bluuebunny/crossref_metadata_2025 huggingface dataset:
Brain Ischemia in Patients with Intracranial Hemorrhage: Pathophysiological Reasoning for Aggressive Diagnostic Management
Authors: Naranjo Daniel , Arkuszewski Michal , Rudzinski Wojciech , Melhem Elias R. , krejza Jaroslaw
Published: January 2017

Patients with intracranial hemorrhage have to be managed aggressively to avoid or minimize secondary brain damage due to ischemia, which contributes to high morbidity and mortality. The risk of brain ischemia, however, is not the same in every patient. The risk of complications associated with an aggressive prophylactic therapy in patients with a low risk of brain ischemia can outweigh the benefits of therapy. Accurate and timely identification of patients at highest risk is a diagnostic challenge. Despite the availability of many diagnostic tools, stroke is common in this population, mostly because the pathogenesis of stroke is frequently multifactorial whereas diagnosticians tend to focus on one or two risk factors. The pathophysiological mechanisms of brain ischemia in patients with intracranial hemorrhage are not yet fully elucidated and there are several important areas of ongoing research. Therefore, this review describes physiological and pathophysiological aspects associated with the development of brain ischemia such as the mechanism of oxygen and carbon dioxide effects on the cerebrovascular system, neurovascular coupling and respiratory and cardiovascular factors influencing cerebral hemodynamics. Consequently, we review investigations of cerebral blood flow disturbances relevant to various hemodynamic states associated with high intracranial pressure, cerebral embolism, and cerebral vasospasm along with current treatment options.
Delayed Post-Traumatic Fronto-Ethmoidal Sinus Mucocele Evaluated with Short and Long TE MR Spectroscopy
Authors: Aghakhanyan Gayane , Lupi Giancarlo , Frijia Francesca , Hana Hlavata , Lombardo Francesco , De Cori Sara , Canapicchi Raffaello , Vannozzi Riccardo , Montanaro Domenico
Published: January 2017

Mucoceles are slow-growing, benign, expansile, mucoid-filled masses developing after obstruction of the sinus ostium. Late post-traumatic mucoceles are relatively rare entities and the literature is limited to single case reports. We describe an unusual case of post-traumatic frontoethmoidal mucocele, evaluated with computed tomography (CT), magnetic resonance imaging (MRI) and proton MR-spectroscopy (1H-MRS). As a contribution to the diagnostic work-up of the mucocele, 1H-MRS demonstrates a dominant peak at 2.0 ppm at long echo time (TE) and an additional component at 3.8 ppm at short TE due to mucus glycoprotein compounds of the mucocele.
Primary prevention of cardiovascular disease: A review of contemporary guidance and literature
Authors: Stewart Jack , Manmathan Gavin , Wilkinson Peter
Published: January 2017

Cardiovascular disease is a significant and ever-growing problem in the United Kingdom, accounting for nearly one-third of all deaths and leading to significant morbidity. It is also of particular and pressing interest as developing countries experience a change in lifestyle which introduces novel risk factors for cardiovascular disease, leading to a boom in cardiovascular disease risk throughout the developing world. The burden of cardiovascular disease can be ameliorated by careful risk reduction and, as such, primary prevention is an important priority for all developers of health policy. Strong consensus exists between international guidelines regarding the necessity of smoking cessation, weight optimisation and the importance of exercise, whilst guidelines vary slightly in their approach to hypertension and considerably regarding their approach to optimal lipid profile which remains a contentious issue. Previously fashionable ideas such as the polypill appear devoid of in-vivo efficacy, but there remain areas of future interest such as the benefit of serum urate reduction and utility of reduction of homocysteine levels.
The Effects of Digitally Enhanced Photos on Product Evaluation and Young Girls' Self-Esteem
Authors: Borges Adilson
Published: January 2017

This research builds on Social Comparison Theory to predict that a computer-enhanced photo of a model will have an impact on product evaluation and young girls' self-esteem. The results of two experiments show that a computer-enhanced photo will increase the product purchase intention. Moreover, girls are willing to pay more for the product when they are exposed to a computer-enhanced photo than when they see a non-enhanced photo. However, the social drawbacks can be significant. For instance, girls exposed to a computer-enhanced photo declare lower self-esteem, lower social assurance, and a greater desire to change their physical appearance than girls exposed to the same non-enhanced photo. A text warning message explaining that the photo has been computer-enhanced does not change these effects (studies 1 and 2), while a graphic warning reduces the negative effects of a computer-enhanced photo (study 2). The implications for advertising and health regulators are discussed.
Brand Characters on Packaging, a Catalyst for Children's Purchase Request: The Moderating Effect of the Narrative Presentation of the Character, the Child's Familiarity with the Character and the Child's Educational Level
Authors: Hémar-Nicolas Valérie
Published: January 2017

This paper studies the impact of brand characters on packaging on children's purchase requests. Through two experiments, three moderating variables are tested: Children's familiarity with the brand character, how the character is presented, and the child's educational level. The study shows that a brand character on packaging increases intent to request only if the child is familiar with it. Furthermore, when the brand character is presented in a narrative on the packaging, its influence on purchase request increases in some cases, depending on both the type of narrative and product category.
Condom Usage Negotiation Among Customarily Married Women in Katlehong, Johannesburg
Authors: Dube Nkosiyazi , Nkomo Thobeka S. , Khosa Priscalia
Published: January 2017

South Africa has the highest number of HIV-infected people in the Southern African Region, and of great concern is the fact that cases of new infections among young people, especially young women and girls, are on the increase. The prevalence of HIV and deaths caused by AIDS are still on the increase, whereas condom use, particularly in rural areas, remains low. Consistent condom use is central to the prevention of unwanted pregnancies, HIV, and other sexually transmitted infections (STIs); yet, young men and women alike are hesitant to use condoms because of threats to their relationships, cultural roles, and, at times, economic survival. This study explored the views of customarily married housewives regarding condom use negotiation with their husbands. The findings point toward the need to empower women while they are still young so that they can be assertive, financially independent, and able to make their own decisions with regard to their sexuality.
Osteoarthritis, Osteoporosis, and Exercise
Authors: Garrison Deborah
Published: January 2017

With the aging of the work force, occupational health nurses must prepare for encounters with clients who are challenged by osteoarthritis or osteoporosis. Clients should be encouraged to exercise safely to promote functioning at home and work. This article reviews recent literature on the benefits of exercise for workers with osteoarthritis, osteoporosis, or both.
Factors Influencing Australian Agricultural Workers' Self-Efficacy Using Chemicals in the Workplace
Authors: Blackman Ian R.
Published: January 2017

A hypothetical model was formulated to explore which factors can simultaneously influence the self-reported ability of agricultural employees to embrace chemical safety practices. Eight variables were considered in the study, including the employees' gender, age, duration of current employment status, and whether they were employed full-time or part-time. The self-efficacy measures of 169 participants were then estimated by measuring their self-rated ability to understand and perform different chemical safety practices. Models identifying employee self-efficacy pathways leading to worker readiness to engage in chemical safety were then tested using Partial Least Squares Path Analysis. Study results suggest that employees' self-efficacy to successfully engage in safe chemical practices in their workplace can be directly predicted by four variables, with additional indirect effects offered by one other variable, which cumulatively account for 41% of the variance of employees' chemical safety self-efficacy scores. The most significant predictor variables that directly influenced employees' self-efficacy in adopting chemical safety practices in the workplace were worker age, gender, years of employment, and concurrent confidence (self-efficacy) arising from prior experience using chemicals in the workplace. The variables of employees' prior knowledge and understanding about the use of administrative controls and personal protective equipment to protect workers from chemical exposure had no direct influence on self-efficacy to handle chemical emergencies. Employees' unfamiliarity with risk control strategies and reliance on material safety data sheets for information suggest that ongoing and targeted training are necessary if chemical safety issues are to be addressed.
Writing a Successful Business Plan
Authors: Haag Annette B.
Published: January 2017

In creating and building a business, the entrepreneur assumes all the responsibilities for development and management, as well as the risks and rewards. Many businesses do not survive because business owners fail to develop an effective plan. The business plan focuses on major areas of concern and their contribution to the success of a new business. The finished plan communicates the product or service to others and provides the basis for the financial proposal.
Combined Effect of Cigarette Smoking and Occupational Exposures on Lung Function
Authors: Attarchi Mirsaeed , Dehghan Faezeh , Afrasyabi Mehdi , Sadeghi Zargham , Mohammadi Saber
Published: January 2017

Workers in the rubber industry are exposed to pulmonary health hazards. The main purpose of this study was to assess the combined effect of cigarette smoking and occupational exposures on lung function. The exposed group consisted of tire manufacturing workers in production units and the non-exposed group included executives from the same factory. The researchers calculated the synergy index (SI) to determine the combined effect of exposures to cigarette smoke and pulmonary health hazards on lung function. A significant correlation was found between occupational exposures in the rubber industry and abnormal spirometric findings ( p < .05). The synergistic effect of cigarette smoking and occupational exposures on lung function was significant (SI = 2.25; p < .05). This study demonstrated that occupational exposures and smoking may have a synergistic effect on the respiratory systems of tire manufacturing workers. The results suggest that tire manufacturing companies should consider establishing spirometric surveillance systems in their factories. Also, smoking cessation should be promoted, engineering controls applied, and respiratory protection provided to workers.
Fighting Violence against Health Workers: A Way to Improve Quality of Care?
Authors: Gignon Maxime , Verheye Jean-Charles , Manaouil Cécile , Ammirati Christine , Turban-Castel Emmanuelle , Ganry Olivier
Published: January 2017

Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing antiviolence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.
Professional Activities of Experienced Occupational Health Nurses
Authors: Harber Philip , Alongi Gabriela , Su Jing
Published: January 2017

Occupational health nurses have diverse backgrounds and their practices require the ability to perform unique professional tasks. This study empirically evaluated their activities and skills using a web-based log system to describe activities at 15 specific sampled times. A national sample of 128 occupational health nurses provided 1,893 activity logs revealing occupational health nurses use both clinical and management skills on a regular basis; indirect client care is as common as direct “hands-on” client care. Most occupational health nurses are directly paid by their employer and activities serve to benefit both individual workers and their employers. Occupational health nurses have specific knowledge and skills in addition to general nursing competencies. Understanding the actual work of occupational health nurses is necessary to align training, certification, and competency maintenance systems such as continuing education with the unique skills used in actual practice activities.
Anesthesia Personnel's Knowledge of, Attitudes Toward, and Practice to Prevent Needlestick Injuries
Authors: Motavaf Mahsa , Dolatabadi Mahmoud R. Mohaghegh , Ghodraty Mohammad R. , Siamdoust Seyed Alireza Seyed , Safari Saeid , Mohseni Masood
Published: January 2017

Anesthesia personnel are at risk for needlestick injuries (NSIs). This study evaluated the knowledge of, attitudes toward, and practice of preventing NSIs among anesthesia personnel in four Iranian university hospitals. A self-administered anonymous questionnaire was distributed to 104 anesthesia personnel. In addition, hospital infection control center records were reviewed. The prevalence of NSI among anesthesia personnel was 56.8%. Only 32.2% reported their NSI. Men were more knowledgeable about the risks associated with NSI and the application of standard precautions than women, but were also more likely to experience NSI. Standard precautions were often not followed. In contrast with other hospital staff, most reported NSIs among anesthesia personnel produced high-risk exposures. The knowledge and prevention practices of anesthesia personnel related to needles and other sharps were not satisfactory. These health care providers need appropriate training on standard precautions and administrative oversight to improve their practices. Anesthesia personnel's gender and position should also be considered to improve compliance.
Lower Performance Evaluation Practice Ratings for Teachers of Disadvantaged Students
Authors: Milanowski Anthony
Published: January 2017

Value-added estimates of teachers’ contributions to student achievement have been criticized for bias relating to the sorting of students to classrooms. More recently, research has raised the possibility that sorting leads to differences in practice evaluation ratings between teachers of more or less disadvantaged and/or higher- and lower-achieving students. Adjusting observation ratings for the relevant characteristics of teachers’ classrooms has been proposed as a remedy, analogous to how value-added teacher effectiveness estimates are developed. However, the appropriateness of adjustment depends on the cause of observed differences in average ratings and the use of the ratings. Potential causes include rater bias rubric deficiency, differences in teacher skills and beliefs, and true differences in difficulty of teaching groups of students. The appropriateness of adjustment given these causes and typical uses of the ratings is discussed as well as research needed to identify the influence of the causes.
Valid Competency Assessment in Higher Education
Authors: Zlatkin-Troitschanskaia Olga , Pant Hans Anand , Toepper Miriam , Lautenbach Corinna , Molerov Dimitar
Published: January 2017

The aim of the 15 collaborative projects conducted during the new funding phase of the German research program Modeling and Measuring Competencies in Higher Education—Validation and Methodological Innovations (KoKoHs) is to make a significant contribution to advancing the field of modeling and valid measurement of competencies acquired in higher education. The KoKoHs research teams assess generic competencies and domain-specific competencies in teacher education, social and economic sciences, and medicine based on findings from and using competency models and assessment instruments developed during the first KoKoHs funding phase. Further, they enhance, validate, and test measurement approaches for use in higher education in Germany. Results and findings are transferred at various levels to national and international research, higher education practice, and education policy.
A new measure of skill mismatch: theory and evidence from PIAAC
Authors: Pellizzari Michele , Fichen Anne
Published: January 2017

This paper proposes a new measure of skill mismatch to be applied to the recent OECD Survey of Adult Skills (PIAAC). The measure is derived from a formal theory and combines information about skill proficiency, self-reported mismatch and skill use. The theoretical foundations underling this measure allow identifying minimum and maximum skill requirements for each occupation and to classify workers into three groups: the well-matched, the under-skilled and the over-skilled. The availability of skill use data further permits the computation of the degree of under- and over-usage of skills in the economy. The empirical analysis is carried out using the first round of the PIAAC data, allowing comparisons across skill domains, labour market statuses and countries.
Q estimation and its application in the 3D shallow weathering zone
Authors: Liu Ying , Li Jingye , Chen Xiaohong , Wang Zhikai , Xu Yiran , Wang Benfeng
Published: January 2017

Attenuation in the shallow weathering zone is relatively strong, causing severe energy loss during wave propagation. It is difficult to estimate accurate [Formula: see text] values in the shallow weathering zone, and the influence of shallow weathering zone is seldom considered into attenuation estimation and compensation in the deep part. We achieved [Formula: see text] value estimation where there exist microlog data in the shallow weathering zone using the generalized S transform (GST); then, we establish an empirical formula using the velocity and [Formula: see text] value estimated with microlog data; finally, the [Formula: see text] value in the 3D shallow weathering zone can be obtained using the established formula and the velocity information. During the first procedure, the GST is used to provide reasonable time-frequency resolution, and linear regression is used in the obtained logarithmic spectral ratio to get the estimated [Formula: see text] value. An empirical formula is established using the estimated [Formula: see text] value and the velocity where there exists microlog data in the second procedure. In the third step, [Formula: see text] estimation in the whole shallow weathering zone can be obtained using the established formula and the velocity information, which can overcome the inaccuracy of spatial interpolation with the estimated [Formula: see text] factors where there exist different twin-well microlog data. Attenuation compensation to seismic data obtained from the deep part is carried out to prove the effectiveness of the estimated [Formula: see text] in the shallow weathering zone. After compensation, the resolution of seismic data is effectively increased, which demonstrates the validity of the estimated [Formula: see text] values in the shallow weathering zone. Synthetic data and field data examples demonstrate the validity of our method.
Progress on empirical mode decomposition-based techniques and its impacts on seismic attribute analysis
Authors: Honório Bruno César Zanardo , de Matos Marcílio Castro , Vidal Alexandre Campane
Published: January 2017

Spectral decomposition plays a significant role in seismic data processing and is commonly used to generate seismic attributes that are useful for interpretation and reservoir characterization. Among several techniques that are applied to this finality, complete ensemble empirical mode decomposition (CEEMD) is an alternative procedure that has proven higher spectral-spatial resolution than the short-time Fourier transform or wavelet transform, thus offering potential in highlighting subtle geologic structures that might otherwise be overlooked. We have analyzed a recent development in CEEMD, which we call improved CEEMD (ICEEMD), and its impacts on seismic attribute analysis commonly used in the empirical mode decomposition framework. By replacing the estimation of modes by the estimation of local means, the mode mixing and the presence of noise in the modes are reduced. Application on a synthetic and real data reveals that ICEEMD improves the signal decomposition and the energy concentration in the time-frequency domain, producing a better understanding of the analyzed signal and, consequently, of the geology under investigation.
Sincerely Held; Or, the Pastorate 2.0
Authors: Pellegrini Ann
Published: January 2017

This essay examines the role of sincerity in several recent US Supreme Court cases on religious freedom in which plaintiffs successfully sought religious exemptions from otherwise applicable state or federal laws: Hosanna-Tabor, Hobby Lobby, and Holt. Under a religious sincerity test, law cannot and does not distinguish religion from nonreligion; individual believers can and do. Instead, courts trust a person’s or group’s self-reporting—that they sincerely believe what they say they believe—and adjudicate from that point forward. As a criterion, sincerity invokes a host of epistemological and moral assumptions about personhood, the nature of belief, the substance of religion as somehow equating to belief (a highly contestable assertion), and what it is reasonable for a sincerely religious person to believe and do. Drawing on the work of Michel Foucault, Leerom Medovoi, and José Esteban Muñoz, this essay suggests that sincerity also encodes racialized scripts of proper and improper affect and aligns them with dominant Christianity.
The Racial Infrastructure of the Terror-Industrial Complex
Authors: Rana Junaid
Published: January 2017

This essay draws on ethnographic research in a Pakistani neighborhood in Brooklyn, New York, to illuminate how the concepts of becoming and infrastructure reveal insights into racialization and the workings of the counterterror state. I discuss the concepts of racial becoming and racial infrastructure in the context of the terror-industrial complex, which implements technologies of policing as part of the state and toward a range of community-based approaches in the nonprofit industry. By drawing attention to the concepts of racial becoming and racial infrastructure, this intervention asks what the assumptions are of the recent theorizations of becoming, potentials, infrastructure, and terror in relationship to racism and white supremacy. In considering terror as a racial formation of becoming and infrastructure, the author argues that much is to be gained in terms of theorizing power, hierarchy, domination, the potential of innovation in everyday life, and the possibility of collective struggle.
Should Older Patients Be Selectively Referred to High-Volume Centers for Abdominal Aortic Surgery?
Authors: Dimick Justin B. , Pronovost Peter J. , Cowan John A. , Wainess Reid M. , Upchurch Gilbert R.
Published: January 2017

The objective of the current study was to determine the effect of hospital volume on outcomes of abdominal aortic surgery for patients older than and younger than 65 years. In order to perform this investigation, information on all adult patients who underwent abdominal aortic surgery in Maryland from 1994 to 1996 ( N = 2,987 patients) in 45 acute care hospitals was obtained. Hospitals were designated as low (< 20/year), medium (20 to 36/year), or high (> 36/year) volume according to the annual number of procedures performed. The relationship of hospital volume and mortality was determined for patients less than or greater than 65 years old. Two separate multiple logistic regression models were used to adjust for patient case-mix in each age category.

Of the 2,987 patients, 2,067 (69%) were older than 65 years and 920 (31%) were younger. The crude in-hospital mortality rates according to hospital volume were 2.7% (low), 2.1% (medium), and 2.7% (high) for patients younger than 65 years old ( p = .8). For patients older than 65 years, in-hospital mortality rates were 11.9% (low), 9.9% (medium), and 6.9% (high) ( p = .005). After adjusting for patient case-mix in a multivariate analysis, high hospital volume was associated with a decreased risk of in-hospital mortality for patients older than 65 years (OR 0.57; 95% CI 0.37 to 0.86; p = .008) but not for patients under 65 years old. In conclusion, hospital volume was associated with decreased in-hospital mortality after abdominal aortic surgery only for patients greater than 65 years old. Because of this differential effect, targeting elderly patients for regionalization would achieve most potentially avoidable deaths for this common high-risk surgical procedure.
Arterial Reconstruction in the Upper Extremities
Authors: Shindo Shunya , Kojima Atsuo , Ishimoto Tadao , Iyori Keiji , Kobayashi Masahiro , Tada Yusuke
Published: January 2017

Arterial reconstruction in the upper extremities is rare relative to the incidence of reconstruction in the lower extremities. Twenty-three patients who underwent vascular reconstruction in the upper extremities from 1985 to 2000 were retrospectively reviewed. Atherosclerosis was observed in only two subclavian arteries. The most common cause of occlusion was thromboembolism from the heart, which occurred often in the brachial artery and could be treated successfully with thrombectomy. Seven of eight bypass grafts, including three procedures below the elbow, remained patent during follow-up periods ranging from 2 to 9 years. Arterial reconstruction of the upper extremities differs from that in the lower extremities. Atherosclerosis is a rare cause of ischemia, and the etiology varies with the site of obstruction. Bypass surgery below the elbow is feasible and successful in selected patients. Ischemia of the upper extremity causes significant morbidity and should be treated aggressively whenever possible.
Student Peer Evaluated Line Balancing Competition
Authors: Snider Brent , Southin Nancy , Weaver Sherry
Published: January 2017

The Student Peer Evaluated Line Balancing Competition is a 30-minute in-class problem-based learning experiential exercise that challenges student groups to design a feasible and efficient laptop computer assembly line. Each student group’s proposed design is publicly peer-reviewed by the rest of the class, enabling students to evaluate various alternatives and realize the key requirements for optimally balancing an assembly line. Evidence of effectiveness is provided, including student survey results and a statistical analysis of exam question performance both before and after the exercise was incorporated into our business undergraduate operations management class. The survey revealed that 96% of students recommended continued usage and 92% believed the competition helped them to be able to determine a feasible solution for line balancing problems. Exam question performance analysis revealed that our initial instructions for the competition actually resulted in lower performance compared to traditional lecture. We subsequently improved the instructions and found that this change has resulted in similar exam question performance as traditional lecture. The result is an exercise that significantly improves student engagement while maintaining student performance previously achieved through traditional lecture.
Puzzle—The Fillomino Puzzle
Authors: Pearce Robin H. , Forbes Michael A.
Published: January 2017

Logic puzzles form an excellent set of problems for the teaching of advanced solution techniques in operations research. They are an opportunity for students to test their modelling skills on a different style of problem, and some puzzles even require advanced techniques to become tractable. Fillomino is a puzzle in which the player must enter integers into a grid to satisfy certain rules. This puzzle is a good exercise in using lazy constraints and composite variables to solve difficult problems.
Interactive Excel-Based Gantt Chart Schedule Builder
Authors: Nurre Sarah G. , Weir Jeffery D.
Published: January 2017

Many scheduling dispatching rules are intuitive processes used in every day life. For example, when faced with a variety of tasks due at different times one often implements the earliest due date scheduling rule: The next task worked on is the one with the earliest due date. Other common scheduling dispatching rules are easily understood, thereby enabling one to devise the rule when given the opportunity to experiment via trial and error. In this paper, we present an interactive Excel-based Gantt Chart Schedule builder that enables students to experiment with building schedules for different single and parallel machine problem examples. Instead of explicitly telling students these common scheduling rules, the schedule builder enables students to gain intuition about the rules on their own. Herein we describe the interactive schedule builder we created, explain how instructors and students can use this tool, perform a small preliminary assessment on the student perception metric, and provide supplemental teaching materials enabling use of the schedule builder in a variety of classroom environments.
Targeting Target Shareholders
Authors: Bernhardt Dan , Liu Tingjun , Marquez Robert
Published: January 2017

We integrate heterogeneity and uncertainty in investor valuations into a model of takeovers. Investors have dispersed valuations, holding shares in firms they value more highly, and a successful offer must win approval from the median target shareholder. We derive the consequences for an acquiring firm’s takeover offer—its size and cash/equity structure—and implications for takeover premia, firm returns, share price dynamics, the probability that a takeover succeeds, and shareholder welfare. We characterize when the acquirer prefers cash offers and when equity offers are best. Our model collectively reconciles various empirical regularities that have proven elusive to explain in one unified framework, and we derive new testable predictions.

This paper was accepted by Neng Wang, finance.
Asymmetric Dimethylarginine in Patients with Ascending Aortic Aneurysms
Authors: Gavriliuk Natalia , Druzhkova Tatiana , Irtyuga Olga , Zhloba Alexandr , Subbotina Tatiana , Uspenskiy Vladimir , Alexeyeva Nina , Moiseeva Olga
Published: January 2017

Background:
Ascending thoracic aortic aneurysm (aTAA) is a heterogeneous group of disorders that involve impaired endothelial function. The nitric oxide (NO) synthase inhibitor asymmetric dimethylarginine (ADMA) serves as an endothelial dysfunction marker. Thus, we investigated ADMA levels in patients with aTAA.

Methods:
Eighty-six patients with aTAA and 18 healthy individuals were enrolled. All patients underwent echocardiography. Plasma ADMA levels were measured using high-performance liquid chromatography.

Results:
ADMA levels were higher in aTAA patients than in control patients (p = 0.034). According to the multivariable regression model, higher ADMA levels were associated with ascending aortic diameter (p = 0.017), smoking (p = 0.016), and log-transformed estimated glomerular filtration rate (eGFR, p = 0.005).

Conclusion:
This pilot study demonstrates an association of ADMA with ascending aortic dilatation; however, further studies are needed to investigate whether increased ADMA levels underlie aTAA development.
Conservative Management of Extensive Iatrogenic Aortic Dissection
Authors: Tam Derrick , Mazine Amine , Cheema Asim , Yanagawa Bobby
Published: January 2017

Iatrogenic aortic dissection (IAD) is a rare complication of percutaneous coronary interventions (PCI). There are no clear guidelines for IAD management, and limited data are available. Registry data and case series combined with extrapolations from our experience with spontaneous Type-A dissections suggest that very limited dissections are often managed conservatively with coronary stenting of the entry tear when possible, while more extensive dissections are managed surgically. We present a case report of a 50-year-old woman who underwent PCI for an ST-elevation myocardial infarction that resulted in an extensive IAD from the ostium of the right coronary artery to the aortic root, ascending aorta, and aortic arch. While the current evidence strongly supports surgical management of such extensive dissection, our patient was successfully managed conservatively with complete resolution according to short-term computed tomography imaging. This case suggests that conservative management may be a reasonable approach for select patients with extensive IAD.
The use of touch in developing a therapeutic relationship
Authors: Stonehouse David
Published: January 2017

The use of touch within health and social care is the focus of this article. The different types of touch will first be defined, before moving on to examine the many benefits that expressive touch can bring to the health and social care role and to developing a supportive therapeutic relationship between the support worker and their patient. Relevant sections of the Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England ( Skills for Care and Skills for Health, 2013 ) will be highlighted throughout. The important aspects of communication, compassion and empathy will be explored. Touch is not always appropriate or welcomed by the patient, and the support worker must take into account preferences, cultural needs and beliefs while also gaining consent.
Motivations and influences acting on women choosing a homebirth: Seeking a ‘cwtch’ birth setting
Authors: Meredith Dawn , Hugill Kevin
Published: January 2017

The opportunity to have a homebirth in the UK is highly regarded by both women and midwives. However, few women avail themselves of this birth option. Appreciating the multifarious explanations for why this is the case is fundamental to understanding the situation. Factors that motivate women surrounding homebirth include: past experience; beliefs about childbirth and motherhood; and external and interpersonal influences. This article reviews the influences that affect women when deciding on a homebirth. The authors support the idea that fundamental drivers operate; essentially, women are seeking places of emotional and physical safety for birth. This phenomenon is difficult to encapsulate in one English word, but other languages express this concept well. We borrow a popularised word (used as a noun and verb) from the Welsh lexicon to summarise ideas about women's desires regarding place of birth: in effect, women are seeking a cwtch birth setting.
As a midwife ‘you must respect a woman's right to confidentiality’: A Northern Ireland perspective
Authors: Duff Hayley , Patterson Dorothy
Published: January 2017

Within the role of a registered midwife, the issue of maintaining confidentiality is complex. A midwife's responsibility is outlined and governed by laws such as the Human Rights Act 1998 and the Data Protection Act 1998. The ideology of confidentiality is further reinforced by the Nursing and Midwifery Council, and should not cause the midwife undue pressure or stress; however, it often becomes a cause for concern. Midwives in Northern Ireland may carry out their role in environments that are not well suited for preserving confidentiality or sharing sensitive information. Conflict may arise for midwives in maintaining women's confidentiality while also having a duty of care to protect the public. In today's climate, many midwives experience a fear of litigation, so the importance and complexity of confidentiality must not be underestimated.
New year and the promise of new life
Authors: Page Lesley
Published: January 2017

The start of a new year is an ideal time to reflect on past achievements and look forward to new ideas and ways of working. Lesley Page shares her thoughts on the direction of midwifery in 2017.
Parental access to children's records: Considerations for midwives
Authors: Griffith Richard
Published: January 2017

Midwives work in partnership with women and sometimes, if the person in a midwife's care is a minor, with their parents. Richard Griffith discusses considerations regarding access to records.
Plastics, pregnancy and precaution
Authors: Winter George F
Published: January 2017

The precautionary principle advocates avoiding potential risks even in the absence of clear evidence of cause and effect. George Winter explores how this relates to pregnant women using everyday items.
International nursing: reflections on working in Sierra Leone
Authors: Jones Sergeant Julie
Published: January 2017

Registered Nurse, 4626 (AE) Sqn, RAuxAF, RAF Brize Norton/Nurse Practitioner, Center Parcs Sherwood Forest, Nottinghamshire looks back over her time working in A&E in Sierra Leone
Ensuring care quality at a time of diminishing resources
Authors: Tingle John
Published: January 2017

John Tingle, Reader in Health Law at Nottingham Trent University, discusses the Care Quality Commission's State of Health Care report, in the light of some important clinical negligence trends and reports on major safety failures
Uterotonics for post-partum haemorrhage
Authors: Wright Christian , Geraghty Sadie
Published: January 2017

The active management of the third stage of labour has been defined as the interval between the birth of the neonate and expulsion of the placenta, with the use of an oxytocic drug administered immediately after birth, early cord clamping and cutting, and controlled cord traction ( Deneux-Tharaux et al, 2013 ). Synthetic uterotonics are designed to stimulate contraction of the uterus, in order to prevent post-partum haemorrhage (PPH), as uterine atony accounts for 90% of primary PPH in woman globally ( Say et al, 2014 ). Oxytocin, Syntometrine, ergometrine, and misoprostol, remain the front line drug therapies used to prevent and manage this complication.
Drug-plant interactions: Herbs and beyond
Authors: Greener Mark
Published: January 2017

Herbal remedies are commonly used alongside conventional medicines, although often prescribers are unaware of the concomitant use. Some herbs, however, cause liver damage or potentially serious drug interactions. While fruit and vegetables are an important part of a healthy diet, chemicals in some plants we eat can also result in interactions. At least 85 drugs are known to possibly interact with grapefruit, for example. This article introduces the issues that prescribers need to be cognisant of, underscores the need to check the summary of product characteristics (SPC) and the British National Formulary (BNF), and highlights some limitations in the current evidence. For example, most interactions studies involve two drugs, usually in healthy volunteers, but patients often receive several drugs and have a range of diseases, some of which may influence metabolic capacity. At least 50 drugs are metabolised by the gut microbiota, although this is almost certainly an underestimate. Prescribers need to check the SPC and BNF for each drug and ask patients whether they use herbal remedies: patients often do not volunteer that they are taking herbs. Therefore, prescribers need to remain vigilant for potential interactions.
Newly qualified NMP: The challenges of primary care
Authors: Cox Ella
Published: January 2017

Ella Cox reflects on her time as a newly-qualified independent and supplementary prescriber, and discusses the improvements made and challenges she has faced along the way.
Las familias de SANAA. O cómo Kazuyo Sejima y Ryue Nishizawa responden a sus intereses arquitectónicos mediante secuencias de proyectos
Authors: Iborra Pallarés Vicente , Capdevila Castellanos Iván , Almazan Caballero Jorge
Published: January 2017

Tras el estudio de la producción arquitectónica de Kazuyo Sejima y Ryue Nishizawa se puede detectar la existencia de diversas temáticas recurrentes en su trabajo, algo que se evidencia en las secuencias de proyectos que comparten características que se definen como “relaciones de parentesco”. Este artículo muestra las relaciones existentes entre diversos proyectos que integran la producción arquitectónica de estos arquitectos japoneses, en base a esta serie de temáticas recurrentes: modos de agrupación y de compartimentación no jerárquicos, neutralización de la estructura, transformaciones geométricas-equivalencias topológicas y parques. Se emplean para ello técnicas de visualización gráfica que dan como resultado la construcción de un árbol taxonómico. Este método de representación muestra 43 de sus proyectos estudiados, las relaciones existentes entre los mismos y las temáticas recurrentes abordadas.
Profil Mikroorganisme Penyebab Sepsis Neonatorum di Departemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo Jakarta
Authors: Juniatiningsih Anita , Aminullah Asril , Firmansyah Agus
Published: January 2017

Latar belakang. Angka morbiditas dan mortalitas sepsis neonatorum (SN) masih tinggi. Pemberian antibiotiksesuai dengan hasil kultur diperlukan untuk mencegah resistensi kuman terhadap antibiotik.Tujuan. Mengetahui profil mikroorganisme penyebab SN serta sensitivitasnya terhadap antibiotik diDepartemen Ilmu Kesehatan Anak Rumah Sakit Cipto Mangunkusumo (IKA-RSCM) JakartaMetode. Studi potong lintang, dilakukan di ruang rawat Divisi Perinatologi Departemen IKA, pada Desember2006 - Juli 2007, pada neonatus tersangka sepsis untuk pertama kalinya, belum pernah mendapat antibiotiksebelumnya, tidak terdapat kelainan kongenital mayor dan mendapat persetujuan dari orang tua.Hasil. Terdapat 334 kasus tersangka SN, 102 kasus di antaranya memenuhi kriteria inklusi dan dapatdianalisis. Empat puluh dua kasus (41,2%) memiliki biakan darah positif. Mikroorganisme penyebab SNterbanyak adalah bakteri gram negatif seperti Acinetobacter calcoaceticus, Enterobacter aerogenes, Pseudomonassp dan Eschericia coli. Bakteri gram negatif mempunyai sensitivitas yang rendah terhadap antibiotik linipertama dan kedua, kecuali Enterobacter aerogenes yang masih sensitif terhadap gentamisin dan Pseudomonasyang masih sensitif terhadap seftazidim. Sensitivitas bakteri gram positif dan negatif umumnya masih sangatbaik terhadap meropenem. Sensitivitas bakteri gram negatif cukup baik terhadap imipenem namun bakterigram positif kurang sensitif terhadap imipenem.Kesimpulan. Etiologi SN umumnya adalah bakteri gram negatif dengan isolat terbanyak Acinetobactercalcoaceticus. Umumnya bakteri gram negatif mempunyai sensitivitas yang rendah terhadap antibiotik linipertama dan kedua, kecuali Enterobacter aerogenes yang masih sensitif terhadap gentamisin dan Pseudomonasterhadap seftazidim.
Saat Terbaik Pemberian Suplementasi Zat Besi pada Bayi 0 Bulan sampai 6 Bulan
Authors: Ringoringo Harapan Parlindungan , Wahidiyat Iskandar , Sutrisna Bambang , Setiabudy Rahayuningsih , Suradi Rulina , Setiabudy Rianto , Bardososono Sapatawati
Published: January 2017

Latar belakang. Anemia defisiensi besi (ADB) merupakan salah satu masalah kesehatan gizi di Indonesia. Survei kesehatan rumah tangga (SKRT) tahun 2001 menunjukkan prevalensi ADB pada bayi 0-6 bulan 61,3%.Tujuan. Mengetahui berapa insidens defisiensi besi dengan atau tanpa anemia, dan kapan mulai terjadi deplesi besi atau defisiensi besi sebelum terjadi ADB pada bayi berusia 0-6 bulan.Metode. Desain penelitian adalah studi kohort prospektif dengan pembanding eksternal. Di antara 211 bayi yang ikut penelitian, terdiri dari 143 bayi yang lahir dari ibu tanpa anemia dan 68 bayi yang lahir dari ibu dengan anemia. Pemeriksaan darah tepi lengkap, gambaran darah tepi, saturasi transferin (ST) dilakukan saat bayi berusia 0, 1, 2, 3, 4, 5, dan 6 bulan. Diagnosis ADB berdasarkan 1) kadar Hb <14g/dL untuk usia 0-3 hari, <11g/dL untuk usia 1 bulan, <10g/dL untuk usia 2-6 bulan, 2) mikrositik dan atau hipokrom, 3) kadar Hb meningkat setelah diberi terapi besi, 4) RDW >14%, 5) Indeks Mentzer >13; 6) Indeks RDW >22,0. Deplesi besi bila ST <30% untuk usia 0-1 bulan, ST <21% untuk usia 2-6 bulan. Defisiensi besi bila ST <20% untuk usia 0-1 bulan, ST <16% untuk usia 2-6 bulan.Hasil. Insidens deplesi besi, defisiensi besi, ADB berturut-turut 28,0, 27,0, dan 40,8%; artinya 95,8% bayi mempunyai status besi bermasalah. Insidens deplesi besi, defisiensi besi, ADB paling tinggi pada bayi berusia 0 bulan, berturut-turut 9,5, 14,2, dan 11,8%.Kesimpulan. Insidens deplesi besi, defisiensi besi, ADB paling tinggi pada bayi berusia 0 bulan. Suplementasi zat besi elemental dengan dosis 1 mg/kg/hari hendaknya diberikan pada semua bayi aterm sejak lahir.
Kepatuhan Berobat dengan Antibiotik Jangka Pendek di Poliklinik Umum Departemen Ilmu Kesehatan Anak Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Authors: Wibowo Rahmadi , Soedibyo Soepardi
Published: January 2017

Latar belakang. Kepatuhan berobat (compliance) merupakan masalah kompleks dan multifaktor yang dapat mempengaruhi hasil pengobatan. Sedangkan dampak dari ketidakpatuhan berobat (non-compliance) pada seseorang dapat mengakibatkan kesalahan dalam menilai efektivitas obat, uji diagnostik, perubahan atau penggantian obat, dan perawatan di rumah sakit yang sebenarnya tidak diperlukan.Tujuan. Mengetahui karakteristik pasien rawat jalan dalam kepatuhan menjalankan pengobatan antibiotik jangka pendek.Metode. Studi analitik deskriptif secara potong lintang, dilakukan di Poliklinik Umum Departemen IKA RSCM selama 12 minggu (Februari-April 2008) pada semua orangtua/wali pasien berusia 1 bulan-18 tahun yang mendapat pengobatan antibiotik jangka pendek. Sampel diambil secara consecutive sampling, data diolah dengan program SPSS ver 12 for windows.Hasil. Delapan puluh dua subjek ikut serta dalam penelitian. Angka kejadian kepatuhan berobat (compliance) dalam melaksanakan pengobatan antibiotik jangka pendek 75,6%. Terdapat korelasi kuat antara ”lupa” (adjusted OR 0,086, IK 95%; 0,019-0,378, p=0,001) dan ”sibuk” (adjusted OR 0,023, IK 95%; 0,003-0,153, p=0,000) dengan ketidakpatuhan berobat seseorang.Kesimpulan. Angka kejadian kepatuhan berobat dalam melaksanakan pengobatan antibiotik jangka pendek di Poliklinik Umum IKA RSCM adalah 75,6%. Lupa dan sibuk merupakan dua faktor yang sangat mempengaruhi kepatuhan berobat pasien.