bluuebunny/crossref_metadata_2025 huggingface dataset:
DYNAMICS OF THE DEVELOPMENT OF PEDIATRIC PALLIATIVE CARE IN THE CITY OF ST. PETERSBURG
Authors: Simakhodskiy A. S. , Minchenko S. I. , Tkachenko A. E.
Published: June 2019

Palliative care is a system of medical measures aimed at maintaining the quality of life of patients with incurable, life-threatening and severely occurring diseases, at the highest possible for a given patient’s condition, a comfortable level for the person. At the same time the provision of palliative care for children differs considerably from adults. There was executed the analysis of the dynamics of the development of palliative care for children in the city of St. Petersburg for 2011-2015. Features of its implementation, changes in the number of those in need, the restructuring of hospital beds fund, the development of hospital substitution technologies, there are presented delivered guidelines for the different types of palliative care for children.
DELAYED PUBERTY IN BOYS. MODERN ASPECTS
Authors: Novikova E. P. , Bolotova N. V. , Sharkov S. M. , Sinitsyna A. A.
Published: June 2019

Pubertal impairment in adolescents is an urgent pediatric problem conditioned by progressive worsening of the population’s reproductive health in general. One of the variants of teenagers’ puberty disturbances is the delayed puberty (DP) as no secondary sexual maturation by the age of 14 years in boys. There are discriminated hypogonadism and constitutional DP, the latter being the most frequent form of the disorder of pubertal development in boys, accounting for 60-80% of all forms of DP. At the base of pathogenesis of constitutional DP there are lied deteriorations in the system of the regulation of impulse secretion of gonadotrophin-releasing hormone (Gn-RH) and such non-hormonal factors as monamines of adrenergic and dophaminergic system, melatonin, neuropeptide Y, estragens, insulin-like growth factor-1 (IGF-1), leptine, interacting with Gn-RH-secreting neurons. Pathology of the development and maturation of structures of the diencephalon, as the cause of constitutional APD, is a rather frequent consequence of antenatal and perinatal pathology, traumatic injury of the brain, microcirculatory disorders. DP proves to be an unfavorable factor in the formation of bone density and final growth, in psychological personality achievement of the adolescent, in the maturation of the reproductive system, thus is the subject to correct. The problem of the therapy of constitutional puberty arrest remains to be controversial up to recent time. Some authors adhere to the observation tactics. They believe that children with constitutional DP may have a favorable prognosis of final growth and pubertal development. However, obvious negative psychosocial and medical consequences of the delayed growth and puberty have not yet been taken into consideration. Lately, hormonal therapy with puberty-stimulating steroids, anabolic agents has been suggested. But both a number of questions concerning the effect of therapy with androgens on activation of the hypophyseal-gonadal system in adolescents, and the impact of this treatment on the final growth of the patients remain to be unsolved. The necessity to produce an effect on central mechanisms of regulation by applying physiotherapeutic transcranial techniques, particularly transcranial magnetic therapy also exists. The presented review showed the diversity of factors influencing on the pubertal development of adolescents, various tactical methods of treatment and correction of disorders in patients with constitutional PD.
No Idle Threat: Coercive Control and Enacted Violence in the Pre-Prison Relationships of Incarcerated Women
Authors: McLeod David Axlyn , Jones Melissa S. , Sharp Susan F. , Gatlin Leah
Published: June 2019

While much research documents physical and sexual abusive experiences in the lives of women prisoners, less is known about their experiences with coercive control. Utilizing Dutton, Goodman, and Schmidt's (2008) measures of coercive control and framed by a feminist pathways approach, this study examines the connections between experiences of coercive control and physical and sexual violence in adult intimate relationships, including how women perceive and respond to experiences of coercion. Findings demonstrate how incarcerated women experience significant levels of control, manipulation, threats, and demands from their partners in relation to personal activities, financial resources, interpersonal interactions, illegal activities, and other areas. Moreover, findings show these threats and demands to be aggressively enforced and directly related to physical and sexual violence against these women, as well as threats to the safety and security of their family, friends, and children. Additional findings and details are discussed.
Trajetórias das pedagogas da terra do MST no estado de São Paulo: intencionalidades e atuações possíveis a partir desta formação
Authors: Rezende Janaína Ribeiro de , Neto Luiz Bezerra
Published: June 2019

Este artigo objetiva analisar as trajetórias de vida das profissionais for-madas em Pedagogia da Terra que atuam ou atuaram no MST paulista.Para tanto, lançamos mão de pesquisa bibliográfica e documental, en-trevistas semi e não estruturadas. A análise das informações foi feitapor triangulação das informações e validação consensual. Encontra-mos onze mulheres que se encaixam neste perfil, que apresentaramtrajetórias de vida bem diversas, cujos pontos em comum são origenspobres, migração, empregos precários, luta pela terra e educação docampo. As motivações que as aproximaram ao MST são bem dife-rentes, sendo que todas encontraram na militância uma forma de sereenraizar. As participantes cursaram cinco turmas diferentes de Pedagogia da Terra e avaliaram positivamente os cursos, nos aspectospolíticos e pedagógicos. Oito delas atuam em diversas regionais de SãoPaulo, duas, fora do estado, desenvolvendo atividades do Movimento euma se afastou da militância. Em São Paulo, nenhuma das pedagogasda terra assumiu a docência de escolas devido à prioridade na atuaçãopolítica no MST do estado. Compreendemos que os cursos formaisresultaram na formação de quadros para MST. Assim, as trajetóriasdas pedagogas da terra convergiram para que elas mantivessem suascontribuições com o MST.
Ativismo infantil contra as instituições: pais, comunidade, escola
Authors: Fernandes Renata Sieiro
Published: June 2019

O intuito do artigo é propor uma reflexão sobre infância e exercício deações políticas, entendidas como ativismo, a partir de cenas extraídas dofilme tcheco “Um dia, um gato”, de Vojtech Jasny, de 1963, conversan-do com cenas do filme “Doce Amanhã”, de Atom Egoyan, de 1997 e ahistória do flautista de Hamelin. A partir disso, pensar a criança como sercom capacidade de auto-organização, mobilização, protesto, contestaçãoe denúncia, realizando-o no espaço público da cidade – entendida comolugar de educação não formal – e em meio à coletividade, criando “situa-ções” emblemáticas e manifestando-se de forma poética e artística contraas ideias e instituições erigidas e sustentadas pelo poder dos adultos, nocaso específico, a família/os pais, a comunidade/coletividade e a escola.
Revitalização do patrimônio cultural e experiência educativa através do cineclubismo
Authors: Silva Juliana Perez de Aragão , Braz Diego Fernandes , Batista Sueli Soares dos Santos
Published: June 2019

A partir da leitura do texto “A era do cinema”, de Arnold Hauser e das visitas ao antigo cinema de Francisco Morato, surgiu o tema que resul-tou nesta pesquisa que tem como problema central as relações atuaisestabelecidas com o patrimônio cultural em decorrência das media-ções entre tecnologia e cultura e a importância de analisar a produçãocinematográfica neste contexto. Devido à ausência de espaços públi-cos para a divulgação e preservação do patrimônio cultural produzidopelo cinema, optou-se por estudar a ação dos cineclubes para analisarem que medida exercem uma função social de valorização da culturana relação com a tecnologia e sua eficiência aliada à construção de umprocesso educativo potencializador da percepção dos espectadoresvalorizando elementos históricos, sociais, da memória e de incentivo àprática cultural local e alternativa. Por meio de pesquisa bibliográficae de campo a respeito das práticas cineclubistas em Itatiba e Jundiaíe das relações estabelecidas entre tecnologia, educação, cultura, e so-ciedade verificou-se a nítida atuação dos cineclubes enquanto práticasocial e ação fomentadora da experiência educativa, resgatando dife-rentes linguagens e possibilidades como instrumento de expressão eoportunidade de resistência e produção cultural.
Caderno aluno/professor, gêneros textuais e mídia: apontamentos no ensino público paulista
Authors: Costa Adilson Aparecido , Costa Nanci Aparecida , Pechula Marcia Reami
Published: June 2019

Este artigo tem como objetivo discutir a presença da mídia no proces-so de ensino-aprendizagem de Língua Portuguesa, buscando para istouma análise das apostilas (do aluno e do professor) em circulação narede estadual de ensino, em São Paulo. E, abordar como a influência dodiscurso midiático ocorre no processo de construção dos gêneros tex-tuais, utilizando para isto alguns conceitos de Mikhail Bakhtin e umacontextualização histórica sobre o processo de inserção da tecnologiana educação.
Meio ambiente e cidade: relato de experiência da Conferência Vamos Cuidar de Laranjal
Authors: Melo Teresa Mary Pires de Castro
Published: June 2019

Este texto é um relato da experiência da gestão da comunicação emuma atividade de extensão da Universidade Federal de São Carlos,campus Sorocaba, realizada no município de Laranjal Paulista (SP) –a Conferência Municipal Infanto-Juvenil Vamos Cuidar de Laranjal.Embasada na metodologia de Conferências Infanto-Juvenis da Coor-denação Geral de Educação Ambiental (MEC e MMA), a ConferênciaVamos Cuidar de Laranjal está sendo implementada incorporando ascaracterísticas próprias da cidade, seja nas questões de potencialidadese fragilidades ambientais, seja nas questões culturais. Com o apoio dopoder público e a partir da capilaridade do sistema de ensino, o projetobaseia-se na construção e implementação de uma Carta de Respon-sabilidades elaborada pelos jovens participantes a partir de pesquisas,debates e encaminhamentos nas escolas e na comunidade.
A medida socioeducativa de liberdade assistida como alternativa de educação não formal
Authors: Dias Aline Fávaro , Onofre Elenice Maria Cammarosano
Published: June 2019

Este texto apresenta algumas compreensões do papel da educação nãoformal no contexto de um Programa de Medidas Socioeducativas emMeio Aberto, do interior do estado de São Paulo. Foram utilizadoscomo procedimentos de coleta de dados, a observação participante,conversas informais e entrevistas. Participaram como sujeitos dez jo-vens em cumprimento de Medida de Liberdade Assistida e que fre-quentavam as atividades do Programa. Os resultados da análise dos dados apresentam práticas sociais ali vivenciadas, incluindo-se as re-lações conflituosas, as quais se traduzem em processos educativos naformação dos jovens e contribuem para a construção da identidade, doautoconceito e da autoestima. O estudo evidencia que, pelas práticassociais não formais de educação, os jovens aprendem convivendo, oque lhes possibilita criações e recriações, significações e ressignifica-ções em diferentes tipos de relações, inclusive as escolares, e vão seconstituindo como seres históricos que (re)constroem suas identida-des, subjetividades, valores e percepções de seu papel no mundo.
The Funeral by M. James
Authors: Liu Yina
Published: June 2019

James, Matt. The Funeral. Groundwood Books-House of Anansi Press, 2018.

The Funeral, written by Matt James, focuses on a day that Norma goes to her Uncle Frank’s funeral. While this book will appeal to children, it is also good for adults to look at something heavy in life, such as a funeral, through a child’s eye.

In a relaxed tone and cozy painting style, the story starts with Norma finding out that she won’t have to go to school on the day of her uncle’s funeral. She is excited about the day off and the “plan” of the day, playing with her cousin. Throughout the funeral, the story is developed through Norma’s eyes, showing how she experiences the time with her cousin. Before Norma leaves the funeral, she thinks Uncle Frank would have loved his funeral, since she noticed he was smiling right at her in his photo.

Instead of a heavy, didactic teaching of the meaning of death, Matt explores a delicate way to describe a funeral from a child’s perspective. For example: 

There was a little flag [which said FUNERAL] on the car that drove them to the church. Norma tried to sound out the word printed on it.“F-U-N,” she said.And then she said it again.  

Matt James, a Canadian artist, is an illustrator of many picture books. With this picture book, James debuts as a writer and illustrator. The illustrations of the book are mostly acrylic and ink on masonite. Also, this book is the first time he combined a few digital pieces on the background illustrations. This book would tie in perfectly to a classroom talk about funerals and similar occasions and illustrates what a funeral is like from a child’s perspective. 

Highly Recommended: 4 out of 4 starsReviewer: Yina Liu

Yina Liu is a first year PhD student in Language and Literacy, in the department of Elementary Education. Her research interests are digital literacies and children's literature, especially digital picture books. She finished her Master's degree at the University of Saskatchewan and worked in a preschool classroom as an early childhood educator for a year in Saskatchewan.
Florette by A. Walker
Authors: Petrunia Sara
Published: June 2019

Walker, Anna. Florette. Illustrated by Anna Walker, Clarion Books, 2018.

Written and illustrated by Anna Walker, this picture book’s fresh, beautiful watercolour images match the joyful feeling this story will leave you with. Follow Florette on her quest through a sterile city to find a garden in place of the one she left behind in her family’s move. Not only did she leave behind a garden filled with apple trees and butterflies but also all her friends and fun adventures. Find out how Florette navigates this new world and finds joy in her own way not only for herself, but for everyone around her.

This book compels readers to consider the world surrounding them and what it might be missing. Its illustrations emphasize the stark difference in feeling between the man-made and natural worlds while suggesting a beautiful way to combine the two. The text is simple and expanded upon using emotive pictures, making this book an easy, satisfying read for young and old readers alike.

Although Florette does not openly talk about her feelings, we can observe the loneliness that follows the character in this new city surrounded by packing boxes and concrete. This book would resonate with any child who has felt that loneliness in any sense of the word and offers an easy solution of seeking out those things that bring us joy.

A beautiful fusion of friendship and nature, open this book and watch something meaningful grow. 

Recommended: 3 out of 4 starsReviewer: Sara Petrunia

Sara Petrunia is a University of Alberta undergraduate student excited to use literature in her future elementary classrooms. When she is not preoccupied with her studies, Sara is busy working as a hairdresser or enjoying a trip somewhere far away!
Y-TZP surface treatments and their effects on the bond strength to resin cement
Authors: May Michele Mirian , Marchionatti Ana Maria Estivalete , Valandro Luiz Felipe , Foletto Edson Luiz , Dorneles Lucio Strazzabosco , May Liliana Gressler
Published: June 2019

Aim: This study evaluated the effect of surface treatments of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramics on their bond strength to a resin cement. Methods: Seventy zirconia blocks (6 × 6 × 2 mm3, IPS e.max ZirCAD) were assigned into 7 groups (n=10) – as-sintered (AS), no treatment; tribochemical silica coating + silanization (TBS; Cojet-sand; ProSil); airabrasion with 45 μm alumina particles + universal primer (AAP; Monobond®Plus); fusion sputtering (FS); SiO2 nanofilm + silanization (SN; ProSil); FS+SN+ silanization (FSSN; ProSil); FS+SN+Universal Primer (FSSNP; Monobond®Plus). Afterwards, a resin cement (RelyX™ ARC) was applied inside cylinders (Ø = 0.96 mm × 1 mm height) placed on the zirconia surfaces. Microshear bond strength tests (μSBS) were carried out (1 mm/min). Failure and phase transformation analysis were performed. Bond strength data (MPa) were subjected to Kruskal-Wallis/Mann Whitney tests. Results: TBS (27 ± 1.2) and AAP (24.7 ± 0.8) showed higher bond strengths than the other groups, followed by FSSNP (15.5 ± 4.2) and FSSN (13.3 ± 3.6). FS (3.4 ± 0.44) and SN (9.5 ± 2.7) showed the lowest values (p < 0.001). Most of the specimens exhibited an adhesive failure. Conclusion: Air-abrasion by silica-coated alumina particles followed by silanization or by alumina particles followed by universal primer resulted in the highest resin bond strength to zirconia. Fusion sputtering and silica nanofilm deposition induced low strengths. However, when these methods are applied in combination and with a primer (FSSN and FSSNP), higher bond strengths may be achieved. Low bond strengths are obtained when no zirconia treatment is performed.
Tools for inventory control of dental supplies of a municipal health department
Authors: Guimarães Fernando Silva , Santos Chazele Barbosa dos , Gonçalves Letycia Barros , Thurow Leandro Leitzke , Silveira Marysabel Pinto Telis
Published: June 2019

Aim: Carry out a descriptive and organizational analysis of the Oral Health warehouse of the Municipal Health Department in a city in the South of Brazil in order to assist in its management. Methods: This case study is a descriptive and organizational analysis of the Oral Health warehouse of the Municipal Health Department. The Always Better Control (ABC) curve, and Vital Essential Desirable (VED) analysis and ABC-VED matrix was performed, in order to assist the warehouse’s management. The first stage was a descriptive situational analysis. In the second stage, the supplies were classified by the ABC curve and the VED analysis. Subsequently, the ABC-VED matrix was carried out. Results: Changes were made together with the local manager, such as organizing the products, labeling the items in the proper places and, carrying out the inventory more frequently (monthly). Furthermore, the method the first in, first out (FIFO) was applied. Of the 120 inputs, 13% corresponded to 65% of the expenditures (class A). In class B, close to 26% of the items accounted for 25% of the expenditures. Class C accounted for 10% of the costs and 61% of total materials. In the VED analysis, 19.2% of the items were classified as vital, and 62% and 19% as essential and desirable, respectively. In ABC-VED matrix, 23.3% (72%) belonged to category I, while 63% (25.6%) and 13% (2%) were classified in categories II and III, respectively. Conclusion: The use of inventory control tools granted a better storage of products and made it easier to find the items. The ABC curve, VED analysis and ABC-VED analysis allowed greater control, considering both cost and importance of supplies.
Artes de si no magistério
Authors: Zordan Paola Basso Menna Barreto Gomes , Hoffmann Ana Cleia Christovam
Published: June 2019

Este artigo pensa o ensino, a moda e a arte em novos modos de se reinventar na vida magisterial. Para isso, toma o dandismo e as práticas desenvolvidas no século XIX como disparo para tratar a prática educativa como um exercício afirmativo da vida, tal como a estética da existência em Michel Foucault. A partir disso, fabrica um conjunto de práticas, nas quais possam se operar outros modos de pensar a arte, enquanto campo de um saber ampliado sobre si. Cada procedimento é também uma multiplicidade e entende que seus processos e feituras na educação são imanentes à vida e acontecem junto dela. Deste modo, o dândi educador, através de sua arte, opera por repetição. Ao repetir, observa seus procedimentos, afim de produzir singularidades e constituir o seu modo de ser professor
Livros didáticos de Matemática da EJA
Authors: Azevedo Danilo Pires de , Martins-Salandim Maria Ednéia
Published: June 2019

Neste artigo, apresenta-se uma análise dos livros de Matemática que compõem a coleção “EJA – Mundo do Trabalho”. Tal coleção, composta por 12 volumes, destinada ao segundo segmento do Ensino Fundamental, foi adotada pela Secretaria do Estado da Educação de São Paulo em 2013. Esta análise é um recorte de pesquisa de mestrado, cujo objetivo foi analisar como a coleção mobiliza a Matemática para abordar a concepção de trabalho, quando este surge como tema. Para tanto, se valeu da Hermenêutica de Profundidade e do conceito de Paratextos Editoriais, para efetivar três diferentes análises, dentre elas a formal ou discursiva, apresentada neste artigo. Nessa perspectiva, focaram-se a estruturação e o conteúdo dos livros, os quais foram descritos detalhada e criteriosamente. Foi possível constatar que a estruturação dos livros se baseia em um currículo mínimo de Matemática, e que os conteúdos matemáticos se relacionam a atividades específicas de algumas profissões.
Arduino Fault Tolerant System, Internet of Things (IoT)
Authors: Bowoto Oluwole K. , Oladapo Bankole I. , Nimako Prince A. , Omigbodun Francis T. , Emenuvwe Omonigho A.
Published: June 2019

New developments in broadcast technology, such as the ad hoc wireless network and the detection devices that work, enable daily connections to the Internet, commonly referred to as the Internet of Things (IoT). IoT saw this as a support for the development of creative and contextual services and applications. The service can respond to the user's environment and preferences. Finite state machines are recently making waves when the issue of self-controlling systems come into the picture of designs. This research focuses on the design of a fault tolerant system that controls random failures impressed on the network. The method comprises of diodes, Resistors, Optocouplers, ESP8266 WI-FI Module Webpage with button, and two Arduinos which in effect will determine iteratively who to handle a failure at hand modelled as when the button on the webpage is pressed. In this work, a Heartbeat Detection and Monitoring System will be made using Arduino that detect the electrical state using the Pulse Sensor and show the readings in Beats Per Minute on the LED connected a microcontroller. It sends the texts to the server using the Wi-Fi module ESP8266 to signals can be monitored from the monitoring zone via the internet.   This is reflected by the declaration of a master state by either of two Arduinos whenever the push button is pressed as observed on the codes. The result obtained from the research shows apparently, the state of the fault tolerance system none power deny of heartbeat condition connected to the LED.
A Global Seamless DEM Based on Multi-Source Data Fusion (GSDEM-30): Product Generation and Evaluation
Authors: Yue Linwei , Shen Huanfeng , Liu Lu , Yuan Qiangqiang , Zhang Liangpei
Published: June 2019

The quality of digital elevation models (DEMs) is inevitably affected by the limitations of the imaging modes and the generation methods. One effective way to solve this problem is to merge the available datasets through data fusion. In this paper, a fusion-based global DEM dataset (82°S-82°N) is introduced, which we refer to as GSDEM-30. This is a 30-m DEM mainly reconstructed from the unfilled SRTM1, AW3D30, and ASTER GDEM v2 datasets combining the multi-source and multi-scale fusion techniques. A comprehensive evaluation of the GSDEM-30 data, as well as the 30-m ASTER GDEM v2 and AW3D30 DEM, was presented. Global ICESat GLAS data and the local National Elevation Dataset (NED) were used as the reference for the vertical accuracy validation, while GlobeLand30 was introduced for the landscape analysis. Furthermore, we employed the maximum slope approach to detect the potential artefacts in the DEMs. The results show that the GDEM data are seriously affected by noise and artefacts. With the advantage of the multiple datasets and the refined post-processing, the GSDEM-30 are contaminated with fewer anomalies than both ASTER GDEM and AW3D30. The fusion techniques used can also be applied to the reconstruction of other fused DEM datasets.
Student Affairs Practitioners' Leadership on behalf of Undocumented College Students in the USA
Authors: Aguirre Hilda Cecilia Contreras
Published: June 2019

The United States is considered a country of immigrants that has historically hosted people from all over the world. Oftentimes, immigrants struggle to find and shape an American identity, especially when it comes to undocumented youth (Gonzales, 2008). New waves of immigrants to this country trigger feelings of fear concerning the loss of national identity and the lack of cultural incompatibility (Kim & Díaz, 2013a). In this sense, the emergence of anti-immigration attitudes has been in the political, social, and economic agenda over the last years. As a result, postsecondary institutions have been constantly looking for accomplishing social progress and growth (McDermott, 1973); however, there are still gaps to fill in at institutions with respect to create a welcome atmosphere and campus-wide acceptance for all students. In particular, undocumented students which the National Immigration Law Center defined as “a foreign national who: (1) entered the United States without inspection or with fraudulent documents; or (2) entered legally as a nonimmigrant but then violated the terms of his or her status and remained in the United States without authorization” (as cited in Educators for Fair Consideration, 2019) face socioeconomic and institutional barriers. Therefore, it deems necessary to find appropriate services and allocate resources that help undocumented students cope with difficulties concerning both their college adjustment and personal struggles reaching a holistic development (Gildersleeve &Ranero, 2010). The purpose of this paper is to address the topic of undocumented students as it relates to their college persistence. In particular, four leadership theories help highlight the important role of student affairs practitioners to become advocates and seek social justice for this unique student population.

The organization of the manuscript encompasses the following sections. First, a brief literature review concerning federal and state legislation on undocumented students is presented. Then, an overview of student affairs practitioners’ importance to promote a positive college climate and better serve this student population is addressed. The aforementioned section includes four leadership theories, which student affairs professionals could adopt. Next, an outline addressing the social justice aspect on behalf of undocumented students is introduced. Finally, a section covering recommendations for student affairs professionals is proposed yielding the conclusion.
Social Traditions and the Violation of Women’s Right in the Tagin Society of Arunachal Pradesh
Authors: Raji Bijay
Published: June 2019

There are 26 major tribes and 110 sub tribes in Arunachal Pradesh. Out of these tribes and sub tribes, Tagin is one of the major tribes in Arunachal Pradesh. The Tagin are descendants of Abo Tani. They are settled in Upper Subansiri District of Arunachal Pradesh, bordering east with Galo, west south with Nyishi and North with the Tibet (China). The Tagins are recognized as a separate tribal group very lately. Macknise had noted thatDafla living on the border of North Lakhimpur was known as Tagin Dafla.  “Till very recently the Bagins, a Western branch of the Dafla tribe, occupying wild terrain in the east of Kameng and west of the Subansiri call the Daflas across the frontier of the Kameng district Tagins. Here, the term Tagin implies the sense of being an eastern people”.
Teaching Cortical-Screw Tightening
Authors: Buck J. Stewart , Wally Meghan K. , Patt Joshua C. , Scannell Brian , Seymour Rachel B. , Hsu Joseph R.
Published: June 2019

Background:

Cortical-screw insertion is a fundamental skill in orthopaedic surgery, yet, to our knowledge, no standardized method of teaching this skill exists. The purpose of this study was to evaluate a training protocol that was designed to teach residents how to tighten a cortical screw without causing any stripping.

Methods:

Twenty-five residents and 8 attending surgeons from an orthopaedic residency program tightened cortical screws in a synthetic bone model with a digital torque screwdriver using 3 different techniques: percutaneous; open, dominant hand; and open, nondominant hand. The residents then participated in a training protocol during which each tightened additional screws while receiving real-time torque feedback. During training, the residents targeted 50% to 70% of the stripping torque for each screw. They were assessed at baseline, immediately after training, and at 12 to 15 weeks after training. During each assessment, the percentage of screws that were tightened in the target range and the percentage of stripped screws were recorded. The costs of the training protocol were assessed.

Results:

After training, all of the residents tightened screws with lower insertional torque compared with their baseline, but only the senior residents tightened more screws in the target range and stripped fewer screws. The attending surgeons, when compared with the residents at baseline, tightened more screws in the target range and tended to strip fewer screws, but these differences were absent at final testing. Costs included $1,927 for durable equipment and an estimated $74 per resident per training session for consumable goods.

Conclusions:

The senior residents inserted more screws in the target range and stripped fewer screws after participating in this training protocol, but the junior residents did not show significant improvement. Implementation of this training protocol for all residents may improve clinical performance but, because our sample size was limited, additional study is required to assess skill transfer to clinical practice.

Clinical Relevance:

Cortical-screw tightening is a fundamental skill in orthopaedics, and completion of this torque-directed training protocol may accelerate residents’ skill acquisition.
Bone Repair Using the Masquelet Technique
Authors: Masquelet Alain , Kanakaris Nikolaos K. , Obert Laurent , Stafford Paul , Giannoudis Peter V.
Published: June 2019

➤ The optimal time for the second stage is between 4 and 8 weeks.

➤ Multiple tissue biopsy specimens must be sent for microbiological analysis during both stages of the procedure.

➤ Recurrence of infection requires debridement of the membrane and surrounding soft tissues and reinitiation of the technique (return to first stage).

➤ The bone graft utilized is autologous cancellous pieces or filtered reamer-irrigator-aspirator graft, which can be expanded further with osteoconductive, osteoinductive, and osteogenic material.

➤ Bone healing of the defect is independent of its size.
Aseptic Glenoid Baseplate Loosening After Reverse Total Shoulder Arthroplasty
Authors: Rojas Jorge , Choi Kyubo , Joseph Jacob , Srikumaran Uma , McFarland Edward G.
Published: June 2019

Background:

Aseptic glenoid baseplate loosening can lead to the failure of reverse total shoulder arthroplasty (RTSA). Estimates of the prevalence of aseptic glenoid baseplate loosening after RTSA are required to guide clinical decisions, but published results are variable and lack precision. The goal of this meta-analysis was to determine a precise estimate of the prevalence of aseptic glenoid baseplate loosening after RTSA and to explore variation in the prevalence according to different variables, such as the type of procedure (primary or revision), preoperative diagnosis, the center of rotation of the glenoid component (medialized or lateralized), study size, the definition of aseptic glenoid baseplate loosening, and the duration of follow-up.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We searched the MEDLINE and Embase databases for English-language articles describing the outcomes after RTSA with a minimum 12-month follow-up in which radiographic findings of aseptic glenoid baseplate loosening were reported. Random-effects meta-analysis was performed, and meta-regression was used to explore the influence of variables on heterogeneity. Subgroup analyses and sensitivity analyses were performed.

Results:

One hundred and three studies (covering 6,583 RTSAs) performed from 1991 to 2015 met our inclusion criteria. The pooled prevalence of radiographic aseptic glenoid baseplate loosening for all RTSAs was 1.16% (95% confidence interval [CI], 0.80% to 1.69%). The prevalence of aseptic glenoid baseplate loosening was lower among primary RTSAs (0.90%; 95% CI, 0.54% to 1.49%) than among revision RTSAs (3.64%; 95% CI, 1.91% to 6.84%). The pooled prevalence of aseptic glenoid baseplate loosening by diagnosis was 2.69% for osteoarthritis with bone loss, 1.71% for cuff tear arthropathy, 1.20% for rheumatoid arthritis, 1.08% for sequelae of fracture, 0.94% for irreparable massive cuff tear, and 0.25% for acute proximal humeral fracture. The prevalence of aseptic glenoid baseplate loosening was not significantly different for prostheses with a medialized center of rotation (1.15%) versus a lateralized center of rotation (1.84%).

Conclusions:

To our knowledge, the present study represents the first meta-analysis investigating only aseptic glenoid baseplate loosening after RTSA. Multiple variables were found to be associated with the prevalence of aseptic glenoid baseplate loosening. The rates reported here are lower than those reported previously because of the inclusion of more recent evidence and more studies that evaluated aseptic glenoid baseplate loosening.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
El teletándem en el aprendizaje Alemán – Español: mediateca ENALLT – UNAM y Universidad de Würzburg
Authors: Cruz Lecona Edú Alberto , Alfaro Martínez María Guadalupe
Published: June 2019

El teletándem en la actualidad es un apoyo importante en el aprendizaje de una lengua extranjera, ya que este actúa como herramienta útil y eficiente desde el punto de vista del empleo de recursos prácticos. En el caso del español y del alemán, la Universidad de Würzburg y la Universidad Autónoma de México (UNAM) participan en un proyecto denominado Aprendizaje Virtual de Lenguas Extranjeras (AVLE). En este ámbito se evaluó la situación del desempeño de los estudiantes que aprenden español y de aquellos que aprenden alemán. La variable que se consideró en el rendimiento del aprendizaje es la confianza con la que los participantes pudieron resolver situaciones cotidianas, por ejemplo: ser capaces de comunicarse a través de pares en diferentes contextos culturales/comunicativos: costumbres, fiestas nacionales y celebraciones típicas de sus países respectivos. A través de diarios de aprendizaje se pudo evaluar y reflexionar cómo fue el desarrollo de su aprendizaje. También se pudo advertir cómo fue su expectativa al inicio, durante el desarrollo y al final del proyecto. Por lo anterior, se pretende analizar la función de la mediateca de la Escuela Nacional de Lingüística Aplicada (ENALLT) y el Centro de Enseñanza de Lenguas Extranjeras de la Universidad de Würzburg.
Barriers from calling ambulance after recognizing stroke differed in adults younger or older than 75 years old in China
Authors: Li Shengde , Cui Li-Ying , Anderson Craig , Gao Chunpeng , Yu Chengdong , Shan Guangliang , Wang Longde , Peng Bin
Published: June 2019

Background

As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40-74- and 75-99-year-old adults.

Methods

Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40-74 and 75-99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke.

Results

In the 40-74 and 75-99 age groups, the rates of participants who chose “Self-observation at home” were 3.0% (3912) and 3.5% (738), respectively; the rates of “Wait for family, then go to hospital” were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one's family, low income (<5000 RMB per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one's family in both groups. However, unlike in the 40-74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75-99 age group.

Conclusions

Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups. Different strategies that mainly focus on changing the “Wait for family” behavior and emphasize on immediately calling EMS are recommended for both age groups.
Analyzing the interactions of circRNAs, miRNAs, and mRNAs to predict ceRNA networks in human acute type A aortic dissection
Authors: huang maoxun , piao hulin , wang yong , wang weitie , li bo , zhu zhicheng , xu rihao , li dan , wang tiance , liu kexiang
Published: June 2019

Background: Acute type A aortic dissection(ATAAD) is a life-threatening vascular disease. However, its underlying mechanism is still not well understood. Here, circular RNAs(circRNAs) were shown to function as competitive endogenous RNAs (ceRNAs) to regulate the effect of microRNAs(miRNAs) on their target genes may play a critical role in ATAAD. However, comprehensive identification and integrated analysis of the circRNA-miRNA-mRNA network in ATAAD have not been performed.
Results: The gene expression profile of circRNAs, miRNAs, and mRNAs was performed between 6 ATAAD patients and 6 age-matched normal ascending aortic wall tissues patients were analyzed using the Arraystar human RNAs microarray. We identified that the expression of 12576 circRNAs,1603 miRNAs, and 14596 mRNAs were found to be differentially expressed(DE). Gene ontology(GO) and Kyoto Encyclopedia of Genes and Genomes pathway analyses(KEGG) were performed on these DE mRNAs and miRNA-mediated target genes of circRNAs. Furthermore, we used a multi-step computational framework and several bioinformatics methods to construct a ceRNA network containing circRNAs, miRNAs, and mRNAs based on co-expression analysis between the DE genes. The constructed ceRNA regulatory network containing 25 circRNAs, 17 miRNAs and 72 mRNAs. In the whole ceRNA network. We identified that plenty of key genes, such as hsa_circRNA_404522, hsa_circRNA_0022920, hsa_circ_0075881, hsa-miRNA1285-3p, hsa-miRNA-1285-3p, hsa-miRNA-637, hsa-miRNA-650, TINAGL1, JPH4, PLXNA2, TGFBR1, and THSD4. Furthermore, we also integrated the circRNA-miRNA-mRNA regulatory modules of the key genes.
Conclusions: This study found a profile of dysregulated circRNAs, miRNA and mRNAs, and competitive circRNA-miRNA–mRNA regulatory networks were comprehensively integrated and predicted to be involved in ATAAD by GO and KEGG pathway analysis. It might be prospective clinical markers associated with ATAAD, and it is worthwhile to perform further studies to reveal the underlying link between these key genes and the molecular mechanisms of AD.

Keywords：aortic dissection; circRNAs; miRNAs; mRNAs; ceRNA
Acupuncture with Rehabilitation in the Treatment of Ischemic Stroke Recovery: A Randomized Controlled Trial
Authors: Li Lixia , Zhu Weifeng , Lin Guohua , Chen Chuyun , Tang Donghui , Lin Shiyu , Weng Xiaorong , Xie Liqin , LU Lihong , Li Weilin
Published: June 2019

Background: Acupuncture is a well known treatment for ischemic stroke recovery, but evidence of its effectiveness remains limited.
Methods: Rehabilitation training was provided to a control group. In Arm 1 and Arm 2, acupoint schemes were determined by a consensus of acupuncture experts and previous clinical research. Arm 1 was based on an acupoint summary of ancient literature, and Arm 2 was based on the summary of effective acupuncture points from modern RCT literature. Acupuncture was given on the acupoint. After acupuncture, the needles were left in for 30 minutes, and checked every 10 minutes. The three groups received treatment once a day, 5 times a week, for 2 weeks. The primary outcome was the National Institute of Health stroke scale (NIHSS), and the secondary outcomes were the Barthel index (BI) and the modified Ashworth scale (MAS). Outcomes were observed in patients both before and after treatment.
Results: A total of 497 patients with ischemic stroke were randomized into either Arm 1 (159 cases), Arm 2 (173 cases) or a control group (165 cases). After 2 weeks of treatment, the NIHSS scores for Arm 1 were lower than those of the control group (P=0.017); the BI scores were higher in Arm 2 than they were in the control group (P=0.020). Additionally, there was no significant difference between Arm 1 and the control group for either the BI scores or the modified Ashworth scale scores (P>0.05).
Conclusion: The clinical efficacy of Arm 1 and Arm 2 (acupuncture groups) was superior to that of the control group.
Efficacy of acetaminophen with and without oxycodone for analgesia in nonoperative treatment of extremity fractures in adults: Protocol for a double-blind randomized clinical trial
Authors: Gao Tao , Zhu Hongyi , Zhang Changqing , Chai Yimin , Guo Cheng , Zhu Xiaozhong , Bao Bingbo , Li Xingwei , Lin Junqing , Zheng Xianyou
Published: June 2019

Background: Opioids and acetaminophen are both widely used to relieve pain after nonoperative treatment of limb fractures, but evidence for superiority of opioids versus acetaminophen is lacking. In this study we aim to determine whether acetaminophen is noninferior to the acetaminophen/oxycodone combination for pain relief after nonoperative fixation of an extremity limb fracture. We hypothesize that acetaminophen is noninferior to the acetaminophen/oxycodone combination.
Methods: A double-blind, randomized controlled trial will be conducted. Power analysis determined that 1,226 participants will be needed (p<0.05, power 90%). Patients with acute limb fracture who receive nonoperative treatment will be recruited and randomly allocated into two groups: the intervention group will receive oral oxycodone (10 mg)/acetaminophen (650 mg), and the control group will receive acetaminophen (650 mg) only. All participants will be instructed to take one pill of study medication on an as-needed basis and no more frequently than once every 8 hours. The primary outcome measure will be scores on the 11-point Numeric Rating Scale (NRS-11) over 14 days. Secondary outcome measures are scores on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), EuroQol five dimensions’ questionnaire (EQ-5d), self-rated satisfaction with the analgesia produced, self-reported nighttime sleep duration, number of intervention or control pills used, total duration for taking intervention or control medication. Change of pain scores and the number of times that analgesic drugs were taken in the two groups will be statistically evaluated with t-student tests according to their fracture site.
Discussion: This study will be a randomized controlled trial that is adequately powered to test the hypothesis that acetaminophen is noninferior to the combination of acetaminophen and oxycodone in relieving objectively measured pain after nonoperative treatment of limb fractures in adults. It is hopeful to provide a safe and effective analgesic plan for such patients.
Trial registration numbers: ChiCTR registry: ChiCTR1800017015 ( http://www.chictr.org.cn/showproj.aspx?proj=28612). Registered on 8 July 2018.
HetEnc: A Deep Learning Predictive Model for Multi-type Biological Dataset
Authors: Wu Leihong , Liu Xiangwen , Xu Joshua
Published: June 2019

Background: Researchers today are generating unprecedented amounts of biological data. One trend in current biological research is integrated analysis with multi-platform data. Effective integration of multi-platform data into the solution of a single or multi-task classification problem; however, is critical and challenging. In this study, we proposed HetEnc, a novel deep learning-based approach, for information domain separation.

Results: HetEnc includes both an unsupervised feature representation module and a supervised neural network module to handle multi-platform gene expression datasets. It first constructs three different encoding networks to represent the original gene expression data using high-level abstracted features. A six-layer fully-connected feed-forward neural network is then trained using these abstracted features for each targeted endpoint. We applied HetEnc to the SEQC neuroblastoma dataset to demonstrate that it outperforms other machine learning approaches. Although we used multi-platform data in feature abstraction and model training, HetEnc does not need multi-platform data for prediction, enabling a broader application of the trained model by reducing the cost of gene expression profiling for new samples to a single platform. Thus, HetEnc provides a new solution to integrated gene expression analysis, accelerating modern biological research.
Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery
Authors: Battaglini Denise , Robba Chiara , Rocco Patricia Rieken Macêdo , De Abreu Marcelo Gama , Pelosi Paolo , Ball Lorenzo
Published: June 2019

Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant [1]. The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality [2]. In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional techniques might promote faster recovery and reduce opioid consumption. In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient’s need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.