bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypothermia in the newborn: An exploration of its cause, effect and prevention
Authors: Vilinsky Aliona , Sheridan Ann
Published: August 2014

According to the World Health Organization ( WHO, 1997 ) a newborn is normothermic when its body temperature is between 36.5°C and 37.5°C with hypothermia considered to be any temperature below this identified spectrum. Neonatal hypothermia is a potentially common and dangerous occurrence related to a number of risk factors categorised as environmental, physiological, behavioural and socioeconomic. Babies delivered by caesarean section are at particular risk of developing hypothermia. The purpose of this review is to provide an overview of the factors contributing to neonatal hypothermia including the physiology of thermoregulation, mechanisms of thermogenesis and heat loss, and the effects that neonatal hypothermia has on the newborn infant. The paper will also review the interventions, which may be adopted to prevent hypothermia occurring and to identify and intervene to reduce the impact of hypothermia including the effect of skin-to-skin contact as both a preventative and management strategy in neonatal hypothermia.
The role of antenatal and postnatal social support for pregnant women with a body mass index ≥ 30 kg/m2
Authors: Smith Debbie , Taylor Wendy , Lavender Tina
Published: August 2014

Pregnancy can be both a time of change and increased stress for women. Through taking part in a research study and attending an antenatal lifestyle programme for women with a body mass index (BMI) ≥30kg/m2, a group of eight women formed a reference group and became a strong and effective source of social support for each other. This article discusses the role of social support from reference groups in engaging in postnatal healthy behaviours, such as physical activity (social learning theory) and protection against stressful situations (social support as a buffer for psychosocial stress), by presenting some observations and data from a number of women taking part in a larger research study and the literature base. Two conclusions are made in this discussion article and require further research attention in the opinion of the research team. First, health professionals should educate women about the different sources of social support that they may need during and after pregnancy; and second, they should provide antenatal opportunities for women to meet others with whom they can form a social support group (e.g. BMI can be the basis for a reference group).
Midwifery care in the UK for older mothers
Authors: O'Connor Anita , Doris Faye , Skirton Heather
Published: August 2014

In many countries, care during pregnancy, labour and the postnatal period is often provided by a practising midwife. Despite specific risks associated with pregnancy in advanced maternal age, attention has shifted away from this group of women with regard to fetal screening and testing. This study aimed to explore the experiences of mothers aged 35 years and over during pregnancy and the perinatal period, as it is unclear whether their needs are currently being met by midwives.

Qualitative and quantitative data were collected via an online survey tool between May and August 2012 and the study was advertised on the social networking site Twitter.

Of the 397 mothers who completed the survey, many reported receiving good midwifery care, but others felt their care needs were not met or were offered inadequate support. Continuing education for midwives and professional leadership is needed, to support practitioners in developing skills essential to care for women.
Think pink! A sticker alert system for psychological distress or vulnerability during pregnancy
Authors: McKenzie-McHarg Kirstie , Crockett Melanie , Olander Ellinor K , Ayers Susan
Published: August 2014

The importance of good clinical communication to women during pregnancy and birth is clear. Poor communication in labour is associated with general dissatisfaction, more complaints and a range of perinatal mental health problems including post-traumatic stress disorder (PTSD) and postnatal depression. To communicate effectively, maternity staff need information about which women are vulnerable and require extra support. To address this, a pink sticker communication system to alert midwifery and obstetric staff to potential psychological difficulties experienced by some women was implemented and evaluated. Evaluation showed this system was viewed positively by women and midwifery staff. Audit of referrals to the perinatal psychology service during this period suggests no woman with a pink sticker developed birth trauma as a direct result of perceived poor care. In addition, the proportion of referrals to perinatal psychology for birth trauma significantly reduced during this period.
Managing the diabetic foot
Authors: Kochhar Suneeta
Published: August 2014

Footcare

The feet of diabetics are at risk of ulceration. Suneeta Kochhar discusses assessment and prevention in these patients
Understanding fever in babies
Authors: Paul Siba Prosad , Routley Christine
Published: August 2014

Infants

Fever is one of the top reasons why parents seek medical advice. Siba Prosad Paul and Christine Routley clarify some misconceptions around febrile infants
Investigating and treating cases of vaginal discharge
Authors: Kochhar Suneeta
Published: August 2014

Gynaecology

Women often experience problematic discharge. Suneeta Kochhar outlines investigations and possible diagnoses
Infant skin conditions
Authors: Watkins Jean
Published: August 2014

NewBorns

Birthmarks and rashes frequently cause concern in parents. Jean Watkins provides an overview of the causes and outcomes for seven common newborn skin problems
Solve the case: Pruritus in an older patient
Authors: Nazarko Linda
Published: August 2014

As the population in the UK ages increasing numbers of people will present with skin problems ( Associate Parliamentary Group on Skin, 2000 ; Office for National Statistics (ONS), 2013 ). Ageing skin is more prone to a range of conditions including infections, infestations, eczema and psoriasis ( Davies, 2008 ). One of the presenting features of many of these conditions is itching, also known as pruritus. It can be difficult for busy professionals to diagnose skin conditions in day-to-day practice ( All Party Parliamentary Group on Skin, 1998 ; Associate Parliamentary Group on Skin, 2000 ). This article uses a case study approach that aims to enable nurses practicing at advanced level to identify and treat the causes of pruritus.
Trials and tribulations of hepatitis C treatment in Lothian prisons
Authors: Rose Fiona , Lamond Sara
Published: August 2014

Hepatitis C virus (HCV) is blood-borne virus that can cause both acute and chronic infection. In Scotland, it is well known that the main transmission route of HCV is through drug use and a study into prevalence of HCV in Her Majesty's Prisons (HMPs) in Scotland showed that 53% of intravenous drug users (IVDU) tested were antibody positive ( Taylor et al, 2012 ). The aim of HCV treatment is to reduce the risk of progression to cirrhosis, lessen the risk of hepatocellular carcinoma, reduce/clear infectivity and improve the quality of life ( British Liver Trust, 2014 ). Involving non-medical prescribers in the treatment of hepatitis C in prisons has contributed to a more seamless and timely patient pathway, avoiding delays from the onset of symptoms to the issuing of an appropriate medication if indicated.
Three-axis vibration measurement by using a grating-interferometric vibrometer
Authors: Ito So , Aihara Ryo , Kim Woo Jae , Shimizu Yuki , Gao Wei
Published: August 2014

Three-axis vibration measurement of the linear air-bearing stage demonstrated by utilizing the method of the multi-axis laser interferometer is discussed. In order to detect the X-Y-Z directional vibration of the positioning stage table simultaneously, two-dimensional XY gratings are utilized as the scale grating and the reference grating of the interferometer. The X- and Y-directional positive and negative first-order diffracted beams are superimposed to generate the interference signals on the photodetectors. When the multi-axis vibration is applied to the scale grating, the intensities of the interference signals in X- and Y-directions varied corresponding to the vibration of the scale grating. Consequently, three-axis vibrations of the scale grating can be calculated by processing the X- and Y-directional positive and negative first-order interference signals. In this paper, a three-axis vibrometer based on the grating-interferometer has been developed for measurement of the positioning stage table vibration. The detection method of the vibration based on the Doppler frequency shift has been demonstrated. As an application of the multi-axis grating-interferometric vibrometer, multi-axis vibrations of the linear air-bearing stage are measured by using the developed vibrometer.
Rapid functionalisation of cellulose-based materials using a mixture containing laccase activated lauryl gallate and sulfonated lignin
Authors: Cusola Oriol , Valls Cristina , Vidal Teresa , Roncero M. Blanca
Published: August 2014

An innovative method has been developed for the surface hydrophobisation of cellulose-based materials by coating it with a functionalised solution (FS), in which sonicated lauryl gallate (LG, dodecyl 3,4,5,-trihydroxybenzoate), sulfonated kraft lignin, and the enzyme laccase play a pivotal role. The rapid treatment with FS increases the hydrophobicity of cellulose sheets considerably. The FS retention on the paper surface was analysed as a function of refining and application of additives. The properties of the functionalised sheets were assessed by the water-drop test (WDT), and the surface free energy (SFE) was determined via contact angle (CA) measurements in a goniophotometer. WDT resulted in long absorption times of up to 4000 s and CA values were around 130°. Functionalised solution modification of eucalyptus paper sheets decreased SFE essentially from 55 mJ m-2 to 10 mJ m-2. ATR-FTIR suggested that FS was grafted onto the cellulosic sheets. The stability of FS and the control solutions were characterised by Z potential and light scattering measurements. The functionalised solution method is a one-step roll-to-roll process, which is easy to perform also in industrial application without additional investments. It has a potential to substitute the traditional hydrophobing processes.
Sweetened kallikrein-related peptidases (KLKs): glycan trees as potential regulators of activation and activity
Authors: Guo Shihui , Skala Wolfgang , Magdolen Viktor , Brandstetter Hans , Goettig Peter
Published: August 2014

Most kallikrein-related peptidases (KLKs) are N-glycosylated with N-acetylglucosamine2-mannose9 units at Asn-Xaa-Ser/Thr sequons during protein synthesis and translocation into the endoplasmic reticulum. These N-glycans are modified in the Golgi machinery, where additional O-glycosylation at Ser and Thr takes place, before exocytotic release of the KLKs into the extracellular space. Sequons are present in all 15 members of the KLKs and comparative studies for KLKs from natural and recombinant sources elucidated some aspects of glycosylation. Although glycosylation of mammalian KLKs 1, 3, 4, 6, and 8 has been analyzed in great detail, e.g., by crystal structures, the respective function remains largely unclear. In some cases, altered enzymatic activity was observed for KLKs upon glycosylation. Remarkably, for KLK3/PSA, changes in the glycosylation pattern were observed in samples of benign prostatic hyperplasia and prostate cancer with respect to healthy individuals. Potential functions of KLK glycosylation in structural stabilization, protection against degradation, and activity modulation of substrate specificity can be deduced from a comparison with other glycosylated proteins and their regulation. According to the new concept of protein sectors, glycosylation distant from the active site might significantly influence the activity of proteases. Novel pharmacological approaches can exploit engineered glycans in the therapeutical context.
Kallikrein-related peptidase 6 (KLK6) expression in the progression of colon adenoma to carcinoma
Authors: Vakrakou Athina , Devetzi Marina , Papachristopoulou Georgia , Malachias Apostolos , Scorilas Andreas , Xynopoulos Dimitris , Talieri Maroulio
Published: August 2014

KLK6 is a secreted trypsin-like serine protease. KLK6 mRNA expression and its association with colon cancer (CC) progression was studied using quantitative real-time PCR. We examined the expression of KLK6 in 232 colon tissues (cancerous, non-cancerous, and adenomatous). We proved that KLK6 expression in CC behaves as a continuous variable, as its expression correlates significantly with increasing tumor stage (p=0.004) and histological grade (p=0.007). Interestingly, the expression of KLK6 in adenomas was significantly higher than that in the cancerous or non-cancerous tissues examined (p<0.001). Cox proportional hazard regression model using univariate analysis revealed that positive KLK6 expression is a significant factor for disease-free survival (DFS) (p=0.017) and overall survival (OS) (p=0.002) of patients. Kaplan-Meier survival curves demonstrated that KLK6-negative expression is significantly associated with longer DFS (p=0.009) and OS (p=0.001). ROC analysis showed that KLK6 expression has significant discriminatory power in distinguishing cancerous from non-cancerous colon tissues (p<0.001), or cancerous from adenoma tissues (p=0.001), or adenoma from non-cancerous colon tissues (p<0.001). Additionally, strong KLK6 immunostaining was seen in the cancer cells of selected CC sections, as well as in glandular cells and inflammatory cells of adenomas. In conclusion, KLK6 may represent a potential unfavorable prognostic biomarker for CC.
Development of a High Efficiency In-Line Tube Fan Using CFD
Authors: Yen Hung-Cheng , Hsu Wen-Syang , Huang Jeng-Min , Lu Chi-Wen , Hsu Chin-Nan
Published: August 2014

An in-line tube fan with design flow rate 1 m
Biaxial Ratcheting of Ultra High Molecular Weight Polyethylene: Experiments and Constitutive Modeling
Authors: Asmaz Kerem , Çolak Özgen Ü , Hassan Tasnim
Published: August 2014

Responses of ultra-high molecular weight polyethylene (UHMWPE) under biaxial cyclic loading were investigated through systematically conducting experiments. Biaxial experiments on UHMWPE tubular specimens were conducted first by prescribing a steady internal pressure followed by a symmetric axial-strain controlled cycle. The steady internal pressure induced a steady nominal circumferential stress, which under the application of the axial strain-controlled cycle, induced circumferential strain ratcheting in the UHMWPE tubular specimens. Experimentally observed ratcheting responses of UHMWPE under biaxial cyclic loading was simulated using one of the unified state variable theories, the viscoplasticity theory based on overstress for polymers (VBOP). To improve the circumferential strain ratcheting simulation of the VBOP model, the Chaboche kinematic hardening rule was implemented in the model. The simulation of the VBOP model with the classical kinematic hardening model was also carried out to demonstrate the current state of the modeling for UHMWPE. Improvement of the circumferential strain ratcheting simulation by the modified VBOP model is demonstrated; however, simulations also indicate that further model modification will be needed.
Stress–Strain Characteristics and Elastic–Plastic Damage Constitutive Equation of Steel Fiber Reinforced Concrete Under Cyclic Compression at Medium Strain Rate
Authors: Bai Wei , Wang Qian-Feng
Published: August 2014

An experimental investigation was performed on dynamic compressive stress–strain relationships for steel fiber reinforced concrete (SFRC) with various steel fiber volumetric contents under cyclic compression at a medium strain rate. Results indicate that the mechanical properties of SFRC are not only affected by strain rates but are also influenced by loading modes. The envelope curves of unconfined SFRC are different from those of specimens under monotonic compression. Dynamic compressive strength presents a non-monotonic enhancement with increasing steel fiber content. On the basis of the experimental results of cyclic compression at a medium strain rate, the elastic–plastic damage constitutive equations are proposed to describe the dynamic compressive stress–strain relationships of SFRC under cyclic compression at a medium strain rate. These equations match the test results well.
The Influence of Binder Rheology on the Cracking of Asphalt Mixes in Airport and Highway Projects
Authors: Rowe G. M. , King G. , Anderson M.
Published: August 2014

It is well known that asphalt rheology affects the cracking performance of asphalt binders. For many years researchers have struggled to develop tests that adequately deal with this aspect of pavement performance in a manner that can be incorporated rapidly into a specification. The use of the fatigue parameter developed during the Strategic Highway Research Program (SHRP), G*sin δ, has been shown to be a poor surrogate for cracking performance. Other tests, such as the direct tension test, used for cold-temperature cracking, also have been implemented poorly into specifications. However, use of the bending beam rheometer as an indicator of cold-temperature cracking has been widely adopted. As a result, a pavement stiffness of 300 MPa has been regarded as a reasonable parameter for cold-temperature cracking performance. The interrelationship between cold-temperature cracking parameters and those selected for fatigue cracking is not well understood. The onset of brittle behavior that occurs around 300 MPa stiffness and the selection of a fatigue parameter G*sin δ at 5 MPa are not wildly divergent in concept. More recently, the Glover–Rowe parameter has been revealed as a good indicator of cracking performance. In this paper we explore those differences that have occurred and make suggestions for the use of alternate parameters to better define the rheology of the binder as it relates to cracking.
Effect of Specimen Thickness and Punch Diameter in Evaluation of Small Punch Test Parameters Toward Characterization of Mechanical Properties of Cr–Mo Steels
Authors: Kannan C. , Bhattacharya S. , Sehgal D. K. , Pandey R. K.
Published: August 2014

Small punch tests on circular specimens were conducted using hemispherical tipped punches on Chromium–Molybdenum (Cr–Mo) steels of varying thermal histories. Combinations of punch diameters and sample thicknesses were used to obtain load–load line displacement (LLD) responses of these steels. Characteristic load, displacement, and energy values at transition points on LLD curves were identified and their dependency on punch diameter and sample thicknesses were studied. From the studies, sample thicknesses in the range of 0.4 to 0.5 mm and a punch tip diameter of more than 1.7 mm have been suggested to be used for the application of the SPT test procedure in the assessment of mechanical properties of in-service Cr–Mo steel components.
Selective Whole Genome Amplification for Resequencing Target Microbial Species from Complex Natural Samples
Authors: Leichty Aaron R , Brisson Dustin
Published: August 2014

Population genomic analyses have demonstrated power to address major questions in evolutionary and molecular microbiology. Collecting populations of genomes is hindered in many microbial species by the absence of a cost effective and practical method to collect ample quantities of sufficiently pure genomic DNA for next-generation sequencing. Here we present a simple method to amplify genomes of a target microbial species present in a complex, natural sample. The selective whole genome amplification (SWGA) technique amplifies target genomes using nucleotide sequence motifs that are common in the target microbe genome, but rare in the background genomes, to prime the highly processive phi29 polymerase. SWGA thus selectively amplifies the target genome from samples in which it originally represented a minor fraction of the total DNA. The post-SWGA samples are enriched in target genomic DNA, which are ideal for population resequencing. We demonstrate the efficacy of SWGA using both laboratory-prepared mixtures of cultured microbes as well as a natural host–microbe association. Targeted amplification of Borrelia burgdorferi mixed with Escherichia coli at genome ratios of 1:2000 resulted in >105-fold amplification of the target genomes with <6.7-fold amplification of the background. SWGA-treated genomic extracts from Wolbachia pipientis-infected Drosophila melanogaster resulted in up to 70% of high-throughput resequencing reads mapping to the W. pipientis genome. By contrast, 2–9% of sequencing reads were derived from W. pipientis without prior amplification. The SWGA technique results in high sequencing coverage at a fraction of the sequencing effort, thus allowing population genomic studies at affordable costs.
Localized Juvenile Spongiotic Gingival Inflammation: A Report on 3 Cases
Authors: Petruțiu Ștefan Adrian , Roman Alexandra , Soancă Andrada , Sârbu Ciprian , Stratul Ștefan Ioan
Published: August 2014

Background and Aims: A new pathological entity with distinct clinico-pathological features has been recently described and termed as juvenile spongiotic gingivitis. Histopathological associated features are unique and characterized by prominent intercellular edema (spongiosis) and neutrophil infiltrate. The aims of this paper were to: introduce juvenile spongiotic gingivitis to the dental and pediatric communities, to report three cases based on clinical and histopathological findings, and to discuss the most common clinical differential diagnoses. The cases were documented at baseline and follow-ups. The clinical appearance of the lesions described in this paper  correspond to the pattern described by the literature: 1) localized lesions as bright red slightly raised overgrowths, most often with a subtle papillary or finely granular surface; or 2) multifocal masses or raised papular lesions with a pebbly texture. The first intention treatment approach was personal and professional plaque control. Because of the lack of a good clinical response to conventional therapy, excisional biopsies were performed, which helped establish the diagnosis. The plaque control was reinforced and additional antiseptic local treatment was administered. A real improvement  in the local gingival conditions was recorded for all the patients. However, because of the persistence of some bright reddish gingival masses in one of the patients these lesions were treated by surgical excision. The overall clinical outcome was good and stable after one year. Conclusions: The presented cases might raise awareness of this condition among orthodontic specialists  because orthodontic treatment could not be applied until the gingival gum disease was resolved
Small intestinal bacterial overgrowth is associated with intestinal inflammation in the irritable bowel syndrome
Authors: David Liliana , Babin Alexandru , Picos Alina , Dumitrascu Dan Lucian
Published: August 2014

Background and aim. Small intestinal bacterial overgrowth is encountered in bowel disorders, including irritable bowel symptoms. Low degrees of inflammation have been recently reported in the irritable bowel syndrome. We looked for the association between intestinal inflammation and small intestinal bacterial overgrowth in irritable bowel syndrome.Methods. Small intestinal bacterial overgrowth was assessed by the H2 glucose breath test in 90 consecutive patients with irritable bowel syndrome. A check-up of the oral cavity was carried out before the breath testing.  Further on, the patients were classified into two groups, positive and negative, at the breath test. Then they were tested for intestinal inflammation with a fecal test for calprotectin. We used a semiquantitative test for this study. Both groups were compared for the association of intestinal inflammation with small intestinal bacterial overgrowth.Results. A number of 24/90 (26.7%) patients with irritable bowel syndrome had small intestinal bacterial overgrowth. A positive test for intestinal inflammation was significantly more frequent in patients with irritable bowel syndrome and small intestinal bacterial overgrowth (chi2: p<0.05).Conclusions. Small intestinal bacterial overgrowth is present in almost one quarter of patients with irritable bowel syndrome. It is significantly associated with intestinal inflammation.
Improved Understanding of Stent Malapposition Using Virtual Bench Testing
Authors: Mortier Peter , van Beusekom Heleen MM , De Beule Matthieu , Krabbendam-Peters Ilona , Van Der Smissen Benjamin , De Santis Gianluca , Ligthart Jurgen M , Verhegghe Benedict , van der Giessen† Wim J ,   FEops bvba, Ghent; IBiTech-bioMMeda, Ghent University, IIC UGent, Technologiepark 3/13, 9052 Ghent, Belgium. E: peter.mortier@feops.44:com,   Thoraxcenter, Erasmus Medical Center, Rotterdam,   FEops bvba, Ghent; IBiTech-bioMMeda, Ghent University,   Thoraxcenter, Erasmus Medical Center, Rotterdam,   IBiTech-bioMMeda, Ghent University; University College Ghent, Department of Mechanics, Ghent,   IBiTech-bioMMeda, Ghent University,   Thoraxcenter, Erasmus Medical Center, Rotterdam,   FEops bvba, Ghent; IBiTech-bioMMeda, Ghent University,   Thoraxcenter, Erasmus Medical Center, Rotterdam; ICIN-KNAW, Utrecht
Published: August 2014

Intravascular imaging techniques such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are often used to assess strut apposition, but only provide limited insight into the three-dimensional appositioning behaviour of stents. Recently, a new approach has been introduced to study the phenomenon of incomplete stent apposition (ISA) based on finite element simulations. In this study, we employed this virtual strut apposition assessment technique in the setting of coronary bifurcation stenting and compared simulated strut–artery distances of two stent designs with actual measurements based on OCT imaging using a silicone model. Stenting of the main branch leads to malapposed struts in the proximal part and the average strut–artery distance in that region for the Integrity stent is 126 μm based on the simulation and 117±14 μm based on the OCT analysis. For the Multi-Link 8 stent, this average distance is 150 μm and 174±7 µm for the simulation and thein vitroOCT measurements respectively. In conclusion, the virtual assessment of strut appositioning results in similar strut–artery distances when compared with measurements based on OCT-visualisedin vitrostent deployments and could be used to optimise devices and procedures.
Optical Coherence Tomography Assessment of the Effect of High-pressure Non-compliant Balloon Postdilation on Underexpansion and Malapposition in Drug-eluting Stents
Authors: Adriaenssens Tom , Ughi Giovanni J , Dhooge Jan , Desmet Walter ,   Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. E: tom.adriaenssens@uzleuven.be,   Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium,   Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium,   Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
Published: August 2014

Concerns of an increased risk of thrombosis in drug-eluting stents (DES) and the association, in human pathology studies of stent thrombosis, of delayed healing with malapposition of stent struts has fostered a renewed interest in stent implantation optimisation techniques. We investigated the rationale of the use of optical coherence tomography (OCT), an intravascular imaging technique with 10-fold better resolution than intravascular ultrasound (IVUS), in the guidance of percutaneous coronary intervention (PCI) with respect to the correction of stent underexpansion and malapposition in DES. In 12 patients with OCT characteristics of frank malapposition immediately after DES implantation, high-pressure postdilation with a non-compliant balloon was performed. We concluded that high-pressure non-compliant balloon postdilation for underexpansion and malapposition in DES significantly improves minimal stent diameter (MSD) and minimum cross-sectional area (CSA), as assessed with OCT. There was a highly significant decrease in the percentage of malapposed struts. Larger series, correlated with OCT and clinical follow-up, will shed light on the clinical implications of postdilation in case of severe acute incomplete stent apposition (ISA).
Questioning ‘Keep it Simple’ in Treatment of Coronary Bifurcation Disease
Authors: Routledge Helen ,   Worcestershire Royal Infirmary, Worcestershire Royal Hospital, Aconbury East, Charles Hastings Way, Worcester, WR5 1DD, UK. E: Helen.Routledge@worcsacute.nhs.uk
Published: August 2014

The favoured approach for coronary bifurcation disease is provisional stenting, which involves stenting the main vessel (MV) and ignoring the side branch unless clinical circumstances warrant placement of a second stent. This approach is based on a number of studies showing that provisional stenting is superior to conventional two-stent approaches. There is reason to suspect, however, that the conventional wisdom regarding provisional stenting does not accurately reflect the risks and benefits of a traditional two-stent approach. Analysis of studies (e.g. Nordic I; Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents [CACTUS]; and the British Bifurcation Coronary Study: Old, New and Evolving Strategies [BBC ONE]) shows that provisional stenting frequently has similar long-term outcomes to a conventional two-stent approach in some patient populations. The long-term superiority of provisional stenting in coronary bifurcation disease depends on measuring a periprocedural or post-procedural rise in cardiac enzymes; removing this measure results in similar long-term outcomes between provisional and conventional two-stent approaches. New technologies or techniques will hopefully yield clear, unambiguous improvement in coronary bifurcation stenting.
Combined Intracoronary Glycoprotein Inhibitors and Manual Thrombus Extraction in Patients with Acute ST-segment Elevation Myocardial Infarction – Does Incorporation of Both Have a Legitimate Role?
Authors: Natarajan Deepak ,   Department of Interventional Cardiology, Moolchand MedCity, Lajpat Nagar III, New Delhi,110024, India. E: deepaknatarajan19@gmail.com
Published: August 2014

In a substantial number of patients with acute ST-segment elevation myocardial infarction (STEMI), myocardial perfusion at the myocardial cellular level continues to be impaired despite achieving brisk antegrade flow in the infarct-related coronary artery by primary percutaneous intervention. This is attributable to embolisation of the coronary thrombus into the distal vasculature, producing microvascular plugging, vasospasm, interstitial oedema and cellular injury. There is consequently less salvage of infarct size, reduced left ventricular function and poorer clinical outcomes. Glycoprotein inhibitors are the most potent inhibitors of platelet aggregation and have been repeatedly shown to improve clinical outcomes in acute STEMI when administered intravenously. In recent years, randomised trials have demonstrated that glycoprotein inhibitors administered by the intracoronary route are safe and effective in reducing infarct size and providing better clinical outcomes than when given intravenously. Simultaneously, numerous randomised studies using adjunct manual thrombus extraction during primary percutaneous intervention in patients with acute STEMI have shown significantly better ST-segment resolution and myocardial blush grade, suggesting improved myocardial reperfusion, and, more importantly, significant one-year reductions in mortality. However, manual thrombus extraction cannot be used in all patients because there are occasions when the thrombus burden is too large to be aspirated completely or it is impossible to negotiate the thrombus extraction catheter beyond the occlusion. Similarly, glycoprotein inhibitors albeit delivered by the intracoronary route are unable to produce disaggregation of thrombus in all STEMI patients. A small pilot study involving 40 patients with acute STEMI demonstrated that the combination of intracoronary tirofiban and manual thrombus extraction is both safe and effective. However, there are no randomised data on the combined usage of intracoronary tirofiban and manual thrombus extraction in acute ST-elevation and, therefore, it is imperative that large, adequately powered, randomised studies are undertaken to study the synergistic effects of these two modalities. This article describes the various studies that have compared intracoronary glycoprotein inhibitors with the intravenous route and the rationale behind the advantages of manual thrombus extraction in the setting of acute STEMI.
Transcatheter Aortic Valve Implantation in the Hybrid Catheterisation Laboratory – Navigating into the Future
Authors: Lauterbach Michael , Sontag Bruno , Hauptmann Karl Eugen ,   Consultant Cardiologist, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292 Trier, Germany. E: lauterbach@uni-mainz.de,   Consultant Cardiologist,   Head of Department, Department of Medicine III, Krankenhaus der Barmherzigen Brüder Trier, a teaching affiliate of the University Medical Center Mainz
Published: August 2014

Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment option for high-risk patients with symptomatic, senile degenerative aortic stenosis. Since the first TAVI in 2002, the technology has evolved tremendously. With the downsizing of the device delivery catheter profile, vascular access site complications have decreased significantly. Current access routes are transfemoral, subclavian, transapical and transaortic, with most centres preferring a ‘transfemoral-first’ strategy. Other significant complications of TAVI are cerebrovascular events and conduction disturbances with the need for pacemaker implantation. The current TAVI devices with the largest number of implantations and the best evidence are the Medtronic CoreValve™ and the Edwards SAPIEN XT™. Both devices are already in their third generation. Navigation technology, such as the HeartNavigator, has been developed to facilitate the preparation of the procedure and the actual device implantation. The use of hybrid catheterisation labs for performing TAVI is becoming the standard of care due to the significant advantages with regard to safety and hygiene.
Transcatheter Tricuspid Valve Replacement
Authors: Weich Hellmuth ,   Senior Specialist, Division of Cardiology, Department of Internal Medicine, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, Private Bag x1, Tygerberg 7505, South Africa. E: hweich@sun.ac.za
Published: August 2014

Despite the explosion in the field of transcatheter aortic valve implantations over the last 10 years, only a handful of transcatheter tricuspid valve-in-valve implants have been described to date. This review describes the basic anatomy and pathology of the tricuspid valve. Current treatment remains surgical repair or replacement and the shortcomings is discussed. Results of surgical replacement are varied but generally not very good. Redo surgery has even more problems and this is the field where transcatheter valve-in-valve implants may have its biggest role. Technical aspects of the procedure is discussed, including the choice of valve, the approach and positioning of the device.
A Política Científica e Tecnológica de Santa Catarina: análise a partir do modelo de coalizões de defesa
Authors: Souza Luiz Ricardo de , Secchi Leonardo
Published: August 2014

Este artigo utiliza o modelo de coalizões de defesa (Advocacy Coalition Framework - ACF), de Sabatier e Jenkins-Smith (1993), para analisar a prevalência da comunidade científica catarinense como ator-chave na formulação da Política Científica e Tecnológica (PCT) de Santa Catarina. A coleta de dados foi realizada a partir de relatórios e documentos oficiais das instituições, bem como de entrevistas realizadas com 10 atores do processo de formulação da PCT que ocuparam funções estratégicas no período de 1989 a 2009, assim classificados: 1) comunidade científica; 2) burocratas; 3) designados politicamente; 4) empresários; 5) políticos. A análise dos dados teve como conceitos sensíveis aqueles presentes no modelo de coalizões de defesa: a) o papel dos atores; b) sistemas de convicções e recursos; c) trajetórias da política pública; d) características da política pública; e) conteúdo da política pública. Foram identificadas as conexões entre os atores, suas convicções, estratégias, recursos e constrangimentos. A pesquisa conclui que a comunidade científica exerce um papel de destaque na formulação da política científica e tecnológica catarinense, sendo prevalente na formulação da PCT em todo o período analisado. Em relação aos empresários, políticos e burocratas, não se identificou uma atuação destacada e contínua desses atores. Entretanto, os designados politicamente, que na maioria das vezes são recrutados no seio da comunidade científica, exerceram papel importante na formulação e na reafirmação do sistema de convicções da comunidade científica. Em relação às principais trajetórias que ajudam a explicar as mudanças da PCT catarinense no período analisado, a trajetória "aprendizagem orientada pela política pública" destaca-se perante as demais.
O Orçamento Participativo e a democratização da gestão pública municipal - a experiência de Vitória da Conquista (BA)
Authors: Novaes Flávio Santos , Santos Maria Elisabete Pereira dos
Published: August 2014

Este artigo discute as possibilidades do Orçamento Participativo (OP) de ampliar a democratização da gestão pública e de interferir efetivamente na destinação de recursos municipais. Parte-se da teoria da democracia participativa e do histórico do OP no Brasil para analisar a experiência de Vitória da Conquista (BA). Recorrendo a pesquisa documental, entrevistas, observação direta e aplicação de questionários a delegados do IX Congresso do OP de Vitória da Conquista (2011), o trabalho conclui que essa experiência contribuiu parcialmente com a democratização da gestão municipal, uma vez que não consistiu em fórum de efetiva participação da população na definição de políticas públicas e na aplicação de recursos municipais.
Escolas de governo: o panorama brasileiro
Authors: Aires Renan Felinto de Farias , Salgado Camila Cristina Rodrigues , Ayres Kátia Virgínia , Araújo Afrânio Galdino de
Published: August 2014

Escolas de governo têm papel significativo na vida do servidor público, valorizando-o e qualificando-o para a construção de uma nova imagem do serviço público. Apesar disso, esse é um universo de instituições ainda não totalmente conhecido e com poucos estudos. Partindo desse princípio, o objetivo deste artigo é traçar o panorama das escolas de governo do Brasil, descrevendo-as e analisando-as criticamente. Para tanto, foi realizada uma pesquisa exploratório-descritiva, por meio de um levantamento bibliográfico em estudos já publicados e nos websites relacionados às escolas, seguida de uma análise de conteúdo baseada nos critérios utilizados por Aires e colaboradores (2012). Os resultados apontaram que os estados pertencentes às regiões Norte e alguns estados da região Nordeste apresentaram um baixo desempenho nos critérios analisados, se comparados às escolas das outras regiões brasileiras.
Ética na administração pública: desafios e possibilidades
Authors: Gomes Nanci Fonseca
Published: August 2014

Este artigo discute aspectos da conduta moral presentes no trabalho na administração pública. As discussões baseiam-se em reflexões de pensadores da teoria crítica, em particular em Adorno, Horkheimer e Marcuse, na psicanálise de Freud e em tese de doutorado em psicologia. As análises são apresentadas a partir da percepção de aspectos da moralidade em ocupantes de cargos de chefias em órgãos públicos, entrevistados para a pesquisa de doutorado. Apresentam-se os efeitos e manifestações de dois aspectos na conduta ética no contexto do trabalho no serviço público: a racionalidade da administração pública; e a moralidade do indivíduo. A relevância do estudo está em apontar alguns atributos importantes a serem fortalecidos nos indivíduos, bem como a relevância da autorreflexão como fatores fundamentais na conduta ética.
Rastreio cognitivo em pacientes com acidente vascular cerebral: um estudo transversal
Authors: Dantas Ana Amália Torres Souza Gandour , Torres Sara Viviane de Souza , Farias Izabel Myckilane Alves de , Sant'Ana Suzane Beatriz Calixto de Lira , Campos Tania Fernandes
Published: August 2014

Objetivo O estudo objetivou-se a fazer um rastreio cognitivo nos pacientes com acidente vascular cerebral (AVC), a fim de determinar pontos de corte de acordo com a idade, escolaridade e grau de comprometimento neurológico. Métodos Foi realizado um estudo transversal no qual participaram 109 pacientes ambulatoriais, sendo 61 homens, com média da idade de 59 anos (± 11), média do tempo de escolaridade de 5 anos (± 4) e do tempo de sequela de 16 meses (± 14). Os pacientes foram avaliados por meio do Miniexame do Estado Mental (MEEM) e pela National Institute of Health Stroke Scale. Os dados foram analisados pela regressão linear múltipla (stepwise forward). Resultados Verificou-se que as variáveis grau de comprometimento neurológico, idade e escolaridade contribuíram significativamente para o valor global do MEEM e explicaram a variância do estado cognitivo (R2 ajustado = 0,24). Cada aumento do comprometimento neurológico representou diminuição de 0,456 no escore do MEEM. Quanto maior a idade, ocorreu uma diminuição de 0,202 no MEEM, e à medida que diminui o tempo de escolaridade, houve uma diminuição de 0,190 no MEEM. Os pontos de corte variaram de 14 a 22 de acordo com o grau de comprometimento neurológico, idade e escolaridade. Conclusão Os resultados apontaram que, por meio do rastreio positivo de déficit cognitivo, foram encontrados pontos de corte associados ao comprometimento neurológico, necessitando também serem ajustados pela idade e escolaridade, sugerindo que essas associações sejam preferencialmente levadas em consideração na planificação da reabilitação neuropsicológica dos pacientes com AVC.
Influência da família no consumo de crack
Authors: Horta Rogério Lessa , Vieira Luna Strieder , Balbinot Alexandre Dido , Oliveira Grazieli Oliveira de , Poletto Simone , Teixeira Vanessa Andina
Published: August 2014

Objetivo Dimensionar a contribuição de características de grupos familiares de usuários de crack tanto em situações de consumo quanto na promoção da cessação do uso da substância. Métodos Estudo observacional, transversal, misto, com delineamento quantitativo (estatísticas descritiva e analítica, por regressão de Poisson robusta) e qualitativo (análise temática de conteúdos de entrevistas individuais semiestruturadas). Resultados Foram analisados dados oriundos de entrevistas com 519 usuários de crack, dos quais 48,3% referiram já ter feito uso compartilhado com algum familiar. A relação mais referida para compartilhamento do crack foi a conjugal, indicada por 30,6% dos entrevistados. A estimativa das razões de prevalência do desfecho abstinência na data da entrevista, por regressão de Poisson robusta controlada para fatores de confusão, para usuários de crack que referiram uso compartilhado com irmãos, foi de 0,940 (IC95%: 0,885-0,999; p = 0,045), tendo os que não referiram como referência. Na dimensão qualitativa, 20 entrevistados expuseram livremente modalidades de envolvimento dos familiares com o uso da droga, alguns indicando oposição ao consumo, outros estímulo, ou oferta, além da influência recíproca entre consumo de crack e conflitos familiares ou um ambiente considerado negativo. Além disso, os entrevistados que informaram ter familiares em tratamento em saúde mental tiveram 9% mais probabilidade de estar em uso cessado por 12 semanas ou mais (RP = 1,09; IC95%: 1,03-1,15; p = 0,005). Conclusão Os grupos familiares aparecem não somente como fator de proteção, mas também como importante fator de risco para o uso do crack, e sua inclusão como grupo primário de atendimento se justifica com essas evidências.
Consumo de álcool por frequentadores de academia de ginástica
Authors: Oliveira Daiane Gonçalves de , Almas Saulo Peters , Duarte Lidiane Castro , Dutra Sheila Cristina Potente , Oliveira Renata Maria Souza , Nunes Renato Moreira , Nemer Aline Silva de Aguiar
Published: August 2014

Objetivo Como não há na literatura informações sobre o perfil de consumo alcoólico entre desportistas, o objetivo deste trabalho foi avaliar o perfil de consumo alcoólico por frequentadores de academia de ginástica associando com a antropometria e a intensidade do treino. Métodos Foram convidados a participar do estudo indivíduos praticantes de musculação, por no mínimo seis meses, com idade entre 20 e 40 anos, de ambos os sexos. Foram realizadas medidas antropométricas e de composição corporal. Para avaliação do consumo alcoólico, utilizou-se o questionário AUDIT (The Alcohol Use Disorders Identification Test). A intensidade do treino foi identificada por meio de um questionário semiestruturado. Resultados Dos participantes, 74,1% (n = 35) disseram ter feito uso de álcool. Além disso, 19 voluntários (38,8%) apresentaram comportamento de risco para o consumo de álcool (AUDIT ≥ 8). Considerando o consumo alcoólico em binge, 32 voluntários (65,3%) consumiram seis ou mais doses de álcool em alguma ocasião no ano anterior, não havendo diferença entre os sexos. A adiposidade corporal estava acima dos valores recomendados entre os que relataram consumo em binge. Não houve associação entre a intensidade do treinamento físico e o consumo de álcool em binge, nem entre a intensidade do treinamento e o comportamento de risco para o consumo de álcool. Conclusão A maioria dos desportistas apresentou consumo de bebidas alcoólicas no padrão binge, não sendo associado à intensidade do treinamento. Este não condiz com os seus objetivos ao frequentar academias de ginástica. A adiposidade corporal estava acima dos valores recomendados.
Significados dos episódios maníacos para pacientes com transtorno bipolar em remissão: um estudo qualitativo
Authors: Bin Luiz Carlos Pereira , Campos Lia Keuchguerian Silveira , Santos Junior Amilton dos , Turato Egberto Ribeiro
Published: August 2014

Objetivo Discutir os significados da vivência de episódios maníacos para pacientes com transtorno bipolar (TAB). Métodos Trata-se de uma pesquisa qualitativa, feita por meio de entrevistas semidirigidas em profundidade, em uma amostra fechada pelo critério de saturação com oito pacientes com TAB em remissão. A técnica de tratamento de dados foi feita por meio da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Os resultados foram submetidos à validação externa, no Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da Unicamp, composto por 37 pesquisadores do método, entre eles mestrandos, doutorandos, pós-doutorados e pesquisadores seniores. Resultados Foram identificadas três categorias – Ambivalência e vergonha: pensar ou não pensar sobre os episódios maníacos; Organizando sentimentos pessoais: a remissão como um momento de autoconsciência; Episódios maníacos estruturando relações interpessoais versus projeções da angústia. Conclusão Os achados da presente pesquisa contribuem para a maior compreensão dos quadros maníacos no TAB, que podem auxiliar nas reflexões acerca da relação profissional-paciente, para elaborar estratégias para aderência e para as medidas terapêuticas e preventivas da recorrência dos episódios. Podem auxiliar a equipe de saúde envolvida no acompanhamento desses casos e também os pesquisadores na investigação da contribuição dos significados aqui discutidos nos fenômenos de aderência ao tratamento e de um melhor prognóstico.