To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Antibiotics are frequently prescribed inappropriately for acute respiratory infections in the outpatient setting. We report the implementation of a multifaceted outpatient antimicrobial stewardship initiative resulting in a 12.3% absolute reduction of antibiotic prescribing for acute bronchitis in primary care clinics receiving active interventions.
Cyanotic CHD is one of many disorders in paediatrics that influence the health of children in different clinical aspects. One of the fundamental aspects that may be affected is bone mineral density.
The aim of our study is to assess bone mineral density in children with congenital cyanotic heart disease of different anatomical diagnoses.
Cross-sectional, observational study included 39 patients (20 males) with congenital cyanotic heart disease of different anatomical diagnoses following with the cardiology clinic in Mansoura University children’s hospital. All patients were subjected to anthropometric measures, oxygen saturation assessment, and lumber bone mineral density using dual-energy X-ray absorptiometry.
Six patients (15.4%) out of the 39 included patients showed bone mineral density reduction, 13 patients (33.3%) showed bone mineral density with Z-score between −1 and −2, while 20 patients (51.3%) showed bone mineral density with Z-score more than −1.
Low bone mineral density can be found in children with cyanotic CHD, making it important to consider bone mineral density assessment and early treatment if needed to avoid further complications.
This study examined the effects of zinc chloride (ZnCl2) and sodium selenite (Na2SeO3) supplementation in maturation medium on in vitro maturation (IVM) rate, oxidative biomarkers and gene expression in buffalo oocytes. Ovaries from a slaughterhouse were aspirated and good quality cumulus–oocyte complexes (COCs) with at least four layers of compact cumulus cells and evenly granulated dark ooplasm were selected. COCs were randomly allocated during IVM (22 h) to one of four treatment groups: (1) control maturation medium (basic medium), or basic medium supplemented with (2) ZnCl2 (1.5 µg/ml), (3) Na2SeO3 (5 µg/l), or (4) ZnCl2 + Na2SeO3 (1.5 µg/ml + 5 µg/l, respectively). Oocytes were denuded after 22 h of IVM in the first four replicates. Specimens were fixed and stained to evaluate the stage of nuclear maturation. The spent medium was collected for biochemical assays of total antioxidant capacity (TAC), malondialdehyde (MDA) and hydrogen peroxide concentrations. A second four replicates were used for COCs for RNA extraction. The expression levels of antioxidant (SOD1, GPX4, CAT and PRDX1), antiapoptotic (BCL2 and BCL-XL) and proapoptotic (BAX and BID) genes were measured. Supplementation with ZnCl2 and Na2SeO3 during IVM increased the ratio of oocytes reaching metaphase II at 22 h, increased TAC and decreased MDA and H2O2 concentrations in the maturation medium (P < 0.05). Moreover, beneficial effects were associated with complementary changes in expression patterns of antioxidative, antiapoptotic and proapoptotic genes, suggesting lower oxidative stress and apoptosis. Supplementation medium with zinc chloride and sodium selenite improves the maturation rate, reduces oxidative stress and increases expression levels of antioxidative and antiapoptotic genes.
Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80 % of households are moderately or severely food insecure. For people with HIV (PWH), food insecurity is associated with poor antiretroviral therapy adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge.
The current study examines the factor structure of the nine-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model.
Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA.
Participants (n 440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorised as severely (n 250, 56·82 %) or moderately (n 107, 24·32 %) food insecure in the past 30 d.
Revised parallel analysis suggested a three-factor structure, which was inadmissible. A two-factor structure was examined but did not adequately fit the data. A two-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (comparative fit index = 0·995, standardised root mean square residual = 0·019). The two specific factors identified were: anxiety/insufficient quality and no food intake. Reliability was adequate (ω = 0·82).
Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilised in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.
Since April 2004, Government policy in England upholds that clinicians should send copies of their clinical letters to their patients. However, some argue that patients already have the right to access their records under the Data Protection Act, 1998. Others suggest it wiser not to provide a letter in certain circumstances. Little evidence is available examining the factors that impact on and underlie patients’ views in relation to this.
To inform professionals about patients’ views on receiving clinical letters.
To establish the proportion and characteristics of patients who would like to receive clinical letters and to elicit underlying reasons for decisions.
Subjects were randomly sampled from an outpatient clinic and data collected using an 11-item questionnaire, between October 2010 and July 2013.
The majority (60%) of patients wished to receive their clinical letter. Most (62%) favoured wanting to know about treatment primarily. Of those who did not wish to have a copy, greatest concerns were of loss in the post and ‘unnecessary paperwork’ (each 11%). This group of patients were characteristically male, aged 61-80, of asian ethnicity, unmarried and unemployed. Patients with a diagnosis of adult personality and behaviour (ICD-10 F60-69) were most likely to opt to receive their clinical letter.
Although the majority preferred to receive clinical letters, reasons for preferences varied widely. With an increasing drive towards greater transparency in the health service, approaches to enhancing patient involvement will need to be flexible to the individual to enable truly meaningful patient participation.
Opening of C.E.P.P.D (Center for Emotional, Personal and Professional Development). Almost every child in the world joins school and as per policy and procedures school staff/teachers develop their educational level but emotional health is not in focus at all; therefore child raised up with many severe negative and self-defeating behaviors; they understand others but others not understand them and that's the beginning all problems start from here…. The Center will provide state of the art guidelines/guidance (one stop solutions) supporting facilities starting from schooling onward throughout entire life for people belongs to all walks of life. In these centers anyone can go and will come out with clear head and in hand solutions, team of professionals shall provide guidance and support to everyone for healthy and balanced life by all means and will also develop alumni networking for permanent intact and fund raising on continuous basis from all over the world. C.E.P.P.D will play central and synergizing role between all sectors (for instance, schools, colleges, universities, counseling, vocational, community, hospitals, NGOs, mental and emotional health centers, child up-bringing, parenting, career counseling, soft skills training's; likewise list is on.... along with financial assistance from Govt. and semi-government sectors, will share implementation details as needed/at the time of symposium/brain storming sessions. These centers will become surely The turning point center in city than progress in next cities; likewise in country than at global level and yes together positively we can set landmark by mainly utilizing the medium of education and guidance.
Disclosure of interest
The author has not supplied his declaration of competing interest.
To assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy.
A prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients.
Cholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001).
Diffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.