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Context: Clinicians use brain magnetic resonance imaging (MRI) to discuss neurodevelopmental prognosis with parents of neonates with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Purpose: To investigate how clinicians and parents discuss these MRI results in the context of HIE and TH and how these discussions could be facilitated and more meaningful for parents. Procedures: Mixed-methods surveys with open-ended and closed-ended questions were completed by two independent groups. (1) Clinicians responded to clinical vignettes of neonates with HIE treated with TH with various types of clinical features, evolution and extent of brain injury and questions about how they discuss brain MRI results in this context. (2) Parents of children with HIE treated with TH responded to questions about the discussion of MRI that they had while still in the neonatal intensive care unit and were asked to place it in perspective with the outcomes of their child when he/she reached at least 2 years of age. Open-ended responses were analyzed using a thematic analysis approach. Closed-ended responses are presented descriptively. Results: Clinicians reported uncertainty, lack of confidence, and limitations when discussing brain MRI results in the context of HIE and TH. Brain MRI results were “usually” (53%) used in the prognostication discussion. When dealing with day-2 brain MRIs performed during TH, most clinicians (40%) assumed that the results of these early MRIs were only “sometimes” accurate and only used them “sometimes” (33%) to discuss prognosis; a majority of them (66%) would “always” repeat imaging at a later time-point to discuss prognosis. Parents also struggled with this uncertainty, but did not discuss limitations of MRI as often. Parents raised the importance of the setting where the discussion took place and the importance to inform them as quickly as possible. Clinicians identified strategies to improve these discussions, including interdisciplinary approach, formal training, and standardized approach to report brain MRI. Parents highlighted the importance of communication skills, the stress, the hope surrounding their situation, and the need to receive answers as soon as possible. The importance of showing the pictures or making representative drawing of the injury, but also highlighting the not-injured brain, was also highlighted by parents. Conclusions: Discussing brain MRI results for neonates with HIE treated with TH are challenging tasks for clinicians and daunting moments for parents.

The current study aims to theoretically investigate the opportunities and vulnerabilities apposite for the small and medium-sized enterprises (SMEs), insisting on the internationalization conditions, and to empirically explore the European initiatives meant to support the SMEs in their various endeavors, from accessing relevant knowledge to deploying successful operations in foreign markets. To this end, a qualitative research was conducted through the case study method. Over 10 European initiatives were described and more than 20 relevant documents available on official European websites were analyzed. The underlying assumption for conducting this study resided in the fact that a better understanding of the European context describing SMEs performance would provide valuable insights to the actors interested in their future business activity, specifically in their cross-border projects and operations. Moreover, a refined outlook would enlarge their vision of the existing opportunities and thus catalyze the process of converting current challenges into positive results.

The right vertebral artery most commonly originates as the first branch of the right subclavian artery. Although anatomical variants of the aortic arch are commonly encountered on cross-sectional imaging, certain variants of the right vertebral artery are exceedingly rare. In this report, we present 3 cases of aberrant right vertebral artery arising as the last branch of the aortic arch, a very rare variant.

The process of Europeanization has been intensively discussed and participation in debates has been vigorously tested by the academic world, mostly concerned with examining political personalities. This process is often seen through a political and economic view, ignoring the spiritual part pointing to a collective identity rationale. Hereby, our interest consists of finding how this concept is perceived through students’ lens. We aim at investigating students’ opinions, revealing young citizens’ points of view. The conducted research is qualitative, consisting of in-depth interviews, for discovering participants’ standpoints and attitudes towards admitting European bonds and becoming Europeans not just as frame, but in a substantial way, from the perspective of belongingness to a European Union (EU) member state or to an Eastern Partnership (EaP) member state. As the findings show, the bond with the European Union is seen through a political and cultural approach. Students’ understanding of the Europeanization process is varied, and so are their endeavours of spreading the importance to adhere to the European Union and to share the European spirit among students belonging to EaP states.

Context: Accuracy of locating various lumbopelvic landmarks for novice athletic trainers has not been examined. Objective: To examine reliability of novice athletic trainers for identification of the L4 spinous process and right and left posterior superior iliac spine (PSIS). Design: Cross-sectional reliability. Setting: Laboratory. Patients or Other Participants: Sixteen physically active volunteers participated (age = 22.56 ± 2.67 years, height = 172.0 ± 9.38 cm, mass = 67.39 ± 9.73 kg, body mass index = 22.8 ± 1.97). Four novice athletic trainers (certified < 2 years) served as the testers of interest. Intervention(s): Subjects were placed prone and 2 expert athletic trainers (certified > 12 years) agreed upon each bony landmark and transferred the palpation markings to contact paper. Each novice athletic trainer palpated the landmarks twice within the same test session and used the same method as the experts for transfer and recording. Novice athletic trainers rotated between subjects after 1 marking trial. Expert marks were transposed over the tester marks to assess distance and agreement. Main Outcome Measure(s): Independent variables were novice athletic trainer (AT1, AT2, AT3, AT4) and time (Trial 1, Trial 2); dependent variables included distance from the expert marking in millimeters for L4 and PSIS palpations, and agreement within or outside of a designated area for the L4 spinous process. Intraclass correlation coefficients (ICC [2,1]), standard error of measurement, and percent agreement were calculated. Results: Intratester reliability for L4 ranged from 0.370 to 0.833, right PSIS (RPSIS) ranged from 0.371 to 0.771, and left PSIS (LPSIS) ranged from -0.173 to 0.760. Intertester ICC (2,1) for Trial 1 and Trial 2 were, respectively, 0.319 and 0.466 (L4), 0.213 and 0.002 (RPSIS), and 0.96 and 0.073 (LPSIS). Percent agreement between expert and testers ranged from 18.75%--81.3% for L4 spinous process. Conclusions: Our results indicate novice athletic trainers are generally poor at reliably locating lumbopelvic anatomical landmarks, and this should be addressed within educational programming.

Cartea este un exemplu pentru compararea spaţiului public naţional cu cel european, a massmediei tradiţionale cu noile medii şi a europenizării cu stagnarea în naţionalism. Autorul demonstrează o siguranţă de expert în analizarea societăţii româneşti ca agregat european, perceput punctual de cetăţenii români: aderarea României la Uniunea Europeană nu-i activează marelui public conştiinţa de a fi parte componentă a realităţii europene. Canalele de comunicare în masă au potenţialul de a înrădăcina spiritul european în atitudinile şi concepţiile românilor, însă mass-media rămâne puternic închistată în sistemul social românesc, iar mediile apărute ulterior, prin intermediul serviciilor de Internet, sunt doar suplinitoare ale vechilor medii, în actualul context economic şi social. Din studiul cărţii înţelegem că modificările societăţii româneşti înspre europenizare pot fi efectuate numai prin depăşirea spaţiului limitat al claselor şi instituţiilor româneşti şi prin solicitarea de informaţii de interes european

The European Union continuously endeavors to submit to an integrative framework which support the formation of a European spirit and identity. Among the accelerating factors, new media stands for a catalyst of European integration, online networks supporting the users to share opinions, experiences, information, etc. The interactivity provided by new media allow Europeans to learn more about each other and to discover similar or subsidiary objectives. Here, the paper aims to investigate the role of new media in the reconfiguration of social relationships which encompass a shared identity. To this end, several in-depth interviews were conducted with active users who are anchored in online European debates. As the findings showed, new media facilitate people’s engagement in virtual relations and supports the creation of social groups with similar values and standpoints on the European constructs.

Aim of the study The purpose of this paper was to present a case of a teenager patient with traumatic injuries of anterior upper arch, in order to reveal the importance of applying a complex rehabilitation, prosthetic and orthodontic treatment. Material and methods A 12-year-old girl was referred as a patient to our dental office, in order to treat the edentulous anterior space after a traumatic injuries (bicycle accident), with premature loss of anterior permanent teeth (14, 13, 12, 11, 21, 22). Results The removable orthodontic appliance consist of a palatal acrylic plate, with a special three-dimensional screw placed by a custom section in order to move only lateral side arch segments, and to maintain the anterior zone, where there were placed artificial acrylic teeth, which can be easily adjusted in mixed dentition. Conclusions Complex prosthetic and orthodontic rehabilitation of teenagers with edentulous space after traumatic injuries with loss of permanent teeth, involves a multidisciplinary team, in order to apply the optimal treatment to restore all affected functions.

Few if any Native American/Alaska Native (NA/AN) people have been included in highly active antiretroviral therapy (HAART) treatment trials or epidemiologic studies, leaving little data on which to be assured of the efficacy of HAART in this unique population. This study aims to evaluate the impact of HAART and review determinants of survival in a cohort of NA/AN persons receiving treatment for HIV in a real life clinical setting. A retrospective chart review of 235 HIV-infected Native Americans receiving services at an urban medical center operated by the Indian Health Service from January 1, 1981 through June 30, 2004 was conducted, providing 782.7 person-years of follow-up. The main outcome measures were time from study entry and from incident AIDS diagnosis to death. Death rates fell from 18.4 (13.3-25.4) per 100 person-years in the period prior to 1998 to 6.4 (4.6-8.8) per 100 person-years in the years 1998-2004, (RR 0.35, p < 0.0001). Factors associated with the greatest reduction in risk of death from time of study entry were current use of HAART, HR 0.13 (0.06-0.30, p 0.001), and CD4 count [greater than or equal to] 200 at entry, HR 0.16 (0.08-0.35, p < 0.001). Current use of HAART was the strongest predictor of survival from time of AIDS diagnosis, HR 0.11 (0.05-0.25, p 0.001). The use of HAART therapy and CD4 count were primary predictors of survival. Earlier diagnosis and access to effective medical treatment will be key factors in reducing disparities in health brought about by HIV infection in Native American/Alaska Native communities.