Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS).

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of \u3e8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of initial manifestations, should be first be managed with non-pharmacologic approaches which in turn, should not be considered as the sole alternative to drug therapy, but rather, as the base upon which all patients are treated. Those who continue to have symptoms despite supportive care should be pharmacologically treated, which in the most severe cases, is life-saving

What does a primary care annual review for RA include? A national GP survey

Letter to the edito

The lifetime cost to English students of borrowing to invest in a medical degree:a gender comparison using data from the Office for National Statistics

OBJECTIVE: To evaluate this impact on male and female English medical graduates by estimating the total time and amount repaid on loans taken out with the UK's Student Loans Company (SLC). SETTING: UK. PARTICIPANTS: 4286 respondents with a medical degree in the Labour Force Surveys administered by the Office for National Statistics (ONS) between 1997 and 2014. OUTCOMES: Age-salary profiles were generated to estimate the repayment profiles for different levels of initial graduate debt. RESULTS: 2195 female and 2149 male medical graduates were interviewed by the ONS. Those working full-time (73.1% females and 96.1% males) were analysed in greater depth. Following standardisation to 2014 prices, average full-time male graduates earned up to 35% more than females by the age of 55. The initial graduate debt from tuition fees alone amounts to £39 945.69. Owing to interest charges on this debt the average full-time male graduate repays £57 303 over 20 years, while the average female earns less and so repays £61 809 over 26 years. When additional SLC loans are required for maintenance, the initial graduate debt can be as high as £81 916 and, as SLC debt is written off 30 years after graduation, the average female repays £75 786 while the average male repays £110 644. CONCLUSIONS: Medical graduates on an average salary are unlikely to repay their SLC debt in full. This is a consequence of higher university fees and as SLC debt is written off 30 years after graduation. This results in the average female graduate repaying more when debt is low, but a lower amount when debt is high compared to male graduates

TINJAUAN KRIMINOLOGIS TERHADAP TINDAK PIDANA INCEST DENGAN KORBAN ANAK(STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)

ABSTRAKTRI KARUNIA PUTRI AMELIA,TINJAUAN KRIMINOLOGIS TERHADAP 2015 TINDAK PIDANA INCEST DENGAN KORBAN ANAK (STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)Fakultas Hukum Universitas Syiah Kuala(v,54),pp.,bibl(Dr. DAHLAN ALI., S.H., M.Hum., M.Kn.,)Salah satu kejahatan yang sering terjadi adalah tindak pidana perkosaan. Tindak pidana perkosaan merupakan salah satu dari tindak pidana terhadap kesusilaan. Dalam Bab XIV dalam Buku II KUHP memuat kejahatan terhadap kesusilaan yang tersebar pada pasal 281 hingga 303 KUHP. Di dalamnya yang dimaksud dengan kesusilaan sebagian besar berkaitan dengan seksualitas. Salah satu jenis kelainan seksual adalah hubungan seks yang dilakukan secara paksa bersama seseorang yang masih ada hubungan darah yaitu incest, dan yang biasanya menjadi korban ialah anak-anak. Incest sebagaimana dirumuskan dalam kamus besar bahasa Indonesia adalah hubungan seksual antara orang-orang yang bersaudara dekat yang dianggap melanggar adat, hukum dan agama. Sanksi mengenai incest dengan korban anak dapat dilihat dalam Pasal 81 dan Pasal 82 Undang-Undang No. 23 Tahun 2002 Tentang Perlindungan Anak.Penelitian ini bertujuan untuk menjelaskan faktor penyebab terjadinya tindak pidana incest, dan untuk mengetahui upaya yang perlu dilakukan untuk menanggulangi tindak pidana incest di provinsi Aceh.Untuk memperoleh data dalam penelitian skripsi ini, dilakukan penelitian pustaka (library research) dan penelitian lapangan (field research) yang dilaksanakan di Banda Aceh dengan lokasi penelitian pada Lembaga Pemasyarakatan Klas IIA dengan tipe penelitian deskriptif yaitu menganalisis data yang diperoleh dari studi lapangan dan kepustakaan dengan cara menjelaskan dan menggambarkan kenyataan objek. Hasil penelitian menunjukkan bahwa faktor-faktor penyebab terjadinya tindak pidana incest adalah: Faktor rendahnya pendidikan dan ekonomi, Faktor lingkungan atau tempat tinggal, Faktor alkohol, Faktor kurangnya pemahaman terhadap agama, dan Peranan korban. Penanggulangan tindak pidana incest dapat dilakukan dengan cara mengadakan pelayanan emergency call kepada masyarakat, mengadakan pengedukasian bagi para orang tua, dan juga pembinaan mental kepada pelaku dan korban tindak pidana incest.Disarankan kepada pemerintah agar hendaknya memperbanyak wadah tempat pengaduan untuk masyarakat, serta diadakan penyuluhan hukum agar dapat menumbuhkan kesadaran masyarakat untuk benar-benar mentaati hukum. Selain itu disarankan agar sistem pembuktian dalam kasus perkosaan dapat lebih permudah, khususnya incest.Banda Ace

Impact of COVID-19 on clinical outcomes for patients with fractured hip

AIMS: There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods: We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results: In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion: This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected

Analysis of interfacial shrinkage stresses in patch repairs

This paper presents simple analytical expressions that predict the interfacial shrinkage stresses in a repair patch over time. Four repair materials (L2, L3, L4 and G1) were applied by spraying (gunite) to unpropped compression members of two highway structures, and their performance was monitored to approximately six months' age. The elastic moduli of all the repair materials, E rm , were greater than the elastic moduli of the substrate concrete, E sub . The mechanics of patch repair interaction with the substrate were established, and analytical models, based on an analogy of the bimetallic strip undergoing a drop in temperature, were developed. Basic properties of the repair material (elastic modulus, shrinkage and tensile creep) and substrate concrete (elastic modulus), and geometrical details of the repair patch, are required to analyse the interfacial stresses in the repair patch. Verification of the analytical procedures is based on the field data, and the results show a satisfactory correlation between the actual and predicted stress redistribution.</p

Understanding esports-related betting and gambling: a systematic review of the literature

Esports gambling has steadily grown in popularity alongside esports itself. While research has been increasing in the field of esports-related gambling, no study has yet reviewed the relevant literature on esports gambling. The present study aimed to comprehensively review all empirical research conducted in the wider field of esports gambling. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was undertaken using PsycINFO, PubMed, Scopus, and Web of Science databases. Only empirical studies were included and were also assessed for potential biases using the ROBUST guidelines. A total of 30 studies from eight countries were included in the review. Esports gamblers were found more likely to be young males, likely to score high on problematic gambling scales, and likely to belong to households speaking a non-English language at home in English speaking countries. Esports gamblers are a unique type of gambling population, with rare characteristics and behaviors compared to other types of gamblers. Given the limited number of studies, there is a need for further research in this field to understand these populations, as well as the need for longitudinal research

Assessment of concrete damage and strength degradation caused by reinforcement corrosion

Structural performance deterioration of reinforced concrete structures has been extensively investigated, but very limited studies have been carried out to investigate the effect of reinforcement corrosion on time-dependent reliability with consideration of the influence of mechanical characteristics of the bond interface due to corrosion. This paper deals with how corrosion in reinforcement creates different types of defects in concrete structure and how they are responsible for the structural capacity deterioration of corrosion affected reinforced concrete structures during their service life. Cracking in cover concrete due to reinforcement corrosion is investigated by using rebar-concrete model and realistic concrete properties. The flexural strength deterioration is analytically predicted on the basis of bond strength evolution due to reinforcement corrosion, which is examined by the experimental data available. The time-dependent reliability analysis is undertaken to calculate the life time structural reliability of corrosion damaged concrete structures by stochastic deterioration modelling of reinforced concrete. The results from the numerical example show that the proposed approach is capable of evaluating the damage caused by reinforcement corrosion and also predicting the structural reliability of concrete structures during their lifecycle

Durability of concrete structures in marine atmosphere zones – The use of chloride deposition rate on the wet candle as an environmental indicator

Durability of concrete structures under marine environments has been studied for a long time. This work was focused on marine atmosphere zone and studied the deposition of chlorides on wet candle devices and its relation with chlorides accumulated into concrete. Concrete specimens with three different mixtures were exposed at places located at four different distances from the sea. Periodically, chloride profiles were obtained and analysed taking into account environmental data. Results of numerical extrapolations show that chloride deposition rate on the wet candle can be used as an environmental indicator, helping to preview the expectancy of service life of concrete structures or suggesting minimum concrete cover thicknesses for a required service life. Regarding the studied region, service life decreases between 30% and 60% were observed when changing chloride deposition from 120 mg/m2 day to 500 mg/m2 day, which shows that chloride deposition plays an important role as an environmental indicator on service-life analysis of concrete structures in marine atmosphere zone