bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Esophageal Mixed Sarcomatoid and Small Cell Neuroendocrine Carcinoma With Brain Metastasis: A Challenging Diagnosis on Biopsy
Authors: Schwartz Christopher J. , Hickman Richard , Zhang Xuchen , Galvao Neto Antonio , Adler Esther
Published: July 2018

Mixed carcinomas in the esophagus are highly uncommon neoplasms that represent a diagnostic challenge on small tissue biopsies. We present a case of a primary mixed sarcomatoid–small cell carcinoma of the esophagus that was diagnosed after repeat sampling of the lesion. The components were morphologically distinct and could be further classified by immunohistochemistry. Next-generation sequencing identified mutations in PIK3CA and CDKN2A. The small cell component morphology was also identified in brain metastasis.
Reconsidering the LGBT Climate Inventory: Understanding Support and Hostility for LGBTQ Employees in the Workplace
Authors: Holman Elizabeth Grace , Fish Jessica N. , Oswald Ramona Faith , Goldberg Abbie
Published: July 2018

Workplace climate matters significantly for lesbian, gay, bisexual, queer, or other sexual minority (LGBQ) employees, given that the presence of workplace hostility or support can affect well-being. The Lesbian, Gay, Bisexual, and Transgender Climate Inventory (LGBTCI) is a measure of workplace climate for LGBQ individuals, intended to capture the full range of workplace climate from hostility to support. The purpose of this article is to provide evidence that the recommended scoring approach of the LGBTCI needs to be reconsidered. We used latent class analysis to estimate classes of work-related experiences in our sample of 442 LGBQ employees who completed the LGBTCI. A four-class solution fit the data best. Characteristics of each class were identified and consequently labeled: supportive work climate, tolerant work climate, ambiguous work climate, and hostile work climate. Findings suggest that a more accurate measure of workplace climate would include independent scales for support and hostility.
Comparison of Lateralizing Calcaneal Osteotomies for Varus Hindfoot Correction
Authors: An Tonya W. , Michalski Max , Jansson Kyle , Pfeffer Glenn
Published: July 2018

Background:

There is limited consensus on the optimal operative technique for correcting heel varus in patients with Charcot-Marie-Tooth (CMT) disease. This comparative study evaluated the ability of 4 lateralizing calcaneal osteotomies, with and without Dwyer wedge resection and coronal rotation of the posterior tuberosity, to correct severe heel varus.

Methods:

The computed tomography (CT) scan of a teenage CMT patient with severe hindfoot varus was used to create 3-dimensional (3D)–printed models of the talus, calcaneus, and cuboid. A custom jig facilitated precise replication of the osteotomy cuts. Four different configurations were created: oblique osteotomy with lateralization, oblique osteotomy with lateralization and internal rotation of the posterior tuberosity, Dwyer wedge resection with lateralization, and Dwyer wedge resection with lateralization and internal rotation. CT scans were performed on each model before and after osteotomy. Statistical analysis was used to evaluate differences in several predefined radiographic parameters.

Results:

The sequential transformations generated increasing lateral translation of the weight-bearing calcaneus. Dwyer wedge osteotomy significantly improved lateralization (effect = 8.0 mm), valgus hindfoot angle (effect = 6.1 degrees), and coronal calcaneal tilt (effect = −17.6 degrees) compared with the oblique osteotomy. Internal rotation of the posterior tuberosity further improved lateralization (effect = 3.3 mm), valgus hindfoot angle (effect = 2.5 degrees), and coronal calcaneal tilt (effect = −11.7 degrees). Dwyer osteotomy models had on average 5-mm shorter posterior tuberosity lengths than the oblique osteotomies. The addition of rotation did not significantly affect length.

Conclusions:

Significant lateralization of the posterior tuberosity was achieved in all transformations. The Dwyer wedge osteotomy improved hindfoot valgus angle, coronal calcaneal tilt, and lateralization of the weight-bearing surface compared with oblique osteotomy. Posterior tuberosity internal rotation further lateralized the plantar surface and normalized weight bearing. Lateralization, combined with Dwyer osteotomy and coronal plane internal rotation, achieved the greatest correction of varus heel.

Clinical Relevance:

This study compares multiple lateralizing calcaneal osteotomies and proposes a combined technique of lateralization, Dwyer wedge resection, and coronal plane rotation to address advanced cavovarus hindfoot deformities.
Macular oedema due to immune reconstitution uveitis occurring in an HIV-negative patient without cytomegalovirus retinitis
Authors: Callet Marie , Donnadieu Benjamin , Gascon Pierre , Matonti Frederic
Published: July 2018

We describe a case of immune reconstitution uveitis occurring in an HIV-negative patient with bone-marrow transplant, not directly related to cytomegalovirus retinitis.
The Stony Brook Health Enhancement Program: The development of an active control condition for mind–body interventions
Authors: Mahaffey Brittain L , Mackin Daniel M , Vranceanu Ana-Maria , Lofaro Lindsay , Bromet Evelyn J , Luft Benjamin J , Gonzalez Adam
Published: July 2018

This article describes the development of a manualized, eight-session multiple health behavior change program which addresses sleep, exercise, nutrition, substance use, and working with one’s healthcare team. Our goal was to design a structured, evidence-based program that could be facilitated by a single health professional and could act as an active, credible control for mind–body intervention studies. Psychoeducational content was adapted from the latest government and peer-reviewed guidelines. Preliminary work suggests the program is acceptable and feasible for use in patients of varying ages with heterogeneous mental and physical health problems. It is adaptable for both face-to-face and online delivery.
First and second language use in English medium instruction contexts
Authors: Macaro Ernesto , Tian Lili , Chu Lingmin
Published: July 2018

Although there is a wealth of research on the use of the first language (L1) in English as a foreign language (EFL) classrooms, there is as yet very little research of this kind in classrooms where the prime pedagogical objective is to teach academic content through English as a second language (English medium instruction; EMI). It is important to begin filling this gap because a purported aim of content-based programs is to expose students to large quantities of the target language. We investigated the practices of five EMI teachers in a Chinese university and measured the reactions of their students both quantitatively and qualitatively. Our findings show that these teachers switched to the L1 rarely (although with considerable differences among the teachers) and mostly to explain both simple and complex concepts in their academic disciplines. Although students were unperturbed by the switches to the L1, some felt that the teacher could have made more of an effort to explain it in L2 first.
Polarization and the Nationalization of State Legislative Elections
Authors: Zingher Joshua N. , Richman Jesse
Published: July 2018

The electoral fortunes of state parties are partly shaped by the positions adopted by national parties. This creates the potential dilemma: The position that is best for the national party might be too extreme for the electorate in some states. Some state parties attempt to address this problem by adopting more moderate positions than their national-level counterparts. We argue that the efficacy of state party moderation hinges on the degree of polarization at the national level. We develop theory and examine empirical evidence that higher relative polarization at the national level exacerbates the degree to which national party positions and loyalties determine outcomes in U.S. state elections. When relative national polarization is high, we find evidence that state legislative election outcomes are determined by states’ orientations toward the national parties rather than the positions taken by state legislative parties.
A Prospective Evaluation of Adverse Reactions to Single-Dose Intravenous Antibiotic Prophylaxis During Outpatient Hand Surgery
Authors: Sandrowski Kristin , Edelman David , Rivlin Michael , Jones Christopher , Wang Mark , Gallant Gregory , Beredjiklian Pedro K.
Published: July 2018

Background: While it is established that routine prophylactic antibiotics are not needed for all hand surgery, some cases do require it. The purpose of this study was to determine the rate of adverse reactions resulting from prophylactic antibiotic administration on patients undergoing outpatient hand and upper extremity surgical procedures. We hypothesize that the rate of complications resulting from the use of antibiotic prophylaxis is smaller than that reported in the currently referenced literature. Methods: We prospectively evaluated 570 consecutive patients undergoing outpatient upper extremity surgery. Patients were excluded if they were on antibiotics prior to surgery, were discharged on antibiotics, or if they wished to be excluded. Nineteen patients were excluded, resulting in a study cohort of 551 patients. Patients were monitored perioperatively, 2 to 3 days postoperatively, during the first postoperative visit and 1 month postoperatively for adverse reactions. The type and timing of the adverse reaction was recorded. Results: Five hundred fifty-one patients were included for evaluation and 8 patients (1.5%) developed an adverse reaction to antibiotics. Five patients (0.9%) reported a rash and 3 patients (0.5%) reported diarrhea within 3 days of surgery. There were no anaphylactic reactions or complications necessitating hospital transfer or admission in the postoperative period. Conclusion: This study represents a prospective investigation designed to determine the rate of adverse reactions to single-dose antibiotics given during outpatient hand surgery. We conclude that the use of intravenous, single-dose prophylactic antibiotic is safe in the outpatient setting for cases that require it.
Early Versus Late Motion Following Volar Plating of Distal Radius Fractures
Authors: Dennison David G. , Blanchard Charlene L. , Elhassan Bassem , Moran Steven L. , Shin Alexander Y.
Published: July 2018

Background: Distal radius fractures are common, and the trend in fixation has included the use of locked volar plating. The duration of splinting required after surgery and the effect splinting has upon outcome of the wrist are not clear. Our aim was to compare outcome of patients treated with early versus late motion protocol after volar plating. Methods: Thirty-three patients with distal radius fractures were prospectively and randomly enrolled into an early versus late motion study including volar plating of the distal radius fracture. Early motion included an active and passive wrist motion protocol by 14 days after surgery and delayed motion was initiated at 5 weeks. Fractures were defined as intra-articular and extra-articular, and those with, and without, ulnar styloid fracture. Motion and outcome scores (Disabilities of the Arm, Shoulder and Hand [DASH]/patient-rated wrist evaluation [PRWE]), and strength were measured through 1 year. Results: Wrist motion, DASH, and PRWE scores were only significantly different at 6 weeks with no significant differences at any later time points up to 1 year. One patient had complex regional pain syndrome (CRPS) and one had adhesive capsulitis in the late motion group. Conclusions: Following locked volar plating of distal radius fractures, early motion favored earlier return of motion along with lower DASH, PRWE, and pain scores within first 6 weeks. Although the late motion group had delayed recovery, there were no long-term significant differences in motion, strength, outcome, or pain scores. The 2 cases with complications (CRPS and adhesive capsulitis) did occur in the late motion group and may implicate late motion with these problems.
MitraClip procedure as ‘bridge to list’, the ultimate therapeutic option for end‐stage heart failure patients not eligible for heart transplantation due to severe pulmonary hypertension
Authors: Crimi Gabriele , Gritti Valeria , Ghio Stefano , Crescio Valeria , Magrini Giulia , Scelsi Laura , Turco Annalisa , Gazzoli Fabrizio , Ferrario Maurizio , Raineri Claudia , Oltrona Visconti Luigi
Published: July 2018

Patients with end‐stage heart failure (HF), pulmonary hypertension and elevated pulmonary vascular resistance (PVR) despite medical therapy are not eligible for heart transplantation (HTx). In this ‘proof of concept’ case series, we demonstrate the feasibility and efficacy of the MitraClip procedure as ‘bridge to list’ in end‐stage HF patients not eligible for HTx. In fact, in the three patients reported, who were initially excluded from the HTx list because of elevated PVR, the MitraClip procedure was followed by a sustained improvement of PVR, allowing the patients’ risk to be reclassified, and they were then considered eligible for HTx.
Thiazide Diuretic Dose and Risk of Kidney Stones in Older Adults: A Retrospective Cohort Study
Authors: Alexander R. Todd , McArthur Eric , Jandoc Racquel , Welk Blayne , Fuster Daniel G. , Garg Amit X. , Quinn Robert R.
Published: July 2018

Background:

Thiazide diuretics are commonly prescribed to prevent kidney stones. However, it is unclear whether higher doses confer greater benefit.

Objective:

To determine whether lower doses of thiazide diuretics confer a similar protective effect against kidney stone events as higher doses.

Design:

Population-based cohort study.

Setting:

Linked health administrative databases in Ontario, Canada.

Patients:

Older adults newly prescribed a thiazide diuretic between 2003 and 2014 were separated into 2 groups based on daily dose: low dose (⩽12.5 mg hydrochlorothiazide/chlorthalidone, or ⩽1.25 mg indapamide) or high dose.

Measurements:

The primary outcome was time to a kidney stone event, using diagnosis and procedure codes. A secondary outcome was kidney stone surgery.

Methods:

An association between thiazide diuretic dose and a kidney stone event was estimated using Cox proportional hazards regression.

Results:

A total of 536 of 105 239 patients (0.51%) experienced a kidney stone event. We did not detect a difference in kidney stone risk in the high-dose relative to the low-dose group (adjusted hazard ratio, 1.10; 95% confidence interval, 0.93-1.31). Results were similar when analysis was restricted to the more specific outcome of kidney stone surgery. Neither a history of prior kidney stones nor the type of thiazide diuretic modified the effect of diuretic dose on outcome.

Limitations:

Patients were >65 years old and we were unable to adjust for some potential confounders such as dietary factors.

Conclusions:

Lower dose thiazide diuretics appear to confer a similar protective effect as higher dose thiazides against the development of kidney stones.
Effectiveness of a multicenter training programme to teach point‐of‐care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes
Authors: Normahani Pasha , Agrawal Rishi , Bravis Vasilliki , Falinska Agnieszka , Bloomfield Linda , Mehar Zaheer , Gaulton Dawn , Sangster Alex , Arkle Tracey , Gomm Corinna , Aslam Mohamed , Standfield Nigel J. , Jaffer Usman
Published: July 2018

Background

The primary aim of this study was to evaluate the effectiveness of a training programme to teach a focused bedside ultrasound scan (PAD‐scan; Podiatry Ankle Duplex Scan) for the detection of arterial disease in people with diabetes.

Methods

Five podiatrists and one diabetologist across two hospitals were enrolled in a structured training programme consisting of a training course (1‐day), supervised scanning (5‐weeks), independent scanning (3‐weeks) and a final evaluation of performance (1‐day).

Time, technical skills (Duplex Ultrasound Objective Structured Assessment of Technical Skills tool (DUOSATS); minimum score = 6, maximum score = 26) and accuracy (level of agreement with vascular scientist PAD‐scan assessment) were assessed for every supervised scan and again for the final evaluation of performance.

Results

A total of 90 PAD‐scans in 65 patients were performed during the supervised phase. Participants demonstrated significant improvements in median time (19 min(IQR 13.9–25.5) vs 9.3 min (IQR 7.3–10.5);p = 0.028) and DUOSATS scores (17.5 (IQR 16.8–21) vs 25 (IQR 24–25.3); p = 0.027). At the final evaluation, participants completed scans in 5.4 min (IQR 5.3–5.9), achieved full DUOSAT scores and perfect agreement with the vascular scientist.

Conclusion

A structured training programme, integrated into diabetic foot clinics, was effective in teaching the PAD‐scan
Antibiotic use on paediatric inpatients in a teaching hospital in the Gambia, a retrospective study
Authors: Chaw Pa Saidou , Schlinkmann Kristin Maria , Raupach-Rosin Heike , Karch André , Pletz Mathias W. , Huebner Johannes , Nyan Ousman , Mikolajczyk Rafael
Published: July 2018

Background

Antibiotics are useful but increasing resistance is a major problem. Our objectives were to assess antibiotic use and microbiology testing in hospitalized children in the Gambia.

Methods

We conducted a retrospective analysis of paediatric inpatient data at The Edward Francis Small Teaching Hospital in Banjul, The Gambia. We extracted relevant data from the admission folders of all patients (aged > 28 days to 15 years) admitted in 2015 (January–December), who received at least one antibiotic for 24 h. We also reviewed the microbiology laboratory record book to obtain separate data for the bacterial isolates and resistance test results of all the paediatric inpatients during the study period.

Results

Over half of the admitted patients received at least one antibiotic during admission (496/917) with a total consumption of 670.7 Days of Antibiotic Therapy/1000 Patient-Days. The clinical diagnoses included an infectious disease for 398/496, 80.2% of the patients on antibiotics, pneumonia being the most common (184/496, 37.1%). There were 51 clinically relevant bacterial isolates, Klebsiella species being the most common (12/51, 23.5%), mainly from urine (11/12, 91.7%). Antibiotic resistance was mainly to ampicillin (38/51, 74.5%), mainly reported as Coliform species 11/51, 21.6%.

Conclusions

More than half of the admitted patients received antibiotics. The reported antibiotic resistance was highest to the most commonly used antibiotics such as ampicillin. Efforts to maximize definitive antibiotic indication such as microbiological testing prior to start of antibiotics should be encouraged where possible for a more rational antibiotic use.
Understanding the attitudes toward sunless tanning product use: implication of tanning product consumption
Authors: Yoo Jeong-Ju , Cho Hyeon Jeong
Published: July 2018

The goal of this study is to test the antecedents of overall attitudes toward sunless tanning product use. The data collected from 302 US female college students with an average age of 20.11 were included in the analysis. A structural equation modeling was performed to test the hypothesized relationships. The results revealed that body surveillance and social ostracism influenced the individuals’ cutaneous body image dissatisfaction, which also influenced perceived attractiveness and fitness of tanned appearance. Perceived tanning attractiveness and perceived tanning physical fitness positively influences attitudes toward tanning product use. It is evident that seeing one’s own body through the lens of others is at the root of positive attitudes toward sunless tanning products. Positive attitudinal changes toward sunless tanning products can be successfully established emphasizing sunless tanning products as fashion consumption. The findings in this study have important relevance, in that tanning products can be marketed as cosmetic appearance-enhancement products for people to look attractive, toned, and fit.
Heterogeneity and Coexistence of T790M and T790 Wild-Type Resistant Subclones Drive Mixed Response to Third-Generation Epidermal Growth Factor Receptor Inhibitors in Lung Cancer
Authors: Piotrowska Zofia , Hazar-Rethinam Mehlika , Rizzo Coleen , Nadres Brandon , Van Seventer Emily E. , Shahzade Heather A. , Lennes Inga T. , Iafrate Anthony J. , Dias-Santagata Dora , Leshchiner Ignaty , Jessop Nicholas A. , Hu Haichuan , Digumarthy Subba R. , Nagy Rebecca J. , Lanman Richard B. , Moody Susan , Niederst Matthew J. , Engelman Jeffrey A. , Hata Aaron N. , Corcoran Ryan B. , Sequist Lecia V.
Published: July 2018

Purpose

Third-generation epidermal growth factor receptor (EGFR) inhibitors like nazartinib are active against EGFR mutation–positive lung cancers with T790M-mediated acquired resistance to initial anti-EGFR treatment, but some patients have mixed responses.

Methods

Multiple serial tumor and liquid biopsies were obtained from two patients before, during, and after treatment with nazartinib. Next-generation sequencing and droplet digital polymerase chain reaction were performed to assess heterogeneity and clonal dynamics.

Results

We observed the simultaneous emergence of T790M-dependent and -independent clones in both patients. Serial plasma droplet digital polymerase chain reaction illustrated shifts in relative clonal abundance in response to various systemic therapies, confirming a molecular basis for the clinical mixed radiographic responses observed.

Conclusion

Heterogeneous responses to treatment targeting a solitary resistance mechanism can be explained by coexistent tumor subclones harboring distinct genetic signatures. Serial liquid biopsies offer an opportunity to monitor clonal dynamics and the emergence of resistance and may represent a useful tool to guide therapeutic strategies.
Novel Preoxygenation Technique to Deliver High-Flow Oxygen in a Patient With Facial Trauma: A Case Report
Authors: Aykanat Verna M. , McGlade Desmond P.
Published: July 2018

This case demonstrates a novel preoxygenation technique in a patient with difficult access to the airway after a traumatic facial injury. To find a solution, a fusion of oxygenation equipment was trialed by altering and combining a tracheostomy mask and the tubing of an Optiflow circuit from which the nasal cannula component had been removed. This novel combination delivered high-flow humidified oxygen (60 L/min) orally, avoided further facial injury, and was well tolerated by the patient. Effective preoxygenation was confirmed by arterial gas measurements. This study supports the use of this novel Optiflow-tracheostomy mask fusion device in appropriately selected cases.
Nutcracker Syndrome—An Unusual Case of Chronic Left Upper Abdominal Pain: A Case Report
Authors: Patel Bimal , Samuel Samuel
Published: July 2018

A 38-year-old woman presented with a chief complaint of sharp, achy left upper abdominal pain with radiation to the left flank. This pain started approximately one-and-a-half years before she consulted with a pain specialist. Although an extensive workup was completed, no organic cause was established as the cause of her pain. After undergoing successful fluoroscopically guided celiac plexus blocks, an abdominal magnetic resonance imaging scan was obtained that revealed nutcracker phenomenon. The patient was evaluated by an urologist and underwent renal autotransplantation. The patient subsequently had complete relief of her pain.
Prednisolone induces osteoporosis-like phenotypes via focal adhesion signaling pathway in zebrafish larvae
Authors: Huo Lei , Wang Lei , Yang Zhaoyao , Li Pingyuan , Geng Dechun , Xu Yaozeng
Published: July 2018

Patients taking glucocorticoid or glucocorticoid-like drugs for an extended period of time may develop osteoporosis, termed glucocorticoid-induced osteoporosis (GIOP). GIOP is the most common form of secondary osteoporosis, but the mechanism underlying its development is unclear. In the present study, we used prednisolone to treat zebrafish larvae to investigate GIOP. Our RNA deep-sequencing (RNA-seq) results show that prednisolone affects genes known to act in the extracellular region. Therefore the extracellular region, extracellular matrix, and collagen trimer might be involved in glucocorticoid-induced osteoporosis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that the focal adhesion signaling pathway is the most enriched signaling pathway in terms of differentially expressed genes (DEGs). In this pathway, integrin subunit alpha 10 (itga10) and integrin subunit beta like 1 (itgbl1), genes encoding two adapter proteins, were down-regulated in the prednisolone-treated larvae. Further experiments showed that prednisolone contributes to GIOP by down-regulating itga10 and itgbl1.
Sex Differences in Training Loads during British Army Basic Training
Authors: O’LEARY THOMAS J. , SAUNDERS SAMANTHA C. , MCGUIRE STEPHEN J. , VENABLES MICHELLE C. , IZARD RACHEL M.
Published: July 2018

Purpose

To compare training loads between men and women during 14 wk of British Army standard entry basic training.

Methods

Thirty-one male (mean ± SD: age, 21 ± 4 yr; height, 1.78 ± 0.08 m; mass, 77.1 ± 10.5 kg) and 28 female (age, 22 ± 4 yr; height, 1.65 ± 0.05 m; mass, 63.9 ± 8.9 kg) British Army recruits had external (distance) and internal (HR, training impulse [TRIMP], RPE) training loads measured during weeks 1, 2, 6, 12, and 13 of basic training. Total energy expenditure was measured during weeks 1 to 2 and weeks 12 to 13.

Results

Daily distance was higher for men than women (13,508 ± 666 vs 11,866 ± 491 m, respectively, P < 0.001). Average daily HR (29% ± 3% vs 30% ± 3% HR reserve) and RPE (4 ± 1 vs 4 ± 1) were not different between men and women, respectively (P ≥ 0.495). Daily TRIMP was higher for women than men (492 ± 130 vs 261 ± 145 au, respectively, P < 0.001). Total energy expenditure was higher for men than women during weeks 1 to 2 (4020 ± 620 vs 2847 ± 323 kcal·d−1, respectively) and weeks 12 to 13 (4253 ± 556 kcal·d−1 vs 3390 ± 344 kcal·d−1, respectively) (P < 0.001). Daily RPE, HR, and TRIMP were related to daily distance (R
2 = 0.18–0.57, P ≤ 0.037), and daily RPE was related to daily TRIMP and HR (R
2 = 0.37–0.77, P ≤ 0.001).

Conclusions

Sex differences in training loads could contribute to the greater injury risk for women during basic training. Daily RPE appears a practical option for measuring internal training load during military training.
Quantum Mechanics and Global Determinism
Authors: Adlam Emily Christine
Published: July 2018

It is proposed that certain features of quantum mechanics may be perspectival effects, which arise because experiments performed on locally accessible variables can only uncover a certain subset of the correlations exhibited by an underlying deterministic theory. This hypothesis is used to derive the no-signaling principle, thus resolving an open question regarding the apparently fine-tuned nature of quantum correlations. Some potential objections to this approach are then discussed and answered.Quanta 2018; 7: 40–53.
Sintomas internalizantes, externalizantes e relações interpessoais de adolescentes em tratamento para dependência química
Authors: Silva Dhiordan Cardoso da , Boff Raquel De Melo , Wendling Maria Isabel , Oliveira Margareth Da Silva
Published: July 2018

O uso de drogas na adolescência produz importantes impactos psicológicos, comportamentais e nos estilos interpessoais do individuo. Este estudo visou examinar e descrever tais aspectos através do instrumento Young Self Report (YSR), uma entrevista clínica semi-estruturada e uma sessão de grupo focal com cinco adolescentes internados pela a dependência de drogas. O discurso dos participantes foi analisado através da Análise de Conteúdo de Bardin, modalidade temática e as sintomatologias clínicas examinadas pelo YSR. O conteúdo do grupo obteve seis categorias finais: habilidades interpessoais, dificuldades interpessoais, aspectos emocionais, aspectos físicos, ambiente escolar e ambiente familiar. Os resultados mostraram características importantes no funcionamento adaptativo, que facilita as relações e problemas clínicos que podem estar associados a estilos menos adaptativos. Este estudo destaca a importância de avaliar os elementos individuais envolvidos na dependência das drogas e no plano terapêutico, bem como, sugerir modelos de intervenções que atendem a essas demandas.
Correlações entre Habilidades Sociais Educativas dos Professores, Burnout e Relação Professor-Aluno
Authors: Achkar Ana Maria Nunes El , Leme Vanessa Barbosa Romera , Soares Adriana Benevides , Yunes Maria Angela Mattar
Published: July 2018

Este estudo teve por objetivo correlacionar as habilidades sociais educativas dos professores (HSE), o Burnout e a relação professor-aluno. Participaram 400 professores (M= 36,08 anos, DP = 9,94), de ambos os sexos (348 mulheres e 52 homens), os quais lecionavam no 7º, 8º e 9º ano do Ensino Fundamental, provenientes de oito escolas, sendo quatro públicas e quatro particulares, situadas em cidades do Estado do Rio de Janeiro. Os professores responderam ao Questionário com informações demográficas e nível socioeconômico, à Escala da Relação Professor-Aluno (IHSE-Del-Prette), ao Inventário de Habilidades Sociais Educativas (IHSE-Del-Prette) e ao Inventário de Burnout de Maslach (MBI). Os resultados indicaram que as HSE dos professores se associaram positivamente com a relação professor-aluno e negativamente com o Burnout, sendo esse correlacionado negativamente com a relação professor-aluno. O modelo de regressão evidenciou que as HSE dos professores têm maior poder preditivo sobre as relações entre professores e alunos nos Anos Finais do E.F. Conclui-se que intervenções com foco na aprendizagem de HSE dos professores podem contribuir para a prevenção de Burnout, assim como promover o desenvolvimento acadêmico e socioafetivo de seus alunos.
O "continente negro" da paternidade no contexto da reprodução assistida
Authors: Sonego Joice Cadore , Lopes Rita De Cássia Sobreira
Published: July 2018

O presente estudo buscou acompanhar o percurso singular rumo à paternidade no contexto da reprodução assistida, da gestação até o primeiro ano de vida do bebê. Trata-se de um estudo de caso único, longitudinal, envolvendo um homem que se submeteu, junto com sua esposa, à fertilização in vitro, cuja infertilidade era mista. Foram realizadas entrevistas semiestruturadas em três momentos: terceiro trimestre de gestação; terceiro mês de vida do bebê; final do primeiro ano de vida do bebê. Foi construído um relato clínico, a partir do qual acompanhamos o percurso de Luis. Pode-se perceber que a infertilidade, o tratamento e, posteriormente, a paternidade, foram vivenciadas de modo bastante singular. O percurso de elaboração e integração dessas vivências levou tempo. A convivência com o bebê foi essencial para que o pai se percebesse, aos poucos, como pai e pudesse tomar posse de seu desejo de paternidade. Assim, espera-se que este estudo tenha contribuído como um espaço de escuta que ajuda a descortinar o "continente negro" da paternidade nesse contexto, ainda pouco acessível, tanto para os homens que vivem essa experiência, quanto para os profissionais.
REPRESENTAÇÕES SOCIAIS DA ESCOLA: UM ESTUDO COM ADOLESCENTES EM ACOLHIMENTO INSTITUCIONAL NO MUNICÍPIO DE PONTA GROSSA/PR
Authors: Somer Diana Galone , De Oliveira Junior Constantino Ribeiro , Barros Solange Aparecida Barbosa de Moraes
Published: July 2018

Resumo: Este texto refere-se a uma pesquisa realizada com o objetivo de entender as Representações Sociais que as adolescentes acolhidas, em abril de 2016, na Casa Santa Luiza de Marillac e na Associação de Promoção a Menina (APAM), em Ponta Grossa/PR, possuem em relação à escola. As representações sociais estão ligadas ao grupo, no qual os indivíduos compartilham de uma realidade comum a um conjunto social na vida cotidiana. Ainda, a vulnerabilidade e risco social e suas implicações, no plano subjetivo, são estudadas. Posto que, com a família em situação de risco social seus membros podem se encontrar em vulnerabilidade, especialmente a criança e adolescente, e essas situações podem levá-los ao acolhimento. A metodologia empregada para obtenção e análise dos dados foi: pesquisa exploratória; grupo focal; e análise de conteúdo de categorias temáticas. Com base nos resultados da pesquisa, conclui-se que as relações positivas na escola são com os amigos, trazendo um sentimento de pertencimento; enquanto que as relações e interações negativas são com algumas professoras (os) e pedagogas (os), que tem ações que implicam na ocorrência do: bullying, estigma e a alteridade radical. Esses elementos descobertos influenciam na construção da identidade das adolescentes acolhidas. Percebeu-se que as escolas públicas possuem dificuldades no atendimento das crianças e adolescentes que estão em acolhimento.Palavras-chaves: Alunas/adolescentes acolhidas. Representação social. Escola.Abstract: This text refers to a research carried out with the purpose of understanding the Social Representations that the adolescents refuged in April of 2016 in Casa Santa Luiza de Marillac and the Association of Girl Promotion (APAM), in Ponta Grossa / PR, have in relation to the school. Social representations are linked to the group, in which individuals share a reality common to a social set in everyday life. Furthermore, vulnerability and social risk and their implications, on a subjective level, are studied. With the family at social risk, their members may find themselves in vulnerability, especially children and adolescents, and these situations may lead them to refuge them. The methodology used to obtain and analyze the data was: exploratory research; focus group; and content analysis of thematic categories. Based on the results of the research, we conclude that positive relationships in school are with friends, bringing a sense of belonging; while the negative relations and interactions are with some teachers and pedagogues, who have actions that imply in the occurrence of: bullying, stigma and radical alterity. These uncovered elements influence the construction of the identity of the adolescents. It was noticed that the public schools have difficulties in the care of the children and adolescents that are in refuge.Keywords: Students/teenagers in care. Social representation. School.
MIGRAÇÃO, PESQUISA BIOGRÁFICA E COMUNIZAÇÃO DE EXPERIÊNCIAS DE VIDA
Authors: Ozório Barroso Lúcia Maria
Published: July 2018

Resumo: Refletimos sobre a problemática comunitária e o processo migratório, quer dizer, sobre as alianças deste processo com a  construção de um comum no mundo. A experiência de mobilidade precisa ser compreendida desde as experiências de vida, perspectiva que dá importância ao encontro dialógico com os atores deste processo. As histórias orais de vida em comum, nosso dispositivo de pesquisa e de resistência, aprofundam nossas reflexões. Como dispositivo da biopolítica tem como chave de ouro a produção de subjetividades que busca responder às urgências de um comum no presente. Buscamos apostar no potencial revolucionário da memória nas suas conexões com o comum, reservatório de heterogêneses, intervindo numa memória sequestrada e sobrecodificada que quer silenciar as diferenças. Este trabalho no campo imanente da memória permite o surgimento das potências revolucionárias de afetos imemoriais que convocam experiências de liberação, contribuindo para a reconstrução de si e de um comum no mundo, produzindo subjetividades. Palavras chave: Processo migratório. Comum. Histórias orais de vida em comum. Subjetividades.                              Abstract: We reflect on the community issues and the migration process, that is, on the alliances of this process with the construction of a common in the world. The experience of mobility needs to be understood from life experiences, a perspective that gives importance to the dialogical encounter with the actors of this process.The oral life stories in common as a research device, of resistance, allows to deepen this perspective. As a device of biopolitics, it has as a golden key the production of subjectivities that seeks to respond to the urgencies of a common in the present. We seek to bet on the revolutionary potential of memory in its connections with the common, reservoirofheterogenesis, seeking to intervene in a kidnapped and overcoded memory that wants to silence the differences. Work with the immanent field of memory permeated by the common allows the emergence of the revolutionary powers of immemorial affections that call for liberation experiences, contributing to the reconstruction of oneself and of a common in the world, producing subjectivities.Keywords: Migrationprocess. Common. Oral lifestories in common. Subjectivities.
Lavender Blue, Dilly Dilly …
Authors: Francis-Pester Dawn
Published: July 2018

If you have a well-drained sunny spot in your garden or outdoor space, you should try growing this attractive plant, bringing fragrance, colour and relaxation to your setting.
Mathematics: B for Balance…
Authors: Hammond Paula , Lillie Stephen
Published: July 2018

This month, we continue our series based on the maths area of learning in the foundation stage, providing an A-Z of activities that will help children progress while having fun.
Latest developments
Authors: Bayram Liz , Leitch Neil , Smith Susan
Published: July 2018

Send your letters, news stories or latest developments to: The Editor, Child Care, St Jude's Church, Dulwich Road, Herne Hill, London, SE24 0PB email: childcare@markallengroup.com
LONG-TERM SAFETY AND EFFICACY OF TOCILIZUMAB IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS OF MODERATE OR HIGH ACTIVITY (RESULTS OF PHASE III MULTICENTER EXTENSION CLINICAL STUDY ML28124)
Authors: Nasonov E. L. , Stanislav M. L. , Mazurov V. I. , Chernykh T. M. , Sorotskaya V. N. , Salnikova T. S. , Saikovsky R. S. , Reshet’ko O. V. , Popova T. A. , Shmidt E. I. , Tyurin V. P. , Shilkina N. P. , Bokarev I. N. , Kanevskaya M. Z. , Yakushin S. S.
Published: July 2018

Objective: to assess the long-term safety and efficiency of tocilizumab (TCZ) therapy in patients with early rheumatoid arthritis (RA) of moderate and high activity, who have completed the basic WA19926 study, as well as the rate of sustained drug-free remission.

Subjects and methods. A long-term open-label multicenter Phase III extension study (ML28124) was conducted using a group of 49 patients (36 (73.5%) women and 13 (26.5%) men; mean age 53.3±10.8 years) with early RA of moderate and high activity. All the patients received an intravenous infusion of TCZ 8 mg/kg every 4 weeks for 104 weeks (a total of 27 infusions). The safety assessment criteria were the rate and severity of all adverse events (AE), serious AE (SAE), and AE of particular interest; the rate of AE causing drug dosage changes or withdrawal from the study; the frequency of clinically significant laboratory abnormalities. The analysis of efficiency (secondary end points) included changes of DAS8, which was calculated using erythrocyte sedimentation rate (ESR) (DAS28-ESR) and SDAI, the of tender joint count (TJC) and swollen joint count (SJC); the number of patients who had achieved drug-free remission; and the time to a RA exacerbation in patients who had achieved non-drug remission.

Results and discussion. The total rate of AE was found to be 69.4%; that of SAE was 10.2%; SAE were 6.9% of the the total number of AE; AE of particular interest were 17.2% of the total number of AE. More than one-third (35.6%) of the AE caused drug dose changes or therapy discontinuation or complete cessation. The laboratory clinically significant abnormalities included those in complete blood cell counts (blood alanine aminotransferase, aspartate aminotransferase, total and direct bilirubin, creatinine, and glucose). The evaluation efficiency analysis showed that the main disease activity measures (DAS28-ESR, SDAI, SJC, and TJC) decreased at 104-week follow-up versus at baseline. The rate of drug-free remission was 71.4%; that of recurrence was 40.0% (the median time to recurrence was 23 weeks). The findings suggest that the safety profile of TCZ is acceptable in the long-term treatment of early RA and correspond to earlier results.
THE RISK OF OSTEOPOROTIC FRACTURES IN PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS OF THE PROGRAM «OSTEOSCREENING RUSSIA»
Authors: Nikitinskaya O. A. , Toroptsova N. V. , Demin N. V. , Feklistov A. Yu. , Nasonov E. L.
Published: July 2018

Rheumatoid arthritis (RA) and the use of glucocorticoids (GCs) are proven risk factors for osteoporosis (OP) and osteoporotic fractures (OPF). There are also other reasons for increased fracture risk in RA.

Objective: to determine the rate of RA in an epidemiological sample of persons aged 50 years and older and to identify those in need of antiosteoporotic therapy among the patients with RA in order to prevent OPF.

Subjects and methods. The epidemiological sample included 18,018 people aged 50 years and older (13,941 women and 4,077 men; mean age, 62±10 years). The survey consisted of a unified questionnaire, measurement of daily dietary calcium intake, and calculation of a 10-year fracture risk using the FRAX® algorithm.

Results and discussion. The prevalence of RA in the epidemiological population sample aged 50 years and older was 1.7% (1.9% in women and 1.2% in men; p=0.0047). The mean FRAX® values for major OPF in RA patients were significantly higher than those in non-RA individuals: 18.4±10 and 13.2±7.9%, respectively (p=0.0001) for women and 8.9±6.4 and 6.2±3.7%, respectively (p=0.0001) for men. 42% of the patients with RA were at high risk for OPF. Thus, 48% of the women with RA had FRAX® values above the therapeutic intervention threshold; and the non-RA group needed antiosteoporotic therapy significantly less (31%; p=0.00001). At the same time, the detection rate of high-risk OPF in men with and without RA did not differ significantly (8 and 5%, respectively; p>0.05). The most common risk factors (RFs) for OP and OPF in RA patients included previous fractures (33%), secondary causes of OP (30%), GC use (18%), and, additionally, smoking (33%) in male patients with RA. The female patients with RA significantly more frequently took GCs (17%) and had other secondary causes of OP and OPF (33%) than those without RA (7.7% (p=0.0001) and 23% (p=0.0004, respectively). The male patients with RA versus to the population-based control showed significant differences when they only used GCs (20 and 5%, respectively; p = 0.0001); the remaining RFs were encountered at the same frequency. Less than half of the normal daily calcium intake was observed in 20% of men and 16% of women (p=0.53).

Conclusion. 42% of the RA patients aged 50 years and older were at high risk for OPF and needed antiosteoporotic therapy. Every third woman with RA had at least one other comorbidity or condition associated with the increased risk of OPF. In the male patients with RA, the FRAX® algorithm could reveal only 8% of persons at high risk for fractures, while 58% of them had two or more additional RFs that can negatively affect bone mineral density and increase the risk of fracture. To identify those who require prevention and treatment of OP and OPF, it is preferable to perform bone densitometry of the axial skeleton among male patients with RA.
IMPACT OF THE FREQUENCY OF USING NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ON THE RADIOGRAPHIC PROGRESSION OF SACROILIITIS IN PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS
Authors: Rumyantseva D. G. , Dubinina T. V. , Erdes Sh. F.
Published: July 2018

Objective: to compare the impact of continuous or on-demand use of nonsteroidal anti-inflammatory drugs (NSAIDs) on the activity and radiographic progression of early axial spondyloarthritis (axSpA).

Subjects and methods. The investigation enrolled patients from the early spondyloarthritis cohort who met the 2009 Assessment of Spondyloarthritis International Society (ASAS) criteria for axSpA. This analysis included 68 patients who had been followed up for at least 24 months. The mean age at the time of inclusion in the investigation was 28.5±5.8 years; the mean disease duration was 24.1±15.4 months; 63 (92.6%) patients were HLA-B27-positive. The patients were divided into two groups: 1) 35 patients used NSAIDs at maximum therapeutic doses continuously during the follow-up period; 2) 33 patients received these drugs on-demand, depending on the presence and severity of back pain.

Results and discussion. After 2-year follow-up, the median stage of radiographic sacroiliitis (SI) in Group 1 was unchanged and remained equal to 4; that in Group 2 in this period significantly increased from 3 to 4 scores (p < 0.05). At baseline, the patient groups did not differ in C-reactive protein (CRP) levels, the Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), and the Bath Ankylosing Spondylitis Functional Index (BASFI); however, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was higher in Group 1 (p < 0.05). The number of patients with active SI, as evidenced by magnetic resonance imaging (MRI), and the degree of its severity did not differ significantly between groups. After 2 years, all the patients retained low disease activity according to ASDAS-CRP, BASDAI, and CRP levels; and these measures did not differ significantly between groups either; the BASFI became higher in Group 1. MRI findings indicated that the number of patients with active SI decreased, but no differences were found between the groups.

Conclusion. In patients with early axSpA, the continuous intake of NSAIDs can slow radiographic progression to a greater extent than their on-demand use.
HEART FAILURE IN SYSTEMIC LUPUS ERYTHEMATOSUS: RISK FACTORS AND DIAGNOSTIC FEATURES
Authors: Panafidina T. A. , Popkova T. V.
Published: July 2018

With increased survival in patients with systemic lupus erythematosus (SLE), cardiovascular diseases have become the main causes of death. Heart failure (HF) is the final stage of the cardiovascular continuum; decompensation of this condition commonly results in death. Studies of HF, its frequency, risk factors, and diagnostic features in patients with SLE are extremely few. The paper details data on the definition, frequency, current classification, and the algorithm for the diagnosis of HF and comparatively analyzes the risk factors of the latter in the general population and among patients with SLE. HF diagnostic problems in this patient category and possible ways of their resolution are discussed.
COXITIS AS A MANIFESTATION OF PARANEOPLASTIC SYNDROME
Authors: Smirnova L. A. , Simonova O. V. , Sukhikh E. N. , Nemtsov B. F.
Published: July 2018

The paper describes a clinical case of late diagnosis of malignant lung tumor with the development of skeletal and intracranial lymph node metastatic lesions. Right hip joint pain was the reason for seeking medical advice; coxitis was diagnosed. Weight loss, obvious blood inflammatory changes, and a long-term smoking history aim to find cancer. Further examination as multislice spiral computed tomography of the lungs and pelvic bones could establish a diagnosis.
Working with Legal Principles – demonstrated using Private Autonomy and Freedom of Contract as Examples
Authors: Möllers Thomas M.J.
Published: July 2018

Resolving legal problems at the national and European level, legal principles are of outstanding significance. However, it often remains unclear how to utilise these legal principles – which are partly not codified – in the specific legal solution. This article addresses two questions: How can we derive legal principles from the law if they have not been codified in the law? Moreover, how can we concretise legal principles? These two main issues will be illustrated on the basis of contractual freedom and particular legal institutes such as obligation to contract, price control, and frustration of contract. A last issue will be to tackle methodical difficulties posed by legal principles at the European level.
Statistical convergence of multiple sequences on a product time scale
Authors: Yilmaz Emrah , Altin Yavuz , Koyunbakan Hikmet
Published: July 2018

In this study, we extend the
concepts and fundamental results on statistical convergence from a single
time scale to any product time scale. Various
characterizations about these new notions are also obtained.