bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Personal Characteristics on Contraceptive Choices and Use Over 5 years
Authors: Carlson Cathy , Plonczynski Donna J. , Yao Ping
Published: January 2017

Worldwide, there is an unintended pregnancy rate of 40%. That rate is higher in some areas, such as in the United States—where it is nearly 50%. These pregnancies have potentially negative outcomes for the mother and child that include health, economic, social, and psychological aspects. Long-acting reversible contraceptives (LARCs) are highly reliable methods for family planning. Identifying personal characteristics associated with choosing LARCs will better address the unintended pregnancy rates. The purpose of this research project was to evaluate characteristics of adolescents and women at high risk for unintended pregnancies by (a) describing the use of a LARC and selected personal characteristics for the years 2009 and 2014 and (b) exploring relationships among LARC choice and selected personal characteristics of clients seeking family planning services. A retrospective chart review was conducted on 268 randomly selected records, half of which were each from the years 2009 and 2014. One Midwestern U.S. family planning clinic was the site of the research. The characteristics used in the chart reviews were derived from the literature and Healthy People 2020 goals. Key differences between the years 2009 and 2014 included a significant increase in the number of LARCs prescribed to high-risk women. There was a significant relationship between the choice of a LARC and having used one in the past. Personal characteristics influencing LARC birth control choice included White, Hispanic females, those with a history of a teen pregnancy, those who experienced any previous pregnancy or live birth, and those below the poverty level. The findings indicate the importance of educating clients on LARC options. To foster initial use of a LARC, an application, based on the findings of this study, has been developed that provides individualized choices and education on contraceptive methods including LARCs.
A novel humanized mouse model with significant improvement of class-switched, antigen-specific antibody production
Authors: Yu Hua , Borsotti Chiara , Schickel Jean-Nicolas , Zhu Shu , Strowig Till , Eynon Elizabeth E. , Frleta Davor , Gurer Cagan , Murphy Andrew J. , Yancopoulos George D. , Meffre Eric , Manz Markus G. , Flavell Richard A.
Published: January 2017

Key Points

Human IL-6 improves T-cell engraftment and serum IgG production in humanized mice. IgG-switched memory B cells in IL-6 knock-in mice displayed a diverse antibody repertoire and high specificity against immunized antigen.
A Predictive Model for Extended Postanesthesia Care Unit Length of Stay in Outpatient Surgeries
Authors: Gabriel Rodney A. , Waterman Ruth S. , Kim Jihoon , Ohno-Machado Lucila
Published: January 2017

BACKGROUND:

A predictive model that can identify patients who are at an increased risk for prolonged postanesthesia care unit (PACU) stay could help optimize resource utilization and case sequencing. Although previous studies identified some predictors, there is not a model that only utilizes various patients demographic and comorbidities, that are already known preoperatively, and that may affect PACU length of stay for outpatient procedures requiring the care of an anesthesiologist.

METHODS:

We collected data from 4151 patients at a single institution from 2014 to 2015. The data set was split into a training set (cases before 2015) and a test set (cases during 2015). Bootstrap samples were chosen (R = 1000 replicates) and a logistic regression model was built on the samples using a combined method of forward selection and backward elimination based on the Akaike Information Criterion. The trained model was applied to the test set. Model performance was evaluated with the area under the receiver operating characteristic (ROC) Curve (AUC) for discrimination and the Hosmer-Lemeshow (HL) test for goodness-of-fit.

RESULTS:

The final model had 5 predictor variables for prolonged PACU length of stay, which included the following: morbid obesity, hypertension, surgical specialty, primary anesthesia type, and scheduled case duration. The model had an AUC value of 0.754 (95% confidence interval 0.733–0.774) on the training set and 0.722 (95% confidence interval 0.698–0.747) on the test set, with no difference between the 2 ROC curves (P = .06). The model had good calibration for the data in both the training and test data set indicated by nonsignificant P values from the HL test (P = .211 and .719 for the training and test set, respectively).

CONCLUSIONS:

We developed a predictive model with excellent discrimination and goodness-of-fit that can help identify those at higher odds for extended PACU length of stay. This information may help optimize case-sequencing methodologies.
We Deportees
Authors: Drumsta Emily , Feldman Keith P.
Published: January 2017

This article addresses a critical inflection point in the history of the long War on Terror: Israel’s 1992 deportation of over four hundred Palestinians to the “no-man’s-land” between Israel and Lebanon, and the camp that the deportees fashioned for the better part of one year to contest the legitimacy of Israeli colonialism and demand their return. The deportation—meant to incapacitate Islamic militant resistance to the US-brokered peace process between Israel and the Palestine Liberation Organization—paradoxically provided the conditions of possibility for conversation and collaboration among attorneys, doctors, professors, university students, and imams, which had heretofore been highly restricted and regulated by Israel’s carceral practices in the West Bank and Gaza. The deportees—those who in Giorgio Agamben’s estimation had been literally abandoned in a zone of indistinction—engaged in a political practice of “habitational resistance,” refusing their conversion into homines sacri by performing instead a mode of life that rendered multiple lines of transterritorial affiliation, self-assertion, and continuity. The deportees’ published archive—poetry, photobooks, autoethnographies—is understood as a technology of mediation that operates beyond the bounds of the prevailing Islamophobic and orientalist frames while also addressing Palestinians in Israel, the West Bank, and Gaza. The case of the deportees thus illuminates the articulation of race, religion, and war as it rubs against the linkage between settler colonial dispossession and the Westphalian trinity of nation, state, and territory.
Synthesis of δ-Lactone and Amino Acid Frameworks Utilizing the Umpoled Reactivity of β,γ-Alkenyl α-Iminoester
Authors: Kawanishi Mami , Mizota Isao , Aratake Kana , Tanaka Hirotaka , Nakahama Kenta , Shimizu Makoto
Published: January 2017

An umpolung N-alkylation reaction of β,γ-alkenyl α-iminoesters was studied, and various tandem reactions were found utilizing this N-alkylation. A useful synthesis of δ-lactones and dienamines was developed by tandem N-alkylation/vinylogous aldol-type reaction. The synthesis of α-quaternary alkenyl amino esters was also developed via the tandem N-alkylation/bromination/C-alkylation. These methods using β,γ-alkenyl α-iminoesters are operationally simple and useful, and exhibit broad substrate generality.
Problems Facing Vascular Surgery in 2004
Authors: Berguer Ramon
Published: January 2017

The most pressing challenges we face in the immediate future are endovascular training for those already in practice and a new educational paradigm for our residents.

A number of avenues for training those in practice have been implemented, and newer methods, including computer simulation, are being explored.

Vascular training programs should be 3 years in length, include vascular navigation and interventional skills, and follow 3 years of basic general surgical training. These changes in our resident training paradigm can take place only through two avenues: a successful reapplication to the American Board of Medical Specialties for an independent American Board of Vascular Surgery or a full reconfiguration of the training programs for general and vascular surgeons that would have to be spearheaded by the American Board of Surgery. There is skepticism that the latter could take place in the limited time we have left to make the vascular surgery residency attractive to candidates and sufficient in experiential and knowledge content.
The Status of Vascular Surgery as an Independent Specialty in Europe: Are the Relationships with General and Cardiothoracic Surgery a Problem?
Authors: Paaske William P.
Published: January 2017

Vascular surgery has established a clear clinical and scientific profile in Europe over the last decade, but it presents a highly complex, disorganized, and unplanned pattern. It is a specialty in the majority of the present member states of the European Union (EU), but in the United Kingdom, Germany, the Netherlands, and Sweden this is not the case. With the current expansion of the EU with 13 countries, mainly from the former Eastern Bloc, it will be even more necessary to ensure at least some level of convergence in the standards of training, certification, quality assured practice, continuing medical education, recertification, access to and quality of care, etc, because free migration of doctors, and patients, is a derivative of the cornerstones of the EU treaties, namely free movement of the citizens (and capital).

The profession has been successful in creating a simple and coherent system for organization within the European Union of Medical Specialists with a board of vascular surgery, for a (voluntary) European proficiency test for specialists (the EBSQ-Vasc), and for European continuing medical education, all in close collaboration with the premier scientific society, the European Society for Vascular Surgery.

The fantastic reductions in working hours for young doctors in the EU represent a serious threat to standards of training and, ultimately, to the patients. This, in connection with increased litigation and compensation demands for incompetence and negligence, makes it even more necessary to establish European minimum standards for training, professional competence, and an obligatory European specialist examination. A key element in this difficult process is the establishment of vascular surgery as a specialty in all member states.

Day-to-day collaboration with radiologic interventionalists has developed pragmatically at the local level in most places, but only when the administrative structures mature and vascular surgery becomes a specialty in all countries will the necessary tools be available for the avoidance of professional conflicts with colleagues from other specialties.
Feasibility evaluation of diffusion-weighted imaging using an integrated MRI-radiotherapy system for response assessment to neoadjuvant therapy in rectal cancer
Authors: Shaverdian Narek , Yang Yingli , Hu Peng , Hart Steven , Sheng Ke , Lamb James , Cao Minsong , Agazaryan Nzhde , Thomas David , Steinberg Michael , Low Daniel A , Lee Percy
Published: January 2017

Objective:

To evaluate the feasibility of on-board diffusion-weighted imaging (DWI) with an integrated low-field MRI radiotherapy system to assess responses to neoadjuvant chemoradiation (NAC) in rectal cancer.

Methods:

A spin echo-based planar imaging diffusion sequence on a 0.35-T MRI radiotherapy system was acquired over the course of NAC. The apparent diffusion coefficients (ADCs) from the tumour regions of interest (ROIs) were calculated. A functional diffusion map (fDM) was created showing a pixelwise ADC analysis of the ROI over the course of treatment. Surgical pathology was correlated with ADC data.

Results:

Consecutive patients treated on a 0.35-T MRI radiotherapy system were evaluated. Patient A had the worst pathological response to NAC with a tumour regression score of 1 and was the only patient with a negative slope in the change of ADC values over the entire course of NAC, and during both the first and second half of NAC. The fDM from the first half of NAC for Patient A showed discrete dark areas in the tumour ROI, reflecting subregions with decreasing ADC values during NAC. Patient C had the most favourable pathological response to NAC with a Grade 3 response and was the only patient who had an increase in the slope in the change of ADC values from the first to the second half of NAC.

Conclusion:

DWI using a low-field MRI radiotherapy system for evaluating the responses to NAC is feasible.

Advances in knowledge:

ADC values obtained using a 0.35-T MRI radiotherapy system over the course of NAC for rectal cancer correlate with pathological responses.
Diagnostic performance of wrist magnetic resonance (MR) arthrography: comparison of three-dimensional isotropic T
1 weighted fast spin-echo MR arthrography and two-dimensional MR arthrography
Authors: Oh Eunsun , Yoon Young C , Park Min J
Published: January 2017

Objective:

To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with two-dimensional (2D) T  1 weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T  1 weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears.

Methods:

26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T  1 weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated.

Results:

Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667–0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent.

Conclusion:

In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T  1 weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears.

Advances in knowledge:

The diagnostic performance of 3D isotropic T  1 weighted FSE D-MRA and that of 2D T  1 weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T  1 weighted FSE D-MRA has potential for substituting 2D imaging.
Genome-wide measurement of spatial expression in patterning mutants of Drosophila melanogaster
Authors: Combs Peter A. , Eisen Michael B.
Published: January 2017

Patterning in theDrosophila melanogasterembryo is affected by multiple maternal factors, but the effect of these factors on spatial gene expression has not been systematically analyzed. Here we characterize the effect of the maternal factors Zelda, Hunchback and Bicoid by cryosectioning wildtype and mutant blastoderm stage embryos and sequencing mRNA from each slice. The resulting atlas of spatial gene expression highlights the intersecting roles of these factors in regulating spatial patterns, and serves as a resource for researchers studying spatial patterning in the early embryo. We identify a large number of genes with both expected and unexpected patterning changes, and through integrated analysis of transcription factor binding data identify common themes in genes with complex dependence on these transcription factors.
Coalition-Based Pricing in Ascending Combinatorial Auctions
Authors: Bichler Martin , Hao Zhen , Adomavicius Gediminas
Published: January 2017

Bidders in larger ascending combinatorial auctions face a substantial coordination problem, which has received little attention in the literature. The coordination problem manifests itself by the fact that losing bidders need to submit nonoverlapping package bids that are high enough to outbid the standing winners. We propose an auction format, which leverages the information that the auctioneer collects throughout the auction about the preferences of individual bidders and suggests prices for the members of losing bidder coalitions, which in total would make a given coalition winning. We model the bidder’s bundle selection problem as a coordination game, which provides a theoretical rationale for bidders to agree to these prices, and highlights the role of the auctioneer in providing relevant information feedback. Results of extensive numerical simulations and experiments with human participants demonstrate that this type of pricing substantially reduces the number of auction rounds and bids necessary to find a competitive equilibrium, and at the same time significantly increases auction efficiency in the lab. This rapid convergence is crucial for the practical viability of combinatorial auctions in larger markets.

The online appendix is available at https://doi.org/10.1287/isre.2016.0681 .
“Ten Million Readers Can’t Be Wrong!,” or Can They? On the Role of Information About Adoption Stock in New Product Trial
Authors: Morvinski Coby , Amir On , Muller Eitan
Published: January 2017

Most new-product frameworks in marketing and economics, as well as lay beliefs and practices, hold that the larger the stock of adoption of a new product, the greater the likelihood of additional adoption. Less is known about the underlying mechanisms as well as the conditions under which this central assumption holds. We use a series of field and consequential choice experiments to demonstrate the existence of nonpositive and even negative effects of large adoption stock information on the likelihood of subsequent adoption. The results highlight the degree of homophily with the adopting stock as well as the level of customer uncertainty as key characteristics determining the nature of the effect of stock information. In particular, information about a large existing adoption stock generates a positive effect on adoption only under moderate customer uncertainty combined with sufficient homophily; in other levels of uncertainty and/or homophily we find effects ranging from null to negative. This is the first direct test and demonstration of the intricate role of information about a large stock of adoption in the new product diffusion process, and it carries direct implications for marketers.

Data and the online appendix are available at https://doi.org/10.1287/mksc.2016.1011
Screening Spinouts? How Noncompete Enforceability Affects the Creation, Growth, and Survival of New Firms
Authors: Starr Evan , Balasubramanian Natarajan , Sakakibara Mariko
Published: January 2017

This paper examines how the enforceability of noncompete covenants affects the creation, growth, and survival of spinouts and other new entrants. The impact of noncompete enforceability on new firms is ambiguous, since noncompetes reduce knowledge leakage but impose hiring costs. However, we posit that enforceability screens formation of within-industry spinouts (WSOs) relative to non-WSOs by dissuading founders with lower human capital. Using data on 5.5 million new firms, we find greater enforceability is associated with fewer WSOs, but relative to non-WSOs, WSOs that are created tend to start and stay larger, are founded by higher-earners, and are more likely to survive their initial years. In contrast, we find no impact on non-WSO entry and a negative effect on size and short-term survival.

The online appendix is available at https://doi.org/10.1287/mnsc.2016.2614 .

This paper was accepted by David Hsu, entrepreneurship and innovation.
Industrial Development Through Tacit Knowledge Seeding: Evidence from the Bangladesh Garment Industry
Authors: Mostafa Romel , Klepper Steven
Published: January 2017

We explore how the establishment of an industry pioneer through foreign seeding of industry knowledge can subsequently catalyze the growth of a developing country’s industry by involuntarily propagating the knowledge to subsequent entrants. As industry knowledge has tacit elements, we focus on mechanisms that enable experienced workers from the pioneer to seed the knowledge to new entrants. We examine the relationship between entrants’ characteristics and the mechanisms exploited to access the industry knowledge, and the impact of the mechanisms exploited on firm performance. Empirical findings from two historical episodes in the Bangladesh garment industry suggest that industry knowledge seeding was essential for the initial establishment and subsequent expansion of the industry. Our paper highlights the role of experienced workers’ mobility in building new firm capabilities and provides novel insights into industrialization in developing economies.

This paper was accepted by Bruno Cassiman, business strategy.
Analytical and Scalable Analysis of Transient Tandem Markovian Finite Capacity Queueing Networks
Authors: Osorio Carolina , Yamani Jana
Published: January 2017

This paper proposes an analytical model to approximate the transient aggregate joint queue-length distribution of tandem finite (space) capacity Markovian networks. The methodology combines ideas from transient aggregation-disaggregation techniques as well as transient network decomposition methods. The complexity of the proposed method is linear in the number of queues and is independent of the space capacities of the individual queues. This makes it a suitable approach for the analysis of large-scale networks. The transient joint distributions are validated versus simulation estimates. The model is then used to describe urban traffic dynamics and to address a dynamic traffic signal control problem. The signal plan analysis shows the added value of using joint distributional information, and more generally spatial-temporal between-link dependency information, to enhance urban traffic operations.

The online appendix is available at https://doi.org/10.1287/trsc.2015.0629 .
Healthcare law and ethics, 10: restraint and surveillance within care homes (1/2)
Authors: Barber Chris
Published: January 2017

Overt and covert forms of surveillance and physical, psychological and chemical forms of restraint have been used for many years to manage the behaviour of—and to safeguard—vulnerable people. However, such forms of surveillance and restraint are closely associated with deprivation of liberty and can be harmful. This article seeks to define what is meant by surveillance and restraint and will focus on the advantages and disadvantages of the various forms of restraint that could be used against a person and their association with deprivation of liberty.
Cultural considerations in postnatal dietary and infant feeding practices among Chinese mothers in London
Authors: Leung Georgine
Published: January 2017

Background

Zuo yuezi (ZYZ) is the traditional Chinese practice of confinement for 1 month after childbirth. During this time, there are customs that Chinese mothers may choose to follow, which affect their dietary choices and how they feed their infants.

Aims

This study aimed to explore Chinese women's cultural considerations around their diet and infant feeding practices.

Methods

Ten self-identified Chinese mothers who live in London were interviewed in a qualitative study during June–September 2015.

Findings

All participants were aware of ZYZ and a majority practised it to varying extents, depending on practicality and availability of specific ingredients. Most of the practice was through dietary approaches, to regulate the intakes of different foods and drinks for recovery and breast milk production, to foster the balance of yin and yang based on principles of traditional Chinese medicine. The participants' partners and own mothers were important influences in shaping their diets, which suggests ZYZ as a period to help foster family bonds. All women breastfed their babies either exclusively or with supplementation of infant formula. For those who had introduced solids, the women cooked a Chinese dish called ‘congee’ (rice porridge) for their babies. There was consensus on the limited awareness of ZYZ and cultural sensitivity by midwives and health visitors in providing postpartum dietary advice, which can be contrary to their cultural beliefs.

Conclusions

Training and the creation of a trusted online resource available in English may help promote understanding of traditional health beliefs among health professionals, and support them to build rapport with Chinese mothers in the UK.
Including the newborn physical examination in the pre-registration midwifery curriculum: National survey
Authors: Yearley Carole , Rogers Cathy , Jay Annabel
Published: January 2017

Aims

This study aimed to assess the scope of newborn infant physical examination (NIPE) education in programmes of pre-registration midwifery education.

Methods

An online questionnaire was sent to all lead midwives for education in the UK. Findings are reported in two parts: part A (the current paper) examines the education provision for the inclusion of NIPE in the midwifery curriculum. Part B (a subsequent paper) explores NIPE education as a post-registration module.

Findings

Of 58 education institutions, 40 (68.9%) completed the questionnaire. A quarter (25.0%) stated that NIPE training is included in their pre-registration midwifery programmes; 37.5% reported plans to implement it within the next 2–5 years and 30.0% had no plans to do so. Benefits for practice partners, commissioners, students and service users were identified. Challenges were noted, particularly in relation to resources and student support in practice.

Conclusion

Although barriers doubtless exist, the success of the few institutions that have incorporated NIPE into their curricula is evidence that this is not only possible, but has proven benefits.
Development of a home induction of labour framework
Authors: Clarke Paula , Round Nicola , Blythe Sarah
Published: January 2017

Background

Nationally, it is recommended that women should be offered post-dates induction of labour (IOL) at 40 weeks + 10–12 days. There is evidence that an outpatient IOL service may be associated with improved maternal satisfaction.

Aims

A home IOL service was developed to offer women choice about where labour onset can be awaited.

Methods

In an attempt to fully understand key factors and improve the local IOL service, a baseline audit of care and outcomes for low-risk post-dates women was undertaken (hospital group). A home IOL service was then set up (home group) for women to await labour onset in the comfort of their own home. Once this option was available, a second audit aimed to highlight any advantages or disadvantages with the new service so as to inform future improvement.

Findings

Audit findings highlighted that the majority of women remained at home for between 6–14 hours and all returned to the hospital safely.

Conclusions

Findings from the audits undertaken before, during and after the home IOL service was implemented, highlight useful benefits for women. It is recommended that other Trusts considering implementing the same improvement carefully monitor their findings.
Storytelling in midwifery: Is it time to value our oral tradition?
Authors: Gould Jo
Published: January 2017

Historically, midwifery has been an oral culture, where the generation of knowledge occurs through narrative or ‘storytelling’ rather than through scientific data. In recent years, however, the prevalence of scientific knowledge has dominated midwifery. The gold standard of scientific research is the randomised controlled trial, which is arguably a poor fit for normal midwifery practice because, in its purest form, midwifery is about supporting and enabling physiology with minimal intervention. A number of practices in midwifery have seen widespread adoption before there were published scientific data to support them. These include non-suturing of perineal tears in the 1990s, the use of water and, more recently, the use of hypnosis techniques for labour and birth. It seems possible that the narrative tradition of knowledge-sharing in midwifery may have contributed to these phenomena. Midwives should be encouraged to value this ‘way of knowing’ more highly, and research in the context of UK midwifery practice should be undertaken to develop the knowledge base.
What does studying research methods have to do with practice? Views of student midwives and nurses
Authors: Power Alison , Ridge Jacquie
Published: January 2017

At the point of registration, the Nursing and Midwifery Council ( NMC, 2015 ) requires nurses and midwives to prioritise people, practise effectively, preserve safety and promote professionalism and trust. Registrants must ‘always practise in line with the best available evidence’ ( NMC, 2015: 7 ), both in terms of their skills and competencies and the evidence on which their practice is based. A key aspect of a university lecturer's role in teaching on pre-registration nursing and midwifery programmes is to ensure students appreciate the link between research and practice. Student midwives and nurses must develop an understanding that gold-standard care is based on best evidence and realise that by studying research methods during their programme of study they are actually developing higher-order skills of critical thinking and decision making. Such skills are highly transferable for safe and effective clinical practice, commensurate with graduate-level programmes of study.
Nurse education and the development of the nursing associate role
Authors: Glasper Alan
Published: January 2017

Emeritus Professor Alan Glasper, from the University of Southampton, discusses the recently launched curriculum for nursing associates and what this might mean for the delivery of care
Ineligibility criteria and deprivation of liberty in relation to guardianship
Authors: Griffith Richard
Published: January 2017

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses how the law surrounding deprivation of liberty safeguards relates to a person who is the subject of a guardianship order
Creating stories through growth
Authors: Ward Sue
Published: January 2017

In our eighth extract from The Early Years Gardening Handbook by Sue Ward (Practical Pre-School Books) we look at how gardening can meet two of the early learning goals.
Update on non-hormonal treatment options during the menopause
Authors: Holloway Debra
Published: January 2017

The standard treatment for women who have menopausal symptoms was previously hormone replacement therapy (HRT); however, women have been increasingly looking for alternatives. In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines on the management on short-term symptoms in the menopause, which has brought HRT back into focus. Despite this, many women still desire a different therapy. This article gives an overview of prescribed alternatives to HRT and discusses lifestyle and diet, alternative and complementary therapies, vaginal problems and patient support, as well as nurse education.
Managing ADHD in children and young people
Authors: Laver-Bradbury Cathy
Published: January 2017

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent disorders seen in both child and adolescent mental health services and paediatric services. It is estimated that around 5% of school-aged children are affected by ADHD with 1% meeting the diagnostic criteria for severe combined type ADHD ( National Institute for Health and Care Excellence (NICE), 2016 ). It is therefore important that children and young people are identified early and offered support in a variety of ways to enable them to reach their full potential. The identification and management of ADHD depends on the age of the child and the severity of the presentation of symptoms. Based on the recommendations of NICE (2016) and using the International Classification of Diseases (ICD-10) ( World Health Organization (WHO), 1990 ), to confirm a diagnosis children and young people need to have significant problems both at home and at school in the domains of overactivity, inattention and impulsivity. In addition to these symptoms, there needs to be significant impairment to the child either socially, academically or emotionally. Once the criteria are met, diagnosis can be confirmed to the child or young person, family and school. NICE recommends parent training for mild-to-moderate cases to help parents understand ADHD and why a child who has the disorder might be challenging. For children with extreme symptoms and impairment, medication is recommended.
What is a fair price for new medicines?
Authors: Ali Omar
Published: January 2017

In this new column, Omar Ali aims to unravel the science of Health Technology Appraisal in everyday language and relate many of these concepts to everyday health care issues that face non-medical prescribers daily.
The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia
Authors: Nakamura S. , Tian Y. , Tanaka Y. , Kuriyama S. , Ito H. , Furu M. , Matsuda S.
Published: January 2017

Objectives

Little biomechanical information is available about kinematically aligned (KA) total knee arthroplasty (TKA). The purpose of this study was to simulate the kinematics and kinetics after KA TKA and mechanically aligned (MA) TKA with four different limb alignments.

Materials and Methods

Bone models were constructed from one volunteer (normal) and three patients with three different knee deformities (slight, moderate and severe varus). A dynamic musculoskeletal modelling system was used to analyse the kinematics and the tibiofemoral contact force. The contact stress on the tibial insert, and the stress to the resection surface and medial tibial cortex were examined by using finite element analysis.

Results

In all bone models, posterior translation on the lateral side and external rotation in the KA TKA models were greater than in the MA TKA models. The tibiofemoral force at the medial side was increased in the moderate and severe varus models with KA TKA. In the severe varus model with KA TKA, the contact stress on the tibial insert and the stress to the resection surface and to the medial tibial cortex were increased by 41.5%, 32.2% and 53.7%, respectively, compared with MA TKA, and the bone strain at the medial side was highest among all models.

Conclusion

Near normal kinematics was observed in KA TKA. However, KA TKA increased the contact force, stress and bone strain at the medial side for moderate and severe varus knee models. The application of KA TKA for severe varus knees may be inadequate. Cite this article: S. Nakamura, Y. Tian, Y. Tanaka, S. Kuriyama, H. Ito, M. Furu, S. Matsuda. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia: A case study for varus knee. Bone Joint Res 2017;6:43–51. DOI: 10.1302/2046-3758.61.BJR-2016-0090.R1.
The effects of posterior cruciate ligament deficiency on posterolateral corner structures under gait- and squat-loading conditions
Authors: Kang K-T. , Koh Y-G. , Jung M. , Nam J-H. , Son J. , Lee Y.H. , Kim S-J. , Kim S-H.
Published: January 2017

Objectives

The aim of the current study was to analyse the effects of posterior cruciate ligament (PCL) deficiency on forces of the posterolateral corner structure and on tibiofemoral (TF) and patellofemoral (PF) contact force under dynamic-loading conditions.

Methods

A subject-specific knee model was validated using a passive flexion experiment, electromyography data, muscle activation, and previous experimental studies. The simulation was performed on the musculoskeletal models with and without PCL deficiency using a novel force-dependent kinematics method under gait- and squat-loading conditions, followed by probabilistic analysis for material uncertain to be considered.

Results

Comparison of predicted passive flexion, posterior drawer kinematics and muscle activation with experimental measurements showed good agreement. Forces of the posterolateral corner structure, and TF and PF contact forces increased with PCL deficiency under gait- and squat-loading conditions. The rate of increase in PF contact force was the greatest during the squat-loading condition. The TF contact forces increased on both medial and lateral compartments during gait-loading conditions. However, during the squat-loading condition, the medial TF contact force tended to increase, while the lateral TF contact forces decreased. The posterolateral corner structure, which showed the greatest increase in force with deficiency of PCL under both gait- and squat-loading conditions, was the popliteus tendon (PT).

Conclusion

PCL deficiency is a factor affecting the variability of force on the PT in dynamic-loading conditions, and it could lead to degeneration of the PF joint. Cite this article: K-T. Kang, Y-G. Koh, M. Jung, J-H. Nam, J. Son, Y.H. Lee, S-J. Kim, S-H. Kim. The effects of posterior cruciate ligament deficiency on posterolateral corner structures under gait- and squat-loading conditions: A computational knee model. Bone Joint Res 2017;6:31–42. DOI: 10.1302/2046-3758.61.BJR-2016-0184.R1.
Percepción y uso social de una transformación urbana a través del social media. Las setas gigantes de la calle San Francisco
Authors: López-Baeza Jesús , Serrano-Estrada Leticia , Nolasco-Cirugeda Almudena
Published: January 2017

El análisis del espacio público urbano a partir de su dimensión perceptual ha sido, tradicionalmente, un recurso fundamental para reconocer qué características físicas lo diferencian y le confieren actividad y vitalidad. Esta aproximación es particularmente relevante en entornos urbanos transformados. Conocer la percepción social  sobre el espacio público permite valorar en qué medida las acciones realizadas modifican las dinámicas urbanas. Bajo esta consideración, el objetivo de este trabajo es estudiar la vida urbana tras la transformación de la Calle San Francisco, en Alicante, España,  en un espacio lúdico caracterizado por la implantación de una serie de setas gigantes. Para ello, se definieron y evaluaron tres indicadores de vida pública: las actividades económicas en la edificación antes y después de la intervención; el uso social del espacio proyectado; y, la imagen pública —o imagen percibida— resultante. Se propone una metodología híbrida que combina los datos recogidos en un estudio de campo con los datos provenientes de fuentes de base tecnológica, concretamente, de la red social Instagram y del servicio web Google Street View. Los resultados obtenidos ponen de manifiesto que la utilización de datos offline y online permite confirmar, complementar o cuestionar las deducciones parciales de cada uno de los métodos, ratificando así que la transformación de la Calle San Francisco ha modificado sustancialmente no sólo su identidad física, sino sobre todo la imagen colectiva del espacio con relación a la del resto de la ciudad. En definitiva, este trabajo evidencia la pertinencia de incorporar técnicas de base tecnológica para entender la complejidad de las relaciones sociales, físicas y virtuales, que se producen como consecuencia de la transformación de un espacio urbano.
La creatividad que se experiencia
Authors: Ingold Tim
Published: January 2017

En ocasiones se representa la creatividad como un factor enigmático que explica la emergencia espontánea de lo radicalmente nuevo. La obsesión con la novedad supone, sin embargo, un enfoque hacia los productos finales y una atribución retrospectiva de sus formas a ideas sin precedentes surgidas en la mente de los individuos. Esta obsesión impide reconocer el potencial de generación formal de las relaciones y procesos en los que cosas y personas se hacen y crecen.  En estos procesos lo característico sería pedir a los practicantes que copien las obras de maestros pasados. Sin embargo, a pesar de dejarse llevar por un guión o partitura, cada individuo ha de improvisar su propio camino a través de la variedad de tareas que supone cualquier práctica.  Con ejemplos extraídos de los ámbitos de la música, la caligrafía y el encaje de bolillos, muestro que las fuentes de creatividad no residen en las cabezas de los individuos, sino en su atender a un mundo en constante formación.  Para este tipo de creatividad, experienciada en lugar de hecha, la imaginación no consiste tanto en la capacidad de topar con nuevas ideas como en el impulso aspiracional de una vida que no es únicamente vivida, sino también guiada. Pero su destino aún no está fijado. Al abrirse a lo desconocido, al resultar expuesta, la imaginación no guía a través de la maestría, sino de la entrega.  Por tanto la creatividad que se experiencia, la de acción sin agencia, es la de la vida misma.
Gambaran Limfoma Burkitt di Departemen Ilmu Kesehatan Anak RSUP Cipto Mangunkusumo Jakarta
Authors: Nafianti Selvi , Windiastuti Endang , Gatot Djajadiman
Published: January 2017

Latar belakang. Limfoma Burkitt merupakan bentuk keganasan pada anak yang jarang ditemukan dibandingkankeganasan lain. Angka kematian limfoma Burkitt sangat tinggi, namun prognosis menjadi sedikitlebih baik karena banyak pilihan kemoterapi.Tujuan. Mengetahui gambaran limfoma Burkitt pada anak di RSUPN Cipto Mangunkusumo Jakarta.Metode. Penelitian dilakukan secara retrospektif dengan mengambil data dari rekam medik Divisi Hematologi-Onkologi RSUPN Cipto Mangunkusumo periode Januari 2001 hingga Desember 2006. Semuapasien yang datang ke Poliklinik rawat jalan dan ruang rawat inap dengan diagnosis Limfoma Burkittdiikutsertakan dalam penelitian.Hasil. Tercatat 7 kasus limfoma Burkitt, terdiri dari 6 laki-laki dan 1 perempuan. Usia termuda 1 tahun 5bulan sedangkan usia tertua 14 tahun 10 bulan. Enam kasus mendapat kemoterapi, yaitu 4 kasus mendapatkemoterapi dan operasi 2 kasus. Dari 7 kasus yang tercatat satu orang meninggal dunia.Kesimpulan. Limfoma Burkitt adalah penyakit keganasan pada anak yang jarang ditemukan.
Perbedaan Fungsi Tiroid pada Epilepsi yang Mendapat Pengobatan Asam Valproat dan Karbamazepin
Authors: Barreto Aniceto Cardoso , Fadil R.M Ryadi , Garna Herry
Published: January 2017

Latar belakang. Obat-obat antiepilepsi seperti asam valproat (AVP) dan karbamazepin (KBZ) mempengaruhifungsi tiroid dengan adanya perubahan kadar TSH (thyroid stimulation hormone) dan fT4 serum(free tetraiodothyroxine). Kadar AVP meningkatkan akumulasi GABA (gama amino-butiric acid) dalamhipofisis, hal ini diduga sebagai penyebab meningkatnya kadar TSH serum karena reseptor GABA-Amempunyai afinitas yang kuat terhadap TRH (thyroid releasing hormone) untuk mengeluarkan TSH.Karbamazepin meningkatkan induksi enzim sitokrom P450 hepar, akibatnya eliminasi hormon tiroiddapat meningkat.Tujuan. Mengetahui perbedaan kadar TSH dan fT4 serum anak epilepsi yang mendapat pengobatan AVPdibandingkan KBZ.Metode. Penelitian cross sectional terhadap 60 anak epilepsi (30 AVP dan 30 KBZ) yang memenuhi kriteriainklusi dan dipilih secara selektif sampling pada bulan Juni-Juli 2007 di Poliklinik Neuropediatrik AnakRSHS, kemudian dilakukan pemeriksaan kadar TSH dan fT4 serum. Perbedaan hasil kedua kelompokdianalisis dengan uji-t untuk data distribusi normal dan uji Mann-Whitney bila uji normalitas data tidakberdistribusi normal.Hasil. Pada kelompok AVP 12 (40%) anak perempuan dan 18 (60%) laki-laki. Tidak didapatkan perbedaankarakteristik antara kedua kelompok. Sembilan subjek mempunyai kadar TSH serum meningkat, satu subjekkadar fT4 serum rendah. Kelompok KBZ, 16 (53%) perempuan dan 14 (47%) laki-laki, dua subjek kadarfT4 serum di bawah normal sedangkan TSH serum normal. Kadar TSH serum kedua kelompok berbedabermakna (p=0,043), sedangkan kadar fT4 serum tidak berbeda (p=0,871).Kesimpulan. Obat asam valproat cenderung menyebabkan subklinik hipotiroid dibanding karbamazepin
Pertumbuhan Bayi Berat Lahir Rendah yang Memperoleh Susu “Post Discharge Formula” Modifikasi Dibandingkan dengan Susu “Post Discharge Formula” Komersial
Authors: Rukmini Ni Ketut Prami , Hendarto Aryono , Rohsiswatmo Rinawati , Putra Sukman Tulus
Published: January 2017

Latar belakang. Bayi berat lahir rendah (BBLR) memiliki pertumbuhan berat badan (BB), panjang badan (PB) dan lingkar kepala (LK) yang terlambat pada saat keluar dari rumah sakit, sehingga memerlukan nutrisi yang khusus.Tujuan. Mengetahui hubungan antara pemberian susu PDF modifikasi dan susu PDF komersial, dengan peningkatan BB, PB dan LK pada saat usia satu dan dua bulan.Metode. Penelitian ini bersifat studi uji klinis dengan randomisasi tanpa penyamaran.Hasil. Berat badan, panjang badan dan lingkar kepala bulan pertama dan kedua pada BBLR yang memperoleh susu PDF modifikasi tidak berbeda bila dibandingkan dengan yang memperoleh susu PDF komersial. Apabila diperhatikan secara seksama, tampak adanya kecenderungan peningkatan PB dan LK pada bulan pertama dan peningkatan BB, PB, LK yang lebih baik pada bayi yang memperoleh susu PDF modifikasi dibandingkan dengan susu PDF komersial. Pada penelitian kami tidak ada timbul reaksi simpang yang berarti.Kesimpulan. Pemberian susu PDF modifikasi dapat dijadikan alternatif untuk BBLR yang memerlukan susu PDF.
Pengaruh Vaksinasi BCG Terhadap Serum Interferon Gamma pada Kasus Asma Ekstrinsik Atopi Anak
Authors: Palandeng Yolanda Olivia , Sondakh Diana Devi Takumansang
Published: January 2017

Latar belakang. Prevalensi asma makin meningkat, diduga berkaitan dengan kejadian infeksi pada anak yang menurun sehingga menyebabkan pergeseran keseimbangan antara limfosit T helper 1 (Th1) dan T helper 2 (Th2) ke arah predominan Th2. Infeksi mikobakterium dan vaksinasi BCG dapat meningkatkan respon imun Th1 (interferon gamma (IFN-γ)) dan menekan Th2.Tujuan. Mengetahui pengaruh vaksinasi BCG terhadap kadar IFN-γ serum pasien asma ekstrinsik atopi anak setelah vaksinasi BCG satu kali.Metode. Penelitian kuasi-eksperimental pretest posttest control group design pada anak asma atopi. Pengacakan perlakuan dilakukan terhadap subjek ke dalam kelompok BCG dan plasebo. Sebelum dan 8 minggu sesudah perlakuan diukur kadar IFN-γ serum.Hasil. Kadar IFN-γ serum tidak meningkat sesudah vaksinasi BCG (median 1,580 dan 0,780 pg/ml, p= 0,326) dan plasebo (median 1,255 dan 0,670 pg/ml, p= 0,079). Selisih kadar IFN-γ serum kelompok BCG dan plasebo tidak berbeda bermakna (median 0,020 dan -0,420 pg/ml, p= 0,449).Kesimpulan. Kadar IFN-γ serum pasien asma ekstrinsik atopi anak tidak meningkat setelah vaksinasi BCG 1 kali.
Pengalaman Klinik Mahasiswa Fakultas Kedokteran Universitas Indonesia Tingkat V di Departemen Ilmu Kesehatan Anak Rumah Sakit Dr. Cipto Mangunkusumo Jakarta
Authors: Irene Irene , Soedibyo Soepardi , Satari Hindra I.
Published: January 2017

Latar belakang. Evaluasi yang berkesinambungan mengenai komponen-komponen dalam proses pembelajarandi Fakultas Kedokteran Universitas Indonesia (FKUI) mutlak dibutuhkan, yang berguna untukmelakukan perbaikan dan pengembangan yang dianggap perlu.Tujuan. Membahas tentang paparan mahasiswa FKUI klinik terhadap kasus dan prosedur inti bidangpediatri selama menjalani rotasi di Departemen Ilmu Kesehatan Anak (IKA), serta mengetahui persepsimereka mengenai peran supervisor.Metode. Penelitian merupakan survei, deskriptif, potong lintang pada mahasiswa FKUI tingkat V tahunajaran 2007–2008, yang telah melalui rotasi kepaniteraan IKA.Hasil. Lebih 50% dari 160 mahasiswa pernah menghadapi 10 dari 55 kasus yang terdapat dalam daftarkasus inti secara mandiri dan atau bersama-sama setidaknya satu kali. Lebih dari 50% mahasiswa pernahmelakukan 7 dari 17 prosedur inti secara mandiri dan atau asistensi setidaknya satu kali. Lebih dari 50%mahasiswa setuju dengan cara mengajar supervisor, dan menilai bahwa hubungan supervisor dengan mahasiswaadalah baik.Kesimpulan. Paparan mahasiswa terhadap kasus dan prosedur inti bidang pediatri masih rendah. Rataratamahasiswa setuju dengan cara mengajar supervisor, dan menilai bahwa hubungan supervisor denganmahasiswa adalah baik.