bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital selenium radiography: anti-scatter grid for chest radiography in a clinical study.
Authors: Bernhardt T M , Rapp-Bernhardt U , Hausmann T , Reichel G , Krause U W , Doehring W
Published: June 2014

The purpose of this study was to evaluate the diagnostic performance of an additional stationary anti-scatter grid in digital selenium radiography (DSR) compared with images acquired with only an air gap. Chest radiographs were obtained with DSR in 100 patients with and without an anti-scatter grid. Four observers scored 12 anatomical landmarks, catheters and wire cerclages for their visualization in both subsets of images. Statistical analysis was performed using a paired t-test. Anatomical landmarks, catheters and wire cerclages were statistically better visualized in regions of high attenuation when the images were performed with an anti-scatter grid. No statistically significant difference was noted for peripheral regions, nor for sex and weight of the patient between the two modalities. Therefore, an anti-scatter grid is not recommended for chest radiography as it increases the radiation exposure of patients without having a significant impact on visualization for all regions of the chest.
Hip axis length in an Italian osteoporotic population.
Authors: Rosso R , Minisola S
Published: June 2014

Models proposed so far for the pathogenesis of osteoporosis often do not take into account the factors underlying the different incidences of hip fracture in different populations. To address this issue, we identified 34 female patients with hip fracture (HF) and 16 women with at least four vertebral fractures (VF) in a population-based retrospective study. Each participant had a bone mineral density (BMD) measurement of the lumbar spine and hip using a Hologic QDR-2000 scanner, in single beam mode for the latter site. Hip axis length (HAL) was determined automatically (precision 1.5%). HAL derived from 149 normal subjects (age range 19-75 years) was 10.3 +/- 0.5 cm. BMD values found at the femoral neck were almost similar, but differed significantly at the spine between the two groups. Mean values of femur HAL in HF patients (10.55 +/- 0.5 cm) were significantly higher compared with VF patients (9.85 +/- 0.54 cm; p < 0.001). Interestingly, both mean values differed significantly from the mean for normal subjects. Our results demonstrate that patients with multiple vertebral fractures have significantly lower vertebral BMD values but similar femoral neck values compared with patients who fracture at the hip; furthermore, hip axis length was more than 1 SD higher in these latter patients compared with that of VF patients. These results suggest that the size and shape of the hip can explain part of the observed aetiologic differences between these two types of osteoporotic fractures.
How should breathing motion be combined with other errors when drawing margins around clinical target volumes?
Authors: McKenzie A L
Published: June 2014

Geometric uncertainties in radiotherapy treatment may be accommodated by drawing an adequate margin around the clinical target volume (CTV). The width of the margin is commonly based upon the quadrature sum of the standard deviations of the contributory errors. This approach is satisfactory when the probability distributions of the component errors are Gaussian, but breathing-induced motion of the CTV is generally not Gaussian. This paper shows that the blurred dose distribution D(z) arising from a step function beam edge that is moving cyclically along the z-axis is given by D(z) = 2t/tau, where t(z) relates time to position and tau is the cycle duration. Applying this relation to realistic breathing models results in a dose distribution in which the sharp edge of the step function is still evident even after blurring caused by the motion. This suggests that breathing-induced motion should be accounted for separately, with the breathing margin added linearly to the quadrature sum of the other contributing errors.
Measurement of dose in panoramic dental radiology.
Authors: Williams J R , Montgomery A
Published: June 2014

The National Radiological Protection Board (NRPB) has recommended the introduction of dose-width product (DWP) for the measurement of patient dose in panoramic dental radiology and has proposed a reference level of 65 mGy mm for adult exposures. This paper describes a method for measuring DWP and dose-area product (DAP) using thermoluminescent dosemeters (TLDs). The technique was used on 16 sets with a range of exposure settings. The mean value of DWP was 14% higher than the mean value reported from a survey by the NRPB. This difference is most likely to be caused by systematic variations due to measurement method. The average DAP for a standard adult examination was shown to be 11.3 cGy cm2. Data are presented so that the DAP can be derived from the exposure factors (tube current and operating potential) and beam area. Based on published data for effective dose, it is estimated that the DAP to effective dose conversion factor is approximately 0.06 mSv(Gy cm2)-1. The average DAP value (11.3 cGy cm2) can be compared with the average value for intraoral radiography (9.3 cGy cm2) based on the NRPB survey of entrance surface doses assuming 6 cm circular collimation.
The influence of clinical information on the reporting of CT by radiologists.
Authors: Leslie A , Jones A J , Goddard P R
Published: June 2014

The aim of the study was to determine whether clinical information alters the CT report. This prospective blinded study consisted of 50 consecutive patients who attended a Department of Radiology for CT. Each study was interpreted by two of three consultant radiologists, before and after knowledge of the clinical information. 19 reports were changed after clinical information was known. Clinical follow-up was available in 15 cases. In ten cases the reports were more accurate after clinical information and in five cases the reports were less accurate. In three of the five cases where accuracy was reduced, the clinical information was incorrect. It was concluded that clinical information affects the CT report. If the information is accurate it has a beneficial effect; if it is inaccurate it has a detrimental effect. The more complex the investigation, the more important the clinical information. There was a correlation between readers regarding the influence of clinical information. Correct clinical information therefore improves the radiology report. It is the responsibility of the clinician to provide this information in an accurate and legible form.
Evaluation of combined therapy with chemoembolization and irradiation for large hepatocellular carcinoma.
Authors: Guo W J , Yu E X
Published: June 2014

The effects of combined transcatheter arterial chemoembolization (TACE) and radiotherapy in patients with large hepatocellular carcinoma (HCC) were analysed retrospectively. A total of 107 patients with large unresectable HCC was treated with TACE followed by external beam irradiation. The largest dimension of the tumours ranged from 5 cm to 18 cm. Acute effects, survival rates, toxicity and prognostic factors were analysed. Follow-up ranged from 4 months to 98 months (median 24 months). An objective response, i.e. reduction of tumour area greater than 50%, was achieved in 48.6% of cases. In 64.9% of the cases with increased alpha-feto protein (AFP) values, AFP level underwent a reduction of more than 25%. The cumulative survival rates at 1, 3 and 5 years were 59.4%, 28.4% and 15.8%, respectively (median survival 18 months). The combination therapy was generally well tolerated. Only two patients died from liver failure or variceal bleeding associated with therapy. The Cox proportional hazards model showed that the number of tumours and the irradiation dose were independent prognostic factors. The results indicate that combined TACE with radiotherapy is a promising therapeutic approach for large unresectable HCC. Prospective controlled trials to ascertain the real potential benefit of this approach are required.
MR appearances of the locked knee.
Authors: Elliott J M , Tirman P F , Grainger A J , Brown D H , Campbell R S , Genant H K
Published: June 2014

This review illustrates the MR appearances of commonly encountered problems that can present as a "locked knee", as well as several unusual causes. Internal derangement of menisci, particularly bucket handle tears, predominate. Loose bodies as a result of trauma/degeneration and lesions such as cysts of the cruciate ligaments and focal pigmented villonodular synovitis are also illustrated. While meniscal tears are the major cause of "locked knee" in clinical practice, interference with normal knee kinematics is non-specific with regard to the diagnosis. Emphasis is therefore given to less frequently seen abnormalities that lead to a mechanical block of knee extension.
Advances in ultrasound: from microscanning to telerobotics.
Authors: Wells P N
Published: June 2014

This paper is in memory of W V Mayneord (1902-1988). Experiments conducted in Mayneord's laboratory were amongst the first to show that ultrasound had diagnostic potential. Now, one in every four imaging studies uses ultrasound. Amongst numerous contemporary advances, microscanning is concerned with imaging subcentimetre size volumes of tissue in three dimensions with 10-100 microns resolution. The traditional approach is by pulse echo imaging, with a focused ultrasonic beam in the frequency range 20-100 MHz. This approach may be complemented by ultrasonic CT (to correct for attenuation and speed variations), reflex transmission imaging (to provide attenuation data) and synthetic aperture scanning (to decrease imaging time). Harmonic microscanning may reduce artefacts, and elasticity imaging may also be possible. Microscanning is likely to have applications in pathology and in the operating room, for trackless microintervention, in molecular biology and drug studies, and in experimental imaging of small mammals including, in particular, the mouse. Robotics is the engineering science concerned with devices that are able to execute tasks usually performed by humans. Two procedures, ultrasonically guided biopsy and ultrasonic laparoscopy, are being used to demonstrate the feasibility of telerobotics. The approach is that of telepresence, as distinct from supervisory control or virtual reality. Problems associated with image compression and communications latency are identified. Although incremental developments in medical ultrasound have resulted from clinical pull, major advances have, in general, been due to technical push.
Superselective embolisation for intractable idiopathic epistaxis.
Authors: Oguni T , Korogi Y , Yasunaga T , Sadanaga T , Uozumi H , Kawanaka K , Sumi S , Takahashi M
Published: June 2014

37 patients with intractable idiopathic epistaxis were treated with superselective embolisation between 1995 and 1999. A total of 40 embolisations was performed, including three procedures for recurrence. The embolic material was gelatin sponge in 27 procedures, microcoils in 9 and both gelatin sponge and microcoils in 4. Immediate cessation of nasal bleeding was obtained in all patients after embolisation. Recurrent epistaxis occurred in 2 (5.4%) of the 37 patients within 7 days after initial embolisation, giving a short-term success rate of 94.6%. The long-term follow-up ranged from 1-51 months (mean 21.6 months). Late re-bleeding occurred in two patients, giving a long-term success rate of 94.6%. Two patients underwent re-embolisation; it was necessary to embolise the ipsilateral facial artery and/or the contralateral internal maxillary as well as the ipsilateral maxillary artery. Although the overall complication rate was 45.0%, no major complications occurred. Superselective embolisation with gelatin sponge is an effective and safe treatment technique for intractable idiopathic epistaxis.
CT criteria for venous invasion in patients with pancreatic head carcinoma.
Authors: Phoa S S , Reeders J W , Stoker J , Rauws E A , Gouma D J , Laméris J S
Published: June 2014

The purpose of the study was to evaluate CT criteria for venous invasion in patients with potentially resectable carcinoma of the pancreatic head, with surgical and histopathological correlation. In 113 patients evaluated with spiral CT for suspected pancreatic head carcinoma, several CT criteria for venous invasion were scored prospectively for the portal vein (PV) and the superior mesenteric vein (SMV): length of tumour contact with PV/SMV (0 mm, < 5 mm, > 5 mm); circumferential involvement of the vein (0 degree, 0-90 degrees, 90-180 degrees, > 180 degrees); degree of stenosis; irregularity of the vessel margin; and tumour convexity towards vessel. 65 patients underwent surgery. Pancreatic head carcinoma was proven and pathology of the vascular margin was obtained in 50 of these patients. CT findings for single and combined criteria were correlated with pathology in these 50 patients, 30 of whom showed venous ingrowth. Invasion was found in all cases with SMV narrowing (n = 7), PV contour involvement > 90 degrees (n = 6), PV narrowing (n = 5) and PV wall irregularity (n = 3). The vascular ingrowth rate was 88% (15/17) for tumour concavity towards the PV or SMV. Poor predictors of ingrowth were length of tumour contact with PV > 5 mm (78% ingrowth, 14/18) and contour involvement of the SMV > 90 degrees (83% ingrowth, 10/12). Absence of vascular ingrowth could not be predicted in 100%. In conclusion, CT criteria can predict a high risk of invasion in potentially resectable tumours. Narrowing of the SMV and the PV seems the most reliable criterion, as well as circumferential involvement of the PV > 90 degrees. The best combination of criteria was tumour concavity with circumferential involvement > 90 degrees (sensitivity 60% and positive predictive value 90%).
Role of high magnification specimen radiography in surgical and core biopsies of the breast.
Authors: Moritz J D , Mertens C , Westerhof J P , Oestmann J W
Published: June 2014

The clinical relevance of a high magnification specimen radiography (HMSR) system in breast biopsies was evaluated and compared with conventional specimen radiography with a mammography system (SRM). 100 surgical biopsies of 72 patients and 248 core biopsies of 30 patients were examined in (a) maximal 20-fold HMSR in combination with storage phosphors and (b) 1.8-fold SRM using a film-screen system. Detection of calcifications/soft tissue lesions and the impact on management were evaluated. In surgical biopsies, SRM could detect only 22% of individual microcalcifications, 39% of calcified lesions and 67% of soft tissue lesions identified with HMSR. Calcifications down to 10 microns were identified with HMSR. In five biopsies, peripheral calcifications leading to additional resection were recognized only with HMSR; in three of these they were indicative of malignant tissue. In core biopsies, only 12% of individual microcalcifications seen with HMSR were identified with SRM. 52% and 16% of all cores were calcified on HMSR and SRM, respectively. Microcalcifications within cores were found only with HMSR in 41% of patients with calcified lesions. In conclusion, the better detectability of microcalcifications with HMSR led to justified additional tissue resections in surgical patients and reduced the number of core biopsies required in interventional patients.
Ultrasonographic features of nephrocalcinosis in preterm neonates.
Authors: Schell-Feith E A , Holscher H C , Zonderland H M , Kist-Van Holthe J E , Conneman N , van Zwieten P H , Brand R , van der Heijden A J
Published: June 2014

Nephrocalcinosis (NC) in preterm neonates has been reported frequently and small studies suggest an unfavourable effect on renal function. Data on ultrasonic features are limited and the reproducibility of ultrasonography (US) in detecting NC in preterm neonates is unknown. In this study, interobserver and intraobserver agreement of US was determined through videotape recordings of US examinations of preterm neonates. Furthermore, a prospective US study was performed in 215 preterm neonates (gestational age < 32 weeks) to evaluate ultrasonic characteristics, incidence, time course and effect on kidney length of NC. Patients were studied at 4 weeks after birth and at term. Patients with NC were followed for 2 years. NC was defined as bright reflections in the medulla or cortex seen in both transverse and longitudinal direction. The length of the kidneys was noted. The kappa value was 0.84 for intraobserver and 0.46 for interobserver agreement, whereas the overall agreement was 73%. NC was found in 50 of 150 (33%) patients at 4 weeks and in 83 of 201 patients (41%) at term. NC was localized mainly in the medulla. At 1 and 2 years, NC had persisted in 36% and 26%, respectively, of the patients with NC at term. Kidney length was comparable with normal values. In conclusion, US has a very good intraobserver agreement but a moderate interobserver agreement in detecting NC. Medullary NC is common among preterm neonates. During the first 2 years of life, the incidence decreases spontaneously and NC does not influence kidney length.
Radiotherapy for vaginal carcinoma: a 23-year review.
Authors: Stryker J A
Published: June 2014

The purpose of the study was to evaluate prognostic variables and morbidity in patients with vaginal carcinoma. 34 patients, mean age 67 years (+/- 8 SD), were treated between 1976 and 1994. 14 patients had a history of prior hysterectomy. In 13 of the 34 patients the tumour site was the upper vagina, in 9 it was the middle third, in 8 the lower third and in 4 the entire length of the vagina. Disease stage was I in 9 patients, II in 16, III in 7 and IV in 2. There were four treatment groups: external beam therapy + intracavitary brachytherapy (Group WPIC, n = 15); external beam therapy + interstitial brachytherapy (Group WPIS, n = 10); external beam therapy alone (Group WP, n = 7); and brachytherapy alone (Group BA, n = 2). Kaplan-Meier estimates and log-rank tests were used to evaluate survival. Disease-specific 5-year survival was 68% for 28 patients with squamous cell carcinoma and 50% for 6 patients with adenocarcinoma (p-value 0.3). 5-year survival was 78% for stage I disease, 63% for stage II, 33% for stage III and 50% for stage IV (p-value 0.2). Vaginal site of carcinoma, history of hysterectomy and treatment type are not significant prognostic factors. Local failure occurred in 2 patients (13%) in the WPIC group, 2 (20%) in WPIS, 3 (43%) in WP and 1 (50%) in BA. 9 patients (26%) had late small/large intestine and/or bladder morbidity. Vaginal morbidity occurred in 15 patients (44%); 9/15 (60%) in the WPIC group and 3/10 (30%) in the WPIS group having vaginal morbidity. This means that, when combining external beam therapy with brachytherapy, interstitial techniques are preferred over intracavitary techniques.
Paraffin oil bezoar impacted in the small bowel: CT findings.
Authors: Gayer G , Gotlieb W H , Apter S
Published: June 2014

A case of a paraffin oil bezoar impacted in the small bowel, resulting from the prolonged use of paraffin oil as treatment for increasing constipation in a patient with metastatic ovarian carcinoma, is described. Although pharmacobezoars are reported in the literature, we could not find a description of the CT findings of a paraffin oil bezoar.
Angiographic features associated with antiphospholipid syndrome.
Authors: Dongola N A , Foord K D
Published: June 2014

We describe a case of primary antiphospholipid syndrome presenting with varied arterial abnormalities. Patients with antiphospholipid syndrome commonly present with thrombotic problems, but there is a subgroup of patients who develop aneurysms with no evidence of vasculitis. This may represent part of the spectrum of the syndrome itself rather than an associated disease such as polyarteritis nodosa.
Neurofibromatosis associated with a coronary artery aneurysm.
Authors: Tins B , Greaves M , Bowling T
Published: June 2014

A case of a patient with type 1 neurofibromatosis associated with popliteal and coronary artery aneurysms is described in which cross-sectional imaging provided diagnostic information.
The usefulness of orbital lines in detecting blow-out fracture on plain radiography.
Authors: Kim S H , Ahn K J , Lee J M , Choi K H , Han S H
Published: June 2014

The purpose of this study was to assess the diagnostic value of orbital line changes on plain radiographs in detecting blow-out fracture. 92 cases of surgically confirmed blow-out fracture were retrospectively analysed in regard to plain radiographs and CT. Anterior and posterior lamina papyracea lines (ALPL and PLPL, respectively) of the orbital medial wall as well as the posteromedial floor line (PMFL) were assessed on orbital posteroanterior projections. The inferomedial orbital line (IMOL) and the inferior wall line were assessed on Waters projections. Orbital lines on plain radiographs were compared with CT findings. Of 53 cases of lamina papyracea fracture, 47 cases showed orbital line changes on plain radiographs (sensitivity 88.7%). Changes of PLPL (41/47), IMOL (29/47), ALPL (4/47) and PMFL (2/47) were demonstrated as depression, loss, discontinuity and irregularity. In four cases showing normal radiographs, the fractures measured less than 9 mm in size on CT. All 25 cases with orbital floor fracture accompanying medial wall fracture demonstrated orbital line changes of PMFL (16/25), PLPL (14/25), ALPL (3/25) and IMOL (2/25) (sensitivity 100%). 12 of 14 cases with orbital floor fracture demonstrated changes of inferior wall line (7/12) and PMFL (6/12) (sensitivity 85.7%). Two cases demonstrated asymmetric focal soft tissue density without orbital line changes. Orbital line changes on plain radiographs corresponded well with CT findings, confirming the usefulness of plain radiographs in detecting blow-out fracture.
Effect of a full and empty bladder on radiation dose to the uterus, ovaries and bladder from lumbar spine CT and X-ray examinations.
Authors: Nicholson R , Coucher J , Thornton A , Connor F
Published: June 2014

This is a quantitative study of the effect of a full and empty bladder on the position of the uterus, ovaries and bladder relative to the lumbar spine. Data are used to estimate the difference in radiation dose to these organs from performing a lumbar spine CT investigation or a lateral lumbar spine radiograph with a full bladder compared with an empty bladder. 12 women of child-bearing age underwent pelvic magnetic resonance scans with full and empty bladders. The positions of the uterus, ovaries and bladder were matched with the radiation dose distribution that would have occurred either side of the inferior boundary of the CT scan volume and the lateral lumbar spine radiograph. These radiation dose profiles were measured on phantoms using a combination of ionization chambers and thermoluminescent dosemeters. When the bladder was emptied, the mean position of the endometrial cavity fundal tip moved from 4.1 cm to 6.1 cm inferior to the centre of the L5/S1 disc space, and from 0.87 cm to 1.12 cm anterior to the centre of the L5/S1 disc space. This movement on micturation would have reduced the mean dose to the uterine internal fundal tip during a pelvic CT scan from 6.8 mGy to 3.9 mGy, which represents a mean reduction of 43% (range 12-67%). The mean dose from a lateral lumbar spine examination would have been reduced from 197 microGy to 126 microGy. The change in ovary position results in the mean ovary dose being reduced by 48% for the lumbar spine CT scan and by 43%) for a lateral lumbar spine radiograph. When the bladder was emptied, the average position of the bladder wall moved from 7.2 cm to 10.3 cm inferior to the L5/S1 disc space. This change in bladder position reduces the mean dose to the wall of a full bladder from 5.7 mGy for a CT scan and 114 microGy for a lumbar spine radiograph to 2.2 mGy and 42 microGy, respectively, for an empty bladder.
Evaluation of physical performance of a scintillation dosemeter for patient dosimetry in diagnostic radiology.
Authors: de Sousa M C , Aubert B , Ricard M
Published: June 2014

The physical performance of the patient scintillation dosemeter Skin Dose Monitor (SDM) was evaluated for use in diagnostic radiology. The SDM response was found to be linear, with output air kerma and output air kerma rate having a reproducibility in time lower than +/- 2.4%) (one standard deviation). A calibration protocol taking into account the more significant parameters, such as radiation quality dependence and the relative sensitivity of SDM detectors of the same batch, can be applied so that the maximum overall uncertainty is +/- 18% at the 95% confidence level. The SDM detectors did not show any loss of sensitivity during the 5-month period of evaluation. SDM performance was evaluated against thermoluminescent dosemeters (TLDs) (GR200A) by monitoring chest X-rays in 18 adult patients. The difference in entrance surface dose (ESD) values between the SDM and TLDs was less than 10%, but a lack of accuracy in ESD values of less than 0.3 mGy was observed. The main benefit of the SDM device compared with TLDs is the real-time read-out of dose combined with a better flexibility and rapidity of use for approximately the same cost per measurement. The SDM device is a good candidate for regular measurement of patient doses in diagnostic imaging departments as required under implementation of the European Council Medical Exposure Directive of 30 June 1997.
Metastasis to the male breast from carcinoma of the urinary bladder.
Authors: Cappabianca S , Grassi R , D'Alessandro P , Del Vecchio A , Maioli A , Donofrio V
Published: June 2014

We report a case of male breast metastasis from a urothelial carcinoma. Only two cases of this type of metastasis have been previously reported, and these were in the female breast. Clinical examination showed a progressive swelling of the left mammary region, with periareolar skin infiltration. Both mammography and ultrasound showed a rounded mass. Only histological examination with immunohistochemical staining permitted the correct diagnosis to be made. A particular feature of the present case is the absence of contralateral gynaecomastia, normally seen in cases of metastatic tumour to the breast from prostatic carcinoma.
Intracranial dural empyema.
Authors: Rich P M , Deasy N P , Jarosz J M
Published: June 2014

Intracranial dural empyema is a neurosurgical emergency with potentially devastating complications. The prognosis is adversely affected by delay in diagnosis. Modern imaging techniques, especially contrast enhanced CT and MRI, have improved the speed and accuracy of radiological diagnosis of this condition, with an associated reduction in mortality. Despite this, there may still be a delay in diagnosis, partly owing to the subtlety of early radiological signs, especially on unenhanced CT. We present cases that illustrate some of the radiological manifestations, complications and potential pitfalls in diagnosis.
Stability in Large Matching Markets with Complementarities
Authors: Ashlagi Itai , Braverman Mark , Hassidim Avinatan
Published: June 2014

Labor markets can often be viewed as many-to-one matching markets. It is well known that if complementarities are present in such markets, a stable matching may not exist. We study large random matching markets with couples. We introduce a new matching algorithm and show that if the number of couples grows slower than the size of the market, a stable matching will be found with high probability. If however, the number of couples grows at a linear rate, with constant probability (not depending on the market size), no stable matching exists. Our results explain data from the market for psychology interns.
A Dynamic Near-Optimal Algorithm for Online Linear Programming
Authors: Agrawal Shipra , Wang Zizhuo , Ye Yinyu
Published: June 2014

A natural optimization model that formulates many online resource allocation problems is the online linear programming (LP) problem in which the constraint matrix is revealed column by column along with the corresponding objective coefficient. In such a model, a decision variable has to be set each time a column is revealed without observing the future inputs, and the goal is to maximize the overall objective function. In this paper, we propose a near-optimal algorithm for this general class of online problems under the assumptions of random order of arrival and some mild conditions on the size of the LP right-hand-side input. Specifically, our learning-based algorithm works by dynamically updating a threshold price vector at geometric time intervals, where the dual prices learned from the revealed columns in the previous period are used to determine the sequential decisions in the current period. Through dynamic learning, the competitiveness of our algorithm improves over the past study of the same problem. We also present a worst case example showing that the performance of our algorithm is near optimal.
Managing shoulder dystocia: Understanding and applying RCOG guidance
Authors: Jenkins Louise
Published: June 2014

Shoulder dystocia occurs in less than 1% of births but can have severe consequences for both the mother and baby. It is also the third most common cause of litigation in the UK. A structured approach to management has been shown to help practitioners provide effective care, and since 2000 many Trusts have implemented the HELPERR mnemonic developed by the Advanced Life Support in Obstetrics group (ALSO) as a basis for care. In 2012, the Royal College of Obstetricians and Gynaecologists (RCOG) updated guidance on managing shoulder dystocia and moved away from the use of the mnemonic HELPERR; however, our midwifery students reported that they felt daunted by the RCOG algorithm and preferred to use a mnemonic to help them provide systematic care. This article sets out a modified approach and adapted version of the HELPERR mnemonic for use in practice that incorporates the latest RCOG guidance for use in the management of shoulder dystocia.
Termination of pregnancy for fetal abnormality
Authors: Lyus Richard , Creed Karen , Fisher Jane , McKeon Lucy
Published: June 2014

A small but important minority of pregnant women will be diagnosed with a fetal abnormality, and most women diagnosed with a serious fetal abnormality choose to terminate the pregnancy. Midwives have a key role to play in providing high quality care to women given a diagnosis of fetal anomaly. This includes provision of information about the option of and methods of termination, which may be discussed before women opt into screening.

Both medical and surgical termination are safe and effective, but involve very different experiences for the patient and her support person. Therefore, both options should be available to all women having a termination for fetal abnormality up to 24 weeks gestation and health professionals should help women to choose the method which best suits their individual coping style. In addition to medical advice about future pregnancy planning, women may need ongoing emotional and psychological support after their termination.
Birth complications more likely in assisted reproduction babies
Authors: Bainbridge Jane
Published: June 2014

Research in Australia has found that still births, preterm births, and low birth weight babies are more likely in assisted reproduction pregnancies.
Discussing breastfeeding: Turning an idea into an intervention
Authors: November Lucy
Published: June 2014

Attitudes towards infant feeding are often formed during childhood and adolescence. Lucy November explains how she developed a school-based intervention to encourage positive attitudes towards breastfeeding in secondary-aged students in Havering.
An update on the childhood flu immunisation programme
Authors: Crown Hannah
Published: June 2014

Hundreds of people die each year as a result of influenza. Hannah Crown provides an overview of the children flu vaccination programme and the 2014/15 flu plan, as well as some insight into the pilot programmes.
Supporting children with type 1 diabetes in schools
Authors: Dowling Libby
Published: June 2014

From September, all schools in England will be legally obliged to support children with medical conditions as a result of new legislation. Libby Dowling offers some advice on supporting pupils with type 1 diabetes.
The Solihull Approach
Authors: Martland Rebecca
Published: June 2014

They way we relate to others has a profound effect on our working practices, this article introduces an approach that builds trust through attachment, containment and reciprocity.
The power of the elements – the Sun
Authors: Garner Lynne
Published: June 2014

In the first of a new series, Lynne Garner uses practical activities to examine the forces of natures that shape our lives and the places we live. We begin with a look at the Sun.
Diet in pregnancy: Eating for two?
Authors: Balman Alison
Published: June 2014

The diet for an optimum pregnancy is one advisable for all healthy adults, says Alison Balman.
Treatment of venous leg ulcers: Part 2
Authors: Williams Clare
Published: June 2014

In the second of a series of articles on wound care, Clare Williams examines why venous ulceration occurs.
Allergic rhinitis and asthma
Authors: Greener Mark
Published: June 2014

Allergic rhinitis is often trivialized. Unlike asthma, allergic rhinitis is not life-threatening. However, allergic rhinitis often undermines quality of life, impairs education and reduces economic productivity, and it's often forgotten that most allergic rhinitis patients suffer symptoms year round rather than just in the spring and summer.

Mark Greener examines the link between allergic rhinitis and asthma.
Fever in Childhood: Friend or Foe?
Authors: Leitao Palmira
Published: June 2014

Fever is a common event in childhood which alerts carers to the fact that something is amiss in the child. It is defined as an abnormal elevation of the core body temperature to 38° C (Murphy, 1992). Although the link between raised body temperature and disease has been known since time memorial, the protective role of mild to moderate fever is often forgotten and ‘fever phobia’ may develop as the anxious carers try to comfort their child (Blumenthal, 1997).
Are You Something Special?
Authors: Richards Sue
Published: June 2014

The UKCC has finally clarified what is meant by specialist practice, and all the argument, bickering and complaining is to cease forthwith. The council debated and accepted the report and recommendations from the Specialist Practice Task Group, of which I was a member. Producing it was hard work, we held a series of seminars where opinions were sought from over 200 people and written comments were received from 60 occupational groups and individuals.
Teenage Sexual Health
Authors: Hadley Alison
Published: June 2014

Alison Hadley explains how to get the message across to teenagers.
Cervical Screening: A Case Study
Authors: Buchleitner Mandy
Published: June 2014

The purpose of this article is to examine the cervical screening programme pertinent to the ‘high risk’ client, and also to ask how unusual is she? With the change in women's lifestyles and their sexual behaviour over the last fifty years or so, the need for cervical screening is as great as ever, even though mortality rates have declined dramatically in the 1990s.
Readers Respond
Authors: Meekings Jaki , Garner Hilary
Published: June 2014

Are PCGs ready for financial worries?

Voluntary sector has a lot to offer PCGs
A versatile model of open-fracture infection
Authors: Penn-Barwell J. G. , Rand B. C. C. , Brown K. V. , Wenke J. C.
Published: June 2014

Objectives

The purpose of this study was to refine an accepted contaminated rat femur defect model to result in an infection rate of approximately 50%. This threshold will allow examination of treatments aimed at reducing infection in open fractures with less risk of type II error.

Methods

Defects were created in the stablised femurs of anaethetised rats, contaminated with Staphylococcus aureus and then debrided and irrigated six hours later. After 14 days, the bone and implants were harvested for separate microbiological analysis. This basic model was developed in several studies by varying the quantity of bacterial inoculation, introducing various doses of systemic antibiotics with and without local antibiotics.

Results

The bacterial inoculation associated with a 50% infection rate was established as 1 × 102 colony forming units (CFU). With an initial bacterial inoculum of 1 × 105 CFU, the dose of systemic antibiotics associated with 50% infection was 5 mg/Kg of cafazolin injected sub-cutaneously every 12 hours, starting at the time of the first debridment and continuing for 72 hours (seven doses). The systemic dose of cafazolin was lowered to 2 mg/Kg when antibiotic polymethyl methacrylate beads were used concurrently with the same amount of bacterial inoculation.

Conclusion

This model of open fracture infection has been further refined with potential for local and systemic antibiotics. This is a versatile model and with the concepts presented herein, it can be modified to evaluate various emerging therapies and concepts for open fractures. Cite this article: Bone Joint Res 2014;3:187–92.
Fragmentation and competition: voluntary organisations’ experiences of support for family carers
Authors: Moriarty Jo , Manthorpe Jill
Published: June 2014

In England, voluntary organisations such as the Carers Trust and Alzheimer’s Society play major roles in providing practical help and support to family carers. This article draws on a large study looking at social care practice with carers to illustrate how changes in social care commissioning and cuts in funding have created difficulties for organisations such as these. It asks whether contracting policies based on competition between providers threaten collaborative campaigning and strategic alliances.
Experience of portraiture in a clinical setting: An artist’s story
Authors: Gilbert Mark
Published: June 2014

In this article the author reflects upon the challenges, rewards and learning he experienced as a portrait painter working on two arts-based research projects in hospitals. He describes how the relationships with the patients and caregivers who sat for their portraits generated new realizations for artist and model. Although initially resistant to the notion of art as research, his profound experiences co-creating with people portrayed, convinced him of the healing values and therapeutic benefits that artistic practices have in abundance. Portraiture, here, served as a bridge that brought the two worlds of art and medicine together.
Assessing well-being outcomes for arts and heritage activities: Development of a Museum Well-being Measures toolkit
Authors: Thomson Linda , Chatterjee Helen
Published: June 2014

Many museums and galleries offer services directed at improving the health and well-being of their audiences. Despite this increasing area of activity there is no standardized method for assessing the impact on participants. Recent research into heritage-in-health revealed the need for a culture-specific toolkit of measures to assess the well-being of adults participating in museum, arts and heritage activities. A pre-trial survey of UK specialist museums ascertained how a toolkit might be used and what methods of evaluation already existed. Prototypes were trialled over twelve months and a post-trial survey was conducted prior to production of the toolkit. Statistically reliable measures were constructed for positive and negative emotion. Comparison of pretest-posttest differences showed highly significant increases in positive scores and decreases in negative scores with medium to large effect sizes. All words in the measures contributed to changes in emotion. Full and short Generic Well-being Questionnaires (GWQ) were developed for people with dementia.
Creating community: An arts-based enquiry
Authors: Horsford Ro , Rumbold Jean , Varney Helen , Morris Deborah , Dungan Lynette , Lith Theresa Van
Published: June 2014

This article presents a small cooperative enquiry in a public health setting where six researchers used arts-based methods to explore our experiences of community and its effects. We represented our experiences in images and stories, and include these presentational forms of knowing here alongside the analyses that connect our findings to propositions about health, community and social inclusion. In terms of practical knowing, we sought a greater understanding of what forms, what constrains and what sustains community.
Arts on prescription for older people: Different stakeholder perspectives on the challenges of providing evidence of impact on health outcomes
Authors: Goulding Anna
Published: June 2014

Providing evidence of health or well-being outcomes for arts on prescription (AoP) programmes for older people is problematic. A number of reports have shown that the Department of Health (DoH) supports the role of art in health (ACE 2007a; 2007b, Cayton 2007), but this has not translated into long-term, strategic funding. This article uses interviews with health, arts and voluntary sector professionals involved in five AoP programmes in England, UK, to provide an understanding of the challenges of providing evidence and of sustaining such work. Interviewees noted the tension between arts and health requirements, arguing that quantitative evaluation fails to capture the process of participation and the impact of programmes within the context of an individual’s life. However, using both qualitative and quantitative methods and demonstrating cost-savings was felt necessary. The substantial changes the National Health Service (NHS) is undergoing presents threats to embedding AoP in the light of financial cuts and opportunities through new commissioning structures. To attempt to gain policy support from the DoH and sustained funding from the NHS, the development of quantitative evaluation of health outcomes and demonstration of cost-savings alongside qualitative evaluation is recommended. Despite being in a relatively weak position in terms of influencing health policy, the article also recommends arts organizations invest energy in advocacy.
Fatores críticos de sucesso na implementação do programa seis sigma: uma revisão sistemática das pesquisas quantitativas
Authors: Marzagão Daniela Santana Lambert , Lopes Ana Paula Vilas Boas Viveiros , Gouvêa Maria Aparecida , Carvalho Marly Monteiro de
Published: June 2014

O objetivo desse trabalho é revisar a bibliografia sobre Seis Sigma, identificando fatores críticos de sucesso. Para isso, os autores construíram uma fundamentação teórica para auxiliar as análises estatísticas. Buscaram artigos na base ISI Web of Knowledge, através das palavras chaves “Six Sigma” e “Quality”, no período entre 1988 e 2010. Dos 270 trabalhos gerados na busca, 11 abordavam uma pesquisa tipo Survey com similaridade de assuntos. A meta análise foi feita em 6 destes 11 artigos, os quais estavam disponíveis sem custo. Os resultados mostraram que poucos estudos quantitativos foram realizados. Do ponto de vista estatístico, as principais limitações foram o tamanho das amostras e a escolha de ferramentas adequadas. Os quatro fatores críticos de sucesso que puderam ser comparados foram: cultura da qualidade, envolvimento dos funcionários, seleção de projetos e treinamento e aprendizado. Um diferencial encontrado entre Seis Sigma e outras iniciativas de qualidade é a integração com a Gestão de Portfólio.
Geração de spin-offs tecnológicos - um estudo multicaso
Authors: Constante Jonas Mendes , Fiala Nathalia , Andreassi Tales
Published: June 2014

O objetivo do estudo é compreender como pequenas e médias empresas podem inovar por meio de spin-offs tecnológicos, identificando motivações, influências e barreiras para realização deste fenômeno. A pesquisa classifica-se como qualitativa e exploratória, sendo analisados quatro casos de spin-offs tecnológicos no Estado de Santa Catarina. Os dados foram coletados a partir de observações em campo, dados históricos e entrevistas semiestruturadas. As principais motivações encontradas para geração de spin-offs foram: diversificação e complemento à cadeia de valor da empresa-mãe, e garantia de maior foco para uma tecnologia específica. Já a principal barreira encontrada foi a falta de capital. As iniciativas governamentais de apoio à criação de novas empresas, aliadas à cultura organizacional aberta ao empreendedorismo e investimentos em P&D contribuíram para o desenvolvimento dos spin-offs analisados. Este trabalho contribui para o entendimento de que pequenas e médias empresas de base tecnológica são fonte de geração de spin-offs tecnológicos e podem beneficiar-se com a ocorrência deste processo.
Avaliação de presença de recursos alternativos em plano de processos para melhorar o desempenho de sistemas manufatura
Authors: De Mello Mário Henrique , Ferreira João Carlos E.
Published: June 2014

Usualmente os planos de processos são gerados sem considerar a utilização de máquinas alternativas, isto é, no planejamento de processo convencional uma única máquina é selecionada para a execução de uma determinada operação. Com isso, as máquinas preferidas pelos processistas são selecionadas para executar a maioria das tarefas, ocasionando a formação de gargalos na produção. Nesse contexto, a inclusão de máquinas alternativas em planos de processo pode ser usada como uma estratégia para resolver o problema de formação de gargalos, pois a eventual indisponibilidade de uma máquina permite que outra máquina pré-planejada seja selecionada e utilizada imediatamente. Para avaliar essa proposta, foi desenvolvido um modelo para simulação de um sistema de manufatura sujeito aos dois tipos de planos de processo, isto é, com ou sem máquinas alternativas. Verificou-se que a inclusão de máquinas alternativas em planos de processo resulta na melhoria no desempenho do sistema de manufatura em relação à produtividade, ao estoque em processo e à utilização de máquinas, ainda que a máquina alternativa selecionada tenha uma menor eficiência.
Bayesian Reliability Sampling Plans under the Conditions of Rayleigh-Inverse-Rayleigh Distribution
Authors: Kalaiselvi S. , Loganathan A. , Vijayaraghavan R.
Published: June 2014

Reliability sampling plans are used to take decisions on the disposition of lots based on life testing of products. Such plans are developed taking into the consideration of relevant probability distributions of the lifetimes of the products under testing. When the quality of products varies over lots, then a predictive distribution of the lifetime should be used to design sampling plans. In this paper, designing of reliability single sampling plan based on the predictive distribution of the lifetime is considered. It is assumed that sampling inspection is carried out through life testing of products with hybrid censoring. The predictive distribution is obtained assuming that the probability distribution of the lifetime of the product is Rayleigh and the process parameter has an inverse-Rayleigh prior. Plan parameters are determined using hypergeometric, binomial and Poisson probabilities, providing protection to both producer as well as consumer.