bluuebunny/crossref_metadata_2025 huggingface dataset:
Coaching Experts: Applications to Surgeons and Continuing Professional Development
Authors: Zahid Assad , Hong Jonathan , Young Christopher J.
Published: January 2018

Surgery is a science and an art, which is mastered through years of training and refined by the accumulation of individual experience and preference. Continuing professional development (CPD) is a concept that emphasizes a self-directed approach to education. Coaching is a process that leads to increased utilization of a person’s current skills and resources without counselling or advising. Coaching in surgery could be used to facilitate and optimize feedback and reflection, thus enhancing performance and outcomes through elite performance of an operative procedure. Therefore, it can be applied under the umbrella of CPD. Ultimately also emphasizing that better quality surgery is not necessarily purely based on technical outcomes, it is a combination of both technical and nontechnical practice. Coaching of surgeons is a conceptually formidable tool in the successful implementation of effective CPD programs. CPD currently provides an opportunity for surgeons to gain access to constantly evolving medical knowledge and technique; however, there is no accountability to its understanding or implementation. Coaches have the potential to provide confidential appraisal and feedback in a constructive approach with the aim to eliminate any barriers to the transfer of technique and knowledge.
Absence of Neck Scars With Total Endoscopic Submandibular Sialadenectomy Using a Chest Wall Approach: A New Technique
Authors: Elzahaby Islam A. , Khater Ashraf , Abdallah Ahmed , Refky Basel , Abd Elaziz Mahmoud , Shetiwy Mosab , Zaid Amir M.
Published: January 2018

Introduction. This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic submandibular sialadenectomy through a chest wall approach without the creation of any neck incisions. Methods. Four patients with benign submandibular gland lesions underwent a total endoscopic submandibular sialadenectomy through a chest wall approach using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Results. The operative time ranged from 140 to 170 minutes. Conversion to the open technique was only necessary in one case with good visualization of the facial vein and artery, marginal mandibular and lingual nerve. No significant perioperative complications were encountered. All patients were discharged on the third postoperative day, and they were satisfied with the cosmetic outcome. Conclusion. Total endoscopic submandibular sialadenectomy through a chest wall approach is technically feasible and safe with satisfactory cosmetic results. It may be a valid alternative to conventional surgery when performed in select patients. The absence of neck scars and the ability to avoid potential nerve injuries are the most obvious advantages of this innovative technique.
The Role of Microsatellite Instability in Positive Margin Gastric Cancer Patients
Authors: Polom Karol , Marrelli Daniele , Smyth Elizabeth C. , Voglino Costantino , Roviello Giandomenico , Pascale Valeria , Varas Julian , Vindigni Carla , Roviello Franco
Published: January 2018

Purpose. A positive resection margin (RM+) is acknowledged as a poor prognostic factor after gastrectomy. Microsatellite instability (MSI-H) gastric cancer has been identified as a subgroup of gastric cancer that may be associated with an improved prognosis. The aim of the study was an analysis of MSI status on patients with margin involvement after gastrectomy and examination of the association between MSI, margin status, and survival outcomes. Methods. From a large prospectively annotated surgical database we collected clinicopathological and survival data on patients who had undergone a potentially curative resection for gastric cancer. MSI status was assessed using a standard 5-marker quasi-monomorphic mononucleotide repeat panel. Patients who were R+ and either microsatellite stable (MSS) or MSI-H were identified and clinicopathological characteristics and disease specific survival was compared. Results. Three hundred and eighty-six patients were identified; 102 (26.4%) cancers were MSI-H. The proportion of R+ resections was not significantly different in MSS and MSI-H groups. For MSS patients 3-, 5-, and 10-year disease-specific survival rates were 9.1%, 0%, and 0%, respectively; for patients with MSI-H R+ tumors these were 38.5%, 30.8%, and 15.4%, respectively. In Cox analysis MSI-H, female gender, and T ≥3 were significantly associated with survival. Conclusions. Patients with MSI-H gastric cancer may have long-term survival despite R+ margin status. The molecular division of gastric cancer may be an important step in identifying possible tailored surgical treatments corresponding to clinical and pathological factors.
Outcomes following operative management of thoracic outlet syndrome in the pediatric patients
Authors: Matos Jesus M , Gonzalez Lorena , Kfoury Elias , Echeverria Angela , Bechara Carlos F , Lin Peter H
Published: January 2018

Objectives

Thoracic outlet syndrome, a condition commonly reported in adults, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of thoracic outlet syndrome in pediatric patients.

Methods

Clinical records of all pediatric patients with thoracic outlet syndrome who underwent operative repair from 2002 to 2015 in a tertiary pediatric hospital were reviewed. Pertinent clinical variables and treatment outcomes were analyzed.

Results

Sixty-eight patients underwent a total of 72 thoracic outlet syndrome operations (mean age 15.7 years). Venous, neurogenic, and arterial thoracic outlet syndromes occurred in 39 (57%), 21 (31%), and 8 (12%) patients, respectively. Common risk factors for children with venous thoracic outlet syndrome included sports-related injuries (40%) and hypercoagulable disorders (33%). Thirty-five patients (90%) with venous thoracic outlet syndrome underwent catheter-based interventions followed by surgical decompression. All patients underwent first rib resection with scalenectomy via either a supraclavicular approach (n = 60, 88%) or combined supraclavicular and infraclavicular incisions (n = 8, 12%). Concomitant temporary arteriovenous fistula creation was performed in 14 patients (36%). Three patients with arterial thoracic outlet syndrome underwent first rib resection with concomitant subclavian artery aneurysm repair. The mean follow-up duration was 38.4 ± 11.6 months. Long-term symptomatic relief was achieved in 94% of patients.

Conclusions

Venous thoracic outlet syndrome is the most common form of thoracic outlet syndrome in children, followed by neurogenic and arterial thoracic outlet syndromes. Competitive sports-related injuries remain the most common risk factor for venous and neurogenic thoracic outlet syndromes. Temporary arteriovenous fistula creation was useful in venous thoracic outlet syndrome patients in selective children. Surgical decompression provides durable treatment success in children with all subtypes of thoracic outlet syndrome.
A new action recognition method by distinguishing ambiguous postures
Authors: Liu Zhiqiang , Yin Jianqin , Li Jinping , Wei Jun , Feng Zhiquan
Published: January 2018

One of the most important aspects of promoting the intelligence of home service robots is to reliably recognize human actions and accurately understand human behaviors and intentions. In the task of action recognition, there are many common ambiguous postures, which affect the recognition accuracy. To improve the reliability of the service provided by home service robots, this article presents a method of probabilistic soft-assignment recognition scheme based on Gaussian mixture models to recognize similar actions. First, we generate a representative posture dictionary based on the standard bag-of-words model; then, a Gaussian mixture model is introduced for the similar poses. Finally, combined with the Naive Bayesian principle, the method of weighted voting is used to recognize the action. The proposed scheme is verified by recognizing four types of daily actions, and the experimental results show its effectiveness.
Seating in aged care: Physical fit, independence and comfort
Authors: Blackler Alethea , Brophy Claire , O’Reilly Maria , Chamorro-Koc Marianella
Published: January 2018

Objectives:

This research was intended to provide a greater understanding of the context and needs of aged care seating, specifically: To conduct an audit of typical chairs used in aged care facilities; To collect data about resident and staff experiences and behaviour around chairs in order to gain a deeper understanding of the exact issues that residents and staff have with the chairs they use at aged care facilities; To identify positive and negative issues influencing use of chairs in aged care facilities; To deliver evidence-based recommendations for the design of chairs for aged care facilities.

Methods:

Methods included a chair dimension audit, interviews with residents, experts and carers and observations of aged care residents getting into chairs, sitting in them and getting out.

Results:

Results showed that residents, experts and carers all prefer chairs which are above the recommended height for older people so that they will be able to get out of them more easily. Armrests were essential for ease of entry and egress. However, many residents struggled with chairs which were also too deep in the seat pan so that they could not easily touch the floor or sit comfortably and were forced to slump. Most residents used cushions and pillows to relieve discomfort where possible.

Conclusion:

The implications of these issues for chair design and selection are discussed. Variable height chairs, a range of chairs of different heights in each space and footrests could all address the height problem. Chair designers need to address the seat depth problem by reducing depth in most aged care specific chairs, even when they are higher. Armrests must be provided but could be made easier to grip. Addressing these issues would increase access to comfortable yet easy-to-use chairs for a wider range of the aged care population.
Coping, social support and information in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A 2-year retrospective cohort study
Authors: Ivarsson Bodil , Rådegran Göran , Hesselstrand Roger , Kjellström Barbro
Published: January 2018

Objectives:

Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension are severe diseases with complicated treatment that need care at specialist clinics. The aim was to investigate changes in the patients’ perceptions on coping, social support and received information when attending a newly started nurse-coordinated pulmonary arterial hypertension-outpatient clinic.

Methods:

The present study was a descriptive, questionnaire-based cohort study including 42 adult patients. To evaluate coping, the Pearlin Mastery Scale was used. Social support, information and health-related quality of life were measured using Social Network and Support Scale, QLQ-INFO25 and the EQ-5D.

Results:

Attending the pulmonary arterial hypertension-outpatient clinic increased coping ability (Mastery Scale) significantly (baseline 16.0 ± 3.3 points vs 2-year follow-up 19.6 ± 5.2 points, p < 0.001) while there was no difference in social network and support or in perception of received information after. Patients who improved their coping ability (67%) were younger, had better exercise capacity, experienced better health-related quality of life and were more satisfied with received information about treatment and medical tests than those who reduced the coping ability. There was no difference in gender, diagnosis, time since diagnose, pulmonary arterial hypertension–specific treatment, education level or civil status between the two groups.

Conclusion:

This study suggests that the pulmonary arterial hypertension-team, in partnership with the patient, can support patients to take control of their disease and increase their health-related quality of life.
Can Partible Inheritance Explain Land Fragmentation? The Case of Bulgaria
Authors: Boliari Natalia
Published: January 2018

Partible inheritance, alone or together with population growth, is widely assumed to be the fundamental cause of land fragmentation in Bulgaria. This study questions the explanatory power of these two supply-side causes of fragmentation. Relying on historical sources and an analysis of historical agricultural census data, the article presents evidence that partible inheritance and population growth are unlikely causes of land fragmentation. The study also traces the development of land markets to establish the purchasing behaviour of farmers. It reveals documented high demand for scattered plots of land in the years before Liberation from Ottoman rule. Attention is drawn to demand-side factors such as the risk aversion of farmers and optimization of self-employment, among others, as the likely fundamental causes of fragmentation. The article suggests that the possible endogenous nature of fragmentation in the country must be taken into account when policies are designed to target its undesirable aspects.
Prevention and Treatment of Problem Behaviors in Young Children: Clinical Implications From a Randomized Controlled Trial of BEST in CLASS
Authors: Conroy Maureen A. , Sutherland Kevin S. , Algina James , Werch Brittany , Ladwig Crystal
Published: January 2018

The prevention science approach to emotional/behavioral disorders (EBD) focuses on early intervention targeting risk and resilience factors (e.g., early problem behaviors, teacher-child interactions, classroom climate). The current study investigates the effectiveness of BEST in CLASS, a classroom-based indicated preventive intervention targeting young children at risk for EBD, in terms of producing clinically meaningful reductions of problem behaviors and improvements in social skills. A total of 185 early childhood teachers (92 in the treatment condition) and 462 young children (230 in treatment) participated in the study. Teachers completed rating scale measures of problem behaviors and social skills. The clinical significance of the findings indicated that the BEST in CLASS condition had a lower percentage of children with clinical or borderline range scores at posttest when compared with children in the control classrooms. The BEST in CLASS prevention model, clinically significant intervention outcomes, and prevention of EBD are discussed.
Evaluation of public–private partnerships: A life-cycle Performance Prism for ensuring value for money
Authors: Liu Henry J , Love Peter ED , Smith Jim , Sing Michael CP , Matthews Jane
Published: January 2018

Public–private partnerships have become an integral strategy to deliver infrastructure projects in Australia. Yet, public–private partnerships have been plagued with controversy due to recurrent time and cost overruns. The paucity of an approach to evaluate the performance of public–private partnerships throughout their life-cycle has hindered the ability of governments to manage their effective and efficient delivery. This paper examines the practice of evaluation for a hospital and prison that were delivered using public–private partnerships. The empirical evidence indicates that with public–private partnerships: (1) performance is typically measured during the construction and operation phases using time, cost and quality and a restricted number of key performance indicators; and (2) a process-based and stakeholder-oriented measurement approach would be better suited to evaluate performance. Building upon the extant literature and the findings emerging from ‘practice’ (i.e. actual activity, events or work), a Performance Prism for ameliorating the evaluation of public–private partnerships throughout their lifecycle is proposed. The research presented in this paper provides stakeholders of public–private partnerships, especially governments, with a robust framework for governing and future proofing their assets to ensure value for money.
The impact of future cities on commuting patterns: An agent-based approach
Authors: Marini Marcello , Gawlikowska Anna P , Rossi Andrea , Chokani Ndaona , Klumpner Hubert , Abhari Reza S
Published: January 2018

Over the next 35 years, the population of Switzerland is expected to grow by 25%. One possible way to accommodate this larger population is to transform smaller cities in Switzerland through the direct intervention of urban planners. In this work, we integrate agent-based simulation models of people flow, mobility and urban infrastructure with models of the electricity and gas systems to examine the increase of the density of existing residential zones and the creation of new workplaces and commercial activities in these urban areas. This novel simulation framework is used to assess, for the year 2050, two different scenarios of urbanization in a region with small urban areas. It is shown that a densification scenario, with a preference for multi-dwelling buildings, consumes 93% less land than a sprawl scenario, with a preference for single-family houses. The former scenario also accommodates 27% more people than the latter scenario, as there is a higher penetration of battery electric vehicles – and therefore reduced air pollution from the transportation sector – and also a larger shift of commuters to the use of public transport. However, in the former scenario, the commuting time is 20% longer. The outcome of this work demonstrates how this novel simulation framework can be used to support the formulation of policies that can direct the transformation of urban areas.
Further characterization of adult sheep ovarian stem cells and their involvement in neo-oogenesis and follicle assembly
Authors: Patel Hiren , Bhartiya Deepa , Parte Seema
Published: January 2018

Background

Stem cells in the ovary comprise of two distinct populations including very small embryonic-like stem cells (VSELs) and slightly bigger progenitors termed ovarian stem cells (OSCs). They are lodged in ovary surface epithelium (OSE) and are expected to undergo neo-oogenesis and primordial follicle (PF) assembly in adult ovaries. The ovarian stem cells express follicle stimulating hormone (FSH) receptors and are directly activated by FSH resulting in formation of germ cell nests (GCN) in vitro. Present study was undertaken to further characterize adult sheep OSCs and to understand their role during neo-oogenesis and PF assembly.

Methods

Stem cells were collected by gently scraping the OSE cells and were characterized by H&E staining, immuno-localization, immuno-phenotyping and RT-PCR studies. Expression of FSH receptors and markers specific for stem cells (OCT-4, SSEA-4) and proliferation (PCNA) were studied on stem/progenitor cells in OSE culture and on adult sheep ovarian cortical tissue sections. Effect of FSH on stem cells was also studied in vitro. Asymmetric cell division (ACD) was monitored by studying expression of OCT-4 and NUMB.

Results

Additional evidence was generated on the presence of two populations of stem cells in the OSE including VSELs and OSCs. FSHR expression was observed on both VSELs and OSCs by immuno-localization and immuno-phenotyping studies. FSH treatment in vitro stimulated VSELs that underwent ACD to self-renew and give rise to OSCs which divided rapidly by symmetric cell divisions (SCD) and clonal expansion with incomplete cytokinesis to form GCN. ACD was further confirmed by differential expression of OCT-4 in VSELs and NUMB in the OSCs. Immuno-histochemical expression of OCT-4, PCNA and FSHR was noted on stem cells located in the OSE in sheep ovarian sections. GCN and cohort of PF were observed in the ovarian cortex and provided evidence in support of neo-oogenesis from the stem cells.

Conclusion

Results of present study provide further evidence in support of two stem cells populations in adult sheep ovary. Both VSELs, OSCs and GCN express FSH receptors and FSH possibly regulates their function to undergo neo-oogenesis and primordial follicle assembly.
The market trend analysis and prospects of cancer molecular diagnostics kits
Authors: Seo Ju Hwan , Lee Joon Woo , Cho Daemyeong
Published: January 2018

Background

The molecular diagnostics market can be broadly divided into PCR (rt-PCR, d-PCR), NGS(Next Generation Sequencing), Microarray, FISH(Fluorescent in situ-hybridization) and other categories, based on the diagnostic technique. Also, depending on the disease being diagnosed, the market can also be divided into cancer, infectious diseases, HIV/STDs (herpes, syphilis), and women’s health issues such as breast cancer, cervical cancer, ovarian cancer, HPV(human papillomavirus), and vaginitis.

Chromosome analysis (including Fluorescent In-situ Hybridization) is one type of blood cancer diagnostic method, which involves the direct detection of individual cells with chromosomal translocation, but there have been problems of sensitivity when using this method. PCR targeting individual genes or the RT (reverse transcription)-PCR method offers outstanding sensitivity, but one drawback is the risk of false-positive reaction caused by contamination of samples, etc. Blood cancer molecular diagnostics kits allow us to overcome these shortcomings, and related products have been under development, with a focus on improving detection sensitivity, enabling multiple tests, and reducing the cost and diagnostic time.

Results

Blood cancer molecular diagnostics is usually performed based on platforms such as PCR. The global market for blood cancer molecular diagnostics kits is $ 335.9 million as of 2016 and is expected to reach $ 6980 million in 2026 with an average annual growth rate of 32.9%. The market in South Korea is anticipated to grow at an average annual rate of 28.9%, from $ 3.75 million as of 2016 to $ 60.89 million in 2026.

Conclusions

The Market for blood cancer molecular diagnostics kits is judged to be higher in growth possibility due to the increase in the number of cancer patients.
Sulfobetaine methacrylate hydrogel-coated anti-fouling surfaces for implantable biomedical devices
Authors: Lee Se Yeong , Lee Yunki , Le Thi Phuong , Oh Dong Hwan , Park Ki Dong
Published: January 2018

Background

Zwitterionic molecules have been widely studied as coating materials for preparing anti-fouling surfaces because they possess strong hydration properties that can resist non-specific protein adsorption. Numerous studies on surface modification using zwitterionic molecules have been investigated, such as electrochemically mediated and photoinitiated radical polymerization. However, these methods have some limitations, including multi-step process, difficulties in producing thick and dense layers as well as the requirement of extra facilities. In this study, we report a novel zwitterionic hydrogel-coating method via Fenton reaction for the preparation of anti-fouling surfaces.

Methods

Sulfobetaine methacrylate (SBMA) hydrogel was coated on polyurethane (PU) by polymerization of SBMA molecules via the Fenton reaction. The coated surfaces were characterized by the measurements of water contact angle, SEM and XPS. The anti-fouling properties of the modified surfaces were evaluated by reductions of fibrinogen absorption and cell (human dermal fibroblasts, hDFBs) adhesion.

Results

SBMA hydrogel layers were coated on the PU substrates and these layers have a high affinity for water. The hydrogel coatings were highly stable for 7 days, without a significant change in surface wettability. Importantly, the hydrogel-coated PU substrates decrease 80% of surface-adsorbed fibrinogen and surface-attached hDFBs (compared with uncoated PU substrates), indicating the excellent anti-fouling activities of modified surfaces.

Conclusions

The hydrogel-coated PU surfaces prepared by Fenton reaction with anti-fouling properties could have potential uses for implantable biomedical devices.
Mental health, coercion and family caregiving: issues from the international literature
Authors: Rugkåsa Jorun , Canvin Krysia
Published: January 2018

This article summarises current knowledge about two aspects of family care for people with mental illness: potentially pressurising or coercive aspects of family life; and family carers' experiences of being involved in coercive service interventions. There is a paucity of studies on these topics, especially outside Europe, North America and Australasia, and further research is recommended.
Key international themes in coercion
Authors: Molodynski Andrew , O'Brien Anthony , Burns Jonathan
Published: January 2018

Coercion remains a dominant theme in mental healthcare and a source of major concern. While the presence of coercion is ubiquitous internationally, it varies significantly in nature and degree in different countries and is influenced by a variety of factors. Recent reports have raised concerns about physical restraint and the increasing use of legislation in high-income countries. At the same time, a recent Human Rights Watch report on pasung (the practice of tying or restricting movement more generally) in Indonesia has served to highlight the plight of many in middle- and lower-income countries who are subject to degrading and dehumanising ‘treatment’.
The management of offenders with mental disorders within the criminal justice system in Brunei Darussalam
Authors: Ho Hilda
Published: January 2018

This paper examines the management of offenders with mental disorders in Brunei Darussalam. The existing legislation, resources and service configuration are discussed in the context of recent developments and the challenges that need to be addressed. An innovative multi-agency approach is suggested to improve the management of a group of people with complex needs.
Steric hindrance in the upper 50 kDa domain of the motor Myo2p leads to cytokinesis defects in fission yeast
Authors: Palani Saravanan , Srinivasan Ramanujam , Zambon Paola , Kamnev Anton , Gayathri Pananghat , Balasubramanian Mohan K.
Published: January 2018

Cytokinesis in many eukaryotes requires a contractile actomyosin ring that is placed at the division site. In fission yeast, which is an attractive organism for the study of cytokinesis, actomyosin ring assembly and contraction requires the myosin II heavy chain Myo2p. Although myo2-E1, a temperature-sensitive mutant defective in the upper 50 kDa domain of Myo2p, has been studied extensively, the molecular basis of the cytokinesis defect is not understood. Here, we isolate myo2-E1-Sup2, an intragenic suppressor that contains the original mutation in myo2-E1 (G345R) and a second mutation in the upper 50 kDa domain (Y297C). Unlike myo2-E1-Sup1, a previously characterized myo2-E1 suppressor, myo2-E1-Sup2 reverses actomyosin ring contraction defects in vitro and in vivo. Structural analysis of available myosin motor domain conformations suggests that a steric clash in myo2-E1, which is caused by the replacement of a glycine with a bulky arginine, is relieved in myo2-E1-Sup2 by mutation of a tyrosine to a smaller cysteine. Our work provides insight into the function of the upper 50 kDa domain of Myo2p, informs a molecular basis for the cytokinesis defect in myo2-E1, and may be relevant to the understanding of certain cardiomyopathies.
Myosin phosphorylation improves contractile economy of mouse fast skeletal muscle during staircase potentiation
Authors: Bunda Jordan , Gittings William , Vandenboom Rene
Published: January 2018

Phosphorylation of the myosin regulatory light chain (RLC) by skeletal myosin light chain kinase (skMLCK) potentiates rodent fast twitch muscle but is an ATP requiring process. Our objective was to investigate the effect of skMLCK-catalyzed RLC phosphorylation on the energetic cost of contraction and the contractile economy (ratio of mechanical output to metabolic input) of mouse fast muscle in vitro (25° C). To this end, extensor digitorum longus (EDL) muscles from Wildtype and from skMLCK devoid (skMLCK−/−) mice were subjected to repetitive low-frequency stimulation (10 Hz for 15 s) to produce staircase potentiation of isometric twitch force after which muscles were quick frozen for determination of high-energy phosphate consumption (HEPC). During stimulation, Wildtype muscles displayed significant potentiation of isometric twitch force while skMLCK−/− muscles did not (i.e. 23 vs 5% change, respectively). Consistent with this, RLC phosphorylation was increased∼3.5-fold from the unstimulated control value in Wildtype, but not in skMLCK−/− muscles. Despite these differences, the HEPC of Wildtype muscles was not greater than for skMLCK−/− muscles. As a result of the increased contractile output relative to HEPC, the calculated contractile economy of Wildtype muscles was greater than for skMLCK−/− muscles. Thus, our results suggest that skMLCK-catalyzed phosphorylation of the myosin RLC increases the contractile economy of Wildtype mouse EDL muscle compared to skMLCK−/− muscles without RLC phosphorylation.
Cold-hearted bats: uncoupling of heart rate and metabolism during torpor at subzero temperatures
Authors: Currie Shannon E. , Stawski Clare , Geiser Fritz
Published: January 2018

Many hibernating animals thermoregulate during torpor and defend their body temperature (Tb) below 10°C by an increase in metabolic rate. Above a critical temperature (Tcrit) animals usually thermoconform. We investigated the physiological responses above and below Tcrit for a small tree dwelling bat (Chalinolobus gouldii, ∼14 g) that is often exposed to subzero temperatures during winter. Through simultaneous measurement of heart rate (HR) and oxygen consumption (V̇O2) we show that the relationship between oxygen transport and cardiac function is substantially altered in thermoregulating torpid bats between 1 and -2°C, compared with thermoconforming torpid bats at mild ambient temperatures (Ta 5-20°C). Tcrit for this species was Ta 0.7±0.4°C, with a corresponding Tb of 1.8±1.2°C. Below Tcrit animals began to thermoregulate, indicated by a considerable but disproportionate increase in both HR and V̇O2. The maximum increase in HR was only 4-fold greater than the average thermoconforming minimum, compared to a 46-fold increase in V̇O2. The differential response of HR and V̇O2 to low Ta was reflected in a 15-fold increase in oxygen delivery per heart beat (cardiac oxygen pulse). During torpor at low Ta, thermoregulating bats maintained a relatively slow HR and compensated for increased metabolic demands by significantly increasing stroke volume and tissue oxygen extraction. Our study provides new information on the relationship between metabolism and HR in an unstudied physiological state that may occur frequently in the wild and can be extremely costly for heterothermic animals.
Phylogenetics and historical biogeography of Lomaridium (Blechnaceae: Polypodiopsida)
Authors: Vicent María , Gabriel y Galán Jose María , Sessa Emily B.
Published: January 2018

Blechnaceae is a worldwide family of leptosporangiate ferns composed of about 250 species. Most of the species in the family were recognised under a single large genus Blechnum until recently, when a new classification proposed the recognition of 24 genera. Given this new systematics of Blechnaceae, which largely resolves the genus‐level relationships in the family, there is a need for phylogenetic research to investigate relationships within the majority of the newly proposed genera. In this paper, we unravel the phylogenetic relationships and the historical biogeography of the species of Lomaridium, a genus including most of the hemiepiphytic species in the Blechnaceae. Our sampling includes 11 species, which represents 85% of the diversity in the genus and which covers the entire geographic distribution of the group. We constructed two datasets with three plastid markers: one for phylogenetic analyses (maximum likelihood, Bayesian inference) with four outgroups from phylogenetically close genera (Brainea, Lomaria, Sadleria, Woodwardi); and a second for molecular dating and historical biogeographic analyses that included a larger set of outgroups so that we could accurately reconstruct ancestral events at the base of Lomaridium, under different models. We are able to recognize four highly supported lineages: L. contiguum and the L. schottii, L. attenuatum, and L. fragile clades. Our results date the origin of Lomaridium at some point during the Paleocene epoch, and the most likely geographic area for its origin is Australia plus tropical Central and South America. Several dispersal events are inferred, all of which are most likely long‐distance dispersal events. From Australia, we infer a first dispersal event that brought the ancestor of the extant species L. contiguum to New Caledonia. In Central and South America, Lomaridium continued to diversify and colonized additional areas, including the Caribbean (L. binervatum), some Pacific islands (L. schottii), and Africa and Madagascar. While our goal in the current study was not to estimate the biogeographic or diversification history of all Blechnaceae, our analyses do suggest that the early history of the family was complex biogeographically, with extensive long‐distance dispersal events. Lomaridium exemplifies this high dispersal capacity, as a genus with only a modest number of species that have reached far‐flung regions of the globe via numerous long‐distance dispersal events.
Hormonal control and maintenance of lactation
Authors: Viccars Anne
Published: January 2018

This article explores the hormonal control of lactation with reference to bromocriptine and analyses the physical effects and side effects resulting from bromocriptine therapy.
Experiences of stillbirth
Authors: Knowles Anna
Published: January 2018

Infant death is difficult for both parents and health professionals, and midwives should give consideration to the best approach to the situation in order to give maximum help to all concerned. This article presents the experiences of two mothers who had stillborn babies and concludes with a midwife’s comment on the current arrangements for support and counselling.
What can midwives do to help?
Authors: Long Edith
Published: January 2018

Over 20 years separate these two personal accounts but a common theme connects them. The assumption by many professionals that they know best what is appropriate for bereaved parents is evident in both stories. Whether it be in regard to the manner in which parents say ‘goodbye’ to their stillborn child, or how the subject of sibling loss is broached with other children, the decision must always rest with the parents. Yet we, as those professionals, have the difficult job of formulating guidelines for parents, to assist them in making these choices. The author of Case 1 poses a pertinent question when she asks, ‘What are hospitals to do?’
Midwifery education in England: direct entry is different
Authors: Maggs Christopher
Published: January 2018

The report of the 3-year evaluation of preregistration midwifery education in England recently released by the Department of Health (Kent et al, 1994) marks an important milestone in midwifery education and presents an exciting opportunity for change.
Antenatal casenotes 2: general comments
Authors: Fawdry Rupert
Published: January 2018

Expectant mothers should be encouraged to contribute to their own maternity record in order to improve communications both between professionals and with the mother herself.
Letters
Authors: Ritchie Lyn , Clement Sarah
Published: January 2018

Students express disappointment

Antenatal depression receives scant notice
The role of a small posterior malleolar fragment in trimalleolar fractures
Authors: Evers J. , Fischer M. , Zderic I. , Wähnert D. , Richards R. G. , Gueorguiev B. , Raschke M. J. , Ochman S.
Published: January 2018

Aims

The aim of this study was to investigate the effect of a posterior malleolar fragment (PMF), with < 25% ankle joint surface, on pressure distribution and joint-stability. There is still little scientific evidence available to advise on the size of PMF, which is essential to provide treatment. To date, studies show inconsistent results and recommendations for surgical treatment date from 1940.

Materials and Methods

A total of 12 cadaveric ankles were assigned to two study groups. A trimalleolar fracture was created, followed by open reduction and internal fixation. PMF was fixed in Group I, but not in Group II. Intra-articular pressure was measured and cyclic loading was performed.

Results

Contact area decreased following each fracture, while anatomical fixation restored it nearly to its intact level. Contact pressure decreased significantly with fixation of the PMF. In plantarflexion, the centre of force shifted significantly posteriorly in Group II and anteriorly in Group I. Load to failure testing showed no difference between the groups.

Conclusion

Surgical reduction of a small PMF with less than 25% ankle joint surface improves pressure distribution but does not affect ankle joint stability. Cite this article: Bone Joint J 2018;100-B:95–100.
Synovasure ‘quick test’ is not as accurate as the laboratory-based α-defensin immunoassay
Authors: Suen K. , Keeka M. , Ailabouni R. , Tran P.
Published: January 2018

Aims

α-defensin is a biomarker which has been described as having a high degree of accuracy in the diagnosis of periprosthetic joint infection (PJI). Current meta-analyses are based on the α-defensin laboratory-based immunoassay rather than the quick on-table lateral flow test kit. This study is the first meta-analysis to compare the accuracy of the α-defensin laboratory-based immunoassay and the lateral flow test kit for the diagnosis of PJI.

Materials and Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all clinical studies where the diagnosis of PJI was uncertain. All studies selected used the Musculoskeletal Infection Society (MSIS) or modified MSIS criteria. Two independent reviewers reviewed the studies and extracted data. A meta-analysis of results was carried out: pooled sensitivity, specificity, positive and negative likelihood ratio, heterogeneity and areas under curves are reported.

Results

Ten studies (759 patients) were included. Of these, seven studies (640 patients) evaluated the laboratory-based α-defensin immunoassay and three (119 patients) the lateral flow test. The pooled sensitivity and specificity of the qualitative α-defensin laboratory immunoassay was 0.953 (95% confidence interval (CI) 0.87 to 0.984) and 0.965 (95% CI 0.943 to 0.979) respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 34.86 (95% CI 19.34 to 62.85) and 0.02 (95% CI 0.00 to 0.11). The pooled sensitivity and specificity of the lateral flow test were 0.774 (95% CI 0.637 to 0.870) and 0.913 (95% CI 0.828 to 0.958), respectively. The pooled PLR and NLR were 8.675 (95% CI 4.229 to 17.794) and 0.248 (95% CI 0.147 to 0.418), respectively.

Conclusion

The pooled sensitivity and specificity of the lateral flow test were lower than those of the α-defensin laboratory-based immunoassay test. Hence, care must be taken with interpretation of the lateral flow test when relying on its results for the intra-operative diagnosis of PJI. Cite this article: Bone Joint J 2018;100-B:66–72.
Quality of life among obese and non-obese early adolescents
Authors: Paryati Putu Vivi , Sidiartha I. G. Lanang , Windiani I. G. Ayu Trisna , Adnyana I. G. A. N. Sugitha
Published: January 2018

Background Obesity in adolescents adversely affects both their psychological as well as their physical health.Objective To compare the quality of life between obese and non-obese early adolescents, using the PedsQL inventory.Methods A cross-sectional study was carried out on early adolescents aged 10-12 years among several elementary schools in Denpasar, Bali. Body mass index (BMI) percentiles for age and sex were categorized as obese (BMI ≥95th percentile) and non-obese (BMI <95th percentile). Data on quality of life were collected using PedsQL Generic Core Scales version 4.0 inventory, filled by the children and their parents separately.Results Total PedsQL score in obese and non-obese group were significantly difference in both reports [child report: mean difference of 9.59 (95%CI 7.14 to 12.05; P<0.05) and parent-proxy report: mean difference at 8.95(95%CI6.64 to 11.26; P<0.05)]. After classifying subjects into impaired and not impaired quality of life based on a total score cut-off <78 as well as other cut-off points for each domain, the individual domains of physical, social, and school function were also significantly associated with obesity (child report: P=0.02, P< 0.001, P=0.018, respectively, and parent-proxy report:P=0.007, P<0.001, P<0.001, respectively). However, emotional function was not significantly associated with obesity (P>0.05). After adjusting for age, gender, and parental education, obesity was significantly associated with PedsQL scores in the child report (OR 7.25; 95%CI 2.94 to 17.89; P<0.05) and the parent-proxy report (OR 10.87; 95%CI 3.83 to 30.84; P<0.05).Conclusion Obese early adolescents reported significantly poorer quality of life with regards to the physical, social, school function domains and total quality of life than those who were classified into non-obese.
Financial and non-financial forms of employ-ee motivation - theoretical approach
Authors: Gaudyn Dorota
Published: January 2018

The article attempts to explain the essence and the growing importance of motivation in modern economic conditions. This subject is still current and evolving, despite the fact that many publications presenting motivational concepts have emerged. Each company should identify the needs of its employees. The article presents the theoretical basis of financial and non-financial forms of employee motivation.
Prevalence of chronic kidney diseases and determinants among TDF users of pregnant and lactating women based on eGFR-cg, and MDRD-4 in hospital setting of north east Amhara, Ethiopia
Authors: Gebretsadikk Eyob , Hadush Azmach , Hussien Mohammed , Asres Getahun
Published: January 2018

In recent days, it is common to see increasing incidence of Fanconi, proximal kidney tubular damage and chronic kidney diseases-CKD among high risk populations that drew the cliniciansâ€™ attention to monitor closely. Among these risk populations with potential CKD incidence; HIV positive patients who uses TDF as a component of HAART need to be monitored for the incidence of CKD as a toxicity of TDF before initiation and during treatment despite the fact that the current monitoring practice in Ethiopia in most hospitals remain to be poor. Hence this study aimed at measuring the incidence of CKD among high risk segment of HIV positive pregnant and lactating women who uses TDF as part of their HAART treatment. Using a non-proportionate stratified sampling, a total of 111 HIV+ pregnant and lactating women who are on TDF based HAART treatment were enrolled to measure the incidence of CKD based on NKF K/DOQI Classification. Using the Android application of Medicalc GFR-cg, and MDRD-4; the prevalence of stage-2 CKD was 16.2 % (60-89 ml/min) and Stage 5-CKD/Renal Failure who require dialysis were 3.6% (CrCl < 15ml/min/1.72m2) by both method of calculation CrCl (GFR-cg and MDRD-4). Women who were lactating had a relative risk of 0.918 (95% CI lies within 0.845-0.998) of acquiring CKD (P= 0.045). The other associated factors were BMI less than 18.5 (P= 0.004 and adjusted OR of 7.82), WHO clinical stage-1 (P=0.014, odds ratio of 5.4 and 95% CI of 1.24-24.42), baseline CD4 count > 500 (P=0.02), and duration on TDF (> 12 months on treatment) and low haematocrit of 30 had a higher risk of falling into Stage 2 CKD with cohort risk estimate of 4.103 (95 % CI of 1.02, 16.54). The risk estimate of WHO stage 2 to acquire stage-4 CKD was 1.087 (95% CI of 1.002, 1.180) statistically significant (P=0.05.). The prevalence of stage 2 CKD among pregnant and lactating women by GFR-cg method of calculation was higher than MDRD-4 calculation. In this study, MDRD-4 method underestimated stage 2 CKD. Hence it is worth and highly recommended to use GFR-cg method in the baseline and during treatment monitoring of TDF toxicity to the kidney particularly for diagnosing the early stage of CKD.
Investigation of conflict strategies of physical education teachers working in public and private high schools (Sample of Ankara province)
Authors: Savran Mustafa , Sunay Hakan
Published: January 2018

When the conflict is managed with an appropriate strategy, the organization is increasing the efficiency of the work and raising the motivation of the employees. Being able to comprehend the inner workings of conflicts and conflicts between groups and to manage these conflicts well is an inevitable role for the manager and the employee. This research aims to examine conflict strategies of Physical Education teachers working in public and private high schools in central districts of Ankara. In addition, it was determined whether there is a difference between the conflict strategies used by the physical education teachers participating in the research and whether they had gender, occupational seniority, age, duration of work at the school, previous seminars on conflict management strategies, educational status and school type variables and conflict strategies. The universe of the research is a total of 412 physical education teachers, 114 of which are private high schools in Ankara and 298 are teachers working in official high schools. Of these, 275 physical education teachers (special 55, official 220) constitute the sample of the research. The teachers who participated in the questionnaire were selected by appropriate / favorable sampling method. As data collection tools; "Personal Information Form" for determining the conflict strategies of physical education teachers and "Conflict Management Strategies Scale" developed by Ozgan (2006) were used. The Reliability study of the scale was performed with SPSS Reliability, and the reliability coefficient of Cronbach Alpha (α) internal consistency method was found to be .90.  In the analysis of the data, frequency, mean and standard deviations were examined, and t-test was used in binary groups. One-way ANOVA (one-way analysis of variance) was used in more than one group. In the tests p <0.05 significance level was taken into consideration. According to the findings obtained at the end of the analyzes; there was no significant difference in conflict strategies according to variables such as age, education level, occupational seniority, duration of duty at school, previous conflict management strategies, and gender and school type variables of physical education teachers. As a result, it is seen that the physical education teachers working in Ankara use the most integration strategy. Avoidance is the least used strategy. Consequently, it is said that physical education teachers' working at official and state schools in Ankara does not affect the conflict management strategies they used.
Strategie komunikacyjne w obliczu trudności językowych
Authors: Morytz Jolanta
Published: January 2018

Foreign language classes at university should enhance not only knowledge of foreign languages but with the use of different methods, should also develop skills of communication strategies, which are very important to compensate for deficits in communication. These strategies are indispensable for language learners irrespective of their level of proficiency. The objective of the study described in the present paper is to explore the communication strategies used by Polish students at different levels of knowledge of Italian. Data was collected by two types of questionnaires, one including two open-ended questions. The other was based on a Likert-scale method which examined the frequency of usage of avoidance strategies, verbal and non verbal strategies, as well as the strategy of transfer. Emphasis was placed on the relationship between the use of types of communication strategies and students’ level of proficiency. In the final part the author recommends types of lexical exercises which should be practised during classes to help students to develop their communicative skills.