bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘The Good Doctor’: the Making and Unmaking of the Physician Self in Contemporary South Africa
Authors: Pentecost Michelle , Cousins Thomas 
Published: September 2019

AbstractIn this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems.
“How can we leave the traditions of ourBaab Daada” socio‐cultural structures and values driving menstrual hygiene management challenges in schools in Pakistan
Authors: Mumtaz Zubia , Sivananthajothy Priatharsini , Bhatti Afshan , Sommer Marni 
Published: September 2019

ABSTRACTIntroductionDespite the growing attention to the relationship between menstruation and girls schooling, there remain many challenges to addressing the issue. Current interventions, which mostly focus on developing WASH infrastructure and sanitary hygiene management products, while necessary, may not be sufficient. This paper aimed to identify the root causes of poorly maintained WASH infrastructure, and understand the deeply embedded socio‐cultural values around menstrual hygiene management that need to be addressed in order to provide truly supportive school environments for menstruating girls.MethodsQualitative data were collected in rural and urban sites in three provinces in Pakistan using participatory activities with 312 girls aged 16–19 years, observations of 7 School WASH facilities, 42 key informant interviews and a document review.ResultsThree key themes emerged from our data: (1) a poorly maintained, girls‐unfriendly School WASH infrastructure was a result of gender‐insensitive design, a cultural devaluation of toilet cleaners and inadequate governing practices; (2) the design of WASH facilities did not align with traditionally‐determined modes of disposal of rag‐pads, the most common used absorbents; (3) traditional menstrual management practices situate girls in an ‘alternate space’ characterised by withdrawal from many daily routines. These three socio‐culturally determined practices interacted in a complex manner, often leading to interrupted class engagement and attendance.ConclusionsTo be truly effective, current menstrual hygiene management strategies need to address the root causes of poor WASH infrastructure and ensure facility design is sensitive to the gendered and deeply embedded local socio‐cultural values and beliefs around menstrual hygiene management.
Anejaculation: Relevance to Sexual Enjoyment in Men and Women
Authors: Shindel Alan W. 
Published: September 2019

ABSTRACT

Introduction
Ejaculation and orgasm are important components of sexual response in men. Our understanding of both phenomena is limited. Anejaculation can be a source of substantial distress, even when procreation (ostensibly the only purpose of ejaculation itself) is not a priority.

Aim
To present an opinion on male perceptions of ejaculation disorders (specifically anejaculation) based on a variety of data sources, including peer-reviewed literature.

Methods
A non-systematic review of literature on anejaculation and other impairments of ejaculatory and orgasmic response was conducted. Relevant articles were critically analyzed and reported

Main Outcome Measure
An opinion is presented, based on existing data sources, on how and why ejaculation is deemed important to men and their sexual partners.

Results
The peer-reviewed literature on disorders of ejaculation is scant; existing reports oftentimes do not adequately distinguish between orgasm and ejaculation in assessment. Men’s perceptions of ejaculation quality appear to be positively associated with satisfaction with sexual response, particularly regarding orgasm. Based on very limited data, female sexual partners of men appear to often (but not always) value the orgasmic experience of their partner; only a minority prioritize actual ejaculation. There is evidence that disorders of ejaculation may be particularly troublesome for men who have sex with men.

Clinical Implications
The influence of medical conditions and treatments on ejaculation should be considered in the clinical context. Psychological adaptations and interventions may be of value in some cases.

Strengths & Limitations
Data on the clinical relevance of anejaculation outside the context of concomitant orgasmic dysfunction are sparse. Men’s experience of orgasm is at least partially associated with ejaculation-specific variables; whether this association is mediated by psychological, physical, or a combination of factors remains unclear.

Conclusions
Ejaculation, orgasm, and sexual satisfaction are closely intertwined but distinct phenomena.
Spencer's double: the decolonial afterlife of a postcolonial museum prop
Authors: KOWAL EMMA 
Published: September 2019

AbstractIn the mid-1990s, staff at Museum Victoria planned the new Melbourne Museum. The Indigenous gallery was a major focus at a time when many museums around the world forged new ways of displaying Indigenous heritage. Named Bunjilaka (a Woiwurrung word meaning ‘place of Bunjil', referring to the ancestral eaglehawk), the permanent Indigenous exhibit was a bold expression of community consultation and reflexive museum practice. At its heart was a life-size model of Baldwin Spencer, co-author of the classic anthropological monographThe Native Tribes of Central Australia(1899). When Bunjilaka was replaced with a wholly Indigenous-designed exhibit of Aboriginal Victoria in 2011, the model was informally retained by museum staff. Initially sitting awkwardly on a trolley in a narrow room where objects were processed for accession, Spencer himself remained unrecorded in any database. With no official existence but considerable gravity, he ended up housed in the secret/sacred room, surrounded by restricted objects that Spencer the man had collected. This article traces Spencer's journey from a post-colonial pedagogical tool to a transgressive pseudo-sacred object in an emerging era of decolonial museology. I argue that Spencer's fate indicates a distinct period of post-colonial museology (c.1990–2010) that has ended, and illustrates how the shifting historical legacies of science operate in the present.
Evaluation of a multifaceted approach to antimicrobial stewardship education methods for medical residents
Authors: VanLangen Kali M. , Dumkow Lisa E. , Axford Katie L. , Havlichek Daniel H. , Baker Jacob J. , Drobish Ian C. , Jameson Andrew P. 
Published: September 2019

AbstractObjective:Medical residents are an important group for antimicrobial stewardship programs (ASPs) to target with interventions aimed at improving antibiotic prescribing. In this study, we compared antimicrobial prescribing practices of 2 academic medical teams receiving different ASP training approaches along with a hospitalist control group.Design:Retrospective cohort study comparing guideline-concordant antibiotic prescribing for 3 common infections among a family medicine (FM) resident service, an internal medicine (IM) resident service, and hospitalists.Setting:Community teaching hospital.Participants:Adult patients admitted between July 1, 2016, and June 30, 2017, with a discharge diagnosis of pneumonia, cellulitis, and urinary tract infections were reviewed.Methods:All 3 medical teams received identical baseline ASP education and daily antibiotic prescribing audit with feedback via clinical pharmacists. The FM resident service received an additional layer of targeted ASP intervention that included biweekly stewardship-focused rounds with an ASP physician and clinical pharmacist leadership. Guideline-concordant prescribing was assessed based on the institution’s ASP guidelines.Results:Of 1,572 patients, 295 (18.8%) were eligible for inclusion (FM, 96; IM, 69; hospitalist, 130). The percentage of patients receiving guideline-concordant antibiotic selection empirically was similar between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%;P= .702). No differences were observed in appropriate definitive antibiotic selection among groups (FM, 92.4%; IM, 89.1%; hospitalist, 89.9%;P= .746). The FM resident service was more likely to prescribe a guideline-concordant duration of therapy across all diagnoses (FM, 74%; IM, 56.5%; hospitalist, 44.6%;P< .001).Conclusions:Adding dedicated stewardship-focused rounds into the graduate medical curriculum demonstrated increased guideline adherence specifically to duration of therapy recommendations.
Vitamin A intakes remain higher among intervention participants 3 years after a biofortification intervention in Mozambique
Authors: de Brauw Alan , Moursi Mourad , Munhaua A. Bernardinho 
Published: September 2019

AbstractThe Reaching End Users (REU) project introduced orange sweet potatoes (OSP) to farmers in northern Mozambique between 2006 and 2009, and the associated cluster randomised control trial found increased vitamin A intake among targeted children and women of child-bearing age and reduced prevalence of inadequate vitamin A intake. Yet little is known about whether successful agricultural–nutrition interventions have lasting effects. This study measures the lasting effects of the REU project, 3 years after the project ended, on vitamin A intake. To do so, dietary intake data were collected in the same thirty-six villages as the original study, focusing on both women of child-bearing age and children under 6 years old, the latter including both children who had been measured before and younger children (under 3 years old) in the same farmer groups. The dietary intake is then converted to micronutrient intake to compare treated households with control households. Vitamin A intake remains higher in treated villages than in control villages among both children under 3 years old, who had not been born when the original intervention ended, and mothers of child-bearing age. Differences in vitamin A intake can wholly be attributed to differences in OSP intake. Therefore, the REU project appears to have had lasting impacts on vitamin A intake beyond the intervention period. Had the vine retention component been enhanced, lasting impacts could have been even larger.
Niacin nutrition and rumen-protected niacin supplementation in dairy cows: an updated review
Authors: Chen Juncai , Yang Zhenguo , Dong Guozhong 
Published: September 2019

AbstractAs the precursor to NAD+ and NADP+, niacin is important for catabolic and anabolic redox reactions. In addition, niacin is known for its anti-lipolytic action via a hydroxycarboxylic acid-2-receptor-dependent mechanism. The anti-lipolytic effects of traditional free niacin supplementation during transition periods had been studied extensively, but the reported effects are ambiguous. In the past decade, a series of studies were conducted to evaluate the effects of rumen-protected niacin (RPN) on production performance and metabolic status in early lactation and on heat stress in dairy cows. Feeding RPN seems more effective than free niacin regarding increasing circulating niacin concentration. The rebound of plasma NEFA was found after termination of niacin abomasal infusion. Feeding RPN or infusion of niacin via the abomasum could suppress lipolysis and reduce insulin resistance in early lactation. Additionally, RPN supplementation could possibly relieve heat stress through vasodilation during moderate to severe heat stress condition. However, these beneficial effects of niacin supplementation have not always been observed. The inconsistent results across studies may be related to dosages of niacin supplementation, rebound of plasma NEFA concentration, stage of lactation or severity of heat stress. Overall, the current review is to present updated information on niacin nutrition in dairy cows and the recommendations are given for future research.
A survey of bolus tube feeding prevalence and practice in adult patients requiring home enteral tube feeding
Authors: Hubbard Gary P. , Andrews Sophie , White Sean , Simpson Gary , Topen Sarah , Carnie Lindsay , Murphy Claire , Collins Rhian , Davies Judith , Owen Annalisa , Barker Julie , Green Lisa , Patel Ileen , Ridgway Joanne , Lenchner Jo , Faerber Julie , Pearce Lorna , Meanwell Hannah , Kominek Natalie , Stark Lucy , Best Heather , Simons Rebecca , Cross Tessa , Stratton Rebecca J. 
Published: September 2019

AbstractAnecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
Laboratory experiments on intrusive flows and internal waves in a pycnocline
Authors: MADERICH V. S. , VAN HEIJST G. J. F. , BRANDT A. 
Published: September 2019

A laboratory study has been performed to simulate intrusive flows generated by
internal wave-breaking activity in the oceanic pycnocline. Two different cases were
considered. In the first set of experiments a short-duration source of motion was modelled
by creating a finite region of well-mixed fluid. The collapse of this region resulted
in intrusive flows and internal waves in the pycnocline. Attention was focused on the
formation and subsequent evolution of solitary ‘bulges’ in the intrusion. Detailed flow
measurements have revealed that the weak motion inside these bulges (which contain
well-mixed fluid from the source) is organized in a four-vortex structure. Numerical
flow simulations provided important information about the dynamics of this four-cell
structure: the outer cells are associated with baroclinic generation of vorticity, while
the inner cells are characterized by a balance between the advective and the viscous
terms in the vorticity equation.In the second set of experiments continuous mixing was induced by a vertically
oscillating, horizontal grid centred in the pycnocline. The mixed region collapses, thus
forming an intrusive flow into the pycnocline and internal waves that propagate along
the pycnocline at higher speed than the intrusion. It was found that the velocity of
the intrusive flow is approximately constant and that its dynamics is controlled by an
inertial–buoyancy balance. The parameters of the internal waves in both cases were
compared with theory.
Instabilities of the undertow
Authors: LI LI , DALRYMPLE ROBERT A. 
Published: September 2019

The steady undertow created by waves breaking at a beach and slowly
flowing
offshore can become unstable and create a train of submerged offshore migrating

vortices with shorter length scales and longer time scales than the incident
waves, as
shown by Matsunaga, Takehara & Awaya (1988, 1994). These vortices rotate
about
horizontal axes parallel to the shoreline. Our larger-scale laboratory
experiments show
that an additional layer of vortices can exist over the water depth, with
vortices near
the water surface rotating in the same direction as the wave-induced water
particle
trajectories, while those located at about mid-depth rotate in the opposite
direction.A theoretical and numerical analysis shows that these vortices are due
to instabilities
of the undertow. Far offshore of the surf zone, the vortex trains decay
because the
velocity profile for the undertow becomes linear over depth, hence neutrally
stable to
any disturbances.
Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist
Authors: Mather M W , Yates P D , Powell J , Zammit-Maempel I 
Published: September 2019

AbstractBackgroundMastoiditis is an otological emergency, and cross-sectional imaging has a role in the diagnosis of complications and surgical planning. Advances in imaging technology are becoming increasingly sophisticated and, by the same token, the ability to accurately interpret findings is essential.MethodsThis paper reviews common and rare complications of mastoiditis using case-led examples. A radiologist-derived systematic checklist is proposed, to assist the ENT surgeon with interpreting cross-sectional imaging in emergency mastoiditis cases when the opinion of a head and neck radiologist may be difficult to obtain.ResultsA 16-point checklist (the ‘mastoid 16’) was used on a case-led basis to review the radiological features of both common and rare complications of mastoiditis; this is complemented with imaging examples.ConclusionAcute mastoiditis has a range of serious complications that may be amenable to treatment, once diagnosed using appropriate imaging. The proposed checklist provides a systematic approach to identifying complications of mastoiditis.
On Polytropy: Or the Natural Condition of Spiritual Cosmopolitanism in India: The Digambar Jain Case
Authors: CARRITHERS MICHAEL 
Published: September 2019

As Jog Maya remarked to me, there are religions enough for everyone to
choose, just like vegetables in the morning bazaar. Gellner 1992:70The family was in continuous communion with a whole range of business
associates, gods and men. Bayly 1983:390
Memory complaints as a precursor of memory impairment in older people: a longitudinal analysis over 7–8 years
Authors: JORM A. F. , CHRISTENSEN H. , KORTEN A. E. , JACOMB P. A. , HENDERSON A. S. 
Published: September 2019

Background. There is considerable dispute about the validity of memory complaints. While some
studies find that complaints are an early indicator of dementia or cognitive decline, there are also
many studies showing that complaints are more closely associated with negative affect (depression,
anxiety and neuroticism). The present paper used three-wave longitudinal data to test three
hypotheses: (1) that memory complaints reflect an evaluation of present and past memory
performance; (2) that memory complaints predict future memory performance; and (3) that
memory complaints predict current and future negative affect.Methods. A longitudinal study was carried out with a community sample of people aged 70 and
over. Participants were assessed for memory complaints, memory performance and negative affect
at three waves separated by 3·6 years and 4·0 years. There were 331 persons with data on all relevant
variables. The data were analysed using structural equation modelling.Results. Significant paths in the structural model were found from memory performance to future
memory complaints, as well as from memory complaints to future memory performance,
supporting hypotheses 1 and 2. Memory complaints were associated with current negative affect,
but did not predict future negative affect.Conclusions. Memory complaints do reflect perceptions of past memory performance and are also
an early manifestation of memory impairment. However, current negative affect (anxiety and
depression symptoms) shows the greatest association with memory complaints.
PRIVATE PHARMACY PRACTICE AND REGULATION
Authors: Stenson Bo , Syhakhang Lamphone , Lundborg Cecilia Stålsby , Eriksson Bo , Göran  
Published: September 2019

Objectives: The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country.Methods: The intervention comprised inspections of the pharmacies, information, and distribution of documents to drug sellers and sanctions. It was implemented at two different intensity levels, active and regular intervention. The methods used to assess the effect of the interventions were interviews with the district drug inspectors, drug sellers and customers, inspection of drug purchases, and indicator surveys of pharmacies. Indicators for pharmacy-specific quality as well as for dispensing quality were developed.Results: The main finding was one of strong overall improvements from initially low levels. The improvements were particularly marked by increases in the availability of essential materials for dispensing by 34% and in order in the pharmacy by 19%. Information given to customers increased from 35% to 51% and the mixing of different drugs in the same package went down from 17% to 9%. The pharmacies in the active intervention districts showed greater improvements for four of the six indicators, although statistically significant compared with the regular intervention districts only for the essential materials indicator.Conclusions: It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements. It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting.