bluuebunny/crossref_metadata_2025 huggingface dataset:
Patologia da icterícia obstrutiva
Authors: Leitão Regina M. C.
Published: December 2013

Neste artigo, são abordados dois aspectos da patologia da icterícia obstrutiva. O primeiro se refere à repercussão, a nível hepático, sendo analisadas as características morfológicas da colestase e seus principais marcadores, com ênfase no diagnóstico diferencial com causas intra-hepáticas e nas situações em que a biópsia hepática está indicada. O segundo destaca a importância do estudo anatomopatológico das doenças causadoras de obstrução extra-hepática, principalmente no diagnóstico diferencial entre colangiopatias inflamatórias e neoplásicas.
Condições adversas na vida de crianças com atraso no desenvolvimento
Authors: Graminha Sônia Santa Vitaliano , Martins Maria Angélica de Oliveira
Published: December 2013

O objetivo deste estudo foi o de identificar os fatores de risco a que foram expostas as crianças portadoras de atraso no desenvolvimento, encaminhadas ao Centro de Psicologia Aplicada da FFCLRP-USP, nos últimos cinco anos. O grupo ficou constituído por doze meninos e dez meninas, cujas idades variavam de um mês a oito anos. Os dados foram extraídos das entrevistas realizadas com as mães, no momento da inscrição da criança junto ao serviço. Os problemas referidos pelas mães, na queixa, bem como os eventos e as circunstâncias adversas relatados, na história de vida da criança, foram classificados de acordo com os Sistemas de Categorias elaborados pelas autoras desse estudo. Os resultados mostram que, além do atraso, aparecem referidos na queixa, com maior freqüência, os problemas de fala, coordenação motora, aprendizagem e agitação/inquietude. A análise das circunstâncias adversas, presentes na história de vida desse grupo de crianças, evidenciou que todas elas foram expostas a uma ou mais das condições de risco biológico, sendo as mais freqüentes: problemas congênitos, problemas de saúde física da mãe durante a gestação, problemas de saúde física da criança, crises convulsivas, complicações no parto e hospitalização. Além disso, observou-se que 36% das crianças havia sido exposta a fatores de risco ambiental, especialmente aqueles ligados a atitudes e práticas de cuidado e educação inadequadas. Com base nos resultados, discutem-se as implicações da presença do risco biológico como condição importante para o acesso da criança e da família a serviços especializados.
Intervenções psicológicas em pacientes com lombalgia crônica
Authors: Linton Steven J.
Published: December 2013

Lombalgia crônica é uma causa importante de incapacidade física e ausência do trabalho nos países ocidentais. O desconforto intenso associado a este sintoma não é satisfatoriamente aliviado pela terapêutica médica tradicional, levando ao desenvolvimento de terapias alternativas, incluindo avanços recentes nas intervenções psicológicas. Neste aspecto, discutimos aqui: 1) cinco técnicas comuns da abordagem comportamental-cognitiva (técnicas de relaxamento, operantes, cognitivas, de treinamento social e de aceitação; 2) o programa de treino de atividades operantes e 3) um caso clínico ilustrando a aplicação deste programa.
Cefaléias primárias
Authors: Sanvito Wilson Luiz , Monzillo Paulo Hélio
Published: December 2013

Nesta revisão, as cefaléias primárias são conceituadas como doenças crônicas, de apresentação episódica ou contínua, com etiologia desconhecida, mas de natureza disfuncional, não estrutural. As quatro principais formas de cefaléia primária (enxaqueca, cefaléia em salvas, tensional e crônica diária) são discutidas em seus aspectos etiopatogênicos, clínicos e terapêuticos.
Perdas fetais e natimortalidade no município de Ribeirão Preto-sp, Brasil, 1991 e 1992
Authors: Sardas Renato , Manço Amábile Rodrigues Xavier
Published: December 2013

No Município de Ribeirão Preto ocorreram 299 perdas fetais nos anos de 1991/92, sendo 165, em 1991, e 134, em 92, dos quais 148 eram masculinos, 134 femininos, 21 de sexo ignorado e 15 não declarados. Os óbitos fetais provenientes de outros municípios perfizeram 39,8% deste total. Em 103 Declarações de Óbito, o peso ao nascer não foi declarado. Com relação à duração de gestação, 142 casos (47,5%) tinham 28 ou + semanas, 52 (17,4%) situavam-se entre 20 e 27 semanas, em 105 casos (35,3%) a informação estava em branco ou assinalada como ignorada. A gestação única foi apontada em 46,8% dos casos e não declarada em 46,5%. A hipoxia intra-uterina foi apontada como causa básica de morte, em 41,8% dos casos.
Nutrição parenteral
Authors: Marchini Júlio Sérgio , Okano Nelson , Cupo Palmira , Passos Nilva Maria Rodrigues R. da Silva , Sakamoto Luiz Maçao , Basile-Filho Anibal
Published: December 2013

O suporte nutricional, na terapêutica de pacientes hospitalizados, requer o desenvolvimento de princípios que determinarão a melhor assistência nutricional, associada ao menor custo do procedimento. Reconhece-se, atualmente, o impacto causado pela formação de equipes ou comissões multidisciplinares de suporte nutricional parenteral, formadas por médicos, enfermeiros e farmacêuticos, sobre a racionalização da terapêutica nutricional, como a escolha de nutrientes específicos e a padronização das formulações nutritivas. O objetivo deste trabalho se relaciona com o uso de nutrição parenteral total, no Hospital das Clínicas de Ribeirão Preto, incluindo indicações, formulações, efeitos colaterais e benefícios. Paralelamente, é apresentada a padronização das formulações nutritivas parenterais, efetuada pela Comissão de Nutrição Parenteral do Hospital das Clínicas de Ribeirão Preto, a ser utilizada nos pacientes hospitalizados, que necessitem de terapia nutricional parenteral.
Complicações após aplicações, por via intramuscular, do diclofenaco de sódio
Authors: Cassiani Silvia H. B. , Rangel Silvia M. , Tiago Francisco
Published: December 2013

O uso da injeção intramuscular na terapêutica medicamentosa envolve, na atualidade, uma série de aspectos como: desvantagens quanto ao local, reações adversas e complicações surgidas após as injeções. Este estudo tem o objetivo de relatar o caso de uma paciente com complicações pós-aplicação de dezoito injeções de Diclofenaco de Sódio. As complicações apresentadas foram dermatológicas e musculares. Ao final, são discutidos cuidados a serem tomados na aplicação de injeções intramusculares, em especial, no uso de Diclofenaco de Sódio, a fim de se evitarem mais casos de complicações, após administração de medicações por via intramuscular.
Fisiologia e fisiopatologia respiratórias
Authors: Manço José Carlos
Published: December 2013

Este artigo é um texto introdutório de fisiologia e fisiopatologia respiratórias, direcionado para estudantes de Medicina e para um grupo bem definido de médicos que dedicam, pelo menos, parte de seu tempo às doenças respiratórias.
Cor pulmonale
Authors: Ota Jaquelina S. , Pereira Carlos Alberto de Castro
Published: December 2013

Nesta revisão, são discutidos aspectos etiológicos, clínicos, diagnósticos, terapêuticos e prognósticos da hipertensão pulmonar, levando a cor pulmonale.
Câncer de pulmão
Authors: Uehara César , Jamnik Sérgio , Santoro Ilka Lopes
Published: December 2013

Este artigo contém os fundamentos básicos para o diagnóstico, tratamento e conduta dos pacientes portadores do carcinoma broncogênico. Nele, ainda, descrevemos os conhecimentos mais recentes que são discutidos na literatura mundial. É voltado para graduandos, pós-graduandos de Pneumologia, pneumologistas e generalistas.
Síndrome do anticorpo antifosfolípide
Authors: Louzada Junior Paulo , Simon Selvio Machado , Voltarelli Júlio C. , Donadi Eduardo A.
Published: December 2013

A Síndrome do Anticorpo Antifosfolípide (SAF) foi descrita recentemente e está associada a episódios de trombose venosa e arterial recorrentes, abortamento de repetição e trombocitopenia e, menos freqüentemente, à anemia hemolítica auto-imune e a manifestações cutâneas, cardíacas e neurológicas. Nesta revisão, discutem-se a fisiopatologia, o quadro clínico, a classificação e o tratamento da SAF e se analisam sessenta e nove (69) casos atendidos em nosso serviço.
Monitorização hemodinâmica invasiva
Authors: Pereira Júnior Gerson Alves , Marson Flávio , Ostini Fátima M. , Antoniazzi Paulo , Gomide Mabel Duarte A. , Basile-Filho Anibal
Published: December 2013

O objetivo deste artigo é revisar todos os aspectos envolvidos na monitorização hemodinâmica invasiva do uso do cateter de Swan-Ganz. Esta prática, à beira do leito, será analisada em termos da sua indicação, da sua técnica de introdução, da verificação do seu posicionamento

¾ através do acompanhamento das ondas de pressão e de encunhamento, e da radiografia do tórax ¾  e do procedimento para as medidas hemodinâmicas, discutindo-se os principais fatores de erros que podem ser cometidos e as possíveis complicações do uso desse procedimento.
O papel da UTI no tratamento das fístulas entéricas
Authors: Jorge Filho Isac
Published: December 2013

As fístulas entéricas continuam representando complicações pós-operatórias, extremamente graves e respondem por relevante mortalidade. Seu tratamento depende de um trabalho planificado, executado por equipe multiprofissional. Medidas clínicas e cirúrgicas se complementam, já que, apesar da prioridade para o tratamento conservador, as intervenções cirúrgicas podem ser indispensáveis como medidas auxiliares, principalmente no combate à sepse. Ao longo do tratamento, o concurso do intensivista pode ser necessário, principalmente na fase inicial, quando o paciente pode apresentar importantes distúrbios hidroeletrolíticos, sépticos, ou cardiorrespiratórios. Em mais da metade dos pacientes, as fístulas se fecham espontaneamente com o tratamento conservador. O tratamento operatório definitivo, para o fechamento da fístula, fica reservado para os casos em que falharam os esforços para o fechamento espontâneo, mas só será realizado após o completo desaparecimento da sepse abdominal.
Sarcoma de Kaposi e síndrome da imunodeficiência adquirida
Authors: Fonseca Benedito A. L. , Bollela Valdes R. , Pires Neto Roberto da Justa
Published: December 2013

No início da década de 80, a síndrome da imunodeficiência adquirida foi reconhecida e descrita em homossexuais jovens, do sexo masculino, previamente saudáveis, acometidos por pneumopatia atípica causada por microorganismo oportunista, identificado como sendo o Pneumocystis carinii, e com lesões cutâneas vinhosas, nodulares, cujo estudo histopatológico revelou tratar-se de Sarcoma de Kaposi. O Sarcoma de Kaposi é a neoplasia mais freqüente em pacientes com infecção pelo vírus da imunodeficiência humana. Apesar de não totalmente esclarecida, sua fisiopatogenia tem sido associada à presença de um herpes vírus, de provável transmissão sexual, que estaria implicado no surgimento da doença. Esta revisão busca atualizar conceitos da fisiopatologia e tratamento desta condição grave e freqüente associada à infecção pelo HIV.
Infecção congênita e perinatal por citomegalovirus
Authors: Yamamoto Aparecida Yulie , Mussi-Pinhata Marisa M. , Figueiredo Luiz Tadeu Moraes
Published: December 2013

Citomegalovírus (CMV) é considerado o agente mais comum de infecção congênita e perinatal em todas as regiões do mundo. Esta revisão visa apresentar os principais aspectos clínicos, epidemiológicos, diagnósticos e de tratamento desta infecção em recém-nascidos e lactentes.
Acesso venoso central de longa duração
Authors: Carvalho Roberto M. , Joviliano Edwaldo E. , Kawano Marcelo Y. , Gomes Carlos A . P. , Souza Antonio C. de , Cherri Jesualdo , Moryia Takachi , Piccinato Carlos E.
Published: December 2013

Procedimentos, como o transplante de medula óssea, a quimioterapia, a nutrição parenteral total e a hemodiálise, exigem a necessidade cada vez maior do acesso venoso central de longa duração (AVCLD). Utilizam-se, de acordo com a indicação, cateteres totalmente implantáveis (com reservatório) e parcialmente implantáveis (Broviac-Hickman ). Foram avaliados setenta e nove (79) cateteres implantados, consecutivamente, em sessenta e seis (66) pacientes, tratados no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP, no período de janeiro de 1993 a junho de 1997. Avaliaram-se os seguintes parâmetros: indicação do acesso venoso, tipo de cateter implantado, técnica utilizada, complicações precoces e tardias e duração do implante. Dos sessenta e seis (66) pacientes, trinta e quatro (34) (51,5%) eram homens. A idade média foi de 28,2 anos. Houve predomínio de indicação de implante de cateter para realizar-se a quimioterapia em cinquenta e cinco (55) (69,5%) pacientes e transplante de medula óssea em doze (12) (15,2%). Foram implantados vinte e oito (28) (35,5%) cateteres com reservatório e cinqüenta e um (51) (64,5%) parcialmente implantáveis. Quanto à técnica utilizada, 71,4% foram implantados por punção percutânea e os demais por dissecção e cateterização venosa, a céu aberto. Ocorreram duas complicações relacionadas à técnica, nove (9) infecções e oito (8) oclusões tardias. A duração média da implantação dos cateteres foi trezentos e setenta e um (371) dias para os cateteres Broviac- Hickman e trezentos e noventa e cinco (395) para o totalmente implantável. Não houve óbito associado aos implantes. Os índices de complicações precoces e tardias, observadas nesta casuística, assemelham- se aos dados encontrados na literatura.
Métodos laboratoriais para o diagnóstico da infecção pelo vírus da imunodeficiência humana (HIV)
Authors: Machado Alcyone A. , Costa João Carlos da
Published: December 2013

Os autores revisam os principais métodos laboratoriais, atualmente conhecidos e disponíveis para o diagnóstico da infecção pelo Vírus da Imunodeficiência Humana (HIV), salientando as orientações gerais sobre sua aplicação e interpretação.
Clínica e tratamento das infecções pelos vírus herpes símplex tipo 1 e 2
Authors: Fonseca Benedito Antônio Lopes da
Published: December 2013

As infecções pelos vírus herpes símplex são conhecidas da raça humana desde a antiguidade. Estes vírus são responsáveis por uma gama de infecções que vão desde erupções cutâneas até quadros graves de encefalite. Atualmente, um antiviral específico para estes vírus, o aciclovir, está disponível para o tratamento destas infecções. Nesta revisão, o uso do aciclovir é discutido em relação às diversas manifestações da infecção herpética.
Abordagem psicoterápica da criança e da família no hospital das clínicas da faculdade de medicina de ribeirão preto - usp
Authors: Golfeto José H. , Mian Heloísa
Published: December 2013

A psicoterapia é um dos recursos utilizados na Psiquiatria Infantil, assim como a orientação familiar e a psicofarmacoterapia. Pode receber diferentes classificações de acordo com o fundamento teórico, alvo da intervenção e duração ou objetivo da terapia. Pretendemos fazer um relato da técnica psicoterápica, adotada no Ambulatório de Psiquiatria Infantil do Hospital das Clínicas da FMRP-USP, denominada de tempo limitado, assim como fazer um paralelo com técnicas utilizadas na psicoterapia longa. Relatamos, também, aspectos da orientação familiar por nós realizada. Os casos atendidos são previamente avaliados e, após discussão clínica, é feita a indicação dos procedimentos a serem adotados, que podem ser desenvolvidos isoladamente ou associados entre si.
Evocando a XIII semana de debates científicos - Ribeirão Preto, 1959
Authors: Oliveira José Alberto Mello de
Published: December 2013

Durante a década de cinqüenta, as Semanas Brasileiras de Debates Científicos representaram um importante evento, que reunia estudantes de medicina de todo o Brasil, paraapresentar e discutir trabalhos de pesquisa realizados como atividade extra-curricular de iniciação científica. Este texto recorda o congresso organizado pelo Centro Acadêmico Rocha Lima,em Ribeirão Preto, no ano de 1959, do qual participaram alguns estudantes que estão hoje entre pesquisadores brasileiros de nomeada.
Boomerangs to Partnerships? Explaining State Participation in Transnational Partnerships for Sustainability
Authors: Andonova Liliana B.
Published: December 2013

This article examines under what conditions states engage in transnational public–private partnerships for the environment. While there is hardly a disagreement in the literature on the rise of transnational actors and new modes of collaborative governance, their interaction with and impact on state institutions remain debated and insufficiently illuminated by empirical research. Some scholars of globalization interpret transnational partnerships as evidence of state insufficiency and retreat, others emphasize the continued primacy of state power in manipulating old and new institutional arenas, still other scholars anticipate the “rearticulation” of the state to partake in new governance. This study is one of the first to examine theoretically and empirically, using a sample of some 230 partnerships, how domestic capacity, the constituencies of transnational actors, as well as international donors and institutions shape the variable rearticulation of the state to partake in partnerships. A comparative case study of Brazil and Russia provides further detail on the political dynamics that enable or constrain state-society collaborations for the environment.
Improving Social Well-Being Through New Democratic Institutions
Authors: Touchton Michael , Wampler Brian
Published: December 2013

We evaluate the role of a new type of democratic institution, participatory budgeting (PB), for improving citizens’ well-being. Participatory institutions are said to enhance governance, citizens’ empowerment, and the quality of democracy, creating a virtuous cycle to improve the poor’s well-being. Drawing from an original database of Brazil’s largest cities over the last 20 years, we assess whether adopting PB programs influences several indicators of well-being inputs, processes, and outcomes. We find PB programs are strongly associated with increases in health care spending, increases in civil society organizations, and decreases in infant mortality rates. This connection strengthens dramatically as PB programs remain in place over longer time frames. Furthermore, PB’s connection to well-being strengthens in the hand of mayors from the nationally powerful, ideologically and electorally motivated Workers’ Party. Our argument directly addresses debates on democracy and well-being and has powerful implications for participation, governance, and economic development.
Pedagogy for Liberation
Authors: Fiore Mia
Published: December 2013

The Black Arts Movement of the 1960s and 1970s, hip hop of the 1980s and early 1990s, and spoken word poetry have each attempted to initiate the dialogical process outlined by Paulo Freire as necessary in overturning oppression. Each art form has done this by critically engaging with the world and questioning dominant systems of power. However, unlike the Black Arts Movement and early hip hop, spoken word—with its growing foothold in urban classrooms and contemporary culture—may be in a unique position to facilitate unprecedented social change by providing students with a platform from which to question and negotiate the conditions of their lives.
The Japanese tourist survival guide: Undead tropes of the Pacific War in contemporary New Zealand literature
Authors: McKay Daniel
Published: December 2013

During the 1980s Japanese corporations acquired a strong foothold in the American market, prompting media commentators to speculate that American society was being undermined by an encroaching Japanese “takeover”. Employing a comparative approach, I place New Zealand source material in conversation with an American cultural context in order to expose the mobility and malleability of Japanophobic discourses. New Zealand culture provides a basis for comparison in that the nation contained no hi-tech or car manufacturing industries, and yet writers there took issue with the presence of Japanese tourists and their increasing purchasing power. Writers Keri Hulme and Vivienne Plumb portrayed the Japanese as vampires and body-snatchers, while Ian Middleton suggested that the Japanese were seeking an escape from modern culture into an “untouched”, pre-modern environment. These features set New Zealand writing apart from the thriller genre adopted by Michael Crichton, Steven Schlossstein, and Tom Clancy. But in spite of these differences, a crosscurrent runs through both the New Zealand and American sources, making them more alike than not — that is, they all hark back to the wartime tropes of the Pacific War, which were reinstated within the context of the 1980s.
The Periductal Channels of the Endolymphatic Duct, Hydrodynamic Implications
Authors: Linthicum Fred H. , Doherty Joni , Webster Paul , Makarem Andres
Published: December 2013

Objective

To describe the anatomy of a small network of channels surrounding the human endolymphatic duct.

Study Design

Archival temporal bone sections and a surgical specimen were studied using a variety of techniques.

Setting

Temporal bone laboratory of the House Research Institute.

Subjects and Methods

Archival temporal bone sections were examined by light microscopy, 3D reconstruction, and immunohistochemical labeling. A surgical specimen was examined using electron microscopy. Sections from temporal bones with blocked endolymphatic ducts or amputated sacs were examined for the manifestations of endolymphatic hydrops.

Results

Peri‐endolymphatic duct channels were found to extend from the proximal cisternal part of the endolymphatic sac to the supporting tissue of the saccule and utricle. Tissue in the channels, as seen by conventional and electron microscopy, is continuous with and identical with the tissue surrounding the endolymphatic duct. Tissue in the channels labels with the S100 antibody similar to the spiral ligament and supporting tissue of the vestibular end organs and suggests a neural crest origin, as did the presence of melanocytes. Obstruction of the endolymphatic duct resulted in endolymphatic hydrops whereas amputation of the sac did not.

Conclusion

Endolymph is probably absorbed in the endolymphatic duct. The peri‐endolymphatic duct channels that extend from the proximal sac to the supporting tissue of the saccule label with the S100 antibody and contain melanocytes suggest a neural crest origin and involvement in fluid and potassium hydrodynamics similar to those described for the similarly staining spiral ligament of the cochlea.
Bone Ablation without Thermal or Acoustic Mechanical Injury via a Novel Picosecond Infrared Laser (PIRL)
Authors: Jowett Nathan , Wöllmer Wolfgang , Reimer Rudolph , Zustin Jozef , Schumacher Udo , Wiseman Paul W. , Mlynarek Alex M. , Böttcher Arne , Dalchow Carsten V. , Lörincz Balazs B. , Knecht Rainald , Miller R. J. Dwayne
Published: December 2013

Background and Objective

A precise means to cut bone without significant thermal or mechanical injury has thus far remained elusive. A novel non‐ionizing ultrafast pulsed picosecond infrared laser (PIRL) may provide the solution. Tissue ablation with the PIRL occurs via a photothermal process with thermal and stress confinement, resulting in efficient material ejection greatly enhanced through front surface spallation photomechanical effects. By comparison, the Er:YAG laser (EYL) ablates via photothermal and cavitation‐induced photomechanical effects without thermal or acoustic confinement, leading to significant collateral tissue injury. This study compared PIRL and EYL bone ablation by infrared thermography (IRT), environmental scanning electron microscopy (ESEM), and histology.

Study Design

Prospective, comparative, ex vivo animal model.

Setting

Optics laboratory.

Subjects and Methods

Ten circular area defects were ablated in ex vivo chicken humeral cortex using PIRL and EYL at similar average power (~70 mW) under IRT. Following fixation, ESEM and undecalcified light microscopy images were obtained and examined for signs of cellular injury.

Results

Peak rise in surface temperature was negligible and lower for PIRL (1.56°C; 95% CI, 0.762‐2.366) compared to EYL ablation (12.99°C; 95% CI, 12.189‐13.792) (P <. 001). ESEM and light microscopy demonstrated preserved cortical microstructure following PIRL ablation in contrast to diffuse thermal injury seen with EYL ablation. Microfractures were not observed.

Conclusion

Ablation of cortical bone using the PIRL generates negligible and significantly less heat than EYL ablation while preserving cortical microstructure. This novel laser has great potential in advancing surgical techniques where precision osseous manipulation is required.
Chronic Pepsin Exposure Promotes Anchorage‐Independent Growth and Migration of a Hypopharyngeal Squamous Cell Line
Authors: Kelly Elizabeth A. , Samuels Tina L. , Johnston Nikki
Published: December 2013

Outcome Objectives

(1) Investigate the role of reflux, specifically pepsin, in laryngopharyngeal carcinogenesis. (2) Evaluate effects of chronic pepsin exposure on cell migration, apoptosis, and colony‐forming ability in hypopharyngeal cells.

Study Design

Translation research.

Setting

Academic research laboratory.

Methods

Human hypopharyngeal squamous carcinoma FaDu cells were chronically exposed to nonacidic pepsin (exposed for 24 hours, 4 times over 2 weeks at the following concentrations: 0.01 mg/mL, 0.1 mg/mL, or 1 mg/mL). Precise wounds were created in confluent cell plates, and rates of cell migration into wounds were quantified. Separately, cell viability of chronic pepsin‐exposed FaDu cells acutely treated with paclitaxel was measured. Finally, a clonogenic assay was performed on these cells to measure effects of chronic pepsin exposure on colony‐forming ability.

Results

An increased rate of relative wound density was observed in chronic pepsin‐treated (0.01 mg/mL, 0.1 mg/mL) cells compared with control (P <. 001), suggesting greater rates of cell migration. Pepsin‐treated (0.1 mg/mL) cells demonstrated on average greater cell viability compared with control after exposure to paclitaxel, suggesting possible apoptotic resistance; however, this was not statistically significant. Chronic pepsin exposure (0.1 mg/mL, 1 mg/mL) was associated with a dose‐dependent increase in colony‐forming ability relative to control (P <. 001).

Conclusion

Hypopharyngeal squamous cell line chronically exposed to pepsin demonstrated increased cell migration and colony‐forming ability relative to control cells. These experiments indicate that chronic pepsin exposure acts as a promoter of tumorigenesis and metastasis of airway epithelium, suggesting a role for pepsin in laryngopharyngeal carcinogenesis attributed to gastric reflux.
Usefulness of Sleep Endoscopy in Predicting Positional Obstructive Sleep Apnea
Authors: Victores Andrew J. , Hamblin John , Gilbert Janet , Switzer Christi , Takashima Masayoshi
Published: December 2013

Objectives

The aim of the study was to (1) evaluate whether position affects drug‐induced sleep endoscopy (DISE) findings in positional and nonpositional patients and (2) determine which areas of the upper airway obstruct in different body positions.

Study Design

Prospective, case‐controlled study.

Setting

Academic tertiary care center.

Subjects and Methods

Twenty‐two patients with obstructive sleep apnea (OSA) were enrolled. Two groups were individually recruited to make 11 consecutive patients with positional OSA and 11 consecutive patients with nonpositional OSA. Positional OSA was defined by nonsupine 50% reduction in apnea‐hypopnea index. DISE was performed with patients in both lateral and supine sleep positions. Upper airway collapse was compared between the sleep positions and between the 2 groups.

Results

Most patients (77%) demonstrated multilevel obstruction on DISE. Nearly all patients with positional OSA (91%) had at least a partial improvement in collapse while in the lateral sleep position. Most of the reduction in collapse involved the tongue base and epiglottis (P <. 05). Sleep position did not significantly alter the upper airway morphology of patients with nonpositional OSA. Apnea‐hypopnea index and body mass index were not significantly different between the 2 groups.

Conclusions

Sleep position can change upper airway morphology on DISE, particularly positional OSA patients. Hypopharyngeal collapse was the primary site that improved with change in position. DISE in multiple sleep positions should be considered as part of a minimally invasive approach to surgical therapy of OSA.
Biomechanical Validation of Load-Sharing Rip-Stop Fixation for the Repair of Tissue-Deficient Rotator Cuff Tears
Authors: Burkhart Stephen S. , Denard Patrick J. , Konicek John , Hanypsiak Bryan T.
Published: December 2013

Background:

Poor-quality tendon is one of the most difficult problems the surgeon must overcome in achieving secure fixation during rotator cuff repair. A load-sharing rip-stop construct (LSRS) has recently been proposed as a method for improving fixation strength, but the biomechanical properties of this construct have not yet been examined.

Purpose:

To compare the strength of the LSRS construct to that of single-row fixation for rotator cuff repair.

Study Design:

Controlled laboratory study.

Methods:

Rotator cuff tears were created in 6 cadaveric matched-pair specimens and repaired with a single row or an LSRS. In the LSRS repair, a 2-mm suture tape was placed as an inverted mattress stitch in the rotator cuff, and sutures from 2 anchors were placed as simple stitches that passed medial to the suture tape. The suture tape limbs were secured with knotless anchors laterally before sutures were tied from the medial anchors. Displacement was observed with video tracking after cyclic loading, and specimens were loaded to failure.

Results:

The mean load to failure was 371 ± 102 N in single-row repairs compared with 616 ± 185 N in LSRS repairs ( P = .031). There was no difference in displacement with cyclic loading between the groups (3.3 ± 0.8 mm vs 3.5 ± 1.1 mm; P = .561). In the single-row group, 4 of 6 failures occurred at the suture-tendon interface. In the LSRS group, only 1 failure occurred at the suture-tendon interface.

Conclusion:

The ultimate failure load of the LSRS construct for rotator cuff repair was 1.7 times that of a single-row construct in a cadaveric model.

Clinical Relevance:

The LSRS rotator cuff repair construct may be useful in the repair of difficult tears such as massive tears, medial tears, and tears with tendon loss.
The Escalation of Ethnonationalist Radicalization
Authors: Neumann Martin
Published: December 2013

This article describes an agent-based simulation model of ethnonationalist radicalization between political actors and their constituencies based upon evidence from the former Yugoslavia. The central mechanism is the recursive feedback between political and cultural dynamics, focusing on processes prior to the outbreak of actual violence. The results offer theoretical insights by revealing mechanisms that lead to escalation. These can be found within politics as well as among the population: between conflicting ethnically homogeneous regions, opposing radicalization forces fuel an escalation spiral. These processes are driven by political influences. Challenging the theory that diversity breeds conflict, this suggests that multiethnic regions are more capable of withstanding political pressures. However, they are vulnerable to imported violence, driven by the local population. This finding is tested with a different model of the same events, in which different implemented mechanisms generate results, in line with the diversity-breeds-conflict theory. A comparative discussion demonstrates how simulation is sensitive to theoretical predispositions.
Comparison of Oral Vancomycin Capsule and Solution for Treatment of Initial Episode of Severe Clostridium difficile Infection
Authors: Bass Stephanie N. , Lam Simon W. , Bauer Seth R. , Neuner Elizabeth A.
Published: December 2013

Objective:

Vancomycin is recommended as a first-line therapy for severe Clostridium difficile infection (CDI). Due to the high cost of commercially available vancomycin capsules, hospitals frequently compound oral solution despite a lack of data comparing outcomes. This study was conducted to determine treatment outcome differences based on oral vancomycin formulation.

Methods:

Medical charts of 76 patients with an initial episode of severe CDI receiving oral vancomycin as a commercially available capsule or a compounded oral solution for at least 72 hours were retrospectively reviewed. The primary objective was to compare the time to clinical cure of CDI.

Results:

Baseline characteristics between groups were similar except for the median lactate, which was higher in compounded oral solution group (1.5 vs 0.6 mmol/L, P < .001). There was no difference in clinical cure at day 10 (64% solution vs 59% capsules, P = .664). Median time to clinical cure was 8 days for solution and 7 for capsules ( P = .597). After adjustment, the hazard ratio of time to clinical cure for solution compared to capsules was 1.15 ( P = .69). No significant differences in mortality, recurrence, or complications were noted.

Conclusion:

Formulation of oral vancomycin did not impact treatment outcomes in this retrospective study.
Local public goods as vote-purchasing devices? Persuasion and mobilization in the choice of clientelist payments
Authors: Rosas Guillermo , Johnston Noel P , Hawkins Kirk
Published: December 2013

We consider the behavior of an incumbent that can deploy local public goods and private goods to buy votes, and is unable to verify vote choice but capable of monitoring voter turnout, a common scenario in secret-ballot polities. As advanced by recent literature, the ability to monitor turnout rather than vote choice implies that politicians should use targetable private goods to mobilize voters. However, politicians also deploy non-excludable local public goods, which have low mobilization potential because of free-rider incentives. We argue that vote-buying politicians reserve local public goods for loyal constituencies (where they enjoy support from most voters that bother to turn out) and provide private goods in other constituencies where they gain from motivating less committed supporters to turn out. We test aggregate-level implications of our theory on Venezuela’s social programs.
Wheel reprofiling of a high-speed electric-multiple-unit train based on a multi-objective optimization strategy
Authors: Lu Zhenggang , Zhang Baoan , Wang Hengliang
Published: December 2013

An approach to optimize the wheel reprofiling of a high-speed electric multiple unit (EMU) train is presented; it has three functions as objectives: the critical speed of the train, the contact stress that affects the contact fatigue of wheel/rail wear and the diameter of the nominal rolling circle of the wheel. The vertical coordinates of the control points on the curve of the wheel profile are used as design variables and the upper and lower values of each control point are utilized as additional limiting conditions of the curve, with the height, thickness and contact angle of the wheel flange as well as the derivative of the curve acting as constraints on the geometry parameters. A multi-objective optimization model is established for the wheel reprofiling of a high-speed EMU train; three models are created: standard, worn and optimized wheel profiles. Comparisons of wheel/rail contact, running stability and curving performance of the vehicle are performed. It is shown that the wheel profile obtained from the reprofiling optimization model satisfies the constraints and its corresponding dynamic performance has a good agreement with that of a standard wheel profile with a 30 mm thick wheel flange. A performance close to that of a standard wheel profile can be obtained even though the worn wheel is not reprofiled to have the standard profile. Also, the amount of diameter reduction in the direction of the nominal rolling circle is reduced and service life-time is extended by employing the proposed wheel reprofiling approach based on the multi-objective optimization strategy.
Relation of Environmental and Self-Career Exploration With Career Decision-Making Difficulties in Chinese Students
Authors: Xu Hui , Hou Zhi-Jin , Tracey Terence J. G.
Published: December 2013

The relationship of environmental exploration (EE) and self-exploration (SE) with three dimensions of career decision-making difficulties was examined in a sample of Chinese college students ( N = 911) using a structural equation modeling model comparison approach. Results indicated that neither self- nor environmental exploration predicted lack of readiness difficulties, but both were equally predictive of information-deficit problems. Finally, only SE was predictive of information inconsistency. The implications of this study are discussed and suggestions for future research are provided.
Ankle Arthroscopy
Authors: Zaidi Razi , Hasan Kamrul , Sharma Aadhar , Cullen Nicholas , Singh Dishan , Goldberg Andrew
Published: December 2013

Background:

More than 10 000 ankle arthroscopy procedures are performed in the United Kingdom annually. Tourniquet use is thought to allow improved visibility and reduce operative time. However this is not without risk as it predisposes to neurovascular injury. The purpose of our study was to establish the feasibility of a subsequent larger randomized controlled trial, to test the hypothesis that tourniquet use might be unnecessary in ankle arthroscopy.

Methods:

We performed a prospective nonrandomized case control study on 63 patients undergoing ankle arthroscopy to assess the feasibility of a randomized control trial comparing tourniquet versus no tourniquet. All patients had a tourniquet placed on the thigh and a standard arthroscopic technique. In 1 group (n = 31) the tourniquet was routinely inflated, whereas in a second group (n = 32) the tourniquet was not inflated. Demographic data, intraoperative fluid pressures, and visibility were recorded, as were any intraoperative or postoperative complications.

Results:

There were no significant differences between the 2 groups with respect to duration of operation, maximum intraoperative fluid pressures or visibility, and postoperative complications. In no cases where a tourniquet was not used did the surgeon need to inflate the tourniquet during the case.

Conclusion:

Most orthopaedic surgeons continue to use a tourniquet routinely for ankle arthroscopy, presumably on the belief that a clear operative view can be achieved only with a tourniquet. The findings of our feasibility study revealed that ankle arthroscopy was possible without the use of a tourniquet. We propose a randomized clinical trial to determine the best option for patient care.

Level of Evidence:

Level III, comparative series.
Exercise Guidelines for Patients With Parkinson’s Disease
Authors: McGraw Samantha M. , Hoover Donald L. , Shirey Matthew P.
Published: December 2013

Parkinson’s disease (PD) is a progressive neurological condition with no known cure. This disease progression is characterized by severe motor degeneration that often limits functional mobility during gross motor skills common in activities of daily living, work, and recreation. Exercise programs have been shown to slow symptom onset and lessen the progression of PD, helping to improve quality of life of individuals with this condition. This article provides an overview of recent studies addressing the impact of exercise programs on individuals with PD, and also provides home health care professions with suggestions for exercise program implementation within this clinical population.
Are the Elderly Responsive in Their Savings Behavior to Changes in Asset Limits for Medicaid?
Authors: Greenhalgh-Stanley Nadia
Published: December 2013

In light of recent policy discussions aimed at reforming Medicaid, it is important to understand how the elderly respond to changes in the incentives of Medicaid. This article estimates the effect of a decrease in the implicit tax of holding assets brought about by the Medicare Catastrophic Coverage Act of 1988. Using the Health and Retirement Study (HRS), I find that a $1 increase in state asset protections increased median total wealth holdings by $0.20, financial wealth by $0.04, and home equity by $0.27. As expected, larger responses are found for residents of states with income limits in place prior to the law change and for states that chose the highest level of protected resource amounts.
‘You’re making our city look bad’: Olympic security, neoliberal urbanization, and homeless youth
Authors: Kennelly Jacqueline
Published: December 2013

Drawing on ethnographic research with homeless and street-involved youth in Vancouver before, during, and after the 2010 Olympic Games, this article offers a portrait of neoliberal urbanization as experienced by a city’s most marginalized residents. Taking as paradigmatic the aspirational goals of Olympic host cities to enhance their reputation as ‘global cities’, the article explores what this means for homeless youth through three processes: city cleansing, city marketing, and self-regulation. Examining how each of these are imbricated with policing and security practices, the article offers an in-depth look at how these abstractions are lived by homeless youth in the everyday. The article concludes by suggesting that marginalized young people are not the beneficiaries of Olympic legacies, despite promises made by organizing committees. In contrast, findings indicate that homeless young people are further marginalized by the Olympics, providing support for previous research that aligns mega-events with neoliberal outcomes.
Screencasts: How effective are they and how do students engage with them?
Authors: Morris Cecile , Chikwa Gladson
Published: December 2013

The use of screencasts as an instructional technology is increasing rapidly in higher education. While there appears to be a consensus around students’ satisfaction with the provision of technology-enhanced tools, there is limited evidence revolving around their impact in terms of knowledge acquisition. Moreover, the reasons why students choose to engage (or not) with these resources remain largely unreported. The study assessed the effect of using screencasts on undergraduate students’ understanding and engagement with learning material in one of their modules. Customised screencasts were used as optional additional learning and teaching resources. Grades obtained in a test module (with screencasts) and a control module (without screencasts) were compared to gauge the impact of screencasts on knowledge acquisition. Furthermore, the reasons for students’ engagement (or lack thereof) with the screencasts were explored using questionnaires. A modest but significant impact of screencasts on knowledge acquisition was found, and students’ perception of the screencasts was overwhelmingly positive. Students suggested that screencasts should be kept short to summarise lectures or delve in-depth into complex concepts but should not replace whole lectures. Reasons for not using screencasts revolved around a lack of understanding of what the resources were and also a reported lack of fit between the nature of the tool and self-assessed learning style.
The experience of family carers attending a joint reminiscence group with people with dementia: A thematic analysis
Authors: Melunsky Nina , Crellin Nadia , Dudzinski Emma , Orrell Martin , Wenborn Jennifer , Poland Fiona , Woods Bob , Charlesworth Georgina
Published: December 2013

Reminiscence therapy has the potential to improve quality of life for people with dementia. In recent years reminiscence groups have extended to include family members, but carers’ experience of attending joint sessions is undocumented. This qualitative study explored the experience of 18 family carers attending ‘Remembering Yesterday Caring Today’ groups. Semi-structured interviews were transcribed and subjected to thematic analysis. Five themes were identified: experiencing carer support; shared experience; expectations (met and unmet), carer perspectives of the person with dementia’s experience; and learning and comparing. Family carers’ experiences varied, with some experiencing the intervention as entirely positive whereas others had more mixed feelings. Negative aspects included the lack of respite from their relative, the lack of emphasis on their own needs, and experiencing additional stress and guilt through not being able to implement newly acquired skills. These findings may explain the failure of a recent trial of joint reminiscence groups to replicate previous findings of positive benefit. More targeted research within subgroups of carers is required to justify the continued use of joint reminiscence groups in dementia care.
Perceptual Relearning of Binocular Fusion and Stereoacuity After Brain Injury
Authors: Schaadt Anna-Katharina , Schmidt Lena , Reinhart Stefan , Adams Michaela , Garbacenkaite Ruta , Leonhardt Eva , Kuhn Caroline , Kerkhoff Georg
Published: December 2013

Background. Brain lesions may disturb binocular fusion and stereopsis, leading to blurred vision, diplopia, and reduced binocular depth perception for which no evaluated treatment is currently available. Objective. The study evaluated the effects of a novel binocular vision treatment designed to improve convergent fusional amplitude and stereoacuity in patients with stroke or traumatic brain injury (TBI). Methods. Patients (20 in all: 11 with stroke, 9 with TBI) were tested in fusional convergence, stereoacuity, near/far visual acuity, accommodation, and subjective binocular reading time until diplopia emerged at 6 different time points. All participants were treated in a single subject baseline design, with 3 baseline assessments before treatment (pretherapy), an assessment immediately after a 6-week treatment period (posttherapy), and 2 follow-up tests 3 and 6 months after treatment. Patients received a novel fusion and dichoptic training using 3 different devices to slowly increase fusional and disparity angles. Results. At pretherapy, the stroke and TBI groups showed severe impairments in convergent fusional range, stereoacuity, subjective reading duration, and partially in accommodation (only TBI group). After treatment, both groups showed considerable improvements in all these variables as well as slightly increased near visual acuity. No significant changes were observed during the pretherapy and follow-up periods, ruling out spontaneous recovery and demonstrating long-term stability of binocular treatment effects. Conclusions. This proof-of-principle study indicates a substantial treatment-induced plasticity of the lesioned brain in the relearning of binocular fusion and stereovision, thus providing new, effective rehabilitation strategies to treat binocular vision deficits resulting from permanent visual cortical damage.