The evaluation and management of neonatal brachial plexus palsy

Neonatal brachial plexus palsy presents at birth and can be a debilitating condition with long-term consequences. Presentation at birth depends on the extent of nerve injury, and can vary from transient weakness to global paresis, with active range of motion affected. Serial clinical examination after birth and during the neonatal period (first month of life) is crucial to assess recovery and predicts long-term outcomes. This position statement guides the evaluation of neonates for risk factors at birth, early referral to a multidisciplinary specialized team, and ongoing communication between community providers and specialists to optimize childhood outcomes.

Research Trends and Hotspots of Extracorporeal Membrane Oxygenation: A 10-Year Bibliometric Study and Visualization Analysis

Objective: To determine the research hotspots and trends in the field of extracorporeal membrane oxygenation (ECMO), and to provide a reference for further and wider research in the future.Methods: The literatures on ECMO from January 2011 to July 2021 in the Web of Science Core Collection (WOSCC) database were searched, and Citespace5.8.R1 software was used to conduct bibliographic and visual analysis on the literature by country, institution, author and keywords.Results: A total of 5,986 articles were enrolled. According to an observation, the number of articles published in the past decade has increased, especially from 2019 to 2020. The USA had the largest number of publications, while less ECMO related studies were conducted among non-developed countries. The University of Michigan (Univ Michigan) was the institution that had the largest number of publications and the highest centrality, and Daniel B was the author who had the largest number of publications. However, more inter-institutional cooperation among author teams was needed. The focus of existing ECMO research has primarily been on the treatment of patients suffering from severe cardiopulmonary failure, and the prevention and management of complications during the application ECMO.Conclusion: Inter-regional and inter-institutional cooperation and exchanges should be carried out among ECMO research teams and institutions. The suggested research direction is to further broaden the application scope of ECMO, while determining the ways to reduce the incidence of complications and the cost, cultivate specialized team talents, and promote the application thereof.

MPEP Scorecard: A New Quantitative Approach to Measure Project's Maturity in Medco EP Indonesia

Oil & gas companies in Indonesia continue to struggle in executing their projects due to highly volatile oil price, lower demand and marginal field developments. Consequently, these companies need to be as prudent as possible in investing their limited resources to the selected projects in their portfolio. In order to face this challenge, MedcoEnergi developed a tool called Medco Project Excellence Process (MPEP) Scorecard to effectively measure the maturity of all of its major projects using a quantitative approach. The application of this tool can greatly help MedcoEnergi in deciding which projects to execute or which projects to hold, and therefore enabled the company to maximize its returns from its oil and gas projects portfolio. The paper presents the design of the MPEP Scorecard and how the tool is applied. The application of the tool is integrated with the gate review which is held when the project wants to proceed to its next stage. The project assurance committee which is a specialized team consist of experts from engineering, subsurface, drilling, commercial, etc., will review the projects deliverables during this gate review and the tool will allow them to assign a “score” based on their assessment and their discussion with the project team. There will be an individual score for each discipline and these scores will be used as inputs to calculate a single (overall) score that can accurately represents the project’s maturity. Currently, MPEP Scorecard has already been applied to the major capital projects in MedcoEnergi and the results have been presented to the senior management. Based on their feedbacks, it is agreed that the tool can give a much clearer picture on the project’s current condition, significantly help them in making the go/no go decision and enables them to create the most optimum investment strategy.

Innovative tracking, active search and follow-up strategies for new leprosy cases in the female prison population

Background Regarding the leprosy transmission through the upper airways, overcrowded locations such as prisons can become a risk to get sick. Like the leprosy hidden endemic demonstrated in male prison population, being interesting to assess the leprosy scene also among confined women. Methods A prospective descriptive study conducted at Female Penitentiary, Brazil. Leprosy Suspicion Questionnaire (LSQ) were applied to the participants, and submitted to specialized dermatoneurological exam, peripheral nerve ultrasonography, and anti-PGL-I serology. Findings 404 female inmates were evaluated, 14 new cases were diagnosed (LG-leprosy group), a new case detection rate (NCDR) of 3.4%, 13 multibacillary, while another 390 constituted the Non-Leprosy group (NLG). Leprosy cases were followed up during multidrug therapy with clinical improvement. The confinement time median was 31 months in LG, similar to NLG, less than the time of leprosy incubation. Regarding LSQ, the neurological symptoms reached the highest x2 values as Q1–numbness (5.6), Q3–anesthetizes areas in the skin (7.5), Q5–Stinging sensation (5.8), and Q7–pain in the nerves (34.7), while Q4-spots on the skin was 4.94. When more than one question were marked in the LSQ means a 12.8-fold higher to have the disease than a subject who marked only one or none. The high 34% rate of anti-PGL-I seropositivity in the penitentiary, higher levels in LG than NLG. Three additional leprosy cases each were diagnosed on the second (n = 66) and third (n = 14) reevaluations 18 and 36 months after the initial one. Semmes-Weinstein monofilaments demonstrated lower limbs (32.2%) more affected than the upper limbs (25%) with improvement during the follow-up. Interpretation The NCDR in this population showed an hidden endemic of leprosy as well as the efficacy of a search action on the part of a specialized team with the aid of the LSQ and anti-PGL-I serology as an auxiliary tracking tools.

Analysis of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation in the Kyrgyz Republic and ways to increase treatment adherencе

Aim. To analyze anticoagulant therapy in elderly patients with non-valvular atrial fibrillation and ways to increase adherence in the work of a specialized team. Methods. The study followed 250 patients with non-valvular atrial fibrillation aged 65 to 74 years (mean age 70.74.39 years). The patients were divided into three groups: the first group included 105 people, who were prescribed warfarin in a retrospective study; the second group 57 people treated with rivaroxaban, and the third group 88 people treated with warfarin. The second and third groups were prospective study groups which were supervised by a specialized team of physicians. The groups were matched on sex and age, comorbidities. Statistical data analysis and mathematical processing were performed by using the methods of descriptive and variational statistics. Most parameters reported as absolute values and percentages, while quantitative data the 25th and 75th percentiles. Results. All patients included in the study had a high risk of developing thromboembolic complications by their CHA2DS2-VASc score (2) and a low risk of developing hemorrhagic complications on the HAS-BLED scale (average score 1.490.04). They were prescribed anticoagulant therapy. By the end of the year follow-up from the start of anticoagulant therapy, only 9.5% of patients were treatment adherent, in the second group 43.8%, in the third group 70.5% of patients. The reason for refusing to take warfarin in the vast majority of cases was the inability to control the international normalized ratio, medical contraindications, and the high cost of the drug in prescribing rivaroxaban. The results showed that the majority of patients with atrial fibrillation (90.5%) receive inadequate antithrombotic therapy in routine outpatient clinical practice. At the same time, in a very small number of patients (9.5%) receiving warfarin, this type of therapy can be considered adequate (60% or more of the stay time in the therapeutic range of international normalized ratio of 2.0 to 3.0). Conclusion. Anticoagulant therapy prescription under the supervision of a specialized team contributes to a significant improvement in treatment adherence (from 43.8 to 70.5%); promising in the future is the use of drugs from the group of new oral anticoagulants that do not require routine monitoring of coagulogram.

Antithrombotic Therapy in Elderly Patients with Atrial Fibrillation: The State of the Problem in the Real Clinical Practice of a Family Medicine Doctor

Introduction. The research aimed at studying the efficacy and safety of anticoagulant therapy in patients with atrial fibrillation (AF), especially in older age groups, is now increasingly relevant.The aim of the study is to analyze the situation with prescribing anticoagulant therapy in elderly and senile persons with atrial fibrillation in real clinical practice and to demonstrate the possibility of improving the quality of observation and management of a group of patients as part of the work of a specialized team.Materials and methods. A total of 2,770 medical records of outpatient patients with atrial fibrillation were studied for the period from 2017 to 2019. Of this number, 320 patients with AF of nonvalvular etiology were selected, the average age of which was 70.3 ± 8.15 years. There were 270 women and 50 men. An observational prospective study in 45 elderly and senile patients with AF of non-valvular etiology was carried out by a team of specialized doctors for 12 months.Results. Of the 301 patients, anticoagulant therapy was prescribed to 166 (55.1 %), of which only 17 (10.2 %) people received proper anticoagulant therapy. The excessive activity was observed in 114 (37.9 %) patients, who underwent antiplatelet therapy with aspirin, and 21 (7.0 %) patients remained without any treatment with anticoagulants nor antiplatelet agents. Although, in the case of both, prescribing aspirin and not prescribing, anticoagulants have been indicated. In the prospective part of the study (for 12 months), all 45 patients continued to take anticoagulants and were systematically monitored. The INR in the target range over 60 % of the time was achieved in 37 % of patients receiving warfarin therapy.Conclusion. In the actual clinical practice of Kyrgyzstan family medicine centers, older patients with atrial fibrillation receive inadequate antithrombotic therapy. The main drug of choice for specialists remains warfarin, a therapy that can be recognized as adequate only in a small number (16 %) of patients. The ability to improve the quality of surveillance and management of a group of patients with AF and high adherence to treatment was demonstrated by the work of a specialized team of doctors.

My choices are better than yours! Gender differences in narcissistic start-up entrepreneurs

PurposeThe paper explores the role of narcissism on entrepreneurs' decisions in terms of organizational choices, discussing gender differences. The aim relies in the influence that entrepreneurs' personality, capabilities and cognitive orientation have in the creation and management of start-ups.Design/methodology/approachAnalyzing an Italian sample of 207 entrepreneurs and using Analysis of variance (ANOVA) and generalized linear model methods, the hypotheses were tested to understand whether and how narcissism affects Research and development (R&D) expenditure, patent ownership and the presence of a specialized team in organizations led by women and men entrepreneurs.FindingsDifferences in the management and organizational choices of narcissistic women entrepreneurs compared to their men counterparts emerged. First, results show that women entrepreneurs are less narcissistic than men. Second, gender is shown to moderate the effect of narcissism on the choice of having a qualified team in a start-up. Third, narcissistic women entrepreneurs were found to engage less in risk-taking activities, such as R&D expenditure, and to patent their ideas more than their male counterparts.Originality/valueThe study expands the existing literature by applying a gendered lens to entrepreneurs' narcissism to investigate whether they behave and manage their start-ups differently.

Optimal Team Composition: Diversity to Foster Implicit Team Incentives

We study optimal team design. In our model, a principal assigns either heterogeneous agents to a team (a diverse team) or homogenous agents to a team (a specialized team) to perform repeated team production. We assume that specialized teams exhibit a productive substitutability (e.g., interchangeable efforts with decreasing returns to total effort), whereas diverse teams exhibit a productive complementarity (e.g., cross-functional teams). Diverse teams have an inherent advantage in fostering desirable implicit/relational incentives that team members can provide to each other (tacit cooperation). In contrast, specialization both complicates the provision of cooperative incentives by altering the punishment agents can impose on each other for short expected career horizons and fosters undesirable implicit incentives (tacit collusion) for long expected horizons. As a result, expected compensation is first decreasing and then increasing in the discount factor for specialized teams, while expected compensation is always decreasing in the discount factor for diverse teams. We use our results to develop empirical implications about the association between team tenure and team composition, pay-for-performance sensitivity, and team culture. This paper was accepted by Brian Bushee, accounting.

Paleontological rescue, depositional environment, and stratigraphic correlation of a section of the Ponta Grossa Formation (Paraná Basin)

The urban area of Ponta Grossa (PR) occurs on one of the most abundant fossiliferous fields in the country, which records an endemic fauna that occurred in the Devonian of the Paraná Basin. The growing urbanization of the city increasingly buries these outcrops, and new works must be accompanied by a specialized team to safeguard the paleontological heritage. This is the case of the Bosque Mistral project, which exposed many layers of the Ponta Grossa Formation, rich in fossils and trace fossils. This study reports the main fossiliferous occurrences in the section, correlates the section with classical outcrops from the literature, and interprets the main depositional environments as well stratigraphic cycles using an integrated analysis of sedimentology and ichnology. The ichnological distribution also evidences the retrogradation pattern, and, particularly, the occurrence of ichnofabrics dominated by Zoophycos at the top of the section is a signature of high-frequency cycles associated with the transgressive systems tract. Macrofossill biodiversity varies according to the facies, in the sandy and silty layers different organisms from the muddy layers occur. In the former, the epibiont fauna (mainly trilobites and brachiopods) is predominant while in the muddy layers the predominance is the endobiont and semi-endobiont fauna (bivalve mollusks and infaunal brachiopods). In other words, the distribution of taxa across the layers is not random.

Paleontological rescue, depositional environment, and stratigraphic correlation of a section of the Ponta Grossa Formation (Paraná Basin)

The urban area of Ponta Grossa (PR) occurs on one of the most abundant fossiliferous fields in the country, which records an endemic fauna that occurred in the Devonian of the Paraná Basin. The growing urbanization of the city increasingly buries these outcrops, and new works must be accompanied by a specialized team to safeguard the paleontological heritage. This is the case of the Bosque Mistral project, which exposed many layers of the Ponta Grossa Formation, rich in fossils and trace fossils. This study reports the main fossiliferous occurrences in the section, correlates the section with classical outcrops from the literature, and interprets the main depositional environments as well stratigraphic cycles using an integrated analysis of sedimentology and ichnology. The ichnological distribution also evidences the retrogradation pattern, and, particularly, the occurrence of ichnofabrics dominated by Zoophycos at the top of the section is a signature of high-frequency cycles associated with the transgressive systems tract. Macrofossill biodiversity varies according to the facies, in the sandy and silty layers different organisms from the muddy layers occur. In the former, the epibiont fauna (mainly trilobites and brachiopods) is predominant while in the muddy layers the predominance is the endobiont and semi-endobiont fauna (bivalve mollusks and infaunal brachiopods). In other words, the distribution of taxa across the layers is not random.