bluuebunny/crossref_metadata_2025 huggingface dataset:
Portal hypertension in pregnancy – Concealed perils
Authors: Morton Adam , Laurie Josephine , Hill Jessica
Published: December 2018

Pregnancy in women with portal hypertension is high risk due to the danger of variceal haemorrhage, which complicates 15–34% of cases. Variceal bleeding in pregnancy to women with non-cirrhotic portal hypertension is associated with increased risk of abortion (29%) and perinatal death (33%). Pregnancy in women with cirrhosis while less common due to hypogonadism, is associated with additional potential complications of hepatic decompensation and encephalopathy (10%), hepatorenal syndrome, ascites and bacterial peritonitis. Pregnancy in women with cirrhotic portal hypertension is associated with maternal death in 1.6%, and fetal loss in 10–66%. We present a case of non-cirrhotic portal hypertension in pregnancy, discussing two other potential critical complications of portal hypertension in pregnancy, splenic artery aneurysm (SAA) and pulmonary hypertension.
Reliability and validity of a taekwondo electronic body protector
Authors: Razman Rizal , Chong Ryan Wy Lunn
Published: December 2018

The Protector and Scoring System was introduced in taekwondo to encourage transparency in scoring during competition. The system, which has been used in the past two Olympics, consists of two main components, the electronic body protector and socks. The few studies that have been conducted on the Protector and Scoring System have not been comprehensive and used questionable testing methods. The main objectives of this study were to methodologically examine the validity and reliability of a Protector and Scoring System body protector. To fulfil these objectives, a customized mechanical pendulum was built to test the Protector and Scoring System. The reliability of the pendulum was first determined by tracking the pendulum’s mean velocity at impact for 50 trials on two separate occasions. Data from both days were compared and showed no significant differences ( p = 0.08). Mean kinetic energy of the pendulum was then calculated to be 55.52 J. For the experimental trial, the electronic body protector was divided into 12 sections. Each section was tested with the pendulum for 50 trials on two separate days. It was found that only three sections had no significant differences between the two days ( p > 0.01), while the rest of the sections had significantly different readings between Day 1 and Day 2. Based on the homologous descriptive statistics, only two sections were in the same group, which translated to the Protector and Scoring System being only 16.7% reliable overall for both days. In terms of validity, an independent samples t-test was used to determine the differences between the calculated kinetic energy from the pendulum (the criterion) and the displayed kinetic energy on the Protector and Scoring System, and values were found to be significantly different ( p < 0.01). Overall, the reliability and validity of the Protector and Scoring System was found to be questionable. The system needs to be examined exhaustively before being used in any future tournaments.
Long head of biceps tenodesis at the superior aspect of the biceps groove: A biomechanical comparison of inlay and onlay techniques
Authors: Cagle Paul J , London Daniel A , Gluck Matthew J , Morel Sabrina , Parsons Bradford O
Published: December 2018

Purpose

Pathology involving the long head of the biceps tendon is a common source of shoulder pain. Biceps tenodesis has been successfully used in areas below the pectoralis, above the pectoralis, and above the biceps groove. However, clinical data are lacking for additional techniques for tenodesis at the superior aspect of the biceps groove.

Methods

A biomechanical comparison was completed examining six matched pairs of cadaveric shoulders. The ultimate load to failure was compared between an inlay and onlay biceps tenodesis at the superior aspect of the biceps groove.

Results

The results demonstrate an average construct strength of 215 N for the inlay technique and 210 N for the onlay technique. The difference between the two techniques was not significant.

Conclusions

This study demonstrates similar biomechanical strength for both constructs.
Interpersonal conflict at work: Age and emotional competence differences in conflict management
Authors: Beitler Lena A. , Scherer Sonja , Zapf Dieter
Published: December 2018

Previous research has illustrated that older workers have high emotional competence (EC) that could enable them to effectively manage interpersonal conflict. However, it is still unclear whether age, potentially via EC, also influences a variety of conflict management behaviors. To address this question, we present a systematic review of the literature on the direct relationships between age, EC, and conflict management, and on EC as a potential mediator. We classify conflict management behaviors using the dual concern model (e.g., De Dreu, Evers, Beersma, Kluwer, & Nauta, 2001), and identified 15 studies on age-related conflict management, and 14 studies on EC and conflict management. Unfortunately, we found that none of the previous studies examined EC as a mediator between age and conflict behaviors. Overall, our review does reveal a positive age trend for EC, avoiding, compromising, and problem-solving, and a negative age trend for forcing. Additionally, EC seems to be positively related to problem-solving, compromising, and yielding. We discuss potential moderators and the role of EC as a potential mediator.
Transforming education through solidarity and collective representation
Authors: Mays Jennifer M
Published: December 2018

In the spirit of solidarity, critical activist scholarship and collaborative critical inquiry, this article calls for adoption of a counterhegemonic, transformative education strategy by proposing the development of an alternative vision to current neoliberal education projects and standardization. The political economy of education is driven by the economic imperatives of neoliberalism promoting new modes of governance in the university space. Education, once positioned in the public domain and constructed as a place of intellectual thought and progressive pedagogy, is reframed and reconstituted into the knowledge economy and social enterprise. The article draws on Thomas Piketty’s concepts of educational convergence, institutional change, and collective representation to embed transformative strategies that reclaim democratic academic thought and collective action. Piketty’s concepts are supplemented by narratives from service users from a large non-government organization helping people transition out of poverty, which has an early childhood center as part of the support. Such an emancipatory strategy through the use of critical pedagogy helps reconnect links between learning, knowledge, and social change.
‘Shaking up’ neoliberal policy in schools: Looking for democratic alternatives in Jacinta’s satchel
Authors: Robinson Janean , Down Barry , Smyth John
Published: December 2018

Our research is driven by a strong belief that the stories of young people gathered through ethnographic interviews can generate awareness not only of the complexities, uncertainties and possibilities of young people’s lives but also the ways in which their identities and life chances are shaped by broader structural, institutional and historical forces beyond their control. In this article, we introduce Jacinta, a young person who describes the events and conditions which serve to hinder and/or support her journey in school and beyond. We have used Jacinta’s story from a larger research project, to speak back to the impact the broader neoliberalising agenda is having on young lives with a view to reimagining democratic alternatives in education.
The pharmacokinetics of intranasal droperidol in volunteers characterised via population modelling
Authors: Cooper Isabelle , Landersdorfer Cornelia B , St John Ashley Gordon , Graudins Andis
Published: December 2018

Background:

Droperidol is used parenterally to treat nausea and vomiting, migraine and acute behavioural disturbance. Intranasal use is not reported for droperidol. Intranasal drug administration reduces need for intravenous line placement and risk of needle-stick.

Objective:

To model population pharmacokinetics of intranasal droperidol.

Method:

Single doses of intranasal and intravenous droperidol (0.02 mg/kg) were studied in an open-label crossover-trial in seven volunteers with a 1-week washout period. Blood samples collected over 10-h were analysed by liquid chromatography tandem mass spectrometer. Droperidol plasma concentrations following intravenous and intranasal administration were subjected to non-compartmental analysis and population pharmacokinetic modelling using S-ADAPT. Monte Carlo simulations were conducted for various potential intranasal dosage regimens.

Results:

The droperidol concentration-time profiles following intravenous and intranasal administration were best described by a model with two equilibrating disposition compartments and linear elimination. The apparent elimination clearance for intranasal dosing was 87.9 L/h and apparent central volume of distribution 18.2 L. Monte Carlo simulations of 5 mg droperidol (corresponding to the maximum volume that can be practically administered intranasal at a time) given intranasally at 0 and 5 min or 0 and 10 min indicated peak concentrations would reach those seen at 25 min after single intravenous administration of 1.5 mg. No adverse clinical effects or QT interval prolongation were observed.

Conclusion:

Given the reduced bioavailability of intranasal droperidol, Monte Carlo simulations suggested that it could potentially be used at a higher dose (2.5–5 mg) than currently used intravenously in clinical trials assessing the effectiveness in treatment of nausea, vomiting and migraine.
HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens
Authors: Kapadia Shashi N , Grant Robert R , German Susan B , Singh Baljinder , Davidow Amy L , Swaminathan Shobha , Hodder Sally
Published: December 2018

Background:

Single-tablet regimens are preferred prescription choices for HIV treatment, but there are limited outcomes data comparing single-tablet regimens to multiple-tablet regimens.

Methods:

We retrospectively assessed treatment-naïve patients at a single urban HIV clinic in the United States for viral load suppression at 6 and 12 months after initiating either single-tablet or multiple-tablet regimens. Multivariate regression was performed to obtain relative risks and adjust for potential confounders.

Results:

Of 218 patients, 47% were on single-tablet regimens and 53% on multiple-tablet regimens; 77% of single-tablet regimen patients had undetectable viral load at 6 months compared to 61% of multiple-tablet regimen patients (p = 0.012). At 12 months, 82% on single-tablet regimens and 66% on multiple-tablet regimens (p = 0.019) had undetectable viral load. Relative risk of any detectable viral load was 1.6 (95% confidence interval: 1.1–2.5) for patients on multiple-tablet regimens compared to single-tablet regimens at 6 months, and 2.2 (95% confidence interval: 1.2–4.0) at 12 months.

Conclusion:

Single-tablet regimens may provide better virologic control than multiple-tablet regimens in urban HIV-infected persons.
Participants and developers experiences with a chronic pain self-management intervention under development: A qualitative study
Authors: Grønning Kjersti , Nøst Torunn Hatlen , Rannestad Toril , Bratås Ola
Published: December 2018

Background:

Non-pharmacological interventions aim to promote health and self-management for people with chronic pain.

Objective:

The aim of this study was to explore if the participants’ experiences with a self-management intervention under development were aligned with the developers’ rationale and desired outcome of the intervention.

Methods:

This was a qualitative study interviewing both participants and developers of a chronic pain self-management intervention. Seven participants, six females and one male in the age from early thirties to mid-seventies attended the chronic pain self-management intervention developed by the staff at a Healthy Life Centre. The data were analysed by the systematic text condensation method.

Results:

The analyses showed that the participants evaluated the intervention as valuable. They described using coping techniques to manage their chronic pain better, and the developers stated that the aim with the intervention was to provide the participants with coping techniques. The intervention was built upon the developers’ professional knowledge and experience in cognitive techniques, health theories, models for behavioural change, and service user involvement.

Conclusion:

This study found that the chronic pain self-management intervention was in concordance with theory of health promotion and empowerment. The participants experienced the intervention as targeting their resources, capacities, and fulfilling social needs, which aligned with the developers aim with the intervention. The participants found the intervention evocative; they learned new ways to manage their pain through theory/education, movement exercises, homework, and sharing their experiences with each other.
On acoustic milieus
Authors: Wang Jing
Published: December 2018

This essay critiques the notion of soundscape and proposes the concept of acoustic milieus as an alternative conceptual tool to facilitate our understanding of the human condition mediated through and with sound. As a kind of ‘charged atmosphere’ to use Kathleen Stewart’s expression, an acoustic milieu, offers a rich understanding of everyday practice which often seems to be banal, ephemeral and resistant of scholarly interpretation. An acoustic milieu, similar to any charged atmosphere, is not completely natural or neutral; they are sentient, technical and anthropological. They are composed, set in motion and, if not taken care of, puffed out or exhausted away. An acoustic milieu, like a spider web, a kind of ‘exorganismes’, to use Bernard Stiegler’s language, once created, reciprocates a new kind of life. To answer to the call of Gregory Bateson that one needs to think ecologically, an acoustic milieu is a conceptual tool to help one towards perceiving the circuit, rather than just its arc.
Place, sociality, health: Forms of relocation and recuperation in modern Japan
Authors: Zhao Jing
Published: December 2018

After the earthquakes hit northeastern Japan and caused the catastrophic meltdowns at Fukushima on 11 March 2011, a large number of families chose not to relocate and are still living in contaminated areas. From the summer of 2011, Japan started a hoyo—health recovery camp which has been mainly aimed at helping people, especially children, to relieve the stress of their minds and bodies that have been affected by the radioactivity. This camp offers children therapeutic treatments by sending them for a few days to places that are out of the radioactive contamination zone. In the camp, a place with less pollution becomes the key link between the recovering person and the program, and the landscapes are therapeutic for the human body and mind. In this article, I focus on the health recovery camp as being a form of relocation and recuperation from a historical perspective and show how this camp provides a therapeutic landscape for healing. I consider the concept of therapeutic landscape which was developed by Wil Gesler in the early 1990s to be an insightful and effective approach for studying closely the process of healing in the nuclear pollution era, even though the cultural contexts of Gesler’s and the present study are very different. Working from a non-Western perspective and also from that of health recovery from radiation exposure, my study focuses on the interaction between health recovery camp participants and the natural, built, symbolic, and social factors which Gesler mentions as aspects of “healing environments.”
The environment, humankind, and slow violence in Chinese science fiction
Authors: Li Hua
Published: December 2018

This essay takes an analytical approach to examine some Chinese science fiction narratives with the themes of climate change, terraforming, and environment degradation—written from the mid-20th century to the early years of the 21st century. My broad reading of the texts treats these narratives as archive—textual sources that document a historical development of the impact of human activities on nature. On one hand, these narratives are all closely related to the country’s modernization, its economic takeoff, and the rhetoric of building a powerful China. On the other hand, they form one set of what can be understood as an emerging body of Chinese fiction located firmly within the strata and sediment of the Anthropocene. This body of literature offers a venue for explaining and exploring how economics, technological developments, and government policies have transformed the ecology, environment, and climate in the Anthropocene. These narratives also echo the concept of slow violence dubbed by Rob Nixon in 2011. These terraforming and climate narratives reveal an attritional violence of environmental degradation, climate change, and the consequential social and political problems that permeate so many of our lives. My close reading of Chen Qiufan’s novel The Waste Tide ( Huangchao, 2013) specifically portrays a slow and attritional violence—namely, the ways in which the electronics recycling industry have caused severe environmental and occupational impacts on nature and humans—through exploration of the complex relationships among technology, the economy, and the environment.
Writing the therapeutic waterscape: Bodies, memories, and nature in post-socialist Chinese texts
Authors: Yee Winnie LM
Published: December 2018

This article takes an ecocritical approach that challenges the urban imaginary informing the notion of place and the identity of inhabitants in mainland China. It explores an alternative mode of imagination, symbolized by the flow and instability of water. The work of documentary filmmaker Dong Jun and renowned writer Su Tong can be seen as attempts to evaluate and revisit history and memories through a reconnection with water, whether it be the Yellow River in Dong Jun’s Flood or the river/water world in Su Tong’s The Boat to Redemption. Instead of commenting directly on the destruction of nature as a result of human development and cultural upheaval, both works use water as an indirect means to raise these issues.
Predictors and Sequelae of Postoperative Delirium in Geriatric Hip Fracture Patients
Authors: Arshi Armin , Lai Wilson C. , Chen James B. , Bukata Susan V. , Stavrakis Alexandra I. , Zeegen Erik N.
Published: December 2018

Introduction:

Perioperative delirium in elderly hip fracture patients has been correlated with significant morbidity. The purpose of this study was to determine the preoperative risk factors for and short-term sequelae of postoperative delirium in geriatric hip fracture patients.

Methods:

We queried the American College of Surgeons National Surgical Quality Improvement Program to identify geriatric (≥65 years) patients who sustained operative hip fractures in 2016. Cohorts of patients with and without documented postoperative delirium were identified. Primary data on patient demographics and comorbidities were collected and correlated with postoperative complications and hip fracture outcome measures. Multivariate regression was used to compute risk-adjusted odds ratios (OR) of risk factors and sequelae of delirium.

Results:

In total, 8,439 geriatric hip fracture patients were identified of whom 2,569 patients (30.4%) had postoperative delirium. Age (OR 1.03 [1.02-1.04, p < 0.001), white race (OR 1.54 [1.19-2.00], p = 0.001), American Society of Anesthesiologists classification (OR 1.20 [1.07-1.36], p = 0.003), baseline dementia (OR 2.46 [2.11-2.86], p < 0.001), and preoperative delirium (OR 10.06 [8.12-12.45], p < 0.001) were independent risk factors for postoperative delirium in multivariate analysis. Patients with postoperative delirium had a significantly higher risk-adjusted 30-day mortality (12.0% vs. 4.8%, OR 2.22 [1.74-2.84], p < 0.001) and morbidity profile. Postoperative delirium was also independently associated with higher rates of discharge to (OR 1.65 [1.32-2.06], p < 0.001) and prolonged stay in (OR 1.79 [1.53-2.09], p < 0.001) an inpatient facility, hospital readmission (OR 1.94 [1.58-2.38], p < 0.001) and hospital length of stay (7.6 ± 5.0 vs. 6.1 ± 4.1 days, p < 0.001), as well as lower rates of immediate postoperative weight bearing (OR 0.73 [0.63-0.86], p < 0.001).

Discussion:

Postoperative delirium is a common occurrence in geriatric hip fractures with multiple risk factors. Delirium portends higher mortality and worse perioperative hospital-based outcomes.

Conclusions:

Multidisciplinary foreknowledge and management efforts are warranted to mitigate the risk of developing delirium, which strongly predicts perioperative morbidity, mortality, and hip fracture outcomes.
Peer-Mediated Literacy-Based Behavioral Interventions: A Job Coaching Strategy for Secondary Students With ASD
Authors: Honsberger Toby J. , Brady Michael P. , Honsberger Christine F. , Kearney Kelly B.
Published: December 2018

Many secondary students with autism spectrum disorder (ASD) are not taught employability skills and routines needed for competitive or supported employment in regular community environments. Literacy-based behavioral interventions (LBBIs) that combine print, pictures, and behavioral rehearsal are effective for promoting acquisition and maintenance of numerous skills, but have not been investigated as a job coaching intervention for individuals with ASD. In this study, a peer coworker was taught to deliver an LBBI guide to students with ASD as a job coaching intervention for three skills in an employment preparation routine: preparing and selling coffee in a work-site food truck. Results showed students’ accuracy with the skills in the work routine increased, and maintained after the intervention.
Incremental Innovations in Ghanaian SMEs: Propensity, Types, Performance and Management Challenges
Authors: Oduro Stephen , Nyarku Kwamena Minta
Published: December 2018

Incremental innovation has been recognised as a key factor to SMEs’ survival and growth in today’s hyper-competitive business world. Notwithstanding this inspired recognition, analytical and empirical studies on SMEs’ incremental innovation practices are still measly in emerging economies. Drawing from the dynamic capabilities theory, the present study sought to examine SMEs’ incremental innovation practices in Accra, Ghana. The study followed a multiple-case qualitative methodology using a semi-structured interview and a simple random sampling method to select 17 SMEs for the study while an inductive approach was used to analyse the transcribed data from the informants. The findings disclosed that the incremental innovation propensity and innovation types in the SMEs differ from small firms to medium firms and from manufacturing firms to service firms. It was further disclosed that the incremental innovation practices have improved the performance of the SMEs in terms of increased customer satisfaction and loyalty, sales growth, competitiveness, and global market reach, while their paramount innovation management challenges were lack of financial resources, infrastructure, specialized personnel, and information on technology. These findings add to SMEs theory and practice and offer novel theoretical insights for researchers and valuable managerial implications for SMEs’ managers in emerging economies.
Institutional Effects of Higher Education Acquisitions: The Case of Texas A&M School of Law
Authors: Lyke Austin
Published: December 2018

This study analyzes the acquisition of the Texas Wesleyan University School of Law by Texas A&M University. In particular, institution-level effects are examined by measuring selectivity, tuition prices, job outcomes, and bar passage rate before and after the law school changed names from a hyperregional institution to one of statewide eminence and national recognition. Difference-in-differences estimations and synthetic control analysis are used to measure effects of the acquisition on various institutional metrics. Results show an increase on school selectivity and null effects on tuition price and job outcomes, suggesting heterogeneity in response to the acquisition. Implications for higher education and legal education, specifically, are discussed.
Risk Factors for Short- and Long-Term Outcomes in Children With STEC-HUS/D+ HUS: A Single-Center Experience
Authors: VanSickle Judith Sebestyen , Srivastava Tarak , Alon Uri S.
Published: December 2018

Background. Hemolytic uremic syndrome (HUS) is one of the common causes for acute kidney injury in childhood. Objective. The goals of our study were to identify risk factors for short-term complications and long-term outcomes of chronic kidney disease (CKD) in Shiga toxin–producing Escherichia coli (STEC)-HUS and other diarrhea positive (D+) HUS. Methods. Retrospective chart review was obtained of 58 pediatric patients treated for STEC-HUS and other D+ HUS between February 2002 and January 2011. Results. Thirty-three patients (56.9%) required dialysis. Dialysis was more likely initiated if a patient was a female ( P < .012), oliguric (urine output < 0.5 mL/kg/h, P < .0005), or hemoglobin (HGB) level >10 g/dL ( P = .009) at admission. Neurological complications developed only among 5 dialyzed patients ( P < .042), and were more common if the patient received hemodialysis (HD) compared with peritoneal dialysis ( P < .0005). CKD was noted during the subsequent follow-up clinic visits in 5 patients (8.6%). Those who developed CKD received HD ( P = .002), dialysis for >10 days ( P = .0004), or HGB level >10 g/dL ( P = .034) at admission. Conclusions. Children with STEC-HUS/D+ HUS who may need dialysis are identified by female gender, lower urine output, higher serum creatinine level, and higher HGB at admission. They are at higher risk developing central nervous system complications especially if they needed HD. Children requiring >10 days of dialysis are at risk for development of CKD.
Access to School and Higher Education among Scheduled Castes and Scheduled Tribes: Changing Scenario and Policy Issues
Authors: Khan Khalid
Published: December 2018

During the past two decades, access to school and higher education has increased significantly among every group. Since the commencement of the constitution, emphasis has been laid on the universalisation of elementary education. With the adoption of economic reforms, the role of private sector has significantly increased and resulted in reducing the State’s commitment towards social sector under the pretext of fiscal discipline. The obvious repercussion of such a policy shift was increasing the role of private sector at the cost of government sector. Against this background of expansion along with privatisation, it would be worthwhile to analyse whether the expansion during the previous two decades has been inclusive or not. This article thus, seeks to analyse how the expansion in school and higher education has affected the access of marginalised groups such as Scheduled Castes (SCs) and Scheduled Tribes (STs). Although the access at elementary level has reached universal level at elementary but the issue of retention is a major concern in this regard. The access at Secondary & Higher Secondary and Higher Education has increased among every social group and the growth rate is higher among SCs and STs, respectively than “Others’ but this increase has not been sufficient to overcome the existing disparities. The issue is noteworthy due to increasing share of private unaided institutions, lack of financial support and hence lower share of SCs and STs in private unaided institutions. Thus, there is a need of emphasis on providing equal opportunity with the consideration of structural changes in higher education.
Perspectives from affective science on understanding the nature of emotion
Authors: Fox Elaine
Published: December 2018

Emotions are at the heart of how we understand the human mind and of our relationships within the social world. Yet, there is still no scientific consensus on the fundamental nature of emotion. A central quest within the discipline of affective science is to develop an in-depth understanding of emotions, moods, and feelings and how they are embodied within the brain (affective neuroscience). This article provides a brief overview of the scientific study of emotion with a particular emphasis on psychological and neuroscientific perspectives. Following a selective snapshot of past and present research in this field, some current challenges and controversies in affective science are highlighted.
The utility of stem cells for neural regeneration
Authors: Goncalves Kirsty , Przyborski Stefan
Published: December 2018

The use of stem cells in biomedical research is an extremely active area of science. This is because they provide tools that can be used both in vivo and vitro to either replace cells lost in degenerative processes, or to model such diseases to elucidate their underlying mechanisms. This review aims to discuss the use of stem cells in terms of providing regeneration within the nervous system, which is particularly important as neurons of the central nervous system lack the ability to inherently regenerate and repair lost connections. As populations are ageing, incidence of neurodegenerative diseases are increasing, highlighting the need to better understand the regenerative capacity and many uses of stem cells in this field.
Compliance to current national medicines law for proper storage and dispensing of medicines at community pharmacies in Bhutan
Authors: Chejor Pelden , Jamphel Kinga , Tsheten  , Letho Zimba , Guru  , Tshering Ugyen
Published: December 2018

Introduction:

Compliance of community pharmacies with the national medicines law for proper storage and dispensing of medicines is crucial for ensuring the quality and safety of medicines. Community pharmacies in Bhutan are of two types: retail pharmacies and wholesale pharmacies.

Objective:

This study was aimed to assess the compliance of community pharmacies with the Medicines Act of the Kingdom of Bhutan 2003 and Bhutan Medicines Rules and Regulation 2012.

Methods:

This is a retrospective cross-sectional study from the inspection reports of community pharmacies inspected from January 2015 to December 2017. Descriptive statistics in frequency and percentage was used to report the results.

Results:

The overall compliance level for the regulatory provisions under critical and minor categories was 90.4% followed by 86.74% for major category. Around 32.99% of community pharmacies were found without standard operating procedures for storing and dispensing of medicines while 100% of community pharmacies had technical authorization from the Drug Regulatory Authority.

Conclusion:

Although the compliance level of community pharmacies in Bhutan for storing and dispensing of medicines was found to be above 80%, there are several areas that need to be corrected to ensure full compliance. This study will serve as a baseline for policymakers, managers, and researchers in developing designs for future interventions.
Cluster-like headache secondary to maxillary sinusitis by Aspergillus
Authors: Rodriguez Laura Martinez , Alvarez Angel Ignacio Perez , Alvarez Jose Maria Sanchez
Published: December 2018

A symptomatic cluster headache (CH), caused by fungal maxillary sinus infection fulfilling the criteria of International Headache Society (ICDH-3) for CH is presented. A 35-year-old man without previous headaches reported episodes of pain in the right fronto-orbitary region, with severe eyelid oedema, photophobia, frontal sweating, lacrimation, conjunctival injection and rhinorrhoea, which lasted for 2–3 h. A brain magnetic resonance imaging (MRI) showed occupation of the right maxillary sinus, a mycetoma due to Aspergillus fumigatus. Although rare, secondary causes must be discarded before the diagnosis of a primary CH is made. Imaging study should always be performed, even though no atypical feature was present and ICDH-3 were fulfilled.
Comparison of Transthoracic Echocardiography, Transesophageal Echocardiography, and Transcranial Doppler in the Detection of Patent Foramen Ovale as the Etiology for Cryptogenic Stroke
Authors: Stafford Madison B. , Bagley Jennifer E. , DiGiacinto Dora
Published: December 2018

The correlation between cryptogenic stroke and patent foramen ovale is high in young patients. Currently, transesophageal echocardiography is the gold standard for detection. However, it is invasive and limits Valsalva maneuvers. This article reviews the diagnostic accuracy of the three modalities: transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler. The results suggest that transcranial Doppler sonography is an accurate, easily accessible procedure for detecting patent foramen ovale and should be considered an excellent alternative to transthoracic or transesophageal echocardiography. Transesophageal echocardiography is still necessary for patients who require treatment. The combination of transcranial Doppler and transesophageal echocardiography provides the highest level of information regarding the complete diagnosis of patent foramen ovales.
Continuity of care and clinical outcomes in the community for people with severe mental illness
Authors: Macdonald Alastair , Adamis Dimitrios , Craig Tom , Murray Robin
Published: December 2018

Background

High continuity of care is prized by users of mental health services and lauded in health policy. It is especially important in long-term conditions like schizophrenia. However, it is not routinely measured, and therefore not often evaluated when service reorganisations take place. In addition, the impact of continuity of care on clinical outcomes is unclear.

Aims

We set out to examine continuity of care in people with schizophrenia, and to relate this to demographic variables and clinical outcomes.

Method

Pseudoanonymised community data from 5552 individuals with schizophrenia presenting over 11 years were examined for changes in continuity of care using the numbers of community teams caring for them and the Modified Modified Continuity Index (MMCI). These and demographic variables were related to clinical outcomes measured with the Health of the Nation Outcome Scales (HoNOS). Data were analysed using generalised estimating equations and multivariate marginal models.

Results

There was a significant decline in MMCI and significant worsening of HoNOS total scores over 11 years. Higher (worse) HoNOS scores were significantly and independently related to older age, later years and both lower MMCI and more teams caring for the individual in each year. Most HoNOS scales contributed to the higher total scores.

Conclusions

There is evidence of declining continuity of care in this 11-year study of people with schizophrenia, and of an independent effect of this on worse clinical outcomes. We suggest that this is related to reorganisation of services.

Declaration of interest

None.
Multimodality Monitoring in the Neurocritical Care Unit
Authors: Lara Lucia Rivera , Püttgen Hans Adrian
Published: December 2018

PURPOSE OF REVIEW

This article focuses on the multiple neuromonitoring devices that can be used to collect bedside data in the neurocritical care unit and the methodology to integrate them into a multimodality monitoring system. The article describes how to apply the collected data to appreciate the physiologic changes and develop therapeutic approaches to prevent secondary injury.

RECENT FINDINGS

The neurologic examination has served as the primary monitor for secondary brain injury in patients admitted to the neurocritical care unit. However, the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care concluded that frequent bedside examinations are not sufficient to detect and prevent secondary brain injury and that integration of multimodality monitoring with advanced informatics tools will most likely enhance our assessments compared to the clinical examinations alone. This article reviews the invasive and noninvasive technologies used to monitor focal and global neurophysiologic cerebral alterations.

Multimodal monitoring is still in the early stages of development. Research is still needed to establish more advanced monitors with the bioinformatics to identify useful trends from data gathered to predict clinical outcome or prevent secondary brain injury.
Ethical Considerations in End-of-life Care in the Face of Clinical Futility
Authors: Kass Joseph S. , Lewis Ariane , Rubin Michael A.
Published: December 2018

Management of patients with terminal brain disorders can be medically, socially, and ethically complex. Although a growing number of feasible treatment options may exist, there are times when further treatment can no longer meaningfully improve either quality or length of life. Clinicians and patients should discuss goals of care while patients are capable of making their own decisions. However, because such discussions can be challenging, they are often postponed. These discussions are then conducted with patients’ health care proxies after patients lose the capacity to make their own decisions. Disagreements may arise when a patient’s surrogate desires continued aggressive interventions that are either biologically futile (incapable of producing the intended physiologic result) or potentially inappropriate (potentially capable of producing the patient’s intended effect but in conflict with the medical team’s ethical principles). This article explores best practices in addressing these types of conflicts in the critical care unit, but these concepts also broadly apply to other sites of care.
Critical Care of Neuromuscular Disorders
Authors: Greene-Chandos Diana , Torbey Michel
Published: December 2018

PURPOSE OF REVIEW

Weakness is a common reason patients are seen in neurologic consultation. This article reviews the differential diagnosis of neuromuscular disorders in the intensive care unit (ICU), discusses the intensive care needs and evaluation of respiratory failure in patients with neuromuscular disorders, and provides a practical guide for management.

RECENT FINDINGS

Although primary neuromuscular disorders used to be the most common cause for weakness from peripheral nervous system disease in the ICU, a shift toward ICU-acquired weakness is observed in today’s clinical practice. Therefore, determining the cause of weakness is important and may have significant prognostic implications. Guillain-Barré syndrome and myasthenia gravis remain the most common primary neuromuscular disorders in the ICU. In patients with myasthenia gravis, it is important to be vigilant with the airway and institute noninvasive ventilation early in the course of the disease to attempt to avoid the need for intubation. On the other hand, patients with Guillain-Barré syndrome should be intubated without delay if the airway is at risk to avoid further complications. In patients with ICU-acquired weakness, failure to wean from the ventilator is usually the challenge. Early mobility, glucose control, minimizing sedation, and avoiding neuromuscular blocking agents remain the only therapeutic regimen available for ICU-acquired weakness.

Critical care management of neuromuscular disorders requires a multidisciplinary approach engaging members of the ICU and consultative teams. Developing an airway management protocol could have implications on outcome and length of stay for patients with neuromuscular disorders in the ICU. Tending to the appropriate nuances of each patient who is critically ill with a neuromuscular disorder through evidence-based medicine can also have implications on length of stay and outcome.
Search the Theme of Educational Projects As Co-Creation of a Teacher and Students (on Geometric Material)
Authors: Павлова О. , Pavlova O. , Чиркова Н. , Chirkova N.
Published: December 2018

The role of independent search activity in achieving the goals of the child’s development is recognized. The involvement of the child in the educational and research activities and the role of the teacher in its organization depend on the children’s age. The article shows techniques for helping to find an idea for the project, on the example of visual geometry. The role of co-creation between the teacher and the students in the search for the theme of the educational project is highlighted. Examples of ideas for simulation projects are given.
Station Dispatching Problem for a Large Terminal: A Constraint Programming Approach
Authors: Kumar Rajnish , Sen Goutam , Kar Samarjit , Tiwari Manoj Kumar
Published: December 2018

The authors developed a model based on constraint programming to provide the best feasible solution(s) for minimizing the dispatching delays within a given planning horizon.
VIDAS PRECARIZADAS E EXISTÊNCIAS REINVENTADAS: EXPERIÊNCIAS TRANS ENTRE O BRASIL E A EUROPA DO SUL
Authors: França Gonçalves dos Santos Rafael , Nicolau Marcio
Published: December 2018

Neste artigo abordamos a problematização sobre a produção de vidas precárias, ditas como vidas e corpos que não importam, que por possuírem menos peso no cistema[1] heteronormativo, são produzidas como vidas descartáveis. Para analisar e tencionar tal elaboração teórica, discutimos algumas formas e modelos de resistência à chamada tecnologia biopolítica de produção dos corpos e com isso almejamos visibilizar históricas construções de si que representam como subjetividades enfrentam, por meio de relações de amizade, redes de afeto e outros mecanismos de (re) existência, o cistema e criam modos de vida que provocam fissuras na lógica precária definida para suas vidas. Para tal intento, dialogamos com sujeitos, reflexões e pesquisas que privilegiam as experiências trans.[1] Utilizamos “cistema” como uma corruptela da palavra sistema, para fazer referência ao modelo de organização da sociedade pautado no modelo cis-sexista, conforme sugerido por Viviane Vergueiro (2015) a partir da leitura de Ramón Grosfoguel (2012) em relação ao sistema-mundo.
O MASCULINO, O FEMININO E O ESPORTE – O PROJETO DE LEI JOÃO NERY E UM OLHAR SOBRE A JOGADORA DE VÔLEI TIFFANY
Authors: De Aquino Paes Erica , Da Costa Moas Luciane
Published: December 2018

O presente artigo cuida de assunto urgente na sociedade brasileira, embora envolva grande carga de estigmas e pré-conceitos que terminam por dar alicerce a preconceitos e sérias consequências sociais, qual seja: a transgeneridade. Refletimos acerca do tema, sem pretensões de definitividade, mas com argumentos científicos e de autoridade, partindo da análise de questões sociais que dizem respeito à matéria, como as violências, passando pela análise de sua classificação médica de acordo com a Organização Mundial da Saúde, pelo projeto de lei João Nery e terminamos aplicando os conhecimentos a um caso específico de uma mulher trans, o da jogadora de voleibol, Tiffany Abreu.
SEXUALIDADE HOMOSSEXUAL NO JORNAL LAMPIÃO DA ESQUINA
Authors: De Freitas Silva Natanael , De Assis Rubio Natam Felipe
Published: December 2018

O objetivo deste artigo é discutir e apresentar como as homossexualidades foram tematizadas, nomeadas e significadas no Brasil durante os anos 1978-1981. E para isso, iremos apresentar um debate historiográfico sobre o tema a partir de bibliografia pertinente, em seguida, enfatizamos o que era dito e entendido por homossexualidade à época, e por fim, exemplificamos como o Lampião da Esquina teceu e comunicou outros olhares sobre as homossexualidades.
Vitamin D reduces postpartum depression and fatigue among Iranian women
Authors: Rouhi Maryam , Rouhi Narges , Mohamadpour Shabnam , Tajrishi Hasti Poormahammad-Reza
Published: December 2018

Background

Depression and fatigue have been recognised as common postpartum morbidities. One of the proposed well established aetiologies is vitamin D deficiency, which is prevalent among Iranian women.

Aim

To determine the efficiency of vitamin D supplement on postnatal depression and fatigue.

Method

In this double blind, randomised controlled trial, 80 primiparous women, who scored ≥13 and ≥20 on the Edinburgh Postnatal Depression Scale and the Fatigue Identification Form, respectively, were randomly distributed into the control and intervention groups over 4-10 months following birth. Groups received vitamin D3 1000IU and placebo pills daily for 6 months. Logistic regression tests assessed the relation between variables.

Findings

Vitamin D decreased depression scores and fatigue scores in the intervention group (P>0.001).

Conclusion

Considering vitamin D supplements as routine postpartum care among high-risk women would be useful. However, more studies are needed to support this conclusion.
Midwives' experiences of caring for women with early pregnancy loss in an Irish maternity hospital
Authors: Nash Mary , Barry Maebh , Bradshaw Carmel
Published: December 2018

Background

Midwives provide care for women experiencing early pregnancy loss, as well as support for women throughout childbirth. Research has predominately focused on women's experience of early pregnancy loss, with little research on how such loss affects midwives and care provision.

Aim

To explore the perceptions of midwives caring for women experiencing early pregnancy loss.

Methods

This study used a descriptive qualitative design with semi-structured interviews. A purposive sample of eight midwives, all of whom had relevant experience, were recruited from a maternity hospital in Ireland.

Findings

Themes identified were: ‘coping with the experience of early pregnancy loss’, ‘compassionate care for women and midwives’, and ‘what midwives found difficult’.

Conclusions

Repeated exposure to early pregnancy loss can have a profound emotional effect on midwives, with a potential for this to affect the care that women receive. Midwives identified the need for further education in the area of early pregnancy loss, time out during the shift to debrief, and counselling for staff. Structured support is needed for midwives and other health professionals where there is repeated exposure to early pregnancy loss.
Blasmusik als Vermittlerin von Heimatgefühlen
Authors: Järmann Thomas
Published: December 2018

Thomas Järmann widmet sich in seinem Beitrag zwei Fallbeispielen und zeigt auf, wie Komponisten Schweizerisches in ihre Werke einzuarbeiten versuchten. Er stellt dabei auch die Frage, welchen Beitrag die hineinkomponierte »Swissness« bei der Evokation von Heimatgefühlen leisten konnte und welche Bedeutung diese Musikstücke für die nationale Identität hatten. Programminhalte und Musik des Schweizerischen Kurzwellendiensts wurden daher so ausgewählt, dass sie sich von denen der anderen Sender abgrenzten, und die Eigenheiten der Schweiz wurden bewusst betont. So wurde rund die Hälfte der Sendezeit mit Musik gefüllt, und gerade die Schweizerische Volksmusik fungierte dabei als Alleinstellungsmerkmal; aber auch qualitativ hochstehende Unterhaltungsmusik und Ernste Musik von hauptsächlich Schweizer Komponisten interpretiert und von Schweizer Ensembles. Im Fokus des Artikels stehen jedoch nicht die oft gehörten Militärmärsche, sondern zwei Werke aus der Gattung der Sinfonischen Blasmusik.
Heteronormativitätskritische Jugendbildung
Authors: Busche Mart , Hartmann Jutta , Nettke Tobias , Streib-Brzic Uli
Published: December 2018

Bildung zu vielfältigen geschlechtlichen und sexuellen Lebensweisen gewinnt zunehmend an Bedeutung. Doch wie kann Pädagogik Lernprozesse für Kinder und Jugendliche ermöglichen, ohne (ungewollt) Stereotype und hierarchische Verhältnisse zwischen den Lebensweisen zu reproduzieren? Wie kann sie eine Auseinandersetzung mit der vorherrschenden heteronormativen Ordnung anregen? Als Ergebnis eines Forschungsprojekts im Jugend Museum Berlin Schöneberg bietet das Buch theoretische Perspektiven, empirische Erkenntnisse und Orientierungslinien für die Praxis.