bluuebunny/crossref_metadata_2025 huggingface dataset:
MRSA screening in ambulatory upper limb trauma day cases
Authors: O'Neill Tomás , Itte Vinay , Bourke Gráinne
Published: January 2015

Aims:

Approximately 3% of the UK population are carriers for methicillin-resistant Staphylococcus aureus (MRSA). The NHS set a target of reducing MRSA nosocomial infections by 20% in 2012/13. The Department of Health instigated mandatory universal screening for elective and trauma surgery at significant cost and increased resource demand. Patients presenting to our service with simple upper limb trauma requiring day case surgical intervention are included in mandatory universal MRSA screening, despite being discharged post-operatively before any screening result is known. The aim of this study was to examine the effectiveness of mandatory screening in our patient cohort.

Methods:

We undertook a retrospective audit of 500 consecutive day case upper limb trauma cases that were managed in our hand unit between 1 May and 31 October 2011. Patient demographics, injury, operative intervention, pre-operative MRSA screening result and post-operative wound swab results were examined. Patients with frankly infective conditions such as abscesses and flexor tenosynovitis were excluded.

Results:

78% of our patients were male. 91% were less than 60 years old. 98% of patients had a pre-operative MRSA screening swab. None were positive. 2% had positive post-operative swabs for organisms other than MRSA.

Conclusion:

We approached our trust and successfully proposed that young, ambulatory, day-case upper limb trauma patients be exempt from mandatory screening. At an average throughput of 1000 cases per annum and an estimated cost of £42.50 per MRSA screen, excluding this cohort of patients from mandatory screening has saved approximately £42 500. The true savings would be likely far greater if applied to similar cohorts across the trust, bringing with it a reduction in screening infrastructure.
Intuition
Authors: Robinson Jean
Published: January 2015

It was a midwifery lecturer who reawakened my interest in intuition, on one of my visits to the University of Ulster. A mother was checked, bedded and settled with the new baby. All seemed well, and she and another midwife were leaving the room. About to go through the door, she turned to look at the mother just once more and she quietly said to her companion, ‘I think we'll just check the blood pressure (BP) again’. The colleague was surprised, but stood by while she did so. In that short time the BP had shot up and the mother was clearly at risk.
Using complementary therapies during the childbearing process
Authors: Duddridge Emma
Published: January 2015

Complementary therapies are increasing in popularity with almost a quarter of the British public having at some point consulted a practitioner of alternative therapy or medicine (British Medical Association, 1993). Women are seeking alternatives to relieve pain and morbidity during pregnancy, childbirth and the postnatal period. This article briefly looks at some therapies currently available to women and discusses some of the advantages and possible problems associated with the different methods. The article predominantly focuses on the use of massage during the childbearing process as this is non-invasive, has few contraindications, is cost-effective and can promote a holistic therapeutic relationship between the midwife, her clients and their family.
Tesco offers a range of services to ensure ‘every little helps’!
Authors: Baldock Sarah
Published: January 2015

Despite being one of Britain's most successful retailers, midwives and health professionals are sometimes unaware of the breadth of services offered by Tesco to parents with young children. This product focus article provides an overview of the baby and toddler facilities, with references to the many charities and supporting organizations working with Tesco.
Staffing, stress, bullying and the midwife
Authors: Dimond Bridgit
Published: January 2015

In the light of the serious staffing situation in midwifery services, identified by the RCM annual statistics, this article looks at the law relating to stress and bullying and a recent Court of Appeal decision.
A Christmas wish list
Authors: Page Lesley
Published: January 2015

This year the Christmas decorations were in the shops before Halloween was over. It seems to get earlier every year, but I still feel a mixture of childlike anticipation in addition to the stress of getting it all done around this time of year. The‘work/life balance’ is difficult enough to manage at any time, but at Christmas the tensions get higher, there is simply too much to do. At The Royal Free we have started working on our Christmas rotas and tried to figure out how to fill stockings for the babies and decorate wards with the amount of money we have. At the same time I am thinking about life at home. As the holiday season approaches I feel I will never get it all done. Yet, when we get to Christmas Eve the enchantment takes over and there is the hope I always feel from the Christmas story. Despite all the difficulties of the world, for me, the story contains such promise and hope for the future.
A problem-based learning approach to midwifery
Authors: McNiven Patricia , Kaufman Karyn , McDonald Helen
Published: January 2015

In 1993, McMaster University implemented the first midwifery education programme in Ontario, Canada. A 4–year, direct-entry baccalaureate programme was established and reflects the philosophy of midwifery with a focus on normal, healthy childbearing. Self-directed and problem-based learning (PBL) are integral parts of the programme. The authors selected a PBL format because of the benefits demonstrated in medical education. The use of PBL, as a method of instruction, has been found to enhance clinical reasoning skills, knowledge acquisition and self-directed learning patterns (Woods, 1994). A PBL curricula also provides students with an earlier opportunity to acquire information in context (Woodward, 1989). Students from a traditional curricula, compared with students from a PBL curricula, have been found to be less able to use what they have learned (Gonella et al, 1970). The development and implementation of a PBL midwifery curricula are described in this paper. Graduates of the programme reported that they enjoyed the small group tutorials and found it to be one of the most effective aspects of learning in the programme, second only to clinical placements.
Removing babies from mothers at birth: Midwives' experiences
Authors: Marsh Wendy , Robinson Ann , Gallagher Ann , Shawe Jill
Published: January 2015

It is evident from a review of the literature that looking after the psychological and emotional needs of women who have their baby removed at birth is a vital part of midwifery care in the childbirth continuum. This review reports on the experiences of midwives who have provided care and emotional support to mothers who have had their baby removed at birth and the challenges they have encountered from doing so. BNI, CINAHL, EMBASE, Google Scholar, Maternity and Infant Care and PsycInfo were searched for articles published until January 2014 and findings suggest that providing care and emotional support to women who have had their babies removed at birth remains one of the most challenging aspects of contemporary midwifery practice. It is anticipated that this study will raise awareness of the challenges associated with providing care and emotional support for women whose babies have been removed at birth and contribute to the evidence base for best practice.
Reducing post-dates induction numbers with post-dates complementary therapy clinics
Authors: Pauley Tara , Percival Rebecca
Published: January 2015

This short discussion article examines induction of labour (IOL) and how complementary therapy clinics were established for post-dates pregnant women. The number of post-dates inductions performed 1 year after the clinics were established was 5% less than in the 1 year prior to their set up. The service has provided positive patient experience, and is being reviewed further. Consideration also has to be given to potential cost-savings when a reduction in medical inductions is recorded.
Public health and wellbeing: A matter for the midwife?
Authors: Crabbe Katy , Hemingway Ann
Published: January 2015

This paper will provide a critical narrative review of public health interventions in pregnancy and the role of the midwife in public health. The historical and political context of public health and midwifery will be examined to give a background to the current midwifery public health agenda. The article will identify specific public health interventions used in pregnancy by midwives and assess how midwives perceive their role in implementing them.

Midwives are important public health practitioners, who alongside other agencies can make a long-term, positive contribution to the life course of women and their families.
An exploration of the benefits and drawbacks of intrapartum pain management strategies
Authors: Sanders Ruth , Lamb Kathryn
Published: January 2015

The advantages and disadvantages of pain management strategies in labour demand comprehensive midwifery exploration, with equal attention to psychological, physiological and pharmaceutical methods. This review of relevant literature discusses an array of options and their clinical sequelae from a midwifery perspective. Often intrapartum pain management is reductionist in approach, being cited around pharmacological options, negating the influential and holistic possibilities of a wider therapeutic perspective. In order to facilitate truly woman-centred care, midwives must endeavour to educate themselves and inform their practice to offer myriad of diverse coping strategies. An innate understanding of the ramifications that each strategy may have is fundamental, not only on women's perceptions and lived experience of their birth, but on the midwifery management implications which each strategy affords. Sharing this midwifery expertise enables women to self-direct their own individualised care plans in partnership with midwives, facilitating informed decisions regarding their journey through the unknown territory of labour.
Fairy tale midwifery—fact or fiction: The lived experiences of newly qualified midwives
Authors: Reynolds Ellen Kitson , Cluett Elizabeth , Le-May Andree
Published: January 2015

Aims:

To explore the lived experiences of newly qualified midwives through the first 12 months post-registration.

Design and method:

Digitally recorded semi-structured interviews occurred at the point of registration, 4 and 12 months post-registration with 12 participants from one University on the South Coast of the UK. Analysis and interpretation were achieved using van Manen's methodology combined with an interpretive phenomenological approach.

Results:

Participants described their journey through the complexities of ‘reality shock’, ‘false promises’, ‘being part of the club’, ‘self-doubt’, ‘struggling’ and being ‘beyond competence’.

Conclusion:

Newly qualified midwives face changing levels of professional responsibility. They attain either autonomy or support dependent on where they practise. Newly qualified midwives may still be in ‘student mode’ and expect both autonomy and support rather than seek it for themselves.
An overview of NICE guidance: acute kidney injury
Authors: Ellis Peter , Jenkins Karen
Published: January 2015

Acute Kidney Injury (AKI) as a financial, resource and human burden on both the NHS and people with AKI. Clearly if AKI is the cause of much morbidity and mortality and significant amounts of it can be prevented and/or detected earlier, this could only be a good thing. In part, the problem with AKI is that it has historically been regarded as little more than a sequal to other more pressing physical illnesses and therefore not taken as seriously as it might. The 2013 guidance from NICE—clinical guideline 169—and the accompanying pathway, seek to address this with an emphasis on assessment and prevention, identification of disease, management and subsequent chronic disease management ( NICE, 2013a ).
Avoiding accidental exposure to intravenous cytotoxic drugs
Authors: Meade Elizabeth
Published: January 2015

Many cytotoxic drugs have been shown to be mutagenic, teratogenic and carcinogenic with second malignancies known to be associated with several specific cancer drugs. Occupational exposure to cytotoxic drugs presents a signification danger to healthcare staff and unwarranted handling of these drugs should be avoided. Guidelines have been established for the safe handling of hazardous drugs but not all professionals are adhering to these recommendations. Recent environmental studies have demonstrated measurable drug contamination on surfaces even when recommended guidelines are followed. It is therefore imperative that healthcare workers are aware of the potential hazards of antineoplastic agents and employ the recommended precautions to minimise exposure. This article outlines the potential risks associated with exposure to cytotoxic drugs for healthcare staff. The safe-handling precautions required in the storage, preparation, transport, administration and waste disposal of cytotoxic drugs are presented.
The Care Quality Commission gets tough over NHS complaints
Authors: Tingle John
Published: January 2015

John Tingle discusses a new publication on complaints in health and social care by the Care Quality Commission (CQC)
Nursing care to facilitate and support ‘good’ grieving
Authors: Mendes Aysha
Published: January 2015

In this monthly column, Aysha Mendes discusses the importance of the role nurses play in the grieving process, and discusses what constitutes good support for patients who are dying and their relatives
A clash of personalities
Authors: Jones Julia
Published: January 2015

Young children are learning all the time about building friendships, about sharing and social norms, but what happens if two of those in your care just will not ‘get along’?
Anger over ARF increase
Authors: Lambert Xyanthe , Lee Vicky , Dyer Becky , Lockyer Alison
Published: January 2015

In the last issue of Dental Nursing, we published a story on the GDC's plans to increase the annual retention fee in 2011. A vigorous debate has ensued among dental nurses, who feel that they will be the hardest hit among the DCPs. Below are some of the letters we have received, including a response from the GDC
Fissure sealants in children: a practical guide for the dental team
Authors: Morgan Annie
Published: January 2015

Dental caries remain a common disease in children and young people, with many forced to suffer toothache and infection as a result. Fissure sealing is a simple intervention available to the dental team that is effective at reducing decay in the pits and fissures of teeth.
Algae for horses
Authors: Warren Helen
Published: January 2015

Dr Helen Warren examines the benefits
The wet dry cycle
Authors: Chard Richard
Published: January 2015

Richard Chard AWCF, explains just why our ever changing weather conditions have a devastating effect on equine feet
Prevention is the key to disease control
Authors: Besognet Bruno
Published: January 2015

Bruno Besognet DVM MS, technical manager for Zoetis International Services, discusses the role of vaccination in disease control
Case study: Keratoma - A cause of recurrent lameness
Authors: Hall Suzy
Published: January 2015

Suzy Hall resident in lameness and diagnostic imaging, Liphook Equine Hospital
Respect, care, wisdom
Authors: Marlen Dorothy
Published: January 2015

The Pikler approach to early care and education is not well-known in the UK, but it has much to offer, and may well challenge our expectation of the capabilities of children younger than three-years-old.
Power to the workers
Authors: O'Sullivan June
Published: January 2015

Over the years, the early years workforce has become submerged in endless policy changes that have consistently ignored our vision and knowledge, so what can we do to start influencing those in power?
Agency childcare solutions
Authors: Robb Sue
Published: January 2015

Finding a childminder is one of the most important decisions a parent has to make. Here, 4Children profiles Total Childcare Services Ltd, one of the first childminder agencies to offer childcare solutions.
Optimizing patient adjustment to stoma formation: Siting and self-management
Authors: Slater Rebecca C
Published: January 2015

Stoma surgery is an intrusive operation which can have a great impact on daily life. Having a stoma can affect everyday activities that most of us take for granted. The control over bodily functions is fundamental and is pivotal to an individual's ability to function within society. The formation of a stoma will involve an adaptation process, where individuals will have to come to terms with the loss of ‘normal’ control of bodily function. Rebecca C Slater outlines how patients can best learn to manage their stoma while returning to their daily activities and adapting to the alteration in their body image.
Stress and inflammatory bowel disease: Encouraging adaptive coping in patients
Authors: Jordan Cheryl
Published: January 2015

Inflammatory bowel disease (IBD) is the term used to describe two specific conditions: ulcerative colitis and Crohn's disease. It is thought that stress may play a role in the course of this disease, impacting the pattern of flare-ups and remission. In this article, Cheryl Jordan reviews the evidence for the impact of stress on the course of IBD. The findings of this article suggest that it is the perception of being under long-term stress that impact on the course of the disease, rather than stressful life events themselves. Additionally, certain styles of coping show links to poorer perceptions of health, wellbeing and greater disease concerns. Finally, areas for exploration are suggested for nurses working with this group of patients, with the aim of beginning discussions as the first step in encouraging adaptive coping.
Book Reviews
Authors: Kirk Kate , Gilbert Jenny , Aldred Hilary
Published: January 2015

Spirituality and Palliative Care: Social and Pastoral Perspectives

Primary Palliative Care. Dying, Death and Bereavement in the Community

Crucial Decisions at the beginning of Life. Parents' Experiences of Treatment Withdrawal from Infants
Views and experiences of nurses and health-care assistants in nursing care homes about the Gold Standards Framework
Authors: Nash Anne , Fitzpatrick Joanne M
Published: January 2015

Aim:

To explore the views and experiences of nurses and health-care support staff about the use of the Gold Standards Framework (GSF) for end-of-life care (EoLC) for older people in nursing care homes (NCHs) with GSF accreditation.

Methods:

A qualitative descriptive study was conducted with three purposively selected NCHs in London. Individual interviews were conducted with NCH managers (n=3) and in each NCH, a focus group was conducted with registered nurses (RNs) and health-care assistants (HCAs): focus group 1, n=2 RN, n=2 HCA; focus group 2, n=2 RN, n=3 HCA; focus group 3, n=3 RN, n=3 HCA. Interviews were audio-recorded, transcribed and analysed using framework analysis.

Findings:

Three core themes were identified: (i) a positive regard for the GSF for care homes (GSFCH); (ii) challenges around EoLC for older people; and (iii) difficulties in using the GSFCH.

Conclusions:

RNs, HCAs and managers regarded the training and support afforded by the GSFCH programme to inform EoLC for older residents positively. The framework has the potential to promote a coordinated approach to EoLC for older people. In the post accreditation period, there is a need for ongoing support and development to help embed the key tenets of the GSFCH in the culture of caring.
Therapist's influence on the design of Invacare's Flo-Tech Solution Xtra
Authors: Hall Sarah
Published: January 2015

The trend for inclusive design appears to becoming stronger, and an area that clinicians are urged to participate in. Combining clinical and technical expertise can often be a demanding challenge and this paper looks to show the results of how a modular postural cushion was designed and evaluated by Invacare Ltd. The Flo-Tech Solution Xtra modular system was conceived through joint collaboration between manufacturer and therapists following discussion and demand from NHS wheelchair services (WCS) in the UK. Concept, rationale and design of the cushion are discussed from a clinical perspective, which underpins the manufacturing process from conception through to the finished product. The seating system was designed to address the postural requirements primarily of the neurological population and consequently the cushion underwent clinical trial at the Royal Hospital of Neuro-Disability, Putney, London.

Seven subjects were identified as suitable for the evaluation by the postural team at Putney and three were trialed independently by Invacare Ltd. The main focus of this study was identifying and meeting the individual's therapeutic aims of posture and pressure through using the Solution Xtra. Even though the study size was small and the results subjective in nature, there was an overall favourable outcome of using the modular system as a seating intervention, and it was also rated highly by the clinicians involved.
Latest clinical research
Authors: Greener Mark
Published: January 2015

Mark Greener presents recent findings published in medical journals
Diagnosing lipodermatosclerosis
Authors: Kochhar Suneeta
Published: January 2015

An overview of the diagnosis of this condition affecting the lower leg is outlined by Suneeta Kochhar
Keeping malaria at bay
Authors: Brewer Catherine
Published: January 2015

Avoiding mosquito bites is the frontline defence against malaria. Catherine Brewer describes how travellers can best avoid being bitten
Building a service with families, for families: Blackpool Better Start
Authors: Cuthbert Chris
Published: January 2015

Blackpool is one of five areas to receive investment as part of the Big Lottery Fund's A Better Start programme, with the NSPCC leading on the £45 million project.
Research into fabrics used in compression therapy and assessment of their impact on treatment regimens
Authors: Hegarty-Craver M. , Grant E. , Kravitz S. , Reid L. , Kwon K. , Oxhenham W.
Published: January 2015

The objective of this paper is to provide a definition for interface compression that uses essential principles of engineering science. This definition discusses factors that influence the amount of applied pressure, including the size of the limb, the amount of fabric tension (graduated pressure profile), the number of layers, and the material creep characteristics. Laplace's law has been applied to compression therapy. Tension-extension profiles have been derived for different types of compression fabric to demonstrate the effects of resistance and friction. Force-time profiles have been derived for different types of fabric compression systems to demonstrate the effects of creep (creep is defined generally as the irreversible deformation of a material over time in the presence of a constantly applied load). Here, the fabric compression systems were applied to a test-bed that supplied a constant force to the fabric; creep was taken as the loss of compression (pressure) over time.

Laplace's law has been interpreted for compression therapy. The amount of fabric tension is determined by the extent to which it is stretched during application, as well as by changes in the size of the limb. The fabric's relative elasticity, which is quantified by the rigidity index and is related to the slope of the tension-extension profile, dictates the amount that the applied force changes with extension.

Compression systems that use multiple layers of fabric are generally more resistive to stretching than single-layer systems. Friction acting between the layers, as well as the added force from each layer, serves to increase the overall compression of these systems. As the applied force rises, the amount of pressure supplied by the fabric increases. However, when the same force (or fabric extension) is used, the applied pressure is less when distributed over a larger surface area. In other words, as the circumference of the limb increases, the pressure decreases. This is the driving principle behind graduated compression. In addition to the changes in fabric tension resulting from extension, the creep characteristics of the material affect the amount of compression provided throughout the wear cycle.

The factors influencing interface compression are multi-faceted. Based upon the interpretation of the material properties of compression fabrics (tension-extension profile, number of fabric layers, and creep), new therapeutic guidelines have been established, and others clarified.

Declaration of interest: This study was sponsored by Carolon. L. Reid, and S. Kravitz are employees of Carolon and E. Grant is a Member of the Board. M. Hegarty-Craver and C. Kwon have received monetary compensation as researchers for Carolon.
Bovine respiratory disease
Authors: Potter Tim
Published: January 2015

Bovine respiratory disease (BRD) remains one of the most costly cattle diseases worldwide. Its multi-factorial nature both in terms of risk factors and causative agents means that when approaching the disease it is important to develop a systematic approach to the identification, investigation, management and future prevention of the disease. Diagnostic sampling can play a key role in understanding the disease process on a specific farm but it is important to select the correct animals for sampling and the correct diagnostic testing. Treatment for BRD remains symptomatic and needs to be instituted quickly in order to have the most effect. Following the identification and initial management of a disease outbreak it is important to then look at future prevention strategies. Prevention consists of both vaccination programmes and establishing and maintaining management practices which reduce the risk of disease.
Nutritional considerations to maximise fertility performance in dairy farms — macro-nutrition
Authors: Gammon Dan
Published: January 2015

This is the first of three articles reviewing the interrelationships between nutrition and fertility. The three articles together will give a comprehensive and evidence-based approach for the general practitioner to investigate and advise their clients in this area.
The equine infundibulum and infundibular disease: background, review and techniques
Authors: Pearce Chris
Published: January 2015

Disease of equine maxillary cheek teeth infundibula has been recognised for many years however the significance has been slow to be widely accepted. Infundibular hypocementosis is now recognised as an aetiopathological factor for the onset of infundibular caries, and has been linked to other dental disease such as apical abscessation and pathological fracture. A full understanding of the anatomy of the equine infundibulum and the aetiopathogenesis of infundibular disease is required before preventative treatments may be considered. Early recognition of infundibular disease combined with diagnostic imaging where appropriate will give horse owners the opportunity to consider preventative treatments before irreversible disease occurs.
Heart murmurs in horses — what's important and what's not
Authors: Malalana Fernando
Published: January 2015

Cardiac murmurs are a common finding in horses. In the great majority of cases they represent a normal cardiac event or non-significant pathology, but on some occasions they can indicate serious cardiac disease. Determining the significance of a murmur and whether it can affect the horse's performance or even increase the risk of sudden death can be challenging. A more specific cardiac examination (including palpation of peripheral pulses, assessment of jugular filling and/or pulse, assessment of mucous membranes and detailed cardiac auscultation) should be carried out in order to gain as much information as possible to be able to provide an accurate prognosis and the correct advice. This article will review a series of recommendations for horses in which a murmur is detected.
Great potato adventure
Authors: Hewson Claire
Published: January 2015

Supertato by Sue Hendra describes the story of a heroic potato whose mission is to save other vegetables from a badly behaved pea. Claire Hewson shares some literacy activities based on the book.
Snakes and Ladders
Authors: Hampshire Viv
Published: January 2015

Board games can help develop communication and language, as well as other skills, in children. Viv Hampshire explains how to make the most of the Snakes and Ladders game.
Shake, rattle and roll
Authors: Hampshire Viv
Published: January 2015

Plastic drink bottles are an easy to find, cheap and versatile product. The following activities invite children to get creative with them by makings skittles, bottle art and music.
IEDs and a Jack-in-the-Box: The mystery of motivation in The Hurt Locker (2008)
Authors: Deutelbaum Marshall
Published: January 2015

Though based upon his non-fiction article ‘The Man in the Bomb Suit’, published in Playboy in 2005, the dramatic structure of Mark Boal’s script for The Hurt Locker (2008) is eccentric, only revealing its true subject, the motivation of its central character for being a bomb technician, just before its ending. In comparison with the clarity of motivations in Paul Haggis’ script for In the Valley of Elah (2007), adapted by him from an earlier non-fiction essay by Boal that also takes place during the Iraq war, the script for The Hurt Locker deviates decidedly from the format of classical Hollywood narrative; because he lacks a clearly defined goal, the psychology and motivations of the central character remain obscure. Indeed a comparison of the final script with an earlier version readily illustrates how rigorously insights into the character’s motivations, and his self-awareness, were reduced. As a result, The Hurt Locker in its final version asks considerably more imaginative and intellectual engagement from its viewers than most commercial cinema.
Re-inventing the origins of the boy who wouldn’t grow up: Régis Loisel’s Peter Pan
Authors: Blin-Rolland Armelle
Published: January 2015

Régis Loisel’s Peter Pan (Vents d’Ouest, 1990–2004) is a striking re-formulation of the origins of this mythical character due to its stylistic, narrative and thematic darkness. This article uses Loisel’s bande dessinée to examine the potential of comics as an adaptive medium, and the reading process of the comic prequel, two aspects which are productively linked by the concept of the network. I draw on Sanders’ and Groensteen’s uses of the concept in adaptation studies and comics studies respectively, to reflect on both the way that Loisel’s bande dessinée is connected to the network of proliferating Peter Pan narratives, and the way in which the comic functions as a network itself, engaging the reader in a translinear and plurivectoral reading. This article first explores how core elements of the well-known Peter Pan narrative are adapted in Loisel’s comic, both echoing and contrasting with previous versions as Loisel’s bande dessinée engages with and re-formulates the character’s textual and visual multiplicities from the network of Peter Pan narratives. This article then draws on Paul Sutton’s theorization of the ‘dual temporality’ of the prequel to reflect on the reading process of Loisel’s Peter Pan as a comic prequel that productively uses the nature of a comic as a network, and its potential for translinear and plurivectoral reading. Loisel’s Peter Pan engages the reader in an active, retrospective, prospective and anticipatory reading process, in a dynamic of repetition and difference.
Steve Ditko: Violence and Romanticism in the Silver Age
Authors: Kruse Zack
Published: January 2015

The introduction of Steve Ditko and Stan Lee’s Amazing Spider-Man radically changed the face of graphic literature. Spider-Man would go on to be one of the most recognized and beloved characters in western culture, and by mixing the individualist Zeitgeist of the mid-twentieth century with the ideals of Romanticism, co-creator Steve Ditko set a standard that would lead to some of the most significant work in comic book history. Unlike any comics creator who had preceded him, Ditko set a clear path for the psychological growth of his character and developed him over more than 38 issues. Applying a particular view of the Byronic hero, Ditko created a sort of ‘Romantic epic’ that continued in his post-Spider-Man works with the Blue Beetle, the Question and Mr A. Ditko set himself further apart from his contemporaries by developing a complicated view of violence that challenged the Comics Code Authority. The ‘right to kill’ that Steve Ditko invented for superheroes was not intended to bring the anti-hero to comics; rather, Ditko utilized it to demonstrate the moral authority of heroes against villains that, in his view, forfeited their lives. By pairing this new right to kill with psychologically complex protagonists, Ditko’s work reflected the anxieties of 1960s western culture and brought about a paradigm shift in Code era comics. This shift would lead to even more challenging works from creators like Alan Moore and Frank Miller and the eventual abandonment of the Code.
Design, arthrology and transtextuality in Seagle’s and Kristiansen’s It’s a Bird
Authors: Jacobs Dale
Published: January 2015

A theory of multimodality helps to explain how meaning is created by readers of comics at the level of the page and how readers situate themselves in relation to specific comics texts. In this article, I want to build on that theory in order to argue that in reading a comics text making meaning also involves the internal and external linkages that are continually made and unmade for and by readers. That is, it is not only at the level of a particular sequence of panels or page layout that meaning is made by comics creators and readers, but also through the connections that are made between various parts of the comics text itself (arthrology) and between the comics text and external texts (transtextuality). This article seeks to extend theories of multimodality to Thierry Groensteen’s arthrology and Gerard Genette’s transtextuality, concepts that help explain both the internal and external linkages created within comics texts. In doing so, I wish to explore some questions regarding how readers make sense of a complex comics text such as It’s a Bird by Steven Seagle and Teddy Kristiansen. What are the elements with which a reader must engage, at both the level of the page and the level of the text as a whole? How do these elements combine in the reading process? What accounts for the divergence of narrative meanings and textual interpretations between readers? In this article I examine how reading It’s a Bird involves making sense of the multimodal elements of each page, the arthrological connections between panels at both restricted and general levels, and the multiple kinds of transtextual connections between this text and myriad other texts.
Defining units of analysis for the systematic analysis of comics: A discourse-based approach
Authors: Bateman John A. , Wildfeuer Janina
Published: January 2015

Although regularly contested and rejected, the idea of a ‘grammar of comics’ continues to be applied to the analysis of comics in many disciplines and frameworks. The motivation for this is the evident regularity and systematicity exhibited by the comics medium as a form of expressive communication. Less commonly realized is that nowadays there are powerful descriptive mechanisms developed in approaches to verbal texts and linguistics that do not require the assumption of ‘grammar’ to explain productive structural regularity. This is important for the future study of comics because the notion of ‘grammar’ is in many respects deeply problematic when applied outside of its home area of natural language. In this article we demonstrate how more recent accounts of dynamic discourse provide a more appropriate set of mechanisms for talking about visual media such as comics. These mechanisms allow us to naturally relate panel, page and multiframe compositions as well as their combinations. By critical discussion of examples addressed in the literature, we show how these constructs also entail treatments of panel transitions that move beyond overly tight linking of panels and panel transitions to time and space and offer a methodologically sound way of identifying units of analysis in comics in general.
Regulation of glucagon secretion by incretin-like hormone family in the patients at risk of developing type 2 diabetes mellitus
Authors: Shestakova E A , Ilyin A V , Deev A D , Shestakova M V , Dedov I I
Published: January 2015

The study included 127 patients with type 2 diabetes (T2D) risk factors, who underwent oral glucose tolerance test (75 g glucose) with pancreatic and incretin hormones estimated in fasting state, at 30 and 120 minutes after glucose load. According to the test results the population was divided into 3 groups: group with normal glucose tolerance (NGT), group with high risk of diabetes developing (impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG)) and newly-diagnosed T2D. The stimulated glucagon secretion was suppressed in NGT group, whereas in T2D patients there was an increase in glucagon levels at 30 min after the glucose load. Within high risk group the area under curve (AUC) of glucagon secretion was significantly elevated in IFG patients comparing to IGT (0,52 vs 0,07 ng·ml-1·min-1, р=0,0005). AUC of glucagon secretion was positively related only to fasting glucagon-like peptide 2 (GLP-2) level (r=0,61, р=0,0001), that suggests glucagonotropic properties for GLP-2. We conclude that glucagon stimulation by GLP-2 may play a role in decreased glucagon suppression in T2D patients and IFG state development.
Type 3 form of MODY: the clinical and molecular-genetic characteristic. Nine cases of the disease
Authors: Zubkova N A , Arbatskaya N Yu , Petryaikina E E , Malievsky O A , Tulpakov A N
Published: January 2015

Monogenic forms of diabetes mellitus make up a group of rare pathologies associated with various forms of carbohydrate metabolism disorders. This group includes genetically determined dysfunction of pancreatic Β-cells and/or factors participating in glucose metabolism. Mutations in the HNFIA gene encoding for the nuclear transcription factor are responsible for the development of MODY3, one of the most widespread forms of monogenic diabetes mellitus. We present the description of the cases of MODY3 caused by mutations in the HNFIA gene reported from this country.
The advantages of insulin pump therapy and real time glucose monitoring systems as the tools for reducing the frequency of hypoglycemic episodes in the children and adolescents with type 1 diabetes mellitus
Authors: Laptev D N
Published: January 2015

The primary objective of the present study was to analyse the advantages of insulin pump therapy and real time glucose monitoring systems as the tools for reducing the frequency of hypoglycemic episodes. The study included 190 children and adolescents at the age varying from 1 to 18 years suffering from type 1 diabetes mellitus. All the patients were hospitalized at the Endocrinological Research Centre for the treatment the disease using different modalities of insulin therapy, such as multiple injections of insulin (MII) and its continuous subcutaneous infusion (CSII). The blood glucose level was monitored during 72 hours making use of the continuous blind and real time monitoring protocols (blind-CGM and RT-CGM respectively). All the patients were divided into 4 groups depending on the therapeutic modality and the mode of blood glucose monitoring. Group 1 was comprised of the patients given multiple insulin injections in combination with blind glucose monitoring ("blind-CGM + MII"), group 2 included the patients undergoing blind glucose monitoring in conjunction with continuous insulin infusion ("blind-CGM + CSII"), group 3 contained the patients treated by multiple insulin injections followed by real-time blood glucose monitoring ("RT-CGM + MII"), and group 4 was composed of the patients undergoing continuous subcutaneous infusion of insulin combined with real-time blood glucose monitoring ("RT-CGM + CSII"). In all the cases, the blood glucose levels were measured and the occurrence of hypoglycemia during the period of monitoring time was evaluated. It was shown that the highest frequency of hypoglycemia during 72 hours was recorded in the "blind-CGM" group and the lowest one in the RT-CGM groups. Despite adequate self-control, almost half of the patients in the "blind-CGM + MII" group reported at least one hypoglycemic episode either at the daytime or at night ; the duration of such episode was more than 1 hour on the average. In the "blind-CGM" group, CSII resulted in the decrease of the number of hypoglycemic episodes both at night and daytime (p<0.05). In the "RT-CGM + CSII" group, continuous insulin infusion reduced the mean duration of nocturnal hypoglycemic episodes (p<0.05) whereas this parameter was not significantly different between the other groups. It is concluded that hypoglycemia especially nocturnal one is rather a common problem facing children and adolescents suffering from type 1 diabetes mellitus. The use of insulin pump therapy and real time glucose monitoring systems (RT-CGM) makes it possible to substantially decrease the frequency and duration of hypoglycemic episodes in this population group.
Federal clinical practice guidelines on the management of the patients presenting with congenital adrenal hyperplasia
Authors: Kareva M A , Chugunov I S
Published: January 2015

Clinical practice guidelines on Congenital Adrenal Hyperplasia (CAH) give a brief review of epidemiology, etiology and pathogenesis of all disease causative steroidogenic defects. Recommendations on neonatal screening and management of early-diagnosed CAH due 21-hydroxylase deficiency were given in details. We also included the algorithm for the hormonal treatment and management of the patients of different age. Prenatal and preimplantation genetic diagnosis of 21-hydroxylase deficiency has been also discussed.
Hyperghrelinemia in the patients presenting with Prader-Willi syndrome
Authors: Bogova E A , Volevodz N N , Ilyin A V , Peterkova V A
Published: January 2015

The present study was designed to measure pre- and postprandial ghrelin secretion in the children presenting with Prader-Willi syndrome (PWS). The clinical, hormonal, and metabolic characteristics of 17 prepubertal children with the genetically verified diagnosis of PWS, 15 patients with exogenous-constitutional obesity, and 10 healthy children are presented. The children suffering PWS were found to exhibit pre- and postprandial hyperghrelinemia.
Diagnostics of impaired glucose tolerance by the direct mass-spectrometric analysis of plasma metabolites
Authors: Lokhov P G , Trifonova O P , Maslov D L , Balashova E E , Archakov A I , Shestakova E A , Shestakova M V , Dedov I I
Published: January 2015

We have investigated the possibility of application of the direct mass-spectrometric analysis of plasma metabolites for diagnostics of impaired glucose tolerance (IGT). The plasma samples obtained from the control group of patients showing no disturbances of carbohydrate metabolism (n=30) and those with IGT (n=20) were treated with methanol to precipitate proteins and the residual fractions were analysed on a quadrupole flight-of-time mass-spectrometer. A total of 230 metabolites were identified the levels of which were attributable to IGT. The accuracy of diagnostics using the mass-spectrometric analysis was 92% (specificity 94%, sensitivity 89%, area under the Roc-curve 0.94, reproducibility 85%). The detected metabolites included endocanabioids, cresol, ornithine, phospholipids, and fatty acids the presence of which was related to the previously described risk factors of diabetes mellitus. It is concluded that the direct spectrometric analysis of plasma metabolites can be used in routine clinical practice as a more rapid and better reproducible alternative method in comparison with the glucose tolerance test .
Federal clinical recommendations on diagnostics and treatment of hypoparathyroidism in the children and adolescents
Authors: Orlova E M
Published: January 2015

Hypoparathyroidism is a rare etiologically heterogeneous condition that manifests itself in the children in the first place as hypocalcemia. The purely hypocalcemic convulsions are usually interpreted as manifestations of epilepsy which leads to the prescription of an inadequate treatment. The early diagnostics and correct therapy ensure the normal development and social adaptation of the affected child. The present clinical guidelines developed at the Institute of Pediatric Endocrinology, Endocrinological Research Centre, highlight the diagnostic problems pertaining to hypoparathyroidism, as well as its clinical and genetic variants. In addition, the algorithm of diagnostics of hypocalcemic syndrom is proposed in conjunction with the schemes for its treatment.
Carbohydrate and lipid metabolism in the patients differing in the degree of gestational body weight gain
Authors: Pokusaeva V N , Nikiforovsky N K , Pokusaeva K B , Galieva M O , Troshina E A
Published: January 2015

Aim. To elucidate the character of the relationship between gestational body weight gain (GBWG) and carbohydrate/lipid metabolism during pregnancy. Material and methods. This prospective cohort study enrolled 85 women with full-term sigleton pregnancy in the absence of signs of diabetes mellitus or severe somatic pathology including 15 ones with subnormal GBWG, 35 with excessive GBWG, and 36 with recommended GBWG. Detection of gestational body weight gain, carbohydrate tolerance test, measurement of baseline and stimulated insulin secreation, lipidograms obtained in the first, second, and third trimesters. Results. The biochemical profile in the patients with pathological GBWG has the following peculiarities in comparison with that of the women with recommended GBWG during pregnancy. The women with excessive GBWG in the second and third trimesters are characterized by enhanced levels of baseline and stimulated insulin secretion, high HOMO-IR index and LDLP concentration (p<0.05). The women with subnormal GBWG in the first trimester have a higher fasting blood glucose level whereas in the third trimester both fasting glycemia and insulin concentration in response to standard carbohydrate loading decrease to below the respective normal values (p<0.05). The biochemical and hormonal characteristics of carbohydrate and lipid metabolism undergo secondary changes following body mass variations. Conclusion. The results of this study show that changes in sensitivity to insulin are in all probability the consequence of pathological enhancement of body mass rather than its cause.