bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of an analgo-sedation protocol for neurointensive patients: a two-phase interventional non-randomized pilot study
Authors: Egerod Ingrid , Jensen Malene Brorsen , Herling Suzanne Forsyth , Welling Karen-Lise 
Published: April 2010

Abstract
Introduction
Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia-based sedation and improved pain management. The secondary outcomes were a reduction in unplanned extubations and duration of sedation.

Methods
This was a two-phase (before-after), prospective controlled study at a university-affiliated, 14-bed neurointensive care unit in Denmark. The sample included patients requiring mechanical ventilation for at least 48 hours treated with continuous sedative and analgesic infusions or both. During the observation phase the participants (n = 106) were sedated as usual (non-protocolized), and during the intervention phase the participants (n = 109) were managed according to a new sedation protocol.

Results
Our study showed a shift toward analgo-sedation, suggesting feasibility of the protocol. We found a significant reduction in the use of propofol (P < .001) and midazolam (P = .001) and an increase in fentanyl (P < .001) and remifentanil (P = .003). Patients selected for daily sedation interruption woke up faster, and estimates of pain free patients increased from 56.8% to 82.7% (P < .001), suggesting efficacy of the protocol. The duration of sedation and unplanned extubations were unchanged.

Conclusions
Our pilot study showed feasibility and partial efficacy of our protocol. Some neurointensive patients might not benefit from protocolized practice. We recommend an interdisciplinary effort to target patients requiring less sedation, as issues of oversedation and inadequate pain management still need more attention.

Trial registration
ISRCTN80999859.
Impaired Down-Regulation of E-Cadherin and β-Catenin Protein Expression in Endometrial Epithelial Cells in the Mid-Secretory Endometrium of Infertile Patients with Endometriosis
Authors: Matsuzaki Sachiko , Darcha Claude , Maleysson Elodie , Canis Michel , Mage Gérard 
Published: April 2010

Context: Only a few, small, human studies on E-cadherin and β-catenin expression in normal cycling human endometrium have been reported. It remains unclear whether expression of these molecules might be altered in the endometrium of infertile patients with endometriosis.
Objectives: The aim of the present study was to investigate E-cadherin and β-catenin expression in the endometrium of infertile patients with endometriosis, those with uterine fibromas, and patients with unexplained infertility.
Design: Expression levels of E-cadherin and β-catenin mRNA and/or protein in the endometrium of infertile patients with endometriosis (n = 151), those with uterine fibromas (n = 41), patients with unexplained infertility (n = 9), as well as healthy fertile controls (n = 57) were measured. This study utilized laser capture microdissection, real-time RT-PCR, and immunohistochemistry.
Results: No significant differences in E-cadherin or β-catenin mRNA expression in microdissected epithelial cells were observed among the different groups throughout the menstrual cycle. However, very low or no protein expression of E-cadherin, total β-catenin, or dephosphorylated β-catenin in luminal and glandular epithelial cells was detected in the mid-secretory endometrium of healthy fertile controls. E-cadherin, total β-catenin, and dephosphorylated β-catenin protein expression in the mid-secretory endometrium of infertile patients with endometriosis or unexplained infertility was significantly higher compared to that of healthy fertile controls in both luminal and glandular epithelial cells.
Conclusions: These findings suggest that impaired down-regulation of E-cadherin and β-catenin protein expression, along with Wnt/β-catenin signaling pathway activation during the window of implantation, might be one of the potential molecular mechanisms of infertility in patients with endometriosis.
Serum Insulin-Like Growth Factor-I and Pro-Collagen Type III N-Terminal Peptide in Adolescent Elite Athletes: Implications for the Detection of Growth Hormone Abuse in Sport
Authors: Guha Nishan , Erotokritou-Mulligan Ioulietta , Burford Caroline , Strobridge Gail , Brigg Joanna , Drake Tamsin , Bassett E. Eryl , Cowan David , Bartlett Christiaan , Sönksen Peter H. , Holt Richard I. G. 
Published: April 2010

Abstract
Context: A method based on two GH-dependent markers, IGF-I and pro-collagen type III N-terminal peptide (P-III-P), has been devised to detect exogenously administered GH. Because previous studies on the detection of GH abuse involved predominantly adult athletes, the method must be validated in adolescent athletes.
Objective: The aim of the study was to examine serum IGF-I and P-III-P concentrations in elite adolescent athletes and to determine whether the method developed in adults is appropriate to detect GH abuse in this population.
Design and Setting: We conducted a cross-sectional observational study at national sporting organization training events.
Subjects: A total of 157 (85 males, 72 females) elite athletes between 12 and 20 yr of age participated in the study.
Intervention: Serum IGF-I and P-III-P were each measured by two commercially available immunoassays. GH-2000 discriminant function scores were calculated.
Results: Both IGF-I and P-III-P rose to a peak during adolescence, which was earlier in girls than in boys. All GH-2000 scores lay below the proposed cutoff limit of 3.7 (although some scores were close to this value), indicating that none of these athletes would be accused of GH doping if the GH-2000 discriminant formulae were used. The results between the two immunoassays for IGF-I and P-III-P were closely aligned.
Conclusions: The GH-2000 score rises in early adolescence, reaches a peak in athletes aged 13–16 yr, and then falls. We have found no evidence that the proposed GH-2000 score developed in adults would lead to an unacceptable rate of false-positive results in adolescent athletes, but caution may be required around the time of peak growth velocity.
Archives of the Black Atlantic: Postcolonial Citation in The Pagoda
Authors: Walters Wendy W. 
Published: April 2010

Contemporary African diasporic literature often displays “the allure of the archive” when writers encode archival documents into their narratives, revising the remnants found in an archive, and foregrounding the elements of archival research and data in their texts. Against the well-theorized connection between the archive and the nation-state, diaspora novels require a transnational reading practice that encompasses multiple national archives. This critical practice opens the archive and exposes the nation-state's exclusionary investments in it. Diaspora literature thus unmoors the archive from its stubborn attachment to national narratives.
Bound by the forms of the governments who sponsor their enunciation, archival documents are frequently legal depositions, statements of arrest, indenture, capture, and execution. What can these documents tell us about the subjectivity of those laboring in fields or battened under hatches making a middle passage toward indentureship? This essay focuses on one aspect of novelistic citation of a transnational archive, using Jamaican author Patricia Powell's 1998 novel, The Pagoda, as an example. I suggest that the novel's foregrounding of archival documents (letters, maps, ships' logs, newspaper clippings, etc.), loosens Powell's characters from the social identities to which they were bound. I offer a reading between novel and archive, focusing on a letter being written by Powell's protagonist, Lowe, and the letter's interaction with a history sometimes called “the coolie trade.” The critical reading practice that I argue diasporic literature demands leads us from the literature back toward recognition of the archive itself as transnational.
The Association of Socioemotional Problems With Early Sexual Initiation
Authors: McLeod Jane D. , Knight Syndee 
Published: April 2010

CONTEXT: Research on the association between socioemotional problems and early sexual initiation has not evaluated differences across types of problems, by gender, or by race or ethnicity.
METHODS: Data were analyzed for a sample derived from the Children of the National Longitudinal Surveys of Youth: 1,836 youth who were 10–11 years old at the 1992, 1994 and 1996 waves. Mothers’ reports of their child’s socioemotional problems at age 10–11 were assessed; sexual initiation before age 15 was assessed using youth self‐reports. Logistic regression analyses estimated associations between socioemotional problems and early initiation; predicted probabilities and group differences were calculated using various regression techniques.
RESULTS: Twenty‐six percent of youth had had intercourse before turning 15, and their average level of each problem was higher than the level of those who had not. Both internalizing problems (e.g., depression and dependency) and externalizing problems (e.g., hyperactivity and antisocial behavior) were associated with early sexual initiation (odds ratios, 1.1 and 1.2, respectively), but only externalizing problems retained significance when both types were included in the model (1.2). Among specific problems, only hyperactivity and antisocial behavior were associated with early initiation (1.2 for each). Youth with a high level of externalizing problems had a higher predicted probability of having early sex than did those with a low level (0.28 vs. 0.21). Associations between socioemotional problems and early initiation did not differ by gender or by race or ethnicity.
CONCLUSIONS: Interventions should be targeted at youth with externalizing problems, especially those who engage in antisocial or hyperactive behavior, in an effort to promote positive social interactions.
Withdrawal Attitudes and Experiences: A Qualitative Perspective Among Young Urban Adults
Authors: Whittaker Paul G. , Merkh Rebecca D. , Henry‐Moss Dare , Hock‐Long Linda 
Published: April 2010

CONTEXT: Withdrawal is a widely used pregnancy prevention practice, but is popularly regarded as ineffective. An in‐depth study of withdrawal behaviors would improve understanding of its role in reproductive health care.
METHODS: Ninety‐five ethnically diverse males and females aged 18–25, recruited through family planning clinics and community outreach in a large U.S. city, participated in semistructured, open‐ended interviews in 2006 and 2007. Interviews examined up to six heterosexual relationships and focused on contraceptive attitudes, norms and experiences. Transcripts were reviewed and coded, and key themes related to withdrawal were identified.
RESULTS: Withdrawal was a popular contraceptive technique, but opinions on its effectiveness were mixed. Some participants (especially women) expressed anxiety concerning pregnancy risk due to perceived ineffectiveness of withdrawal, and women were concerned about their partner’s capacity to consistently withdraw prior to ejaculation. Others described confidence and skill in using withdrawal, and considered it effective. Reasons for use of withdrawal included convenience and dissatisfaction with hormonal contraceptives and condoms. Withdrawal was described as an expected alternative to condoms in both casual and long‐term relationships, and as a secondary, or backup, method with use of hormonal contraceptives or condoms. Participants had rarely discussed withdrawal with health care providers; knowledge about the method had generally come from less reliable sources, including peers.
CONCLUSIONS: Health care provider discussions with patients about withdrawal could give greater insight into risk behaviors. More informed prevention counseling messages would be helped by better effectiveness estimates and understanding of factors most likely to result in withdrawal failure.
Biopsychosocial Factors and Musculoskeletal Symptoms of the Lower Extremities of Saleswomen in Department Stores in Thailand
Authors: Pensri Praneet , Janwantanakul Prawit , Chaikumarn Montakarn 
Published: April 2010

Biopsychosocial Factors and Musculoskeletal Symptoms of the Lower Extremities of Saleswomen in Department Stores in Thailand: Praneet Pensri, et al. Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, ThailandObjectivesTo identify individual, work‐related physical and psychosocial factors associated with the self‐reported prevalence of musculoskeletal symptoms in the hip, knee and ankle/foot of saleswomen in department stores in Thailand.MethodsA cross‐sectional survey was conducted in which 1,310 saleswomen in 18 department stores received a self‐administered questionnaire. Returns were 1,200 (92%) questionnaires, and after screening for exclusion criteria, 1,189 saleswomen were found to be eligible for the study.ResultsHaving a child, number of working hours per day, frequency of body twisting during work and self‐rated perception of light intensity in the workplace were each significantly associated with the prevalence of experiencing hip symptoms. Significant associations were found between age, number of hours per day required to stand or walk and self‐rated perception of temperature in the workplace, and the prevalence of experiencing knee symptoms. The number of working hours per day and working days per week as well as frequency of working in static postures and rest breaks during work were each significantly related to the prevalence of experiencing ankle/foot symptoms.ConclusionsAmong saleswomen, various individual and work‐related physical factors were identified as risks and preventive factors for musculoskeletal symptoms in the lower extremities. Further research should focus on these modifiable factors in order to develop effective strategies for reducing the occurrence of such symptoms in saleswomen.
Tolerance and Withdrawal From Prolonged Opioid Use in Critically Ill Children
Authors: Anand Kanwaljeet J. S. , Willson Douglas F. , Berger John , Harrison Rick , Meert Kathleen L. , Zimmerman Jerry , Carcillo Joseph , Newth Christopher J. L. , Prodhan Parthak , Dean J. Michael , Nicholson Carol ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
Published: April 2010

OBJECTIVE:After prolonged opioid exposure, children develop opioid-induced hyperalgesia, tolerance, and withdrawal. Strategies for prevention and management should be based on the mechanisms of opioid tolerance and withdrawal.PATIENTS AND METHODS:Relevant manuscripts published in the English language were searched in Medline by using search terms “opioid,” “opiate,” “sedation,” “analgesia,” “child,” “infant-newborn,” “tolerance,” “dependency,” “withdrawal,” “analgesic,” “receptor,” and “individual opioid drugs.” Clinical and preclinical studies were reviewed for data synthesis.RESULTS:Mechanisms of opioid-induced hyperalgesia and tolerance suggest important drug- and patient-related risk factors that lead to tolerance and withdrawal. Opioid tolerance occurs earlier in the younger age groups, develops commonly during critical illness, and results more frequently from prolonged intravenous infusions of short-acting opioids. Treatment options include slowly tapering opioid doses, switching to longer-acting opioids, or specifically treating the symptoms of opioid withdrawal. Novel therapies may also include blocking the mechanisms of opioid tolerance, which would enhance the safety and effectiveness of opioid analgesia.CONCLUSIONS:Opioid tolerance and withdrawal occur frequently in critically ill children. Novel insights into opioid receptor physiology and cellular biochemical changes will inform scientific approaches for the use of opioid analgesia and the prevention of opioid tolerance and withdrawal.
Knowledge of Interim Recommendations and Use of Hib Vaccine During Vaccine Shortages
Authors: Kempe Allison , Babbel Christine , Wallace Gregory S. , Stokley Shannon , Daley Matthew F. , Crane Lori A. , Beaty Brenda , Black Sandra R. , Barrow Jennifer , Dickinson L. Miriam 
Published: April 2010

OBJECTIVES:
The goals were to determine among pediatricians and family physicians (1) knowledge of interim recommendations regarding Haemophilus influenzae type b (Hib) vaccine administration, (2) current practices, and (3) factors associated with nonadherence.

METHODS:
An Internet-based survey was conducted in April 2008 among national samples.

RESULTS:
Response rates were 68% (220 of 325 physicians) among pediatricians and 51% (153 of 302 physicians) among family physicians. Seventy-three percent of pediatricians and 45% of family medicine physicians reported insufficient Hib vaccine supplies, and 22% to 24% reported having to defer doses for infants 2 to 6 months of age ≥10% of the time. Ninety-eight percent of pediatricians and 81% of family physicians were aware of the interim recommendations (P ≤ .0001), and virtually all knew that the booster dose should be deferred; however, 22% of pediatricians and 33% of family medicine physicians reported not deferring this dose. Physicians in both specialties were less likely to adhere to recommendations to defer in this age group if they thought that their practice had sufficient vaccine supplies (pediatricians, odds ratio: 0.01 [95% confidence interval: 0.003–0.03]; family medicine physicians, odds ratio: 0.10 [95% confidence interval: 0.03–0.33]). Family medicine physicians were less likely to adhere to recommendations if they had not heard about the interim recommendations (odds ratio: 0.04 [95% confidence interval: 0.01–0.21]).

CONCLUSIONS:
Most primary care physicians experienced Hib vaccine shortages, and many have had to defer doses for 2- to 6-month-old children. Most are knowledgeable regarding interim recommendations, but one-fifth to one-third reported nonadherence.
The Prevalence of Infections WithTrichophyton tonsuransin Schoolchildren: the CAPITIS Study
Authors: Abdel-Rahman Susan M. , Farrand Nancy , Schuenemann Eric , Stering Tricia K. , Preuett Barry , Magie Richard , Campbell Annette 
Published: April 2010

BACKGROUND:Although Trichophyton tonsurans has become the leading cause of tinea capitis in the United States, reported infection rates vary widely, and prevalence estimates for the pediatric population at large remain poorly characterized.METHODS:A prospective, cross-sectional, surveillance study of children attending kindergarten through fifth grade in 44 schools across the bi-state (Kansas/Missouri), Kansas City metropolitan area was conducted. Fungal cultures were collected from all participants, and molecular analyses were used to characterize the patterns of infection within the population.RESULTS:Of 10514 children (age: 8.3 ± 1.9 years) examined for the presence of T tonsurans on their scalps, 6.6% exhibited positive cultures. Infection rates at participating schools ranged from 0% to 19.4%, exceeding 30% at a given grade level in some schools. Black children demonstrated the highest rates of infection (12.9%), with prevalence estimates for the youngest members of this racial group approaching 18%. Infection rates for Hispanic (1.6%) and white (1.1%) children were markedly lower. A single genetic strain of T tonsurans was identified in only 16.6% of classrooms, whereas each child harbored a unique genetic strain in 51.4%.CONCLUSIONS:We report a large-scale, citywide, surveillance study of T tonsurans infection rates among children in primary school in a metropolitan area. The striking prevalence rates and genetic heterogeneity among the fungal isolates confirm the relatively large degree to which this pathogen has become integrated into metropolitan communities.
Smoking and smoking cessation in pregnancy
Authors: Eastham Rob , Gosakan Radhika 
Published: April 2010

Key content

A 2005 survey of new mothers in England revealed that the prevalence of smoking among pregnant women remains high.
Smoking remains the single largest preventable cause of fetal and infant morbidity in the UK.
Potential problems during pregnancy include ectopic pregnancy, miscarriage, placental complications, premature rupture of membranes, premature birth and fetal growth restriction.
Counselling sessions are effective in pregnancy and lead to a reduction in the incidence of preterm birth and low birthweight.
Nicotine replacement therapy can be considered in pregnant women under some circumstances, whilst current evidence suggests other pharmacological therapies are contraindicated.

Learning objectives

To understand the risks of smoking to fetal and child health.
To understand epidemiological factors and implications for smoking cessation services.
To become familiar with the recommended smoking cessation methods offered during pregnancy.

Ethical issues

Nicotine crosses the placenta and has been shown to cause a dose‐related rise in maternal blood pressure and heart rate. Some argue that use of nicotine replacement therapy unnecessarily exposes the fetus to health risks.

Please cite this article as: Eastham R, Gosakan R. Smoking and smoking cessation in pregnancy. The Obstetrician & Gynaecologist 2010;12:103–109.
Academic training in obstetrics and gynaecology in the UK: current progress and opportunities
Authors: David Anna L , Whitten Melissa , Rodeck Charles H 
Published: April 2010

Key content

UK initiatives to promote academic training in obstetrics and gynaecology are under way.
New posts at all levels of academic training are available nationally.
Guidance towards a career in academic obstetrics and gynaecology is available from the Royal College of Obstetricians and Gynaecologists.
Academic mentors are available to support academic trainees in the specialty.

Learning objectives

To understand the initiatives that are supporting progress in academic obstetrics and gynaecology at all career levels in the UK.
To find out more information about academic training in general.
To learn about academic training opportunities in obstetrics and gynaecology.

Ethical issues

How can academic trainees be good clinicians and researchers?
Why is research valued more than teaching and what can be done about this?
How can future academic leaders in obstetrics and gynaecology be identified and nurtured?

Please cite this article as: David AL, Whitten M, Rodeck CH. Academic training in obstetrics and gynaecology in the UK: current progress and opportunities. The Obstetrician & Gynaecologist 2010;12:111–118.