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Uterine fibroids are very common in women of reproductive age and are mostly benign. However, they are often a cause of abnormal bleeding and, in severe cases, can cause infertility. This comprehensive guide reviews the clinical management of uterine fibroids, with a particular focus on practical surgical techniques. Engage with topics such as the anatomy of the pelvis, key theatre equipment and surgical treatments including hysteroscopic and laparoscopic techniques. Features also include debates around morcellation and less invasive treatments such as uterine artery embolisation are also covered.An online video library of surgical procedures reinforces the practical techniques taught in the book and detailed colour images supplement the book's thorough coverage of fibroid management. This makes Modern Management of Uterine Fibroids an essential resource for practicing gynaecologists and IVF specialists, as well as students.
The morphology of the zoeal stages IX and XI of the shrimp Thalassocaris lucida is described and illustrated in detail from plankton specimens identified by barcoding of the mitochondrial 16S ribosomal RNA gene (sequence similarities 99.4–99.6%). The present study confirms the larval morphology of Thalassocaris, that shows distinct features within Pandaloidea: (1) carapace broad and dorsoventrally flattened, (2) coxal endite of maxilla with only one lobe, (3) basis of third maxilliped with a distal globose lobe. On the other hand, the funnel-shaped eyes, and the development with long series of larval stages of Thalassocaris indicate affinities with some genera of Pandalidae which corroborates the results of recent phylogenetic analyses in abandoning the family status of Thalassocarididae.
Our study analysed evolving regional commitments on food policy in the Pacific. Our aim was to understand regional priorities and the context of policy development, to identify opportunities for progress.
We analysed documentation from a decade of regional meetings in order to map regional policy commitments relevant to healthy diets. We focused on agriculture, education, finance, health, and trade sectors, and Heads of State forums. Drawing on relevant political science methodologies, we looked at how these sectors ‘frame’ the drivers of and solutions to non-communicable diseases (NCD), their policy priorities, and identified areas of coherence and tension.
The Pacific has among the highest rates of non-communicable diseases in the world, but also boasts an innovative and proactive response. Heads of State have declared NCD a ‘crisis’ and countries have committed to specific prevention activities set out in a regional ‘Roadmap’. Yet, diet-related NCD risk-factors remain stubbornly high and many countries face challenges in establishing a healthy food environment.
Policies to improve food environments and prevent NCD are a stated priority across regional policy forums, with clear agreement on the need for a multi-sectoral response. However, we identified challenges in sustaining these priorities as political attention fluctuated. We found examples of inconsistencies and tension in sectoral responses to the NCD epidemic that may restrict implementation of the multi-sectoral action.
Understanding the priorities and positions underpinning sectoral responses can help drive a more coherent NCD response, and lessons from the Pacific are relevant to public health nutrition policy and practice globally.
Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
A ubiquitous manufacturing (UM) system is used in manufacturing for obtaining the Internet of things solutions and provides location-based manufacturing services. Human-induced uncertainty and early termination are two complications that hamper the effectiveness of an UM system based on three-dimensional (3D) printing. To resolve these complications, several solutions were considered in this study. First, fuzzy-valued parameters were defined to determine uncertainty. Subsequently, slack was derived to determine whether to restart an early terminated 3D printing process in the same 3D printing facility. Consequently, two optimization models – a fuzzy mixed-integer linear programming model and a fuzzy mixed-integer quadratic programming model – were developed in this study. Based on the two optimization models, a fuzzy 3D printing-based UM system that considers uncertainty and early termination was developed. The effectiveness of the proposed methodology was tested by conducting a regional experiment. The experimental results revealed that the proposed methodology could shorten the average cycle time by 9% and could enable 3D printing facilities to make real-time, online reprinting decisions.
Although it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.
To explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI.
Two mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China.
Compared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status.
Socioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.
Inspired by notions of interest of humankind and intergenerational equity, we explored Antarctic perceptions of a subset of future generations—university students. Students at three universities in Canada, the Netherlands, and the USA were surveyed to determine the relationships between nationality, academic major, opinions on values of Antarctica, and support for a range of human activities in Antarctica (n = 618). Logistic regression was used to model the relationship of these variables with support for designation of Antarctica as a wilderness reserve, construction of new research stations, and mining. Compared with business and economics majors, biological sciences and natural resources/conservation majors were more likely to support wilderness designation and less likely to support mineral resource development. Nationality was not significantly associated with support for construction of new research stations and mineral resource development. Opinions on the value of Antarctica and support for activities also exhibited significant influences on dependent variables. Consistent with earlier studies of Antarctic scientists, personnel, tourists, and other members of the general public, university students valued Antarctica as one of the world’s last great wildernesses (66%), an important component of the Earth’s climate system (66%), and a science laboratory for the benefit of mankind (62%).
Radiotherapy is an option to treat high-grade laryngeal dysplasia. This study aimed to evaluate the use of intensity-modulated radiotherapy, 55 Gy in 20 daily fractions, in treating this disease.
Acute toxicity was evaluated in all 14 patients treated. In 10 patients, functional voice outcome was measured using the Voice Handicap Index, and the Grade, Roughness, Breath, Asthenia, Strain (‘GRBAS’) scale. These measurements were performed pre-treatment and three months after intensity-modulated radiotherapy.
All but one patient managed to complete radiotherapy. Acute toxicity was significant (one patient developed grade 4 and three patients developed grade 3 dysphagia). Four patients required hospital admission. In 9 out of 10 patients, radiotherapy improved voice quality.
This radiotherapy regimen using intensity-modulated radiotherapy for laryngeal dysplasia is feasible and provided excellent functional outcome, but acute toxicity was significant. Dose de-escalation can be considered in the framework of clinical trials.
To determine the efficacy of 2 types of antimicrobial privacy curtains in clinical settings and the costs involved in replacing standard curtains with antimicrobial curtains.
A prospective, open-labeled, multicenter study with a follow-up duration of 6 months.
This study included 12 rooms of patients with multidrug-resistant organisms (MDROs) (668 patient bed days) and 10 cubicles (8,839 patient bed days) in the medical, surgical, neurosurgical, orthopedics, and rehabilitation units of 10 hospitals.
Culture samples were collected from curtain surfaces twice a week for 2 weeks, followed by weekly intervals.
With a median hanging time of 173 days, antimicrobial curtain B (quaternary ammonium chlorides [QAC] plus polyorganosiloxane) was highly effective in reducing the bioburden (colony-forming units/100 cm2, 1 vs 57; P < .001) compared with the standard curtain. The percentages of MDRO contamination were also significantly lower on antimicrobial curtain B than the standard curtain: methicillin-resistant Staphylococcus aureus, 0.5% vs 24% (P < .001); carbapenem-resistant Acinetobacter spp, 0.2% vs 22.1% (P < .001); multidrug-resistant Acinetobacter spp, 0% vs 13.2% (P < .001). Notably, the median time to first contamination by MDROs was 27.6 times longer for antimicrobial curtain B than for the standard curtain (138 days vs 5 days; P = .001).
Antimicrobial curtain B (QAC plus polyorganosiloxane) but not antimicrobial curtain A (built-in silver) effectively reduced the microbial burden and MDRO contamination compared with the standard curtain, even after extended use in an active clinical setting. The antimicrobial curtain provided an opportunity to avert indirect costs related to curtain changing and laundering in addition to improving patient safety.
“Time for Change”; “For Real Change Let's Vote for NLD”
On 8 November 2015, in Myanmar's sixth multiparty general election (hereafter GE2015) since independence in 1948, voters’ desire for “change” swept away the conservative forces associated with more than five decades of military dominance in the politics of Myanmar. That simple catchy C-word, reminiscent of Barak Obama's U.S. presidential campaign battle cry in 2008, proved more effective than the “goodies” delivered during the five years of USDP (Union Solidarity and Development Party) rule under President U Thein Sein, as well as the last-minute deluge of amenities, goods and services brought in by powerful USDP candidates to their designated constituencies to garner votes from the weary public. The National League for Democracy (NLD), led by Daw Aung San Suu Kyi, the charismatic daughter of Myanmar's martyred independence hero, “Bogyoke” (general) Aung San, clinched supermajorities in both houses of parliament, stunning pundits, competitors, detractors, supporters and the NLD itself, not only in Myanmar but also in the international community. Thus, GE2015 appeared to herald the dawn of a new era in Myanmar politics, whose troubled experiment in parliamentary democracy was truncated by the military coup of 2 March 1962. However, both powerful agencies and rigid structures stand in the way of “real change” as envisaged by the NLD leadership and aspired to by those who voted in the popular party led by their beloved hero's daughter.
The Bumpy Road to GE2015
One could say that the re-entry of the NLD, especially its chairperson Aung San Suu Kyi, into the mainstream political playground through the by-elections in April 2012 set the stage for the race to win GE2015. People took notice of the NLD's comeback when it won forty-three of the forty-fives seats it then contested. It allowed the party and its leader to play a high-profile role in and out of the parliamentary system and capture the imagination of a public apathetic to electoral politics since the huge setback when the junta ignored the results of the 1990 general election.
Meanwhile, the government of President U Thein Sein, formed in March 2011, carried out significant political and economic reforms as well as administrative restructuring and attempted to achieve performance legitimacy and overcome its image as a quasi-civilian government comprising many retired military officers and serving generals.
Intranasal octenidine, an antiseptic alternative to mupirocin, can be used for methicillin-resistant Staphylococcus aureus (MRSA) decolonisation in the prevention of nosocomial transmission. A controlled before–after study was conducted in three extended-care hospitals in Singapore. All inpatients with >48 h stay were screened for MRSA colonisation in mid-2015(pre-intervention) and mid-2016(post-intervention). Hospital A: universal daily chlorhexidine bathing throughout 2015 and 2016, with intranasal octenidine for MRSA-colonisers in 2016. Hospital B: universal daily octenidine bathing and intranasal octenidine for MRSA-colonisers in 2016. Hospital C: no intervention. In 2015, MRSA prevalence was similar among the hospitals (Hospital A: 38.5%, Hospital B: 48.1%, Hospital C: 43.4%, P = 0.288). From 2015 to 2016, MRSA prevalence reduced by 58% in Hospital A (Adj OR 0.42, 95% CI 0.20–0.89) and 43% in Hospital B (Adj OR 0.57, 95% CI 0.39–0.84), but remained similar in Hospital C (Adj OR 1.19, 95% CI 0.60–2.33), after adjusting for age, gender, comorbidities, prior MRSA carriage, prior antibiotics exposure and length of hospital stay. Compared with the change in MRSA prevalence from 2015 to 2016 in Hospital C, MRSA prevalence declined substantially in Hospital A (Adj OR 0.35, 95% CI 0.13–0.97) and Hospital B (Adj OR 0.48, 95% CI 0.22–1.03). Topical intranasal octenidine, coupled with universal daily antiseptic bathing, can reduce MRSA colonisation in extended-care facilities.
Engage with practical and active solutions to day-to-day issues of reproductive medicine and the use of artificial reproductive techniques (ART), occurring in clinical and laboratory environments. Authored by leading experts in the field, this user-friendly guide is invaluable for any IVF practitioner and embryologist, facing everyday hands-on issues, through to high-pressure laboratory problems, efficiency ratings and ensuring cost-effective delivery of care. With the strict governance of regulatory bodies worldwide, the success of any fertility centre depends on successful problem solving, all day every day. Based on a wealth of experience, identify commonly occurring problems, and fresh perspectives of problem-solving, with 'must-have' protocols, patient information sheets and suggested equipment. This go-to companion tackles operational, organisational, clinical and laboratory issues to financial and clinical governance, with a focus on quick and effective solutions for the busy practitioner.
Breast-feeding in the first 6 months of life is critical for ensuring both child health and well-being. Despite efforts to improve breast-feeding practices, recent studies have reported that Myanmar continues to have low rates of exclusive breast-feeding.
A community-based breast-feeding promotion programme using trained community members was implemented for 1 year in hard-to-reach townships of Myanmar. The present study assessed the breast-feeding practices using a cross-sectional survey of 610 mothers of children under 2 years old: specifically, breast-feeding within 24 h, exclusive breast-feeding up to 6 months and breast-feeding duration.
Using Cox models for breast-feeding duration before 24 months, the hazard of breast-feeding cessation was lower in programme v. non-programme townships (hazard ratio (HR)=0·55; 95 % CI 0·32, 0·95). Mothers who worked as shop owners or ran a family business had lower hazard of breast-feeding cessation (HR=0·13, P<0·05) v. those who worked as supervisors, managers, self-employed and businesswomen. The hazard of breast-feeding cessation was higher in women in higher wealth quintiles v. those in the lowest quintile (lower quintile, HR=3·49, P<0·1; higher quintile, HR=3·50, P<0·1; highest quintile, HR=3·47, P<0·1).
The intervention did not affect exclusive breast-feeding practices or breast-feeding within the first 24 h. Potential reasons include existing high levels of early initiation of breast-feeding due to ongoing government-led maternal and child health activities, and social and traditional practices related to complementary feeding. Community-based breast-feeding programmes should continue to promote exclusive breast-feeding and develop strategies to support working mothers.
Late prehistoric archaeological research in Myanmar is in a phase of rapid expansion. Recent work by the Mission Archéologique Française au Myanmar aims to establish a reliable Neolithic to Iron Age culture-historical sequence, which can then be compared to surrounding regions of Southeast Asia. Excavations at Nyaung'gan and Oakaie in central Myanmar have provided 52 new AMS dates, which allow the creation of Myanmar's first reliable prehistoric radiometric chronology. They have also identified the Neolithic to Bronze Age transition in central Myanmar, which is of critical importance in understanding long-range interactions at the national, regional and inter-regional level. This research provides the first significant step towards placing late prehistoric Myanmar in its global context.
To determine the incidence and risk factors associated with Clostridium difficile colonization among residents of nursing homes and to identify the ribotypes of circulating C. difficile strains.
A prospective cohort study with a follow-up duration of 22 months.
Of the 375 residents in 8 nursing homes, 300 residents (80.0%) participated in the study. A further prospective study of 4 nursing homes involving 141 residents with a minimum of 90 days of follow-up was also performed.
Baseline and 90-day stool cultures were obtained; additional stool cultures were obtained for residents who had been discharged from hospitals. Polymerase chain reaction (PCR) ribotyping and slpA typing were performed for all C. difficile strains isolated.
Toxigenic C. difficile was isolated in 30 residents (10%) at baseline, and 9 residents (7.3%) had acquired toxigenic C. difficile in the nursing homes. The presence of nasogastric tube was an independent risk factor (adjusted odds ratio, 8.59; 95% confidence interval, 1.18–62.53; P=.034) for C. difficile colonization. The Kaplan-Meier estimate of median carriage duration was 13 weeks. The C. difficile ribotypes most commonly identified were 002 (40.8%), 014 (16.9%), 029 (9.9%), and 053 (8.5%).
The high incidence of C. difficile colonization and the overrepresentation of C. difficile ribotype 002 confirmed the contribution of nursing home residents to C. difficile transmission across the continuum of care. An infection control program is needed in long-term care.