a cocktail of strong drugs, but effective rehabilitation depends upon robust exercise and splinting programmes carried out at home. This article describes the pilot stage from a larger research project and explores the global impact of both the disease process and associated health care programmes on the child with JCA, the parents, the siblings and other family members.

The pilot study used a pre-tested self-completion questionnaire with families attending JCA outpatient appointments. The questionnaire was designed around six key issues in order to test issue validity and significance for the families involved. It elicited both quantitative and qualitative data that informed and guided subsequent in-depth fieldwork.

The findings included the following: (a) 41% of all families reported that the experience prior to diagnosis had a strong impact on later coping; (b) the degree of understanding about the aims and methods of exercise and splinting programmes varied widely; (c) there was common confusion about prognosis; and (d) there was evidence of parental grieving.

The literature review and study findings strongly suggest a knowledge gap between families and professionals. There were indications of the wideranging root causes of compliance difficulties.

The recommendations include more reflexive practice by service providers, greater attention to the families' priorities and perspectives, and improvements in effective mutual information sharing between practitioners and families. There were strong indications for further in-depth research.
Characterisation of porcine dermis scaffolds decellularised using a novel non-enzymatic method for biomedical applications
Authors: Greco KV , Francis L , Somasundaram M , Greco G , English Nicholas R , Roether Judith A , Boccaccini Aldo R , Sibbons P , Ansari T
Published: April 2015

Off-the-shelf availability of tissue-engineered skin constructs, tailored by different combinations of reagents to produce a highly preserved biological matrix is often the only means to help patients suffering skin damage. This study assessed the effect of five different decellularisation methods on porcine dermal scaffolds with regard to matrix composition, biomechanical strength, and cytotoxicity using an in vitro biocompatibility assay. Results demonstrated that four out of the five tested decellularisation protocols were efficient in producing acellular scaffolds. Nevertheless, decellularisation method using osmotic shock without enzymatic digestion showed to be efficient not only in removing cellular material and debris from dermal scaffolds but was also beneficial in the preservation of extracellular matrix components (glycosaminoglycans and collagen). Histological assessment revealed that the dermal architecture of coarse collagen bundles was preserved. Examinations by scanning electron microscopy and transmission electron microscopy showed that the arrangement and ultrastructure of collagen fibrils in the scaffolds were retained following non-enzymatic method of decellularisation and also after collagen crosslinking using genipin. Moreover, this decellularised scaffold was not only shown to be biologically compatible when co-cultured with bone marrow-derived mesenchymal stem cells and fibroblasts, but also stimulated the cells to release trophic factors essential for tissue regeneration.
Psychosexual Characteristics of Women Reporting Sexual Aggression Against Men
Authors: Carvalho Joana , Nobre Pedro J.
Published: April 2015

Sexual aggression as committed by women has been the target of little empirical research and is still regarded as a myth by many people. The aim of this study was to evaluate the psychosexual profile of young and educated women reporting sexual aggression against men. This is a cross-sectional study; a total of 260 female college students answered to an online survey. Among them, 93 (35.8%) reported having committed some form of sexual aggression against men: 46.2% of sexually aggressive women fell into the category of sexual coercion, 34.1% fell into the category of sexual abuse, and 19.8% reported having used physical force. Findings revealed that sexually aggressive women reported significantly higher levels of sociosexuality, sexual fantasies of dominance and submission, sexual compulsivity, sexual excitation, and sexual inhibition due to the threat of sexual performance failure. Data are expected to affect prevention strategies for a relevant yet understudied social concern.
Two Strikes
Authors: Okonofua Jason A. , Eberhardt Jennifer L.
Published: April 2015

There are large racial disparities in school discipline in the United States, which, for Black students, not only contribute to school failure but also can lay a path toward incarceration. Although the disparities have been well documented, the psychological mechanisms underlying them are unclear. In two experiments, we tested the hypothesis that such disparities are, in part, driven by racial stereotypes that can lead teachers to escalate their negative responses to Black students over the course of multiple interpersonal (e.g., teacher-to-student) encounters. More generally, we argue that race not only can influence how perceivers interpret a specific behavior, but also can enhance perceivers’ detection of behavioral patterns across time. Finally, we discuss the theoretical and practical benefits of employing this novel approach to stereotyping across a range of real-world settings.
Sex and the menopausal woman: A critical review and analysis
Authors: Ussher Jane M , Perz Janette , Parton Chloe
Published: April 2015

Medical discourse has positioned the menopausal transition as a time of sexual atrophy and loss of femininity, with hormonal replacement as the solution. In contrast, feminist critics have argued that women’s experience of sexual embodiment during menopause is culturally and relationally mediated, tied to discursive constructions of aging and sexuality, which are negotiated by women. The aim of this article is to present a critical examination of women’s experiences of sexuality during and after the menopausal transition, drawing on previous research in this field, as well as qualitative research we have conducted with women at midlife, and women who have experienced premature menopause as a consequence of cancer treatment. We aim to challenge myths and misconceptions about the inevitability of sexual decline at menopause, as well as normalise the embodied changes that some women experience – whether menopause is premature, or occurs at midlife. We argue that sexual difficulties or disinterest reported by women during and after menopause are more strongly associated with psycho-social factors than hormonal status, in particular psychological well-being, relationship context and a woman’s negotiation of cultural constructions of sex, aging and femininity. However, sexuality can continue to be a positive experience for women throughout adult life and into old age, with many menopausal women reporting increased sexual desire and response. This undermines the biomedical construction of menopause as a time of inevitable sexual atrophy and decay.
Enhanced detection of Porcine reproductive and respiratory syndrome virus in fixed tissues by in situ hybridization following tyramide signal amplification
Authors: Trang Nguyen Thi , Hirai Takuya , Ngan Pham Hong , Lan Nguyen Thi , Fuke Naoyuki , Toyama Keiko , Yamamoto Tsukasa , Yamaguchi Ryoji
Published: April 2015

This study evaluated the sensitivity of biotinyl–tyramide-based in situ hybridization (TISH) method by comparison with chromogenic in situ hybridization (CISH) and immunohistochemical staining (IHC) methods. This study also determined the effect of fixative and fixation time on the detection of Porcine reproductive and respiratory syndrome virus (PRRSV) in paraffin-embedded tissues. Lung samples were fixed in 4% paraformaldehyde (PFA) or 10% neutral buffered formalin (NBF) for various times before paraffin embedding. Of 30 paraffin-embedded lung samples, fixed for 1 day in 4% PFA or 10% NBF, 18 (60%) were positive for PRRSV by nested reverse transcription polymerase chain reaction (nRT-PCR). All 18 lung samples (100%) also were positive for PRRSV by TISH, but only 10 of these 18 specimens (56%) were positive for PRRSV by IHC and CISH. We demonstrated that TISH can detect PRRSV RNA in paraffin-embedded tissues after up to 90 days of fixation. PRRSV nucleic acids and antigens were better preserved in 4% PFA than in 10% NBF. Compared with CISH and IHC testing methods, TISH appeared to be more sensitive for the detection of PRRSV in paraffin-embedded tissues.
Perceptions of Health Professionals on Pain in Extremely Low Gestational Age Infants
Authors: Gibbins Sharyn , Stevens Bonnie , Dionne Kim , Yamada Janet , Pillai Riddell Rebecca , McGrath Patrick , Asztalos Elizabeth , O’Brien Karel , Beyene Joseph , McNamara Patrick , Johnston Celeste
Published: April 2015

Extremely low gestational age infants (<28 weeks at birth) experience significant pain from repeated therapeutic procedures while hospitalized in the neonatal intensive care unit. As part of a program of research examining pain in preterm infants, we conducted a qualitatively driven mixed-methods design, supplemented with a qualitative and quantitative component, to understand how health care professionals (HCPs) assess and manage procedural pain for tiny and underdeveloped preterm infants. Fifty-nine HCPs from different disciplines across four tertiary-level neonatal units in Canada participated in individual or focus group interviews and completed a brief questionnaire. Four themes from the content analysis were (a) subtlety and unpredictability of pain indicators, (b) infant and caregiver attributes and contextual factors that influence pain response and practices, (c) the complex nature of pain assessment, and (d) uncertainty in the management of pain. The information gleaned from this study can assist in identifying gaps in knowledge and informing unit-based and organizational knowledge translation strategies for this vulnerable population.
Direct-Acting Oral Anticoagulants as Emerging Treatment Options for Heparin-Induced Thrombocytopenia
Authors: Miyares Marta A. , Davis Kyle A.
Published: April 2015

Objective: To review the evidence for the use of the direct-acting oral anticoagulants (DOACs) in adult patients with heparin-induced thrombocytopenia (HIT). Data Source: A PubMed search (1950-February 2015) was collected using the terms heparin-induced thrombocytopenia, with dabigatran, rivaroxaban, or apixaban, or heparin-induced thrombocytopenia and target-specific anticoagulants, or heparin-induced thrombocytopenia and direct-acting oral anticoagulants, or heparin-induced thrombocytopenia and new oral anticoagulants. Study Selection and Data Extraction: All English-language articles were reviewed for inclusion. The references of included articles were reviewed for additional data. Data Synthesis: HIT is an immune-mediated, prothrombotic adverse reaction that requires not only discontinuation of heparin but also initiation of an alternative nonheparin anticoagulant to counter the effects of the autoimmune cascade. Pharmacotherapeutic management with argatroban is unpredictable and problematic. The DOACs display predictable pharmacokinetic and pharmacodynamic profiles and exhibit no interaction with platelet factor 4. Currently, the DOACs are approved by the Food and Drug Administration for venous thromboembolism, yet have limited evidence in both in vitro and clinical HIT studies. Conclusions: Though dabigatran, rivaroxaban, and apixaban have been used in case reports, currently data are not yet sufficient to recommend clinical use of these agents in the management of HIT. Future trial results may further substantiate management of HIT with use of the DOACs.
Thermal comfort properties of simulated multilayered diaper structures in dry and wet conditions
Authors: Özen İlhan , Çinçik Emel , Şimşek Süleyman
Published: April 2015

The objective of this research is to study the thermal comfort of simulated multilayered diaper structures in dry and wet conditions. To that end, a back sheet, breathable films, a superabsorbent core, and top sheets were provided and diaper structures were generated. In order to reveal their possible effects on thermal comfort, five different types of breathable films and two different types of top sheet layers were selected. Relative water vapor permeability, water vapor resistance, thermal conductivity, thermal resistance, and thermal absorptivity characteristics were analyzed and the results were evaluated statistically using analysis of variance tests. The test results indicated that the breathable film type and the top sheet type used showed significant changes on the breathability and thermal comfort of the diaper structures in dry state. Nevertheless, no statistically significant effects were observed in wet state.
Nintedanib in non-small cell lung cancer: from preclinical to approval
Authors: Caglevic Christian , Grassi Massimiliano , Raez Luis , Listi Angela , Giallombardo Marco , Bustamante Eva , Gil-Bazo Ignacio , Rolfo Christian
Published: April 2015

Angiogenesis is a driving force of a tumor’s development. Targeting this process is an attractive option, as this is a feature shared by most of the solid tumors. A lot of antiangiogenic drugs have been developed following this path, including bevacizumab, sorafenib, sunitinib, vandetanib, ramucirumab, motesanib and many others. The latest drug of this class to be approved for patients with non-small cell lung cancer (NSCLC) was nintedanib, a triple angiokinase inhibitor. This molecule targets vascular endothelial growth factor (VEGF), platelet derived growth factor (PDGF) and fibroblast growth factor (FGF) pathways, avoiding the tumor’s switch to normal escape mechanisms. The pharmacokinetic, pharmacodynamic and toxicity profiles of nintedanib have been tested in several studies. These trials revealed it to be very interesting, as this agent did not lead to the classical adverse events of other tyrosine kinase inhibitors. A phase III clinical trial that recently concluded provided us with relevant information in patients with NSCLC of adenocarcinoma histology. Here we present a short overview of the tumor angiogenesis pathways and antiangiogenic drugs. In particular, we will focus on nintedanib, from the preclinical studies to the latest phase III clinical trial that allowed this new agent to be approved by the European Medicines Agency as a second-line treatment option in association with docetaxel for NSCLC patients with adenocarcinoma histology.
The use of elastic therapeutic tape and eccentric exercises for lateral elbow tendinosis: a case series
Authors: Wegener Raewyn L , Brown Ted , O’Brien Lisa
Published: April 2015

Introduction

‘Lateral elbow tendinosis’ or ‘lateral elbow tendinopathy’ have been suggested to be more appropriate diagnostic terms instead of ‘lateral epicondylitis’ as the condition is degenerative rather than inflammatory. For this reason, it is important that interventions target this degeneration at the common extensor tendon.

Methods

A descriptive, retrospective review of a series of four patients with lateral elbow tendinosis was conducted to examine functional outcomes with the use of elastic therapeutic tape, eccentric exercises and activity modification techniques.

Results

All patients recorded improved changes in pain and grip strength within three months of treatment using elastic therapeutic tape, eccentric exercises and activity modification techniques.

Conclusions

There may be clinical benefit in the use of elastic therapeutic tape, in conjunction with eccentric exercises and activity modification techniques, for the treatment of lateral elbow tendinosis. More rigorous and comprehensive studies are recommended to further investigate this intervention.
Evaluation of pulmonary function changes in children with type 1 diabetes mellitus in Upper Egypt
Authors: Mohamad Ismail L. , Saad Khaled , Abdel-Azeem Ali , Mohamed Sherif A.A. , Othman Hisham A.K. , Abdel Baseer Khaled A. , Thabet Ahmad F. , El-Houfey Amira A.
Published: April 2015

Background:

Diabetes mellitus is a leading cause of morbidity and mortality among children across the world and is responsible for a growing proportion of global healthcare expenditure. However, limited data are available on lung dysfunction in children with diabetes.

Aim:

The aim of this study was to evaluate the pulmonary function changes in children with type 1 diabetes mellitus (T1DM).

Methods:

We studied 60 children with T1DM (mean age 10.5 ± 2.32 years; disease duration 2.45 ± 0.6 years, and 50 healthy control children (mean age 9.9 ± 2.5 years). Spirometry was performed for all individuals to measure forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR). Glycemic control was assessed on the basis of glycated hemoglobin (HbA1c), with HbA1c values <8% considered to indicate good glycemic control, and HbA1c values ⩾8% to indicate poor control.

Results:

There was significant reduction in all spirometeric parameters in diabetic children in comparison with healthy control children. Children with poor glycemic control had significant impairment in lung functions compared with those with good glycemic control.

Conclusions:

T1DM in children leads to impairment of lung functions and this impairment increases with poor glycemic control.
Universal Child Victims and Normal Guys
Authors: Houston Taylor Martin
Published: April 2015

This study builds upon the growing empirical literature on the commercial sexual exploitation of children (CSEC) and scholarship on framing strategies. Previous research has focused on the causes and consequences of CSEC, but less attention has been paid to the social movements working to raise awareness about the issue and create social change. Drawing upon 48 in-depth interviews and a year of fieldwork with the anti-CSEC movement in Georgia, this article analyzes activists’ discursive framing of juveniles involved in prostitution and their buyers. In their effort to broaden support for the movement, activists employed all-inclusive frames that emphasized “any child” can be a victim and customers are “normal guys” who must meet justice. Through a materialist feminist approach, I account for the discursive and material contexts that shape and, in turn, are shaped by the anti-CSEC movement’s frames. In particular, I discuss how hegemonic narratives and race, class, and gender assumptions surrounding juvenile prostitutes and buyers complicated activists’ frames, causing those most likely to be commercially sexually exploited youth and customers to be ignored. More broadly, this study illustrates how efforts to generate awareness and gain broader appeal through all-inclusive frames can undermine a social movement’s objectives.
Interdisciplinary Synergy in the Teaching of Applied Community-Based Research Methods
Authors: Dutton Matthew Thomas , Lopez Ivette Amelia , Brown C. Perry , Simmons Jazmyne Vanecia
Published: April 2015

The public health human power is one of the most diverse in race, ethnicity, gender, age, religion, and sexual orientation. Another area of diversity is the disciplinary background of its workers. Environmental, behavioral, biostatistical, health education, epidemiological, and health policy practitioners converge into the Master of Public Health (MPH) track offerings of our MPH program. The applied community-based participatory research class is a third semester course that is taken only after students have completed the core curriculum. We explain the design and organization of this course, to offer it as a model of interdisciplinary approaches, with experiential, learn-by-doing components that can be replicated and incorporated into public health research methods, as well as to share our own methodological crossovers with mixed methods and theoretical models in our public health research together. Semistructured interviews were applied to elicit feedback from MPH graduates who took the course, and describe the utility of the class. We learned that the MPH graduates found the class useful for short- and medium-term research outcomes.
Effects of a botulinum toxin type A injection on the masseter muscle: An animal model study
Authors: Park Si-Yeok , Park Young-Wook , Ji Young-Jun , Park Sung-Wook , Kim Seong-Gon
Published: April 2015

Background

The aim of this study was to investigate the effect of a botulinum toxin type A (BTX-A) injection in the masseter muscle using electromyography (EMG) in an animal model.

Methods

Ten male adult (>3 months of age) New Zealand white rabbits were used. Muscle activity was continuously recorded from 8 hours before to 8 hours after BTX-A injection. The rabbits received unilateral BTX-A injections of either 5 units (group 1, n = 5) or 20 units (group 2, n = 5).

Results

The masseter muscle activity of the rabbits was significantly reduced immediately after BTX-A injection (P < 0.05 for both groups). When the results from group 1 were compared with those from group 2, only the peak voltage was significantly decreased in group 2 (P = 0.013).

Conclusion

Masseter muscle activity measured by EMG was immediately decreased after a BTX-A injection.
Evaluation of cognitive restructuring for post-traumatic stress
disorder in people with severe mental illness
Authors: Mueser Kim T. , Gottlieb Jennifer D. , Xie Haiyi , Lu Weili , Yanos Philip T. , Rosenberg Stanley D. , Silverstein Steven M. , Duva Stephanie Marcello , Minsky Shula , Wolfe Rosemarie S. , McHugo Gregory J.
Published: April 2015

Background

A cognitive–behavioural therapy (CBT) programme designed for
post-traumatic stress disorder (PTSD) in people with severe mental
illness, including breathing retraining, education and cognitive
restructuring, was shown to be more effective than usual services.

Aims

To evaluate the incremental benefit of adding cognitive restructuring to
the breathing retraining and education components of the CBT programme
(trial registration: clinicaltrials.gov identifier: NCT00494650).

Method

In all, 201 people with severe mental illness and PTSD were randomised to
12- to 16-session CBT or a 3-session brief treatment programme (breathing
retraining and education). The primary outcome was PTSD symptom severity.
Secondary outcomes were PTSD diagnosis, other symptoms, functioning and
quality of life.

Results

There was greater improvement in PTSD symptoms and functioning in the CBT
group than in the brief treatment group, with both groups improving on
other outcomes and effects maintained 1-year post-treatment.

Conclusions

Cognitive restructuring has a significant impact beyond breathing
retraining and education in the CBT programme, reducing PTSD symptoms and
improving functioning in people with severe mental illness.
Blockage of the Neonatal Leptin Surge Affects the Gene Expression of Growth Factors, Glial Proteins, and Neuropeptides Involved in the Control of Metabolism and Reproduction in Peripubertal Male and Female Rats
Authors: Mela Virginia , Díaz Francisca , Lopez-Rodriguez Ana Belen , Vázquez María Jesús , Gertler Arieh , Argente Jesús , Tena-Sempere Manuel , Viveros María-Paz , Chowen Julie A.
Published: April 2015

Leptin (Lep) is important in the development of neuroendocrine circuits involved in metabolic control. Because both Lep and metabolism influence pubertal development, we hypothesized that early changes in Lep signaling could also modulate hypothalamic (HT) systems involved in reproduction. We previously demonstrated that a single injection of a Lep antagonist (Antag) on postnatal day (PND)9, coincident with the neonatal Lep peak, induced sexually dimorphic modifications in trophic factors and markers of cell turnover and neuronal maturation in the HT on PND13. Here, our aim was to investigate whether the alterations induced by Lep antagonism persist into puberty. Accordingly, male and female rats were treated with a pegylated super Lep Antag from PND5 to PND9 and killed just before the normal appearance of external signs of puberty (PND33 in females and PND43 in males). There was no effect on body weight, but in males food intake increased, subcutaneous adipose tissue decreased and HT neuropeptide Y and Agouti-related peptide mRNA levels were reduced, with no effect in females. In both sexes, the Antag increased HT mRNA levels of the kisspeptin receptor, G protein-coupled recepter 54 (Gpr54). Expression of the Lep receptor, trophic factors, and glial markers were differently affected in the HT of peripubertal males and females. Lep production in adipose tissue was decreased in Antag-treated rats of both sexes, with production of other cytokines being differentially regulated between sexes. In conclusion, in addition to the long-term effects on metabolism, changes in neonatal Lep levels modifies factors involved in reproduction that could possibly affect sexual maturation.