bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior spinal arthrodesis for adolescent idiopathic scoliosis using pedicle screw instrumentation
Authors: Tsirikos A. I. , Subramanian A. S.
Published: November 2012

We reviewed 212 consecutive patients with adolescent idiopathic scoliosis who underwent posterior spinal arthrodesis using all pedicle screw instrumentation in terms of clinical, radiological and Scoliosis Research Society (SRS)-22 outcomes. In Group 1 (51 patients), the correction was performed over two rods using bilateral segmental pedicle screws. In Group 2 (161 patients), the correction was performed over one rod using unilateral segmental pedicle screws with the second rod providing stability of the construct through two-level screw fixation at proximal and distal ends. The mean age at surgery was 14.8 years in both groups. Comparison between groups showed no significant differences with regard to age and Risser grade at surgery, pre- and post-operative scoliosis angle, coronal Cobb correction, length of hospital stay and SRS scores. Correction of upper thoracic curves was significantly better in Group 1 (p = 0.02). Increased surgical time and intra-operative blood loss was recorded in Group 1 (p < 0.001 and p = 0.04, respectively). The implant cost was reduced by mean 35% in Group 2 due to the lesser number of pedicle screws.

Unilateral and bilateral pedicle screw techniques have both achieved excellent deformity correction in adolescent patients with idiopathic scoliosis, which was maintained at two-year follow-up. This has been associated with high patient satisfaction and low complication rates.
Mid-term equivalent survival of medial and lateral unicondylar knee replacement
Authors: Baker P. N. , Jameson S. S. , Deehan D. J. , Gregg P. J. , Porter M. , Tucker K.
Published: November 2012

Current analysis of unicondylar knee replacements (UKRs) by national registries is based on the pooled results of medial and lateral implants. Consequently, little is known about the differential performance of medial and lateral replacements and the influence of each implant type within these pooled analyses. Using data from the National Joint Registry for England and Wales (NJR) we aimed to determine the proportion of UKRs implanted on the lateral side of the knee, and their survival and reason for failure compared with medial UKRs. By combining information on the side of operation with component details held on the NJR, we were able to determine implant laterality (medial versus lateral) for 32 847 of the 35 624 unicondylar replacements (92%) registered before December 2010. Of these, 2052 (6%) were inserted on the lateral side of the knee. The rates of survival at five years were 93.1% (95% confidence interval (CI) 92.7 to 93.5) for medial and 93.0% (95% CI 91.1 to 94.9) for lateral UKRs (p = 0.49). The rates of failure remained equivalent after adjusting for patient age, gender, American Society of Anesthesiologists (ASA) grade, indication for surgery and implant design using Cox’s proportional hazards method (hazard ratio for lateral relative to medial replacement = 0.88 (95% CI 0.69 to 1.13); p = 0.32). Aseptic loosening/lysis and unexplained pain were the main reasons for revision in both groups, although the reasons did vary depending on whether a mobile- or a fixed-bearing design was used. At a maximum of eight years the mid-term survival rates of medial and lateral UKRs are similar.
The correct rotation of the femoral component in patellofemoral replacement
Authors: Clark D. A. , Upadhyay N. , Gillespie G. , Wakeley C. , Eldridge J. D.
Published: November 2012

Ensuring correct rotation of the femoral component is a challenging aspect of patellofemoral replacement surgery. Rotation equal to the epicondylar axis or marginally more external rotation is acceptable. Internal rotation is associated with poor outcomes. This paper comprises two studies evaluating the use of the medial malleolus as a landmark to guide rotation.

We used 100 lower-leg anteroposterior radiographs to evaluate the reliability of the medial malleolus as a landmark. Assessment was made of the angle between the tibial shaft and a line from the intramedullary rod entry site to the medial malleolus. The femoral cut was made in ten cadaver knees using the inferior tip of the medial malleolus as a landmark for rotation. Rotation of the cut relative to the anatomical epicondylar axis was assessed using CT. The study of radiographs found the position of the medial malleolus relative to the tibial axis is consistent. Using the inferior tip of the medial malleolus in the cadaver study produced a mean external rotation of 1.6° (0.1° to 3.7°) from the anatomical epicondylar axis. Using the inferior tip of the medial malleolus to guide the femoral cutting jig avoids internal rotation and introduces an acceptable amount of external rotation of the femoral component.
Comorbidities in Perthes’ disease
Authors: Perry D. C. , Bruce C. E. , Pope D. , Dangerfield P. , Platt M. J. , Hall A. J.
Published: November 2012

Perthes’ disease is an osteonecrosis of the juvenile hip, the aetiology of which is unknown. A number of comorbid associations have been suggested that may offer insights into aetiology, yet the strength and validity of these are unclear. This study explored such associations through a case control study using the United Kingdom General Practice Research database. Associations investigated were those previously suggested within the literature. A total of 619 cases of Perthes’ disease were included, as were 2544 controls. The risk of Perthes’ disease was significantly increased with the presence of congenital anomalies of the genitourinary and inguinal region, such as hypospadias (odds ratio (OR) 4.04 (95% confidence interval (CI) 1.41 to 11.58)), undescended testis (OR 1.83 (95% CI 1.12 to 3.00)) and inguinal herniae (OR 1.79 (95% CI 1.02 to 3.16)). Attention deficit hyperactivity disorder was not associated with Perthes’ disease (OR 1.01 (95% CI 0.48 to 2.12)), although a generalised behavioural disorder was (OR 1.55 (95% CI 1.10 to 2.17)). Asthma significantly increased the risk of Perthes’ disease (OR 1.44 (95% CI 1.17 to 1.76)), which remained after adjusting for oral/parenteral steroid use.

Perthes’ disease has a significant association with congenital genitourinary and inguinal anomalies, suggesting that intra-uterine factors may be critical to causation. Other comorbid associations may offer insight to support or refute theories of pathogenesis.
Long-term results of dorsal intercarpal ligament capsulodesis for the treatment of chronic scapholunate instability
Authors: Megerle K. , Bertel D. , Germann G. , Lehnhardt M. , Hellmich S.
Published: November 2012

The purpose of this study was to assess the clinical and radiological outcomes of dorsal intercarpal ligament capsulodesis for the treatment of static scapholunate instability at a minimum follow-up of four years. A total of 59 patients who underwent capsulodesis for this condition were included in a retrospective analysis after a mean of 8.25 years (4.3 to 12). A total of eight patients underwent a salvage procedure at a mean of 2.33 years (0.67 to 7.6) and were excluded. The mean range of extension/flexion was 88° (15° to 135°) and of ulnar/radial deviation was 38° (0° to 75°) at final follow-up. The mean Disabilities of the Arm Shoulder and Hand (DASH) score and Mayo wrist scores were 28 (0 to 85) and 61 (0 to 90), respectively. After significant improvement immediately post-operatively (p < 0.001 and p = 0.001, respectively), the mean scapholunate and radiolunate angles deteriorated to 70° (40° to 90°) and 8° (-15° to 25°), respectively, at final follow-up, which were not significantly different from their pre-operative values (p = 0.6 and p = 0.4, respectively). The mean carpal height index decreased significantly from 1.53 (1.38 to 1.65) to 1.48 (1.29 to 1.65) indicating progressive carpal collapse (p < 0.001); 40 patients (78%) had radiological evidence of degenerative arthritis.

Capsulodesis did not maintain carpal reduction over time. Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist.
The design of the acetabular component and size of the femoral head influence the risk of revision following 34 721 single-brand cemented hip replacements
Authors: Jameson S. S. , Baker P. N. , Mason J. , Gregg P. J. , Brewster N. , Deehan D. J. , Reed M. R.
Published: November 2012

Despite excellent results, the use of cemented total hip replacement (THR) is declining. This retrospective cohort study records survival time to revision following primary cemented THR using the most common combination of components that accounted for almost a quarter of all cemented THRs, exploring risk factors independently associated with failure. All patients with osteoarthritis who had an Exeter V40/Contemporary THR (Stryker) implanted before 31 December 2010 and recorded in the National Joint Registry for England and Wales were included in the analysis. Cox’s proportional hazard models were used to analyse the extent to which risk of revision was related to patient, surgeon and implant covariates, with a significance threshold of p < 0.01. A total of 34 721 THRs were included in the study. The overall seven-year rate of revision for any reason was 1.70% (99% confidence interval (CI) 1.28 to 2.12). In the final adjusted model the risk of revision was significantly higher in THRs with the Contemporary hooded component (hazard ratio (HR) 1.88, p < 0.001) than with the flanged version, and in smaller head sizes (< 28 mm) compared with 28 mm diameter heads (HR 1.50, p = 0.005). The seven-year revision rate was 1.16% (99% CI 0.69 to 1.63) with a 28 mm diameter head and flanged component. The overall risk of revision was independent of age, gender, American Society of Anesthesiologists grade, body mass index, surgeon volume, surgical approach, brand of cement/presence of antibiotic, femoral head material (stainless steel/alumina) and stem taper size/offset. However, the risk of revision for dislocation was significantly higher with a ‘plus’ offset head (HR 2.05, p = 0.003) and a hooded acetabular component (HR 2.34, p < 0.001).

In summary, we found that there were significant differences in failure between different designs of acetabular component and sizes of femoral head after adjustment for a range of covariates.
Total meniscectomy in adolescents
Authors: Pengas I. P. , Assiotis A. , Nash W. , Hatcher J. , Banks J. , McNicholas M. J.
Published: November 2012

We continued a prospective longitudinal follow-up study of 53 remaining patients who underwent open total meniscectomy as adolescents and who at that time had no other intra-articular pathology of the knee. Their clinical, radiological and patient-reported outcomes are described at a mean follow-up of 40 years (33 to 50). The cohort of patients who had undergone radiological evaluation previously after 30 years were invited for clinical examination, radiological evaluation and review using two patient-reported outcome measures.

A total of seven patients (13.2%) had already undergone total knee replacement at the time of follow-up. A significant difference was observed between the operated and non-operated knee in terms of range of movement and osteoarthritis of the tibiofemoral joint, indicating a greater than fourfold relative risk of osteoarthritis at 40 years post-operatively. All patients were symptomatic as defined by the Knee Injury and Osteoarthritis Outcome Score.

This study represents the longest follow-up to date and it can be concluded that meniscectomy leads to symptomatic osteoarthritis of the knee later in life, with a resultant 132-fold increase in the rate of total knee replacement in comparison to their geographical and age-matched peers.
Exam Corner – December 2012
Authors: Khanduja V.
Published: November 2012

The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and Clinical Examination. The Vivas are further divided into four sections comprising Basic Science, Adult Pathology, Hands and Children’s Orthopaedics and Trauma. The Clinical Examination section is divided into Upper and Lower limb cases. The aim of this section in the Journal is to focus specifically on the trainees preparing for the exam and to cater to all the sections of the exam. The vision is to complete the cycle of all relevant exam topics (as per the syllabus) in four years.
From the third sector to the Big Society: consensus or contention in the 2010 UK General Election?
Authors: Alcock Pete , Kendall Jeremy , Parry Jane
Published: November 2012

The 2010 General Election marked a turning-point in British politics, with a new coalition government replacing the Labour administration that had been in power for 13 years. This resulted in an apparent change in policy on the third sector, from a period of ‘hyperactive mainstreaming’ in which significant support was provided for the sector to the ‘Big Society’ agenda under which voluntary and community action are promoted as an alternative to state intervention. This article explores this transition through analysis of the presentation of third sector politics in the election campaign and the subsequent development of these under the new government, providing an insight into the relationships between electoral politics and policy development within the United Kingdom.
Building better neighbourhoods? Insights into the contributions of local faith-based organisations
Authors: Lambie-Mumford Hannah , Jarvis David
Published: November 2012

This article presents practitioner-focused insights into the work of local faith-based organisations (FBOs), drawing on recent research in Oxfordshire, England. In particular, the article identifies key features relating to: the internal workings of FBOs, particularly the importance of formalised governance structures; issues that impact on FBOs’ relationships with external partners; and the role of the wider policy context in determining how the work of these organisations, and their faith basis, are viewed and valued. The article proposes a number of ways in which local FBOs can be supported moving forward: practitioners, policy makers and FBOs need to work together to establish foundations for productive partnership working into the future; best practice needs to be shared and support given to help FBOs to establish robust governance structures; and policy, research and practice will all need to come to a better understanding of the distinctiveness of FBOs.
Philanthropy without borders: the European Foundation Statute
Authors: Hellam Mall
Published: November 2012

This article reviews the proposal to create a legal form for a European foundation, which could operate across borders within Europe. The European Foundation Statute was proposed by the European Union executive in 2012. The article outlines the background to, and case for, the initiative, the key elements of the way in which it would work alongside existing national legislative frameworks for foundations, and the hurdles it must overcome if it is to be successfully implemented.
Critical friendships
Authors: Heaphy Brian , Davies Katherine
Published: November 2012

A growing body of social-scientific work has explored friendship as a source of relational goods and as a model for democratic relating. Friendships have been seen as resources for the self, sources of emotional, social and material supports, as central to elective families and affective communities and as pure relationships. Also, an egalitarian friendship ‘ethos’ has been proffered as a solution to the power imbalances associated with other relational forms such as family. These are partial views of friendships. Drawing on data generated for a study of critical associations, this article explores how friendships can be experienced as good, ambivalent and disappointing. There is an assumption in some of the literature that suffused friendships are especially rewarding. However, our own data suggest that they can also be personally troubling. We conclude that idealised friendships are not the answer to the problematic realities of other relational forms.
Culture and motherhood: findings from a qualitative study of East Asian mothers in Britain
Authors: Lim Hyun-Joo , Skinner Tina
Published: November 2012

This article focuses on the possible impacts of Confucianism on the experiences of middle-class East Asian women with dependent children in Britain. By using the concept of ‘intersectionality’, it aims to understand the ways in which mothering identity intersects with class and East Asian cultural identity in the British context, and how identities emerge through this interaction. The study was based on in-depth interview data collected from 20 first-generation East Asian mothers living in Britain, and suggests that East Asian mothers in this study appear to share a discernible trace of Confucianism, including a strong emphasis on education, alongside a high value placed on seniority, and children as a mother’s possession. These Confucian values were portrayed by the interviewees as salient in constructing their mothering identities. Simultaneously, however, certain aspects of British culture were also perceived to be significant in their mothering, in that they appeared to provide the interviewees with opportunities to question and modify their cultural values.
Trying to do more with less? Negotiating intensive mothering and financial strain in Canada
Authors: Leigh Jeanna Parsons , Pacholok Shelley , Snape Tara , Gauthier Anne H.
Published: November 2012

This article explores the ways in which middle-income mothers negotiate the hegemony of intensive mothering when faced with financial strain. We consider how finances are linked to mothers’ ability to practise their preferred version of ‘good’ mothering, and the strategies used to marshal the financial resources necessary to implement this model. We find that much heterogeneity exists in the ways that mothers respond to the discourse of intensive mothering, and that financial resources are linked to how mothers both construct and practise ‘good’ mothering. For example, in an effort to reconcile tensions between their constructions of ‘good’ mothering and paid labour, they employ strategies such as remaining the primary caregiver for their children while also working at night, taking on contract work and taking in boarders. This research has specific implications for the ways that middle-income families are functioning in the current neoliberal political and economic climate.
Blinded by neuroscience: social policy, the family and the infant brain
Authors: Wastell David , White Sue
Published: November 2012

Current social policy initiatives are promoting early intervention to improve the lives of disadvantaged children. Neuroscientific evidence is prominent in this discourse, creating the lustre of science, but too much has been taken on trust. In particular, the argument that the first three years are critical has created a now-or-never imperative to intervene before irreparable damage is done to the developing infant brain. A critique of current policy in the United Kingdom is provided here, drawing on counter-arguments from the policy discourse in the United States during the ‘decade of the brain’, updated with more recent research findings. Overall, we show that the infant brain is not readily susceptible to permanent and irreversible damage from psychosocial deprivation. Rather, plasticity and resilience seem to be the general rule. The co-option of neuroscience has medicalised policy discourse, silencing vital moral debate and pushing practice in the direction of standardised, targeted interventions rather than simpler forms of family and community support, which can yield more sustainable results.
Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment?
Authors: Hoermann Rudolf , Midgley John E M , Larisch Rolf , Dietrich Johannes W
Published: November 2012

Objective

In recognition of its primary role in pituitary–thyroid feedback, TSH determination has become a key parameter for clinical decision–making. This study examines the value of TSH as a measure of thyroid hormone homoeostasis under thyroxine (T4) therapy.

Design and methods

We have examined the interrelationships between free triiodothyronine (FT3), free T4 (FT4) and pituitary TSH by means of i) a retrospective analysis of a large clinical sample comprising 1994 patients either untreated or on varying doses of l-T4 and ii) independent mathematical simulation applying a model of thyroid homoeostasis, together with a sensitivity analysis.

Results

Over a euthyroid to mildly hyperthyroid functional range, we found markedly different correlation slopes of log TSH vs FT3 and FT4 between untreated patients and l-T4 groups. Total deiodinase activity (GD) was positively correlated with TSH in untreated subjects. However, GD was significantly altered and the correlation was lost under increasing l-T4 doses. Ninety-five per cent confidence intervals for FT3 and FT4, when assessed in defined TSH concentration bands, differed significantly for l-T4-treated compared with untreated patients. Higher doses were often needed to restore FT3 levels within its reference range. Sensitivity analysis revealed the influence of various structural parameters on pituitary TSH secretion including an important role of pituitary deiodinase type 2.

Conclusion

The data reveal disjoints between FT4–TSH feedback and T3 production that persist even when sufficient T4 apparently restores euthyroidism. T4 treatment displays a compensatory adaptation but does not completely re-enact normal euthyroid physiology. This invites a study of the clinical consequences of this disparity.
Evolutionary Rate Covariation in Meiotic Proteins Results from Fluctuating Evolutionary Pressure in Yeasts and Mammals
Authors: Clark Nathan L , Alani Eric , Aquadro Charles F
Published: November 2012

Evolutionary rates of functionally related proteins tend to change in parallel over evolutionary time. Such evolutionary rate covariation (ERC) is a sequence-based signature of coevolution and a potentially useful signature to infer functional relationships between proteins. One major hypothesis to explain ERC is that fluctuations in evolutionary pressure acting on entire pathways cause parallel rate changes for functionally related proteins. To explore this hypothesis we analyzed ERC within DNA mismatch repair (MMR) and meiosis proteins over phylogenies of 18 yeast species and 22 mammalian species. We identified a strong signature of ERC between eight yeast proteins involved in meiotic crossing over, which seems to have resulted from relaxation of constraint specifically in Candida glabrata. These and other meiotic proteins in C. glabrata showed marked rate acceleration, likely due to its apparently clonal reproductive strategy and the resulting infrequent use of meiotic proteins. This correlation between change of reproductive mode and change in constraint supports an evolutionary pressure origin for ERC. Moreover, we present evidence for similar relaxations of constraint in additional pathogenic yeast species. Mammalian MMR and meiosis proteins also showed statistically significant ERC; however, there was not strong ERC between crossover proteins, as observed in yeasts. Rather, mammals exhibited ERC in different pathways, such as piRNA-mediated defense against transposable elements. Overall, if fluctuation in evolutionary pressure is responsible for ERC, it could reveal functional relationships within entire protein pathways, regardless of whether they physically interact or not, so long as there was variation in constraint on that pathway.
The Effect of Nonindependent Mate Pairing on the Effective Population Size
Authors: Evans Ben J , Charlesworth Brian
Published: November 2012

The effective population size (Ne) quantifies the effectiveness of genetic drift in finite populations. When generations overlap, theoretical expectations for Ne typically assume that the sampling of offspring genotypes from a given individual is independent among successive breeding events, even though this is not true in many species, including humans. To explore the effects on Ne of nonindependent mate pairing across breeding events, we simulated the genetic drift of mitochondrial DNA, autosomal DNA, and sex chromosome DNA under three mating systems. Nonindependent mate pairing across breeding seasons has no effect when all adults mate pair for life, a small or moderate effect when females reuse stored sperm, and a large effect when there is intense male–male competition for reproduction in a harem social system. If adult females reproduce at a constant rate irrespective of the type of mate pairing, the general effect of nonindependent mate pairing is to decrease Ne for paternally inherited components of the genome. These findings have significant implications for the relative Ne values of different genomic regions, and hence for the expected levels of DNA sequence diversity in these regions.
Protective Factors Can Mitigate Behavior Problems After Prenatal Cocaine and Other Drug Exposures
Authors: Bada Henrietta S. , Bann Carla M. , Whitaker Toni M. , Bauer Charles R. , Shankaran Seetha , LaGasse Linda , Lester Barry M. , Hammond Jane , Higgins Rosemary
Published: November 2012

BACKGROUND:

We determined the role of risk and protective factors on the trajectories of behavior problems associated with high prenatal cocaine exposure (PCE)/polydrug exposure.

METHODS:

The Maternal Lifestyle Study enrolled 1388 children with or without PCE, assessed through age 15 years. Because most women using cocaine during pregnancy also used other substances, we analyzed for the effects of 4 categories of prenatal drug exposure: high PCE/other drugs (OD), some PCE/OD, OD/no PCE, and no PCE/no OD. Risks and protective factors at individual, family, and community levels that may be associated with behavior outcomes were entered stepwise into latent growth curve models, then replaced by cumulative risk and protective indexes, and finally by a combination of levels of risk and protective indexes. Main outcome measures were the trajectories of externalizing, internalizing, total behavior, and attention problems scores from the Child Behavior Checklist (parent).

RESULTS:

A total of 1022 (73.6%) children had known outcomes. High PCE/OD significantly predicted externalizing, total, and attention problems when considering the balance between risk and protective indexes. Some PCE/OD predicted externalizing and attention problems. OD/no PCE also predicted behavior outcomes except for internalizing behavior. High level of protective factors was associated with declining trajectories of problem behavior scores over time, independent of drug exposure and risk index scores.

CONCLUSIONS:

High PCE/OD is a significant risk for behavior problems in adolescence; protective factors may attenuate its detrimental effects. Clinical practice and public health policies should consider enhancing protective factors while minimizing risks to improve outcomes of drug-exposed children.
The Effect of an Osmotic Contrast Agent on Complete Meconium Evacuation in Preterm Infants
Authors: Haiden Nadja , Norooz Florentine , Klebermass-Schrehof Kathrin , Horak Anna Sophie , Jilma Bernd , Berger Angelika , Repa Andreas
Published: November 2012

OBJECTIVE:

To determine whether enteral application of the osmotic contrast agent Gastrografin accelerates complete meconium excretion and improves feeding tolerance in very low birth weight infants.

METHODS:

This study was a stratified, randomized, placebo-controlled trial in premature infants with a birth weight <1500 g and a gestational age <32 weeks who received 3 mL/kg Gastrografin diluted 1:3 with water within their first 24 hours of life, or placebo.

RESULTS:

Passage of last meconium occurred after a median of 7 days (95% confidence interval: 6–9 days, n = 39) in the intervention group and after 8 days (95% confidence interval: 7–10 days, n = 39) in the control group (P = .61); however, Gastrografin application was associated with a 7.5-day shorter time to full enteral feedings, a 24-day shorter stay in the NICU, and a 17-day reduction in the overall hospital stay in the intervention group compared with the control group. A numerically higher incidence of necrotizing enterocolitis (21%) was observed in the intervention group, however.

CONCLUSIONS:

Gastrografin application did not accelerate meconium evacuation, but the higher stool frequency during the first week of life had a beneficial effect on the time to full enteral feedings and later hospital stay; however, it may increase the necrotizing enterocolitis risk. Further investigations are needed with modified protocols, and the prophylactic use of Gastrografin cannot currently be recommended without further clinical trials.
Theoretical Breast Cancer Induction Risk From Thoracic Spine CT in Female Pediatric Trauma Patients
Authors: Egan Kelly R. , Muchow Ryan D. , Peppler Walter W. , Anderson Paul A.
Published: November 2012

OBJECTIVES:

To quantify the radiation dose received during thoracic spine computed tomography (CT) versus plain radiographs as well as the theoretical risk of breast cancer induction in a pediatric trauma population.

METHODS:

A retrospective evaluation of 179 female pediatric trauma patients who received CT or plain radiographs for clearance of the thoracic spine was performed. Subjects were secondarily grouped as children (0–<12 years) or adolescents (≥12–17.9 years). Radiation doses were calculated by using the ImPACT Patient Dosimetry Calculator. Excess absolute risk (EAR) of induction of breast cancer was determined by multiplying the radiation dose by breast cancer induction rates taken from the National Academy's Biological Effects of Ionizing Radiation Committee’s seventh report.

RESULTS:

The average radiation dose to the breast from a thoracic spine CT was 41.1 (SD 11.4) mSv and 1.8 (SD 0.9) mSv for plain radiographs. The EAR for plain radiographs was 2.7 (95% confidence interval [CI] 2.48–2.85) excess cases of breast cancer per 10 000 studies for female children and 1.4 (95% CI 1.14–1.55) for female adolescents. The breast cancer EAR for thoracic spine CT was significantly higher –79.6 (95% CI 58.6–100.5) and 45.8 (95% CI 42.0–49.6) excess cases per 10 000 scans for female children and adolescents, respectively. There was a substantially higher risk of breast cancer induction for children receiving thoracic spine CT compared with adolescents.

CONCLUSIONS:

CT clearance of the thoracic spine in the pediatric trauma patient results in a high dose of radiation and an age-dependent increase in theoretical breast cancer induction.
Collaborative Role of the Pediatrician in the Diagnosis and Management of Bipolar Disorder in Adolescents
Authors: Shain Benjamin N. ,   COMMITTEE ON ADOLESCENCE, Braverman Paula K. , Adelman William P. , Breuner Cora C. , Levine David A. , Marcell Arik V. , Murray Pamela J. , O’Brien Rebecca F.
Published: November 2012

This Clinical Report was reaffirmed September 2021.

Despite the complexity of diagnosis and management, pediatricians have an important collaborative role in referring and partnering in the management of adolescents with bipolar disorder. This report presents the classification of bipolar disorder as well as interviewing and diagnostic guidelines. Treatment options are described, particularly focusing on medication management and rationale for the common practice of multiple, simultaneous medications. Medication adverse effects may be problematic and better managed with collaboration between mental health professionals and pediatricians. Case examples illustrate a number of common diagnostic and management issues.
Supporting the Family After the Death of a Child
Authors: Wender Esther ,   THE COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, Siegel Benjamin S. , Dobbins Mary I. , Garner Andrew S. , McGuinn Laura J. , Pascoe John , Wood David L. , Yogman Michael W.
Published: November 2012

This Clinical Report was reaffirmed September 2021.

The death of a child can have a devastating effect on the family. The pediatrician has an important role to play in supporting the parents and any siblings still in his or her practice after such a death. Pediatricians may be poorly prepared to provide this support. Also, because of the pain of confronting the grief of family members, they may be reluctant to become involved. This statement gives guidelines to help the pediatrician provide such support. It describes the grief reactions that can be expected in family members after the death of a child. Ways of supporting family members are suggested, and other helpful resources in the community are described. The goal of this guidance is to prevent outcomes that may impair the health and development of affected parents and children.
Care of Adolescent Parents and Their Children
Authors: Pinzon Jorge L. , Jones Veronnie F. ,   COMMITTEE ON ADOLESCENCE,   COMMITTEE ON EARLY CHILDHOOD, Blythe Margaret J. , Adelman William P. , Breuner Cora C. , Levine David A. , Marcell Arik V. , Murray Pamela J. , O’Brien Rebecca F. , High Pamela C. , Donoghue Elaine , Fussell Jill J. , Gleason Mary Margaret , Jaudes Paula K. , Rubin David M. , Schulte Elaine E.
Published: November 2012

Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.
Evaluation of vascular function by modern non-invasive methods
Authors: Nemes Attila , Forster Tamás
Published: November 2012

Vascular functional alterations frequently precede morphological changes and, therefore, their recognition may theoretically improve early detection of vascular injury. The aim of this review is to demonstrate recently available non-invasive clinical methods including vascular stiffness examinations, flow-mediated vasodilatation, coronary flow reserve and myocardial flow reserve measurements. Orv. Hetil., 2012, 153, 1887–1895.
QT prolongation and ventricular fibrillation caused by acute necrotising pancreatitis in a young female patient
Authors: Jánosi András , Osztheimer István , Merkely Béla
Published: November 2012

Electrocardiographic alterations associated with acute pancreatitis (AP) have been known for decades. This association may be of particular importance in differential diagnosis, since authors have reported ECG abnormalities suggestive of myocardial infarction. The pathophysiological mechanism of these ECG changes has remained unclear to date. Only a few reports have been published on pancreatitis-induced QT prolongation and malignant arrhythmia. This case report describes the case history of a young female patient with acute pancreatitis accompanied with a substantial prolongation of the QT interval, resulting in recurrent ventricular tachycardia and fibrillation. A thorough cardiologic work-up (including coronary angiography and electrophysiology screen) ruled out other causes of malignant arrhythmia. The patient received an implantable cardioverter-defibrillator. Following resolution of the pancreatitis, the QT interval normalized and arrhythmia has not recurred during long-term follow-up. To the best knowledge of the authors, there is no case reports in the literature similar to that described in this paper. Orv. Hetil., 2012, 153, 1918–1920.
Looking back and moving forward: a bibliographic survey of the Hungarian-language Orvosi Hetilap
Authors: Berhidi Anna , Margittai Zsuzsa , Vasas Lívia
Published: November 2012

Introduction: The first step in the process of acquisition of impact factor for a scientific journal is to get registered at Thomson Reuters Web of Science database. Aim: The aim of this article is to evaluate the content and structure of Orvosi Hetilap with regards to selection criteria of Thomson Reuters, in particular to objectives of citation analysis. Methods: Authors evaluated issues of Orvosi Hetilap published in 2011 and calculated the unofficial impact factor of the journal based on systematic search in various citation index databases. Number of citations, quality of citing journals and scientific output of the editorial board members were evaluated. Adherence to guidelines of international publishers was assessed, as well. Results: Unofficial impact factor of Orvosi Hetilap has been continuously rising every year in the past decade (except for 2004 and 2010). The articles of Orvosi Hetilap are widely cited by international authors and high impact factor journals, too. Further, more than half the articles cited are open access. The most frequently cited categories are original and review articles as well as clinical studies. Orvosi Hetilap is a weekly published journal, which is covered by many international databases such as PubMed/Medline, Scopus, Embase, and BIOSIS Previews. As regards to the scientific output of the editorial board members, the truncated mean of the number of their publications was 497, citations 2446, independent citations 2014 and h-index 21. Conclusions: While Orvosi Hetilap fulfils many criteria for getting covered by Thomson Reuters, it is worthwhile to implement a method of online citation system in order to increase the number of citations. In addition, scientific publications of all editorial board members should be made easily accessible. Finally, publications of comparative studies by multiple authors are encouraged as well as papers containing epidemiological data analyses. Orv. Hetil., 2012, 153, 1905–1917.
Comparative studies on photovoltaic performance of InN nanostructures/p-Si(100) heterojunction devices grown by molecular beam epitaxy
Authors: Bhat Thirumaleshwara N , Rajpalke Mohana K , Kumar Mahesh , Roul Basanta , Krupanidhi S B
Published: November 2012

Comparative studies have been carried out on the performance of the photovoltaic devices with dissimilar shapes of the InN nanostructures fabricated on p-Si (100). The devices fabricated with the nanodots show a superior performance compared to the devices fabricated with the nanorods. The discussions have been carried out on the superior junction property, larger effective junction area and inherent random pyramidal topographical texture of the cell fabricated with nanodots. Such single junction devices exhibit a promising fill factor and external quantum efficiency of 38% and 27%, respectively, under concentrated AM1.5 illumination.
Low Cost Environmental Sensors Using Zinc Oxide Nanowires and Nanostructures
Authors: Kiasari Nima Mohseni , Soltanian Saeid , Gholamkhass Bobak , Servati Peyman
Published: November 2012

Zinc oxide (ZnO) nanowires (NW) are grown on both silicon and sapphire substrates using conventional chemical vapor deposition (CVD) system. As-grown nanostructures are characterized by scanning electron microscope (SEM), X-ray diffraction (XRD) as well as energy dispersive spectroscopy (EDS) and the results confirm high-quality c-axis growth of single-crystalline zinc oxide nanowires. Nanowire are dispersed in solvent and then placed between micro-patterned gold electrodes fabricated on silicon wafers using low cost and scalable dielectrophoresis (DEP) process for fabrication of oxygen and humidity sensors. These sensors are characterized in a vacuum chamber connected to a semiconductor analyzer. Current-voltage characteristics of each device are systematically investigated under different hydrostatic pressure of various gaseous environments such as nitrogen, argon, dry and humid air. It is observed that the electrical conductivity of the nanowires is significantly dependent on the number of oxygen and water molecules adsorbed to the surface of the metal oxide nanowire. These results are critical for development of low cost metal oxide sensors for high performance ubiquitous environmental sensors of oxygen and humidity.
Role of Surface Oxide Layer during CO2 Reduction at Copper Electrodes
Authors: Tsai Cheng-Chun , Bugayong Joel , Griffin Gregory L.
Published: November 2012

We have compared the rates of CO formation on Cu and Cu oxide surfaces during the electrochemical reduction of CO2 in aqueous media. On metallic Cu surfaces, H2 formation is the main reaction at potentials less cathodic than –1.16 V(NHE). At this potential the formation of CO becomes significant, while CH4 appears at potentials more cathodic than –1.36 V(NHE). On electrodeposited Cu oxide surfaces there is a complex transient response. During reduction at constant potential (–1.1 V(NHE)), there is a large, transient cathodic current that corresponds to reduction of the oxide layer. After this initial oxide reduction, the current density stabilizes and the formation rates of H2 and CO show a more slowly varying transient behavior. The H2 formation rate is roughly 3x higher than on freshly cleaned Cu foil, but is largely independent of the thickness of the initial oxide layer. In contrast, the CO formation rate is at least one order of magnitude higher on the (reduced) Cu oxide samples than on Cu foil at the same potential. These results are interpreted as evidence that CO formation is enhanced at low-coordination number Cu sites present on freshly nucleated Cu clusters following oxide reduction.
Land use/cover classification in the Brazilian Amazon using satellite images
Authors: Lu Dengsheng , Batistella Mateus , Li Guiying , Moran Emilio , Hetrick Scott , Freitas Corina da Costa , Dutra Luciano Vieira , Sant'Anna Sidnei João Siqueira
Published: November 2012

Land use/cover classification is one of the most important applications in remote sensing. However, mapping accurate land use/cover spatial distribution is a challenge, particularly in moist tropical regions, due to the complex biophysical environment and limitations of remote sensing data per se. This paper reviews experiments related to land use/cover classification in the Brazilian Amazon for a decade. Through comprehensive analysis of the classification results, it is concluded that spatial information inherent in remote sensing data plays an essential role in improving land use/cover classification. Incorporation of suitable textural images into multispectral bands and use of segmentation‑based method are valuable ways to improve land use/cover classification, especially for high spatial resolution images. Data fusion of multi‑resolution images within optical sensor data is vital for visual interpretation, but may not improve classification performance. In contrast, integration of optical and radar data did improve classification performance when the proper data fusion method was used. Among the classification algorithms available, the maximum likelihood classifier is still an important method for providing reasonably good accuracy, but nonparametric algorithms, such as classification tree analysis, have the potential to provide better results. However, they often require more time to achieve parametric optimization. Proper use of hierarchical‑based methods is fundamental for developing accurate land use/cover classification, mainly from historical remotely sensed data.
Gingival esthetics: an orthodontic and periodontal approach
Authors: Seixas Máyra Reis , Costa-Pinto Roberto Amarante , Araújo Telma Martins de
Published: November 2012

INTRODUCTION: Currently, people's esthetic requirements and expectations have increased substantially. Therefore, dentists have been seeking ways to provide excellent treatment results which, consequently, increasingly require a well organized transdisciplinary approach. The link between orthodontics and periodontics became evident from the moment professionals began to understand the biology of tooth movement. As regards smile esthetics, however, such cooperation is now essential. OBJECTIVE: To show clinically how and when orthodontists and periodontists should work jointly to enhance smile esthetics based on the display and harmony of the gingival contour.
Selection and Successful Application of Jet Pumps in Mangala Oil field: A Case Study
Authors: Chavan C. , Jha M. , Singh M. K. , Singh R.
Published: November 2012

This paper describes the selection, field application and performance monitoring of jet pumps in the giant Mangala field situated in the Barmer basin in Rajasthan, India. The field contains more than a billion barrel of STOIIP (Stock Tank Oil Initially in Place) in high-quality reservoirs. The field was brought on production in August 2009 and is currently producing at a plateau of 150,000 bopd. Mangala field is characterized by multi-Darcy rocks with mix to oil wet characteristics. The oil is waxy and viscous, with wax appearance temperatures close to reservoir temperature.

Jet pump has been selected as the preferred artificial lift method for the deviated wells. The base development plan included hot water flooding; this makes water heated up to 85 °C available at the well pads as power fluid for jet pumping. In order to prevent exposure of carbon steel production casing to corrosive reservoir fluid, the jet pumping process involves pumping the power fluid down the annulus and taking returns through the tubing.

The results have indicated that the jet pumps are giving required drawdown, thereby restoring the liquid productivity of the wells. In addition to restoring well production, jet pumping has also been used as an effective and fast method for cleanup of deviated wells completed with sand screens. The real time monitoring of the jet pump parameters, using Digital Oil Field (DOF), has immensely helped in efficient monitoring the pump performance and reducing the response time in case of problems.

Jet pump application has helped in restoring the deliverability of wells at high water cut for such a viscous crude. Further analysis of the pump behavior will provide insight for efficiently operating these pumps which is critical for maximizing recovery from the field at higher water cuts.
Establishing Tall Fescue and Kentucky Bluegrass Using Subsurface Irrigation and Saline Water
Authors: Schiavon Marco , Leinauer Bernd , Serena Matteo , Sallenave Rossana , Maier Bernd
Published: November 2012

Subsurface capillary irrigation (SCI), drip lines surrounded by a patented membrane, is purported to conserve irrigation water by applying water more evenly and efficiently. A study was conducted at New Mexico State University from 2009 to 2011 to investigate the establishment of tall fescue (Festuca arundinacea L.) and Kentucky bluegrass (Poa pratensis L.) irrigated using either SCI or a sprinkler irrigation system in combination with saline (electrical conductivity [EC] = 2.8 dS m−1) or potable water (EC = 0.6 dS m−1). Tall fescue was seeded in September 2009 and in October 2010 for the second establishment experiment together with Kentucky bluegrass. Seedling density 30 d after seeding (DAS) was greater on sprinkler‐irrigated plots than on SCI plots. Generally, sprinkler‐irrigated plots achieved greater ground coverage at the end of the establishment period than SCI plots. Capillary‐irrigated plots reached 75% ground cover as fast as sprinkler‐irrigated ones in 2010 (202 and 212 DAS. respectively) but were slower in 2011. At the end of both growing seasons, higher EC levels were measured in SCI plots than in sprinkler‐irrigated plots. The highest Na concentration (26.3 mmolc L−1) and Na adsorption ratio (13.0) were measured on plots irrigated through SCI with saline water. Results suggest that SCI can be used to establish cool‐season turfgrass; however, grow‐in of subsurface‐irrigated turf can be delayed compared with sprinkler irrigation. Further research is needed to determine if acceptable turf quality can be maintained past establishment when using a SCI system in combination with lower quality, saline water.