bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttransplant Lymphoproliferative Disorder in Adults Receiving Kidney Transplantation in British Columbia: A Retrospective Cohort Analysis
Authors: Ready Erin , Chernushkin Kseniya , Partovi Nilufar , Hussaini Trana , Luo Cindy , Johnston Olwyn , Shapiro R. Jean
Published: April 2018

Background:

Posttransplant lymphoproliferative disorder (PTLD) is a major complication following kidney transplantation.

Objective:

We undertook this study to characterize PTLD in kidney transplant patients in British Columbia with regard to incidence, patient and graft survival, histological subtypes, treatment modalities, and management of immunosuppression.

Design:

Retrospective cohort analysis.

Setting:

British Columbia.

Patients:

All adult patients who underwent kidney transplantation in British Columbia between January 1, 1996, and December 31, 2012, were included. Patients less than 18 years of age at the time of first transplant and multiple organ transplant recipients were excluded from analysis.

Measurements:

Patients with lymphoproliferative disorders that occurred subsequent to kidney transplantation were considered to have developed PTLD.

Methods:

Cases of PTLD were identified by cross-referencing data abstracted from the provincial transplant agency’s clinical database with the provincial cancer agency’s lymphoma registry. Patients were followed up for the development of PTLD until December 31, 2012, and for outcomes of death and graft failure until December 31, 2014. Data collection was completed via an electronic chart review.

Results:

Of 2217 kidney transplant recipients, 37 (1.7%) developed PTLD. Nine cases were early-onset PTLD, occurring within 1 year of transplant; of these cases, 6 were known/presumed Epstein-Barr virus mismatch, compared with only 2 of 28 late-onset cases. Patient survival for early-onset PTLD was 100% at 2 years post diagnosis. Late-onset PTLD had survival rates of 71.4% and 67.9% at 1 and 2 years, respectively. PTLD was associated with significantly decreased patient survival ( P = .031) and graft survival (uncensored for death, P = .017), with median graft survival of PTLD and non-PTLD patients being 9.5 and 16 years, respectively. Immunosuppressant therapy was reduced in the majority of patients; additional therapies included rituximab monotherapy, CHOP-R, radiation, and surgery.

Limitations:

Limitations to this study include its retrospective nature and the unknown adherence of patients to prescribed immunosuppressant regimens. In addition, cumulative doses of immunosuppression received and the degree of immunosuppression reduction for PTLD management were not effectively captured.

Conclusions:

The incidence of PTLD in British Columbia following kidney transplantation was low and consistent with rates reported in the literature. The incidence of late-onset PTLD and its association with reduced patient and graft survival warrant further analysis of patients’ long-term immunosuppression.
The use of a wearable camera to explore daily functioning of older adults living with persistent pain: Methodological reflections and recommendations
Authors: Wilson Gemma , Jones Derek , Schofield Patricia , Martin Denis J.
Published: April 2018

Background

Persistent pain is prevalent within the ageing population and impacts daily functioning. Measuring daily functioning using conventional measures is problematic and novel technologies offer an alternative way of observing these behaviours.

Methods

This study aimed to consider the use of a wearable camera as a method of exploring a range of day-to-day patterns of functioning of older adults living with persistent pain. This study followed a mixed methods design. A purposive sample of 13 older adults (65±) with persistent pain (pain >3 months) took part in this study. Two younger adults (<65) with persistent pain and two older adults with no pain also participated. Individuals used a wearable camera (Microsoft SenseCam) for seven days

Results

The wearable camera recorded the frequency of body position, movement, and activities of daily living. The wearable camera also presented contextual data of location, social interactions, use of assistive devices, and behavioural adaptations and was used to inform other methods of data collection.

Conclusions

The wearable camera allowed insight into patterns and experiences of daily functioning that would not have otherwise been captured. However, not all aspects of functioning were recorded using the wearable camera, including the relationship between functioning and persistent pain.
Accessibility and Disability: Absent Keywords in Business and Professional Communication
Authors: Knight Melinda
Published: April 2018

An analysis of user interactions, proceedings papers, and Association for Business Communication–sponsored journals reveals an absence of attention to accessibility and disability. While researchers may have demonstrated a passing awareness of the 1990 American with Disabilities Act (ADA) and its implications, so far those implications have not taken center stage. Researchers in fields related to business and professional communication have been publishing work informed by Disability Studies for some time. Thus, a scholarly agenda for accessibility and disability in business and professional communication is long overdue, with a need for studies that address both theory and practice.
The Applied Effectiveness of Clay Art Therapy for Patients With Parkinson’s Disease
Authors: Bae Young-Sil , Kim Dong-Hee
Published: April 2018

This study investigates how clay art therapy affects Parkinson’s disease patients’ overall mental and physical condition as well as future treatment potentiality. The research was nonequivalent control groups pre and post study. A total of 54 patients with Parkinson’s disease (control = 28, experimental = 26) were recruited from 3 setting locations in South Korea. Test measures were completed before and after the 16 sessions. The experimental group received two 80-minute evaluations per week for 8 weeks. Demographic information: hand dexterity, self-expression, mood depression, and quality of life measurements. There were significant differences in hand dexterity ( t = 4.96, P < .001), self-expression ( t = 3.74, P < .001), mood depression ( t = −11.85, P < .001), and quality of life ( t = 8.07, P < .001) between the 2 groups. Further research and development of clay art therapy can advocate the benefits, highlight practicality and demonstrate the possibility for its usage as a treatment methodology.
Plunging Ranula: A Case Report
Authors: Ayers Elizabeth
Published: April 2018

A plunging or diving ranula is a rare mucous fluid collection in the submandibular or parapharyngeal space resulting from damage or rupture of one or more ducts of the sublingual gland. The most common clinical presentation is a painless, slow-growing, pliable mass in the floor of the mouth, sometimes extending below the mandible through a defect in the mylohyoid muscle. This case report presents a young female patient who was suspected of having a plunging ranula. This case also highlights the role that sonography and other diagnostic tools play in the evaluation of this phenomenon.
Exome chip analyses identify genes affecting mortality after HLA-matched unrelated-donor blood and marrow transplantation
Authors: Zhu Qianqian , Yan Li , Liu Qian , Zhang Chi , Wei Lei , Hu Qiang , Preus Leah , Clay-Gilmour Alyssa I. , Onel Kenan , Stram Daniel O. , Pooler Loreall , Sheng Xin , Haiman Christopher A. , Zhu Xiaochun , Spellman Stephen R. , Pasquini Marcelo , McCarthy Philip L. , Liu Song , Hahn Theresa , Sucheston-Campbell Lara E.
Published: April 2018

Key Points

We conducted the first exome-wide association study between germ line variant genotype and survival outcomes after unrelated-donor BMT. A number of novel genes were found to significantly affect survival outcomes.
L'Institut de l'environnement
Authors: Cóme Tony
Published: April 2018

Précis

Si, aux yeux des rares Français qui la visitèrent durant les années 1960, la Hochschule für Gestaltung d'Ulm s'affirma comme un lieu d'étude exemplaire, le climat régnant au sein de cette prestigieuse école de design allemande allait irréversiblement se dégrader en 1968. La complicité qui semblait établie entre enseignants et étudiants allait être mise à mal au cours du mois de mai 1968. Des Français essayèrent néanmoins de faire infuser l'esprit de cet établissement allemand, descendant du Bauhaus, au sein des écoles d'art françaises. Lors des assemblées générales et des commissions pédagogiques de Mai 1968, ceux-ci contribuèrent à la création d'une unité d'enseignement et de recherche pluridisciplinaire animée par plusieurs membres de l'école d'Ulm et soutenue par André Malraux : l'Institut de l'environnement. Les grèves et révoltes étudiantes qui enflammèrent le Quartier latin eurent réciproquement une forte influence au sein de l'école d'Ulm, la conduisant à sa fermeture définitive. L'auteur analyse ici ces complexes effets de vases communicants.

The few French visitors to the Ulm Hochschule für Gestaltung in the 1960s considered it an exemplary place to study. But the prevailing climate in this prestigious German school of design declined irreversibly in 1968. May ’68 challenged its atmosphere of productive collaboration between teachers and students. In France, however, some tried to instill the spirit of this Bauhaus‐affiliated German establishment in French art schools. On the one hand, during the general assemblies and educational commissions of May 1968, these individuals contributed to the creation of a multidisciplinary teaching and research unit led by several members of the Ulm school and supported by André Malraux: the Institut de l'Environnement. On the other hand, the student strikes and protests that raged through the Latin Quarter had a strong influence on the Hochschule für Gestaltung, leading to its final closure. The author analyzes this complex interdependence.
O papel do enfermeiro na oxigenoterapia: revisão narrativa da literatura
Authors: Alves Jullya Carolline Folle , Fank Adriana , Souza Laurindo Pereira de , De Lima Marcia Guerino
Published: April 2018

Introdução: A oxigenoterapia é a administração de O2, em concentrações maiores que as existentes no ar ambiente. Objetivo: a proposta deste estudo de revisão narrativa da literatura foi conhecer a produção científica disponível acerca da importância do papel do enfermeiro e de suas ações quanto à oxigenoterapia. Método: trata-se de uma pesquisa de revisão narrativa da literatura, por meio de busca nas bases de dados virtuais e artigos de fontes sistematizadas que contemplavam o tema do estudo, utilizando os descritores: oxigenoterapia, enfermagem, conhecimento, sendo selecionado um total de 31 artigos, publicados entre os anos de 2004 a 2015, além da busca em livros que contemplavam a temática disponível na biblioteca Maria da Penha Lenci Campos da Faculdade de Ciências de Biomédicas de Cacoal/FACIMED. Resultados: os resultados foram sistematizados e analisados de modo a contribuir para o fortalecimento e conhecimento do enfermeiro a respeito dos cuidados com a oxigenoterapia e sua aplicabilidade. Conclusão: evidenciou-se a necessidade de realização de novas pesquisas que abordem o papel do enfermeiro e os cuidados de enfermagem a respeito dos métodos não invasivos de oxigênio.
Visão de profissionais, acadêmicos e usuários da atenção primária à saúde sobre o descarte correto de medicamentos: revisão integrativa da literatura
Authors: Dantas Airan Martins Silva , Da Silva Patrick Leonardo Nogueira , Fonseca José Ronivon
Published: April 2018

Introdução: o avanço científico na saúde proporcionou a descoberta de novos fármacos e, consequentemente, sua disponibilização e o acesso a esses medicamentos pela população, de modo a aumentar a variabilidade terapêutica no combate a diversas patologias. A Lei nº 12.305/2010 aborda sobre a destinação de resíduos sólidos, porém não há uma aplicabilidade desta legislação, o que não retira a preocupação do poder público. Objetivo: analisar, por meio de uma revisão interativa da literatura, a visão dos profissionais, acadêmicos e usuários da Atenção Primária à Saúde e dos usuários sobre o descarte correto de medicamentos e, por meio disso, promover o cuidado com o meio ambiente e com a saúde pública. Métodos: trata-se de um estudo descritivo, exploratório, com suporte em uma revisão bibliográfica, realizada em bases de dados virtuais, sendo estas: Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e Biblioteca Digital de Enfermagem. A amostra foi composta por 12 estudos científicos, sendo eles, 10 artigos, uma dissertação e um resumo simples. A coleta foi realizada durante o 1º semestre de 2016 por meio de um formulário para a captação dos dados. Resultados: Os resultados demonstraram que 66,6% dos artigos utilizados referem-se a nenhuma ou a poucas informações por parte dos usuários e profissionais de saúde sobre os riscos gerados quando não são descartados de maneira adequada. Conclusão: É possível perceber que, além de gestão, há também a necessidade de elaboração de projetos e participação social e política.
Radial distributions of magnetic field strength in the solar corona as derived from data on fast halo CMEs
Authors: Файнштейн Виктор , Fainshtein Victor , Егоров Ярослав , Egorov Yaroslav
Published: April 2018

In recent years, information about the distance between the body of rapid coronal mass ejection (CME) and the associated shock wave has been used to measure the magnetic field in the solar corona. In all cases, this tech-nique allows us to find coronal magnetic field radial profiles B(R) applied to the directions almost perpendicular to the line of sight. We have determined radial distributions of magnetic field strength along the directions close to the Sun–Earth axis. For this purpose, using the “ice-cream cone” model and SOHO/LASCO data, we found 3D characteristics for fast halo coronal mass ejections (HCMEs) and for HCME-related shocks. With these data we managed to obtain the B(R) distributions as far as ≈43 solar radii from the Sun’s center, which is approximately twice as far as those in other studies based on LASCO data. We have concluded that to improve the accuracy of this method for finding the coronal magnetic field we should develop a technique for detecting CME sites moving in the slow and fast solar wind. We propose a technique for selecting CMEs whose central (paraxial) part actually moves in the slow wind.
Automatic estimation of dynamics of ionospheric disturbances with 1–15 minute lifetimes as derived from ISTP SB RAS fast chirp ionosonde data
Authors: Бернгардт Олег , Berngardt Oleg , Бубнова Татьяна , Bubnova Tatyana , Подлесный Алексей , Podlesnyi Aleksey
Published: April 2018

We propose and test a method of analyzing ionograms of vertical ionospheric sounding, which is based on detecting deviations of the shape of an ionogram from its regular (averaged) shape. We interpret these deviations in terms of reflection from the electron density irregularities at heights corresponding to the effective height. We examine the irregularities thus discovered within the framework of a model of a localized uniformly moving irregularity, and determine their characteristic parameters: effective heights and observed vertical velocities. We analyze selected experimental data for three seasons (spring, winter, autumn) obtained nearby Irkutsk with a fast chirp ionosonde of ISTP SB RAS in 2013–2015. The analysis of six days of observations conducted in these seasons has shown that in the observed vertical drift of the irregularities there are two characteristic distributions: wide velocity distribution with nearly 0 m/s mean and with standard deviation of ~250 m/s and narrow distribution with nearly –160 m/s mean. The analysis has demonstrated the effectiveness of the proposed algorithm for the automatic analysis of vertical sounding data with high repetition rate.
When Two Bosses Are Better Than One: Nearly Decomposable Systems and Organizational Adaptation
Authors: Levinthal Daniel A. , Workiewicz Maciej
Published: April 2018

Organizations, as is true with social systems more generally, tend to be nearly, not fully, decomposable. However, analyses of nearly decomposable systems have tended to be at a single level of analysis and have generally neglected the vertical element of nearly decomposable systems. Critical to the notion of nearly decomposable systems is the property that the details of a particular subproblem may be encapsulated and captured by more aggregate parameters and that those subproblems interact in an aggregate way. We explore these issues in reference to the role of three canonical organizational structures in facilitating adaptation in the presence of near decomposability: a traditional hierarchy in which a subordinate reports to a single boss, an autonomous form in which the subordinate does not have a direct reporting relationship, and a multiauthority structure in which the subordinate reports to multiple bosses. Despite the ubiquity and potential benefits of multiauthority structures in coordinating highly interdependent tasks, our understanding of the mechanisms that determine the performance of those structures is still relatively modest. Scholars have noted conflicting empirical findings and have called for a more rigorous approach to study these organizational forms. To help address these issues, we develop an agent-based computational model that compares the performance of these three canonical types of organizational forms in settings characterized by different degrees of complexity and near decomposability.

The online appendix is available at https://doi.org/10.1287/orsc.2017.1177 .
Demand Heterogeneity in Platform Markets: Implications for Complementors
Authors: Rietveld Joost , Eggers J. P.
Published: April 2018

While two-sided platforms (e.g., video game consoles) depend on complements (e.g., games) for their success, the success of complements is also influenced by platform-level dynamics. Research suggests that greater platform adoption benefits complements by providing more potential users, but this assumes that platform adopters are homogeneous. We build on extensive research exploring the heterogeneity between early and late platform adopters to identify counterintuitive dynamics for complements. Complements launched early in a platform’s life cycle face an audience entirely of early platform adopters, whereas later-launching complements face a mixed audience of both early and late adopters, and we argue that differences in preferences and behavior between early and late adopters affect whether complements will succeed and which types will be most successful. We explore these dynamics in the context of the console video game industry using a unique data set of 2,918 video games released in the United Kingdom from 2000 to 2007. We show that despite the increase in the potential user pool as the platform evolves, video games launched later in the platform life cycle realize lower sales than those launched earlier. While increased competition explains part of this effect, we show substantial evidence consistent with our theory of preference differences between early and late adopters. This includes the finding that the negative effect is stronger for novel games and that the gap between popular and less popular complements widens as later adopters move into the platform, consistent with late adopters being risk averse and seeking to avoid purchasing mistakes.

The e-companion is available at https://doi.org/10.1287/orsc.2017.1183 .
Perspective—Rethinking Teams: From Bounded Membership to Dynamic Participation
Authors: Mortensen Mark , Haas Martine R.
Published: April 2018

Teams have long been defined by boundedness—a clear distinction between members and nonmembers. Yet as we argue in this perspective paper, the distinction between members and nonmembers is often blurred in today’s teams, as a result of trends toward increasing team fluidity, overlap, and dispersion. These trends offer potential organizational benefits, but the resulting boundary blurring can undermine team effectiveness. Moreover, boundary blurring calls into question many of the basic assumptions underpinning our theoretical and empirical research on teams. Accordingly, it is time to rethink our fundamental conceptualization of teams and to revisit our approaches to studying them. We propose a shift from viewing teams as clearly bounded groups of members toward instead viewing teams as dynamic hubs of participants. Reconceptualizing teams in this way opens up new avenues for theory development and offers important implications for future empirical research on teams.
Robust Optimization for a Maritime Inventory Routing Problem
Authors: Agra Agostinho , Christiansen Marielle , Hvattum Lars Magnus , Rodrigues Filipe
Published: April 2018

We consider a single product maritime inventory routing problem in which the production and consumption rates are constant over the planning horizon. The problem involves a heterogeneous fleet and multiple production and consumption ports with limited storage capacity. Maritime transportation is characterized by high levels of uncertainty, and sailing times can be severely influenced by varying and unpredictable weather conditions. To deal with the uncertainty, this paper investigates the use of adaptable robust optimization where the sailing times are assumed to belong to the well-known budget polytope uncertainty set. In the recourse model, the routing, the order of port visits, and the quantities to load and unload are fixed before the uncertainty is revealed, while the visit time to ports and the stock levels can be adjusted to the scenario. We propose a decomposition algorithm that iterates between a master problem that considers a subset of scenarios and an adversarial separation problem that searches for scenarios that make the solution from the master problem infeasible. Several improvement strategies are proposed aiming at reducing the running time of the master problem and reducing the number of iterations of the decomposition algorithm. An iterated local search heuristic is also introduced to improve the decomposition algorithm. A computational study is reported based on a set of real instances.
Just-In-Time Vehicle Routing for In-House Part Feeding to Assembly Lines
Authors: Emde Simon , Schneider Michael
Published: April 2018

This paper deals with the problem of routing in-house transport vehicles that feed parts to workstations in assembly plants or workshops just in time. The capacitated vehicles, typically so-called tow trains, perform their assigned route cyclically without break and provide each station with the exact quantity of parts required until the next arrival of the vehicle. Hence, the demand of each station depends on the duration of the route serving the station: The longer the route duration, the less frequently the station is visited and the higher its demand. The goal is to minimize first the number of vehicles and second the total route duration, while respecting given minimum service frequencies at the stations. We provide a mathematical formulation of this novel problem and address it by means of a large neighborhood search. The algorithm is able to solve realistic instances in acceptable time and vastly outperforms a default solver. We discuss two variants of the problem, one in which split deliveries to stations are allowed and another assuming that all stations lie on a straight line. Finally, we investigate the extent to which assuming constant demand rates may lead to problems during the day-to-day operations of the part-feeding system, where demands are not necessarily constant.
Sobre pedras no meio do caminho: teorias e práticas de alfabetização e letramento na formação de professores
Authors: Silva Gabriela Medela da , Oliveira Marcia Lisbôa Costa de
Published: April 2018

Pensando as tensões entre teorias e práticas na formação de alfabetizadores no Brasil, o presente estudo articula-se em torno da hipótese de que para a superação dos problemas concernentes à alfabetização e ao letramento nas séries iniciais de muitas escolas públicas brasileiras é necessário construir modelos de formação de professores que configurem propostas contínuas, sistemáticas, situadas e fundamentadas de teoria-na-prática, de modo a favorecer a autonomia e a autoria dos docentes. Partimos do pressuposto de que a superficialidade teórica que tende a caracterizar os cursos de formação continuada de professores gerou a má compreensão de conceitos teóricos advindos dos campos da psicogênese e dos estudos do letramento e provocou o processo que Magda Soares nomeou como “desinvenção da alfabetização” (2003, p.1). Esse processo de perda de especificidade do ensino do sistema alfabético é um dos elementos contextuais que explicam a ênfase no trabalho com texto e o abandono da sistematização do ensino da escrita e da leitura. Para demonstrar como isso ocorreu, a proposta deste texto é percorrer análises de diferentes estudiosos, como Soares, Colello, Morais, Botero, Ferreiro, Freire, Mortatti e Kleiman, entre outros, tecendo um panorama das teorias sobre letramento e alfabetização em circulação a partir dos anos 80 e tentando entender como as frequentes discussões sobre a necessidade de letrar levaram ao apagamento da alfabetização, entendida como processo de ensino/aprendizagem do sistema alfabético. Ao final, apresentamos uma proposta de formação de professores fundada na perspectiva da teoria-na-prática.INDEXAÇÃO
Conto “Negrinha” à luz do letramento crítico: uma experiência sobre identidade no projeto Mais Educação
Authors: Silva Jéssica Gonçalves da , Figueiredo Ana carolina Da Conceição , De Abreu Kátia Nazareth Moura
Published: April 2018

O presente artigo é fruto de uma atividade pedagógica sobre o racismo por meio da leitura crítica e de atividades de compreensão e intervenção em um contexto escolar do projeto Mais Educação na cidade de Maricá, situada no Estado do Rio de Janeiro. Essa atividade foi elaborada em uma escola estadual em uma turma do ensino fundamental II, com o intuito de estimular a leitura crítica do texto literário Negrinha de Monteiro Lobato. A abordagem do estudo tem como fundamento teórico e metodológico as concepções de leitura e escrita no viés do letramento crítico de Freire (1989), Gee (1996), Green (1998), Kalantzis e Cope (2012) e no principio de que não há nenhum discurso neutro, ou seja, todo texto possui condicionantes sociais e a da importância de “desenvolver caminhos para ver de onde eles vêm e reconhecer como são designados por nós, leitores” (JANKS, 2016). Além disso, alinhamo-nos com o pensamento teórico de JAUSS (1994), teórico da Teoria da Estética da Recepção, ao compreendermos que a leitura resulta na fusão do horizonte de expectativa do leitor/aluno com o horizonte de expectativa do texto. O objetivo deste artigo é o de tecer reflexões sobre a importância do letramento crítico na prática escolar.
CADERNETA ESCOLAR: ‘ARTES DE FAZER’ NO MOVIMENTO DE APROPRIAÇÃO PELAS NORMALISTAS DA ESCOLA NORMAL MADRE TERESA MICHEL - CRICIÚMA, SC (DÉCADA DE 1960).
Authors: Rosso Graziela Pavei Peruch
Published: April 2018

O texto discute a apropriação da materialidade “caderneta escolar” pelas normalistas na Escola Normal Madre Teresa Michel (Criciúma, SC) em 1960. A caderneta circulou no interior do educandário como estratégia da direção para manutenção da disciplina e efetivação de determinada pedagogia. Buscou-se entender como esse dispositivo foi recebido e significado pelas educandas durante suas práticas escolares. Avaliaram-se duas cadernetas utilizadas em 1964 e 1965, as “memórias” de normalistas que lá estudaram na época e outros documentos que puderam contar a história desse artefato como uma prescrição a ser seguida. Tal análise possibilitou identificar que, apesar das ‘artes de fazer’ engendradas num movimento astucioso de engano e resistência das alunas diante das forças articuladas por esse objeto multifacetado, enquanto estratégia de controle do tempo, espaço e comportamento, a caderneta escolar concretizou sua finalidade.
Could artificial intelligence assist mothers with breastfeeding?
Authors: Bennett Viv
Published: April 2018

Public Health England is using Amazon's Alexa to complement the work of professionals and provide support for breastfeeding mothers at all hours
Changemaker: Preparing student midwives for employability, qualification and beyond
Authors: Power Alison , Dakri Tasneem , Irwin Wray
Published: April 2018

The Royal College of Midwives estimates that there is a shortfall of approximately 3500 full-time midwives in England and, with one-third of practising midwives aged 50 or more, it is evident that recruitment and retention are key to the ongoing success of maternity services. The need for high-quality care is especially acute, given that women are presenting with increasingly complex medical, social and obstetric backgrounds. The role of higher education institutions is not only to ensure student midwives meet the requirements of the EU Directive 2005/36/EC and achieve the Nursing and Midwifery Council Standards, but also to support them to apply for jobs, navigate the recruitment process and understand their legal, ethical and professional responsibilities on qualification. This article will discuss an e-module that was introduced at the University of Northampton, entitled ‘Becoming a midwife’. This module adopted an innovative approach to learning, teaching and assessment in relation to student midwives' employability, social awareness and preparedness for professional practice on qualification.
Perspectives on advance care planning in haematopoietic stem cell transplantation: a qualitative study
Authors: Booker Reanne , Simon Jessica , Biondo Patricia , Bouchal Shelley Raffin
Published: April 2018

Background:

Advance care planning (ACP) engagement and completion of advance directives remain low in patients undergoing haematopoietic stem cell transplantation, despite the high risk of treatment-related mortality.

Aim:

To understand the barriers to and facilitators of ACP in haematopoietic stem cell transplantation.

Methods:

This qualitative study used interpretive description methodology. The researchers conducted audio-recorded semi-structured interviews with participants. The constant comparative method was used to analyse data.

Results:

A total of six patients, five family members and eight clinicians participated in the study. Perceived barriers to ACP included: lack of time, lack of process, lack of understanding of disease/treatment and ACP, need to keep positive and prognostic uncertainty. Potential facilitators of ACP included: early and frequent discussion of ACP, incorporating ACP into routine care, involvement of the multidisciplinary team and framing discussions on ACP as positive.

Conclusions:

Haematopoietic stem cell transplantation poses unique challenges for patients, families and clinicians when it comes to ACP. Introducing advance care planning as part of standard care and providing ongoing facilitation of ACP, including discussion of disease and treatment expectations at the outset and when complications arise may assist patients and families in recognising how ACP can fit into and enhance their care.
Graphetics: When mark-making becomes writing
Authors: Biggs Michael
Published: April 2018

Graphetics is the study of how one recognizes text, and how one differentiates it from other marks and drawings, for example when one views a manuscript and has to decide ‘is this writing or just scribble?’. This article focuses on the pragmatics of graphetics and on the (philosophical) complexity of differentiating graphs into linguistic and non-linguistic content, i.e. the difference between seeing and reading. Deciding the identity of marks when interpreting manuscript sources is sometimes problematic, and this article takes some examples from the project to digitize Wittgenstein’s manuscripts, which are especially relevant because he conducts thought-experiments with imaginary letterforms and other ciphers. The method used in this article is a reductive graphological or pragmatic graphetic analysis of the manuscript source. The results of the enquiry are threefold: that all manuscripts should be assumed to be graphical until textual content is discovered (which is the opposite of the normal assumptions about manuscripts by philologists); that ‘being graphical’ is a property not of appearance but of structure; and that a clear differentiation between text and graphics is not always possible. The author believes that the conclusions are fundamental to our interpretation of two-dimensional media, i.e. the differentiation of modes of communication. However, when looking so closely at a problem (letter by letter, mark by mark) it is sometimes difficult to maintain the reader’s awareness of the broader context in which the problem has significance. The latter is an intrinsic problem of the so-called ‘close-reading’ approach in hermeneutics and is relevant to most doctoral/postdoctoral researchers.
Drawing the city – writing the city: Analogue as linguistic form
Authors: McEwan Cameron
Published: April 2018

This article, and the accompanying montages, approaches the theme of drawing on text through Aldo Rossi’s linguistic concept of the analogical city. I argue the analogue is a linguistic form that assimilates architecture’s history, transforms its language and develops the material into singular forms for combination and recombination, substitution and displacement, structured by formal syntax and association. The aim is to test the possibility of Rossi’s analogical city as a critical project to reassert the city as an architectural discourse and to develop the analogue as a theoretical and methodological device. The argument is developed through a suite of montages and by constructing a genealogy of the analogical city. The montages speculate about textual processes (seriality, syntax, association, substitution, displacement, combination, recombination) using visual means. They visualize an analogical chain of association between elements of the theory and projects of the city of Piranesi, Le Corbusier and Aldo Rossi. The argument is staged in three sections to put forward a genealogy. The first section situates Rossi’s concept of the analogical city and links the formal syntax of Rossi’s collage project, the Analogical City: Panel, with Giovanni Battista Piranesi’s Campo Marzio. The second section connects the analytical view with which Le Corbusier and Piranesi study Rome in their respective projects, ‘The Lesson of Rome’ and the ‘Views of Rome’, to elucidate linguistic operations including identification, abstraction, distillation and transformation. The last section puts forward the Ville Contemporaine as an Analogical City by closely reading the Piranesian and classical elements of Le Corbusier’s Ville Contemporaine plan. The conclusion is subtitled ‘The Linguistic Form of the City’ and I end with the need to reassert a linguistic approach to architecture and the city with its attendant critical, representational and collective ethos against current instrumental and individualistic discourse.
Biological restoration in permanent tooth: four-year follow-up
Authors: Silva Rafael Menezes , Botelho Letícia Pena , Botelho Adriana Maria , Tavano Karine Taís Aguiar
Published: April 2018

Biological restorations, involving a technique of uniting autogenous or homogenous dental fragment for use as the primary restorative material, are an alternative for morphological and functional re-establishment of teeth with extensive coronal destruction.   Despite the wide range of restorative materials available in dentistry, no material has proved to be as efficient as the natural tooth structure. This article illustrates a therapeutic option for rehabilitating a devitalized mandibular tooth with a weakened coronal remainder by using the biological restoration technique. The authors present the sequence of planning and performing the technique, such as the characteristics of preparation of the tooth and fragment, impression taking, cutting and cementation of the fragment, and the  four-year follow-up of the biological restoration, which  shows the success of the technique with marginal adaptation and satisfactory esthetic appearance. KeywordsAdhesive; Devitalized tooth; Permanent dental restorations.
SARCOMA DE EWING: UM RELATO DE CASO
Authors: Alves Ana Beatriz De Melo , Maciel Jefferson Marlon De Medeiros Pereira , Rulim Ana Laís Lacerda , Machado Gabriel Pinheiro , Rulim Marco Antônio Bezerra
Published: April 2018

Introdução: O Sarcoma de Ewing (ES), com incidência de 1/1.000.000 de pessoas, é, em sua maioria (80%), uma neoplasia originária dos ossos, compreendendo o segundo tumor primário mais comum entre crianças e adolescentes.1,2 É uma entidade maligna agressiva, sendo os homens mais acometidos que as mulheres na razão de 1,5:1, e tendo maior prevalência entre pacientes caucasianos em comparação aos de origem africana.1 Objetivo: Relatar o processo investigativo de uma paciente com massa abdominal a esclarecer, até chegar ao diagnóstico etiológico preciso. Relato de caso: Paciente do sexo feminino, 12 anos, procedente de Barbalha – CE, compareceu ao ambulatório de Ginecologia do Hospital Maternidade São Vicente de Paulo queixando-se de dor em região pélvica iniciada há um mês, com irradiação para face anterior da coxa, agravada no período menstrual e associada à perda ponderal de 6 kg durante a evolução da dor. Procedeu-se à investigação diagnóstica com a realização de Ultrassonografia (USG) abdominal e Tomografia Computadorizada (TC) de pelve, esta evidenciou volumosa lesão expansiva heterogênea, predominantemente cística com várias septações grosseiras de permeio, de localização pré-sacral. Realizou-se laparotomia exploradora na expectativa da massa anexial evidenciada ter etiologia ovariana; no entanto, os achados cirúrgicos foram útero e ovários normais e massa de consistência fibro-cística volumosa retroperitoneal aderida ao reto. Como seguimento, foi realizada biópsia percutânea da lesão, que demonstrou neoplasia pouco diferenciada, sugestiva de Tumor de Wilms. Em complemento foi solicitado perfil imunohistoquímico que, em conjunto com os achados morfológicos, foi consistente com Sarcoma de Ewing/Tumor Neuroectodérmico Primitivo (PNET). Após resultado, em virtude do tipo de tumor e da idade, paciente foi transferida para o Hospital Infantil Albert Sabin, em Fortaleza. Conclusão: O caso dá luz à importância da persistência na investigação diagnóstica de patologias que não foram bem elucidadas a despeito da utilização de recursos de imagem e laboratoriais refinados. Apesar de doenças raras não fazerem parte do escopo médico cotidiano, seu diagnóstico não deve ser negligenciado ou menosprezado, pois oportuniza a obtenção de tratamento especializado.
TABAGISMO E CÂNCER: PREVENIR RISCOS OU TRATAR SEQUELAS?
Authors: Rulim Ana Laís Lacerda , Rulim Marco Antônio Bezerra , Machado Gabriel Pinheiro , Alves Ana Beatriz De Melo , Rodrigues Albérico Macedo Bertinode Sá , Oliveira Camila Nayele Viana de
Published: April 2018

Introdução: é de conhecimento quase global que o tabagismo traz ônus à saúde dos seus usuários, constituindo-se como fator de risco para inúmeras doenças, dentre elas o carcinoma espinocelular (CEC), que representa 90-95% dos casos de câncer na cavidade oral¹. Objetivo: o objetivo deste artigo foi descrever o caso clínico de uma paciente idosa, tabagista de longa data, com CEC de área retromolar e história familiar positiva para a mesma neoplasia em irmã, promovendo com isso uma reflexão sobre a necessidade de prevenção contra o tabagismo. Relato de caso: paciente do sexo feminino, 64 anos, tabagista por 50 anos, procedente de Juazeiro do Norte – Ce, com história de massa cervical direita e presença de lesão em mucosa retromolar ipsilateral. Procedeu-se a investigação com realização de ultrassonografia cervical que evidenciou presença de nódulo hipoecoico medindo 3.7x2.3cm de localização periparotídea, confirmado por posterior tomografia computadorizada de pescoço. Seguiu-se a investigação com biópsia de lesão em mucosa retromolar direita, que concluiu tratar-se da presença de um carcinoma epidermóide espinocelular moderadamente diferenciado de grandes células, não ceratinizante e invasor. A paciente já apresentava história familiar positiva para a mesma neoplasia, em irmã. A conduta tomada foi a de excisar cirurgicamente a tumoração mediante pelveglossomandibulectomia à direita ampliada a faringe+ esvaziamento cervical radical ampliado à direita + reconstrução com retalho de peitoral maior. A paciente evoluiu bem, estável, sem quaisquer intercorrências no pós operatório. Conclusão: o caso em questão fornece uma reflexão sobre a importância da profilaxia primária de doenças que têm como fator de risco o tabagismo. Nas entrelinhas de uma história clínica de uma paciente com CEC de cavidade oral, exposta por longos períodos ao tabaco, torna-se notável o potencial que uma intervenção precoce contra o tabagismo teria de prevenir danos, e, no caso em questão, prevenir duplamente, pois tanto a paciente supracitada como a irmã foram acometidas pelo mesmo tipo de câncer. A partir desta análise, portanto, pode-se perfeitamente afirmar ue a frase “prevenir é melhor do que remediar” torna-se não só um dito popular, mas um axioma para o exercício responsável da medicina.
MORTALIDADE POR CÂNCER DE COLO UTERINO E MAMA NO BRASIL: EVIDÊNCIAS REGIONAIS.
Authors: Tavares Cícera Luana Cruz , Oliveira Flaviana Ferreira de , Aguilera Kevellyn Cruz , Silva Cláudio Gleidiston Lima da
Published: April 2018

Introdução: O câncer de mama e colo uterino são os que mais acometem mulheres no contexto mundial. O câncer de mama, juntamente com os cânceres de pulmão e colorretal, aparecem entre os mais incidentes em países de alta renda, enquanto o câncer de colo do útero supera os demais tipos em países de baixa renda¹. A introdução do rastreamento para o câncer de colo do útero em países desenvolvidos provou que essa medida reduziu de forma importante a incidência e a mortalidade da doença e prolongou a sobrevida das pacientes. Isso, no entanto, não foi observado em países de baixa renda onde o acesso a cuidados primários e especializados é limitado². Objetivos: Analisar a evolução da mortalidade por câncer do colo uterino e de mama no Brasil através de indicadores de assistência à saúde e socioeconomicos. Metodologia: Trata-se de uma pesquisa retrospectiva documental, através da base de dados extraídos do Sistema de Informações sobre Mortalidade, os denominadores populacionais do Instituto Brasileiro de Geografia e Estatística, e os indicadores socioeconômicos e assistenciais do Instituto de Pesquisa Econômica e Aplicada, onde foram analisados dados da década de 80 a 2015. Resultados: Evidenciou-se que no Brasil houve queda de mortalidade por câncer de colo uterino em todo o território exceto nas regiões Norte e Nordeste e a partir da década de 90 um declínio no câncer de mama no Brasil nas regiões metropolitanas. Ao passo que houve declínio da taxa de fecundidade pode-se relacionar esse fato aos indicadores socioeconômicos e a taxa de mortalidade por câncer de mama no interior do país, ainda mais prevalente. Os resultados sugerem um mecanismo dinâmico entre exposições de risco determinantes no aparecimento dos cânceres de mama e colo do útero. Conclusão: A queda da mortalidade por câncer do colo uterino foi evidenciada nas regiões Sudeste e Sul e nas regiões metropolitanas do Norte e Nordeste. Os óbitos por câncer de mama começaram a diminuir nas regiões metropolitanas no Sul e Sudeste. A mortalidade declinante do câncer de colo do útero pode refletir a proteção conferida pelo teste de Papanicolaou, porém não se observa esse fato no interior das regiões Norte e Nordeste. A mortalidade é atenuada em função de melhor acesso a medidas diagnósticas e terapêuticas.
NEOPLASIA MALIGNA E DOENÇAS INFECCIOSAS: PRINCIPAIS CAUSAS DE MORTALIDADE FEMININA NA REGIÃO DO CARIRI CEARENSE NO ANO DE 2016
Authors: Lira Esther De Macêdo , Leite Daniel Gonçalves , Melo Antonio Marlos Duaerte de , Uchôa Leyde Jenifer Dias , Alves Barbara Torquato , Silva Brenda Lacerda da , Quidute Patrícia Sobral Luna
Published: April 2018

Introdução: Quantificar a mortalidade por neoplasia e infecções gerais em mulheres, é um ponto muito importante para que haja conscientização para o cuidado com a saúde feminina, além de proporcionar um melhor planejamento por parte do poder público das estratégias dirigidas para diagnóstico precoce, prevenção e controle de tais agravos nessa população específica. Objetivo: Este estudo objetiva descrever a quantidade de óbitos gerados por Neoplasias em comparação aos gerados por complicações infecciosas em mulheres da região do Cariri cearense, durante todo o ano de 2016, a partir da casuística do Serviço de Verificação de Óbitos (SVO) de Barbalha-CE. Método: Foi realizada análise retrospectiva de 836 prontuários de pacientes examinados no SVO no período citado. Foram incluídas apenas aquelas mulheres que possuíam neoplasia ou afecções infecciosas como principal causa base ou final do seu óbito. Foram excluídos os neonatos. O índice de mortalidade foi dividido por faixas etárias tendo em vista a descrição de diferentes resultados para cada uma delas. Por ser o único SVO da região e por atender a sete municípios, incluindo os três mais populosos (Juazeiro do Norte, Crato e Barbalha), a casuística é representativa da população do Cariri cearense. Resultados: Dos 836 prontuários do período estudado, 327 são de mulheres selecionadas para o estudo. Na faixa etária de 1 a 20 anos foram contabilizados 4 (1.2%) óbitos por Infecções e 0 pôr neoplasias. Na faixa de 21 a 40 anos foram verificados 13(3.9%) óbitos, 11 por patologias infecciosas e 2 por neoplasias. De 41 a 60 anos foram quantificadas 23(7.0%) mortes, sendo que 15 por infecções e 8 por neoplasias em geral. Nas mulheres entre 61 e 80 anos foram verificados 40(12.2%) óbitos, 27 por patologias infecciosas e 13 por neoplasias. Na faixa etária acima dos 80 anos foram encontradas 49(14.9%) mortes, onde 34 foram por infecções e 15 por neoplasias. Conclusão: No total, foram quantificados 129(39.4%) óbitos, sendo 37 causadas por Neoplasias e 92 por patologias infecciosas, esse perfil de mortalidade demonstra o grande grupo dessas doenças como principal causa de morte nessa população feminina, principalmente com o avanço da idade, demonstrando a necessidade de priorizar a prevenção, diagnóstico precoce e controle dessas doenças e de seus fatores associados para a promoção da saúde desse grupo especifico no Cariri.