Therapeutic upper gastrointestinal endoscopy in children : An audit of 443 procedures and literature review

The safety, effectiveness and capabilities of therapeutic upper fibreoptic endoscopy in children undergoing therapeutic endoscopic procedures (n = 443) was studied. Therapy for gastrointestinal bleeding formed the major group (injection sclerotherapy for varices, n = 197 procedures; thermocoagulation for haemorrhagic gastritis, n = 1; and photocoaulation for Dieulafoy's disease, n = 1). Sclerotherapy was 97% effective in controlling acute bleeding and 84% effective in obliterating varices with no serious complications or deaths. Oesophageal dilatations for surgical, caustic, congenital and peptic strictures and achalasia (n = 193) were performed with no oesophageal perforations or deaths. Foreign bodies were retrieved (n = 34) with no failures or complications. Percutaneous endoscopic gastrostomy was performed (n = 11) with one failure, proceeding to an unsuccessful surgical gastrostomy. Miscellaneous procedures included endoscopic transpyloric tube placement (n = 5) and endoscopic diathermy of pyloric web (n = 1). Therapeutic fibreoptic endoscopy is therefore concluded to be safe and effective in children, replacing rigid oesophagoscopy and some traditional surgical approaches.

Tarsal tunnel syndrome: A narrative literature review

Background Tarsal tunnel syndrome is classified as a focal compressive neuropathy of the posterior tibial nerve or one of its associated branches individually or collectively. The tunnel courses deep to fascia, the flexor retinaculum and within the abductor hallucis muscle of the foot/ankle. The condition is rare and regularly under-diagnosed leading to a range of symptoms affecting the plantar margins of the foot. There are many intervention strategies for treating tarsal tunnel syndrome with limited robust evidence to guide the clinical management of this condition. The role of conservative versus surgical interventions at various stages of the disease process remains unclear, and there is a need for a structured, step-wise approach in treating patients with this syndrome based on derived empirical evidence. This narrative review attempts to scrutinize the literature to date by clarifying initial presentation, investigations and definitive treatment for the purpose of assisting future informed clinical decision and prospective research endeavours. Process The literature searches that have been incorporated in compiling a rigorous review of this condition have included: the Cochrane Neuromuscular Group's Specialized Register (Cochrane Library 2013), the databases of EMBASE, AMED, MEDLINE, CINAHL, Physiotherapy evidence database (PEDRO), Biomed Central, Science Direct and Trip Database (1972 to the present). Reference listings of located articles were also searched and scrutinized. Authors and experts within the field of lower-limb orthopaedics were contacted to discuss applicable data. Subject-specific criteria searches utilizing the following key terms were performed across all databases: tarsal tunnel syndrome, tibial neuralgia, compression neuropathy syndromes, tibial nerve impingement, tarsal tunnel neuropathy, entrapment tibial nerve, posterior tibial neuropathy. These search strategies were modified with differing databases, adopting specific sensitivity-searching tools and functions unique to each. This search strategy identified 88 journal articles of relevance for this narrative literature review. Findings This literature review has appraised the clinical significance of tarsal tunnel syndrome, whilst assessing varied management interventions (non-surgical and surgical) for the treatment of this condition in both adults and children. According to our review, there is limited high-level robust evidence to guide and refine the clinical management of tarsal tunnel syndrome. Requirements for small-scaled randomized controlled trials in groups with homogenous aetiology are needed to analyse the effectiveness of specific treatment modalities. Conclusions It is necessary that further research endeavours be pursued for the clinical understanding, assessment and treatment of tarsal tunnel syndrome. Accordingly, a structured approach to managing patients who have been correctly diagnosed with this condition should be formulated on the basis of empirical evidence where possible.

May the best Tweeter win : The Twitter strategies of key campaign accounts in the 2012 US election

The 2008 US election has been heralded as the first presidential election of the social media era, but took place at a time when social media were still in a state of comparative infancy; so much so that the most important platform was not Facebook or Twitter, but the purpose-built campaign site my.barackobama.com, which became the central vehicle for the most successful electoral fundraising campaign in American history. By 2012, the social media landscape had changed: Facebook and, to a somewhat lesser extent, Twitter are now well-established as the leading social media platforms in the United States, and were used extensively by the campaign organisations of both candidates. As third-party spaces controlled by independent commercial entities, however, their use necessarily differs from that of home-grown, party-controlled sites: from the point of view of the platform itself, a @BarackObama or @MittRomney is technically no different from any other account, except for the very high follower count and an exceptional volume of @mentions. In spite of the significant social media experience which Democrat and Republican campaign strategists had already accumulated during the 2008 campaign, therefore, the translation of such experience to the use of Facebook and Twitter in their 2012 incarnations still required a substantial amount of new work, experimentation, and evaluation. This chapter examines the Twitter strategies of the leading accounts operated by both campaign headquarters: the ‘personal’ candidate accounts @BarackObama and @MittRomney as well as @JoeBiden and @PaulRyanVP, and the campaign accounts @Obama2012 and @TeamRomney. Drawing on datasets which capture all tweets from and at these accounts during the final months of the campaign (from early September 2012 to the immediate aftermath of the election night), we reconstruct the campaigns’ approaches to using Twitter for electioneering from the quantitative and qualitative patterns of their activities, and explore the resonance which these accounts have found with the wider Twitter userbase. A particular focus of our investigation in this context will be on the tweeting styles of these accounts: the mixture of original messages, @replies, and retweets, and the level and nature of engagement with everyday Twitter followers. We will examine whether the accounts chose to respond (by @replying) to the messages of support or criticism which were directed at them, whether they retweeted any such messages (and whether there was any preferential retweeting of influential or – alternatively – demonstratively ordinary users), and/or whether they were used mainly to broadcast and disseminate prepared campaign messages. Our analysis will highlight any significant differences between the accounts we examine, trace changes in style over the course of the final campaign months, and correlate such stylistic differences with the respective electoral positioning of the candidates. Further, we examine the use of these accounts during moments of heightened attention (such as the presidential and vice-presidential debates, or in the context of controversies such as that caused by the publication of the Romney “47%” video; additional case studies may emerge over the remainder of the campaign) to explore how they were used to present or defend key talking points, and exploit or avert damage from campaign gaffes. A complementary analysis of the messages directed at the campaign accounts (in the form of @replies or retweets) will also provide further evidence for the extent to which these talking points were picked up and disseminated by the wider Twitter population. Finally, we also explore the use of external materials (links to articles, images, videos, and other content on the campaign sites themselves, in the mainstream media, or on other platforms) by the campaign accounts, and the resonance which these materials had with the wider follower base of these accounts. This provides an indication of the integration of Twitter into the overall campaigning process, by highlighting how the platform was used as a means of encouraging the viral spread of campaign propaganda (such as advertising materials) or of directing user attention towards favourable media coverage. By building on comprehensive, large datasets of Twitter activity (as of early October, our combined datasets comprise some 3.8 million tweets) which we process and analyse using custom-designed social media analytics tools, and by using our initial quantitative analysis to guide further qualitative evaluation of Twitter activity around these campaign accounts, we are able to provide an in-depth picture of the use of Twitter in political campaigning during the 2012 US election which will provide detailed new insights social media use in contemporary elections. This analysis will then also be able to serve as a touchstone for the analysis of social media use in subsequent elections, in the USA as well as in other developed nations where Twitter and other social media platforms are utilised in electioneering.

Nursing fever management in adult oncology patients: A literature review

Fever associated with neutropenia, blood transfusion and disease processes is common in adult cancer patients. The literature indicates however that the aetiology, rationale and symptoms of fever are often misunderstood, resulting in fever management that is not evidence-based in this cohort. Thus in this review, an overview of fever, with a focus on fever in cancer contexts, is provided. Content includes an explanation of the therapeutic function of fever, an analysis of the physiological consequences of fever and an exploration of the aetiology of fever in cancer patients. Current guidelines for fever management in cancer patients and existing nursing practice are also discussed.

Digital innovation in social marketing: A systematic literature of interventions using digital channels for engagement

Social marketing uses commercial marketing techniques to deliver interventions for social benefit in order to improve quality of life for individuals and communities. Behaviour change is the primary objective of social marketing interventions (Andreasen 2002). The aim of this systematic review is to provide insight into social marketing interventions and their evaluations published in peer-reviewed journals so as to identify the key elements of social marketing employed by these interventions. as well as understand the use of digital channels for engagement.

Reading the Texture of Reality : Chaos Theory, Literature and the Humanist Perspective

Tutkimuksessa analysoidaan kaaosteorian vaikutusta kaunokirjallisuudessa ja kirjallisuudentutkimuksessa ja esitetään, että kaaosteorian roolia kirjallisuuden kentällä voidaan parhaiten ymmärtää sen avaamien käsitteiden kautta. Suoran soveltamisen sijaan kaaosteorian avulla on käyty uudenlaisia keskusteluja vanhoista aiheista ja luonnontieteestä ammennetut käsitteet ovat johtaneet aiemmin tukkeutuneiden argumenttien avaamiseen uudesta näkökulmasta käsin. Väitöskirjassa keskitytään kolmeen osa-alueeseen: kaunokirjallisen teoksen rakenteen teoretisointiin, ihmisen (erityisesti tekijän) identiteetin hahmottamiseen ja kuvailemiseen sekä fiktion ja todellisuuden suhteen pohdintaan. Tutkimuksen tarkoituksena on osoittaa, kuinka kaaosteorian kautta näitä aiheita on lähestytty niin kirjallisuustieteessä kuin kaunokirjallisissa teoksissakin. Väitöskirjan keskiössä ovat romaanikirjailija John Barthin, dramatisti Tom Stoppardin ja runoilija Jorie Grahamin teosten analyysit. Nämä kirjailijat ammentavat kaaosteoriasta keinoja käsitteellistää rakenteita, jotka ovat yhtä aikaa dynaamisia prosesseja ja hahmotettavia muotoja. Kaunokirjallisina teemoina nousevat esiin myös ihmisen paradoksaalisesti tunnistettava ja aina muuttuva identiteetti sekä lopullista haltuunottoa pakeneva, mutta silti kiehtova ja tavoiteltava todellisuus. Näiden kirjailijoiden teosten analyysin sekä teoreettisen keskustelun kautta väitöskirjassa tuodaan esiin aiemmassa tutkimuksessa varjoon jäänyt, koherenssia, ymmärrettävyyttä ja realismia painottava humanistinen näkökulma kaaosteorian merkityksestä kirjallisuudessa.

Rhetoric and Representation : Exploring the Cultural Meaning of the Natural Sciences in Contemporary Popular Science Writing and Literature

Kirjallisuuden- ja kulttuurintutkimus on viimeisten kolmen vuosikymmenen aikana tullut yhä enenevässä määrin tietoiseksi tieteen ja taiteen suhteen monimutkaisesta luonteesta. Nykyään näiden kahden kulttuurin tutkimus muodostaa oman kenttänsä, jolla niiden suhdetta tarkastellaan ennen kaikkea dynaamisena vuorovaikutuksena, joka heijastaa kulttuurimme kieltä, arvoja ja ideologisia sisältöjä. Toisin kuin aiemmat näkemykset, jotka pitävät tiedettä ja taidetta toisilleen enemmän tai vähemmän vastakkaisina pyrkimyksinä, nykytutkimus lähtee oletuksesta, jonka mukaan ne ovat kulttuurillisesti rakentuneita diskursseja, jotka kohtaavat usein samankaltaisia todellisuuden mallintamiseen liittyviä ongelmia, vaikka niiden käyttämät metodit eroavatkin toisistaan. Väitöskirjani keskittyy yllä mainitun suhteen osa-alueista popularisoidun tietokirjallisuuden (muun muassa Paul Davies, James Gleick ja Richard Dawkins) käyttämän kielen ja luonnontieteistä ideoita ammentavan kaunokirjallisuuden (muun muassa Jeanette Winterson, Tom Stoppard ja Richard Powers) hyödyntämien keinojen tarkasteluun nojautuen yli 30 teoksen kattavaa aineistoa koskevaan tyylin ja teemojen tekstianalyysiin. Populaarin tietokirjallisuuden osalta tarkoituksenani on osoittaa, että sen käyttämä kieli rakentuu huomattavassa määrin sellaisille rakenteille, jotka tarjoavat mahdollisuuden esittää todellisuutta koskevia argumentteja mahdollisimman vakuuttavalla tavalla. Tässä tehtävässä monilla klassisen retoriikan määrittelemillä kuvioilla on tärkeä rooli, koska ne auttavat liittämään sanotun sisällön ja muodon tiukasti toisiinsa: retoristen kuvioiden käyttö ei näin ollen edusta pelkkää tyylikeinoa, vaan se myös usein kiteyttää argumenttien taustalla olevat tieteenfilosofiset olettamukset ja auttaa vakiinnuttamaan argumentoinnin logiikan. Koska monet aikaisemmin ilmestyneistä tutkimuksista ovat keskittyneet pelkästään metaforan rooliin tieteellisissä argumenteissa, tämä väitöskirja pyrkii laajentamaan tutkimuskenttää analysoimalla myös toisenlaisten kuvioiden käyttöä. Osoitan myös, että retoristen kuvioiden käyttö muodostaa yhtymäkohdan tieteellisiä ideoita hyödyntävään kaunokirjallisuuteen. Siinä missä popularisoitu tiede käyttää retoriikkaa vahvistaakseen sekä argumentatiivisia että kaunokirjallisia ominaisuuksiaan, kuvaa tällainen sanataide tiedettä tavoilla, jotka usein heijastelevat tietokirjallisuuden kielellisiä rakenteita. Toisaalta on myös mahdollista nähdä, miten kaunokirjallisuuden keinot heijastuvat popularisoidun tieteen kerrontatapoihin ja kieleen todistaen kahden kulttuurin dynaamisesta vuorovaikutuksesta. Nykyaikaisen populaaritieteen retoristen elementtien ja kaunokirjallisuuden keinojen vertailu näyttää lisäksi, kuinka tiede ja taide osallistuvat keskusteluun kulttuurimme tiettyjen peruskäsitteiden kuten identiteetin, tiedon ja ajan merkityksestä. Tällä tavoin on mahdollista nähdä, että molemmat ovat perustavanlaatuisia osia merkityksenantoprosessissa, jonka kautta niin tieteelliset ideat kuin ihmiselämän suuret kysymyksetkin saavat kulttuurillisesti rakentuneen merkityksensä.

The North in the Old English Orosius : A Geographical Narrative in Context

This doctoral dissertation examines the description of the North as it appears in the Old English Orosius (OE Or.) in the form of the travel accounts by Ohthere and Wulfstan and a catalogue of peoples of Germania. The description is discussed in the context of ancient and early medieval textual and cartographic descriptions of the North, with a special emphasis on Anglo-Saxon sources and the intellectual context of the reign of King Alfred (871-899). This is the first time that these sources, a multidisciplinary approach and secondary literature, also from Scandinavia and Finland, have been brought together. The discussion is source-based, and archaeological theories and geographical ideas are used to support the primary evidence. This study belongs to the disciplines of early medieval literature and (cultural) history, Anglo-Saxon studies, English philology, and historical geography. The OE Or. was probably part of Alfred s educational campaign, which conveyed royal ideology to the contemporary elite. The accounts and catalogue are original interpolations which represent a unique historical source for the Viking Age. They contain unparalleled information about peoples and places in Fennoscandia and the southern Baltic and sailing voyages to the White Sea, the Danish lands, and the Lower Vistula. The historical-philological analysis reveals an emphasis on wealth and property, rank, luxury goods, settlement patterns, and territorial divisions. Trade is strongly implied by the mentions of central places and northern products, such as walrus ivory. The references to such peoples as the Finnas, the Cwenas, and the Beormas appear in connection with information about geography and subsistence in the far North. Many of the topics in the accounts relate to Anglo-Saxon aristocratic culture and interests. The accounts focus on the areas associated with the Northmen, the Danes and the Este. These areas resonated in the Anglo-Saxon geographical imagination: they were curious about the northern margin of the world, their own continental ancestry and the geography of their homeland of Angeln, and they had an interest in the Goths and their connection with the southern Baltic in mythogeography. The non-judgemental representation of the North as generally peaceful and relatively normal place is related to Alfredian and Orosian ideas about the unity and spreading of Christendom, and to desires for unity among the Germani and for peace with the Vikings, who were settling in England. These intellectual contexts reflect the innovative and organizational forces of Alfred s reign. The description of the North in the OE Or. can be located in the context of the Anglo-Saxon worldview and geographical mindset. It mirrors the geographical curiosity expressed in other Anglo-Saxon sources, such as the poem Widsith and the Anglo-Saxon mappa mundi. The northern section of this early eleventh-century world map is analyzed in detail here for the first time. It is suggested that the section depicts the North Atlantic and the Scandinavian Peninsula. The survey of ancient and early medieval sources provides a comparative context for the OE Or. In this material, produced by such authors as Strabo, Pliny, Tacitus, Jordanes, and Rimbert, the significance of the North was related to the search for and definition of the northern edge of the world, universal accounts of the world, the northern homeland in the origin stories of the gentes, and Carolingian expansion and missionary activity. These frameworks were transmitted to Anglo-Saxon literary culture, where the North occurs in the context of the definition of Britain s place in the world.

Toward Figural Fantasy : The Representation of Consciousness in Modern American Fantasy Literature

Tajunnanesitys amerikkalaisessa heterodiegeettisessä fantasiakirjallisuudessa on muuttunut merkittävästi viimeisen kolmen vuosikymmenen aikana: kerrontaa orientoiva ja tarinamaailmaa havainnoiva tajunta on vähin erin vaihtunut kaikkitietävästä kertojasta tarinan sisäiseksi henkilöhahmoksi. Kertoja on samalla vetäytynyt yhä syvemmälle kerronnan kulissien taakse. Tämä tutkielma hahmottaa ja analysoi kyseistä muutosta siirtymänä kertojakeskeisestä kerronnasta kohti henkilökeskeistä kerrontaa. Tutkielmassa tajunnanesityksen teoreettisen kehyksen muodostavat F. K. Stanzelin kertojakeskeisen ja henkilökeskeisen kerrontatilanteen käsitteet. Kerrontatilanteita tarkennetaan fokalisaation, vapaan epäsuoran esityksen, sisäisen monologin ja psykonarraation teorioiden avulla. Tutkielma jakaantuu kahteen osaan. Ensimmäisessä osassa vertaillaan kahta prototyyppistä fantasiaromaania syväluotaavan narratologisen analyysin keinoin. Kertojakeskeistä kerrontaa edustaa Fritz Leiberin "The Swords of Lankhmar" (1968) ja henkilökeskeistä kerrontaa George R. R. Martinin "A Game of Thrones" (1996). Toisessa osassa tarkastellaan pääpiirteittäin kuuttatoista muuta aikaansa edustavaa fantasiaromaania ja hahmotetaan tajunnanesityksen muutoksen kronologista kulkua. Yhdessä osat ilmentävät, kuinka amerikkalainen heterodiegeettinen fantasiakirjallisuus on muuttunut kerrontateknisesti henkilökeskeisemmäksi. Tutkielma on ensimmäinen laatuaan, ja sen on tarkoitus luoda pohjaa uudenlaiselle modernin fantasiakirjallisuuden tutkimukselle ja kirjalliselle arvostukselle.

Workplace acceptance and experiences of LGBTIQ health professionals: A systematic literature review

Background The purpose of this study was to explore the workplace acceptance and experiences of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) paramedics. Methods A systematic search of academic databases and reference lists from selected papers were the sources of the data. Inclusion criteria were research papers published in English, which focused on workplace acceptance and experiences of LGBTIQ health personnel. Results The initial focus of this systematic review was the workplace acceptance and experiences of LGBTIQ paramedics. However due to no published research specific to the paramedic profession the scope of the review was broadened to include of all LGBTIQ health personnel. Thirty-three papers were included in this review. Evidence indicated that LGBTIQ health professionals experienced discrimination from their patients, heterosexual colleagues and ‘closeted’ LGBTIQ peers. Positive contribution of LGBTIQ health professionals include improved patient care and role models for LGBTIQ peers. Inclusive policy is required for LGBTIQ health professional workforce retention. Conclusions The paramedic workforce is known to be a high risk occupational group for post-traumatic stress disorder and depression. Theoretically, LGBTIQ paramedics working in a heteronormative culture experience increased level of stress. While LGBTIQ health professionals receive legislative protection against discrimination, discrimination still exists in practice through lack of visibility. Effective and efficient integration of LGBTIQ health professionals could improve workplace satisfaction, workforce retention, and equity of access by marginalised groups. An inclusive workplace policy of LGBTIQ embraces and celebrates the value of diversity.

Double-Edged Imitation : Theories and Practices of Pastiche in Literature

This study concentrates on the contested concept of pastiche in literary studies. It offers the first detailed examination of the history of the concept from its origins in the seventeenth century to the present, showing how pastiche emerged as a critical concept in interaction with the emerging conception of authorial originality and the copyright laws protecting it. One of the key results of this investigation is the contextualisation of the postmodern debate on pastiche. Even though postmodern critics often emphasise the radical novelty of pastiche, they in fact resuscitate older positions and arguments without necessarily reflecting on their historical conditions. This historical background is then used to analyse the distinction between the primarily French conception of pastiche as the imitation of style and the postmodern notion of it as the compilation of different elements. The latter s vagueness and inclusiveness detracts from its value as a critical concept. The study thus concentrates on the notion of stylistic pastiche, challenging the widespread prejudice that it is merely an indication of lack of talent. Because it is multiply based on repetition, pastiche is in fact a highly ambiguous or double-edged practice that calls into question the distinction between repetition and original, thereby undermining the received notion of individual unique authorship as a fundamental aesthetic value. Pastiche does not, however, constitute a radical upheaval of the basic assumptions on which the present institution of literature relies, since, in order to mark its difference, pastiche always refers to a source outside itself against which its difference is measured. Finally, the theoretical analysis of pastiche is applied to literary works. The pastiches written by Marcel Proust demonstrate how it can become an integral part of a writer s poetics: imitation of style is shown to provide Proust with a way of exploring the role of style as a connecting point between inner vision and reality. The pastiches of the Sherlock Holmes stories by Michael Dibdin, Nicholas Meyer and the duo Adrian Conan Doyle and John Dickson Carr illustrate the functions of pastiche within a genre detective fiction that is itself fundamentally repetitive. A.S. Byatt s Possession and D.M. Thomas s Charlotte use Victorian pastiches to investigate the conditions of literary creation in the age of postmodern suspicion of creativity and individuality. The study thus argues that the concept of pastiche has valuable insights to offer to literary criticism and theory, and that literary pastiches, though often dismissed in reviews and criticism, are a particularly interesting object of study precisely because of their characteristic ambiguity.