bluuebunny/crossref_metadata_2025 huggingface dataset:
Magma chamber evolution of the Ardestan pluton, Central Iran: evidence from mineral chemistry, zircon composition and crystal size distribution
Authors: Babazadeh Shahrouz , Furman Tanya , Cottle John M. , Raeisi Davood , Lima Ianna
Published: July 2019

The Oligo–Miocene Ardestan quartz diorite to tonalite is part of widespread Cenozoic magmatism within the Urumieh–Dokhtar Magmatic Assemblage of Iran. The Ardestan pluton is composed mainly of varying proportions of plagioclase feldspar (normally zoned from bytownite to andesine), amphibole (magnesio-hornblende) and biotite. Biotite exhibits a range of Al values (~2–2.8 apfu) over very restricted Fe# ratios (0.42–0.56) which are characteristic of continental arc magmatic suites. High Ti2O contents of biotite (<6.1 wt.%) suggest a magmatic origin. Ti-in-biotite geothermometery gives a mean crystallisation temperature of 730 ± 56°C, slightly higher than calculated TZr.Ti°C (716 ± 50°C) and similar to the average TZr.sat°C (735 ± 26°C). These results are consistent with the low bulk-rock SiO2 contents, which provide minimum estimates of temperature and indicate zircon crystallised from a fractionated magma. Zircons from the Ardestan pluton have high (Sm/La)N (>10) ratios suggesting a magmatic origin. T–$f_{{\rm O}_{\rm 2}}$ calculations of oxygen fugacity between –13.6 to –16.9 indicate oxidising crystallisation conditions between the Ni–NiO (NNO) and Fe2O3–Fe3O4 (HM) buffers. Tight linear trends of log (XF/XOH), log (XCl/XOH) and log (XCl/XOH) vs. XMg represent a narrow range of $f_{{\rm H}_2O}$, fHF and fHCl, clearly indicating that physico-chemical conditions were essentially constant throughout the formation of magmatic biotite. The shape of crystal size distribution curves along with the medium Al and Mg contents in amphibole and biotite, respectively, are consistent with a history of magma mixing involving injections of basic magma into the evolving felsic chamber. Calculated residence time for Ardestan plagioclase crystals of ~630 years support field evidence that these plutons were emplaced at shallow depths.
Evaluation of three stone-scoring systems for predicting SFR and complications after percutaneous nephrolithotomy: a systematic review and meta-analysis
Authors: Jiang Kehua , Sun Fa , Zhu Jianguo , Luo Guangheng , Zhang Peng , Ban Yong , Shan Gang , Liu Changxiang
Published: July 2019

Background

Clinical studies assessing the feasibility and accuracy of three stone scoring systems’s (SSSs: Guy’s stone score, CROES nomogram and S.T.O.N.E nephrolithometry scoring system) have reported contradictory outcomes. This systematic evaluation was performed to obtain comprehensive evidence with regard to the feasibility and accuracy of three SSSs.

Methods

A systematic search of Embase, Pubmed, Medline, and the Cochrane Library was conducted to identify studies that compared three SSSs up to Mar 2018. Patients were categorized according to stone free (SF) and no-stone free (NSF), Outcomes of interest included perioperative variables, stone-free rate (SFR), and complications.

Results

Ten studies estimating three SSSs were included for meta-analysis. The results showed that SF patients had a significantly lower proportion of male (OR = 1.48, P = 0.0007), lower stone burden (WMD = -504.28, P < 0.0001), fewer No of involved calyces (OR = -1.23, P = 0.0007) and lower proportion of staghorn stone (OR = 0.33, P < 0.0001). Moreover, SF patients had significantly lower score of Guy score (WMD = -0.64, P < 0.0001), but, S.T.O.N.E. score (WMD = -1.23, P < 0.0001) and a higher score of CROES nomogram (WMD = 29.48, P = 0.003). However, the comparison of area under curves (AUC) of predicting SFR indicated that there was no remarkable difference between three SSSs. Nonetheless, Guy score was the only stone scoring system that predicted complications after PCNL (WMD = -0.29, 95% CI: − 0.57 to − 0.02, P = 0.03).

Conclusions

Our meta-analysis indicated that the three SSSs were equally, feasible and accurate for predicting SFR after PCNL. However, Guy score was the only stone scoring system that predicted complications after PCNL.
The role of liver microenvironment in hepatic metastasis
Authors: Williamson Tovah , Sultanpuram Nikhila , Sendi Hossein
Published: July 2019

Metastasis is still poorly understood and thus further research must be conducted to provide insight into the driving factors. Novel research has revealed the significance of the microenvironment in the delegation of metastasis, expanding the field of cancer metastasis to cells and cell environments surrounding the migrated tumor cells. Research on hepatic metastasis is an ever‐growing domain of this field, as several primary tumors can metastasize to the liver. The two features within the liver that promote metastasis—cellular and acellular—are found in the current interpretation of liver microenvironment. Novel findings of both are included in this review. Different hypotheses detailing the methods by which metastasis can occur must be included to understand the significance of the microenvironment, as well as a brief overview of the methods that can be used during research. This review aims to highlight the importance of liver microenvironment on the development or potential regression of hepatic metastasis through discussing both acellular and cellular components of liver microenvironment and their interaction with metastasis.
Mortality After Breast Cancer Among Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study
Authors: Moskowitz Chaya S. , Chou Joanne F. , Neglia Joseph P. , Partridge Ann H. , Howell Rebecca M. , Diller Lisa R. , Novetsky Friedman Danielle , Barnea Dana , Morton Lindsay M. , Turcotte Lucie M. , Arnold Michael A. , Leisenring Wendy M. , Armstrong Gregory T. , Robison Leslie L. , Oeffinger Kevin C. , Henderson Tara O.
Published: July 2019

PURPOSE

Female survivors of childhood cancer have a high risk of subsequent breast cancer. We describe the ensuing risk for mortality and additional breast cancers.

PATIENTS AND METHODS

Female participants in the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancer diagnosed between 1970 and 1986 before age 21 years, and subsequently diagnosed with breast cancer (n = 274; median age at breast cancer diagnosis, 38 years; range, 20 to 58 years) were matched to a control group (n = 1,095) with de novo breast cancer. Hazard ratios (HRs) and 95% CIs were estimated from cause-specific proportional hazards models.

RESULTS

Ninety-two childhood cancer survivors died, 49 as a result of breast cancer. Overall survival after breast cancer was 73% by 10 years. Subsequent risk of death as a result of any cause was higher among childhood cancer survivors than among controls (HR, 2.2; 95% CI, 1.7 to 3.0) and remained elevated after adjusting for breast cancer treatment (HR, 2.4; 95% CI, 1.7 to 3.2). Although breast cancer–specific mortality was modestly elevated among childhood cancer survivors (HR, 1.3; 95% CI, 0.9 to 2.0), survivors were five times more likely to die as a result of other health-related causes, including other subsequent malignant neoplasms and cardiovascular or pulmonary disease (HR, 5.5; 95% CI, 3.4 to 9.0). The cumulative incidence of a second asynchronous breast cancer also was elevated significantly compared with controls ( P < .001).

CONCLUSION

Mortality after breast cancer was higher in childhood cancer survivors than in women with de novo breast cancer. This increased mortality reflects the burden of comorbidity and highlights the need for risk-reducing interventions.
Clinical Features and Outcomes of Invasive Breast Cancer: Age-Specific Analysis of a Modern Hospital-Based Registry
Authors: Kim Ji-Yeon , Kang Danbee , Nam Seok Jin , Kim Seok Won , Lee Jeong Eon , Yu Jong Han , Lee Se Kyung , Im Young-Hyuck , Ahn Jin Seok , Guallar Eliseo , Cho Juhee , Park Yeon Hee
Published: July 2019

PURPOSE

We evaluated the clinical features and outcomes of invasive breast cancer (BC) among different age groups by analyzing a modern BC registry including subtypes and treatment information.

METHODS

This was a retrospective cohort study of 6,405 women aged 18 years or older with pathologically confirmed stage I, II, or III BC who underwent curative surgery followed by adjuvant therapy at a university-based hospital in Seoul, South Korea, between January 2003 and December 2011. The study end point was all-cause mortality. We used Cox proportional hazards models and hazard ratios (HRs) with 95% CIs calculated after adjusting for age, body mass index, stage, subtype, and treatment, including type of surgery and use of chemotherapy, radiation therapy, hormone therapy, and targeted therapy.

RESULTS

During 36,360 person-years of follow-up (median follow-up: 5.45 years; interquartile range, 4.3-7.1), 256 deaths were reported (mortality rate, 7.0/1,000 person-years). The adjusted HR for all-cause mortality was higher in patients older than 40 years (HR, 2.03; 95% CI, 1.44 to 2.87) and older than 60 years (HR, 2.35; 95% CI, 1.63 to 3.39) than in patients aged 40 to 49 years. Across age groups, advanced stage at diagnosis, luminal type as well as triple-negative BC, and not receiving adjuvant treatment were associated with increased risk of mortality.

CONCLUSION

A strong J-shaped relationship was observed between age and mortality, indicating worse clinical outcomes in young and old patients. This study suggested a possible benefit of personalized BC screening examination and precise and active treatment strategies to reduce BC-related mortality.
Comparison of Twitter Use of the American Society of Anesthesiologists and the American Association of Nurse Anesthetists
Authors: Chu Benjamin , Lozada M. James , McCrory Emery Harris , Toledo Paloma , Antalek Matthew , Morely Derek , Lange Elizabeth M. S.
Published: July 2019

Twitter has become a powerful tool for dissemination of information. The objective of this study was to evaluate Twitter usage of the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA). All tweets from ASA (“@ASALifeline”) and AANA (“@aanawebupdates”) were collected over a 1-year time period. The content of each tweet was categorized using a rubric. ASA generated more original tweets than AANA. Twitter use was highest in October for ASA and September for AANA. Both societies are actively using Twitter. Future work should evaluate the impact of societal Twitter use.
miR167 limits anther growth to potentiate anther dehiscence
Authors: Zheng Lanjie , Nagpal Punita , Villarino Gonzalo , Trinidad Brendan , Bird Laurina , Huang Yubi , Reed Jason W.
Published: July 2019

In flowering plants, anther dehiscence and pollen release are essential for sexual reproduction. Anthers dehisce after cell wall degradation weakens stomium cell junctions in each anther locule, and desiccation creates mechanical forces that open the locules. Either effect or both together may break stomium cell junctions. The microRNA miR167 negatively regulates ARF6 and ARF8, which encode auxin response transcription factors. Arabidopsis mARF6 or mARF8 plants with mutated miR167 target sites have defective anther dehiscence and ovule development. Null mir167a mutations recapitulated mARF6 and mARF8 anther and ovule phenotypes, indicating that MIR167a is the main miR167 precursor gene that delimits ARF6 and ARF8 expression in these organs. Anthers of mir167a or mARF6/8 plants overexpressed genes encoding cell wall loosening functions associated with cell expansion, and grew larger than wild-type anthers did starting at flower stage 11. Experimental desiccation enabled dehiscence of miR167-deficient anthers, indicating competence to dehisce. Conversely, high humidity conditions delayed anther dehiscence in wild-type flowers. These results support a model in which miR167-mediated anther growth arrest permits anther dehiscence. Without miR167 regulation, excess anther growth delays dehiscence by prolonging desiccation.
Estimated Cardiorespiratory Fitness and Risk of Atrial Fibrillation: The Nord-Trøndelag Health Study
Authors: GARNVIK LARS E. , MALMO VEGARD , JANSZKY IMRE , WISLØFF ULRIK , LOENNECHEN JAN P. , NES BJARNE M.
Published: July 2019

Purpose

To investigate the association between estimated cardiorespiratory fitness (eCRF) and risk of atrial fibrillation (AF), and examine how long-term changes in eCRF affects the AF risk.

Methods

This prospective cohort study includes data of 39,844 men and women from the HUNT2 (August 15, 1995 to June 18, 1997) and the HUNT3 study (October 3, 2006 to June 25, 2008). The follow-up period was from HUNT3 until AF diagnosis or November 30, 2015. The AF diagnoses were retrieved from hospital registers and validated by medical doctors. A nonexercise test based on age, waist circumference, resting heart rate and self-reported physical activity was used to estimate CRF. Cox regression was performed to assess the association between eCRF and AF.

Results

The mean age was 50.6 ± 14.6 yr for men and 50.2 ± 15.2 yr for women. Mean follow-up time was 8.1 yr. One thousand fifty-seven cases of AF were documented. For men, the highest risk reduction of AF was 31% in the fourth quintile of eCRF when compared with the first quintile (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.53–0.89). For women, the highest risk reduction was 47% in the fifth quintile when compared with the first quintile (HR, 0.53; 95% CI, 0.38–0.74). One metabolic equivalent increase in eCRF over a 10-yr period was associated with 7% lower risk of AF (HR, 0.93; 95% CI, 0.86–1.00). Participants with improved eCRF had 44% lower AF risk compared with those with decreased eCRF (HR, 0.56; 95% CI, 0.36–0.87).

Conclusions

The eCRF was inversely associated with AF, and participants with improved eCRF over a 10-yr period had less risk of AF. These findings support the hypothesis that fitness may prevent AF.
New On-Water Test for the Assessment of Blood Lactate Response to Exercise in Elite Kayakers
Authors: PILOTTO ANDREA M. , RASICA LETIZIA , SCALISE GABRIELE , ANNONI STEFANO , LA TORRE ANTONIO , MARZORATI MAURO , PORCELLI SIMONE
Published: July 2019

Purpose

Lactate thresholds are physiological parameters used to train athletes and monitor performance or training. Currently, the assessment of lactate thresholds in kayakers is performed in a laboratory setting utilizing specific ergometers; however, laboratory tests differ from on-water evaluation for several reasons. The aim of this study was to assess reliability and validity of a new on-water incremental test for the assessment of blood lactate response to exercise in flat-water kayakers. Maximal lactate steady state test (MLSS) was used as criterion measurement.

Methods

Eleven junior (16.5 ± 1.9 yr) élite flat-water kayakers performed: i) an incremental cardiopulmonary test up to voluntary exhaustion on a stationary kayak ergometer to determine peak oxygen uptake; ii) an on-water 1000‐m distance trial (T1000) to record best performance time and average speed (S
1000); iii) two repetitions of on-water incremental kayaking test (WIK test); iv) several repetitions of on-water constant speed tests to determine MLSS. Speed, HR, and blood lactate concentrations were determined during on-water tests.

Results

The best performance time in T1000 was 262 ± 13 s, corresponding to an S
1000 of 3.82 ± 0.19 m·s−1. Lactate threshold determined by modified D
max method (LTDmod) during WIK test was 2.78 ± 1.02 mmol·L−1 and the corresponding speed (S
LT) was 3.34 ± 0.16 m·s−1. Test–retest reliability, calculated on S
LT, was strong (ICC = 0.95 and r = 0.93). MLSS test corresponded to 3.06 ± 0.68 mmol·L−1 and was reached at a speed (S
MLSS) of 3.36 ± 0.14 m·s−1. Correlation coefficient between S
LT and S
MLSS was 0.90 (P = 0.0001). Interestingly, a significant correlation (r = 0.96, P < 0.0001) was observed between S
LT and S
1000.

Conclusions

The WIK test showed good reliability and validity for the assessment of speed corresponding to LTDmod in flat-water kayakers and it could be a useful tool to monitor athletic performance. The speed value at LTDmod nicely predicted performance on 1000 m.
Amiodarone in the treatment of atrial fibrillation of patients with rheumatic heart disease after valve replacement
Authors: Chen Kebiao , Qin Li , Lu Xin , Xia Tao , Gu Qing
Published: July 2019

Objectives: To explore the efficacy of amiodarone in the treatment of atrial fibrillation for patients with rheumatic heart disease after valve replacement.

Methods: Eighty-six patients with rheumatic heart disease who were hospitalized between June 2016 and June 2017 and developed atrial fibrillation after valvular heart valve replacement were randomly divided into a control group and an observation group, 42 cases in each group. The control group was treated with routine medical treatment, while the observation group was given amiodarone on the basis of routine treatment. The cardiac function of the two groups were observed and recorded. Postoperative atrial fibrillation conversion rate, sinus rhythm maintenance rate, intensive care unit (ICU) monitoring time and hospital stay were compared between the two groups.

Results: Compared with the control group, the improvement of cardiac function indexes of the observation group was better, and the difference was statistically significant (P<0.05). The atrial fibrillation conversion rate and the maintenance rate of sinus rhythm of the observation group were 76.2% and 47.6% respectively, which were significantly higher than 57.1% and 33.3% of the control group; the differences had statistical significance (P<0.05). The ICU monitoring time and hospitalization time of the patients in the observation group were (1.69±0.91) d and (10.24±1.11) d respectively, which were significantly shorter than (2.83±0.95) d and (14.07±1.17) d in the control group (P<0.05); the differences were statistically significant (P<0.05).

Conclusion: Amiodarone can effectively treat valve replacement associated atrial fibrillation of patients with rheumatic heart disease. It can significantly improve the heart function, prevent the recurrence of atrial fibrillation, maintain sinus rhythm after operation, and shorten the time of ICU monitoring and hospitalization.

doi: https://doi.org/10.12669/pjms.35.4.1298

How to cite this:Chen K, Qin L, Lu X, Xia T, Gu Q. Amiodarone in the treatment of atrial fibrillation of patients with rheumatic heart disease after valve replacement. Pak J Med Sci. 2019;35(4):918-922. doi: https://doi.org/10.12669/pjms.35.4.1298

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Diabetes in Pakistan: A systematic review and meta-analysis
Authors: Akhtar Sohail , Nasir Jamal Abdul , Abbas Tahir , Sarwar Aqsa
Published: July 2019

Objective: The purpose of this study was assess the time trend of the prevalence of prediabetes and diabetes and risk factors associated with diabetes in Pakistan by using a systematic review and meta–analysis.

Methods: A systematic literature search of Embase, PubMed, and the Cochrane library was carried out between January 1, 1995 and August 30, 2018. Diabetes and prediabetes prevalence estimates were combined by the random–effects model. The existence of publication bias was tested by Egger regression. This systematic review was reported following the PRISMA guidelines.

Results: The search conceded a total of 635 studies, only 14 studies were considered for meta-analysis. The prevalence of diabetes in Pakistan was revealed 14.62% (10.651%–19.094%; 14 studies) based on 49,418 people using the inverse–variance random–effects model. The prevalence of prediabetes was 11.43% (8.26%–15.03%; 10 studies) based on a total sample of 26,999 people. The risk factors associated with diabetes were mean age (β = 0.48%, 95% CI: 0.21–0.78, p<0.001), the proportion of participants with a family history of diabetes (β = 0. 45%, 95% CI: 0.08–0.82, p =0.018, p<0.001), hypertension (β = 0.40%, 95% CI: 0.06–0.75, p = 0.022), weight (BMI) (β = 0.21%, 95% CI: 0.02–0.4, p=0.030).

Conclusions: There has been a continuous increase in the prevalence of prediabetes and diabetes in Pakistan. All parts of the country have been affected, with the highest in Sindh and lowest in Khyber Pakhtunkhwa. The main factors include growing age, family history, hypertension and obesity. A nationwide diabetes care survey on risk factors and prevention policy is highly recommended.

doi: https://doi.org/10.12669/pjms.35.4.194

How to cite this:Akhtar S, Nasir JA, Abbas T, Sarwar A. Diabetes in Pakistan: A systematic review and meta-analysis. Pak J Med Sci. 2019;35(4):1173-1178. doi: https://doi.org/10.12669/pjms.35.4.194

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Injection of immunoglobulin in the treatment process of children with severe pneumonia
Authors: Chen Liping , Qi Xuehai , Li Ruiying , Wang Xudong , Hi Baohai , Meng Qingmei
Published: July 2019

Objective: To observe the effect of intravenous infusion of immune globulin in the treatment of children with severe pneumonia.

Methods: Ninety-eight children with severe pneumonia who received treatment in our hospital between April 2015 and December 2016 were selected, and they were grouped into a control group and an treatment group, 49 each group. The control group received conventional treatment. The treatment group was additionally treated with immune globulin on the basis of conventional treatment. The humoral immune indicators were detected using immunoturbidimetric assay, and the inflammatory reaction indicators were detected using enzyme-linked immunoabsorbent kit. The overall efficacy, clinical symptoms, humoral immunity and inflammatory response were compared between the two groups.

Results: The total effective rate of the treatment group was significantly higher than that of the control group (P<0.05). The cough, rale and fever of the treatment group disappeared faster than those of the control group, the relief of cardiac failure was also faster in the treatment group (P<0.05). The immunoglobulin G (Ig G), Ig A and Ig M of patients in the two groups compared before treatment, and no significant difference was found (P>0.05). The Ig G level of the treatment group was higher than that of the control group after treatment (P<0.05). The comparison of Ig A and Ig M between the two groups indicated no significant difference (P>0.05). The two groups had no significant differences in the content of tumor necrosis factor (TNF)-α, C-reactive protein (CRP), soluble intercellular adhesion molecule (SICAM)-1 and interferon (IFN)-γ (P>0.05) before treatment, but the content of the treatment group was significantly higher than that of the control group (P<0.01).

Conclusion: Immunoglobulin was significantly effective in the adjuvant treatment of children with severe pneumonia, and it can rapidly improve the improvement of symptoms, enhance immune function and inhibit inflammatory reaction; therefore it is worth promotion.

doi: https://doi.org/10.12669/pjms.35.4.83

How to cite this:Chen L, Qi X, Li R, Wang X, Shi B, Meng Q. Injection of immunoglobulin in the treatment process of children with severe pneumonia. Pak J Med Sci. 2019;35(4):940-944. doi: https://doi.org/10.12669/pjms.35.4.83

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Report: Exertional rhabdomyolysis in a spin class participant with sickle cell trait
Authors: Longo Teresa , Shaines Matthew
Published: July 2019

Exertional rhabdomyolysis is more common in sickle trait due to a predisposition to dehydration and inability to concentrate the urine. Spinning, an indoor cycling workout, has been associated with exertional rhabdomyolysis in recent reports. A consequence of rhabdomyolysis is acute kidney injury, which may be expected to be more common in patients with sickle trait. We report a case of spinning induced rhabdomyolysis in a woman with sickle trait that did not result in renal injury. “Spin rhabdo” is thought to be more severe than other causes of exertional rhabdomyolysis and is associated with higher creatine kinase levels than other causes of exertional rhabdomyolysis. Therefore, individuals with known sickle trait should consider visiting their physician prior to participation in spin classes for the first time. We might also consider voluntary screening for sickle trait in at risk populations prior to enrolling in spin classes given that many patients are unaware of their sickle trait status.
Accessing DMPA-SC through the public and private sectors in Nigeria: users’ characteristics and their experiences
Authors: Liu Jenny , Shen Jennifer , Schatzkin Eric , Adedeji Olanike , Kongnyuy Eugene , Onuoha Chidinma , Fajemisin Morenike , Ayodeji Kazeem , Omoluabi Elizabeth
Published: July 2019

Background: Beginning in 2015, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was added to the contraceptive method mix in Nigeria, primarily through social marketing in the private sector and community-based distribution in the public sector. We compare user experiences in acquiring DMPA-SC across sectors during this national scale-up.

Methods: From October 2017 to February 2018, 459 women (Npublic=235; Nprivate=224) completed a phone survey from a convenience sample of 1,444 women (Npublic=912; Nprivate=532) who obtained DMPA-SC from participating providers and agreed to be contacted. We examined the sociodemographic predictors of attending a public vs. private provider and analyzed differences in care-seeking across sectors (becoming aware of DMPA-SC, choosing a provider, choosing DMPA-SC, quality of care).

Results: Respondents obtaining DMPA-SC from public providers were younger and less educated than those attending private providers. Both program respondents were comprised of similar percentages of new users of modern contraception (58.7-60.3%), although most respondents became aware of DMPA-SC through a friend/family member (43.1%) or a provider (41.5%). Relatively more public sector respondents also heard about DMPA-SC through community outreaches whereas relatively more private sector respondents became aware through media. Convenience was the most common reason for choosing a provider—43.8% among all respondents (higher among public sector respondents). Private sector respondents were also more likely to choose a past or usual provider. Having overall higher quality interactions were more likely among clients who attended private providers than public providers, but responses to individual quality item measures show specific areas of poor quality for providers in each sector.

Conclusions: Training emphasizing technical thoroughness, sensitivity toward younger women, and client choice may help improve women’s experiences with obtaining DMPA-SC, ultimately contributing to accelerating demand for and uptake of DMPA-SC specifically and contraception in general.
Cato the Elder on Human and Animal Diseases and Medicines for Them – According to the Treatise on "Agriculture"
Authors: Budzanowska-Weglenda Dominika
Published: July 2019

Cato the Elder was a great speaker, respected politician, military commander and writer. His treatise De agri cultura (On Agriculture) contains not only numerous passages on farm management, but also cooking recipes, religious principles, advice on how to obtain supplies, and very specific medical advice and medicinal recipes. Cato heals many different diseases of humans and quadrupeds (especially oxen). He knows how these medicines, various types of wines and cabbage dishes, should be concocted. His recipes are detailed and appear to indicate that the author knows them well. Cato does not neglect the religious and magical elements in his medical advice. Therefore, his treatise is an interesting source of Roman spells. First of all Cato’s manual on agriculture is a significant testimony of Roman medicinal and veterinary knowledge of the time, but also of the importance of these issues for the elite of the Roman Republic.
An Outline of the History of Classical Philology at the Jagiellonian University
Authors: Miszczyński Damian , Latawiec Zofia , Żółtaszek Kamil
Published: July 2019

This paper aims to familiarize contemporary students and scholars of classical philology with the profiles of prominent Polish classical philologists related to the Jagiellonian University in Kraków. It contains biographical notes and description of works of most important classicists at the Jagiellonian University, who lived in the 19th and in the 20th century. The scholars presented in the article are: Kazimierz Morawski, Tadeusz Sinko, Seweryn Hammer, Leon Sternbach, Wincenty Lutosławski, Ryszard Gansiniec, Stanisław Skimina, Władysław Madyda, Romuald Turasiewicz, Adam Stefan Miodoński, Gustaw Edward Przychocki, Władysław Strzelecki, Kazimierz Kumaniecki, Mieczysław Brożek, Marian Plezia, Kazimierz Korus, Józef Korpanty and Stanisław Stabryła.
10 ways to promote your practice
Authors: Memon Shaz
Published: July 2019

Dental marketing expert Shaz Memon offers a checklist of savvy innovations that you and the rest of the team can use to market your services
On a mission
Authors: Gillies Stephanie
Published: July 2019

Meet dental nurse Stephanie Gillies, who is ensuring a ‘basic human right’ for those who need it most
Normative data and inter-examiner reliability of the upper quarter Y-balance test
Authors: Vaughan Brett , Theisinger Kane , Abels Luke , Bryan Luke , Duggan Sarah
Published: July 2019

Background/Aims

Physical performance measures, such as the lower quarter Y-balance test, can be used to determine performance ability or functional limitations. The aim of this study was to establish a normative data set for the upper quarter Y-balance test and evaluate inter-rater reliability.

Methods

Healthy participants, with no current upper extremity complaint or balance issues, were recruited. Participants undertook the upper quarter Y-balance test by reaching in three directions: medial; superolateral; and inferolateral. Each participant completed three reaches on each side. The mean of the second and third reach distances was used for the analysis and reach distance was normalised to limb length.

Results

Mean participant age was 24.3 (± 5.6) years. Statistically significant differences between males and females were observed for all reach directions (both raw and normalised data), with large to very large effect sizes (P<0.001, effect size (r)=0.82–1.92). Results showed statistically significant differences between left- and right-hand dominance with left inferolateral reach (P=0.038, z=−2.076, r=0.21). Inter-rater reliability was excellent, with an intraclass correlation coefficient (3,1) of 0.98.

Conclusions

The results suggest that males have a statistically significantly larger reach in all directions and that participants reach significantly further when testing the dominant arm versus the non-dominant arm. The data presented here provide researchers with a substantive normative data set that will allow for comparison with symptomatic populations.
Exercise using a foam bead bag improves balance and lower extremity strength in older adults
Authors: Siriphorn Akkradate , Siriphorn Siriporn Vongsaiyat , Sawatthuk Kittaphon , Temvorasub Kanjana , Auttawut Malinee
Published: July 2019

Background/Aims

Balance training using unstable support surfaces is widely used in clinics and research and can reduce the risk of falls in older people. This study aimed to investigate the effect of an exercise programme using a foam bead bag on older adults' ability to balance and the strength of their lower extremities and compare the effect with no exercise and foam pad exercise using the same programme.

Methods

A total of 24 older adults were allocated into one of three groups: control (n=8), foam pad exercise (n=8) and foam bead bag exercise (n=8). The foam pad exercise and foam bead bag exercise groups carried out a programme consisting of 30 minutes of exercise performed twice a week for 5 weeks. The control group did not participate in an exercise programme. Participants' balance abilities were measured using the Fullerton Advanced Balance Scale, the Timed Up and Go Test and the Single-Leg Stance Test. The strength of their lower extremities was measured using the 30-second sit-to-stand test.

Results

The Fullerton Advanced Balance scale and 30-second sit-to-stand scores significantly improved in the foam pad exercise and foam bead bag exercise groups. Both of these groups also demonstrated significant improvements in Timed Up and Go tests. The amount of time that participants were able to stand on one leg while unassisted significantly increased in the foam bead bag group only. No significant differences were found in balance ability or lower extremity strength in the control group.

Conclusions

A foam bead bag is a suitable alternative to a foam pad when performing exercises to improve balance and strength of the lower extremities in older adults.
Feasibility and acceptability of Otago Exercise Programme and Prevention of Falls for Adults with Intellectual Disability: a multiple case study design
Authors: Hale Leigh , Vollenhoven Emile , Caiman Lisa , Dryselius Alice , Buttery Yvette
Published: July 2019

Background/Aims

Many people with intellectual disability fall frequently. Understanding fall prevention intervention characteristics will assist efficacy trials to target appropriate people. An exploration of two exercise-based fall prevention interventions is reported, focusing on viability and acceptability.

Methods

A multiple case study of adults with intellectual disability completing either the group Otago Exercise Programme or the Prevention of Falls for Adults with Intellectual Disability intervention was performed. Integrated data sources were used: semi-structured interviews with participants and support workers, observations, attendance/adherence, falls, adverse events and balance measures.

Results

In total, seven adults with varying intellectual disability levels participated. Overall, three themes enabled understanding of suitability of people to each intervention: suitability of the exercises; role of the environment; and benefits to participants.

Conclusions

Educating adults with intellectual disability and their support workers of the importance of regular exercise is key to participation. Both programmes required high levels of support and prioritisation to ensure exercises occurred and were carried out safely.
An Exploratory Pilot Study Into Undergraduate Physiotherapy Students' Perceptions Of Working With Patients With Mental Illness And Working Within The Mental Health Sector Of Health Care
Authors: McIver Samantha , Toms Jane
Published: July 2019

Background/Aims

Mental illness is widespread throughout the United Kingdom with increasing prevalence. As mental illness affects such a large proportion of the population, it is likely that healthcare professionals, including qualified and student physiotherapists, will work with patients in all areas of healthcare, who have mental illness alongside co-morbidities. Physiotherapy students are placed into a wide range of placements throughout an undergraduate degree to develop skills and autonomy in rehabilitation. Understanding students' perspective appears relatively unexplored and was stimulated by personal experience of the first author where patients' rehabilitation could be impacted by mental illness. The impact varied depending on the severity of their illness, as well as the understanding of that illness by the multidisciplinary team involved in their care. The aim of this phenomenological study was to: explore physiotherapy students' lived experiences and perceptions of working with patients with mental illness, despite no mental health specific placement and understand their views of working in the mental health sector of healthcare

Methods

Ethical approval was obtained from Coventry University Ethics and a qualitative methodology was applied. Purposeful sampling was used to recruit six participants, who were all Undergraduate physiotherapy students at Coventry University, and data were collected via a focus group. The focus group explored their lived experiences, opinions and perceptions.

Results

A number of themes were discovered from the data, with associated sub-themes: ‘Lack of clarity’ with sub-themes: ‘Definitions, Terminology and understanding’, ‘Mental illnesses’ and ‘Physiotherapist role’ ‘Emotional Roller-Coaster’ with sub-themes: ‘Negative reactions’ and ‘Positive sentiments’ ‘Transferable skills’ with sub-themes: ‘Core competencies’ and ‘Core skills to elevate’ ‘Everyone has a story to tell’ with sub-themes: ‘Job’, ‘Placement’ and ‘Personal experience’ The themes influenced their ‘curious intrigue’, which related to their views of working in the mental health sector of health care.

Conclusions

All participants in the study had experiences to discuss and found it challenging to provide effective rehabilitation, appropriate to the patients' needs. Discussing these experiences evoked a complex range of perceptions and emotions.
Dorsiflexion But Not Plantarflexion Force Declines At Lower Foot Skin Temperatures
Authors: Bieles Julie S , Bruce Stuart A , Newham Di J , Green David A
Published: July 2019

Background/Aims

Muscle maximum voluntary force declines at skin temperature <20°C, attributed to cold muscle, however large muscle deep fibres remain at >20°C. Large muscle maximum voluntary force decline is comparable to that in small superficial muscle where muscle temperature remains close to skin temperature. Therefore, factors in addition to temperature may contribute to large muscle maximum voluntary force decline. This study compares the effects of foot and/or shank skin temperature on dorsiflexion and plantarflexion maximum voluntary force with the hypotheses that: dorsiflexion maximum voluntary force>plantarflexion maximum voluntary force decline at lower skin temperature; and, plantarflexion and dorsiflexion maximum voluntary force will decline at lower shank skin temperature independent of foot skin temperature.

Methods

A total of 24 adults (15 females, 9 males, 29 ± 11.8 years, 170.1 ± 8.0 cm, 66.9 ± 9.3 kg [mean ± standard deviation]) gave informed consent to participate on three visits – cooling/warming of: foot only; foot and shank; and shank only. Foot and/or shank temperature was adjusted using Cryocuff™ sleeves filled with ~45°C or ~4°C water. Temperature, taken before each maximum voluntary force set, was monitored through thermocouples placed on the limb. Plantarflexion and dorsiflexion maximum voluntary force were measured with a KinCom isokinetic dynamometer, with subjects seated on a plinth with knee fully extended and neutral ankle. A general mixed model was used to evaluate the effects of skin temperature on maximum voluntary force. Fixed effects were skin temperature and condition, with subject as a random effect. The skin temperature*condition interaction was also modelled. P-values were obtained by likelihood ratio tests.

Results

Foot skin temperature <18.5°C resulted in a 10% (χ2(1)=5.479, P=0.019) dorsiflexion maximum voluntary force decline, with a skin temperature*condition interaction (χ2(2)=11.031, P=0.004), this decline was 12% (χ2(1)=13.18, P=0.0003) in foot only and 8% (χ2(1)=4.675, P=0.031) in foot and shank. Leg skin temperature did not affect (χ2(1)=2.849, P=0.091) dorsiflexion maximum voluntary force. Plantarflexion maximum voluntary force did not change with foot skin temperature (χ2(1)=0.04, P=0.841) or leg skin temperature (χ2(1)=0.082, P=0.929).

Conclusions

Dorsiflexion maximum voluntary force declines at lower foot skin temperature independently of shank skin temperature, whereas plantarflexion maximum voluntary force is unaffected by skin temperature, possibly because in this protocol the shank was insufficiently cooled. Therefore factors other than direct muscle cooling must contribute to dorsiflexion maximum voluntary force decline. One theory is a rightward shift in the force-length relationship, due to stiffer tendon, could result in dorsiflexions operating in the descending limb of the force-length relationship. This warrants further investigation.
Mobilisation And Tactile (Sensory) Stimulation For The Foot Post Stroke: Opinions And Perceptions Of Experienced Therapists
Authors: Aries Alison M , Cooke Lucy , Hunter Sue M
Published: July 2019

Background/Aims

Intensive proprioceptive stimulation applied to the paretic hand post-stroke, using a complex hands-on intervention known as mobilisation and tactile stimulation, has reduced motor impairment and improved hand function in sub-acute and chronic stroke. While, anecdotally, mobilisation and tactile stimulation is also applied to the paretic foot to prepare it for standing, its use in stroke rehabilitation and effects on standing and balance have not been evaluated. Therefore, expert clinicians' experiences, opinions and perceptions of using mobilisation and tactile stimulation in routine clinical practice were explored to inform a subsequent feasibility study of mobilisation and tactile stimulation for the paretic foot post-stroke.

Methods

Following ethical approval, focus groups were undertaken: using purposive sampling, physiotherapists and occupational therapists with >12 months experience of stroke rehabilitation were recruited from a regional special interest group. A pilot study (n=4) and main study (n=7) explored content and application of hands-on therapy for the paretic foot, and the perceived impact of sensory loss on lower limb function. Data were audio-taped and transcribed verbatim. Thematic analysis was undertaken.

Results

All 11 therapists had previous experience of using mobilisation and tactile stimulation for the foot post-stroke. Three main themes were identified: (1) therapeutic intervention (sub-themes: therapy content, sensation, adjuncts, the foot as an active base of support and preparation for function); (2) 24-hour care; and (3) analysis (sub-themes: outcome measures, response to treatment). The most common adjuncts to mobilisation and tactile stimulation were orthotics and task-specific training. The importance of mobilisation and tactile stimulation in restoring foot alignment, sensory feedback and progression of the patient towards weight bearing and ambulation in the clinical setting was highlighted.

Conclusions

Mobilisation and tactile stimulation is a complex intervention used in stroke rehabilitation to enhance weight bearing and ambulation post stroke. Further research into its effects on the foot and lower limb is warranted in order to evaluate it and determine its evidence base for inclusion in routine clinical practice. Alternative methods of applying proprioceptive stimulation should also be considered, for example use of textured insoles, and relative effectiveness of these explored in clinical trials.
An Interpretive Phenomenological Analysis Of Physiotherapy In Mental Health: Exploring Barriers And Facilitators To Care
Authors: Hemmings Laura
Published: July 2019

Background/Aims

Current literature identifies decreased life expectancy and increased physical health complaints for service users with mental health diagnosis. However, research also highlights increased challenges for this population when accessing physical health care services. Physiotherapy is one such service shown to be of benefit for those with co-morbid physical and mental health needs. However, research is currently lacking on experiences and access to physiotherapy for this population. This study aimed to explore lived experiences of physiotherapeutic care for those with co-morbid physical and mental health complaint and identify barriers and facilitators for those attempting to access this service.

Methods

Semi-structured interviews were carried out with service users (n=8) with long-standing physiotherapeutic and severe and enduring psychiatric complaints. Focus groups were completed with physiotherapists working within the field of mental health care. Verbatim transcripts of the interviews and focus groups were analysed using Interpretive Phenomenological Analysis in order to obtain in depth insight into participant experiences. The study was designed to enhance quality through use of methodological and investigator triangulation, negative case analysis, reflexivity, secondary coding and a clear audit trail.

Results

Data was analysed systematically following the structure: individual case analysis, emergence of themes, cross case analysis, validation of themes and ideas. This analysis produced five master themes: (1) Communication with health care provider; (2) holistic care from physiotherapist; (3) perceived benefit of physiotherapy; (4) health care politics and interaction between services; (5) patient activation and motivation to comply with physiotherapy. These factors were seen to be of high importance for patient experience and, when lacking, were identified as barriers to quality physiotherapeutic care.

Conclusions

Results were found to be consistent with current literature around physical health care. This study identifies the need for greater integrated care between physical and mental health services and improved awareness of mental health and use of the biopsychosocial model within physiotherapy practice in order to promote holistic care. Results also highlight the need for positive experience of physiotherapy for those with severe mental illness in order to increase patient activation and motivation to attend and comply with services.
Effects of Gabapentin on Postoperative Pain and Total Analgesic Requirement After Laparoscopic Cholecystectomy
Authors: Abbas Zaffar , Bashir Amina , Abbas Zaffar
Published: July 2019

The aim of this study is to determine the effect of preoperative use of gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. Sixty adult patients listed for laparoscopic cholecystectomy were randomly allocated to two groups of 30 each to receive gabapentin 600 mg p.o. or a matching placebo 2 hours before surgery. Postoperative pain was monitored using 100 mm visual analogue scale (0 for no pain and 100 for worst imaginable pain) at 1, 2, 6, 12 and 24 hours. Diclofenac 75 mg IM was used as rescue analgesic and total analgesic requirement (mg/24hr) in first 24 hours following surgery was recorded. Postoperative pain scores and total analgesic requirement was significantly less in gabapentin group compared to placebo group. A single 600 mg dose of gabapentin given preoperatively decreased postoperative pain and total analgesic requirement following laparoscopic cholecystectomy. Preemptive use of gabapentin can be used to treat postoperative pain caused by laparoscopic cholecystectomy.